Understanding Suicide (Part 1)
The sudden death of any person by suicide is a shocking and distressing incident. There are many reasons as to why some people commit suicide but these reasons are often only known to the deceased themselves. Moreover, it is always difficult to witness the process of suicide as people who commit suicide prefer to be by themselves and thus, suicide behaviors have to be inferred in retrospect (Joiner, 2010). The family and friends of the deceased are the ones who are left to struggle with the aftermath of both the enduring pain and a whole gamut of unanswered questions as to why their loved one has to take his or her own life (Jamison, 1999). Nock et al. (2010) reported that suicide is a leading cause of death worldwide and the act of suicide is a baffling phenomenon as it runs contrary to the idea that all living things are innately driven to survive rather than self-terminate.
People who commit suicide no doubt would have undergone a tremendous amount of psychological pain. This psychological pain is often synonymous with other connotations such as loneliness, shame, depression, affective disorder and alcoholism (Shneidman, 1998). However, not every person who is undergoing such pain will commit suicide. Shneidman (1996) discussed a distinct characteristic which is shared by the minds of people who choose the path of committing suicide – constriction, which refers to the narrowing of the person’s thinking as the person sees death as the only solution. Furthermore, Shneidman proposed the ten commonalities of suicide which are present in almost every suicide – to seek a solution, cessation of consciousness, unbearable psychological pain, frustrated psychological needs, hopeless-helplessness, ambivalence, constriction, escape, communication of intention, and consistency of lifelong styles. Unfortunately, an individual who intends to commit suicide rarely experiences only one of the ten commonalities but rather, they would experience the multiple interactions of a few if not all of them. For example, an individual who is suffering from severe psychological pain is often also suffering from the feeling of hopeless-helplessness and a constriction of thinking which might eventually lead them to choose suicide as the final escape.
Suicide then cannot be just a simple behavior but is a result of the complex interactions between biological, psychological and social risk factors (Kaslow, 2005; Maris, 2002). In fact, Moscicki (1997) reported that epidemiology evidence has consistently demonstrated that suicide is the result of a combination of interacting causes and risk factors which can be external or external to the individual. A risk factor, as defined by Moscicki, is a preceding characteristic that is correlated with the development an adverse outcome. A suicide risk is further explained in terms of its correlation with suicide and it includes factors such as age, sex, psychiatric diagnosis, past suicide attempts, traits and behaviors, and substance abuse (Hendin, Maltsberger, Lipschitz, Haas, & Kyle, 2001). Thus, the identification of risk factors for suicide has been widely accepted for the precipitation and prediction of suicide behavior.
Risk factors for suicide can be either distal or proximal (Maris, 2002). Distal risk factors are of a long-standing nature such as mental illness and a disrupted family environment, whereas proximal factors are of a recency nature such as stressful life events and hopelessness. Although distal risk factors are not specific to suicide, exposure to such factors is necessary for suicide behavior. Neither distal factors nor proximal factors in themselves are sufficient for suicide behavior; their interaction however, can produce an overwhelming burden on the individual to eventuate a suicide (Moscicki, 2001). Rudd et al. (2006) further suggested that the current state of an individual must be considered alongside long-standing risk factors. For example, a vulnerable individual might be experiencing enduring loneliness, but when coupled with his or her current state of feeling hopelessness, suicide risk is greatly increased.
In Western countries, studies have consistently shown that high incidence of mental disorders such as depression, is found to be associated with suicide (Cavanagh, Carson, Sharpe, & Lawrie, 2003; Foster, 1999). In the Eastern countries, the same association has also been found (Cheng, 1995). These studies have also indicated that major depression is the most common and prevalent mental disorder in people who have committed suicide. Major depression therefore is one of the most significant risk factors for suicide. In addition, the likelihood of a depressive disorder was found to be three to four times greater in individuals who had experienced childhood maltreatment which included neglect, physical abuse and sexual abuse (Brown, Cohen, Johnson, & Smailes 1999). Brown and colleagues also found that a history of child maltreatment was significantly associated with suicide behavior.
Previous suicide attempts moreover, were also consistently found to be one of the most significant risk factor of suicide (Shaffer et al., 1996). A number of other psychosocial risk factors are also strongly associated with suicide (Cheng, Chen, Chen, & Jenkins, 2000). Some of these psychosocial risk factors might include poor physical health, separation from a loved one, living alone, lack of social and family support, stressful or negative life events, and sexual orientation. Although sexual orientation, that is, whether being gay, lesbian or bisexual, does not appear to be in independent risk factor (Moscicki, 2001), other studies have shown that there is a close association with suicidality while other factors such as substance abuse were controlled for (Cochran & Mays, 2000; Fergusson, Horward & Beautrais, 1999; Herrel et al. 1999).
The presence of protective factors has been closely associated with reduced suicide behavior and risks; conversely, the absence of protective factors would put a vulnerable individual more at risk of suicide and could double as risk factors (Kawslow et al., 2005). For example, family connectedness could be seen as a protective factor when present, but also as a risk factor when absent. In the study conducted by Linehan, Goodstein, Nielson and Chiles (1983), it was demonstrated that the presence of a belief system for reasons to live was significantly associated with reduced suicide behavior. The various reasons for living such as responsible for living and child related concerns could therefore serve as protective factors for suicide.
Suicide is a highly complex issue, and individuals who ultimately choose to suicide experience an overwhelmingly painful emotional world, which the rest of us may never fully comprehend. However, it is important to support these individuals from a non-judgmental viewpoint and with compassion and at the same time, continue to work toward reducing the stigma in our society surrounding suicide.
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