Suicide is a major public health concern in the United States (US). In fact, the US may be facing a suicide crisis. Research has shown suicides in the US are at the highest they have been in the last 50 years, with over a 30% increase in suicides over the last 18 years (CDC, 2018). In the US, suicide is now the second leading cause of death for those under the age of 35 (NIMH, 2019). One report shows that the US had twice as many suicides than homicides in 2017 (NIMH, 2019). It is now estimated that one person dies by suicide every 12 minutes in the US, or 120 per day (SAVE, 2019). However, worldwide, that number is estimated to be one death by suicide every 40 seconds, up from one death every 17 minutes almost 20 years ago (SAVE, 2019; Curwen, 2001). Based on these numbers, suicide may be reaching epidemic proportions.
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Suicidology, the study of suicide, started 61 years ago, with Edwin Shneidman, the first suicidologist. Shneidman became interested in suicide when the director of the hospital where he worked, asked him to write two letters to the wives of two patients who had died by suicide. Not knowing these two men, Shneidman still felt these two men deserved more than a form letter. This led Shneidman to the basement of the coroner’s office. It was here where he found thousands of files. He decided to go through these files looking for those who died by suicide and left a note. Shneidman wondered what these letters would tell him, should he spend time studying them. Thus, the start of suicidology. Since this time, families, physicians, psychologists, suicidologists, and researchers have been looking for answers as to why suicide rates continue to rise, and how to prevent suicide. Many provide their thoughts about suicide, recommend interventions, and suggest opinions. However, it seems over the years, as much as these thoughts on suicide have changed, there are still no conclusive answers. Suicide rates may vary depending on different life experiences, relationships, and biochemical imbalances; however, these are not inclusive, suicide is this and so much more.
Way back during the western civilization, it was believed the devil caused one to die by suicide while also being considered a sin. Over one hundred years ago, society was believed to be the cause of suicide. Shneidman believed suicide was caused by the unconscious mind. And today, most suicides are blamed on mental illness. Not only have beliefs about causes of suicide changed over the years, but so have treatments used to reduce the suicidal impulse. Back in the 19th century, bloodletting, cold-water plunges, drafts of mercury, quinine and opium were used. Then in the 20th century, psychoanalysis was chosen. In the 1970’s, a link between behavior and the activity of neurotransmitters in the brain was identified, and by the mid 1980’s, Prozac was developed, a drug to increase the availability of serotonin in the brain. Shneidman, believing it was pain, and not mental illness, that was to blame for all preventable suicides, created the term “Psychache” to explain this pain. He believed if you treat this pain, you will treat the suicidal impulse. Treatment could be as easy as listening to the suicidal person and asking two simple questions: “Where do you hurt?” and “How may I help you?” Shneidman is also known for developing the first suicide crisis hotline back in 1958, wanting to prevent preventable suicides. (Curwen, 2001).
Chapter 17: Suicide and Life-Threatening Behavior
Most people will never understand why others choose to end their own life or die by suicide. Yet, suicide was the tenth leading cause of death in the US in 2015. Suicide has no prejudice to age, race, ethnicity, or culture; however, suicide may be more common is particular groups. Every suicide results in 147 people being exposed to the trauma of suicide, resulting in 250,000 suicide loss survivors every year. Although many attempt to understand suicidal behavior, there is not just one explanation. In fact, there are three general types of explanations used to explain suicide: psychological, biological, and sociological. Shneidman also created ten commonalities seen in suicidal behavior. These commonalities may provide some understanding of what or how their loved ones may have felt before making the decision to die by suicide. These survivors of suicide will commonly display signs of anger, sadness, blame, guilt, physical complaints, and other indications of grief associated with loss and bereavement. Different studies provide evidence that survivors of suicide often experience symptoms and issues survivors of other losses do not face. Today, most programs and organizations agree on common interventions to prevent suicide, however, this has not always been the case (Corr, 2019).
Causes and Changes
Most healthcare professionals and researchers agree, for a death to be considered a suicide, one must intend for their actions to result in their own death. There may be times there is confusion as to whether a person’s death is a suicide or not. Because of this, the reported number of total suicides may actually be higher than reported. In the US, men die by suicide far more frequently than women, however, women attempt suicide far more often than men. Equally, men and women choose firearms as a means to carry out suicide in almost half the reported suicides, while hanging accounts for the second chosen means for men, while poisoning or overdose accounts for the second chosen means of suicide for women. As already noted, suicide is the second leading cause of death for those under the age of 35, however, suicide rates are on the rise for middle aged men as well as elderly men. Although suicide rates are highest for Caucasians; Hispanic, Asian, and Native American suicides are also notable.
When one dies by suicide, loved ones are left to pick up the pieces and attempt to make sense of the death. Although these survivors of suicide have an intense yearning to get answers, most will never find clear answers as to why their loved one chose suicide. Some believe that almost 90% of those who die by suicide struggle with some form of mental health issue, although there are some who struggle with mental health who choose to die by suicide, there are other thoughts and beliefs about this. In fact, there are three general explanations used to help understand suicide: psychological, biological, and sociological explanations.
Psychological explanations include those who participate in self destructive behavior after facing a significant loss in hopes to punish this person that has died. Another thought believes clinical depression plays a large part, especially when this person has feelings of hopelessness. This person has lost all hope and cannot see any positives for the future. The last thought is that suicide may be a learned behavior. Depression also plays a roll in this thought; however, this person turns their anger on themselves.
Biological explanations are related to neurochemical or genetic factors. Some believe there may be an imbalance of neurochemicals, such as serotonin, in the brain. Although this may result in depression, some are not clear if this leads to depression and suicidal ideation. Others believe suicidal tendencies may be inherited; however, this is not clear either. It may just be a response to a loved one’s suicide.
Sociological explanations are believed to be related to influential factors in one’s life. Some believe suicide may be a response to one’s relationships within society. This could include those who are isolated and have no or little interaction with other individuals or groups. Some may feel they have a duty to others to take their life, for example, a wife whose husband has died. Some may feel they no longer fit in or feel their livelihood has been torn out from under them. Regardless of what explanation may fit the suicide, the truth remains, suicide is very complex and complicated.
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One thing most suicide “specialists” agree on is that when one dies by suicide, there is not just one single cause, but many causes that lead to the act of suicide. Most also agree that those who die by suicide have feelings of hopelessness and helplessness. The most common question remains, why? One thought may relate to change. Changes in our everyday life, community, environment, and society. It is believed that more has changed in the world in the last 30 years than in the previous hundreds of years. What has changed? Or better yet, what hasn’t? Technology and the internet. Smart phones and computers. Today, information can be exchanged around the world in just seconds. Years ago, it may have taken days or even weeks. Decreased socialization due to these smartphones and tablets. Warnings about terrorist attacks, nuclear war, or global warning. Before we can process one crisis, another hits the internet. We learn of catastrophic activity within minutes but may have took days for our ancestors to hear the news. Let’s think about travel. Years ago, generations before us traveled by horse and cart or wagon, being challenged with terrain, weather, and daylight, taking days, weeks, or even months to complete travel. Today we can fly across time zones in just hours. Think about the increase in cancer and new disease diagnosis, those living longer and being sicker, while being taken care of at home on medical equipment, those battling addiction, those involved in same sex relationships, those facing foreclosure, bankruptcy, divorce, failed relationships, and even the increase in bullying and mass killings. These changes may provide for undue stress that may lead one to choose suicide. It is not clearly understood why one may choose suicide while another does not choose suicide when faced with the same or similar situations. When an individual dies by suicide, many others are affected and may face challenges of their own.
The Survivor and Interventions
Imagine having two police officers knock on your front door, at 9:04 pm, on a cold November night, asking if you are the parent of someone by the name of your oldest son. You proceed to answer yes, and they inform you that his car and body have been found four hours north of your home in a secluded wooded area. It’s obvious he took his own life. Just as they finish telling you this, your daughter comes to door to find out what is going on. As you are breaking the news to her, she starts sobbing hysterically and collapses, causing one police officer and yourself to step in to catch her to prevent her from hitting the ground and getting hurt. This news, about your 30-year-old son, who had everything going his way in life. He had a job he absolutely loved, one he dreamed of since he was two. He had custody of his seven-year-old daughter, whom he absolutely loved. He had such a love for life, always with a smile on his face, and a laugh from his mouth. He had no known diagnosis of mental health issues, nor had he ever suffered from what one could see as depression. This beautiful soul, now gone by suicide.
When one dies so unexpectedly, in such a traumatic way, is there any surprise why one may have additional difficulty dealing with the death or have additional types of issues to deal with? Not only do the survivors have to deal with the unexpected death, but suicide survivors frequently have to deal with the stigma associated with suicide by many in society. Often survivors feel guilt and blame for the loved one’s death or feel rejected or not good enough by the one who died by suicide. Often, survivors go on looking for answers for as long as they live. Answer they will never get as to why their loved one choose suicide to leave this earth. Frequently, there is less support within the community and even by close friends of the survivors of suicide. These survivors find themselves with little support outside the immediate family, usually due to the stigma of suicide within society. This brings on additional stress for the survivors of suicide, that other survivors of death may not have to face. One thing survivors of suicide must always remember, is they are not to blame for their loved one’s death, when one decides to take his/her life, no one will most likely be able to stop them.
One area of suicide most researchers and providers agree on is the interventions that can be taken to assist in suicide prevention as well as the resources available. There are many different programs and organizations who provide education for lay persons, (friends and family), on signs one might display if they are suicidal. If these signs are exhibited, this lay person is provided information on verbiage that can be used and resource numbers that can be called to provide real time guidance as what to do next with the suicidal person. There are also crisis lines that suicidal persons or loved ones can call for immediate steps that can be taken to help ensure the safety of a suicidal person. Another benefit of this education is to help break the stigma associated with suicide.
Clearly, suicide is becoming more of a concern in the US. With rates rising to almost epidemic proportions, something must be done. Although suicide does not show bias between age, gender, race, or culture, statistics show higher death rates in groups narrowed down within these categories. Shneidman, being the first suicidologist, has shared a plethora of research in his years. Although much of his work remains pertinent today, there are different thoughts on suicide as more research is being done. One thing remains consistent with suicide research, and that is that there will always be conflicting views when it comes to beliefs about suicide. Even so, it is important that society comes together to decrease the total number of suicides as well as the stigma associated with suicide.
- Centers for Disease Control and Prevention (CDC). (2018, June 7). Suicide rising across the US. Retrieved from https://www.cdc.gov/vitalsigns/suicide/index.html#anchor_1508427386
- Corr, C. A., Corr, D. M., & Doka, K. J. (2019). Death & dying, life &living (8th ed.). Boston, MA: Cengage
- Curwen, T. (2001). Psychache. Los Angeles Times. Retrieved from https://online2.marianuniversity.edu/pluginfile.php/864385/mod_resource/content/1/Psychache_Curwen_LA_Times.pdf%D2%B2f.pdf
- National Institute of Mental Health (NIMH). (2019, April). Suicide. Retrieved from https://www.nimh.nih.gov/health/statistics/suicide.shtml
- Paul, R. & Elder, L. (2016). The thinkers guide for students on how to study & learn a discipline. Tomales, CA: Foundation for Critical Thinking Press.
- Suicide Awareness Voices of Education (SAVE). (2019). Suicide facts. Retrieved from https://save.org/about-suicide/suicide-facts/
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