9.6 PUTTING IT...together

Psychological and Biological Insights Lag Behind

Once a mysterious and hidden problem, hardly acknowledged by the public and barely investigated by professionals, suicide today is the focus of much attention. During the past 40 years in particular, investigators have learned a great deal about this life-or-death problem.

314

BETWEEN THE LINES

Highest National Suicide Rates

Lithuania (31.5 per 100,000 people)

South Korea (31)

Kazakhstan (26.9)

Belarus (25.3)

Japan (24.4)

Russia (23.5)

Guyana (22.9)

Ukraine (22.6)

(WHO, 2011)

In contrast to most other problems covered in this textbook, suicide has received much more examination from the sociocultural model than from any other. Sociocultural theorists have, for example, highlighted the importance of societal change and stress, national and religious affiliation, marital status, gender, race, and the mass media. The insights and information gathered by psychological and biological researchers have been more limited.

Although sociocultural factors certainly shed light on the general background and triggers of suicide, they typically leave us unable to predict that a given person will attempt suicide. Clinicians do not yet fully understand why some people kill themselves while others in similar circumstances manage to find better ways of addressing their problems. Psychological and biological insights must catch up to the sociocultural insights if clinicians are truly to explain and understand suicide.

Treatments for suicide also pose some difficult problems. Clinicians have yet to develop clearly successful therapies for suicidal people. Although suicide prevention programs certainly show the clinical field’s commitment to helping those who are suicidal, it is not yet clear how much such programs actually reduce the overall risk or rate of suicide.

At the same time, the growth in the amount of research on suicide offers great promise. And perhaps most promising of all, clinicians are now enlisting the public in the fight against this problem. They are calling for broader public education about suicide—for programs aimed at both young and old. It is reasonable to expect that the current commitment will lead to a better understanding of suicide and to more successful interventions. Such goals are of importance to everyone. Although suicide itself is typically a lonely and desperate act, the impact of such acts is very broad indeed.

BETWEEN THE LINES

Suicide and Geography

  • In the United States, the highest rate of suicide is in the West (14 per 100,000 people), followed by the South (13 per 100,000), the Midwest (12 per 100,000), and the Northeast (9 per 100,000).

  • The states with a suicide rate higher than 20 per 100,000 are Wyoming, Alaska, Montana, Nevada, and New Mexico.

  • The only states with a suicide rate lower than 9 per 100,000 are New York, New Jersey, and Maryland.

(AFSP, 2014)

BETWEEN THE LINES

Still at Risk

Approximately 4 percent of all suicides are committed by people who are inpatients at mental hospitals or other psychiatric facilities.

SUMMING UP

  • WHAT IS SUICIDE? Suicide is a self-inflicted death in which a person makes an intentional, direct, and conscious effort to end his or her life. Four kinds of people who intentionally end their lives have been distinguished: the death seeker, the death initiator, the death ignorer, and the death darer. pp. 283–287

  • RESEARCH STRATEGIES Two major strategies are used in the study of suicide: retrospective analysis (a psychological autopsy) and the study of people who survive suicide attempts, on the assumption that they are similar to those who commit fatal suicides. Each strategy has limitations. p. 287

  • PATTERNS AND STATISTICS Suicide ranks among the top 10 causes of death in Western societies. Rates vary from country to country. One reason seems to be cultural differences in religious affiliation, beliefs, and degree of devoutness. Suicide rates also vary according to race, gender, and marital status. pp. 288–290

  • FACTORS THAT TRIGGER SUICIDE Many suicidal acts are triggered by the current events or conditions in a person’s life. The acts may be triggered by recent stressors, such as loss of a loved one and job loss, or long-term stressors, such as serious illness, an abusive environment, and job stress. They may also be preceded by changes in mood or thought, particularly increases in one’s sense of hopelessness. In addition, the use of alcohol or other kinds of substances, mental disorders, or news of another’s suicide may precede suicide attempts. pp. 290–296

    315

  • EXPLANATIONS FOR SUICIDE The leading explanations for suicide come from the psychodynamic, sociocultural, and biological models. Each has received only limited support. Psychodynamic theorists believe that suicide usually results from depression and self-directed anger. Emile Durkheim’s sociocultural theory defines three categories of suicide, based on the person’s relationship with society: egoistic, altruistic, and anomic suicides. And biological theorists suggest that the activity of the neurotransmitter serotonin is particularly low in people who commit suicide. pp. 296–300

  • SUICIDE IN DIFFERENT AGE GROUPS The likelihood of suicide varies with age. It is uncommon among children, although it has been increasing in that group during the past several decades.

    Suicide by adolescents is more common than suicide by children, but the numbers have been decreasing over the past decade. Adolescent suicide has been linked to clinical depression, anger, impulsiveness, major stress, and adolescent life itself. Suicide attempts by this age group are numerous. The high attempt rate among adolescents and young adults may be related to the growing number and proportion of young people in the general population, the weakening of family ties, the increased availability and use of drugs among young people, and the broad media coverage of suicide attempts by the young. The rate of suicide among American Indian teens is twice as high as that among white American teens and three times as high as those of African, Hispanic, and Asian American teens.

    In Western societies, the elderly are more likely to commit suicide than people in any other age group. The loss of health, friends, control, and status may produce feelings of hopelessness, loneliness, depression, or inevitability in this age group. pp. 300–307

  • TREATMENT AND SUICIDE Treatment may follow a suicide attempt. When it does, therapists try to help the person achieve a nonsuicidal state of mind and develop better ways of handling stress and solving problems.

    Over the past 50 years, emphasis has shifted to suicide prevention. Suicide prevention programs include 24-hour-a-day hotlines and walk-in centers staffed largely by paraprofessionals. During their initial contact with a suicidal person, counselors try to establish a positive relationship, to understand and clarify the problem, to assess the potential for suicide, to assess and mobilize the caller’s resources, and to formulate a plan for overcoming the crisis. Beyond such crisis intervention, most suicidal people also need longer-term therapy. In a still broader attempt at prevention, suicide education programs for the public are on the increase. pp. 307–313

Visit LaunchPad

www.macmillanhighered.com/launchpad/comerabpsych9e to access the e-book, new interactive case studies, videos, activities, LearningCurve quizzing, as well as study aids including flashcards, FAQs, and research exercises.