Suicide

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

Suicide is viewed in highly varying ways among the cultures, religions, legal and social systems of the world. It is considered a sin or immoral act in many religions, and a crime in some jurisdictions. 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.

According to stricter definitions of suicide, to be considered suicide, the death must be a central component and intention of the act, not just a certain consequence; hence, suicide bombing is considered a kind of bombing rather than a kind of suicide, and 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.

Suicidal thoughts as a medical emergency

Psychiatric emergency

Severe suicidal thoughts are generally considered to be a medical emergency. People seriously considering suicide are generally advised to seek help right away. This is especially true if the means (weapons, drugs, or other methods) are available, or if a detailed plan is in place.

Current medical advice is that people who are seriously considering suicide should go to the nearest emergency room, or call the emergency services. Severe suicidal ideation, according to this advice, is a condition that requires immediate emergency medical treatment. If depression is a major factor, then treatment usually leads to the disappearance of suicidal thoughts.

First aid

Anyone who knows a person whom they suspect to be suicidal can assist them by taking them aside and asking them directly if they have contemplated committing suicide. Posing such a question does not render a previously non-suicidal person suicidal. Follow-up questions can include if the person has made specific arrangements, has set a date, etc. The person questioning should seek to be understanding and sympathetic above all else. A suicidal person will often already feel ashamed or guilty about contemplating suicide so care should be taken not to exacerbate that guilt.

An affirmative response to these questions should motivate the immediate seeking of medical attention. If the doctor who normally treats the person is unavailable, contacting the emergency room at the nearest hospital is recommended.

If possible a suicidal person should go to an emergency room and ask to be admitted to the mental health ward on a voluntary basis. The advantage of voluntarily seeking treatment rather than being involuntarily committed is that involuntary commitment would require intervention by the legal system. In addition, in most jurisdictions the same process followed to be committed must be followed to be released.

Law enforcement can be involved if the person seems determined to make a suicide attempt. While the police do not always have the authority to stop the suicide attempt itself, in some countries including some jurisdictions in the US, killing oneself is illegal, and a disruptance of public order, which could justify their intervention. In most cases law enforcement does have the authority to have people involuntarily committed to mental health wards. Usually a court order is required, but if an officer feels the person is in immediate danger he can order an involuntary commitment without waiting for a court order. Such commitments are for a certain amount of time, such as 72 hours – which is long enough for a doctor to see the person and make an evaluation. After this initial period, a hearing is held in which a judge can decide to order the person released or can extend the treatment time further. Afterwards, the court is kept informed of the person's condition and can release the person when they feel the time is right to do so.

Treatment

Treatment is directed at the underlying causes of suicidal thinking. Clinical depression is the major treatable cause, with alcohol or drug abuse being the next major categories. Other psychiatric disorders associated with suicidal thinking include bipolar disorder, schizophrenia, Borderline personality disorder, Gender identity disorder and anorexia nervosa. Suicidal thoughts provoked by crises will generally settle with time and counseling. For a person with strong or at least definitive family or community ties, urgently providing information about who else would be hurt and the loss that they would feel can sometimes be effective. For a person suffering poor self-esteem, citing valuable and productive aspects of their life can be helpful. Sometimes provoking simple curiosity about the victim's own future can be helpful.

During the acute phase, the safety of the person is one of the prime factors considered by doctors, and this can lead to admission to a psychiatric ward or even involuntary commitment.

Suicide prevention

Various suicide prevention strategies have been used:

Promoting mental resilience through optimism and connectedness. This can be through various means.
Education about suicide, including risk factors, warning signs and the availability of help.
Increasing the proficiency of health and welfare services at responding to people in need. This includes better training for health professionals and employing crisis counselling organizations.
Reducing domestic violence and substance abuse are long-term strategies to reduce many mental health problems.
Reducing access to convenient means of suicide (e.g., toxic substances, handguns).
Reducing the quantity of dosages supplied in packages of non-prescription medicines e.g., aspirin.
Interventions targeted at high-risk groups.
Research.

There are several major research journals devoted to suicide prevention and intervention research:
- Crisis: The Journal of Crisis Intervention and Suicide Prevention
- Suicide & Life-Threatening Behavior; New York – Guilford Publications, Inc.

Arguments for Pro-Choice and Pro-Euthanasia

There are arguments in favour of allowing an individual to choose between life and suicide. This view sees suicide as a valid option. This line rejects the widespread 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. No being should be made to suffer unnecessarily, and suicide provides an escape from suffering in certain circumstances, such as incurable disease and old age.

Heroic suicide, for the greater good of others, is often celebrated. For instance, Gandhi went on a hunger strike to prevent fighting between Hindus and Muslims, and although they stopped before he died, if they hadn't, he may have indeed killed himself. For this, he earned the respect of many. In the past, the Japanese were often ordered to commit seppuku, a form of ritual disembowelment suicide, by their superiors, and were expected to do so as a matter of honor. 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.

A few rare groups say that people should kill themselves for the greater good. For example, the Church of Euthanasia says that people should kill themselves in order to reduce mankind's stress on the environment.

Epidemiology

It is probable that the incidence of suicide is widely under-reported due to both religious and social pressures, and possibly completely unreported in some areas. Nevertheless, from the known suicides, certain trends are apparent. However, since the data is skewed, attempts to compare suicide rates between nations is statistically unwise.

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.^[1]

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 discernable 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, deliberate self-harm (DSH) are preferred – both of these terms avoid the question of the intent of the action. Those who attempt DSH are, as a group, quite different from those who attempt to die from suicide. DSH is far more common than suicide, and the vast 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.

Suicide in history

Among the famous people who have died by suicide are many artists and state-leaders. For a longer list of suicides, see list of suicides.

Suicide in literature

Suicide has been used as a dramatic plot element in a number of literary works, such as Madame Bovary, Anna Karenina, The Awakening, Romeo and Juliet, and Death of a Salesman. Robert E. Howard wrote several poems, including The Tempter, about suicide.

Legal, Cultural, and Religious Views of Suicide

There are a number of different views on suicide. These views include legal, cultural, and religious views on suicide. While some of these views approve of suicide, others are equally against suicide.

Combination of killing and suicide

The combination of killing or murder and suicide can take various forms, including:

Choosing a means of killing others which necessitates or is facilitated by one's own death, as in suicide bombing or suicide attacks
Suicide in order to escape punishment after committing a severe crime (particularly murder) (e.g., Dunblane massacre, Columbine High School massacre)
A combined objective of suicide and murder
Suicide as a form of self-punishment after an individual has committed a severe crime (particularly murder), often due to feelings of guilt
Viewing one's suicide as the primary goal, but seeing a need to commit murder as a necessary corollary for a particular reason (e.g., to kill one's children as part of one's own suicide, to avoid their becoming orphans, or to be together in an expected afterlife)
Joint suicide: killing another (or multiple others) with consent and later taking one's own life

Sources

^ D.J. Shaffer, "The Edipdemiology of Teen Suicide: An Examination of Risk Factors," Journal of Clinical Psychiatry 49 (supp.) (Sept. 1988): Ppgs 36-41.

External links

Crisis Lines

If you are in suicidal crisis, call a crisis line and talk to someone about it. In the United States, you can call 1-800-SUICIDE to reach a trained counselor near you.

Suicide Prevention Center Los Angeles Serving Southern California
Suicide Hotlines Listing of suicide prevention lines in the United States and around the world. Look here to find a crisis line near you.

Support groups

Samaritans (UK)
#alt.suicide.bus.stop – think about suicide differently. A support group for the suicidal, by the suicidal.
Befrienders International (or in other languages)
SuicideTalk.com Suicide forums
Open Directory Project: Support groups for those who are suicidal or in despair