“Why does the wish to live ever, even temporarily, triumph over the wish to die?” Karl Menninger asked this thought-provoking question in the introductory chapter of his book ‘Man Against Himself’. Superficially suicide can be viewed as an escape from an intolerable life situation. Suicide could be the simple and rational consequence of chronic disease, discouragement, financial downturn, humiliation, frustration, and unrequited love. On the deeper level many thinkers have tried to find the unique universal cause behind suicide; different theories are proposed; but not a single theory is sufficient enough to explain all the variants of suicides ranging from traditional suicide, martyrdom, ritual suicide to hunger strike, euthanasia, and suicide bombing. Below is a brief account of suicide theories and risk factors associated with suicide.
French sociologist Emile Durkheim (On Suicide, 1897) at the end of the 19th century first attempted to explain suicide patterns. He viewed suicide as the result of too loose or too much social integration and social regulation. When an individual is too much integrated into a group altruistic suicide happens; like suicide bombers, Japanese Kamikaze Pilots. Lack of strong integration results in egoistic suicide; higher suicide rates among divorced individuals, Protestants (vs. Catholics), urban population can be explained thus. Lack of social regulation that is breakdown of social structure and values during economic depression, economic prosperity, revolution, social change results in anomic suicide. Fatalistic suicide occurs when there is too much social regulation in the form of pervasive oppression preventing independent living as in prison population.
Jack Douglas (The Social Meanings of suicide, 1967) argues that sociologists should put emphasis on social meaning rather than social structure as Durkheim put. He described suicidal notes, diaries, case histories as the sources of finding suicide meaning and viewed suicide as an act of reunion (release from pressure), atonement (transforming oneself for others), and revenge.
Jean Baechler (Suicides, 1975) another sociologist put more emphasis on personal factors than on external factors. He says that suicides fall into four broad categories: 1) escapist, 2) aggressive, 3) oblative, and 4) ludic. Escapist suicides are the incentives to escape pain, loss, shame, illness, aging, failure, fatigue, or the like. Aggressives are influenced by interpersonal problems or conflict, anger, revenge etc. Oblative suicides are driven by a desire to self-sacrifice and ludic suicides by a desire to live life fully, even if it means getting killed or reducing one’s normal life expectancy (e.g. race car drivers).
Steve Taylor (Durkheim and the Study of Suicide, 1982) divided suicides into etopic or inner directed and symphysic or other directed suicides. These two types are further classified into submissive (individual is certain about life and I am a dead man feeling), thanatation (uncertain about themselves, who am I feeling), sacrifice (certain that people have made life unbearable, I am killed feeling), and appeal (uncertain about others attitude towards themselves, who are you feeling) type.
Roy Baumeister (1990) said suicide may arise when personal expectations or standards are unusually high or events are unusually bad.
Sigmund Freud (Beyond the Pleasure Principle, 1920) stated suicide represents aggression turned inward. He made assumption that the life/eros and death/thanatos instincts, the constructive and destructive tendencies of the personality are in constant conflict. With independence a child learns that the way to pleasure or pleasure leads to endurance, renunciation and suffering; the world is no longer shaped to his subjective demands as was the maternal womb. Great impulse towards death begins to dominate the child. Instead of fighting his enemies, such person fights with (destroy) himself.
Carl Jung (C.G. Jung Letters, 1937) viewed suicide as the surge of unconscious material overwhelming consciousness and an attempt to transform (rebirth) oneself.
Karl Menninger (Man Against Himself, 1938) identified three components of suicide. They are the wish to kill (anger); wish to be killed (guilt); and wish to die (thanatos).
Helen Lewis (Shame and Guilt in Neurosis, 1971) put emphasis on role of shame and guilt on suicidal behavior.
Dave Marcotte (The Economics of Suicide, 1974) explained suicide from behavioral economics perspectives. He noted only a small fraction of suicides are fatal (1 in 30-40 attempts); and suggested suicidal people face three options. Not to attempt, to attempt but not die and to attempt and die. He voiced that suicide is basically a rational tool for life improvement by seeking others help and suicidal people choose not between life and death but between injury and help. The people who attempt but not die see an increase in psychological and familial support. To get this support they attempt suicide.
Edwin Shneidman (The Suicidal Mind, 1996) identified ten commonalities among 95% of suicides. They are
- Common purpose is to seek solution
- Common goal is cessation of consciousness
- Common stimulus is unbearable psychological pain
- Common stressor is frustrated psychological needs
- Common emotion is hopelessness-helplessness
- Common cognitive state is ambivalence
- Common perceptual disturbance is constriction
- Common action is escape
- Common interpersonal act is communication of intent
- Common pattern in suicide is consistency of lifelong styles
Aaron Beck (Cognitive Therapy of Depression, 1979) gave hopelessness theory of suicide. He states that hopelessness is associated with cognitive style like uncertainty about highly valued outcome, expectation about highly aversive outcome, feeling that nothing one can do to change his situation, blaming oneself for negative outcome and believe that occurrence of negative events means that the self is flawed. Degree of hopelessness is directly proportional to the suicidal intent.
Edward Higgins (Self-discrepancy; A theory relating self and affect, 1987) expressed that individuals who possess discrepancies between their actual and ideal selves are relatively more prone to developing depression and subsequently at increased suicidal risk. It is known as self-discrepancy theory of suicide.
JH Riskind (Looming vulnerability to threat: a cognitive paradigm for anxiety, 1997) in his looming vulnerability model of suicide explains that injurious events that have the potential to grow, change, or escalate rapidly are far more anxiety provoking than those of equal magnitude that do not change rapidly. The main point is that individuals with looming vulnerability induced depression and anxiety (because of rapid change) are far more suicide prone than individuals with depression alone. Suicide here may be seen as the desire to avoid rapidly rising intolerable psychological pain
Thomas Joiner (Why People Die by Suicide, 2008) explained suicide from interpersonal psychological point of view. He identified three factors that are associated with suicide. First is the ability to enact lethal injury on oneself; when individual passes through repeated psychological or physical injury he acquires this ability. Thwarted belongingness or perceived loneliness and perceived burdensomeness are the other two factors.
- Johnsonand others (Are defeat and entrapment best defined as a single construct? 2010) suggested that heightened perception of defeat and entrapment can leads to hopelessness, depression and suicidality.
Contemporary suicidologists put more emphasis on suicidal person’s fantasies about what would happen and what the consequence would be if they commit suicide than particular instinct or personality. Such fantasies often include revenge, power, control, punishment, atonement, sacrifice, escape, rescue, rebirth, reunion with the dead, a new life etc. Another term rational suicide is circulating for some times to describe well thought, conscious, autonomous decision to commit suicide.
Biological factors associated with suicide
- Low concentration of serotonin in CSF is associated with suicidal behavior. In attempted suicide patients, the suicide risk of low serotonin subgroup is statistically portrayed as 17%, compared with 7% among those with normal serotonin level.
- Monozygotic, dizygotic twin and adoption studies reveled that suicide is genetically linked.
- Suicide tends to run in families. Usually one person of each generation is affected. Ernest Hemingway, Karl Marx families are famous examples of familial cluster.
- Presence of Tryptophan Hydroxylase (TPH) L allele is associated with repetitive suicidal behavior specially in alcoholics and violent people.
Risk factors of suicide:
Oxford Textbook of Psychiatry mentions following risk factors; it is important to note that risk factor doesn’t indicate causal relationship, rather means if associated it increases the probability of untoward outcome.
- Marked hopelessness
- History of previous suicidal attempts
- Social isolation
- Old age
- Depressive disorder specially when severe with insomnia, anorexia and weight loss
- Alcohol abuse
- Drug dependence
- Schizophrenia
- Chronic Painful illness
- Epilepsy
- Abnormal personality (anxious and obsessional traits)
Suicide is a preventable condition. If you are suicidal, please consult with your doctor.