A rational approach to rational suicide.

Suicide is a reaction to internal and external sources of stress and the impact of life events. In the elderly these situations are prevalent in many who are not suicidal and instead choose life. They represent what may be called rational nonsuicide. They are far more frequent than rational suicide. Nevertheless, considerably more is written about rational suicide than its alternative. The reasons for this phenomenon are reviewed, and suggestions are made for a rational approach to the affirmation of life rather than its rejection, even to the very end.     

Positive mental health,positive affect and suicide ideation

Background/ObjectivePositive mental health (PMH) has been shown to confer resilience against suicide ideation. However, the mechanisms underlying the positive effect of PMH on suicide ideation/behavior are largely unknown. The current study aimed to determine whether positive affect mediates the association between PMH and suicide ideation.MethodA total of 150 adult outpatients (65.3%; female; age: M(SD)=37.79(13.50), range:18–77) completed measures on PMH, positive and negative affect, as well as suicide ideation. Data were collected using self-report questionnaires. Linear hierarchical regression analysis was used to analyze the data. Positive affect was considered to mediate the association between positive mental health and suicide ideation.ResultsWhile positive affect fully mediated the significant negative association between PMH and suicide ideation, negative affect did not reveal to be a significant mediator of this relationship.ConclusionsThe protective influence of PMH against suicide ideation is due to heightened positive affect: If positive mental health translates into positive affect, then suicide ideation becomes less likely.     

An explication of rational suicide: Its definitions,implications, and complications

Abstract

Logical analysis of arguments in favor of “rational suicide” reveals eleven commonly encountered premises. Most of the premises are unclear on close scrutiny, and six are ethical propositions that although acceptable to some will not be acceptable to others. The “rational suicide” literature appears to be an effort to legitimize certain kinds of suicide, largely by appeal to a consensus of experts. This kind of argument is criticized on historical grounds; it has led to moral and social disasters in the past.     

Perspectives in suicidology: families, mental illness, and suicide

The ways in which the key words "family," "mental illness," and "suicide" are interpreted in the context of research into suicide will influence the formation of theories, the interpretation of results, and the development of suicide prevention strategies. It is argued that there is no general agreement about the meaning of these words.     

Mental capacity,mental effort,and cognitive style

This study tests the relationship between two theoretical models of human attentional capacity: Pascual-Leone's mental capacity and Kahneman's mental effort. It was found that significant and positive correlations exist between the empirical measures of the above constructs, and the relationship is demonstrated via construct validation by showing that the two constructs relate in the same manner to the subject's cognitive style (i.e., field-dependence/independence).     

Voluntariness, intention, and the defence of mental disorder: toward a rational approach

This article addresses how mental disorder may be used in common law countries to negate the requirements of voluntariness and intention in serious criminal offences as well as to provide the basis for current versions of the insanity defence. The notion that mental disorder can cause conduct to become completely involuntary or unintentional is questionable, given current thinking in the behavioral sciences. This article argues that different forms of mental disorder should be subsumed within a separate defence of mental disorder. Providing that a range of dispositional options is available, the law in this complex area would be simplified and brought into line with current psychological notions of goal-directed behavior.     

Mental strategies,mental capacity,and instruction: A neo-Piagetian investigation

Pascual-Leone's neo-Piagetian theory of development was used to predict the pre- and postinstruction distributions of scores on a subject-controlled digit placement task as a function of three parameters: (1) the mental strategy which subjects attempted to apply, (2) the demand which attempting to apply this strategy placed on their mental capacity, and (3) the maximum mental capacity which they were capable of mobilizing. The predicted and obtained distributions corresponded quite closely for each kind of strategy at each age level sampled (6, 8, and 10). The discussion focused on the methodological and analytic requirements which must be met if the same approach is to be applied to making successful predictions in more naturalistic paradigms.     

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.     

Relations among mental capacity, Short-term Storage Space, and operational efficiency.

According to R. Case, a subject's Total Processing Space is the sum of his Short-term Storage Space (STSS) and Operating Space (OS). Case has hypothesized a trade-off between the two, that is, an increase in operational efficiency leads to a decrease in operating space, and consequently more short-term space is available for information processing. To test Case's hypothesis 52 freshman students were tested to estimate operational efficiency (time taken to finish the Figural Intersection Test, when administered with a time limit), Pascual-Leone's Structural M-capacity, Ms (i.e., STSS), and Functional M-capacity, Mf. A zero correlation was obtained between operational efficiency and Ms/STSS, which suggests that subjects find it difficult to distribute attentional load from one reserve (OS) to another (STSS). This study supports Pascual-Leone's construct of Ms and Mf. It is concluded that subjects with high operational efficiency seem to be operating with the field-independent cognitive style rather than using a strategy of decreasing operating space.     

Depression, suicide, and suicide prevention in schizophrenia

Suicide is the single largest cause of premature death among individuals with schizophrenia. Furthermore, epidemiological data indicate that nearly 80% of patients with the diagnosis of schizophrenia will experience a major depressive episode at some time during their lifetime. This report reviews recent findings relative to the risk of suicide in schizophrenia, including data from the Chestnut Lodge longitudinal study of schizophrenia subtypes and symptom domains. Paradoxically, those patients with schizophrenia who are most likely to recover or experience a good outcome are also those at greatest risk for suicide. The reduction of morbidity and mortality in schizophrenia should include depression and suicidality as targets for both psychopharmacological and psychosocial treatment.     

Physician-assisted suicide: the role of mental health professionals

A review of the literature was conducted to better understand the (potential) role of mental health professionals in physician-assisted suicide. Numerous studies indicate that depression is one of the most commonly encountered psychiatric illnesses in primary care settings. Yet, depression consistently goes undetected and undiagnosed by nonpsychiatrically trained primary care physicians. Noting the well-studied link between depression and suicide, it is necessary to question giving sole responsibility of assisting patients in making end-of-life treatment decisions to these physicians. Unfortunately, the use of mental health consultation by these physicians is not a common occurrence. Greater involvement of mental health professionals in this emerging and debated area is advocated. Beyond describing mental health professionals' role in the assessment of patient competency or decision making capacity, other areas of potential involvement are described. A discussion of ethical principles relevant to this area follows, along with comments on the training necessary to adequately serve patient needs.     

The first rational therapist: George Lincoln Walton and mental training

In the early years of the twentieth century, George Lincoln Walton, a Boston neurologist, developed, an approach to treating emotional disturbance which anticipated most of the principles of rational-emotive therapy. Walton argued that most neuroses are the product of irrational thinking, and that the only way to eliminate emotional distress is to adopt a rational philosophy of life. Walton's theory is examined and his place in the history of psychotherapy assessed.     

Assessing mental capacity and susceptibility to undue influence

Clinicians are commonly asked to participate in the determination of an individual's mental capacity and susceptibility to undue influence. Vague statutory definitions and lack of operational criteria for both determinations have contributed to inconsistency in the quality and usefulness of expert input to these determinations. Questionnaire responses of 119 probate judges from the U.S. indicate that this input is quite influential despite the problems mentioned above. This paper presents and discusses the judges' views on selected procedural and conceptual aspects of expert evaluation and testimony.     

Posttraumatic stress disorder, traumatic brain injury, and suicide attempt history among veterans receiving mental health services

History of posttraumatic stress disorder (PTSD) or traumatic brain injury (TBI) has been found to increase risk of suicidal behavior. The association between suicide attempt history among veterans with PTSD and/or TBI was explored. Cases (N = 81) and 2:1 matched controls (N = 160) were randomly selected from a Veterans Affairs Medical Center clinical database. PTSD history was associated with an increased risk for a suicide attempt (OR = 2.8; 95% CI: 1.5, 5.1). This increased risk was present for those with and without a history of TBI. Results support incorporating PTSD history when assessing suicide risk among veterans with and without TBI.     

Schizophrenia, dissociation, and consciousness

Current thinking suggests that dissociation could be a significant comorbid diagnosis in a proportion of schizophrenic patients with a history of trauma. This potentially may explain the term “schizophrenia” in its original definition by Bleuler, as influenced by his clinical experience and personal view. Additionally, recent findings suggest a partial overlap between dissociative symptoms and the positive symptoms of schizophrenia, which could be explained by inhibitory deficits. In this context, the process of dissociation could serve as an important conceptual framework for understanding schizophrenia, which is supported by current neuroimaging studies and research of corollary discharges. These data indicate that the original conception of “split mind” may be relevant in an updated context. Finally, recent data suggest that the phenomenal aspects of dissociation and conscious disintegration could be related to underlying disruptions of connectivity patterns and neural integration.     

Schizophrenia,Temporality, and Affection

Phenomenology and the Cognitive Sciences - Temporal experience and its radical alteration in schizophrenia have been one of the central objects of investigation in phenomenological psychopathology....     

Between Hippocrates and God: Ugandan mental health professional's views on suicide

A negative attitude towards suicide is generally assumed to be predominant in low-income countries. In order to understand the negative attitude in general it is necessary to look at how religion and morality influence the attitudes. Our aim in this qualitative interview study was to investigate what attitudes professional mental health workers in Uganda bear towards suicide and suicidal persons. The professionals argue for their attitude by employing religious, communal and medical ethics arguments, which draw both in a negative and positive direction. The professionals are in general unambiguously negative towards suicide and positive towards suicidal people who are mentally ill. In cases other than mental illness non-accepting attitudes surface. This is discussed against previous research showing that effective treatment of suicidal people is to be based on a trusting and accepting relationship.