Suicide: The Psychosocial Dimension

ABSTRACT: This paper explores the relationships among culture, character, and suicide. It draws on the author's research in Scandinavia and his studies of suicide among United States urban blacks and college students. The differences in motivation and significance of suicide in Sweden and Denmark are illustrated. The United States is an amalgam of subcultures which must be studied separately to identify the psychosocial determinants of behavior. The varying rates and motivations for suicide in different cultures and subcultures, the differences between men and women, between young and old, differences in ways of coping with love and loss, life and death make clear that suicide is part of a culture's possibilities. The varying psychodynamic ways in which the suicidal individual in differing cultures and subcultures conceives of, uses, and absorbs death also has much to tell us about how we live.     

Suicide of Japanese Youth

ABSTRACT: The uniquely intense stress due to the Examination Hell (shiken jigoku) not only generates a basic drive for Japan's economic success but also contributes to a high rate of young people's suicide. This paper discusses the major factors in the intensity of Japanese stress on both institutional and psychological levels. The social structural factors which convert stress to suicide are analyzed in terms of weak ego; restraint on aggression; a lack of social resources; and views of life, death and suicide. Japanese views of life, death and suicide are treated in terms of Absolute phenomenalism, the original form of Shintoism, to which Buddhism and Confucianism have been adjusted in Japan. Japanese phenomenalism affects suicide through its three aspects: animism, present-time oriented small groupism, and the absolute acceptance of the established social order. Confusion and conflict since World War II have increased anomic suicides; however, elements of fatalistic suicide (due to excessive formal or informal social regulations) and altruistic suicide (due to strong social integration) are evident. Suicide is still a highly institutionalized adjustment mechanism in Japan.     

Parental Suicide: An Organizing Event in the Development of Latency Age Children

ABSTRACT: This paper proposes that children who are especially vulnerable to parental suicide have not resolved earlier developmental issues of separation-individuation. Five children, ages 6 to 12, were studied intensively. Parental suicide during the child's latency age period has profound influences on children's ego development and character formation because during this time childhood ego functioning is rapidly maturing and superego functions are developing. The trauma of parental suicide is heightened when difficulties for the surviving parent in mourning interfere with open discussion between the parent and child about the death. Parental suicide may stimulate childhood suicidal impulses if the child identifies with and idealizes the dead parent and has wishes of reuniting with the deceased.     

The Kurt Cobain Suicide Crisis: Perspectives from Research,Public Health,and the News Media

The suicide of rock star Kurt Cobain in 1994 raised immediate concerns among suicidologists and the public at large about the potential for his death to spark copycat suicides, especially among vulnerable youth. The Seattle community, where Cobain lived and died, was especially affected by his sudden death. An overview of Cobain's life and death is presented and various crisis center and community-based interventions that occurred are discussed. Preliminary data collected from the Seattle Medical Examiner's Office and from the Seattle Crisis Center to assess the potential impact of Cobain's death on completed suicides and the incidence of suicide crisis calls are presented. The data obtained from the Seattle King County area suggest that the expected “Werther effect” apparently did not occur, but there was a significant increase in suicide crisis calls following his death. It is hypothesized that the lack of an apparent copycat effect in Seattle may be due to various aspects of the media coverage, the method used in Cobain's suicide, and the crisis center and community outreach interventions that occurred. The Cobain suicide and the role of media influence on copycat suicides are further discussed in commentaries from public health and news media perspectives.     

Instructions for Authors

SUICIDE AND LIFE-THREATENING BEHAVIOR is devoted to emergent approaches in theory and practice related to self-destruction, other-destructive, and life-threatening behaviors. It is multidisciplinary and concerned with a variety of topics: suicide, suicide prevention, death, accidents, subintentioned destruction, partial death—threats to life's length and breadth from within and without.     

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.     

The Certification of Suicide in Eleven Western States: An Inquiry into the Validity of Reported Suicide Rates

ABSTRACT: From Durkheim's time to the present social researchers interested in the problem of suicide have relied upon officially reported rates of suicide to develop and test their theories. Despite the fact that the validity of any theory rests upon the accuracy of its underlying data, the relative accuracy of reported suicide rates have rarely been questioned or systematically evaluated. This paper investigates the process of death certification as practiced by a sample of 191 coroners in 11 western states. Findings indicate extensive variation in the backgrounds, professional resources, operating procedures, and governing statutes of coroners and coroners' offices and in policies concerning the use of the suicide mode. Since the coroner is generally charged with the official responsibility for certifying the mode of death when unnatural mode is suspect, the extent of variation found here calls into question the validity and comparability of reported suicide rates.     

Adolescent Bereavement Following Suicide: An Examination of Relevant Literature

For adolescents, a loved one's death by suicide is a tragic event linked with increased morbidity, death fears, and psychopathology. For these reasons, the links between bereavement after suicide and the subsequent development of adolescents (including increased suicide risks) require further study. In the existing literature, inconsistent definitions of adolescence are used, samples of adolescents are drawn from those in psychotherapy, and other methodological problems exist.     

MORTALITY,INTEGRITY, AND PSYCHOANALYSIS (WHO ARE YOU TO ME? WHO AM I TO YOU?)

The author narrates her experience of mourning her therapist's sudden death. The profession has neglected implications of the analyst's mortality: what is lost or vulnerable to loss? What is that vulnerability's function? The author's process of mourning included her writing and her becoming an analyst. Both pursuits inspired reflections on mortality in two overlapping senses: bodily (the analyst is mortal and can die) and character (the analyst is mortal and can err). The subject thus expands to include impaired character and ethical violations. Paradoxically, the analyst's human limitations threaten each psychoanalytic situation, but also enable it: human imperfection animates the work. The essay ends with a specific example of integrity.     

A School-Based Suicide Risk Assessment Protocol

Suicide remains the third leading cause of death among young people in the United States. Considering that youth who contemplate suicide generally exhibit warning signs before engaging in lethal self-harm, school-based mental health professionals can play a vital role in identifying students who are at risk for suicidal behavior. Nevertheless, the assessment of vulnerable children and adolescents is a challenging undertaking, with many variables considered relevant to the determination of a student's suicide risk level. This article introduces school-based mental health professionals to the Student Suicide Risk Assessment Protocol, an evaluation tool developed by the author to aid in the determination of student suicide potential, assist with the selection of appropriate interventions, and allow for documentation of school personnel's actions taken to mitigate a student's suicide risk.     

Awareness of Suicide Risk and Communication Between Health Care Professionals and Next‐of‐Kin of Suicides in the Month Before Suicide

Based on psychological autopsy data, the study compared awareness of suicide risk in the deceased among next‐of‐kin (NOK ) and health care professionals (HCP s), and communication between these two groups in the month before death. The NOK s had significantly more knowledge about the decedent's suicide warning signs than the HCP s (90.5% vs. 44.6%). Contact between NOK and HCP was initiated more often by the family than the HCP s (29.4% vs. 5.9%). The study found communication gaps between HCP s and NOK and stresses the need for suicide prevention strategies strengthening communication between these two groups.     

Some Common Characteristics of Latency-Age Suicidal Children: A Tentative Model Based on Case Study Analyses

ABSTRACT: Eleven latency-age (6 ½ to 12 ½) boys and girls who attempted or threatened suicide were investigated by means of the following information: intensive interviews, therapeutic meetings, direct observation in school, meetings with teachers, and survey of school records. The families of the children were also interviewed. In spite of the many differences between the children's personalities and backgrounds, some common dynamic features seemed to emerge: (a) There was a suicidal parent in the family, in most cases the mother; (b) Most of the families of these children were engaged in a major crisis, not necessarily centered around the suicidal child; (c) The children experienced demands by the parents to assume responsibilities which the children perceived as being beyond their capability; (d) There was a lack of satisfying relationships with adults; (e) Most children perceived death in a paradoxical way, believing that death was a need satisfying state yet fearing death; (f) The children showed strong positive strivings to say alive and were able to experience joy and happiness in spite of feelings of desperation and depression. A model based on the above multifaceted forces is presented. These forces consist of attractiveness of life, repulsiveness of life, attractiveness of death, and repulsiveness of death. Some of diagnostic and predictive uses of this model are elaborated.     

Familial risk of early suicide: variations by age and sex of children and parents

To determine familial risk of early suicide, data on cause of death of all Dutch residents aged 20-55 years who died between 1995 and 2001 were linked to data of their parents. Men whose father died by suicide had a higher odds of suicide themselves, relative to men whose father died of other causes (Odds Ratio (OR): 2.5; 95% confidence interval: 1.8-3.6). This effect was slightly stronger in the case of mother's suicide (OR: 3.4; 2.3-5.0). The same effect was observed for women, for suicide by father (OR: 2.2; 1.3-3.7) and mother (OR: 4.6; 2.6-8.0). The odds of suicide increased with decreasing age at death of parent. Parental suicide is predictive for offspring suicide. Our data suggest that the predictive value is higher in case the mother died by suicide, particularly if the mother died by suicide at a young age.     

Shifting Patterns of Deadly Violence

ABSTRACT: To the casual observer, it would seem that the United States' suicide rate has been remarkably steady in recent years. However, this stability may be more apparent than real. While it is true that the total suicide rate has varied little, this composite figure masks a dramatic shift in the risk of suicide by age. In recent years there has been a reduction of suicide at older ages reciprocated by an unprecedented increase of suicide (and homicide) at younger ages. The extent of this change during the ten-year period 1966–75 is explored along with possible explanations for the increase of aggressive violent death among young people.     

Encountering the Body at the Site of the Suicide: A Population‐Based Survey in Sweden

Encountering the body of a child who died by suicide at the site of death is believed to be especially harmful for bereaved parents. We investigated the association between encountering the body at the site of the suicide and psychological distress in 666 suicide‐bereaved parents. Parents who had encountered their child's body at the site of the suicide (n = 147) did not have a higher risk of nightmares (relative risk [RR] 0.95, 95% confidence interval [CI] 0.67–1.35), intrusive memories (RR 0.97, 95% CI 0.84–1.13), avoidance of thoughts (RR 0.97, 95% CI 0.74–1.27), avoidance of places or things (RR 0.91, 95% CI 0.66–1.25), anxiety (RR 0.93, 95% CI 0.64–1.33), or depression (RR 0.94, 95% CI 0.63–1.42) compared with parents who had not encountered the body (n = 512). Our results suggest that losing a child by suicide is sufficiently disastrous by itself to elicit posttraumatic responses or psychiatric morbidity whether or not the parent has encountered the deceased child at the site of death.     

The cultural theory and model of suicide

A growing body of research has demonstrated important variations in the prevalence, nature, and correlates of suicide across ethnic and sexual minority groups. Despite these developments, existing clinical and research approaches to suicide assessment and prevention have not incorporated cultural variations in any systematic way. In addition, theoretical models of suicide have been largely devoid of cultural influence. The current report presents a comprehensive analysis of literature describing the relationship between cultural factors and suicide in three major ethnic groups (African Americans, Asian Americans, and Latinos) and LGBTQ¹ sexual minority groups. We utilized an inductive approach to synthesize this variegated body of research into four factors that account for 95% of existing culturally specific risk data: cultural sanctions, idioms of distress, minority stress, and social discord. These four cultural factors are then integrated into a theoretical framework: the Cultural Model of Suicide. Three theoretical principles emerge: (1) culture affects the types of stressors that lead to suicide; (2) cultural meanings associated with stressors and suicide affect the development of suicidal tendencies, one's threshold of tolerance for psychological pain, and subsequent suicidal acts; and (3) culture affects how suicidal thoughts, intent, plans, and attempts are expressed. The Cultural Model of Suicide provides an empirically guided cohesive approach that can inform culturally competent suicide assessment and prevention efforts in future research and clinical practice. Including both ethnic and sexual minorities in our investigations ensures advancement along a multiple identities perspective.     

The temporality of intimacy: Promise,world, and death

This paper explores the temporal character of intimacy. I begin by examining the significance of “promise” and “habit” in intimate relationships. These themes are developed through the work of M. Merleau-Ponty and J.H. van den Berg to reveal the embedded or en-worlded character of intimacy. These analyses help to articulate and to problematize the sense we often have of “established” relationships as possessing a fixed, already determined character. The final section discusses the issues of intimacy that surround the situation of dying. Specifically, it analyses (1) ways in which the issue in death is the stripping away of one's world, but also ways in which the meaning of one's death is still something futural, and thus “to be shaped”; and, (2) ways in which the shaping of this meaning with intimate others is significant both for the one manifestly dying and for those whose death seems distant.