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CHAPTER 12
CHAPTER OUTLINE
I.
Correlates of suicide. People may commit suicide if they feel depressed, like a failure,
as though the quality of their life is poor, unwanted, as though their death is for a
greater good and for many other reasons. Suicide is not a disorder in DSM-IV-TR, but
is important in abnormal psychology, and the suicidal person has clear psychiatric
symptoms. Suicide and suicidal ideation (thinking about it) may be separate from
depression. As a topic, suicide has been hidden, but as the eleventh leading cause of
death in the United States, it is now emerging as a focus of research and social
discussion. Those who complete suicide attempts cannot be asked their reasons.
Patterned after medical autopsies, a psychological autopsy attempts to make
psychological sense of suicide by examining the person’s case history, interviewing
family and friends, and analyzing suicide notes. However, these sources of information
are often unavailable or unreliable. Every sixteen minutes or so, someone in the United
States takes his or her own life. Approximately 31,000 persons kill themselves each
year. Suicide is among the top eleven causes of death in the industrialized parts o f the
world; it is the eighth leading cause of death among American males and the third
leading cause of death among young people ages fifteen to twenty-four. Some evidence
shows that the number of actual suicides is probably 25 to 30 percent higher than that
recorded. Many deaths that are officially recorded as accidental—such as single-auto
crashes, drownings, or falls from great heights—are actually suicides. Suicides among
the young have increased dramatically in the past decade. Reasons for suicide include
hopelessness, loneliness, helplessness, relationship problems, unspecified depression,
money problems, and problems with their parents. Men complete suicide three times as
often as women, but women attempt suicide three times as often. Suicides in the 15 to
24 year-old age group increased more than 40 percent during the past decade, and it is
now the second leading cause of death for that age group. Media reports of suicides,
especially of celebrities, seem to spark an increase in suicide. The complete d suicide
rate for men is about four times that for women, although recent findings suggest that
the gap is closing as many more women are now incurring a higher risk. Further,
women are more likely to make attempts, but it appears that men are more successful
because they use more lethal means. Being widowed as compared to divorced appears to
be associated with higher risk of suicide for white men and women and African
American men. At older ages, however, divorce rather than widowhood increases the
risk. Interestingly, the pattern reversal occurs much earlier among white women than for
men. Physicians, lawyers, law enforcement personnel, and dentists have higher than
average rates of suicide. Among medical professionals, psychiatrists have the highest
rate and pediatricians the lowest. Suicide is represented proportionately among all
socioeconomic levels. Level of wealth does not seem to affect the suicide rate as much
as do changes in that level. Over 50 percent of suicides are committed by firearms, and
70 percent of attempts are accounted for by drug overdose. Men most frequently choose
firearms as the means of suicide; poisoning and asphyxiation via barbiturates are the
preferred means for women. Religious affiliation is correlated with suicide rates.
Although the U.S. rate is 12.2 per 100,000, in countries in which Catholic Church
influences are strong—Latin America, Ireland, Spain, and Italy—the suicide rate is
relatively low. Suicide rates vary among ethnic minority groups in the United States.
American Indian groups have the highest rate, followed by white Americans, Mexican
Americans, African Americans, Japanese Americans, and Chinese Americans. American
Indian youngsters have frighteningly high rates (26 per 100,000) as compared with
white youths (14 per 100,000). As might be expected, suicide is the most frequent cause
of death in U.S. jails. A suicide number that ranges from 90 to 230 per 100,000 means
that the suicide rate in prisons is 16 times higher than in the general population.
II. A multi-path perspective of suicide. Most discussions on the correlates of suicide
seem to stress psychological, social, and sociocultural factors. But biological factors and
the interplay of all four seem to be operating in determining suicides. Two sets of
findings—from biochemistry and from genetics—suggest that suicide may have a strong
biological component. There are many psychological factors that have been found to be
significantly related to suicide. Findings have consistently revealed that a number of
individuals who commit suicide suffer from a DSM-IV-TR disorder. One of the most
consistently reported correlates of suicidal behavior is alcohol consumption . Social
factors that operate to separate people or to make them somehow less connected to other
people or to their families, religious institutions, or their community can increase
susceptibility to suicide. Rates of suicide vary with age, gender, marital status,
occupation, socioeconomic level, religion and ethnic group. Higher rates are associated
with high- and low-status (as opposed to middle-status) occupations, urban living,
middle-aged men, single or divorced status, and upper and lower socioeconomic classes.
III. Victims of suicide. Suicide among the young is an unmentioned tragedy in our society.
We have traditionally avoided the idea that some of our young people find life so
painful that they consciously and deliberately take their own lives. Children and
adolescents take their lives at an alarming rate. Those who attempt suicide tend to show
clinical symptoms of psychological disturbance, to use drug overdose as the method, to
make their attempt at home, and to come from families with high levels of stress as a
result of economic instability, substance abuse, or other life events. Copycat suicides, in
which adolescents imitate media portrayals of other adolescents' suicides, are less
common than the media suggest and tend to occur among those already contemplating
suicide. However, highly publicized suicides can increase the chances of attempts. The
many stresses of life among the elderly place them at high risk for suicide. Suicide rates
are particularly high for white males and first-generation Asian Americans. Native
Americans and African Americans show low rates of suicide among older adults,
although both groups are at high risk during young adulthood.
IV. Preventing suicide.
People who attempt suicide have a wish to live along with a wish to die. They usually
leave verbal or behavioral clues of their intentions, although these may be subtle. A
clinical approach to suicide intervention stresses that most individuals are ambivalent
about ending their lives and that counselors must be comfortable discussing the subject.
Crisis intervention strategies are used to assess lethality, and to abort suicide attempts
by offering intensive counseling to the individual and stabilizing him or her, sometimes
in a hospital environment, while clarifying ways to deal with the crisis. Suicide
prevention centers usually use paraprofessionals to take telephone calls from potentially
suicidal individuals. These paraprofessionals are trained to establish rapport with the
caller, evaluate suicidal potential, clarify the nature of the problem and the caller’s
ability to cope, and recommend a plan of action. There is no conclusive evidence for the
effectiveness of suicide prevention centers. Community prevention efforts can involve
going into a school where a suicide has occurred and educating and providing
counseling to survivors. Such an institutional response serves to minimize the mental
health problems of survivors and can prevent future suicides
V. The right to suicide: Moral, ethical, and legal issues The quality of life is a
significant moral and ethical issue that has led to right-to-die legislation and “living
wills” that are recognized in several states. Dr. Jack Kevorkian, a physician in
Michigan, has assisted patients to commit suicide, an act that a new law states is illegal.
Oregon voters passed a bill to allow physicians to help terminally ill patients die.
VI. Implications. There is a saying that goes like this: “We know much about suicide but
we know very little about it.” While this may sound contradictory, this chapter has been
filled with an impressive array of facts, statistics, and information about many aspects
of suicide. We are able to construct fairly accurate portraits of individuals most as risk,
delineate protective factors, and even develop intervention strategies in working with
suicidal individuals. We know that people commit suicide for many reasons. We know
that biological, psychological, social, and sociocultural factors are related to suicides.