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Abnormal
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Lesson
28
SUICIDE
No one
commits suicide out of joy
it is the psychological pain and agony
that one wants to
avoid.
Suicide
has been observed throughout
the history. It has been
recorded among the ancient
Chinese,
Greeks,
and Romans. And in more
recent times, suicides by
such famous people as Ernest Hemingway
and
Marilyn
Monroe have both shocked
and fascinated
society.
Today
suicide ranks among the top
ten causes of death in Western
society. According to the
World
Health
Organization, approximately 120,000 deaths by
suicide occur each year.
More than 30,000
suicides
are
committed annually in the United States
alone, by 12.8 out of every
100,000 inhabitants, accounting
for
almost
2 percent of all deaths in the
nation (McIntosh, 1991;
National Center for Health
Statistics, 1988). It
is
also estimated that each
year more than 2 million
other persons throughout the
world- 600,000 in the
United
States- make unsuccessful
attempts to kill themselves;
these people are called
parasuicides
(McIntosh,
1991).
What
is Suicide?
One
of the most influential writers on this
topic defines suicide
as
an
intentioned death- a
self-
inflicted
death in which one makes an
intentional,
direct, and
conscious effort to end
one's life.
Most
theorists agree that the term
"suicide" should be limited to deaths of
this sort.
Intentioned
deaths may take various
forms. Consider the following three
imaginary instances.
Although
all of these people intended to die,
their precise motives, the
personal issues involved,
and their
suicidal
actions differed greatly.
PRECIPITATING
FACTORS IN SUICIDE
i)
Stressful Events and
Situations
Researchers
have repeatedly counted more
undesirable events in the recent
lives of suicide
attempters
than in those of matched
control subjects. In one study,
suicide attempters reported twice
as
many
stressful events in the year before
their attempt as non-suicidal depressed
patients or non-depressed
psychiatric
patients. An attempt may be precipitated by a
single recent event or, a
series of events that
have
combined
impact.
ii)
Abusive Environment
Suicide
is sometimes committed by victims of an abusive or
repressive environment from
which
there
is little or no hope of escape. Prisoners
of war, victims of the Holocaust, abused spouses,
and prison
inmates
have attempted to end their
lives. Like those who
have serious illnesses,
these people may have
been
in constant psychological or physical
pain, felt that they could endure no
more suffering, and believed
that
there was no hope for
improvement in their
condition.
iii)
Occupational Stresses
Certain
jobs create ongoing feelings
of tension or dissatisfaction that can
precipitate suicide
attempts.
Research has found particularly
high suicide rates among
psychiatrists and
psychologists,
physicians,
dentists, lawyers and unskilled
laborers.
iv)
Role Conflict
Another
long-term stress linked to
suicide is role conflict. Everyone
occupies a variety of roles in
life.
The role of a spouse,
employee, parent and colleague
are some of the few to name.
These different
roles
maybe in conflict with one
another and they may cause
considerable stress. In recent
years researchers
have
found that women who
hold jobs outside of the
home often experience role
conflicts-conflicts
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between
their family demands and
job requirements, for
example, or between their
social needs and
vocational
goals- and that these
conflicts are reflected in a higher suicide
rate.
v)
Mood and Thought
Changes
Many
suicide attempts are
preceded by a shift in the person's
mood and thought. Although
these shifts may
not
be severe enough to warrant a diagnosis of a
mental disorder, they typically represent
a significant
change
from the person's past mood
or point of view.
"No
one commits suicide out of
joy. Pain is what the suicidal
person seeks to
escape".
In
the cognitive realm, many people on the
verge of suicide frequently develop a
sense of hopelessness- a
pessimistic
belief that their present
circumstances, problems, and
negative will not
change.
vi)
Alcohol Use
Studies
indicate that between 20 and 90
percent of those who commit
suicide drink alcohol
just
before
the act (Hirschfeld & Davidson,
1988). Autopsies reveal that about
one-fifth of these people
are
intoxicated
at the time of death.
vii)
Mental Disorders
As
we noted earlier, people who attempt
suicide do not necessarily
have a mental disorder. On the
other
hand, between 30 and 70
percent of all suicide
attempters do display a mental
disorder.
VIEWS
ON SUICIDE
i)
The Psychodynamic View
Psychodynamic
theorists believe that
suicide usually results from
a state of depression and
a
process
of self-directed anger. This
theory was first stated by
Wilhelm Stekel at a meeting in
Vienna in 1910,
when
he proclaimed that "no one
kills himself who has not
wanted to kill another or at least
wished the
death
of another".
Freud
(1917) and Abraham (1916,1911)
proposed that when people
experience the real of
symbolic
loss of a loved one, they
come to "introject" the lost person;
that is, they
unconsciously
incorporate
the person into their own
identity and feel toward
themselves as they had felt
toward the other.
ii)
The Biological View
Until
the 1970s the belief that
biological factors contribute to
suicidal behavior was based
primarily
on
family studies. Researchers
repeatedly found higher rates of
suicidal behavior among the
parents and
close
relatives of suicidal people than
among those of nonsuicidal people,
suggesting that genetic,
and
biological,
factors were at work.
Studies of twins also were
consistent with this view of
suicide (Lester,
1986).
A study of twins born in Denmark
between 1870 and 1920,
for example, located nineteen
identical
pairs
and fifty-eight fraternal pairs in
which at least one of the twins
had committed suicide. In four of
the
identical
pairs the other twin also
committed suicide (21 percent),
while the other twin never
committed
suicide
among the fraternal pairs.
SUICIDE
IN DIFFERENT AGE
GROUPS
The
likelihood of committing suicide
generally increases with
age, although individuals of
all ages
may
try to kill themselves.
Recently particular attention has
been focused on self-destruction in three
age
groups-
children,
partly because suicide at a very young
age contradicts society's perception
that childhood is
an
enjoyable period of discovery and
growth; adolescents
and young adults, because
of the steady and
highly
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publicized
rise in their suicide rate;
and the elderly,
because suicide is more prevalent in this
age group than
any
other.
Adolescents
and Young Adults
Suicidal
actions become much more
common after the age of 14 than at any
earlier age. In the
United
States more than 6,000
adolescents and young adults
kill themselves each year;
that is, more than 13
of
every 100,000 persons
between the age of 15 and 24
(Center for Disease Control,
1987).
Teenagers
Approximately
3,000 teenagers commit suicide in the
United States each year,
and as many as
250,000
may make attempts. Moreover,
in a recent Gallup Poll
(1991) a full third of
teenagers surveyed
said
they
had considered suicide, and
15 percent said they had
thought about it
seriously.
Some
of the major warning signs of suicide in
teenagers are tiredness
and sleep loss, loss
of
appetite,
mood changes, decline in
school performance, withdrawal,
increased smoking, drug or
alcohol
use, increased letter to
friends, and giving away valued
possessions
College
Students
The
suicide rate tends to be higher
for 18-to-24 -year-old college students
than for other young people
in
the
same age range. Again,
female students are more
likely to attempt suicide, but fatal
suicides are more
numerous
among males. Furthermore, studies
suggest that as many as 20
percent of college students
have
suicidal
thoughts at some point in their
college career (Carson &
Johnson, 1985).
Rising
Suicide Rate
The
suicide rate for adolescents
and young adults is not only
high but increasing. The
suicide rate for this
age
group has more than doubled.
Several theories, each
pointing to societal changes,
have been proposed
to
explain why the suicide rate
among adolescents and young
adults has risen
dramatically during the
past
few
decades. First, noting the overall
rise in the number and proportion of
adolescents and young adults
in
the
general population Paul
Holinger and his colleagues
(1991, 1988, 1987, 1984,
1982) have
suggested
that
the competition for jobs,
college positions, and academic and
athletic honors keeps
intensifying
in this age group, leading increasingly to shattered
dreams and frustrated
ambition,
which
in turn lead to suicidal thinking and
behavior.
TREATMENT
AND SUICIDE
Treatment
of people who are suicidal
falls into two major
categories:
(1)
Treatment after suicide has
been attempted and
(2)
Suicide prevention.
Today
special attention is also given to
relatives and friends (Carter &
Brooks, 1991; Farberow,
1991)
whose bereavement, guilt,
and anger after a suicide
fatality or attempt can be intense.
Although many
people
require psychotherapy or support groups
to help them deal with their
reaction to a loved one's
suicide,
the discussion here will be
limited to the treatment afforded
suicidal people themselves.
I)
Treatment after Suicide
Attempt
After
a suicide attempt, the victims' primary need is
medical care. Some are
left with severe
injuries,
brain
damage, or other medical
problems. Once the physical
damage is reversed, or at least
stabilized, a
process
of psychotherapy may begin.
Unfortunately, even after trying to
kill themselves, many
suicidal
people
fail to become involved in
therapy.
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II)
Suicide Prevention
During
the past thirty years
emphasis has shifted from
suicide treatment to suicide prevention.
The
emphasis
on suicide prevention is labeled as
suicide
prevention programs.
In
addition, many mental health
centers, hospital emergency rooms,
pastoral counseling
centers,
and
poison control centers now include
suicide prevention programs
among their services.
Suicide
prevention centers define
suicidal people as people in crisis that
is, under great
stress,
unable
to cope, feeling threatened or hurt, and
interpreting their situations as
unchangeable.
Accordingly,
the centers try to help
suicidal people perceive things more accurately,
make better
decisions,
act more constructively, and overcome
their crisis. Because crises
can occur at any
time,
the
centers have 24-hour-a-day telephone
service ("hot lines") and
also welcome clients to walk
in
without
appointments. Those who call reach a
counselor, typically a paraprofessional a person
without
previous professional training
who provides services under
the supervision of a
mental
health
professional (Heilig et al.,
1983).
Although
specific features vary from
center to center, the general
approach used by the Los
Angeles
Suicide Prevention Center
reflects the goals and
techniques of many of them.
During the initial
contact,
the counselor has several
tasks: establishing a positive
relationship, understanding and clarifying
the
problem,
assessing suicide potential,
assessing and mobilizing the
caller's resources, and
formulating a plan
to
overcome the crisis.
The
Effectiveness of Suicide
Prevention
Do
suicide prevention centers
reduce the number of suicides in a
community? Clinical researchers
do
not know. It is important to note,
however, that the increase in
suicide rates found in some
studies may
reflect
society's overall increase in
suicidal behavior. One investigation
found that although suicide
rates did
increase
in certain cities with
prevention centers, they increased
even
more in cities without
such centers.
After
trying to kill themselves,
some suicidal people receive
therapy. The goal of therapy
is
to
help the client achieve a non-suicidal
state of mind and develop more
constructive ways of
handling
stress and solving problems. Various
therapy systems and formats have been
employed.
Over
the past thirty years,
emphasis has been shifted
form suicide treatment to suicide
prevention
because
the last opportunity to keep
many suicidal people alive comes before
their first attempt. Suicide
prevention
programs generally
consist of 24-hour-a-day "hot
lines" and walking centres
operated by
paraprofessionals.
During
their initial contact with
someone considered suicidal,
these counsellors seek to
establish
a positive relationship, to understand
and clarify the problem, to
assess the suicide potential,
to
assess
and mobilize the caller's
resources, and to formulate a plan
for overcoming the crisis. Although
such
crisis
intervention may be
sufficient treatment for some
suicidal people, longer-term therapy is
needed for
up
to 60 percent of them. Apparently,
only a small percentage of
suicidal people contact prevention
centres.
While
clinical scientists know a great
deal about suicide, they do not
yet fully comprehend
why
people
kill themselves. Furthermore, myths about
suicide and suicide
intervention abound, perhaps
contributing
to tragedies that might
otherwise be averted.
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