Ch. 7 Suicide Flashcards
1
Q
What Is Suicide?
A
SUICIDE – A self-inflicted death in which the person acts intentionally, directly, and consciously.
- Suicide is not officially classified as a mental disorder, although DSM-5 proposes that a category called suicidal behavior disorder be studied for possible inclusion in future revisions of DSM-5.
- 4 kinds of people who intentionally end their lives:
- death seeker – clearly intend to end their lives at the time they attempt suicide death initiator – clearly intend to end their lives, but they act out of a belief that the process of death is already underway and that they are simply hastening the process.
- death ignorer – do not believe that their self-inflicted death will mean the end of their existence. They believe they are trading their present lives for a better or happier existence.
- death darer. – experience mixed feelings, or ambivalence, about their intent to die, even at the moment of their attempt, and they show this ambivalence in the act itself. (Ex: Russian Roulette)
- subintentional death – A death in which the victim plays an indirect, hidden, partial, or unconscious role.
- ? percent of all adolescents try to injure themselves at least once.
- The behavior becomes addictive in nature. The pain brought on by self-injury seems to offer some relief from tension or other kinds of emotional suffering
- self-injury may help a person deal with chronic feelings of emptiness, boredom, and identity confusion.
2
Q
How Is Suicide Studied?
A
Retrospective analysis – A psychological autopsy in which clinicians piece together information about a person’s suicide from the person’s past.
- Such sources of information are not always available or reliable
Studying people who survive their suicide attempts – It is estimated that there are 12 nonfatal suicide attempts for every fatal suicide.
- However, it may be that people who survive suicide attempts differ in important ways from those who do not. Many of them may not really have wanted to die.
3
Q
Suicidal Behavior Disorder
A
Suicidal Behavior Disorder – Suicidal Ideation is thinking about, considering, or planning suicide.
- It alone is not a diagnosis, but it is a symptom of some mental disorders.
- Can also occur in response to adverse events without the presence of a mental disorder.
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Suicide risk scales:
- Passive Suicidal Ideation- thinking about not wanting to live or imagining being dead
- Active Suicidal Ideation- thinking about different ways to die or forming a plan to die
4
Q
Patterns and Statistics
A
Suicide rates vary from country to country due to cultural differences in religious affiliation, beliefs, and degree of devoutness.
- Countries that are largely Catholic, Jewish, or Muslim tend to have low suicide rates.
- Perhaps in these countries, strict prohibitions against suicide or a strong religious tradition deter many people from attempting suicide.
- Research suggests that religious doctrine may not help prevent suicide as much as the degree of an individual’s devoutness.
- Three times as many women attempt suicide as men.
- Men die from their attempts at more than three times the rate of women, likely due to the more aggressive methods used by men.
- Live-streamed Suicides are on the rise
- At least half of individuals who carry out suicide are socially isolated.
- Never-married and divorced persons have a higher suicide rate than married or cohabitating individuals.
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RACE AND CULTURE – In the US, suicide rates seem to vary according to race and ethnicity.
- The overall suicide rate of white Americans is more than twice as high as other ethnicities (except native Americans – due to their extreme poverty and marginalization)
- Alcohol use, modeling, and the availability of guns may also play a role.
5
Q
Stressful Events and Situations: Trigger
A
- One stressor that has been consistently linked to suicide is COMBAT STRESS.
- Common forms of immediate stress seen in cases of suicide are the death of a loved one, divorce, or rejection; loss of a job; significant financial loss; and stress caused by natural disasters, even among very young children.
- People may also attempt suicide in response to long-term rather than recent stress. Four such stressors are particularly common:
- social isolation
- serious illness
- abusive environment
- occupational stress
6
Q
Mood and Thought Changes: Trigger
A
- Many suicide attempts are preceded by a change in mood, usually sadness.
- Also common are increases in:
- feelings of anxiety
- tension
- frustration
- anger
- shame
- Some clinicians believe that a feeling of hopelessness is the single most likely indicator of suicidal intent.
- Hopelessness – A pessimistic belief that one’s present circumstances, problems, or mood will never change. Hopelessness often results from dichotomous thinking – viewing problems and solutions in rigid either/or terms
7
Q
Alcohol and Other Drug Use: Trigger
A
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70% of the people who attempt suicide drink alcohol just before they do so.
- The more intoxicated suicide attempters are, the more lethal their chosen suicide method.
8
Q
Mental Disorders: Trigger
A
- 70% of all suicide attempters had been experiencing severe depression.
- 20% chronic alcoholism
- 10% schizophrenia.
- 25% of people with each of these disorders try to kill themselves.
- People who are both depressed and substance-dependent seem particularly prone to suicidal impulses.
- People who drink alcohol or use drugs just before a suicide attempt actually have a long history of abusing such substances.
- A Confounding factor may be that psychological pain or desperation may cause both substance abuse and suicidal thinking.
- Research indicates that suicides by people with schizophrenia and other disorders featuring psychosis usually reflect feelings of demoralization, a sense of being entrapped by their disorder.
9
Q
Modeling – The Contagion of Suicide: Trigger
A
- One suicidal act serves as a model for another.
- Suicides by family members and friends, those by celebrities, and suicides by coworkers or colleagues are particularly common triggers.
- Social Contagion – a risk factor – even when researchers factor out these issues, they find increases in the risk of suicide among the relatives and friends of people who recently committed suicide.
- Suicides by entertainers, political figures, and other well-known people are regularly followed by unusual increases in the number of suicides across the nation.
- More responsible reporting could reduce the impact of celebrity suicides.
- Ex: The suicide of Kurt Cobain. MTV’s repeated theme on the evening of the suicide was “Don’t do it!” Perhaps because of such efforts, the usual rate of suicide both in Seattle, where Cobain lived and elsewhere held steady during the weeks that followed.
- Postvention – post-suicide programs. Today, a number of schools, for individuals of all ages, put into action programs of this kind after a student dies by suicide.
10
Q
The Psychodynamic View: Cause
A
PSYCHODYNAMIC VIEW – believe that suicide results from depression and from anger at others that is redirected toward oneself.
- When people experience the real or 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.
- For a short while, negative feelings toward the lost loved one are experienced as self-hatred. Anger toward the loved one may turn into intense anger against oneself and finally into depression. Suicide is thought to be an extreme expression of this self-hatred and self-punishment.
- Research supports this, showing a relationship between childhood losses and later suicidal behaviors
- Common forms of loss were loss of a parent through death, divorce, or child neglect (a symbolic loss).
- For a short while, negative feelings toward the lost loved one are experienced as self-hatred. Anger toward the loved one may turn into intense anger against oneself and finally into depression. Suicide is thought to be an extreme expression of this self-hatred and self-punishment.
- Freud proposed that human beings have a basic “death instinct.” He called this instinct THANATOS and said that it opposes the “life instinct”. While most people learn to redirect their death instinct by aiming it toward others, suicidal people, caught in a web of self-anger, direct it toward themselves.
- Research supports this idea.
- SUMMARY – themes of loss and self-directed aggression generally remain at the center of most psychodynamic explanations.
11
Q
Durkheim’s Sociocultural View: Cause
A
EMILE DURKHIEM – the probability of suicide is determined by how attached a person is to such social groups as the family, religious institutions, and community.
- The greater the sense of belonging, the lower the risk of suicide.
- defined several categories of suicide:
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Egoistic suicide – carried out by people over whom society has little or no control. These people are not concerned with the norms or rules of society, nor are they integrated into the social fabric. This kind of suicide is more likely in people who are isolated, alienated, and nonreligious.
- The larger the number of such people living in a society, the higher that society’s suicide rate.
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Altruistic suicide – undertaken by people who are so well integrated into the social structure that they intentionally sacrifice their lives for its well-being.
- Ex: Soldiers who threw themselves on top of a live grenade to save others, Kamikaze.
- Societies that encourage people to sacrifice themselves for others and to preserve their own honor (as East Asian societies do) are likely to have higher suicide rates.
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Anomic suicide – those pursued by people whose social environment fails to provide stable structures, such as family and religion, to support and give meaning to life.
- Such a societal condition, called ANOMIE (literally, “without law”) leaves people without a sense of belonging.
- Unlike egoistic suicide, which is the act of a person who rejects the structures of a society, anomic suicide is the act of a person who has been let down by a disorganized, inadequate, often decaying society.
- When societies go through periods of ANOMIE, their suicide rates increase.
- Periods of population change and increased immigration, too, tend to bring about a state of anomie, and again suicide rates rise.
- A major change in a person’s immediate surroundings, rather than general societal problems, can also lead to anomic suicide.
- Societies with more opportunities for changes in individual wealth or status would have higher suicide rates. This prediction is also supported by research
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Egoistic suicide – carried out by people over whom society has little or no control. These people are not concerned with the norms or rules of society, nor are they integrated into the social fabric. This kind of suicide is more likely in people who are isolated, alienated, and nonreligious.
12
Q
The Interpersonal View: Cause
A
The interpersonal theory of suicide – A theory that asserts that people with perceived burdensomeness, thwarted belongingness, and a psychological capability to carry out suicide are the most likely to attempt suicide.
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Perceived burdensomeness – believe that their existence places a heavy and permanent burden on their family, friends, and even society.
- This belief “typically inaccurate” may produce the notion that “my death would be worth more than my life to my family and friends”.
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Thwarted belongingness – feel isolated and alienated.
- Such individuals are unlikely to attempt suicide unless they further possess the psychological capability to inflict lethal harm on themselves.
- Psychological capability for suicidal acts – We all have a basic motive to live and preserve ourselves – a motive that weakens for certain people as a result of their repeated exposure to painful or frightening life experiences, like abuse, trauma, severe illness, or the like. Given such recurrent experiences, these individuals may develop a heightened tolerance for pain and a fearlessness about death.
- People with a combination of perceived burdensomeness thwarted belongingness, and acquired suicide capability are significantly more likely to attempt suicide than people without these characteristics
- Ex-Military personnel tend to fall into this category more than others.
13
Q
The Biological View: Cause
A
Biological view of suicide – There are higher rates of suicide among the parents and close relatives of suicidal people.
- The connection might be due to genetically predispositioned low serotonin activity and brain-circuit dysfunction – a role in suicide separate from depression.
- Low serotonin activity and brain-circuit dysfunction help produce aggressive feelings and impulsive behavior, which contributes to suicidal tendencies.
14
Q
Children: Age link
A
Suicide attempts by the very young are commonly preceded by:
- Running away from home
- Accident-proneness
- Aggressive acting out
- Temper tantrums
- Self-criticism
- Social withdrawal and loneliness
- Extreme sensitivity to criticism
- Low tolerance of frustration
- Sleep problems
- Dark fantasies
- Marked personality change
- Overwhelming interest in death and suicide
Studies have linked child suicides to:
- Recent or anticipated loss of a loved one
- Family stress
- Abuse by parents
- Victimization by peers (for example, bullying)
- Clinical level of depression
15
Q
Adolescents: Age Link
A
- Suicide has become the second leading cause of death in this age group, after accidents
- 19% of all adolescent deaths are the result of suicide
- Suicide attempts are at least twice as common among teenage victims of bullying as among other teenagers.
- LGBTQ teenagers three times more likely than other teenagers to have suicidal thoughts and to attempt suicide
- More than 55% of teens who attempt suicide received some form of therapy before the onset of their suicidal behavior, but it failed to prevent their later actions
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Adolescence is a period of rapid growth that is often marked by conflicts, depressed feelings, tensions, and difficulties at home and school.
- Adolescents tend to react to events more sensitively, angrily, dramatically, and impulsively than individuals in other age groups; thus the likelihood of their engaging in suicide.
- Finally, the suggestibility of adolescents and their eagerness to imitate others, including others who attempt suicide, may set the stage for suicidal action.
- Adolescents exposed to suicide by an acquaintance or relative within the past year were more likely to attempt suicide
- Recent suicides by individuals on social networking sites may also raise the likelihood of attempted suicide
- Far more teenagers attempt suicide than actually kill themselves – ratio is at least 100 to 1, but perhaps 200 to 1.
- The unusually large number of unsuccessful teenage suicides may mean that adolescents are less certain than middle-aged and elderly people who make such attempts.
- Up to half of the teenagers who make a suicide attempt try again in the future.
- As many as 14 percent eventually die by suicide
Why is the rate of suicide attempts so high among teenagers?
Societal factors are the focus:
- As the number of teenagers and young adults in the general population has risen, the competition for jobs, college positions, and academic and athletic honors has intensified for them, leading increasingly to shattered dreams and ambitions
- Weakening ties in the family and adolescents seek independence
- Easy availability of alcohol and other drugs.
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CULTURAL TRENDS – The highest teenage suicide rate of all is displayed by American Indians. Currently, around 18 of every 100,000 American Indian teenagers die by suicide each year.
- CLUSTER SUICIDES – certain American Indian reservations have extreme suicide rates – called cluster suicides and that teenagers who live in such communities are unusually likely to be exposed to suicide, to have their lives disrupted, to observe suicidal models, and to be at risk for suicide contagion.
