Monday, March 22, 2010

The Many Faces of Suicide

During my first two decades of life, I strongly held the belief that suicide was the ultimate act of failure - at least for myself. Looking back on the suicides that entered my life when I was younger, I don't remember ever feeling disdain for the victim, but I do remember feeling very confused by their acts. My views on suicide became a little less black and white when a friend of mine took a job in a toxicology lab at a local hospital. Her greatest surprise was finding out that many people who overdosed on their medicines or sleeping pills weren't actually trying to end their life. When questioned after being revived, most of them were operating on the misjudgment that if they could sleep a few days straight or just increase their dosage, their bodies and/or minds would be healed and they would be able to live productive lives again. As she put it, "These people could have killed themselves and have no idea of what they had done until they entered the hereafter."

Another loosening of my views on suicide came when I entered treatment for clinical depression. I insisted quite fervently to my psychologist that not only was I not suicidal, but I would never even considered taking my own life because "that would mean that I screwed up my life so badly that not even God could fix it." He looked at me for a moment and then asked me if I had ever had any self-destructive thoughts or acts. I burst into tears. Despite my beliefs, I had indeed had those thoughts - to the point where I could not leave sharp knives out in the open, because I would have visions of me cutting myself in ways that would have lead to my death, had I done them. It was something I guarded against diligently. Every time I used a knife, it was either washed right then and put back in the drawer, or went immediately into the dishwasher. If neither option was available at that moment, it went under a dishcloth. It had to be out of my sight. I even moved my sharp knives to a separate drawer, so I wouldn't see them while getting other utensils. This experience taught me that even people who believed strongly against suicide, could have those type of thoughts.

Sociologist Emile Durkheim studied the social factors of suicide back in the late 1800s. While we tend to think of suicide as a highly individualistic act, it occurs within a social framework that shapes those acts. His research proposed four types of suicidal acts:

Egotistic suicide - These are people who are not well-integrated into the social network around them. Without the social bonds to fall back on for support and guidance, they are left to face their problems alone. These people can be disaffected for a variety of reasons: they're part of undesirable social group; they're highly individualized people; or they have an illness or disorder that makes creating social bonds difficult.

Altruistic suicide - These are people who are overly integrated into the social network around them. This is the kamikaze pilot, the suicide bomber, and the self-martyr. These people kill themselves in the belief that it will save others.

Anomic suicide - This happens when someone loses their standing in their social network. They are no longer guided by the rules they had come to depend upon, because those rules are either no longer relevant or have completely failed them. These are the people who suddenly lost their jobs or social positions, due to things like financial downturns, divorce, or scandal. Not knowing where they now fit into society, they decide that they no longer have a place in it.

Fatalistic suicide - These people are overly controlled by society, whose only real "freedom" is killing themselves. These people include slaves, prisoners and those oppressed by a totalitarian regime.

But social networks are not the only factor in suicidal behavior. Age and level of development is also a great influence on how and why suicide is committed. While it is a difficult concept for even professionals to come to terms with, pre-adolescent children do commit suicide. It's rare, but it does happen in situations where the family bond is weak (strong families rarely tell each other they wish that other family members were dead), especially if the child knows of others who have committed suicide. Children are more likely to commit suicides that can be dismissed as accidents, such as running into traffic or falling from high places. That's not to say that every child that dies this way has committed suicide--far from it. Accidents still are a major reason for childhood deaths; however, for a child who wants to end his/her life, doing similar acts on purpose is the easiest way to achieve their goal.

Adolescents are one of the most likely groups for committing suicide. It is the second highest cause of death for those between the ages of 15 to 24. The lack of problem solving skills among adolescent suicide victims, as well as the lack of parental bonding and guidance probably explains the cut-off point around age 24, which is around the time that the frontal lobes in the brain have finished developing. So it's possible that even those who have an elevated risk will have improved judgment by then. Rick factors include: poor parental-attachment; deficient problem-solving skills; alcohol and drug use in the family; seeing themselves different than their parents; socio-ecomonic adversity; exposure to sexual abuse; high rates of neuroticism; novelty; depression; anxiety; and conduct disorder. There is also a social element involved. Adolescents are more susceptible to cluster suicides--suicides triggered by other who have committed suicide. The attention give to the first suicide victim after the fact can appear to be the type of validation the following victims hope for, though they fail to take in account that they won't actually benefit from it. For this reason, some psychologists are warning Cornell University to be careful how they memorialize the students who have recently comment suicide there.

Adults over 25 who commit suicide are another class, altogether. For one thing, they are less likely to state their suicidal intentions in direct ways. Instead they will talk about not being useful or not being able to stand their current situation anymore. While some, due to delayed development, will behave similar to the adolescent group, most suicidal people from ages 25 to 65 suffer from anomic stressors like job losses, financial and health problems, loss of a loved one, as well as drug use, depression, and hopelessness. Behavioral signs are very similar to clinical depression, with the exception of gettings one's affairs in order. They tend to withdraw from others and start having troubles with sleeping, concentrating, and eating.

Elderly people are largest group to commit suicide and that's not even including those who commit chronic or passive suicide by letting their illnesses have their way or just stop eating and drinking. The group most likely to commit overt suicide in the US are 85 year old white males. The elderly are the most successful at their attempts and the least likely to give any warning of their intentions. Unlike younger people, the elderly rarely use suicide as a threat. Their reasons are often more calculated than emotional. Lack of finances and increases in health care cost often figure prominently in their decision, though depression, isolation, and lack of activity can be major factors. They will often have everything in order to make things easier on their loved ones. During my gerontology studies, a classmate gave a presentation on senior suicides. I will never forget the story she shared of a couple in their 80s, who not only had a file near them containing all their important papers and instructions for their children, but even went as far as laying on trash bags to make the clean up easier. Even my death, dying, and bereavement textbook gives a similar example of elderly suicide.

One type of suicide risk not covered so far is one I'm not sure the mental health industry really has a proper name for - suicidal thoughts caused by medication. Granted, most of these people probably have other risk factors, but based on personal experience, this is not something to tack on just as a footnote. A few years ago, I was placed on blood pressure medication because while my blood pressure wasn't in the danger zone, it was high enough to cause concern with my other medical problems. The first medication I was put up seriously messed with my attention and memory. I stopped driving my car because twice I forgot how to drive. Luckily, both times were in parking lots, and after a few moments I could call up enough of my memory to get me back home. When it became obvious that this side effect was not going to go away, I was switched to another medication. Within a day, I started to have suicidal thoughts. As a precaution, I put my knives out of easy reach. I challenged the thoughts each time they surfaced. Two days later, I took myself off the medication because not only were the thoughts coming just minutes apart, but when I tried to supress them, I began to get suicidal images. Within sixteen hours, I was no longer having those persistant thoughts. I later brought my blood pressure down dramatically by severely limiting the time I spent with negative relatives.

If you experience something similar, it would probably be a good idea to follow the first aid guides at WebMD for suicidal thoughts and not follow my example too closely.

And a final note: Recent studies have shown that animals do commit suicide. While I expected there to be suicides along the lines as the passive suicide done by seniors, having seen a few beloved pets go through this, I had not expected the evidence of animals committing altruistic suicides to protect their population. I do appreciatiate the following statement: "The big difference is that in modern humans that calculation can go wrong. There are some acts of suicide that do save lives. But most of the millions or so human suicides each year worldwide benefit no one, [Thomas] Joiner explained. They are acts that perhaps used to serve a purpose in early human societies, he said, but have lost their function in the modern world."

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