Suicide (Forensic Science)
Suicide has been a part of human society since history has been recorded, and the ethical implications of the act have been debated since ancient times. The scholars of ancient Greece addressed the legitimacy of suicide; Plato rejected the act based on a religious rationale, but Socrates disagreed and ultimately committed suicide. Under the Roman Empire, many soldiers committed suicide after defeat in war or to avoid capture by enemies. Later, Christianity altered views on suicide to mirror the sacrifices made by Jesus Christ. Specifically, Christians typically honored those who committed suicide as a sacrifice for a larger cause, such as in war, but they held in contempt those who used suicide as a way to escape the law or for other reasons deemed cowardly.
Suicide has been used as a strategy in warfare throughout history. During World War II, the Japanese sent what were termed kamikaze pilots to fly bombs into U.S. ships. The North Vietnamese also used suicide tactics against American soldiers during the Vietnam War. Moreover, although suicide is at odds with Islamic law, some Muslims use suicide attacks on their enemies under the notion of martyrdom warfare. The difference between suicide and martyrdom is that martyrdom is undertaken for a higher purpose, whereas suicide is undertaken to escape the hardships of life.
Across cultures, suicide remains a problem in the twenty-first century, with concerns increasing about suicide...
(The entire section is 263 words.)
Investigating Suicide (Forensic Science)
Investigations regarding suicide typically take two forms: research that seeks to explain the phenomenon of suicide and investigations into deaths that appear to have been self-inflicted. Attempts to understand and explain suicide have been undertaken at both micro and macro levels. Macro-level research on the topic has centered on the impact of the social structure on suicide rates across cities and even nationally. Theorists such as Émile Durkheim have attempted to show correlations between factors such as war periods and the Great Depression on suicide rates in the United States. In contrast, micro-level research has attempted to understand individual-level factors that may lead to suicide. For instance, researchers have examined the relationship between suicide and the social pressures placed on teenagers as well as that between suicide and the family problems encountered by adults. Suicide researchers are careful to separate attempted suicides in which the persons survive from completed suicide; many contend that the two are completely separate phenomena with completely separate causes.
Forensic pathologists are typically the members of the criminal justice system who oversee investigations into deaths that are suspicious or unnatural. In the United States, coroners or medical examiners (depending on the state) conduct investigations of unnatural deaths and order lab tests and autopsies on the bodies. However,...
(The entire section is 415 words.)
Further Reading (Forensic Science)
Durkheim, Émile. Suicide: A Study in Sociology. Translated by John A. Spaulding and George Simpson. 1951. Reprint. New York: Free Press, 1997. Classic work examines suicide from a sociological viewpoint, focusing on macro-level trends. Warns against using statistics to attempt to understand the causes of suicide.
Gorsuch, Neil. The Future of Assisted Suicide and Euthanasia. Princeton, N.J.: Princeton University Press, 2006. Lists the arguments for and against the legalizing of assisted suicide and places the phenomenon within an international context.
Holmes, Ronald, and Stephen Holmes. Suicide: Theory, Practice, and Investigation. Thousand Oaks, Calif.: Sage, 2005. Analyzes the theories surrounding the causes of suicide and examines how suicides are investigated. Includes actual suicide notes in discussion of the motives underlying suicide.
Joiner, Thomas. Why People Die by Suicide. Cambridge, Mass.: Harvard University Press, 2005. In-depth discussion of the determinants of suicide includes analysis of the differences between those who attempt suicide but survive and those who complete suicide.
Picton, Bernard. Murder, Suicide, or Accident: The Forensic Pathologist at Work. London: Hale, 1971. Focuses on the difficulty faced by forensic pathologists in distinguishing deaths by suicide from deaths resulting from murder and accidents.
(The entire section is 186 words.)
Causes and Symptoms (Magill’s Medical Guide, Sixth Edition)
Suicide is the deliberate taking of one’s own life. Most often, suicidal individuals are trying to avoid emotional or physical pain that they believe they cannot bear; sometimes, they are very angry and take their lives to lash out at others. Suicide is seen as a solution to an otherwise insoluble problem. Each year, there are about 500,000 self-inflicted injuries and 30,000 completed suicides, with 200,000 family survivors in the United States. In 2006, there were 33,000 suicides, and estimates suggest there were between twelve and twenty-five times as many attempted suicides the same year. Women attempt suicide more often than men, but men complete suicide more often than women because men tend to use more lethal means, such as a gun. It should also be noted that adolescents and the elderly are two high-risk groups.
When an individual contemplates suicide to avoid the physical pain of a terminal illness and does not have a mental disorder, that form of suicidal thought is often called “rational” suicide. This does not imply that this form of suicide is appropriate, moral, or legal but merely that the suicidal thoughts do not arise from a mental disorder (nonrational). Social views on rational suicide vary by culture. For example, many Dutch people consider rational suicide to be acceptable, whereas most Americans do not.
Most suicidal people encountered by physicians, psychologists, social workers, and...
(The entire section is 1597 words.)
Treatment and Therapy (Magill’s Medical Guide, Sixth Edition)
An understanding of the causes, detection, and treatment of suicide has led to the development of a number of suicide hotlines and suicide prevention centers. There is evidence that, after these support groups are introduced into a community, the suicide rate for young women decreases. It is not yet known if they have any effect on other groups, such as young men or the elderly.
Most people who contemplate suicide do not seek professional treatment even if they tell people around them of their suicidal ideas. Thus, it is important for physicians, clergy, teachers, parents, and mental health workers to remain alert to the possibility of suicidal thoughts in those in their care. Someone who is depressed or very anxious should be asked about suicidal thoughts. Such a question will not plant the idea in his or her head, and the person may feel relieved after being asked. Once someone with suicidal ideation is identified, evaluation and treatment should proceed quickly. The following sample composite cases illustrate the application of the concepts described in the overview.
Mary is a seventeen-year-old senior in high school. She is from a broken home and was severely abused by her father prior to her parents’ divorce ten years ago. Her teachers think that she is a bright underachiever who has a rather dramatic personality. Her friends see her as moody and easily angered. Her relationships with boyfriends are...
(The entire section is 1271 words.)
Perspective and Prospects (Magill’s Medical Guide, Sixth Edition)
Throughout history, there have been numerous examples of suicide. In Western culture, early views on the subject were mainly from a moral perspective and suicide was viewed as a sin. Mental illness in general was poorly understood and often thought of as weakness of character, possession by evil spirits, or willful bad behavior. Thus, mental illness was stigmatized. Even though society now has a better medical understanding of mental illness, there is still a stigma attached to mental illness and to suicide. This stigma contributes to underdiagnosis and undertreatment of suicidal individuals, as many sufferers are reluctant to come forth with their symptoms.
Suicide remains an important public health problem. In 2006, it was the eleventh most common cause of death in the United States (although it was third for adolescents and second for young adults). Each year, there are about thirty thousand known suicides in the United States. The actual incidence may be higher because an unknown number of accidental deaths or untreated illnesses may actually be undiagnosed suicides. For every suicide death, between eight and twenty-five other individuals attempt suicide.
Unfortunately, most cases of suicidal ideation never come to the attention of health professionals. Therefore, when someone talks of suicide, a high index of suspicion should be maintained. Those people who express suicidal thoughts should be taken...
(The entire section is 261 words.)
For Further Information: (Magill’s Medical Guide, Sixth Edition)
DePaulo, J. Raymond, Jr., and Leslie Alan Horvitz. Understanding Depression: What We Know and What You Can Do About It. New York: Wiley, 2003. A leading expert on depression examines the disease’s nature, causes, effects, and treatments.
Hafen, Brent Q., and Kathryn J. Frandsen. Youth Suicide: Depression and Loneliness. 2d ed. Evergreen, Colo.: Cordillera Press, 1986. An excellent review of all aspects of teenage suicide, with practical suggestions for helping the suicidal young person.
Jamison, Kay Redfield. Night Falls Fast: Understanding Suicide. New York: Alfred A. Knopf, 2000. Jamison, a distinguished psychologist and academic, brings a rare combination of personal and academic experience to bear in this monumental work on suicide.
Kolf, June Cerza. Standing in the Shadow: Help and Encouragement for Suicide Survivors. New York: Baker Books, 2002. The author, a veteran of hospice work, addresses the impact of suicide on family members and friends, and explores such emotions as forgiveness and depression, as well as the search for answers.
Koplewicz, Harold S. More than Moody: Recognizing and Treating Adolescent Depression. New York: Penguin, 2003. A leading clinician and researcher helps parents distinguish between normal teenage angst and depression, examining the warning signs, risk factors, and key behaviors, as well as treatment options....
(The entire section is 332 words.)
Introduction (Psychology and Mental Health)
Suicide is the intentional taking of one’s own life. Psychologists have devoted much effort to its study, attempting to identify those at greatest risk for suicide and to intervene effectively to prevent suicide.
Sociologist Émile Durkheim introduced what has become a well-known classification of suicide types. Altruistic suicides, according to Durkheim, are those that occur in response to societal demands (for example, the soldier who sacrifices himself to save his comrades). Egoistic suicides occur when the individual is isolated from society and so does not experience sufficient societal demands to live. The third type is the anomic suicide. Anomie is a sense of disorientation or alienation that occurs following a major change in one’s societal relationships (such as the loss of a job or the death of a close friend); the anomic suicide occurs following such sudden and dramatic changes.
Research supports Durkheim’s ideas that suicide is associated with social isolation and recent loss. Many other variables, both demographic and psychological, have also been found to be related to suicide. Numerous studies have shown that the following demographic variables are related to suicide: sex, age, marital status, employment status, urban/rural dwelling, and race. Paradoxically, more women than men attempt suicide, but more men than women commit suicide. Nearly four times the number of men commit suicide as women, and...
(The entire section is 1020 words.)
Research and Prevention (Psychology and Mental Health)
Several methods have been used to study the psychology of suicide. Epidemiological research determines the distribution of demographic characteristics among suicide victims. Another method is to study survivors of suicide attempts. Estimates show that for every twenty-five suicide attempts, one death by suicide occurs. This enables psychologists to examine intensively their psychological characteristics. A third method is to analyze suicide notes, which may explain the individual’s reasons for suicide. A final method is the psychological autopsy. This involves interviewing the victim’s friends and family members and examining the victim’s personal materials, such as diaries and letters, in an attempt to identify the psychological cause of the suicide.
Although all these approaches have been widely used, each has its limitations. The epidemiological method focuses on demographic characteristics and so may overlook psychological influences. Studying survivors of suicide attempts has limitations because survivors and victims of suicide attempts may differ significantly. For example, some suicide attempts are regarded as suicidal gestures, or “cries for help,” the intent of which is not to die but rather to call attention to the self to gain sympathy or assistance. Thus, what is learned from survivors may not generalize to successful suicide victims. The study of suicide notes is limited by the fact that,...
(The entire section is 500 words.)
Assessing Risk (Psychology and Mental Health)
Psychiatrist Aaron Beck and his colleagues developed the Hopelessness Scale in 1974 to assess an individual’s negative thoughts of the self and future. In many theories of suicide, an individual’s sense of hopelessness is related to risk for suicide. Beck and others have demonstrated that hopelessness in depressed patients is a useful indicator of suicide risk. For example, in 1985, Beck and his colleagues reported a study of 207 patients who were hospitalized because of suicidal thinking. Over the next five to ten years, fourteen patients committed suicide. Only one demographic variable, race, differed between the suicide and nonsuicide groups: White patients had a higher rate of suicide (10.1 percent) than African American patients (1.3 percent). Of the psychological variables assessed, only the Hopelessness Scale and a measure of pessimism differed between suicides and other patients. Patients who committed suicide were higher in both hopelessness and pessimism than other patients. Beck and his colleagues determined the Hopelessness Scale score, which best discriminated suicides from nonsuicides. Other mental health professionals can use this criterion to identify those clinically depressed patients who are at greatest risk for suicide.
Several approaches have been developed in efforts to prevent suicide. Shneidman and Farberow developed what may be the most well-known suicide-prevention program, the Los Angeles Suicide...
(The entire section is 421 words.)
Suicide is one of the most extreme and drastic behaviors faced by psychologists. Because of its severity, psychologists have devoted considerable effort to identifying individuals at risk for suicide and to developing programs that are effective in preventing suicide.
Psychological studies of suicide have shown that many popular beliefs about suicide are incorrect. For example, many people erroneously believe that people who threaten suicide never attempt suicide, that all suicide victims truly wish to die, that only the mentally ill commit suicide, that suicide runs in families, and that there are no treatments that can help someone who is suicidal. Because of these and other popular myths about suicide, it is especially important that psychological studies of suicide continue and that the results of these studies be disseminated to the public.
Suicide risk increases in clinically depressed individuals. In depressed patients, suicide risk has been found to be associated with hopelessness: As one’s sense of hopelessness increases, one’s risk for suicide increases. Since the 1970’s, Beck’s Hopelessness Scale has been used in efforts to predict risk for suicide among depressed patients. Although the suicide rate has been relatively stable in the United States since the early twentieth century, the suicide rate of young people has increased since the 1960’s.
For this reason, depression and...
(The entire section is 322 words.)
Pharmacology and Treatment (Psychology and Mental Health)
Because suicide is not a condition, but the result of a condition or a disorder, there is no set pharmaceutical treatment for those who attempt or threaten suicide; however, since depression is a determining factor in suicide, many of those suffering from depression take antidepressant drugs, such as selective serotonin reuptake inhibitors (SSRIs), which may aid in suicide prevention by stabilizing mood. Drug treatment is often accompanied by therapy, which also can reduce risk. Heavily debated studies as of 2005 have indicated controversy that some SSRIs, such as fluoxetine (Prozac), can actually increase the chance of suicide up to 5 percent, particularly in younger patients. Other conditions, such as schizophrenia, are treated with psychotropic drugs that can aid in suicide prevention, such as clozapine (Clozaril). For those who are at risk because of substance abuse, treatment may first entail eliminating that substance from the patient’s environment.
(The entire section is 145 words.)
Sources for Further Study (Psychology and Mental Health)
Durkheim, Émile. Suicide. Reprint. Glencoe, Ill.: Free Press, 1951. In this work, originally published in 1897, Durkheim introduced his system for classifying suicide types—altruistic, egoistic, and anomic suicides—and examined the relationship of suicide to isolation and recent loss.
Fremouw, William J., Maria de Perczel, and Thomas E. Ellis. Suicide Risk: Assessment and Response Guidelines. New York: Pergamon, 1990. This book presents useful guidelines, based on both research and clinical practice, for working with suicidal individuals.
Hawton, Keith. Suicide and Attempted Suicide Among Children and Adolescents. Beverly Hills, Calif.: Sage Publications, 1986. Presents an overview of research results concerning the causes of youth suicide and treatment programs for suicidal youngsters.
Jobes, David A., and Edwin S. Shneidman. Managing Suicidal Risk: A Collaborative Approach. New York: Guilford Press, 2006. A clinical book intended for psychologists and therapists who are working with suicidal patients. Includes visual aids on how to assess risk and develop treatment plans.
Lann, Irma S., Eve K. Moscicki, and Ronald Maris, eds. Strategies for Studying Suicide and Suicidal Behavior. New York: Guilford Press, 1989. This book examines the various research methods used to study suicide. Considers the relative strengths and weaknesses and offers...
(The entire section is 374 words.)
Suicide (American Indians Ready Reference)
Article abstract: The destruction of traditional culture and the corresponding economic deprivation of much reservation life has made suicide epidemic in the Indian population
Traditionally, Native Americans recognized the sanctity of life and stressed family and community responsibility. Suicide was thus uncommon, though it was permitted in some cultures under exceptional circumstances. Throughout North America, the aged and infirm often asked to be left to die rather than impose a burden. Among Plains Indians, suicide was sometimes regarded as preferable to social disgrace or severe physical deformity. Some saw suicide as permissible to avoid pain if all responsibilities had been fulfilled. Others, such as the Navajo, discouraged suicide, believing that it left behind a dangerous ghost.
Studies begun in the 1940’s, however, uncovered a disturbing trend. With the breakdown of cultural traditions, family instability, poverty, and lack of opportunity, Indian suicide has become commonplace, especially among young males. The overall suicide rate for Indians is 30 percent higher than for the general population, and for young males (ages twelve to twenty-four), the rate is double. After age forty-five, the comparative rate begins to decline, and for the elderly it is significantly below the national average.
Sources for Further Study
Chandler, Michael J., et al. with commentary by James E. Marcia....
(The entire section is 276 words.)
Suicide (Encyclopedia of Mental Disorders)
Suicide is defined as the intentional taking of one's own life. In some European languages, the word for suicide translates into English as "self-murder " Until the end of the twentieth century, approximately, suicide was considered a criminal act; legal terminology used the Latin phrase felo-de-se, which means "a crime against the self." Much of the social stigmathat is still associated with suicide derives from its former connection with legal judgment, as well as with religious condemnation.
In the social climate of 2002, suicidal behavior is most commonly regarded- and responded to- as a psychiatric emergency.
Demographics of suicide
In the United States, the rate of suicide has continued to rise since the 1950s. More people die from suicide than from homicide in North America. Suicide is the eighth leading cause of death in the U.S., and the third leading cause of death for people aged 15 to 24. There are over 30,000 suicides per year in the U.S., or about 86 per day; each day about 1,500 people attempt suicide.
The demographics of suicide vary considerably from state to state. Some states, like Pennsylvania, have suicide rates that are very close to the national average; others,...
(The entire section is 2872 words.)
Suicide/Suicidal Behavior (Encyclopedia of Psychology)
The act of taking one's own life voluntarily and intentionally.
The annual death toll from suicide worldwide is 120,000, and it is the eighth leading cause of death in the United States, accounting for one percent of all deaths. Between 240,000 and 600,000 people in the U.S. and Canada attempt suicide every year, and over 30,000 succeed. The suicide rate is three times higher for men than for women in the United States, although females make three times as many suicide attempts as males. Traditionally, men over 45 and living alone are the demographic group at greatest risk for suicide. However, in the past 30 years, youth suicides have risen alarmingly, tripling for people aged 15 to 24. The suicide rate among persons aged 10 to 24 between 1980 and 1992 rose an average of 177%. Suicide among women has also increased dramatically since 1960, when the ratio of male to female suicides was 4 to 1. Suicide rates vary significantly among different ethnic groups in the United States; Native Americans have the highest rate at 13.6 per 100,000 (although there are sizable variations among tribes), compared with 12.9 for European-Americans, and 5.7 for African-Americans.
Attitudes toward suicide have varied throughout history. The ancient Greeks considered it an offense against the state, which was deprived of contributions by potentially useful...
(The entire section is 1329 words.)
Suicide (West's Encyclopedia of American Law)
The deliberate taking of one's own life.
Under COMMON LAW, suicide, or the intentional taking of one's own life, was a felony that was punished by FORFEITURE of all the goods and chattels of the offender. Under modern U.S. law, suicide is no longer a crime. Some states, however, classify attempted suicide as a criminal act, but prosecutions are rare, especially when the offender is terminally ill. Instead, some jurisdictions
require a person who attempts suicide to undergo temporary hospitalization and psychological observation. A person who causes the death of an innocent bystander or would-be rescuer while in the process of attempting suicide may be guilty of murder or MANSLAUGHTER.
More problematic is the situation in which someone helps another to commit suicide. Aiding or abetting a suicide or an attempted suicide is a crime in all states, but prosecutions are rare. Since the 1980s the question of whether physician-assisted suicide should be permitted for persons with terminal illnesses has been the subject of much debate, but as yet this issue has not been resolved.
The debate over physician-assisted suicide concerns persons with debilitating and painful terminal illnesses. Under current laws a doctor who assists a person's suicide could be charged with...
(The entire section is 1279 words.)
Suicide (Encyclopedia of Public Health)
Suicide is defined as the act of deliberately taking one's own life. It occurs most often in response to a crisis such as a death or the loss of a relationship or job. During a crisis people experience a wide range of feelings, and each person's response to crisis is different. It is normal to feel frightened or anxious or depressed. If a person feels overwhelmed or unable to cope, he or she may try to commit suicide.
Almost all people who kill themselves either suffered from depression or had substance abuse problems. People who are lonely and isolated or who have histories of previous suicide attempts are also at greater risk for attempting suicide.
In 1996, approximately 31,000 people died of suicide in the United States. Suicide is the eighth leading cause of death overall, and the third leading cause of death among American teenagers. In Canada, suicide is second only to motor-vehicle accidents as a cause of death among adolescents.
The suicide rate is twice the murder rate among those aged 15 to 24, and it has increased dramatically in recent years. Each year, two thousand adolescents commit suicide in the United States. The highest suicide rates in the United States are found in white men over age 85. Men are more than four times as likely as women to die by suicide, yet women are more likely to make a nonlethal suicide attempt.
Suicide is a major public health problem. The need for a public health approach to suicide can be found in the African-American community, where the suicide rate among youths more than doubled between 1980 and 1995. Further, the number of suicides in the United States outnumbered homicides in 1995. Each year, firearms are used as many times for suicide as they are for murder. In some other countries, 71 percent of all firearm deaths are suicide.
Attempted and completed suicides result in enormous social, economic, and medical costs. Suicide is very disruptive to the quality of life of survivors and their families and friends. In 1995 it was estimated that in the United States each suicide attempt costs approximately $33,000. The cost of a completed suicide has been estimated at almost $400,000. These estimates were derived from factors including the expense of hospitalization, medication, and more general social costs.
Public health professionals have a major role to play in addressing the problem of suicide. Public health programs and policies can play a part before, during, and after completed or attempted suicides. First, public health programs are an important aspect of the prevention of suicide. Education campaigns can be used to increase knowledge and to change people's attitudes, beliefs, and values about suicide, and about people who may have attempted suicide. People may have distorted ideas about suicidal persons. For example, it is a myth that people who commit suicide never talk about it first. Most people provide important warning signs that can help to reduce the risk of suicide.
Health education can be combined with counseling or support programs. These programs can be provided by trained public health professionals or by peer counselors. For example, teenagers can be trained to provide counseling and support for other teens. Suicide awareness or prevention programs can be delivered in a variety of settings such as schools, churches, or in the community as a whole. They can also be delivered in psychiatric settings.
A second aspect of the prevention of suicide lies in judging or assessing a person's risk for suicide. Public health professionals such as nurses or doctors can help to prevent completed suicides by identifying people who may be thinking about or planning to try to commit suicide. They can also provide support through crisis or suicide-prevention counseling.
Public health can also play a valuable role during a suicide attempt. A suicide attempt is often a person's response to a crisis, or to a time when they feel overwhelmed or hopeless. Public health professionals can help during a suicide attempt through suicide-prevention counseling. This type of short-term counseling involves providing support and guidance to an individual who is suicidal. Its purpose is to decrease the person's emotional pain, to make sure that the person is safe, and to help develop a plan for coping. Sometimes suicide-prevention counseling includes connecting a person to community or health services. These services can then provide longer-term support.
Suicide prevention counseling is a valuable tool for public health. It is relatively low-cost, flexible, and simple to provide. A wide variety of health professionals, including doctors, nurses, psychologists, and social workers, can be taught to help people with suicide-prevention counseling techniques. These services can be provided in a wide variety of places or settings, including hospitals, community clinics, and telephone-based crisis centers or helplines. Suicide-prevention services provide an important link between the community and the formal health care system.
Public health professionals who work in suicide prevention and counseling are faced with a growing variety of issues and clients. Most communities are home to an increased number of people from a wide variety of cultural and ethnic backgrounds. There are also more older people in society. New issues that might trigger a suicide attempt include elder abuse, racism or discrimination, bullying, or gay bashing. Police officers, firemen, paramedics, and others are being trained to deliver on-the-spot suicide prevention counseling.
There is also a role for public health following a completed or attempted suicide. A suicide attempt or death can have a traumatic effect on the quality of life of survivors and their families and friends. Public health programs can provide important support services to survivors of a suicide attempt and their families.
Public health is only one important part of society's response to suicide as a health and social problem. There is also a role for law enforcement, the education system, the government, and the formal health care system in prevention, treatment, and follow-up to a suicide attempt.
Law enforcement (police officers) and public health professionals can cooperate to help suicidal persons. Police officers are often the first ones on the scene of a suicide attempt. They may act to prevent a suicidal person from hurting themselves (or someone else) through suicide prevention counseling. The may detain someone who is at high risk for suicide and refer him or her to appropriate public health resources.
Legislators can also help to address the challenges of suicide by creating policies or laws to support the development of public health programs and the training of public health professionals. They can also work to change society's attitude toward suicide and suicidal people. One example of this type of work is the fact that in many countries suicide is no longer illegal. Attempting suicide is seen as a mental health issue, not a crime. In 1999 the United States Public Health Service issued the first-ever Surgeon General's Report on Mental Health, as well as a Call to Action on Suicide Prevention, charting out this new approach to suicide.
The educational and health care systems also have a role to play in the prevention, treatment, and follow-up to a suicide attempt. Schools provide access to most young people and provide a place for delivering suicide prevention or awareness programs. They can also teach young people to recognize the warning signs of a potential suicide attempt in their friends, to provide peer counseling, and how to get immediate help and support. This is important because young people are at higher risk of attempting suicide than most adults.
The formal health care system (hospitals, clinics, doctor's offices) can play an important role in two main ways. First, people who are suicidal may come to an emergency room or a physician's office. In these cases, the health system serves as a "first-response" and crisis service. Second, once a person has been identified by a public health or law enforcement professional as suicidal, they may need to be hospitalized for a period of time. Health professionals can provide medications and further counseling or support to a suicidal person and their family.
Once a suicidal person is released from a hospital, public health professionals may make home visits or provide follow-up support through a community-based clinic. The prevention of suicide and the provision of support to people who are suicidal play an important and increasing role in the health of individuals, families, and communities. The most comprehensive national strategies on suicide have been developed by Finland, Norway, Australia, New Zealand, and Sweden.
C. JAMES FRANKISH
(SEE ALSO: Crisis Counseling; Gun Control; Hotlines, Helplines, Telephone Counseling; Mental Health; School Health; Social Work; Violence)
Carter, C., and Baume, P. (1999). "Suicide Prevention: A Public Health Approach." Australian and New Zealand Journal of Mental Health Nursing 8:450.
Harwitz, D., and Ravizza, L. (2000). "Suicide and Depression." Emergency Medical Clinics of North America 18:26371.
Lester, D. "Estimating the True Economic Cost of Suicide." Perceptual and Master Skills 80:746.
Office of the Surgeon General (1999). Mental Health: A Report of the Surgeon General. Washington, DC: U.S. Public Health Service.
Potter, L. B.; Powell, K. P.; and Kachur, S. P. (1995). "Suicide Prevention from a Public Health Respective." Suicide and Life Threatening Behavior 25:821.
U.S. Public Health Service (1999). The Surgeon General's Call to Action to Prevent Suicide. Washington, DC: U.S. Public Health Service.
Suicide (International Dictionary of Psychoanalysis)
Suicide is a symptomatic act connected most frequently to the framework of depression and melancholy. Its etiology is varied and complex, since it is characterized by the collapse of the ego, along with self-reproach and a diminution or a loss of self-esteemnd, at the same time, by a magic omnipotence which allows the annihilation of internal persecutors, as well as a manic feeling based on the denial of death itself. While suicide may appear to be a response to persecutory guilt, it is also a projection of this guilt onto objects as well as a liberation from their control through the death the subject has chosen for himself.
Suicide was discussed in the psychoanalytic literature as early as 1907, as recorded in the Minutes of the Vienna Psychoanalytic Society (Nunberg, Hermann, and Federn, Ernst, 1962-75), but it was a rather superficial discussion, centered on the fact that the differing choice of means by men and women reveals a primal sexual symbolism. From this came the formula that "suicide is the climax of negative autoeroticism" (Minutes, Vol. 1, February 13, 1907, p. 114). This should be understood in the context of the opposition between the ego instincts and sexual instincts in Freud's earliest theorization: "In suicide the life instinct is overwhelmed by the libido" (Vol. 2, April 20, 1910, p. 494).
In this approach, suicide, interpreted as a substitute for psychosis, seems linked both to an inability to tolerate reality and to autoerotic regression: "Suicide is an act of defense of the normal ego against psychosis" (June 6, 1907). Drive regression is equally central to Freud's ideas on the subject of the suicide of high school students; at school "Teachers. . . .must exercise a life-maintaining influence. [The function of] school is to give the child, in this stage of his detachment from his parents, a new footing within a larger relationship" (Vol. 2, April 20, 1910, p. 495). This should extend as far as not to "deny them the right to linger even in those phases of their development that seem vexing." There might well have been some evolution in Freud's thought here, especially if it is considered that, at the very beginning he insisted on the connection between neurasthenia, masturbation, and the risk of suicide. However, Freud also stressed that "in many cases it is the fear of incest itself that drives [children] to suicide" (p. 494), because of the enormous augmentation of their need for love at puberty; Freud went so far as to suggest, this being the case, that homosexuals make the best teachers, the worst being those whom the repression of their homosexuality has turned into sadists, pushing their students to suicide.
Later psychoanalytic thought on suicide followed the main ideas of Freud on the subject. First of all, in the depressive context, suicide was considered self-punishment for the desire to kill, primally directed toward another, as Freud himself stated in Totem and Taboo: "The law of talion, which is so deeply rooted in human feelings, lays it down that a murder can only be expiated by the sacrifice of another life: self-sacrifice points back to blood-guilt" (1912-13a, p. 154). Since then, the risk of self-mutilation or suicide with infantile or borderline personalities has been much emphasized (Kernberg, Otto, 1984); this risk is especially a factor during fits of rage following disappointments which are blamed on others; or else there is a risk of suicide because of failure to achieve success (guilt), or, even the failure of the cure (negative therapeutic reaction).
In fact, the idea that suicide is self-punishment for the desire to kill someone else cannot be understood completely apart from the process of melancholia, whereby the loved/hated object has been introjected within the ego and has become the target of the attack. More even than "self-punishment," suicide would be murder of the other within oneself. "Probably no one finds the mental energy required to kill himself unless, in the first place, in doing so he is at the same time killing an object with whom he has identified himself, and, in the second place, is turning against himself a death-wish which had been directed against someone else" (1920a, p. 162). Freud explained that "the ego is destroyed by the object."
The enigma constituted by suicide in relation to the self-preservative or ego instincts has also been approached in another way, through considering that it is accompanied paradoxically by a tentative intent to reappropriate vital energy, or, indeed, is even prompted by the fantasy of beginning a new life (Grinberg, León, 1983). Accordingly, suicide would result from a state of crisis dominated by the feeling that something must change. The person committing suicide "convokes death imaginally to assure himself paradoxically that life exists" (Triandafillidis, Alexandra, 1991). Ideal images of oneself and others can then survive, at the price of the death of the bad objects cluttering the ego.
The vital stakes involved in this symptomatic conduct have inclined authors not only to attempt to understand the suicidal mechanism, but also to describe its advance symptoms, evaluating the risk of suicide in order to decide on a therapeutic approach, especially in a care-giving institutional setting. León Grinberg (1983) emphasized suicidal premeditation and the fact that a suicidal plan follows the idea of suicide, which was at first only a way of dealing with anxiety. Continuing to the act of suicide depends on an "encounter," which might favor tipping the fantasy into reality. This author also examined factors of present or past vulnerability (feeling of culpability, narcissistic wound, loss of loved object, and so forth). Otto Kernberg (1984) emphasized the need for the therapist not to be fooled by an accentuation of the manic element; he stressed the seriousness of cases where "aggressiveness has infiltrated the grandiose Self," joined to an inability to enter into interpersonal relations and feel emotions. These considerations, however, concern psychotherapeutic strategies rather than the etiology of suicide.
SOPHIE DE MIJOLLA-MELLOR
See also: Bettelheim, Bruno: Bjerre, Poul; Great Britain; Morgenstern-Kabatschnik, Sophie: Rosenthal, Tatiana; Secret; Silberer, Herbert; Sokolnicka-Kutner, Eugénie; Stekel, Wilhelm; Tausk, Victor.
Freud, Sigmund. (1912-13a). Totem and taboo. SE, 13: 1-161.
Grinberg, León. (1983). Culpabilité et dépression. Paris: Les Belles Lettres.
Kernberg, Otto. (1984). Les trouble graves de la personnalité. Paris: Presses Universitaires de France.
Nuberg, Hermann, and Federn, Ernst. (1962-1975). Minutes of the Vienna Psychoanalytic Society. New York: International Universities Press.
Triandafillidis, Alexandra. (1991). La dépression et son inquiétante familiarité. Paris:itions Universitaires.
Laufer, M. (Ed.). (1995). The suicidal adolescent. Madison, CT: International Universities Press.