Suicidality Among Adolescent Alberta Indians

A high rate of suicide attempts and suicide ideation characterized a sample of 229 grade 7 to 9 adolescents resident on seven reserves in central Alberta. The prevalence of suicidality for these adolescent Indians was very similar to rates reported for Navajo youth and for 8th- and 10th-grade American non-Indian students. Comparison of Indian and non-Indian suicidality risk factors showed somewhat elevated levels of family disruption and psychological problems among Indian adolescents. Compared to Canadian nonadolescents, substance abuse levels were high, and conditions necessary to modeling were virtually omnipresent. Suicide ideation was significantly elevated for Indian adolescents with low psychological well-being, no father in the home, and a prior suicide in the household. Controlling for age, risk factors for suicide attempts were heavy alcohol use, no father in the home, sleeping problems, and low psychological well-being. The high rates of adolescent Native suicide imply that a much higher proportion of their suicide attempts succeed. Targeted, community-based counselling and educational programs are needed to address these problems.     

Mental disorders and suicidal intention

This paper continues a previous report (Litman, 1984) in exploring the use of psychological autopsies to clarify intention in suicide; clinical experience is compared with courtroom experience. The certification of suicide requires a judgment that the deceased intended to use his or her own death to resolve his or her problems of living, as demonstrated by a preponderance of the evidence. Now that suicide has been decriminalized, the issue of "sane or insane" in insurance contracts has probably become irrelevant. Mental disorders are important as part of the suicide constellation, as one element of many interacting factors. The capacity to have the intent to commit suicide--that is, to understand the physical nature of one's own death--is lost due to mental disorders only under special and unique circumstances.     

Urban American Indian Community Perspectives on Resources and Challenges for Youth Suicide Prevention

American Indian (AI) youth have some of the highest rates of suicide of any group in the United States, and the majority of AI youth live in urban areas away from tribal communities. As such, understanding the resources available for suicide prevention among urban AI youth is critical, as is understanding the challenges involved in accessing such resources. Pre‐existing interview data from 15 self‐identified AI community members and staff from an Urban Indian Health Organization were examined to understand existing resources for urban AI youth suicide prevention, as well as related challenges. A thematic analysis was undertaken, resulting in three principal themes around suicide prevention: formal resources, informal resources, and community values and beliefs. Formal resources that meet the needs of AI youth were viewed as largely inaccessible or nonexistent, and youth were seen as more likely to seek help from informal sources. Community values of mutual support were thought to reinforce available informal supports. However, challenges arose in terms of the community's knowledge of and views on discussing suicide, as well as the perceived fit between community values and beliefs and formal prevention models.     

What do Suicide Survivors Tell Us They Need? Results of a Pilot Study

Few studies have examined the natural coping efforts used by suicide survivors, or have identified specific problems and needs survivors experience following the death of a significant other by suicide. In the present study, we used a newly developed needs assessment survey to examine four areas of natural coping efforts: practical, psychological, and social difficulties; formal and informal sources of support; resources utilized in healing; and barriers to finding support since the loss. Sixty-three adult survivors of suicide were recruited from suicide survivor conferences and support groups. Results indicate that participants experienced high levels of psychological distress since the suicide, including elevated symptoms of depression, guilt, anxiety, and trauma. Participants experienced substantial difficulties in the social arena (e.g., talking with others about the suicide). The majority of the sample viewed professional help as beneficial; although many informal sources of support were also valued (e.g., one-to-one contact with other survivors). Depression and a lack of information about where to find help served as barriers to help-seeking behaviors for our participants. Participants who reported higher levels of functional impairment were more likely to report higher levels of psychological distress, social isolation, and barriers to seeking help. Future research with a longitudinal and more inclusive sample is needed to build on these preliminary findings and to provide a solid foundation for evidenced-based interventions with survivors.     

Predictive and concurrent validity of the Suicidal Ideation Questionnaire among American Indian adolescents

Suicide is currently the second leading cause of death for ages 15–24 years; reports indicate that 6–8% of American teens have attempted suicide. Rates of suicide and suicide attempts are at least as high, if not higher, for American Indian adolescents and young adults. The Suicidal Ideation Questionnaire (Junior High School Version) (SIQ-JR) could be used to identify young people who may be at risk for attempting suicide, since this questionnaire focuses on suicidal ideation, a major risk factor for suicide attempt. However, little is known about the predictive validity of the SIQ-JR, particularly in American Indian adolescent populations. A suicide attempt cluster at an American Indian boarding school provided the unique opportunity to examine the performance of the SIQ-JR in a group of American Indian high school students who had taken the SIQ-JR approximately 2 months prior to the outbreak of attempts. The SIQ-JR proved to be an excellent predictor of future suicide attempts when compared to other measures of distress: anxiety, depression, and alcohol use. The SIQ-JR is an effective screener for suicide risk in this American Indian adolescent population.     

Confidential death to prevent suicidal contagion: an accepted, but never implemented, nineteenth-century idea.

Nineteenth-century medical literature often admonished the popular press to limit reports of suicide, because of a belief that knowledge of another's suicide could stimulate some persons to kill themselves. An 1837 case report (perhaps the earliest attempt at a psychological autopsy in an American medical journal) is discussed, because it presciently clarifies the concept of psychological sensitization. Its study leads to documentation of two examples of falsified death certificates. The power to prevent publicity of suicide by not reporting it may have diminished efforts for newspaper restraint, as did editorial resistance and later acceptance of Emile Durkheim's (1897/1951) strongly expressed belief that reports of suicide did not cause an overall increase in suicide. Despite lack of success over the past two centuries, efforts to keep reports of self-inflicted death confidential continue to flow from concern about suicidal contagion. Today, uncensored websites and books advocating suicide may limit the benefit of the U. S. Surgeon General's "call to action" to prevent suicide, which again supports voluntary media restraint in reporting suicide.     

A general systems approach to suicide prevention: lessons from cardiac prevention and control

The pathology of cardiac disease includes genetic, physical, biochemical, psychological, social, and environmental vectors. Factors contributing to suicide have been identified in these same areas. Survival from an acute cardiac event requires a systematized and multisectoral response. Communities that do not have systematized response capabilities to acute cardiac events have poorer survival outcomes. Suicide prevention and control may also be responsive to an integrated community response system. This paper examines the development of a community cardiac care model, explores potential parallels for a community suicide prevention and control model, and outlines a general systems theory framework for a suicide prevention and control system.     

Protective Factors for Suicidal Black Females

The purpose of this study is to evaluate the extent to which a model of social support may help explain the low suicide rate of Black females. The data are taken from the National Institute of Mental Health's Epidemiologic Catchment Area Study 1980–1985 (United States). The LISREL model examines the direct and indirect effects of the background characteristics on attempted suicide as mediated by emotional state. Results indicate evidence that for Black and White males and females, finding emotional and psychological support in friends and family members helps to safeguard against suicide. The most substantial finding is that for all race/sex categories, seeking support from friendship and familial resources is negatively related to attempted suicide, whereas seeking support from professional resources is associated with an increase in the likelihood of a suicide attempt. This increased likelihood of attempted suicide may be reflecting populations members' resistance to seeking professional help until their emotional state has severely deteriorated.     

Some Psychological Reflections on the Death of Malcolm Melville*

ABSTRACT: Malcolm Melville died on September 12, 1867, at age 18 from—to quote his death certificate—a “pistol shot wound in [his] right temporal region.” Contemporary designations of the mode of his death changed within hours from suicide, to accident, to death while of unsound mind. Historically, the mode of his death has remained equivocal. In order to approach this enigma a “psychological autopsy” of an equivocal death case as identical to Malcolm Melville's as was possible was conducted as though it were a genuine current “open” case at the Los Angeles Suicide Prevention Center in 1973. That procedure resulted in a near-unanimous judgment by the center staff that the most accurate certification of the death as described was “probable suicide,” which would then be certified as “suicide.” In this paper the assertion is made that Herman Melville himself had been a psychologically “battered child” and, in a way typical for battered children, psychologically battered his own children when it came his turn to be a parent. The further assertion is made that, for Malcolm, his father was suicidogenic; and established this penchant in Malcolm (through his neglect, active rejection, fearsomeness, and his fixed attention to his own writing—Redburn, White Jacke, and Moby Dick) within the first 2 years of Malcolm's life. For Malcolm, the psychological basis of his suicidal state was isolated desperation—a ubiquitous characteristic of most suicides. Malcolm had a deep unconscious feeling of not being wanted by his father; that it would be better if he were out of the way, dead. On the morning of his death, the choice for Malcolm was between the memory of his mother's kiss a few hours before and the terror of (and the need to protect himself against) his father's rage to come.     

Meriwether Lewis: Was it Suicide?

Even 200 years following the conclusion of the Lewis and Clark Expedition, questions remain about whether Meriwether Lewis' death was a suicide. The purpose of this article is to consider this issue by examining historical evidence from a psychological perspective. A risk factor model for suicide assessment (Sanchez, 2001) is employed to evaluate the nature of Lewis' historical, personal, psychosocial environmental, and clinical risk factors as well as protective factors. The authors conclude that though there is some evidence to support a theory of murder, Lewis was at a high suicide risk at the time of his death, and that the preponderance of the evidence indicates that he died by his own hand.     

Remembering Medard Boss

Abstract

The life and work of Medard Boss is reviewed. This overview includes the development of his daseinsanalysis, presenting its roots in psychoanalysis, existential phenomenological psychiatry, Heideggerian philosophy, and Indian thought. Also examined are Boss's contributions to the fields of psychotherapy, philosophy, and human scientific psychology. The latter contributions include Boss's explication of the meanings of three specific kinds of psychological phenomena: sexual disorders, bodily illnesses and injuries, and dreams. The article then concludes with the author's personal reflections on his experiences with daseinsanalysis and Medard Boss.     

The trauma of attempted suicide

Suicide is a traumatic event, one which may acutely recreate a previously-experienced traumatic situation. The person's capacity to think after a failed suicide attempt is affected by the use of defence mechanisms against persecutory anxieties and depressive pain, and there is a wish to turn a blind eye to the seriousness of the suicidal act. This includes the damaging effects on the person's relationships with others, and damage to his own psychic integrity.

The need to turn a blind eye to the consequences of a failed suicide attempt may also be mirrored by the therapist who assesses and treats the patient in the early hours after such an event. Suicide is associated not only with the pain of despair but also with a ruthless abandonment of life. It is a complex and difficult task for a therapist in the immediate aftermath of a suicide attempt to be able to keep in mind a concept of suicide that includes both the patient's role as the perpetrator of great violence against himself, in which death is the intended outcome of his actions, and at the same time recognise the patient's identification with an abandoned and cruelly treated object.

In this paper, we describe some of the psychodynamic factors that affect and influence the assessment and treatment of patients in the immediate period following a failed suicide attempt. We emphasise the importance of supervision in helping prevent destructive acting-out by the therapist when treating disturbed patients under such painful circumstances.     

Psychological assessment of an artist and impostor

A Rorschach record and a narrative poem are examined to determine how imagination expresses the psychological trauma of being exposed as an impostor. The subject had been trained as a medical corpsman and deceived people under the grandiose fantasy of being a doctor. The role of the impostor physician is seen as an imaginative identity that was designed with an adaptive purpose. A Jungian analysis of his suicide attempt and the Rorschach suggest that the impostor role was a masculine compensatory fantasy that served as a counterforce to negative maternal imagery, linked to death, that is present in his imagination.     

Psychological Assessment of an Artist and Impostor

A Rorschach record and a narrative poem are examined to determine how imagination expresses the psychological trauma of being exposed as an impostor. The subject had been trained as a medical corpsman and deceived people under the grandiose fantasy of being a doctor. The role of the impostor physician is seen as an imaginative identity that was designed with an adaptive purpose. A Jungian analysis of his suicide attempt and the Rorschach suggest that the impostor role was a masculine compensatory fantasy that served as a counterforce to negative maternal imagery, linked to death, that is present in his imagination.     

Lives and deaths: Biographical notes on selections from the works of Edwin S. Shneidman

Edwin S. Shneidman (DOB: 1918-05-13; DOD: 2009-05-15) is a father of contemporary suicidology. His work reflects the intensive study of lives lived and deaths, especially suicides, and is the mirror to his mind. His contributions can be represented by five categories: psychological assessment, logic, Melville and Murray, suicide, and death. His works on suicide can be further divided into five parts: definitional and theoretical, suicide notes, administrative and programmatic, clinical and community, and psychological autopsy and postvention. In this article, not only are the selected works explicated, but also Dr. Shneidman's rather personal biographical notes are shared to allow the reader to understand one more unique individual's life lived, and his death: Edwin S. Shneidman.     

Suicide Prediction

ABSTRACT: Methodological problems intrinsic to suicide prediction are discussed. The research on suicide predictive signs derived from attributes of the suicidal person, his behavior, and his surroundings, and on predictive instruments is reviewed. The results of these researches are equivocal, in that neither single signs, standard psychological tests, specially devised tests, clinical judgments, nor scales are found to be able to predict suicide at useful levels. Scales are shown to offer the best predictive potential, but to date their construction has not been systematic. It is proposed that scales might be better constructed and prediction improved if investigators were to consider the focus, duration, inclusion-exclusion, interactions and subgroupings, and generalizability of suicidal indices.     

A Standard of Care for the Assessment of Suicide Risk and Associated Treatment: The Florida State University Psychology Clinic as an Example

The Florida State University has established a set of guidelines to be used as a standard of care for suicide. This standard of care guides therapists through a suicide risk assessment that focuses on key variables related to suicidal behavior that are among the best predictors of completed suicide. This standard of care includes necessary components of suicide risk assessment, critical steps to follow to ensure the safety of suicidal patients, treatment recommendations, and guidelines for minimizing the legal risk of the therapist. Though this standard of care was developed in a research and training clinic, these principles may be applied to all clinicians offering psychological services to patients, regardless of the nature of the clinic or setting.     

A Reply to Cholbi's 'Suicide Intervention and Non-Ideal Kantian Theory'

abstract    In his 'Suicide Intervention and Non-Ideal Kantian Theory' (2002), Michael J. Cholbi argues that nihilism and hopelessness are often motivating factors behind suicide, contrary to Immanuel Kant's prescribed motive of self-love. In light of this, Cholbi argues that certain paternalistic modes of intervention may not only be effective in preventing suicide, but are ultimately consistent with Kantian morality. This paper addresses certain perceived shortcomings in Cholbi's account of Kantian suicide intervention. Once the psychological complexities of the suicidal person are brought to bear, the suicidal person is found in many cases to be irrational at the time of her death. Because of this, rationalistic intervention strategies may prove ineffective, despite their being consistent with Kantian morality, and despite instances of suicide being non-ideal circumstances. Cholbi assumes throughout his article that suicidal human beings remain Kantian moral agents. However, because rationality represents a crucial criterion for Kantian moral agency, and because certain human beings who commit suicide are not rational, such human beings are not Kantian moral agents. Because Cholbi's intervention strategies are not applicable to (or effective towards) irrational suicidal people, his account is found incomplete.     

Dalí's homage to Rothko: a defense against fusion with the victim

This paper explores the thematic content of a painting by Salvador Dalí in homage to artist Mark Rothko, completed after the latter's suicide. The manifest title of the work suggests respect for Rothko, but the latent intent of the painting, the author suggests, is more of a memoriam to Rothko in a complex identification with him. Among other psychological issues, the author elaborates on two factors that may have played a part in Dalí's artistic reaction to Rothko's suicide: the death of the artist's infant brother nine months before his own birth, and his lifelong struggle against fusion with the victim (Orgel 1974a, 1974b).