THEORIES OF
SUICIDE
14 June 2011
Dr Saman Yousuf
Perspectives

Biological - TO UNDERSTAND HOW CAUSE OF SUICIDE RELATES TO
FUNCTIONING OF THE HUMAN BODY

Psychological – RELATION WITH FUNCTIONING OF THE HUMAN MIND
(THOUGHTS, EMOTIONS, BEHAVIOR)

Sociological - RELATION OF SOCIAL FACTORS TO ILL HEALTH AND
SUICIDE OR SUICIDAL BEHAVIOR
Sociological theories

Emile Durkheim (1867)
Le Suicide. Etude de Sociologie

Each society has a specific tendency toward suicide

Refuted contribution of
individual factors
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Social integration /
Social regulation

Followers of Durkheim
Gibbs and Martin (1964) – Concept of social integration: when a society engenders status
incompatibility and role conflicts  suicide
Lester D (1989, 1997) – Operationalized social integration through indices of modernization of
society(eg. birth rates, divorce rates)

Thomas Masaryk (1881)
An increase in non-religiosity deregulates
the social organism, makes people feel
unhappy and increases social
disorganization. Suicide, as well as mental
illnesses, can be seen as a measure of
societal disturbances

Benjamin Wolman (1976)
Estrangement and contemporary societal
mechanization, decline of family ties –
aggression internalized and turned to selfcriticism and self-hate
Psychological theories

Sigmund Freud
Death instinct “Thanatos” and this drive is in harmony
with “Eros”

David Malan
Results from accumulated trauma

Edwin Scheidman:
explains ambivalence toward life and death, and feelings of
hopelessness and helplessness -- “egotic suicide,” results from a conflict
of internal aspects of self to which the only response is the ending of
the personality

Krauss’s theory:
Unachieved goal or dysfunctional relationship – the internal
representation of the “unattainable object” is killed

Eric Erikson:
Overwhelming feeling of guilt exceeds ability to cope

Aaron T. Beck – Cognitive Theory

Cognitions = Mental processes that are involved in
information gathering, thinking, remembering etc and
exists in three forms:
- Dysfunctional automatic thoughts skew
perceptions of self, others and future
- Schemas: framework or concept that helps
organize the information gathered
• Thomas Joiner (2005) – Interpersonal-psychological theory
• Thwarted
Belongingness
DEATH BY
SUICIDE
• Perceived
Burden on
others
• Reduced fear
• Elevated pain
tolerance
a sense on the part of the individual that he or she
lacks meaningful connections to others, either because
of a belief that nobody cares or a sense that, although
others care, they cannot relate to the individual’s
current situation (e.g., soldiers reintegrating into
civilian life post-combat deployment)
a sense on the part of an individual that he or she
makes no meaningful contributions to the world,
serving instead as a liability to others
acquire the capability to do so through repeated
exposure to painful and provocative experiences.
Such repeated exposures result in habituation to
physiological pain and a diminished fear of death,
thereby enabling an individual to follow through with
the inherently frightening and painful experience of a
suicide attempt with a high rate of lethality
Some psychosocial theories

Halbwachs (1930)

Henry and Short (1954)

Giddens (1966)

Douglas (1967)

Baechler (1975)

Taylor (1978)
Biological theories…




Post-mortem studies have shown changes in
central neurotransmission of serotonin, noradrenaline and post-synaptic signal
transduction
Dysfunction of Hypothalamic-pituitaryadrenal axis (stress response) predicts
suicide in depressed patients
Increased suicide risk associated with low
cholesterol levels
Reduced 5-HIAA levels in CSF of
depressed patients who suicide
NEUROPHYSIOLOGICAL CHANGES
GENES & FAMILY



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Family history of suicide increases the risk two-fold especially in women and
children independent of family psychiatric history
Concordance rates of suicide higher among monozygotic twins
Adoption studies: a greater risk of suicide among biologic rather than adoptive
relatives.
Genetic factors account for 45% of suicidal thoughts and behaviors: 7 types of
genes have been focused on serotonin transporter(SERT), tryptophan hydroxylase
(TPH) 1 and 2, three serotonin receptors (5-HTR1A, 5-HTR2A, and 5-HTR1B), and
the monoamine oxidase promoter(MAOA)
Interaction between gene and environment (incl. intrauterine)
NEUROIMAGING
Holmes & Rahe 1967
Stress-Diathesis Model

Combines psychological and biological factors
Holmes & Rahe 1967
STRESS

A force that disrupts the equilibrium
or normal functioning of an
individual’s mental or physical state.
Different types of stressors may
precipitate suicidal behavior.
Negative Life events
Acute substance intoxication
Acute psychiatric condition
DIATHESIS

Innate vulnerability or predisposition
(in the form of traits) for developing
the suicidal state
Familial / genetic influences
Chronic multiple psychiatric problems
Hopelessness
Being male / loneliness
THEORIES OF
DELIBERATE SELF
HARM
A coping mechanism

Helps in short-term management of problematic emotions

Stress-relieving function



Consequences – disapproval by others and a sense of inability to solve
problems
Regulation of unpleasant self-states (eg. depersonalization) common to
people experiencing trauma
Sense of mastery and control for people who feel powerless or out of
control
Babiker and Arnold, 1997; Gratz, 2003; Williams, 2001
Self-punishment

Re-enactment of past experience of trauma or abuse

Feelings of being evil and bad common

Self-punishment for being bad
Babiker and Arnold, 1997; Gratz, 2003; Williams, 2001
Validating the self

For people who have past experiences of trauma and abuse and there was
no recognition of it or they were actively denied by people around them

Way of testifying to the experience – remembering it

Linehan (1993) – Chronic invalidation: feelings are bad or wrong

Miller (1994) – “Men act out while women act out by acting in”
Babiker and Arnold, 1997; Gratz, 2003; Williams, 2001
Influencing others

A way of communicating distress not heeded by words

To care for the person who has harmed

To keep others at a distance

To make the person cared about feel guilty
Babiker and Arnold, 1997; Gratz, 2003; Williams, 2001
Serotonin

Simeon et al. (1992) found that people who self-injure tend to be extremely angry,
impulsive, anxious, and aggressive, and presented evidence that some of these traits may be
linked to deficits in the brain's serotonin system

Favazza (1993) refers to this study and to work by Coccaro on irritability to posit that
perhaps irritable people with relatively normal serotonin function express their irritation
outwardly, by screaming or throwing things; people with low serotonin function turn the
irritability inward by self-damaging or suicidal acts

Zweig-Frank et al. (1994) also suggest that degree of self-injury is related to serotonin
dysfunction

Steiger et al. (2000), in a study of bulimics, found that serotonin function in bulimic women
was significantly lower in bulimics who also engaged in self-harm
Genetics

Rare genetic syndrome – Lesch-Nyhan (HG-PRT deficiency)

Large turnover of purines

Characterized by self harm

Link largely still unclear
THANK YOU