The role of removal and elimination in Nietzsche’s model of self-cultivation

ABSTRACT

In this paper I call into question the commonplace assumption in Anglophone Nietzsche scholarship that ideal psychological self-cultivation comes about solely by means of the sublimation of all of one's drives. While the psychological incorporation of one’s drives and instincts plays a crucial role in promoting what Nietzsche considers a higher self, I argue that some degree of removal and elimination of particular drives and instincts could be, perhaps necessarily is, involved in ideal cases. Yet I will suggest that we should not think of these cases as constituting ‘repressions’. I will seek to offer a better characterization of the discussions of productive removal and elimination in Nietzsche’s texts, and consider how they fit in his model of self-cultivation. Nietzsche’s texts demonstrate a more nuanced understanding of the ways in which certain kinds of removal and elimination can lead to greater integration for the would-be exemplary individual. My reading, I argue, helps to better understand the instances in the texts where Nietzsche valorizes the removal of particular drives and instincts.     

Exploring the Phenomenology of Suicide

Phenomenology studies conscious experience as experienced from the subjective or first‐person point of view. This paper was developed with the aim of shedding light on the phenomenology of suicide; that is, to focus on suicide as a phenomenon affecting a unique individual with unique motives for the suicidal act. To explore this topic, the author looks back at the past centuries to understand why suicide was thought to be confined to psychiatric illness and to document the bias in studies supporting this notion. One major step forward in the conceptualization of suicide as a psychological disorder was provided by Edwin Shneidman, who focused on the pain of negative emotions. Such a radical approach is laudable in an era where diagnostic criterria and the need to cure are more important than understanding what is not working at the emotional level.     

Proposal for a Distinctive Diagnosis: the Deliberate Self-Harm Syndrome (DSH)

ABSTRACT: Self-destructive behavior is a major clinical problem in psychiatry. A review of the literature reveals the existence of enough clinical data to identify a diagnostic entity, “The Deliberate Self-Harm Syndrome” (DSH). The authors present a diagnostic formulation of the DSH syndrome (in the DSM-III format) which consists of four essential clinical features, a group bof associteds features, clinical features, a group of associated features, a clinical course of typical onset in late adolescence, with multiple recurent episodes, with multiple methods of low lethality physical self-injury, extending over many years. On the basis of relatively exclusive association of clinical signs and symptoms a heuristic clinical entity is proposed.     

Military Veterans' Experiences with Suicidal Ideation: Implications for Intervention and Prevention

We sought to understand Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans' experiences with suicidal ideation. Semi‐structured interviews with 34 OEF/OIF veterans addressed circumstances leading up to disclosure of suicidal ideation during brief clinical assessments. We used an iterative, inductive and deductive thematic analysis approach. Results revealed three pervasive, persistent domains that reinforce the uniqueness of veteran suicidal thoughts: military culture, difficult deployment experiences, and postdeployment adjustment challenges. Within postdeployment, we identified four themes that serve as intervention targets: adjusting to civilian culture, changes to sense of self, feeling overwhelmed by stressors, and lacking life purpose or meaning.     

Awareness,Attitudes, and Use of Crisis Hotlines among Youth At‐Risk for Suicide

Crisis hotlines have been central to suicide prevention efforts; however, utilization among youth remains low. A sample of at‐risk youth was surveyed about their awareness, utilization, and attitudes toward local and national crisis hotlines. Youth reported low rates of awareness and utilization, yet expressed a strong interest in phone hotlines (41% vs. 59% for new media categories combined). Youth reported stigma, but that help‐seeking could be positively influenced by peers and adults in their support system. Implications include making crisis services available across several mediums and the importance of engaging trusted others in youth suicide awareness campaigns and prevention efforts.     

Assessing the Adherence to Guidelines of Media Reporting of Suicide Using a Novel Instrument—the “Risk of Imitative Suicide Scale” (RISc)

Media guidelines for reporting of suicide are considered important in suicide prevention because of the risk of “imitative” suicide. There are currently no established tools for the quantification of quality of reporting. We sought to develop and validate a quality assessment instrument—the Risk of Imitative Suicide Scale (RISc). The RISc appears capable of discriminating reliably between adherent and nonadherent articles. Our data suggest that adherence to guidelines is inconsistent, and there are major differences between web‐based and print media. The RISc could be used to evaluate effectiveness and consistency of media engagement with suicide prevention strategies.     

Screening for Suicidal Ideation and Attempts among Emergency Department Medical Patients: Instrument and Results from the Psychiatric Emergency Research Collaboration

Joint Commission National Patient Safety Goal 15 calls for organizations “to identify patients at risk for suicide.” Overt suicidal behavior accounts for 0.6% of emergency department (ED) visits, but incidental suicidal ideation is found in 3%–11.6%. This is the first multicenter study of suicide screening in EDs. Of 2,243 patients in six diverse emergency settings, 1,068 (47.7%) were screened with a brief instrument. Depression was endorsed by 369 (34.5%); passive suicidal ideation by 79 (7.3%); and active suicidal ideation by 24 (2.3%). One hundred thirty‐seven (12.8%) reported prior attempts, including 35 (3.3%) with current suicidal ideation. Almost half of those with current ideation had a prior attempt (43.8%) versus those without current ideation, 10.3%, χ² (1) = 75.59, p < .001. Twenty cases (25%) were admitted to medical services, but only 10 (12.5%) received mental health assessment; none were admitted directly to a psychiatry service. The prevalence of suicidal ideation here is similar to previous studies but the frequency of prior attempts has not been reported. The 35 cases with current ideation and prior attempt are at risk. As they did not present psychiatrically, they would likely have gone undetected. Despite reporting these cases to clinical staff, few received risk assessment.