Suicide
Definition
Suicide is defined as the
intentional taking of one's own life. Prior to the late nineteenth century,
suicide was legally defined as a criminal act in most Western countries. In the
social climate of the early 2000s, however, suicidal behavior is most commonly
regarded and responded to as a psychiatric emergency.
Description
Suicide is considered a major public
health problem around the world as well as a personal tragedy. According to the
National Institute of Mental Health (NIMH), suicide was the eleventh leading
cause of death in the
United States in 2000, and the third leading cause of death for people between
the ages of 15 and 24. About 10.6 out of every 100,000 persons in the United
States and Canada die by their own hands. There are five suicide victims for
every three homicide deaths in North America as of the early 2000s. There are
over 30,000 suicides per year in the United States, or about 86 per day; and each
day about 1900 people attempt suicide.
The demographics of suicide vary
considerably within Canada and the United States, due in part to differences
among age groups and racial groups, and between men and women. Adult males are
three to five times more likely to commit suicide than females, but females are
more likely to attempt suicide. Most suicides occur in persons below the age of
40; however, elderly Caucasians are the sector of the population with the
highest suicide rate. Americans over the age of 65 accounted for 18 percent of
deaths by suicide in the United States in 2000. Geographical location is an
additional factor; according to the Centers for Disease Control and Prevention
(CDC), suicide rates in the United States are slightly higher than the national
average in the western states, and somewhat lower than average in the East and
the Midwest.
Race is also a factor in the
demographics of suicide. Between 1979 and 1992, Native Americans had a suicide
rate 1.5 times the national average, with young males between 15 and 24
accounting for 64% of Native American deaths by suicide. Asian American women
have the highest suicide rate among all women over the age of 65. And between
1980 and 1996 the suicide rate more than doubled for black males between the
ages of 15 and 19.
Causes
& symptoms
Causes
Suicide is a complex act that
represents the end result of a combination of factors in any individual. These
factors include biological vulnerabilities, life history, occupation, present
social circumstances, and the availability of means for committing suicide.
While these factors do not "cause" suicide in the strict sense, some
people are at greater risk of self-harm than others. Risk factors for suicide
include:
- Male sex.
- Age over 75.
- A family history of suicide.
- A history of previous suicide attempts.
- A history of abuse in childhood.
- A local cluster of recent suicides or a local landmark associated with suicides. Examples of the latter include the Golden Gate Bridge in San Francisco; Sydney Harbor Bridge in Australia; St. Peter's Basilica in Rome; the Eiffel Tower in Paris; Prince Edward Viaduct in Toronto; and Mount Mihara, a volcano in Japan.
- Recent stressful events: separation or divorce, job loss, bankruptcy, upsetting medical diagnosis, death of spouse.
- Medical illness. Persons in treatment for such serious or incurable diseases as AIDS, Parkinson's disease, and certain types of cancer are at increased risk of suicide.
- Employment as a police officer, firefighter, physician, dentist, or member of another high-stress occupation.
- Presence of firearms in the house. Death by firearms is the most common method for women as well as men as of the early 2000s. In 2001, 55% of reported suicides in the United States were committed with guns.
- Alcohol or substance abuse. Mood-altering substances are a factor in suicide because they weaken a person's impulse control.
- Presence of a psychiatric illness. Over 90% of Americans who commit suicide have a significant mental illness. Major depression accounts for 60% (especially in the elderly), followed by schizophrenia, alcoholism, substance abuse, borderline personality disorder, Huntington's disease, and epilepsy. The lifetime mortality due to suicide in psychiatric patients is 15% for major depression; 20% for bipolar disorder; 18% for alcoholism; 10% for schizophrenia; and 5-10% for borderline and certain other personality disorders.
Neurobiological factors may also
influence a person's risk of suicide. Post-mortem studies of the brains of
suicide victims indicate that the part of the brain associated with aggression
and other impulsive behaviors (the frontal cortex) has a significantly lower
level of serotonin, a neurotransmitter associated with mood disorders.
Low serotonin levels are correlated with major depression. In addition, suicide
victims have higher than normal levels of cortisol, a hormone produced in
stressful situations, in the tissues of their central nervous system. Other
research has indicated that abuse in childhood may have permanent effects on
the level of serotonin in the brain, possibly "resetting" the level
abnormally low. In addition, twin studies have suggested that there may be a
genetic susceptibility to both suicidal ideation and suicide attempts which
cannot be explained by inheritance of common psychiatric disorders.
Some psychiatrists propose
psychodynamic explanations of suicide. According to one such theory, suicide is
"murder in the 180th degree" that is, the suicidal person really
wants to kill someone else but turns the anger against the self instead.
Another version of this idea is that the suicidal person has incorporated the
image of an abusive parent or other relative in their own psyche and then tries
to eliminate the abuser by killing the self.
Diagnosis
When a person consults a doctor
because they are thinking of committing suicide, or they are taken to a
doctor's office or emergency room after a suicide attempt, the doctor will
evaluate the patient's potential for acting on their thoughts or making another
attempt. The physician's assessment will be based on several different sources
of information:
- The patient's history, including a history of previous attempts or a family history of suicide.
- A clinical interview in which the physician will ask whether the patient is presently thinking of suicide; whether they have made actual plans to do so; whether they have thought about the means; and what they think their suicide will accomplish. These questions help in evaluating the seriousness of the patient's intentions.
- A suicide note, if any.
- Information from friends, relatives, or first responders who may have accompanied the patient.
- Short self-administered psychiatric tests that screen people for depression and suicidal ideation. The most commonly used screeners are the Beck Depression Inventory (BDI), the Depression Screening Questionnaire, and the Hamilton Depression Rating Scale.
- The doctor's own instinctive reaction to the patient's mood, appearance, vocal tone, and similar factors.
Treatment
of attempted suicide
Suicide attempts range from
well-planned attempts involving a highly lethal method (guns, certain types of
poison, jumping from high places, throwing oneself in front of trains or subway
cars) that fail by good fortune to impulsive or poorly planned attempts using a
less lethal method (medication overdoses, cutting the wrists). Suicide attempts
at the less lethal end of the spectrum are sometimes referred to as suicide
gestures or pseudocide. These terms should not be taken to indicate that
suicide gestures are only forms of attention-seeking; they should rather be
understood as evidence of serious emotional and mental distress.
A suicide attempt of any kind is
treated as a psychiatric emergency by the police and other rescue personnel.
Treatment in a hospital emergency room includes a complete psychiatric
evaluation; a mental status examination;
blood or urine tests if alcohol or drug abuse is suspected; and a detailed
assessment of the patient's personal circumstances (occupation, living
situation, family or friends nearby, etc.). The patient will be kept under
observation while decisions are made about the need for hospitalization.
A person who has attempted suicide
can be legally hospitalized against his or her will if he or she seems to be a
danger to the self or others. The doctor will base decisions about
hospitalization on the severity of the patient's depression; the availability
of friends, relatives, or other social support; and the presence of other
suicide risk factors, including a history of previous suicide attempts,
substance abuse, and psychosis
(loss of contact with reality, often marked by delusions
and hallucinations).
If the attempt is judged to be a nonlethal suicide gesture, the patient may be
released after the psychiatric assessment is completed. According to CDC figures,
132,353 Americans were hospitalized in 2002 following suicide attempts while
116,639 were released following emergency room treatment.
Related
issues
Survivors
of suicide
One group of people that is often
overlooked in discussions of suicide is the friends and family left behind by
the suicide. It is estimated that each person who kills him- or herself leaves
six survivors to deal with the aftermath; thus there are at least 4.5 million
survivors of suicide in the United States. In addition to the grief that
ordinarily accompanies death, survivors of suicide often struggle with feelings
of guilt and shame as well. They often benefit from group or individual
psychotherapy in order to work through such issues as wondering whether they
could have prevented the suicide or whether they are likely to commit suicide
themselves. The American Foundation for Suicide Prevention (AFSP) has a number
of online resources available for survivors of suicide.
Assisted
suicide
One question that has been raised in
developed countries as the average life expectancy increases is the
legalization of assisted suicide for persons suffering from a painful terminal
illness. Physician-assisted suicide has become a topic of concern since it was
legalized in the Netherlands in 2001 and in the state of Oregon in 1997. It is
important to distinguish between physician-assisted suicide and euthanasia, or
"mercy killing.". Assisted suicide, which is often called
"self-deliverance" in Britain, refers to a person's bringing about
his or her own death with the help of another person. Because the other person
is often a physician, the act is often called "doctor-assisted
suicide." Euthanasia strictly speaking means that the physician or other
person is the one who performs the last act that causes death. For example, if
a physician injects a patient with a lethal overdose of a pain-killing
medication, he or she is performing euthanasia. If the physician leaves the
patient with a loaded syringe and the patient injects himself or herself with it,
the act is an assisted suicide. As of early 2005 assisted suicide is illegal
everywhere in the United States except for Oregon, and euthanasia is illegal in
all fifty states.
Media
treatment of suicide
The Centers for Disease Control and
Prevention (CDC) sponsored a national workshop in April 1994 that addressed the
connection between sensationalized media treatments of suicide and the rising
rate of suicide among American youth. The CDC and the American Association of
Suicidology subsequently adopted a set of guidelines for media coverage of
suicide intended to reduce the risk of suicide by contagion.
The CDC guidelines point out that
the following types of reporting may increase the risk of "copycat"
suicides:
- Presenting oversimplified explanations of suicide, when in fact many factors usually contribute to a person's decision to take their own life.
- Excessive or repetitive local news coverage.
- Sensationalizing the suicide by inclusion of morbid details or dramatic photographs.
- Giving "how-to" descriptions of the method of suicide.
- Describing suicide as an effective coping strategy or as a way to achieve certain goals.
- Glorifying the act of suicide or the person who commits suicide.
Alternative
treatment
Some alternative treatments may help
to prevent suicide by preventing or relieving depression. Meditation
practice or religious faith and worship have been shown to lower a person's
risk of suicide. In addition, any activity that brings people together in
groups and encourages them to form friendships helps to lower the risk of
suicide, as people with strong social networks are less likely to give up on
life.
Prognosis
The prognosis for a person who has
attempted suicide is generally favorable, although further research needs to be
done. A 1978 follow-up study of 515 people who had attempted suicide between
1937 and 1971 reported that 94% were either still alive or had died of natural
causes. This finding has been taken to indicate that suicidal behavior is more
likely to be a passing response to an acute crisis than a reflection of a
permanent state of mind.
Prevention
One reason that suicide is such a
tragedy is that most self-inflicted deaths are potentially preventable. Many
suicidal people change their minds if they can be helped through their
immediate crisis; Dr. Richard Seiden, a specialist in treating survivors of
suicide attempts, puts the high-risk period at 90 days after the crisis. Some
potential suicides change their minds during the actual attempt; for example, a
number of people who survived jumping off the Golden Gate Bridge told
interviewers afterward that they regretted their action even as they were
falling and that they were grateful they survived.
Brain research is another important
aspect of suicide prevention. Since major depression is the single most common
psychiatric diagnosis in suicidal people, earlier and more effective
recognition of depression is a necessary preventive measure. Known biological
markers for an increased risk of suicide can now be correlated with personality
profiles linked to suicidal behavior under stress to help
identify individuals at risk. In addition, brain imaging studies using positron emission tomography (PET) are presently in use to detect abnormal patterns of
serotonin uptake in specific regions of the brain. Genetic studies are also
yielding new information about inherited predispositions to suicide.
Another major preventive measure is
education of clinicians, media people, and the general public. In 2002 the CDC,
the National Institutes of Health (NIH), and several other government agencies
joined together to form the National Strategy for Suicide Prevention, or NSSP.
Education of the general public includes a growing number of medical and
government websites posting information about suicide, publications available
for downloading, lists of books for further reading, tips for identifying
symptoms of depressed and suicidal thinking, and advice about helping friends
or loved ones who may be at risk. Many of these websites also have direct
connections to suicide hotlines.
The National Institute of Mental
Health (NIMH) recommends the following action steps for anyone dealing with a
suicidal person:
- Make sure that someone is with them at all times; do not leave them alone even for a short period of time.
- Persuade them to call their family doctor or the nearest hospital emergency room.
- Call 911 yourself.
- Keep the person away from firearms, drugs, or other potential means of suicide.
Prepared by student: Welid Nuredin Herki.
University Of Duhok, College Of Arts, Sociology Department.
Source:
