Suicide and Hopelessness

suicide_6697Edwin Shneidman : suicide is associated with thwarted  or unfulfilled needs, feeling of hopelessness, ambivalent conflicts between survival & unbearable stress, narrowing of perceived options & a need for escape; the suicidal person sends out signal of distress.

Suicide is derived from the latin word for self murder.

Epidemiology

US : > 30.000 persons die by suicide each year ; attempted suicides : 650.000

Risk factors :

sex : men commit suicide > 4 X women; women attempt suicide > 4X men

age ; men : suicides peak: >45 years, women > 55 years

marital status : marriage reinforced by children seems to lessen the risk of suicide significantly.

Occupation

a person’s social status        risk of suicide

Fall in social status                risk of suicide

Greatest risk of suicide : professionals, particularly physicians.

Among physicians, psychiatrists are considered to be at greatest risk, followed by ophthalmologist & anesthesiologist, but the trend is toward an equalization among all specialties.

Special at risk populations : musicians, dentists, law enforcement officers, lawyer & insurance agents. Unemployed >> employed persons,

Methods

Men : fire arms, hanging, jumping from high places.

Women : overdose of psychoactive substances or a poison

Globally, the most common method of suicide is hanging

Etiology

Sociological Factors

Emile Durkheim ( French sociologist )

Durkheim’s Theory.

Durkheim divided  suicides into 3 social categories : egoistic, altruistic & anomic.

Egoistic suicide not strongly integrated into any social group. Lack of family integration explains why unmarried persons suicide  >>married; & why couples with children are the best protected group.  Rural communities…

…>> social integration than urban areas; & thus  less suicide.

Altruistic suicide applies to those prone to suicide stemming from their excessive integration into a group, with suicide being the outgrowth of the integration, e.g : Japanese soldier who sacrifices his life in battle.

Anomic suicide applies to persons whose integration into society is disturbed so that they can’t follow customary norms of behavior. Anomie explain why a drastic change in economic situation makes persons >> vulnerable than before their change in fortune, anomie: social instability & general breakdown society standards & values

Psychological Factors

Freud’s theory ( in Mourning and Melancholia) : suicide represents aggression turned inward against an introjected, ambivalently cathected love object. Freud doubted that there would be a suicide without an earlier repressed desire to kill someone else.

Menninger’s Theory ( In : Man against Himself) conceived of suicide as inverted homicide because of patient ‘s anger toward another person. This retroflexed murder is either turned inward or used  as an excuse for punishment. He also described a self-directed…

…death instinct ( Freud’s concept of Thanatos) + 3 components of hostility in suicide : the wish to kill, the wish to be killed & the wish to die.

Biological Factors :    serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) in CSF

Genetic Factors : Margaux Hemingway ‘s  1997 suicide was the 5 th  suicide among 4 generations of Ernest Hemingway’s family.

Twin studies

Molecular Genetic Studies: Polymorphism in Tryptophan hydroxylase (TPH) : enzyme involved in biosynthesis serotonin 2 alleles : U & L

L allele: associated with repetitive suicidal behavior.

Parasuicidal behavior

Parasuicide : patients who injure themselves by self-mutilation (e.g. cutting the skin) but who usually do not wish to die.

4 % of all patients in psychiatric hospitals have cut themselves; female:male ratio: 3 :1

Incidence of self- injury in psychiatric patients > 50 x general population

>> personality disorder, introverted, neurotic & hostile than control

 

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