Suicide

Suicide (from Latin sui caedere, to kill oneself) is the act of willfully ending one's own life. Suicide is sometimes used as a noun for one who has committed or attempted the act.

The terminology and its implications

Suicide can be stigmatized or honored, depending on cultural context and its apparent reasons. Those experiencing suicidal ideation, or thoughts about fatally harming one's self, may struggle to be heard and understood. The person feeling suicidal may often be made to feel rejected and guilty by those they have confided their thoughts and feelings to - sometimes even by mental health professionals - accusing them of trying to hurt the feelings of the friends or family they just confided to, or of making suicide 'threats', or they might indeed be attempting to manipulate others. This can lead to situations wherein relatives and friends of a person who committed suicide without telling anyone then proceed to question why the person never told them. ^{[citation needed]} Suicidal ideation may result from the experience of emotional pain outweighing the individual's coping strategies and resources for dealing with that pain. Some would claim that it can arise due to an individual's unwillingness to impose self-discipline and care about others more than him or herself; however, this idea ignores the ever-present emotional agony and feelings of immense hopelessness that many people with suicide ideology feel, and this idea is often used by family or others to instill shame or guilt in a person with suicidal thoughts ^{[citation needed]}, in order to avoid a suicide. It may work in some cases, but in others it may only cause a person to continue suffering for the sake of other people, without really addressing their own problems. ^{[citation needed]}

The perception of suicide is highly varied between the cultures, religions and legal and social systems of the world. It is considered a sin or immoral act in many religions, and a crime to help someone commit suicide in some countries. On the other hand, some cultures have viewed it as an honorable way to exit certain shameful or hopeless situations. Persons attempting or dying by suicide sometimes leave a suicide note.

Strictly, suicide is defined thusly: the death of the person who commits suicide must be the central component and only intention of the act, rather than a secondary consequence of an act which is centrally motivated by religion, politics, etc.

A suicide attack is an attack carried out on an enemy at the cost of the attacker's life. It is not a suicide in the abovementioned strict sense.

Martyrdom usually escapes religious or legal proscription. Generally, there are only legal consequences when there is death and proof of intent. However, not all follow this narrower definition. Certainly, a suicide bomber knows that death will be part of the outcome of his or her actions.

Defined as above, acts of suicide are necessarily committed only by human beings. No other known healthy organism possesses both the will and the capability to intentionally terminate its own life for the sole sake of death. There is some dispute over this with cases being reported of dolphins in captivity bashing their heads against walls, or not coming up for air. However, there are organisms that intentionally end their lives due to sickness or as a suicide attack.^[1]

Causes of suicide

No single factor has gained acceptance as a universal cause of suicide. However, depression is a common phenomenon amongst those who commit suicide. Other factors that may be related are as follows:

Pain (e.g. physical agony that is not correctable)
Religious reasons (e.g. many suicide bombings in the Middle East have been based on Islamic fundamentalism)
Extreme nationalism (e.g. the Kamikaze, Selbstopfer, and Kaiten suicide weapons)
Stress, sometimes after being the cause of a fatal accident (especially if the victim was their child or significant other)
Crime — Criminals on the run may commit suicide before they're caught, or they may commit suicide right before they get on trial. In these cases, they would rather die than to face the legal and social consequences of their actions.
Mental illness and disability (e.g. depression, substance abuse)
Morbid curiosity (i.e. what is beyond physical life)
Unresolved sexual issues (e.g. unwanted homosexuality^{[citation needed]}, unrequited love)
Adverse environment (e.g. poverty, discrimination, bullying/bullycide)
Poor Education — There have been increasing numbers of reports ^{[citation needed]} of teenage suicides due to their school, lack of freedom, stress of homework, and exams. Often dropouts commit suicide due to having a poor education.
Copy-cat After Kurt Cobain 'suicided' many copy-cat suicides followed.

Medical views on suicide

Modern medicine treats suicide as a mental health issue. Overwhelming suicidal thoughts are considered a medical emergency. Medical professionals advise that people who have expressed plans to kill themselves be encouraged to seek medical attention immediately. This is especially true if the means (weapons, drugs, or other methods) are available, or if the patient has crafted a detailed plan for executing the suicide. Special consideration is given to trained personnel to look for suicidal signs in patients. Depressive people are considered a high-risk group for suicidal behaviour. Suicide hotlines are widely available for people seeking help. However, the negative and often too clinical reception that many suicidal people receive after relating their feelings to health professionals (threats of institutionalization, simply increasing dosages of medication, the stigmatization of suicide as a topic of discussion, etc), often causes them to keep their suicidal thoughts to themselves.

Methods

In countries where firearms are readily available, many suicides involve the use of firearms. In fact, just over 55% of suicides committed in the United States in 2001 were by firearm^[2]. Asphyxiation methods (including hanging) and toxification (poisoning and overdose) are fairly prevalent as well. Each comprised about 20% of suicides in the US during the same time period. Other methods of suicide include blunt force trauma (jumping from a building/bridge or stepping in front of a train for example), bloodletting (slitting one's wrist or throat), self-immolation, electrocution, car collision, and intentional starvation.

In the Warring States Period and the Edo period of Japan, samurais who have disgraced their honor to their lord and master are ordered to commit harakiri (hara = stomach, kiri = cut) or seppuku, a Japanese suicide method in which the samurai takes a sword and slices into his abdomen, causing a fatal injury. The cut is usually performed diagonally from the top corner of the samurai's writing hand.

Suicide as a form of defiance and protest

File:Thich Quang Duc - Self Immolation.jpg

The self-immolation of Thích Quảng Đức.

Heroic suicide, for the greater good of others, is often celebrated. For instance, Mahatma Gandhi went on a hunger strike to prevent fighting between Hindus and Muslims, and, although he was stopped before dying, it appeared he would have willingly succumbed to starvation. For this, he earned the respect of many.

In the 1960s, Buddhist monks, most notably Thích Quảng Đức, in South Vietnam gained Western praise in their protests against President Ngô Đình Diệm by burning themselves to death. Similar events were reported in eastern Europe, such as the death of Jan Palach following the Soviet invasion of Czechoslovakia. In wars, there have been numerous reports of combatants performing suicidal acts in order to save other soldiers. Not everybody would count all these actions as suicides, as the person's death was clearly not the primary purpose. Opponents argue that these people would probably achieve a comparable result by spending the rest of their lives in active struggle.

Hunger strikes have frequently been used as a form of protest by incarcerated persons, and result in death where neither side in the strike gives way.

Military suicide

In the desperate final days of World War II, many Japanese pilots volunteered for kamikaze missions in a last attempt to forestall defeat for the Empire. The degree to which these pilots were engaging in heroic, selfless action or whether they faced immense social pressure is a matter of historical debate. The Japanese also built one-man "human torpedo" suicide submarines. However, suicide has been fairly common in warfare throughout history. Soldiers and civilians committed suicide to avoid capture and slavery (including a wave of German and Japanese suicides in the last days of World War II). Commanders committed suicide rather than accept defeat. Behavior that could be seen as suicidal occurred often in battle. For instance, soldiers under cannon fire at the Battle of Waterloo took fatal hits rather than duck and place their comrades in harm's way. The Charge of the Light Brigade in the Crimean War, Pickett's Charge at Gettysburg in the US Civil War , and the charge of the French cavalry at Sedan in the Franco-Prussian War were assaults that continued even after it was obvious to participants that the attacks were unlikely to succeed and would probably be fatal to most of the attackers. Japanese infantrymen usually fought to the last man, launched "banzai" suicide charges and committed suicide during the Pacific island battles in World War II. In Saipan, Okinawa, civilians joined in the suicides. Suicidal attacks by pilots were common in the 20th century: the attack by U.S. torpedo planes at the Battle of Midway was very similar to a kamikaze attack. Argentinian fighter pilots made suicide attacks on British ships during the Falklands War in 1982.

This particular reference to suicide is also what leads to the everyday usage of the term when indicating a hopeless situation, often in business, such as "it would be suicide for us to go to market without a viable product."

Debate over suicide

There are arguments in favor of allowing an individual to choose between life and suicide. This view sees suicide as a valid option and a human right and argues that no being should be made to suffer unnecessarily. This view notes that suicide provides an escape from suffering in certain circumstances, such as incurable disease or mental illness, and old age. These theories are most commonly held in Continental Europe, where euthanasia and other such topics are discussed in parliament, unlike the US, with its strong Christian leanings. ^{[citation needed]}

This view rejects the widespread ^{[citation needed]} belief that suicide is always or usually irrational, saying instead that it is a genuine, albeit severe, solution to real problems – a line of last resort that can legitimately be taken when the alternative is considered worse.

On the other hand, a young and healthy person, free from any major trauma in their past, in their opinion free from any mental disorders, and with a future even regarded as bright by observers, can come to the decision that they don't find life rewarding and that they wish to end their experience then and there. This is usually met with a negative reaction, and these persons are often persuaded from their feelings and beliefs, while others choose to disregard such pressures. Those who ultimately kill themselves under these circumstances might argue that going to heaven, or the "peace of nothingness" that comes with death, is much more appealing than the experiences they expect to have in this world. They may feel too eager for this better state of (non)existence to wait, especially during modern times in which the human lifespan is progressively increasing.

In the past, the Japanese were sometimes ordered by their superiors to commit harakiri, a form of ritual disembowelment suicide. This was expected as a matter of honor where staying alive committed a greater dishonor to their family. They may also have done it as a matter of free choice, also for the sake of honor, and it was considered better than being taken prisoner. Achieving a placid indifference to life or death was considered a state of enlightenment in certain Buddhist traditions.

Epidemiology

According to official statistics, about a million people commit suicide annually, more than those murdered or killed in war. ^[3]. As of 2001 in the USA, suicides outnumber homicides by 3 to 2 and deaths from AIDS by 2 to 1 ^[4]

Many theories have been developed to explain the causes of suicide with no strong consensus with one. Nevertheless, from the known suicides, certain trends are apparent:

Gender and suicide: In the Western world, males die much more often than females by suicide, while females attempt suicide more often. Some medical professionals believe this is due to the fact that males are more likely to end their life through violent means (guns, knives, hanging, drowning, etc.), while women primarily overdose on medications. Others ascribe the difference to inherent differences in male/female psychology, with men having more of an operational mindset and women being more aware of social nuance. In any case, violent suicide attempts are much more likely to be successful. ^[5] Typically males die from suicide three to four times as often as females.

Excess male mortality from suicide is also evident from data from non-western countries. In 1979-81, the number of countries with a non-zero suicide rate was 74. Two of these reported equal rates for the sexes: Seychelles and Kenya. Three countries reported female rates exceeding male rates: Papua-New Guinea, Macao, French Guiana. The remaining 69 countries had male suicide rates greater than female suicide rates. ^[6]

Barraclough found that the female rates of those aged 5-14 equaled or exceeded the male rates only in 14 countries, mainly in South America and Asia. ^[7]

National suicide rates sometimes tend to be stable. For example, the 1975 rates for Australia, Denmark, England, France, Norway, and Switzerland, were within 3.0 per 100,000 of population from the 1875 rates (Australian Bureau of Statistics, 1983; Lester, Patterns, 1996, p. 21). The rates in 1910-14 and in 1960 differed less than 2.5 per 100,000 of population in Australia, Belgium, Denmark, England & Wales, Ireland, Japan, New Zealand, Norway, Scotland, South Africa, Spain, Sweden, and The Netherlands (Lester, Patterns, 1996, p. 22).

There are considerable differences between national suicide rates. Findings from two studies showed a range from 0.0 to more than 40 suicides per 100,000 of population. ^[8]

National suicide rates, apparently universally, show an upward secular trend. This trend has been well documented for European countries. ^[9] The trend for national suicide rates to rise slowly over time might be an indirect result of the gradual reduction in deaths from other causes. Falling death rates from causes other than suicide uncover hidden suicide predisposition. This uncovering effect is due to suicide, up to now, not being preventable. ^[10] ^[11] Consistent with this interpretation, between 1971 and 1991, the Australian male suicide rate was rising while the overall mortality rate for Australian males was falling ^[12]

There is a common belief, especially in the US, that Sweden has a higher rate of suicide than other countries; this is actually a myth, as Sweden has an average suicide rate. The myth was probably started because the secular government of Sweden started to measure suicide statistics openly before other countries did. President Eisenhower saw this as a chance to promote his political ideology, and maintained that the statistics showed Sweden was the country of "free love, high taxes and suicide" (none of this was particularly true at the time). Also, the dark, relatively cold climate of Sweden in the winter has added fuel to this myth. (see "Suicide and Season" below).

Race and suicide. At least in the USA, Caucasians commit suicide more often than African-Americans do. This is true for both genders. Non-Hispanic whites are nearly 2.5 times more likely to kill themselves as blacks or Hispanics. ^[13]

Age and suicide At least in the USA, males over 70 commit suicide more often than younger males. There is no such trend for females. Older non-Hispanic white men are much more likely to kill themselves than older men or women of any other group, which contributes to the relatively high suicide rate among whites. White men in their 20s, conversely, kill themselves only slightly more often than black or Hispanic men in the same age group.

Season and suicide People commit suicide more often during spring and summer. The idea that suicide is more common during the winter holidays (including Christmas in the northern hemisphere) is actually a myth.^[14]

Combination of homicide and suicide

Since crime just prior to suicide is often perceived as being without consequences, it is not uncommon to combine homicide with suicide. Motivations may range from guilt, to evading punishment, to insanity, to killing others as part of a suicide pact.

Attempted suicide and parasuicide

Many suicidal people participate in suicidal activities which do not result in death. These activities fall under the designation attempted suicide or parasuicide. Generally, those with a history of such attempts are almost 23 times more likely to eventually end their own lives than those without.^[15]

Sometimes, a person will make actions resembling suicide attempts while not being fully committed, or in a deliberate attempt to have others notice. This is called a suicidal gesture (also known as a "cry for help"). Prototypical methods might be a non-lethal method of self-harm that leaves obvious signs of the attempt, or simply a lethal action at a time when the person considers it likely that they will be rescued or prevented from fully carrying it out.

On the other hand, a person who genuinely wishes to die may fail, due to lack of knowledge about what they are doing; unwillingness to try methods that may end in permanent damage if they fail or harm to others; or an unanticipated rescue, among other reasons. This is referred to as a suicidal attempt.

Distinguishing between a suicidal attempt and a suicidal gesture may be difficult. Intent and motivation are not always fully discernible since so many people in a suicidal state are genuinely conflicted over whether they wish to end their lives. One approach, assuming that a sufficiently strong intent will ensure success, considers all near-suicides to be suicidal gestures. This however does not explain why so many people who fail at suicide end up with severe injuries, often permanent, which are most likely undesirable to those who are making a suicidal gesture. Another possibility is those wishing merely to make a suicidal gesture may end up accidentally killing themselves, perhaps by underestimating the lethality of the method chosen or by overestimating the possibility of external intervention by others. Suicide-like acts should generally be treated as seriously as possible since if there is an insufficiently strong reaction from loved ones from a suicidal gesture, this may motivate future, more committed attempts.

In the technical literature the use of the terms parasuicide, or deliberate self-harm (DSH) are preferred – both of these terms avoid the question of the intent of the action.

An important difference to note is that self-harm is not a suicide attempt. There is a non-causal correlation between self-harm and suicide; individuals who suffer from depression or other mental health issues are also more likely to choose suicide. DSH is far more common than suicide, and the majority of DSH participants are females aged under 35. They are usually not physically ill and while psychological factors are highly significant, they are rarely clinically ill and severe depression is uncommon. Social issues are key – DSH is most common among those living in overcrowded conditions, in conflict with their families, with disrupted childhoods and history of drinking, criminal behavior, and violence. Individuals under these stresses become anxious and depressed and then, usually in reaction to a single particular crisis, they attempt to harm themselves. The motivation may be a desire for relief from emotional pain or to communicate feelings, although the motivation will often be complex and confused. DSH may also result from an inner conflict between the desire to end life and the desire to continue living. See the article on self-harm for an in depth discussion.

Distinction between suicide and attempted suicide

An important distinction has also been made (see Erwin Stengel, 'Suicide and Attempted Suicide') between those who kill themselves and did not mean to, and those who did not kill themselves but did mean to. Thus a 'Suicide' (noun) may either succeed or fail in his/her goal (i.e. succeed in killing himself/herself or not) and an 'Attempted Suicide' (noun) may either succeed or fail in his/her goal (e.g., succeed in 'making a cry for help' or fail and, in doing so, probably die).

This distinction, if correctly drawn, can have important ramifications for the treatment of people who are suicidal. Its definition is when one takes their own life, in other words when a person kills himself or herself. Some people are suicidal and there are many “symptoms” that we can be observant of that can assist us in picking out those who are contemplating suicide. Some of these include a person who has a number of problems in their life which they think have no solution, a person becoming abnormally violent, depressed, becoming drawn to themselves, etc. Some people turn to other means whilst trying to deal or overcome their irrational thoughts and behavior, this might include the consumption of drugs, alcohol, etc. and as a result, their problem only ends up getting worse than it originally was. Most people who try and commit suicide but fail in doing so, very often try again. This is why it is so important to identify these suicidal people before it’s too late ^{[neutrality is disputed]}. Statistics have shown that 4 in every 10 people ^{[citation needed]}, who think about suicide, finally do commit. Most countries have introduced special facilities such as “the lifeline” which is aimed at helping those who are at the brink of suicide. ^{[citation needed]} There are also workshops, which are being carried out and have the same aim. In these workshops, you can speak to trained professionals and motivational speakers who will do all that are possible to help you.

Impact of suicide on family and friends

It is estimated that an average of six people are affected for each suicide in the United States^[16]. As with any death, family and friends of a suicide victim feel grief associated with loss. However, these "survivors" are often overwhelmed with psychological trauma as well, given that most suicides are unforseeable and sudden. This trauma can leave survivors feeling guilty, angry, remorseful, helpless, and confused. It is difficult for survivors because many of their questions as to why the victim felt the need to take his or her own life are left unanswered. Furthermore, many survivors feel that they have failed or that they should have intervened in some way. Given the complex set of emotions associated with a loved one's suicide, survivors usually find it difficult to discuss the death with others and thus feel isolated from their own network of family and friends. In addition, survivors begin to feel hesitant in forming new relationships ^[17].

"Survivor groups" can offer counseling and help bring many of the issues associated with suicide out into the open. They can also help survivors reach out to their own friends and family who may be feeling similarly and thus begin the healing process. In addition, counseling services and therapy can provide invaluable support to the bereaved. There are also online support groups that provide a forum for discussion amongst survivors of suicide (see Support Groups for Survivors under External Links section below).

Suicide in literature

Suicide has been used as a dramatic plot element in a number of literary works, such as The Virgin Suicides, The Sorrows of Young Werther, Madame Bovary, The Sound and the Fury, The Hours, Anna Karenina, Miss Julie, A Long Way Down, Hamlet, Brave New World, The Bell Jar, Demons, Everything is Illuminated, A Perfect Day for Bananafish, Umberto D, The Awakening, Romeo and Juliet, Julius Caesar, Death of a Salesman, Groundhog Day, The Count of Monte Christo, Million Dollar Baby, Macbeth, Stranger in a Strange Land, The Shawshank Redemption, The Juggler, Chushingura, Burmese Days, The Great Gatsby, Veronika Decides to Die, The Driver's Seat and Survivor. Robert E. Howard wrote several poems, including The Tempter, about suicide.

References

^ Doug (SDSTAFF) (2001-02-01). "Does any animal besides humans commit suicide?". The Straight Dope. Retrieved 2006-04-12.{{cite web}}: CS1 maint: year (link)
^ http://www.preventsuicidenow.com/suicide-statistics.html
^ "Suicide prevention". WHO Sites: Mental Health. World Health Organization. February 16, 2006. Retrieved 2006-04-11.{{cite web}}: CS1 maint: year (link)
^ "Teen Suicide Statistics". Adolescent Teenage Suicide Prevention. FamilyFirstAid.org. 2001. Retrieved 2006-04-11.
^ Cantor CH. Suicide in the Western World. In: Hawton K, van Heering K, eds. International handbook of suicide and attempted suicide. Chichester: John Wiley & Sons, 2000: 9-28.
^ Lester, Patterns, Table 3.3, pp. 31-33
^ Barraclough,B M. Sex ratio of juvenile suicide. Journal of the American Academy of Child & Adolescent Psychiatry, 1987, 26, 434-435.
^ La Vecchia, C., Lucchini, F., & Levi, F. (1994) Worldwide trends in suicide mortality, 1955-1989. Acta Psychiatrica Scandinavica, 90, 53-64.; Lester, Patterns, 1996, pp. 28-30.
^ Lester, Patterns, 1996, p. 2.
^ Baldessarini, R. J., & Jamison, K. R. (1999) Effects of medical interventions on suicidal behavior. Journal of Clinical Psychiatry, 60 (Suppl. 2), 117-122.
^ Khan, A., Warner, H. A., & Brown, W. A. (2000) Symptom reduction and suicide risk in patients treated with placebo in antidepressant clinical trials. Archives of General Psychiatry, 57, 311-317.
^ Jain, 1994, p. 18
^ [1] Template:PDFlink
^ "Questions About Suicide". Centre For Suicide Prevention. 2006.
^ Shaffer, D.J. (1988). "The Epidemiology of Teen Suicide: An Examination of Risk Factors". Journal of Clinical Psychiatry. 49 (supp.): 36–41. PMID 3047106. {{cite journal}}: |access-date= requires |url= (help); Cite has empty unknown parameter: |coauthors= (help); Unknown parameter |month= ignored (help)
^ http://www.suicidology.org/displaycommon.cfm?an=6
^ http://www.faqs.org/faqs/suicide/info/

External links

Crisis lines

National Suicide Prevention Lifeline: 1-800-273-TALK (8255) - a 24-hour toll-free suicide prevention helpline, United States
Suicide Prevention Center, Los Angeles - a 24-hour suicide prevention helpline, toll-free in LA Country, United States
Suicide Hotlines - listing of suicide prevention lines in the United States and around the world. Look here to find a crisis line near you.
The Trevor Helpline: 1 866 - 4U TREVOR - nationwide, 24-hour, free, confidential suicide helpline for gay and questioning teenagers, United States. See The Trevor Project article.

Support groups

Samaritans (UK) - 24-hour support help, United Kingdom
TakeThisLife.com - a community offering support and hope to people with depression or suicidal thoughts
#alt.suicide.bus.stop (ASBS) - a support group for the suicidal, by the suicidal
Befrienders Worldwide - information about suicide for most countries
The Suicide Forum - a support forum for people in crisis
Open Directory Project: Mental Health: Disorders: Suicide: "'Support Groups'" - support groups for suicidal people

Support groups for survivors

American Association of Suicidology - Referrals to local self help groups for survivors of suicide across the United States
Heartbeat - Mutual support for those who have lost loved ones to suicide
SOLOS - Survivors of Loved Ones Suicides, offers various e-mail based support groups
SOLES - Survivors of Law Enforcement Suicide
International Friends and Families of Suicide - Online support for survivors internationally
Parents of Suicide - Support via chatrooms and email for those who have lost sons or daughters to suicide

Suicide prevention

Foundation for Suicide Prevention
metanoia.org/suicide - suicide prevention page
"Understanding and Helping the Suicidal Person" - information on suicide prevention
TeenSuicide.us - teenage suicide prevention information
Choose Life - suicide prevention in Scotland
The Debate: a pro-choice FAQ
Teenage Suicide: Identification, Intervention and Prevention - discussion of teenage suicide prevention
Suicide and the Exceptional Child - discussion of suicide prevention in children
Suicide and Sudden Loss: Crisis Management in the Schools - discussion of suicide prevention in schools