Thursday, August 31, 2006

Defining Suicide and Suicide Attempts - By William L. Smith Ph. D.

Suicide can be defined in the following manner: An act is suicide if a person intentionally brings about his or her own death in circumstances where others do not coerce him or her to action, except in those cases where death is caused by conditions not specifically arranged by the person for the purpose of bringing about his or her death, (Tom Beauchamp, 1978).

In general it was believed that two populations (those who commit suicide and those who attempt suicide) are essentially separate, made up of different individuals. In a sense the words attampt suicide are a contradiction in terms. Strictly speaking, a suicide attempt should refer only to those who sought to commit suicide and fortuitously survived. A good example is a story in the New York Times, August 11, 2006. In September 2000, Kevin Hines climbed over the railing of the Golden Gate Bridge, in San Francisco, and jumped. Mr. Hines fell some 250 feet and survived, becoming one of an estimated 1,200 individuals who survived the leap since the Bridge opened in 1937. According to this theory, Mr. Hines is a legitimate attempt suicide surviver.

The overlap of the percentage of individuals who commit suicide with those who previously attempted suicide is estimated to be 45 percent, whereas the overlap of those who attempt suicide and those who subsequently are successful is about 10 percent. To attempt suicide with less than total lethality might be called quasi-suicide except that this term has the unfortunate connotation that such individuals are malingerers or are simply seeking attention, and thus do not merit our full professional and sympathetic response. I believe that any event which uses a suicidal modality is a genuine psychological crisis, even though it might not, under strict semantic rules, be called suicidal event.

Attempted suicide should be used only for those events in which there has been a failure od a conscious effort to end the life. Those events are attempted suicide. All other self-mutilations, excessive dosage of drugs, and other events of this nature should be called quasi-suicidal attempts or probably, most accurately, non-suicidal attempts. An individual who holds a fully loaded gun to his temple and pulls the trigger but the gun does not fire, can legitimately be said to have attempted suicide or have committed suicide and fortuitously survived; or leap from the Golden Gate Bridge and survive.

We should also evaluate each suicidal event on a continum, say from 1-9, of lethality. The term suicide, committed suicide, or attempted suicide should be reserved only for those events in which the lethality is reasonably judged to be high-eight or nine. This may depend on the method used; shooting, jumping, hanging, immolating, and where cutting or barbiturates are the method used, evaluation is based on the risk to rescue ratio. A suicide attempt is an event where the risk of death is extremely high and the probability of rescue or intervention is extremely low. Shooting oneself with a gun, jumping from a high place present few theoretical problems for this paradigm; the difficulties occur mostly in relation to barbiturates. It is not what you is the way that you do it. Thomas E. Hill (1983), recognizing that real life situations are more complex than any of our philosophic categories called our attention to four specially defined types of suicides as follows:

Impulsive suicide is prompted by a temporarily intense, yet passing desire or emotion out of keeping with the more permanent character, preferences and emotional state of the individual. We need not suppose that he is driven, blinded, or momentarily insane, but this act is not the sort that coheres with what he most wants and values over time. In calmer, more deliberate moments, he would wish that he would not respond as he did.

Apathetic suicide, sometime a suicide might result not so much from intense desire or emotion as from apathy. The problem is not overwhelming passion, but the absence of passion, lack of interest in what might be done or experienced in a continued life. One can imagine, for example, an extremely depressed person who simply does not care about the future...not intense shame, anger, fear, but rather emptiness.

Self-abasing suicide results from a sense of worthlessness or unworthiness, which expresses itself not in apathy, but rather in a desire to manifest self-contempt, to reject oneself, to put oneself down. One's life is seen as having a negative value...contemptable like a despised insect one wants to swat or turn away from in disgust.

Hedonistic calculated suicide is decided upon as a result of a certain sort of cost/benefit calculation seeing that others will be unaffected by his decision, the hedonistic calculator regards his choice as determined by his best estimate of the balance of pleasure and pain he expects to receive under such option.

Acccording to Durkheim suicide is the result of society's strength or weakness of control over the individual. Durkheim posited four basic types of suicide, each a result of man's relationship to his society. In one type, the altruistic suicide is literally required by society. In this instance, the customs or rules of the group demand suicide under certain circumstances. Hara-kiri (in feudal Japan) and suttee (in pre-colonial India) are examples of altruistic suicides. In such instances the person seemed almost boxed in by the culture. Under those circumstances, self-inflicted death was honorable; continuing to live would be igominious. Society dictated their action and, as individuals, they were not strong enough to defy custom.

Most suicides in the United States would be called egoistic by Durkheim. Contrary to the circumstances of an altruistic suicide, egoistic suicides occur when an individual's ties to his community are too few or too tenuous. In this case, demands to live do not reach him. Thus, proportionately, more individuals, especially men who are on their own, compared with men who are married or who are church members, kill themselves.

Durkheim's third type of suicide is called anomic suicide from the word anomie which Durkheim may have developed himself to describe that special kind of aloneness or estrangement that occurs when the accustomed relationship between an individual and his society is precipitously disrupted or shattered. The shocking immediate loss of a job, of a close friend, or of a fortune is thought sufficient to expedite anomic suicides; conversely, a poor man surprised by the disruption of a sudden wealth have also been shocked into anomic suicide.

A fourth type, fatalistic suicide, is suicide deriving from excessive regulation of the individual, where the individual has no personal freedom and no hope.

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Dr. Smith is a psychologist and personal consultant with more than thirty years of experience working with clients helping them to understand and resolve profound personal and confidential issues. And I can help you. For a free assessment contact me at:

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