Rational Suicide: An Impoverished Self-Transformation

ABSTRACT: The normal human condition is such that even with the best that life can offer suicide is understandable. Life is short, often painful, unpredictable, and lonely. In addition the lives of some individuals are in effect “suicidal careers” in that the harshness of normal life is combined for them with extra suicidal catalysts. Suicide makes sense. Minimally suicide resolves the life problem for the suicide. At the same time suicide is an impoverished self-transformation. Life, as trying and despairing as it can be, is still all we have. The suicide resolves the life problem by obliterating life itself, rather than by transforming self, history, and society. The suicide gives his or her life back inappropriately. In this sense no suicide is ever rational.     

A Community of Psychotherapists

Services for chronic mental patients in this era of deinstitutionalization present a major challenge to clinicians and planners alike. The complexity of these patients' clinical and other programmatic needs requires that an array of viable comprehensive services be made available to them. Following certain established principles of service planning will help facilitate patients' longitudinal, psychological, financial, and geographical access to care.     

How Psychotherapists Address Hypothetical Multiple Relationships Dilemmas with Asian American Clients: A National Survey

This study examined how psychotherapists address hypothetical nonsexual multiple relationships dilemmas with Asian American clients and identified predictors of conservative decisions and the use of culture-based rationales. This survey of 787 Asian American and non-Asian American psychotherapists revealed that clinicians rely on mostly their personal policies and seldom focus on the clients' cultural backgrounds. Psychotherapists who consider their clients' Asian culture have more cultural knowledge and awareness, have been mental health providers longer, and are Asian American and female. Clinicians who avoid multiple relationships tend to cite formal policies as justification and are less likely to consider clients' cultural worldviews, the therapeutic relationship, or their own values. The results are discussed in terms of specific revisions needed in the American Psychological Association Ethics Code, the benefits of more frequent consultation with colleagues and supervisors about ethical dilemmas, and recommendations for psychotherapists.     

当代中国心理咨询和治疗师的知情同意与保密状况研究

本研究采用问卷调查法,以自编"心理咨询和治疗伦理问题调查问卷(咨询师版)"对全国范围内1 000名心理咨询和治疗师进行调查,以了解心理咨询和治疗师的知情同意和保密情况.结果发现目前国内的心理咨询和治疗从业者知情同意和保密原则的伦理意识和行为比较欠缺.需要增加专业的训练、进行统一伦理规范.     

Toward Empirically Based Standards for Abuser Intervention

Summary

This article describes the development of operational guidelines for Abuser Intervention Programs in Maryland. Unlike in many states which have adopted quite specific standards regarding program format, duration, etc., the Maryland guidelines address a fairly narrow range of issues. These include outreach to victims, communication with the courts, and the need for intervention programs to address domestic abuse directly in their program content. Maryland has also established a research task force on Abuser Intervention Programs, whose goal is to use empirical data to inform the use of best practices in the state, to facilitate empirical research at abuser intervention programs in Maryland, and to develop more detailed program standards in the future.     

The River Model: A Metaphor and Tool for Training New Psychotherapists

A conceptual frame of reference called The River is presented for training of beginning psychotherapists. Using metaphors, trainees are taught specific tools (Equipment) and to identify salient features of the therapy process (Topography) by means of a series of metaphors for the process elements of timing and of level of intervention. Student therapist feedback indicated that this model facilitated learning of how much or little to do at given points in the therapeutic process, and that these metaphors appeared to transcend specific theoretical orientations.     

Bereavement after a Physician-Assisted Suicide: A Speculation Based on Theory

Despite the recent Supreme Court ruling upholding the ban on physician-assisted suicide, the practice continues in the United States. A majority of Americans support physician-assisted suicide, and several surveys document its use by physicians and nurses. This article explores the anticipated bereavement experience of significant survivors following a physician-assisted suicide. Theoretical approaches to bereavement frame the discussion of possible reactions to suicidal death: (1) psychodynamic, (2) attachment theory, (3) crisis theory, and (4) cognitive theory. Three case scenarios illustrate potential survivor reactions, with suggested intervention approaches.     

Empirically Informed Moral Theory: A Sketch of the Landscape

This introduction to the special issue on empirically informed moral theory sketches the more important contributions to the field in the past several years. Attention is paid to experimental philosophy, the work of philosophers like Harman and Doris, and that of psychologists like Haidt and Hauser.     

Suicide: A Multidimensional Malaise

No one really knows why human beings commit suicide. The goal of this paper is to provide a psychological point of view on the topic, among the many other perspectives that are needed. It addresses the question by providing a theory of suicide, arguing that it is theory that allows us to sort out the booming buzzing mess of experience (Wm. James). Suicide is a multidimensional malaise. Metaphorically speaking, it is an intrapsychic drama on an interpersonal stage. As sound theory must be empirically observable, the theory is next applied to research of suicide notes, studying such factors as age, sex, and method of suicide, cross-culture and cross-time. Next, because all theory must have clinical applicability, a clinical case study of Goethe's Werther is provided. Overall, it is concluded that we need to continue to develop models to understand the suicidal mind.     

Youth Suicide Prevention: A Survey and Analysis of Policies and Efforts in the 50 States

State-level initiatives directed at youth suicide prevention since 1980 were analyzed. During 1992 and 1996, each governor was surveyed regarding his or her state's efforts in youth suicide prevention. Questions pertained to legislation, a mandated or recommended school-based suicide prevention curriculum, funding, a special advisory council, a state plan, the development and dissemination of materials, and assessment. Several states sent examples of their prevention activities, which were reviewed to determine the extent to which they represent conceptually and/or empirically grounded preventive intervention strategies. The number of suicides, suicide rates, and percentage change in rate for youth 15–19 years old were reported by state for the periods 1979–1981 and 1992–1994. The results of a repeated measures 2 × 5 ANOVA revealed that while changes in suicide rates over time were statistically significant, there was no relation between these changes and any of the variables studied. Suggestions for future research on state-level initiatives are presented.     

Criteria for psychiatric hospitalization: A checklist approach

The decision to hospitalize a psychiatric patient is often a source of controversy. This fact is reflected in the Connecticut Mental Health Center’s program of quality assessment. The center conducts individual, retrospective chart review using a 32-page checklist of normative criteria. The primary purpose of this portion of the chart review system is to highlight those cases in which a patient may have been hospitalized unnecessarily. We present and analyze the cumulative data from 300 cases for which the criteria-for-hospitalization scale was completed. We conclude that the scale is an efficient instrument and is convenient for justifying hospitalization. We suggest minor revisions in the scale and speculate upon its as-yet-untapped research potential.     

Suicide and occupation: A review

This paper examines the available literature dealing with the relation of occupation to suicide for three occupational categories: health care providers, managerial and professional persons, and military and paramilitary personnel. Following a general introduction, evidence relating to group differences in suicidal behavior is presented and assessed. Sources of bias and inaccuracy in suicide statistics are identified and theories purporting to explain variations in the incidence of suicide are considered. Finally, implications are drawn from the analysis presented and possible directions for future research are identified.     

A Survey of Telephone Answering Services in Suicide Prevention and Crisis Intervention Agencies*

ABSTRACT: The telephone service established by directors of suicide prevention and crisis intervention services is generally given little careful consideration. Many agencies take their telephone systems for granted, assuming that almost any system will function adequately if an operator is available and a crisis worker is on call. There are a number of important issues at stake that should be carefully considered before a program is established that uses any system other than full-time coverage by the trained crisis worker at a permanent location. In order to investigate just what really happens under the various systems in use, a series of 76 calls was placed to 19 different emergency crisis services in the southeastern United States. Times were recorded to show how much time elapsed, through what various systems, to get an actual crisis worker on the line. There were marked differences across the eight different systems identified. The results clearly indicate that crisis services are in danger of unknowingly providing inferior and dangerously low quality service unless they maintain maximum control over their own telephone answering system 24 hours a day.     

A Comparison of Rubrics for Identifying Empirically Supported Practices with Single-Case Research

The use of single-case research methods for validating academic and behavioral interventions has gained considerable attention in recent years. As such, there has been a proliferation of methods for evaluating whether, and to what extent, primary research reports provide evidence of intervention effectiveness. Despite the recent interest in harnessing single-case research to identify empirically supported strategies, examination of these tools has revealed that there is a lack of consistency in the methodological criteria sampled and scoring procedures used to evaluate primary research reports. The present study examined the extent to which various evidence rubrics addressed specific methodological features of single-case research and classified studies into similar evidence categories. Results indicated that the methodological criteria included within rubrics tended to vary, particularly for criteria related to determining the generality of the intervention under study. Moreover, there was substantial discordance observed in the evidence classifications assigned to reviewed studies. These findings are discussed in the context of the still-developing nature of single-case evidence reviews. Recommendations for both research and practice are provided.     

A Bibliographic Survey of the Activities and International Nature of Multiple Criteria Decision Making

One of the fascinating things about multiple criteria decision making (MCDM) is the degree to which the contributions that have built the field have come from all over the world. In this paper the international nature of the authorships of the 1216 refereed journal articles published on MCDM between 1987 and 1992, and the journals in which they have appeared, is examined. Also, an analysis of the 217 books and 31 journal special issues that have been published on MCDM, and 143 conferences that have been held on MCDM since the inception of the field, is similarly conducted. The paper concludes with a conference organizer, author and special issue guest editor index.     

8 African-American Suicide: A Cultural Paradox

African-American suicide rates have traditionally been lower than White rates despite a legacy of racial discrimination, persistent poverty, social isolation, and lack of community resources. This paper focuses on four issues: (1) patterns and trends of Black suicide across the lifespan; (2) risk and protective factors in subgroups of Blacks; (3) the influence of cultural factors on suicide patterns of Blacks; and (4) implications of these patterns for prevention and early intervention of suicidal behavior among African Americans. Risk factors for Black suicide include: male sex, early adulthood, substance abuse, psychiatric disorders, family or interpersonal conflict, antisocial behavior, and homosexuality. Protective factors that mitigate the risks of suicide include religiosity, older age, southern residence, and social support. Implications for preventive policies and programs are discussed to counter the recent trend of rising suicide rates among adolescents and very elderly Blacks.     

Physician-Assisted Suicide: A Mental Health Perspective

Despite their wealth of relevant clinical and research experience, mental health professionals have contributed relatively little to the active and ongoing debate about physicians assisting in the suicide of their patients. Methodologies developed for the study of completed suicide, the knowledge they have revealed, and the complex questions that remain unanswered, all must be considered. Similarly, psychiatry's extensive contributions to our understanding of the doctor-patient relationship, fundamental to the practice of psychodynamically informed treatments, have been almost completely ignored. Mental health care providers have much to contribute to, and should become actively involved in, this important public health and policy debate.     

Cognition and Suicide: A Methodological Review

This article reviews the literature related to studies measuring various cognitive properties in suicidal patients. It provides a structural framework with which to classify the studies, and employs the categories of suicidal logic, cognitive style, social cognition, and cognitive control. The methodological issues discussed include: sample characteristics, operational definitions of suicidal behaviors, use of appropriate control groups, and the temporal nature of assessment. Improvements in experimental design are suggested for use in future research.