Suicide and Life-Threatening Behavior
Ernest Hemingway- in spite of his worldwide success as a writer, Nobel
and Pulitzer Prizes, and an image of raw masculine power, Hemingway was
subject to depression and paranoia. With a legacy of suicide from his father,
he used a shotgun to complete his own suicide when he was 62 years old. He
had been in and out of treatment, but in the end, even under supervision, he
managed to kill himself. There is a link in the family to suicide, as 5
members of his close family have killed themselves.
Sylvia Plath- poet and novelist as well, she published The Bell Jar just a
month before her death in 1963. The book describes a woman caught up in
crisis who attempts suicide. It also outlines family conflict and rebellion
against a society that is so constricting one can’t be oneself. Plath also
experienced the death of her father when she was 8 years old. She also
attempted suicide in 1953 using stolen sleeping pills, and she left a
misleading note to cover her tracks. She was found hiding behind a pile of
firewood in the cellar that time. She had moved away from her husband of 4
years and within 4 months, she was unstable again. She had been on
sedatives and was waiting for a therapist’s appointment. But she convinced
friends she was all right and went back to her apartment with her children.
During the night, she left a note about her doctor, sealed herself in the
kitchen with towels around the door, turned on the gas, and died from gas
exposure. She had opened a window in her children’s room, even leaving
them food if they woke up before the au pair arrived in the morning.
Suicide: Individuality and Perplexity
People who are not desperate and feeling trapped cannot understand
the motives of those who take their own lives. Family will search to find an
answer, a letter, something to help them understand what seems to be a
meaningless act. Jamison said,”Each way to suicide is its own: intensely
private, unknowable, and terrible. Suicide will have seemed to its perpetrator
the last and best of bad possibilities, and any attempt by the living to chart
this final terrain of a life can be only a sketch, maddeningly incomplete.”
What is Suicide?
I do something to cause my own death, or I do not do something to
prevent my own death. No one else is involved. Of course people may do
life-threatening things without the intent to die. Or do things that have high
risks associated with them (sky-diving.) So for a death to be called a suicide,
there must be intent to die. Determining intent is difficult, so many suicides
may be misidentified by family or investigators out of concern for
reputations or lack of clarity. (Single car accidents are one example.) Some
motivations include revenge, a perceived mission (suicide bombers), to gain
attention, to end some form of suffering or some combination of these.
Alvarez wrote, “This time she did not intend to die” – what could he mean
by this? When people are given unfortunate medical diagnoses of conditions
that could be ameliorated by certain diet or treatments, and these people do
not do these things, for whatever reason- are they committing suicide? So
statistical data regarding suicide may be inaccurate. People who know the
decedent and miss the signs of suicide may be acting in concert with what
they believe about the person- from earlier times or other situations. People
may treat a cry for help with denial or humor, in order not to have to deal
with what this truly means. Even cries for help can have lethal outcomes.
Suicide Patterns
In 2004 suicide was the 11th leading cause of death in the US- 32,439 deathsa death rate of 11.1 per 100,000. The rate has declined slightly since 1990
and the US has lower suicide rates than 2/3 of the world. In 2004, suicide
represented 17,357 deaths- more deaths than from homicide and HIV
combined. 44,933 people died in car wrecks- 12,494 more deaths than
suicide.
Attempts: 25.1 attempts for every completed suicide in US. With young
people there may be as many as 200 attempts for every completed suicide,
compared to the elderly who make only 4.1 attempts for every completed
suicide. Rates are higher for single people compared to married. Each
suicide affects at least 6 other people.
Gender: Men complete a suicide more often than women (3.7/1) but women
attempt suicide more often (3/1)
Methods: Firearms are the usual instruments of suicide, used by 51% of all
suicides. For men, hanging or suffocation is second most used. For females,
poison is the most used with firearms used by 33% of women.
Geography: highest rates of suicide are in the Mountain region with the
fewest suicides in the New England area. Alaska has the highest rates, of
23.6, followed by Montana and Nevada. DC and New York had the lowest
rates in 2004.
Age: Suicide rates increase with age, declining in midlife and increasing
again after age 65. The highest rates are for white males over 85.
Ethnicity: Caucasian Americans experience over 90% of all suicide deaths.
While African Americans have a much lower suicide rate, they have much
higher deaths from homicide. There is a belief that Native Americans have
very high deaths by suicide, but when geographical context is factored in,
their rates are not much different than people in the same physical area.
Explaining Suicidal Behavior
Merari studied political violence such as suicide bombers and found:
1) this behavior is not limited to religious believers
2) what the people had in common was they belonged to
organizations that encouraged them to do these things
These groups get members to engage in suicidal/murderous acts
share these characteristics:
a) they build up motivation to overcome ambivalence and
perform the act
b) they provide group pressure to stick to the mission
c) they get a direct commitment from the person to commit the
act- by identifying the person in the group as a living martyr,
and even having him/her write to family identifying
him/herself as such- this makes it very hard to back out
Psychological explanations of suicide
Major psychological theories:
1) Freud’s idea that suicide is murder turned around 180
degrees- it is related to the loss of a desired person/ object. The
person so identifies with the lost person that s/he feels anger
toward this lost object of affection and wishes to punish or kill the
lost person- so self-destructive behavior is targeted at the self.
2) Cognitive problems- depression is often associated with
hopelessness and this relates to negative evaluations of self and
world. The person can only imagine a limited number of
possibilities and all are seen as undesirable. Thinking is often
automatic, involuntary, with such errors as to be described as
distortions. Suicide by cop seems to be a reasonable way to kill
oneself when s/he can’t do it outright.
3) Suicidal behavior is learned- as a child the person learned not to
express anger outward but rather to turn it back on the self.
Depression and lack of expression may have been reinforced by
others. Hemingway’s depression and suicidal ideation was
predicated on his own father’s suicide. Most theorists also believe
there is mental illness associated- mood disorder, schizophrenia,
borderline personality disorder, alcoholism.
Biological Explanations of Suicide
There seem to be disturbances in brain chemicals- serotonin, etc. which
make the brain slow down its firing to the point that suicide seems like a
logical next step. In adopted child studies it was found that suicidal children
had links to biological parents who also expressed mood or impulse control
disorders.
Sociological Explanations of Suicide
Durkheim argued that no psychological condition by itself could explain
suicidal behavior. It could be understood as an outcome of the relationship
of the individual to his social group. Not all people are integrated and
regulated by their group. As such there are 3 types of suicide:
1) Egoistic suicide- isolated people who are not well integrated and
feel a part of some group. Societies may be religious, domestic or
political, but people need to belong to something for their lives to
hold meaning. This could have been a partial explanation for the
Columbine killers.
2) Altruistic suicide- this sort of suicide comes from people being
overinvolved in their social group so the suicide is perceived as
being taken on behalf of the group in some way. Examples given
included the elderly of Eskimo tribes who left the tribe so as not to
slow them down; widows who threw themselves on their
husband’s pyre in India; servants of chiefs or pharaohs who went
into the great beyond with their masters. People who bring shame
on themselves may be suicidal (Chinese leader of the group who
sold the tainted baby formula killed himself when found out.)
People’s Temple of Jim Jones members killed themselves when
the leader demanded it (he also had those who hesitated murdered.)
Members of Heaven’s Gate cult in CA voluntarily killed
themselves in order to ascend to the comet. 9/11 killers.
3) Anomic suicide- social groups help individuals self-regulate by
designing laws and consequences. When society is in such flux
that it can no longer enable people to self- regulate, people may
feel suicide makes sense. This is also true of teens who may feel
their rejection from teen society is a fatal loss of connection.
During the Depression when men lost their money, jobs, and
position, suicide seemed their only option. This is the result of
under-regulation by society.
4) Fatalistic Suicide- derives from excessive regulation of people in
society- a prisoner or slave and there’s no hope of freedom. This
may also apply to people in abusive domestic relationships who
would rather die than endure any more pain or control by another.
Suicide: Levels of Meaning
The complexity of suicide involves 3 elements:
Haplessness (being ill fated or unlucky)
Helplessness
Hopelessness
Three components of the triggering process:
Inimicality- unsettled life pattern in which one acts against one’s own
best interests
Perturbation- increased psychological disturbance in the person’s life
Constriction- tunnel vision or either/or thinking- a narrowing of the
range of perceptions, opinions, and options that occur to the person’s mind
The idea of cessation- resolving the unbearable pain of disturbance
and isolation by simply ending it
Family members will feel desperate to find a note or some explanation for
such an act, but there is usually no single cause. One expert even says, “in
order to commit suicide, one cannot write a meaningful suicide note;
conversely if one could write a meaningful note, one would not have to
commit suicide.”
The Impact of Suicide
Survivors usually have a very difficult time dealing with this sort of death.
Anger, guilt, physical complaints, and deep sadness are present. Many
survivors get stuck in their grief, isolating themselves and having difficulty
feeling close to others. They have more issues to deal with than other
survivors such as issues around a death that is not natural, often perceived as
avoidable, that is sudden, and seems to repudiate the value of life. There are
also issues related to abandonment. Children whose parents kill themselves
hold feelings of rejection and abandonment for much of their adult lives.
There are also feelings of blame and guilt regarding the deceased. Of course
the degree of emotional attachment to the deceased makes a difference in the
quality of grief. While other mourners seem to experience a change in
mourning around six months, suicide survivors take longer to reach that first
change. Families that can form a “healing alliance” by helping one another
through the process are better able to cope with a suicide in their midst.
These families are watchful of one another and allow one another to grieve
in their own ways. Some families talked more openly and that was helpful in
processing what happened and the feelings about the loss. Other families
would keep quiet, or even blame one another for the loss. This complicates
the grief process. Survivors of suicide also are treated differently than other
grieving people. Friends simply don’t know what to say and don’t know
how to help or support these people.
One other issue, particularly regarding adolescent suicides, is the copycat
phenomenon- where there are other suicides soon after a publicized suicide.
Even so, these suicidal people have shown signs of risk before the event,
indicating the publicized suicide simply acted as a trigger for an act already
contemplated. These signs include: substance abuse, mental illness, losing a
girl/boyfriend, witnessing or using violence, self-destructive acts, moving
frequently and changing schools, and experiencing a divorce or other
parental transition.
Suicide Intervention
Interventions aimed at reducing the likelihood of a completed suicide
include crisis intervention, suicide phone lines, and teaching people how to
recognize signs of potential suicide. A determined suicide can find a way
even when people are trying to intervene, but these interventions may give
the person enough relief that the act is delayed until the person is in a better
frame of mind.
Myths
Suicidal people do give signs of their planning- giving away cherished
objects, talking about going away for awhile. 80% of people who are
inclined toward suicide have communicated their plans to someone. This
indicates they really want to live, they just can’t figure out how to do that.
You will not give a person the idea of suicide by talking about it with them
in a frank way- they have been thinking about it for some time if you are
aware of it. It actually takes the onus off them when others confront their
behavior. They can give up the façade of managing when they aren’t.
Signs of depression also relate to risk of suicide: sleeping a lot or not at all,
eating changes, even becoming lighter, more peaceful after a time of being
morose or apathetic. This actually indicates the person has decided on a plan
and finally feels released from the anguish.
What can you do?
Listen to them- pay attention to them and be present, even though that is
often difficult to do- these people are so self-absorbed it is difficult to listen
without feeling very frustrated by their inability to consider solutions to their
problems. Once a suicidal remark is heard, and it may be as subtle as “I just
want to go away for a long time.” “I wish I could go to sleep and never wake
up.” then you need to ask about actual plans. This is critical. Some people,
most of us, have thought generically about suicide, but people at risk have
saved pills, located a gun, considered creating a noose and where they would
put it. If they say they know when and where they would do it, then they
really are at high risk. This is someone who should not be left alone and
plans should be made for professionals to intervene. The problem for many
teens is, they value confidentiality and if a friend is telling his/her friend
these things, teens feel they can’t reveal such a secret. This is a terrible
burden for a teen to carry.
Often with friends or family, when you hear these statements of
hopelessness and despair, you tend to downplay them or gloss over them
with some pablum about your age, life gets better, teen romances don’t
really matter in the long run, etc… But if it seems like a crucial problem to
the person, it is a problem that needs to be addressed seriously.
Tunnel vision is part of the depressant cycle, where the person can not
imagine any acceptable outcome, so death seems the only solution. You can
try to offer various perspectives on the problem, citing the person’s inner
strength, etc. but don’t count on that eliminating the risk.
Specific action is essential- first you can ask for a commitment to a contract
that the person will not hurt himself until he can see a professional. These
contracts are amazingly effective. Even so, some people will go along with
these suggestions just to get the person off their back so they can do what
they planned anyway. No one is responsible for a life except the person
living that life. Suicide is truly an option, whether we like it or not. As
Seneca said, “But to die well is to escape the risk of living badly.”
Can Suicide ever be a morally appropriate act?
Most people believe that suicide is never rational- people contemplating it
are drowning in the midst of powerful negative emotions. Others say that
there are conditions that would make suicide seem like a rational outcome,
given what they are facing. Suicide may seem like a legitimate form of selfdeliverance. In some circumstances, heroes are made when a group is saved
by the deliberate sacrifice of a member for the group. Almost all religions
are opposed to suicide, seeing the self as a gift of God and no one has the
right to take that life.