PSYC 316 Book Notes Chapter 7
PSYC 316 Book Notes Chapter 7 ILAS 261
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Chapter 7 Suicide o Parasuicide a failed suicide attempt does not end in death of the individual What is Suicide Suicide intentional selfin icted death Death Seekers those with a clear intention to end their lives at the time of their suicide attempt intention may last a short time possibly changing to confusion within the hour or the next day and return shortly after EDWIN SHNEIDMAN Death Initiators individuals with a clear intent to end their lives but acting in beliefs that since death is already inevitable they are just bringing it upon themselves faster Death Ignorers selfin icted death is not believed to be the end of the individual s existence but that they are trading their present existence for a better one Death Darers those experiencing mixed feelings about their intentions to die even up until the moment of their attempted suicidewhile they do wish to die their risky behavior does not guarantee death Behavioral Patterns Subintentional Death the individual plays an indirect covert partial or unconscious role in their own death SelfInjury SelfMutilation harmful behavior such as cutting burning oneself or banging one s head NonSuicidal SelfInjury intentional selfinjury without suicidal intent at least 5 occasions over a oneyear period A How is Suicide Studied 1 Retrospective Analysis since the individuals studied are no longer alive this form of studying aids in understanding suicide Researchers analyze the suicide victim s past friends relatives therapists or physicians may recall the victim s past statements conversations and behaviors that may explain the suicide Suicide notes may also be a useful source of information that aids in the understanding Unfortunately not all sources of information are helpful or reliable 2 Studying Peonle Who Survive Their Suicide Attempts There are about 820 failed suicide attempts for every successful one Those that survive may signi cantly differ from those who have succeeded many may not have really wanted to die B Patterns and Statistics 1 Suicide Rates Vary from Country to Country a South Korea Russia Hungary Germany Austria Finland Denmark China and Japan over 20 suicides annually per 100000 people b Egypt Mexico Greece and Spain relatively low rates less than 5 suicides annually per 100000 people c The United States and Canada 115 suicides annually per 100000 people d England 9 suicides annually per 100000 people 2 Religious Affiliation and Beliefs a Countries that are largely Catholic Jewish or Muslim typically have lower suicide rates These religions display strict prohibitions against suicide l Exceptions Austria is a largely Roman Catholic country however it has one of the highest suicide rates in the world b Research has suggested that religiosity may not aid in suicide prevention as much as an individual s devoutness to their religion particularly religious individuals appear to be less likely to commit suicide Gender a 3 times more women than men attempt suicide b Many men succeed four times the rate of women 1 Men tend to employ more violent methods such as shooting stabbing or hanging a Guns are used in 23 of male suicides compared to the 40 of women s suicides in the US 2 Women use less violent methods such as drug overdose c Suicide rates are higher in divorced individuals compared to married or cohabiting individuals US Suicide Rates Vary Across Race a White American s suicide rates are around twice as high as that of African Americans Hispanic Americans and Asian Americans 1 Exception American Indians have 15 times the suicide rate of the national average Factors that may serve to explain these statistics include extreme poverty alcohol use modeling and the availability of guns b Among Hispanic Americans Puerto Ricans are signi cantly more likely than others of this group c Questionable Statistics members of the following groups may be mistakenly categorized as suicide victims due to the likelihood of their chosen methods of suicide accidental deaths due to poisoning drug overdose singlecar crashes and pedestrian accidents 1 African American s suicide rates may be 15 higher than reported 2 Women s suicide rates may be 6 higher than reported 11 What Triggers a Suicide A Stressful Events and Situations Immediate Stress may lead to suicide as well as LongTerm Stress 1 Social Isolation individuals that lack social support are more vulnerable to suicidal thoughts and actions Serious Illness individuals suffering from painful illnesses or severe disabilities may attempt suicide due to the belief that death is unavoidable and imminent or that their suffering is unbearable Studies suggest that around 13 of suicide victims were in poor physical health in the months prior to their suicide 3 Abusive Environment victims of abuse prisoners of war concentration camp inmates abused spouses and children feeling as if their situation is hopeless or inescapable sometimes commit suicide 4 Occupational Stress research shows particularly high suicide rates due to jobrelated tension dissatisfaction exist among psychiatrists psychologists physicians nurses dentists lawyers and police of cers B Mood and Thought Changes 1 Hopelessness pessimistic belief that their current problems mood or overall situation will not change Hopelessness for some clinicians is the most likely indicator of suicidal intent 2 Dichotomous Thinking viewing problems and solutions in rigid eitheror terms C Alcohol and Other Drug Use 1 Study Results a Around 70 of individuals who attempt suicide drink alcohol prior to the act b Autopsies show that about 14 of these individuals are legally intoxicated 2 Possible Explanations a Alcohol lowers inhibitions and the individual s fears of committing suicide and releases underlying feelings of aggression or impairs judgement and problemsolving abilities 3 The use of other drugs may have a similar relationship to suicide D Mental Disorders 1 Around 7 0 of all suicide victims had been experiencing severe depression 20 from chronic alcoholism 10 from schizophrenia a As many as 25 of individuals suffering from these disorders attempt suicide b Depressed individuals that are also dependent on alcohol seem particularly prone to suicidal tendencies c Many individuals with Borderline Personality Disorder attempt selfharm or suicidal tendencies as part of their disorder d Individuals suffering from schizophrenia are sometimes believed to have responded to hallucinations or delusions that suggest suicide 2 Individuals suffering from Maj or Depressive Disorder frequently have suicidal thoughts a Treatments for depression can reduce the rate of suicidal thoughts attempts or completions among patients 3 In individuals with serious physical illnesses severe depression may in uence suicide attempts a Study Results under 14 of 44 terminally ill patients had suicidal thoughts or desired an early death All of these individuals were suffering from a major depressive disorder 4 Those who drink alcohol or use drugs before a suicide attempt typically have a long history of substance abuse but the link between substance use disorders and suicide is unclear It is assumed that their tragic lifestyles or their sense of hopelessness in their entrapment by substance leads to suicidal thoughts 5 Psychological pain or desperation may cause substance abuse and suicidal thinking E Modeling The Contagion of Suicide Teenagers in particular are among individuals that may try to commit suicide after becoming aware of another individual who has committed suicide Family Members and Friends an individual s likelihood to commit suicide is increased if a family member or friend has committed suicide a Social Contagion Effect the risk of suicide increases among the relatives and friends of a suicide victim Celebrities according to research the number of suicides nationwide increases following the suicide of entertainers political gures and other wellknown individuals Other Highly Publicized Cases if a suicide with unusual or bizarre aspects are intensely covered by the media it may lead to similar suicides Following a highly publicized politicallymotivated selfbuming in England 82 other individuals many with histories of emotional problems followed suit even if their motives were not politically motivated Coworkers and Colleagues News of a suicide in schools workplaces or small communities may trigger additional suicide attempts in other individuals a Postvention support programs put in place after a student commits suicide 111 What Are the Underlying Causes of Suicide A The Psvchodvnamic View an individual s suicide results from depression and anger at others that is redirected back to the individual 1 3 Freud and Abraham when individuals eXperience real or symbolic loss of a loved one they unconsciously merge the lost person into their own identity and feel towards themselves the way they felt for the lost person Negative feelings toward the lost loved one turn into selfhatred turn into intense anger against themselves and lead to depression sometimes ending in suicide More From Freud a According to our friend Freud human beings have a basic death instinct or T hanatos that opposes the life instinct He believed that while most individuals learn to redirect their death instinct by aiming it at others suicidal individuals direct it toward themselves b At the end of his career Freud came to disagree with his own theory of suicide but themes of loss and selfdirected aggression have remained central in most psychodynamic explanations Study Results b An examination of 200 family histories found that early loss of a parent was much more common 48 among individuals that attempted suicide than among nonsuicidal individuals 24 A study on 343 depressed individuals showed that those who as children felt rejected or neglected by their parents were more likely than other individuals to attempt suicide as adults B Durkheim s Sociocultural View 1 Durkheim believed that the probability of suicide is determined by how attached a person is to family religious groups and their community Stronger ties to community groups decreases the likelihood of suicide 3 b d Egoistic Suicide victims are those whom society cannot control those who are unconcerned with societal norms and do not integrate themselves into the society The individual intentionally sacri ces their life for the society s wellbeing Altruistic Suicide victims are those who are exceptionally wellintegrated into social structure and intentionally sacrifice their lives for society s wellbeing Anomic Suicide suicides committed by individuals whose social environment does not provide stable structures family religion etc to support and give meaning to the individuals lives 1 Anomie without law 2 Durkheim believed that when societies go through periods of anomie suicide rates increase 3 Maj or changes in a person s immediate surroundings can also lead to anomic suicide 4 Societies with greater opportunities for change in individual wealth or status would have higher suicide rates Durkheim s ideas are not all accepted by today s sociocultural theorists but most agree that social structure and cultural stress are in uential roles in suicide Durkheim s theories cannot completely explain while some individuals experience social pressures and commit suicide while others in the same situation do not C The Bioloeical View 1 Family Pedigree Studies have been the main source of support for the belief that biological factors contribute to suicidal behavior there were higher rates of suicide found among parents and close relatives of suicidal individuals than among those of nonsuicidal individuals Serotonin activity has been found to be low in suicide victims a Study Results Marie Asberg and colleagues studied 68 depressed patients and found that 20 of them had lower levels of serotonin activity 40 of these individuals attempted suicide while the 15 of higherserotonin individuals did not 1 These researchers believed that low serotonin activity may be a predictor of suicidal acts 2 Later studies found that lowserotonin individuals are 10 times more likely to repeat a suicide attempt and succeed compared to individuals with higherserotonin and commit suicide b How does Low Serotonin Activity Increase the Likelihood of Suicidal Behavior 1 it contributes to aggressive and impulsive behaviors 2 serotonin activity is lower in aggressive men than in nonagressive men 3 Low serotonin activity along with key psychosocial factors may be the strongest suicide predictor IV Is Suicide Linked to Ag A Children 1 Over 6 of deaths among children between 1014 years is a suicide 2 Boys Girls 51 3 Suicide attempts among youths are frequently preceded by behavioral patterns such as running away aggression selfcriticism social withdrawal sensitivity to criticism and frustration sleep problems dark fantasies etc 4 Child suicides have been linked to the loss of a loved one experiencing family stress a parent s unemployment or abuse and clinical depression B Adolescents o Suicidal actions are more common after age 14 o Links to teen suicides include o clinical depression low selfesteem feelings of hopelessness anger and impulsiveness and drug or alcohol problems o Longterm pressures resulting from inadequate relationships with parents family con ict inadequate social relationships and social isolation o Immediate Stress parent s unemployment or illness financial issues breakup with a boyfriend or girlfriend o School Stress 1 Teen Suicides Attempts Versus Completions a Attempted vs Successful Suicides 2001 b Possible Explanations for the High Suicide Rates of Teens 1 As the amount of teens and young adults in the general population grows competition for jobs college positions and athletic and academic honors have increased which leads to shattered ambitions and hopes 2 Weakening family ties which may lead to feelings of alienation and rejection 3 The availability of drugs and alcohol and the pressure to engage in use 4 Mass media coverage detailed descriptions of suicide attempts may serve as models for teens considering suicide 5 Prosuicide websites 2 Teen Suicides Multicultural Issues a Teen suicide rates vary across ethnicity in the US 1 75 of every 100000 white American teens commit suicide every year compared to the 5 of every 100000 African American teens and 5 of every 100000 Hispanic American teens 2 Today the white American teen suicide rate is only 50 greater than the African American and Hispanic American suicide rates a Patterns re ect pressures on all groups for good grades college opportunities etc 3 American Indians display the highest teen suicide rates 2 times the rate of white American teenagers 3 times the rate of other minority teenagers b Cluster Suicides certain areas have extremely high suicide rates C The Elderly 1 16 of every 100000 individuals over 75 years in the US commit suicide 19 of all suicides in the US while they account for 12 of the entire US population 2 Possible Explanations for the High Suicide Rates of the Elderly a As people grow older many become ill lose close friends and relatives control over their lives and status in society This leads to feelings of hopelessness loneliness depression and the sense that they are a burden to society 3 Suicide rates of the elderly are lower in certain minority groups a Low rate among the elderly American Indians the elderly are held in high esteem valued respected and looked to for their wisdom b Elderly African Americans have a rate that is 13 that of elderly white Americans V Treatment and Suicide A What Treatments Are Used After Suicide Attempts after the treatment for physical injuries psychotherapy or drug therapy may be used 1 Teens receiving followup care after a suicide attempt attend around 8 sessions About 18 of these teens quit treatment against their therapist s advice 2 Therapy works to keep the individual alive reducing their psychological pain reintroduce hope and help them develop better coping mechanisms for stress 3 Research indicates that CognitiveBehavioral therapy may be one of the most helpful for suicidal individuals B What is Suicide Prevention 1 Suicide Prevention Proqram program that tries to identify individuals that are at risk of suicide and offer crisis intervention a The rst suicide prevention program in the US was founded in Los Angeles in 1955 b Suicide Hotlines 247 telephone services to receive counseling typically from a paraprofessional an individual trained in counseling but without formal degree 2 Crisis Intervention attempting to help suicidal individuals to see their situations more clearly to make better decisions act more constructively and ultimately overcome their crises 3 Establishing a Positive Relationship counselors try to set a positive tone for the discussion convey that they are listening understanding nonjudgmental and available This helps the caller trust and listen to the counselor 4 Understanding and Clarifying the Problem counselors try to understand the caller s crisis and then attempt to help the caller see it clearly and constructively 5 Assessing Suicide Potential Lethality Scale helps counselors estimate the caller s likelihood of committing suicide and helps to determine how to treat the caller Assessing and Mobilizing the Caller s Resources identifying support resources for the caller Formulating a Plan developing a plan of action that includes followup counseling and a No Suicide Contract C Do Suicide Prevention Proqrams Work 1 It is unclear Whether or not suicide prevention centers reduce the amount of suicides in a community 2 Only a small percentage of suicidal individuals contact prevention centers 3 Prevention programs reduce suicide rates among highrisk callers The most effective form of prevention is education Psychache Edwin Shneidman
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