Rational suicide among the elderly.

Old age, in and of itself, should never need to be a cause for self-destruction. But suicide and assisted suicide carried out in the face of terminal illness causing unbearable suffering should be ethically and legally acceptable. This paper outlines a perspective on rational suicide--the final exit--among the elderly.     

Rational suicide and the crisis of terminal illness

Abstract

One of the controversial issues facing counselors in the 1990s is whether or not suicide may be considered a rational choice for clients with terminal illness. This article begins by reviewing the definition of rational suicide and the literature and statistics pertaining to suicide and terminal illness. Then various issues related to rational suicide as a treatment option are addressed, including moral and ethical issues.     

Happiness in the Garden of Epicurus

Epicurus was a philosopher who lived in Greece in the 3rd century B.C. Like his contemporaries, he was much concerned with the question of how to live a good life. In his view the Chief Good is to decrease pain and increase pleasure. Though Epicurus is reputed for advocating the pursuit of refined sensorial pleasures, he recognized the need for deferring gratification or enduring pain. He advised his followers to lead a modest and contemplative life in friendly communities. His advice can be characterized as ‘serene hedonism’. This paper explains that position and considers its applicability for the present day. It concludes that Epicureanism was quite accurate in describing the conditions of happiness and that he offered valuable guidelines in dealing with hardship and difficult emotional content. His ideas that happiness is the same as the absence of pain and that one should withdraw from society are less fortunate. It made him assume that happiness automatically follows if one is in the right state of mind, and that there is no need to actively seek interaction with the environment for the betterment of the circumstances of life. However, Epicurus’ advice might have been a good option for his contemporaries given the societal turmoil in his times.

Perceptions concerning college student suicide: data from four universities

The issue of suicide, including prevention, intervention, and postvention, continues to be a problem on college campuses. For this study, data concerning a variety of issues related to college student suicide were collected from 1,865 students at four different universities. Incidence, risk factors, and potential solutions are described, as well as implications for mental health professionals in university settings.     

Helpline: suicide prevention at a suicide site

In an effort to reduce the number of suicides from the Mid-Hutson Bridge in Poughkeepsie, New York, the Dutchess County Department of Mental Hygiene and the New York State Bridge Authority jointly established a suicide prevention phone on the bridge, which is directly connected to a 24-hour psychiatric emergency service. This program is the first known one in which a dedicated suicide prevention helpline has been installed at a site of known suicides and linked with a mental health service. After 2 years of operation, the phone has been used 30 times; the data suggest that most would-be jumpers are ambivalent enough about dying that they will reach out for help/contact if the opportunity exists, and, as a consequence, can be saved.     

Ancestry, genes, and suicide: a test of the Finno-Ugrian Suicide Hypothesis in the United States

There is now convergent evidence from classic quantitative genetics (family, twin, and adoption studies) and molecular genetic studies for specific genetic risk factors for suicidal behavior. This emerging research field has recently been supplemented by geographical studies concerned with the Finno-Ugrian Suicide Hypothesis (FUSH), which states that population differences in genetic risk factors may partially account for conspicuous geographical patterns seen in suicide prevalence. In particular, the European high-suicide-rate nations constitute a contiguous, J-shaped belt, spanning from Finland to Austria. This area maps onto the second principal component identified for European gene distribution, most likely reflecting a major migration event of the past (i.e., the ancestral adaptation to cold climates and the Uralic language dispersion) still detectable in modern European populations. The present research tested the hypothesis in the United States. Consistent with the hypothesis, available historical (1913-1924 and 1928-1932) U.S. state suicide rates were uniformly positively associated with available state proportions of reported American ancestries from European high-suicide-rate countries (Hungary, Lithuania, Poland, Russia, Slovakia, and the Ukraine). However, contrary to the hypothesis, available contemporary (1990-1994) suicide rates were uniformly negatively associated with these ancestry proportions. The findings of this first test outside Europe are therefore conflicting. A proposal based on the geographical study approach is offered to further the progress of investigations into the genetics of suicide.     

A test of the effectiveness of a list of suicide warning signs for the public

In this study we examined the effect that reading a list of warning signs for suicide has on beliefs about suicide, including the belief that one can recognize a suicidal crisis. All participants read two sets of warning signs (with only the experimental group reading the suicide warning signs) and then answered questions concerning beliefs related to three health problems. Results indicate that participants who read the suicide warning signs reported greater abilities to recognize if someone is suicidal but did not report stronger beliefs that suicidal individuals are partly to blame, nor did they report lower likelihoods of befriending suicidal individuals. Results suggest that reading the list of warning signs may be effective in increasing the public's ability to recognize suicidal crises without creating or magnifying stigmatizing beliefs about suicidal individuals.     

Sex-role change, anomie and female suicide: a test of alternative Durkheimian explanations.

Durkheim's influential book, Suicide, provides general (economic) anomie, conjugal anomie, and sex-role convergence explanations of changes in suicide rates under conditions of social change. We used trend analyses of American suicide rates and female/male suicide ratios from 1950 to 1984 and the regression of the ratios on female educational attainment, white female labor force participation, white fertility rates, and divorce rates to examine these explanations. The general anomie explanation of female suicide trends is supported for the middle-aged (30 to 54 years) but not for the young (10 to 30 years) or the elderly (55 to 74 years). The conjugal anomie proposition is at best supported for age groups between 15 and 44 when general anomie is not pronounced. The role convergence explanation is rejected for all 13 5-year-age-groups. General anomie may not be a viable explanation of suicide trends for groups actively supporting relevant social changes or not yet tradition-bound or for groups whose retirement status reduces the importance of some social changes.     

Psychache and suicide ideation among men who are homeless: a test of Shneidman's model

Suicide ideation among the homeless is 10 times more common than in the general population. Cognitive theories of depression and hopelessness propose to explain suicidality; however, as yet, none of these fully account for the phenomenon. Shneidman has suggested a theory of psychache or unbearable psychological pain to explain suicidality. This theory has found support among low-risk populations but has not been extensively tested within a high-risk population. The current research assessed the utility of psychache among men who are homeless (N = 97). In support of Shneidman's theory, analyses revealed that psychache was a stronger predictor of suicide ideation than was depression, hopelessness, or life meaning.     

Epicurus,Death, and the Wrongness of Killing

This article questions the assumption, held by several philosophers, that the Epicurean argument for death's being “nothing to us” must be fallacious since its acceptance would undermine the principle that killing is (in general) wrong. Two possible strategies are considered, which the Epicurean-sympathizer might deploy in order to show that the non-badness of death (for the person who dies) is compatible with killing's being wrong. One of these is unsuccessful; the other is more promising. It involves arguing that the wrongness of killing is a “basic moral certainty” and hence requires no underpinning by the judgement that death is bad. Problems for this proposal, and possible responses to those problems, are considered. Though the strategy is not decisive, it is deemed to be one that the Epicurean could plausibly adopt.     

Epicurus and B. F. Skinner: In search of the good life

This paper examines similarities in the works of Epicurus, an ancient Greek philosopher, and B. F. Skinner, a behavioral psychologist. They both were empiricists who argued in favor of the lawfulness of behavior while maintaining that random events were included within those laws. They both devoted much effort to describing how individuals could live effective, rewarding and pleasurable lives. They both emphasized simple and natural pleasures (or reinforcers) and the importance of combining personal pleasures with actions that benefit friends and community. They both opposed punishment and all aversive measures used by governments and religions to control behaviors. And both created utopias: a real community, The Garden, where Epicurus lived with his followers, and a fictional one, Walden Two, by Skinner. We consider how a combination of the ideas of Epicurus and Skinner can contribute to their common goal of helping people to live better lives.     

试论伊壁鸠鲁的精神疾患的认知疗法

伊壁鸠鲁创立的哲学在晚期希腊时期的影响甚至超过了斯多亚派,伊壁鸠鲁及其传人卢克莱修的唯物主义哲学其实是面对人类的肉体和精神疾病而进行的治疗活动,其基本原则在两千后演化为精神治疗术中应用广泛、声名著卓的认识疗法。依据伊壁鸠鲁残篇分析了这种古代精神治疗术的基本原理、实施方法及其在思想史上的重要意义。     

Perfectionistic self-presentation, socially prescribed perfectionism, and suicide in youth: a test of the perfectionism social disconnection model

The role of interpersonal components of perfectionism in suicide outcomes among youth was assessed and the Perfectionism Social Disconnection Model (PSDM) was tested by determining whether the links between socially prescribed perfectionism (SPP) and perfectionistic self-presentation (PSP) and suicide outcomes are mediated by experiences of social disconnection, as indicated by social hopelessness and being bullied. PSP, trait perfectionism, suicide outcomes, and experiences of being bullied and social hopelessness were measured in 152 psychiatric outpatient children and adolescents. Correlational tests confirmed that PSP and SPP were associated with suicide outcomes and these interpersonal perfectionism components were associated significantly with bullying and social hopelessness. Support was also obtained for the PSDM. The relationship between the PSP facets, particularly nondisplay of imperfections, and suicide outcomes were mediated by being bullied. Additionally, the relationship between all interpersonal components of perfectionism and suicide risk was mediated by social hopelessness. Theoretical and clinical implications of interpersonal components of perfectionism and social disconnection in suicide outcomes for youth are discussed.