The psychotherapist's duty to act reasonably to prevent suicide: A proposal to allow rational suicide

It is proposed that society should re-examine its assumptions about suicide. Rational suicide is viewed as an extension of the right to die. After a review of the legal liability of the psychotherapist and psychiatric facility for both inpatient and outpatient suicide, the author presents an analysis of philosophical, ethical, and psychoanalytic arguments for allowing rational suicide. It is argued that emotional pain should be given more legitimacy as a reason for suicide. The decision to live or to die is argued to best rest with the individual.     

Laying down one's life for oneself.

Roman Catholicism has long opposed suicide. Although Scripture neither condones nor condemns suicide explicitly, cases in the Bible that are purported to be suicides fall into several different categories, and the Roman Catholic tradition can show why some of these should be considered morally wrong and some should not. While Christian martyrdom is praised, it is not correct to argue that this Christian outlook invites suicide, or that it recommends physician-assisted suicide for altruistic motives. Church Tradition, from its earliest days, has clearly distinguished martyrdom from suicide. The principles of double effect and cooperation, mainstays in Roman Catholic moral theology, enable one to see the moral difference between martyrdom and suicide, and to appreciate why physician-assisted suicide is wrong for both patient and physician.     

自杀“守门人”培训研究述评

在西方国家,自杀“守门人”培训被认为是最有效的自杀预防策略之一.自杀“守门人”培训的具体内容包括传授基础知识、识别自杀征兆、初步评估自杀风险和转介自杀高危个体等4个方面;研究发现自杀“守门人”培训对受训者的知识、态度和干预技能有显著的积极影响,但其对自杀率的影响仍需今后的研究详细探讨;目前的研究存在以下不足:1)随机对照研究少;2)难以评估培训对自杀率的真实影响;3)评价指标单一,缺乏统一的评估工具.未来的研究应弥补现有研究的不足,并重视自杀“守门人”培训的跨文化研究.     

The relationship between violence and youth suicide indicators among Asian American and Pacific Islander youth

The literature documents a relationship between interpersonal violence and suicide. One tool used to understand interpersonal violence is the Power Wheel, developed from clinical experience and originally used in domestic violence education. We examine the relationship between Teen Power and Control Wheel domains and suicidal indicators (seriously considered suicide, made a suicide plan, and attempted suicide) among Asian American and Pacific Islander high school students, in terms of both victimization and perpetration. Data from a 2007 survey of two multi-ethnic high schools on the island of O'ahu, Hawai'i were used. The survey assessed interpersonal youth violence and a multitude of risk and protective factors. It found that females were significantly more likely to seriously consider suicide and attempt suicide, compared to males. There were no statistically significant differences in seriously considering suicide, making a suicide plan, and attempting suicide by ethnic group, employment status, or hours worked per week. Using the Wheel, we found that all dimensions for victimization and perpetration were associated with the three suicidal indicators. However, the magnitude of this association was dramatically higher for victims than for perpetrators. School- and healthcare-based prevention strategies should ensure that both suicide and violence intervention components are addressed. Professionals who work with youth should be trained to feel comfortable, confident, and competent in discussing suicide and violence, and be willing and capable to assess and intervene.     

Grief experiences and expectance of suicide

Suicide is generally viewed as an unexpected cause of death. However, some suicides might be expected to a certain extent, which needs to be further studied. The relationships between expecting suicide, feeling understanding for the suicide, and later grief experiences were explored. In total, 142 bereaved participants completed the Grief Experience Questionnaire and additional measurements on expectance and understanding. Results supported the prediction of a link between expecting suicide and understanding the suicide. Higher expectance and understanding were related to less searching for explanation and preoccupation with the suicide. There was no direct association with other grief experiences. We conclude that more attention should be brought to the relation between expecting the suicide of a loved one and later grief responses in research and in clinical practice.     

Religious Commitment,Attitudes Toward Suicide,and Suicidal Behaviors Among College Students of Different Ethnic and Religious Groups in Malaysia

The variation in suicide patterns across ethnic groups with different religious background is a puzzling social phenomenon. This study sought to examine the impact of religious commitment and attitudes toward suicide on suicidal behaviors of college students across major ethnic and religious groups in a multicultural society of Malaysia. A total of 139 college students completed Religious Commitment Inventory-10, Attitudes Toward Suicide Scale, and Suicidal Behavior Questionnaire-Revised. Findings showed significant discrepancies in attitudes toward suicide, but not suicidal behaviors across ethnic and religious groups. Suicide acceptance significantly affected suicidal behaviors as well. Although religious commitment is not associated with suicidal behaviors, its deviation is reflected in students’ acceptance of suicide. Additionally, college students’ suicide risk, lifetime, and recent suicide ideation, as well as their likelihood of future suicide attempt can be associated with their acceptance of suicide. The influence of attitudes toward suicide and religion, therefore, should be taken into consideration while implementing suicide prevention programs as it helps shape the norms about suicide among youths.     

Suicide Terrorists: Are They Suicidal?

Are suicide terrorists suicidal? A review of the worldwide literature on suicide terrorism uncovered five published empirical studies describing data collected from potential suicide terrorists or the surviving friends and families of deceased terrorists. The many discrepancies uncovered between suicide terrorists and other suicides on key factors known to underpin suicidality, suggest that such terrorists are not truly suicidal and should not be viewed as a subgroup of the general suicide population. Nonetheless, methods developed by suicidologists, such as the psychological autopsy, will help increase our understanding of the individual and group factors that underpin suicide terrorism.     

Cybersuicide: review of the role of the internet on suicide.

The internet as a widespread source of communication is already having a significant influence in medicine and psychiatry. Although the internet has great potential in psychiatric education, clinical care, and research, its impact on social issues should not be underestimated. Firstly, the internet as a means of communication may encourage suicidal behavior by depicting ways by which suicide may be committed. Secondly, some internet websites may discourage people with mental illness from seeking psychiatric help, condone suicide, and forbid entry to anyone offering to discourage users from committing suicide. However, the internet could be a resource to help a potentially suicidal person get help, and can be used to identify those at risk for suicide, communicate with them, and potentially prevent suicide. If used appropriately, the internet is a powerful communication tool that can be used to benefit suicidal patients.     

Suicide Prevention from a Public Health Perspective

The public health approach to health problems provides a strong framework and rationale for developing and implementing suicide prevention programs. This approach consists of health-event surveillance to describe the problem, epidemiologic analysis to identify risk factors, the design and evaluation of interventions, and the implementation of prevention programs. The application of each of these components to suicide prevention is reviewed. Suggestions for improving surveillance include encouraging the use of appropriate coding, reviewing suicide statistics at the local level, collecting more etiologically useful information, and placing greater emphasis on analysis of morbidity data. For epidemiologic analysis, greater use could be made of observational studies, and uniform definitions and measures should be developed and adopted. Efforts to develop interventions must include evaluating both the process and the outcome. Finally, community suicide prevention programs should include more than one strategy and, where appropriate, should be strongly linked with the community's mental health resources. With adequate planning, coordination, and resources, and the public health approach can help reduce the emotional and economic costs imposed on society by suicide and suicidal behavior.     

Rethinking impulsivity in suicide

Elevated impulsivity is thought to facilitate the transition from suicidal thoughts to suicidal behavior. Therefore, impulsivity should distinguish those who have attempted suicide (attempters) from those who have only considered suicide (ideators-only). This hypothesis was examined in three large nonclinical samples: (1) 2,011 military recruits, (2) 1,296 college students, and (3) 399 high school students. In sample 1, contrary to traditional models of suicide risk, a unidimensional measure of impulsivity failed to distinguish attempters from ideators-only. In samples 2 and 3, which were administered a multidimensional measure of impulsivity (i.e., the UPPS impulsive behavior scale; Whiteside & Lynam, 2001), different impulsivity-related traits characterized attempters and ideators-only. Whereas both attempters and ideators-only exhibited high urgency (the tendency to act impulsive in the face of negative emotions), only attempters exhibited poor premeditation (a diminished ability to think through the consequences of one's actions). Neither attempters nor ideators-only exhibited high sensation seeking or lack of perseverance. Future research should continue to distinguish impulsivity-related traits that predict suicide ideation from those that predict suicide attempts, and models of suicide risk should be revised accordingly.     

Rational suicide?

Abstract

Two competing paradigms of suicide imply different views of whether suicide can be rational. The first, the “received orthodoxy” of mental health professionals for more than a century, views all suicides as irrational and holds that suicidal persons should always be prevented from ending their own lives. The second grants that most suicides are irrational, but claims suicide may sometimes be a rational option. Lokhandwala and Westefeld's argument manifests the conflict between these two paradigms: After initially granting that suicide may be a rational option for some people, they in effect urge mental health professionals to presume in practice that any suicidal patient is irrational. Patients for whom suicide might indeed be rational will be ill-served by mental health professionals who follow Lokhandwala and Westefeld's advice.     

Female suicide and wife abuse: a cross-cultural perspective

Data from a number of societies, including North America, indicate that wife abuse may be one of the most significant precipitants of female suicide. Anthropological analysis indicates that in some societies female suicide is a culturally recognized behavior that enables the weak to influence the strong and/or take revenge on those who oppress them. Case studies from West New Britain Province in Papua New Guinea and comparisons with data from other societies suggest that if a woman's support group does not defend her when she is the victim of violence that passes the bounds of normative behavior, her suicide may be revenge suicide, intended to force others to take vengeance on the abusive husband. Research focused on the relationship between domestic violence and female suicide should be a priority of anthropologists as well as suicidologists.     

Shattered Dreams of Professional Competence

Abstract

This article reviews the frequency of suicide, compares and contrasts suicide prediction to suicide assessment and provides a succinct overview of suicide high risk factors that mental health practitioners should be aware. Finally, the article describes common symptoms experienced by mental health practitioners who survive their clients' suicides, and presents a Pre-suicide Preparation Plan that mental health practitioners can implement prior to a crisis to hopefully enable them for a less demanding post-suicide experience.     

Inpatient suicide in a Chinese psychiatric hospital

Little is known about the risk factors for suicide among psychiatric inpatients in China. In this study we identified the risk factors of suicide among psychiatric inpatients at Guangzhou Psychiatric Hospital. All psychiatric inpatients who died by suicide during the 1956-2005 period were included in this study. Using a case-control design, 64 inpatients with schizophrenia who died by suicide were compared with a matched 64 controls. The results indicate that the rate of suicide was 133.1/100,000 admissions (95%CI 103.4-162.9). There were no significant differences in the method, location, or time of suicide between male and female inpatients. The number of hospitalizations was significantly larger in the suicide group than that in the control group. In logistic regression analyses, guilty thought, depressive mood, and suicidal ideation and suicide attempt 1 month before hospital admission were identified as independent predictors of suicide among inpatients with schizophrenia. The findings of risk factors for schizophrenic inpatient suicide should be taken into account when developing interventions to prevent suicide among these patients.     

Turkish Imams’ Experience with and Their Attitudes Toward Suicide and Suicidal Persons

This study investigated the experience with and attitudes toward suicide and suicidality in 70 consenting imams serving in mosques in the province of Aydin which is located at the southwest part of Turkey. A self-report questionnaire was used to collect the data. Attitudes of imams to suicide and suicidality were compared with attitudes of male university students. Only 4 imams (5.7 %) reported having had suicidal thoughts in past, and none reported having attempted suicide. Almost 50 % said that someone in communities they serve has commited suicide and nearly 40 % reported leading funeral ceremony for someone who committed suicide. Majority of imams (64.3 %) were of the opinion that a funeral ceremony should be arranged for people who suicide and 87.1 % were of the opinion that people who suicide can be buried in a common cemetery, but only 21.4 % said that someone who attempted suicide can be appointed as imam. Compared to male medical students, imams saw suicide as an unacceptable option and those engaging in suicidal behavior to be punished after death. But they displayed socially accepting and helping reactions to an imagined close friend who attempted suicide. Therefore, it was concluded that imams might exhibit preventive reactions to suicide when they offer counseling for persons from their congregations during times of suicidal crises.     

On precipitating factors: cancer as a cause of suicide

This case-control study provides individual-based data describing the impact of being a cancer patient on the odds of suicide. 5,009 suicides and 17,064 controls are compared. The data indicate that cancer patients are 50 to 100 percent more likely than nonpatients to commit suicide. This and other studies indicate that health status should be considered in future attempts to relate suicide to social environment.     

Subthreshold bipolar traits and suicide risk among undergraduates

Data from a sample of 500 undergraduate students showed that depression scores were more strongly correlated with suicide risk than were mania scores, uggesting that such traits should be routinely screened to evaluate suicide risk.     

Association Between Suicidal Ideation and Exposure to Suicide in Social Relationships Among Family,Friend, and Acquaintance Survivors in South Korea

Exposure to suicide in social relationships may be associated with suicidal ideation among survivors. In South Korea, which is known for having the highest suicide rate among OECD countries, exposure to suicide in social relationships can have serious consequences as social relationships are greatly emphasized in the society. The purpose of this study was to examine the association between survivors' suicidal ideation and their exposure to suicide in close relationships. Data collected through a telephone survey of a total of 1,000 men and women selected from across the nation using a stratified sampling method were analyzed. The results show that individuals who lost a family member, friend, or acquaintance in their lifetime are 4.5 times, 3.7 times, 2.2 times, respectively, more likely to have suicidal ideation in the past year compared to those without such experience. These findings suggest that special intervention for suicide survivors should be considered for those who experience suicide in close relationships.     

Bringing the Public Health Approach to the Problem of Suicide

Suicide and suicidal behavior are public health problems that should be addressed through a systematic public health approach. The need for such an approach can be found, for example, in Pierre, SD, where the suicide rate is 13 times the national rate; in the African American community, where the suicide rate among Black youths more than doubled between 1980 and 1995; and across the United States, where suicides outnumbered homicides in 1995. The U.S. Public Health Service is applying the public health approach to suicide by preparing the first-ever Surgeon General's Report on Mental Health, and by holding an October conference in Reno aimed at advancing a national strategy for suicide prevention.