Sexual asphyxia: A neglected area of study

Sexual asphyxia, a solitary autoerotic activity practiced almost exclusively by males, is examined in this paper. The self‐induced asphyxia may be either chemical or mechanical, and its purpose it to heighten the sexual pleasure. The practice of sexual asphyxia can result in death; however, many such deaths may erroneously be viewed as suicides or homicides as a result of the lack of knowledge of the practice. Sixteen sexual asphyxiai deaths, reported in Dade County (Miami), Florida, are examined in detail. These data confirm that practitioners are overwhelmingly young, white, middle‐class, unmarried males. When the practice is fatal among older practitioners, the data show that some complicating factor, such as the use of alcohol or other drugs, may have contributed to the accident. The most frequent method of inducing the asphyxia was simple hanging by rope and in most cases there was no indication nor suspicion of suicidal intent     

Sexual Asphyxias

ABSTRACT: Some asphyxial deaths in young white males, usually by hanging, are accidents occurring during aberrant sexual activity. The physical aspects and limited psychological knowledge of these cases that distinguish them from suicidal deaths are discussed.     

The evolution of asphyxial defense

From the time animals became dependent upon molecular oxygen as an integral part of their energy-producing processes, they have remained in the shadow of acute asphyxial threat—the blocking of respiratory exchange resulting in the intracellular triad of hypoxia, hypercapnia and acidosis. The most commonly occurring precipitant of acute asphyxia has always been the transfer between air and water environments. Over the last one hundred years studies on a wide range of living organisms, from single cells to complex multicellular organisms like mammals, have demonstrated the presence of well-defined metabolic and cardiovascular-respiratory mechanisms for protecting living things against acute asphyxia. Single-celled animals depend upon anaerobiosis and secondarily hypometabolism. In addition to these processes, animals with gills or lungs utilize “passive” protection such as increased oxygen storage and the “dynamic” cardiovascular adjustments of bradycardia and selective ischemia. These latter changes decrease overall oxygen consumption and hence utilize the oxygen stores in the most economical way to protect the cardiac and cerebral tissue, which are most sensitive to hypoxia and vital to continued survival of the organism. In this article an attempt is made to place these processes into an evolutionary context. As through a glass darkly we glimpse asphyxial defense running like a paleophysiological thread through hundreds of millions of years, being accentuated here and muted there, depending upon the particular needs of individual species.     

Suicide surveillance in the U.S. Military--reporting and classification biases in rate calculations

The military has a well-defined population with suicide prevention programs that have been recognized as possible models for civilian suicide prevention efforts. Monitoring prevention programs requires accurate reporting. In civilian settings, several studies have confirmed problems in the reporting and classification of suicides. This analysis evaluated whether suicides were underreported or misclassified under accident or undetermined manner of death in the military system. We reviewed all 1998 and 1999 military deaths using official death reports and compared these data with additional sources, most importantly the DoD Medical Mortality Registry. We assessed for evidence of expressed suicidal intent and past psychiatric history among deaths classified as undetermined and accidents due to gunshot, overdose, drowning, falls, or asphyxia. Using sources other than official records, we found 17% more suicides than were reported, and an additional 4% of deaths that were suspicious for suicide. This study suggests that reporting and classification errors may account for 21% additional suicides in the military. These findings are comparable to rates seen in civilian studies and add to the literature regarding the problems inherent in using administrative death classification data for medical surveillance purposes.     

Brain and cognitive-behavioural development after asphyxia at term birth

Perinatal asphyxia occurs in approximately 1-6 per 1000 live full-term births. Different patterns of brain damage can result, though the relation of these patterns to long-term cognitive-behavioural outcome remains under investigation. The hippocampus is one brain region that can be damaged (typically not in isolation), and this site of damage has been implicated in two different long-term outcomes, cognitive memory impairment and the psychiatric disorder schizophrenia. Factors in addition to the acute episode of asphyxia likely contribute to these specific outcomes, making prediction difficult. Future studies that better document long-term cognitive-behavioural outcome, quantitatively identify patterns of brain injury over development and consider additional variables that may modulate the impact of asphyxia on cognitive and behavioural function will forward the goals of predicting long-term outcome and understanding the mechanisms by which it unfolds.     

Formal Defensive Aspects of Cognition and Modes of Thinking Exemplified by Freud's Case History of the Rat Man

Autoerotic gratifications are necessary for children suffering from a disturbed mother relation, and constitute symptoms of the same (jactatis capitis, extreme masturbation, etc.). The origins of the autoerotic functions go as far back as the foetal stage (thumbsucking). In the habits of so-called normal human beings, they also have an important stabilizing function to psychic autonomy. We are accompanied by primary and sublimated autoerotic functions all through our lives, which offer comfort and satisfaction during the different vicissitudes of life. Freud's monistic drive theory seems more plausible to me than his later dualistic theories. In accordance with the former, man can regress from object-libidinal cathexes into autoerotic positions when feeling psychically or physically threatened, and during normal conditions when asleep, sleep constituting a normal narcissistic state.     

厌恶情绪与自杀行为的关系

自杀导致人类死亡的人数与日俱增,然而自杀的心理机制却并不清楚。最近研究发现,厌恶情绪是导致自杀的主要情绪因素,个体因为自身厌恶而走向自杀。厌恶情绪是一种对自己和他人排泄物等反感的基本情绪,促进个体远离毒性和疾病,从而产生“免疫行为”。许多心理问题来自于对周围人或事物的厌恶,有自杀行为的个体对自身极其厌恶,说明他们的厌恶情绪出现了问题。如同躯体免疫攻击自身一样,自身厌恶是自杀意念的关键因素,早年创伤是其根源,生活压力和精神疾病也参与厌恶诱发自杀意念。厌恶诱发自杀意念的神经基础与HPA轴和五羟色胺系统有关。未来研究可利用神经影像和电生理等神经科学技术,检验自杀行为的神经机制,探讨厌恶情绪影响自杀行为的心理和神经机制。     

Incidence of near-death experiences following attempted suicide

Near-death experiences (NDEs), profound subjective experiences occurring during a close brush with death and containing transcendental or mystical elements, have been reported to reduce suicidal ideation, despite their "romanticization" of death. Among 61 consecutive hospital admissions for attempted suicide, 16 patients (26.2%) reported NDEs precipitated by the attempt. NDEs were not significantly associated with any demographic factors. In light of the frequency of NDEs following attempted suicide, further studies are indicated in regard to the effect of those experiences on subsequent suicidal behavior.     

Complicated grief and suicidal ideation in adult survivors of suicide

While the prevalence of complicated grief has been demonstrated to be elevated in survivors of suicide, the association between complicated grief and suicidal ideation among adult survivors of suicide has not been explored. The purpose of the present study is to examine the association between complicated grief and suicidal ideation in suicide survivors. The Inventory of Complicated Grief and the Beck Depression Inventory were administered to 60 adult survivors within 1 month of a death by suicide of a family member or significant other. Complicated grief was associated with a 9.68 (CI: 1.036, 90.417) times greater likelihood of suicidal ideation after controlling for depression, suggesting that syndromal complicated grief heightens vulnerability to suicidal ideation. Clinicians may provide more comprehensive assessments by recognizing the possibility of suicidal ideation in those with complicated grief.     

The false consensus bias as applied to psychologically disturbed adolescents

In order to examine whether the false consensus bias applied to psychologically disturbed adolescents, outpatients at a rural mental health center who described themselves as very depressed or suicidal, and nondisturbed teenagers (who had no history of psychological treatment and were not at that time seeking psychological treatment), were asked to read a newspaper article about either a child's suicidal or viral illness death. Both groups of adolescents, like adults in previous research, viewed the suicidal child and the surviving family more negatively than they did the child and survivors of a viral illness death. Further, consistent with the false consensus hypothesis, adolescent clients viewed either child as more psychologically disturbed than did nonclients. Also, clients, as compared to nonclients, viewed both parents as more psychologically disturbed prior to either child's death. Results somewhat support the hypothesis of a false consensus bias which operates for depressed, suicidal adolescents when they view the tragedy of a child's death, but not when they are making recommendations about psychological help for the surviving family. Results are interpreted as suggesting that adolescent outpatients either view therapy as not particularly beneficial or as not particularly appropriate for bereaved individuals.     

Suicidal Intent/Life Satisfaction: Comparing the Life Stories of Older Women

The purpose of this paper is to examine the Maris hypothesis that some people have relevant biographies and life histories that predispose suicidal careers. Using a life history approach, this paper reports differing themes in the lives of two groups of older women recently relocated to a nursing home—those who are satisfied with their lives and those who are not. Twelve women were selected from a sample of 256 by their scores on a life satisfaction index or suicidal intent scale. Seventy-two hours of transcribed life histories were content-analyzed for dominant themes that contributed to either life satisfaction or suicidal intent. Strong overall themes emerged for both groups under the headings of childhood, families, role models, connectedness, confidantes, life involvement, death experience, and memories. However, the most important correlates to contribute to a suicidal career for ideators were dysfunctional families of origin, poor role models, a feeling of isolation, and a pessimistic outlook.     

The wish to die and the wish to commit suicide in the adolescent: two different matters?

We shall try to demonstrate the difference between two wishes--the wish to die and the wish to commit suicide--as they express themselves during adolescence. First, death is seen as irreversible, while the suicidal act, at least during adolescence, is seen as reversible. While thoughts of suicide may be a part of normal adolescence, and the suicidal act a manifestation of pathological development specific to this stage in life, the wish to die has no age restrictions and may accompany life as a shadow, devoid of any suicidal act, for many years. It should be noted that both of these wishes may be balanced with the wish to live. Pathology appears when there is an imbalance of wishes and abnormal developmental processes. This imbalance can result in two distinct activities: suicidal acts and death behaviors. We suggest that the two stem from different mechanisms and personality pathologies. Therefore, they should be evaluated separately in order to better understand differences between suicidal and other aggressive acts and manifestations of the death wish during adolescence.     

University Students' Perceived Self‐Efficacy in Identifying Suicidal Warning Signs and Helping Suicidal Friends Find Campus Intervention Resources

Currently, suicide is the third leading cause of death among youth 18 to 24 years of age and the second leading cause of death on college campuses. A sample of students (N = 1,019) from three midwestern universities were surveyed regarding their perceived self‐efficacy in identifying suicide warning signs and campus suicide intervention resources. The results indicated that 11% strongly believed they could recognize a friend at suicidal risk, while 17% strongly believed they could ask a friend if he or she was suicidal. Students who had received high school suicide prevention education and who had ever had a family member or friend express suicidal thoughts to them were those most confident in recognizing a friend at risk, asking a friend if he/she is suicidal, and helping a friend to see a counselor. Most (71%) were not aware of on‐campus help resources. These findings underscore the importance of suicide prevention education throughout the high school and college years.     

The Addict as Savior: Heroin,Death, and the Family

The high mortality rate among drug addicts is seen as a suicidal phenomenon with a family basis. The death wish, or instruction for the addict to die, is often quite clearly expressed by the family. He is placed in the role of savior and martyr. His death is seen as a noble, cleansing sacrifice in which he is often a willing participant.     

A suicidal adolescent's sleeping beauty syndrome: cessation orientations toward dying, sleep, and drugs

In a study of hospitalized suicidal youth, the account of a sixteen-year-old girl, diagnosed as schizophrenic, is analyzed to gain insight into a family's role in the suicidal career of an adolescent preoccupied with death and dying, sleep, and drugs; the interplay of her construction of reality with her risk-taking, self-injurious way of life; and her perceived problems of living and need for help. Her cessation orientations revealed a kind of Sleeping Beauty syndrome with fantasies on sleep, drugs, and death, including a death of the mind from overdosing. Such qualitative research on suicidal careers may increase our understanding of the at-risk adolescent population and assist in the development of a policy for identifying and meeting needs and following up on clues for prevention and early intervention.     

Relationship between annual household income and suicidal ideation: a cross-sectional study

Previous studies have shown that high income was associated with low risk of death by suicide; however, the extent to which household income reduces suicidal ideation remains unclear. We performed a survey to examine the relationship between annual household income and suicidal ideation and determine the level of annual household income at which suicidal ideation no longer decreased as income increased. In total, 94,131 members of Internet survey panels were recruited as participants by a major Japanese Internet survey company in 2016. The participants completed a self-administered questionnaire consisting of items pertaining to demographics, annual household income, and suicidal ideation. We performed logistic regression analysis with suicidal ideation as the dependent variable and income level as the independent variable. The results showed that odds ratios for suicidal ideation decreased as annual household incomes increased, with sex, age, educational level, marital status, and parenthood adjusted for; however, once annual household incomes exceeded 8 million JPY (approximately 77,700 USD), the risk of suicidal ideation no longer decreased. We conclude that suicidal ideation was negatively associated with annual household income and 8 million JPY (approximately 77,700 USD) is a threshold beyond which further increases in income no longer reduce individuals’ suicidal ideation.     

Suicide survivors: psychotherapeutic implications of egocide.

Interviews with seven of ten known survivors of jumps from the Golden Gate Bridge and San Francisco-Oakland Bay Bridge revealed that all of them experienced transcendence and spiritual rebirth phenomena. The psychotherapeutic implications of these findings lie in helping depressed and suicidal individuals confront death in a symbolic and meaningful way. The issue is one of "egocide" (symbolic suicide) and aiding individuals in the rebirth process. In this way actual suicides can be prevented. When individuals experience partial "deaths" (like loss, failure, rejection, depression, suicidal states, or negative parts of their egos), there is opportunity for "rebirth" (positive transformation, creative change, growth, and significant spiritual reawakening). The therapeutic task is to help individuals differentiate between "ego death" and total death and to discover through the creative process of psychotherapy that overt suicide need not be a solution.     

Threats of suicide

For patients in treatment, how do suicidal feelings emerge, how do we judge the seriousness of suicide threats and what do we do? The literature on suicidal thinking, suicidal threats and suicidal acts is reviewed as well as some of the accumulated statistics for adults, adolescents and children. Some treatment principles and countertransference reactions are presented. The values of the therapist and the therapist's feelings toward death are seen as coloring the therapist's reaction to suicidal patients.