Friday, July 11, 2008

Suicide: premeditated v. "crime" of passion

I came across an interesting article this week (via the NAME listserv) about suicide. Early on it brings up an interesting statistic that “the nation’s suicide rate (11 per 100,000 inhabitants) is almost precisely what it was in 1965”. Despite all the research, all the programs, all the new medications, the rate has not changed in over 40 years. That really is startling.

The author, as well as some researchers, feels that that is due to a dichotomy in suicidal behavior, much as there is in homicide. He discusses a premeditation vs. passion division amongst deaths by suicide. The premeditated suicides are most easily impacted by programs, medications, and therapy. The passion or impulsive suicides not so much. His discussion resonates with my experience.

The impulsive suicides are best impacted by creating “barriers to suicide or means restriction”. This was well documented (and then ignored) in the 60s and 70s in Great Britain. Death by suicide dropped by a third with the change from coal-gas to natural gas stoves during those decades. In the 50s “sticking one’s head in the oven” accounted for half of all British suicides. "Many of those were impulsive acts using a means with little time for second thoughts". “Remove it, and the process slowed down; it allowed time for the dark passion to pass".

We need to modify how we address death by suicide, how we think about death by suicide. They are not homogenous (neither the individuals nor the methods) and likely require multiple, varied interventions. Youth particularly fall into the more impulsive category, making brief, timely interventions critical. This recognition of differences can lead to more successful intervention.

But never lose sight of the underlying condition:
"They had wanted their inner pain to stop; they wanted some measure of relief; and this was the only answer they could find. They were in spiritual agony, and they sought a physical solution."


Anonymous said...

The article states that the rate has not changed since 1965, despite the medications, treatments, and interventions and then you state that the above has made a difference.
While I personally think that with young, impulsive suicides, intervention may help, it has been my experience that those who do commit suicide have a chronic mental illness that is not the "popular" depression. With them it seems that intervention may put it off, but eventually many will kill themselves.
I have never known anyone that attempted suicide have this near death experience that the author of the article talks about. I do know survivors of the people who commit suicide have an awful guilt that if they had meds, intervention, etc., the loved one would still be alive. I do not believe this to be true.
To me suicidal people have a terminal illness and we really do not have a cure. If someone had bone cancer and was in terrible, relentless pain, we may have more understanding if they took their own life. I think that is what is going on with many suicides. We do not even understand what is really going on in the brain of suicidal people. It is instinctive to try and live, and maybe there is a bad connection, but it certainly is more than 5HT levels. Some people that I know, were very self centered and angry before they committed suicide, others I know were calm days before the event. I think that they had made up their minds and saw some relief from their pain. Relief that they were not getting from meds, intervention, etc. I do not believe that these are "thee" answer, and it is wrong for psychologists to suggest that family and friends of suicide victims could have changed the outcome of things.
Thank you and I love reading your blog!

Dr. Richard Keller said...

My point was that we can make a difference. We must be mindful that there are the 2 types of death by suicide.

Not all who die by suicide have a chronic mental illness, although many do. There is a group of folks with Acute Situational Disorder who can act impulsively and take their own life.

I do know people who have had their suicide prevented. As with all "terminal illnesses" there can be remissions, stuttering course progressions, and even cures.

Most definitely friends and family of folks who die by suicide should not be burdened by guilt, although it is human to should-a, would-a, could-a. They need help, support, and help with healing (healing in the more aboriginal meaning of "making whole again", not "get over it").