Existential themes in the treatment of people at suicide risk. Understandings and practices of specialist healthcare professionals

ABSTRACT

This qualitative study focuses on the ways in which existential themes were understood and addressed in therapeutic relationships with patients who had attempted suicide. Health care professionals (HCP) from Norway specialist healthcare participated in focus groups. The interviews were transcribed and analysed by systematic text-condensation through a four-step procedure. We found that the HCPs emphasised the context-specific functions of their departments. They considered these conversations essential but demanding. They indicated existential themes of hope/hopelessness, loneliness, meaning, life/death, shame, religion and suicide. The HCPs’ understandings of themes deemed to be existential and how they should be addressed were primarily based on clinical experience. This appeared to exacerbate the pressure on their personal involvement, leading to the question of whether patients’ existential needs are tackled or instead disappear into a conversational vacuum. The study suggests that HCPs' professional competence of existential themes pertaining to patients at suicide risk needs to be strengthened.     

论死亡的尊严与权利——以癌症病人自杀现象为例

现代医学对晚期癌症病人死亡过程的过分干预使得死亡的尊严与权利问题日益受到人们的重视。而对病人自杀现象的理解则更应该借助于尊严死亡的理念。通过文献研究认为,难以忍受的躯体和心理上的痛苦是造成癌症病人自杀的首要原因。因此,癌症病人的自杀行为可以在相当程度上解释为一种摆脱艰难生存境遇的尝试。医生和家属都应充分考量癌症病人生命最后阶段的生活质量,给予他们真挚的关爱,在必要的时候,应允许癌症病人选择一种坦然的、平静的、有尊严的死亡方式,赋予他们选择死亡的权利。     

Hungry for love: the influence of self-regulation on infidelity

The current research examines the effect of self-regulation on the likelihood of committing infidelity. Thirty-two college students in exclusive romantic relationships interacted through a private chat room with an opposite-sex confederate. Prior to this interaction, a food-restriction task depleted half the participants of self-control. As predicted, depleted levels of self-regulation increased the likelihood of infidelity. Specifically, depleted participants were more likely to both accept a coffee date from and supply a personal telephone number to the confederate than non-depleted participants. Weakened self-control may be one potential cause for the levels of infidelity occurring in romantic partnerships today.     

国外自杀心理学研究与理论评介

以自杀致病理论、自杀评估理论、自杀治疗理论为线索,回顾与总结了国外近十年来的自杀心理学理论与研究概况,同时重点介绍了致病理论中的应激—易感模型、逃避自我理论、杀死自我理论;自杀评估理论中的SSF评估、四阶段过程模式;自杀治疗理论中的SATIR理论和荣格艺术治疗理论等,并做了简短评论     

Spinoza on Lying and Suicide

Spinoza is often taken to claim that suicide is never a rational act, that a ‘free’ person acting by the guidance of reason will never terminate his/her own existence. Spinoza also defends the prima facie counterintuitive claim that the rational person will never act dishonestly. This second claim can, in fact, be justified when Spinoza's moral psychology and account of motivation are properly understood. Moreover, making sense of the free man's exception-less honesty in this way also helps to clarify how Spinoza should, and indeed does, recognize the possibility of rational suicide.     

Self-Reported Interoceptive Sensibility Does Not Moderate the Relationship Between Eating Disorder Symptoms and Suicidal Thoughts and Behaviors

Past research has demonstrated a strong relationship between eating disorders (EDs) and suicidality (i.e., suicidal thoughts, plans, and attempts), and preliminary work within the framework of the interpersonal psychological theory of suicide (Joiner, 2007) suggests that potentially painful ED behaviors (binge eating, purging, fasting, excessive exercise) may contribute to increased risk of suicide through heightened pain tolerance and increased capability of suicide. However, additional explanations are needed for why only some individuals with EDs actually engage in suicidal behaviors (i.e., attempt suicide), whereas others do not. A growing body of literature suggests that interoceptive deficits (a disconnection from one’s own bodily sensations and emotions; IDs) might be a factor linking eating disorders and suicide. To better understand this relationship, the current study tests the moderating effects of self-reported IDs on the relations between ED behaviors and suicidality and past suicide attempts in a transdiagnostic ED sample (N = 181). We hypothesized that ED behaviors would directly relate to suicidality, but that IDs would moderate the relationship between ED behaviors and past suicide attempts, such that those high in IDs would demonstrate a stronger relationship between ED behaviors and suicide attempts. Contrary to our hypothesis, IDs did not moderate the relationship; instead, fasting and purging had significant and strong main effects on suicidality and past suicide attempts without moderation effects. Results suggest that fasting and purging may be important ED behaviors to consider in the relationship between EDs and suicidality. Future directions include further examining the relationship between IDs, suicidality, and EDs using measures of IDs that better encompass physical (as opposed to emotional) aspects of IDs.     

Suicide prevention in the genetic counseling context

Utilizing a case report, this paper explores psychosocial aspects of suicidal intent in a woman seeking prenatal diagnosis. Using knowledge and practice of appropriate assessment, referral, and intervention procedures, the therapy team of genetic counselor and psychotherapist facilitated successful identification and management of this potentially suicidal client. The main counseling goals for the genetic counselor are to assess the situation adequately, decrease the immediate danger, and, with supervision and/or consultation, stabilize the seriously suicidal person until that individual can be triaged to mental health or medical professionals for treatment. The prevalence of suicide issues in genetic counseling contexts is unknown and reports mentioning suicidal ideation unusual in the genetic counseling literature. Is this reported case a rarity among genetic counseling referrals? Systematically collected information on the prevalence and resolution of suicidal issues in genetic counseling contexts would be helpful for those setting curricula for genetic counseling training programs, standards for professional certification exams, and policy and procedures manuals for clinical units.     

Adolescent suicidal behaviors as a function of depression,hopelessness, alcohol use,and social support: A longitudinal investigation

Surveyed two high school cohorts (ns=698 and 283) to study independent prospective predictors of adolescent suicidal behaviors (thoughts, communicatio to others, attempts). Within each cohort, there were two measurements conducted 6 months apart. Structural equation models were tested, with depressive symptoms, hopelessness, alcohol consumption, social support, and gender serving as predictors. In the larger cohort, depression predicted later levels of all three suicidal behaviors controlling for baseline suicidal behaviors. Also, suicidal thoughts predicted later communications, and suicide attempts predicted future thoughts. In the smaller cohort, alcohol consumption predicted all three suicidal behaviors at the later measurement, whereas depression was predictive only of later thoughts. Major issues regarding prevention, theories of suicide and negative affect, and methodological/analytical approaches were discussed.     

Age variations in the suicide rates and self-reported subjective well-being of married and never married persons

Previous research has established that people who never marry have higher suicide rates and lower self-reported subjective well-being than the married. The present study examines how the differences between: (1) never married persons who live alone, (2) never married cohabitees; and (3) currently married people, vary between age groups. The relevance of such age variations for status integration theory and theories of marital selection is discussed. Summing up results from previous studies of suicide rates, the relative position of the never married is found to be most unfavourable for people in their 30s and 40s; the differences are smaller among the young and the old. Data on self-reported well-being are taken from a large-scale survey of the population of one of Norway's 19 counties (n = 51 000), and are analysed by means of ordinary multiple regression. With regard to single people who were married or who never married, the results are largely consistent with the suicide findings; the advantage of marriage increases until about 40 years of age, then declines. The survey data also provide information about unmarried cohabitation, which seems to be more or less equivalent to marriage in most age groups. Neither status integration theory nor any other single theory of marriage effects or marital selection seems to be able to account for these findings in a satisfactory way.     

Assisted death and martyrdom.

Against the backdrop of ancient, mediaeval and modern Catholic teaching prohibiting killing (the rule against killing), the question of assisted suicide and euthanasia is examined. In the past the Church has modified its initial repugnance for killing by developing specific guidelines for permitting killing under strict conditions. This took place with respect to capital punishment and a just war, for example. One wonders why in the least objectionable instance, when a person is already dying, suffering, and repeatedly requesting assistance in dying, there is still such widespread condemnation of assisted suicide and euthanasia. In a Gedankexperiment, I suggest that certain stories of martyrdom in the history of the Christian Church shed some light on the role of taking one's life, or putting one's life in danger out of love. I further suggest that requesting assisted suicide and/or euthanasia from the motive of love of one's family or care givers might possibly qualify as one instance of justifiable euthanasia, although I acknowledge that the Church will not be making changes in its stance any time soon.