Suicide

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Suicide (from Latin sui caedere, to kill oneself) is the act of ending one's own life. It is considered a sin in many religions, and a crime in some jurisdictions. On the other hand, some cultures have viewed it as an honourable way to exit certain shameful or hopeless situations. Persons attempting or dying by suicide sometimes leave a suicide note.

To be considered suicide, the death must be a central component and intention of the act and not just an almost certain consequence; hence, suicide bombing is considered a kind of bombing rather than a kind of suicide, and martyrdom, self sacrifice in the service of others in emergencies and reckless bravery in battle usually escape religious or legal proscription. In the case that suicide has legal consequences this is reflected in law in that there must be proof of intent as well as death for the act to be suicide.

Epidemiology

It is probable that the incidence of suicide is widely under-reported due to both religious and social pressures, possibly by as much as 100% in some areas. Nevertheless, from the known suicides certain trends are apparent. But since the data are skewed, attempts to compare nation to nation are statistically unwise.

In the United States, males are four times more likely to die by suicide than females. Male suicide rates are higher than females in all age groups (the ratio varies from 3:1 to 10:1). In other western countries, males are also much more likely to die by suicide than females (usually by a factor of 3-4:1). The suicide rate in the USA is 0.02% per annum for males, and 0.005% per annum for females.

Children of either sex are 10-20 times less likely to die by suicide, and teenagers 1.5-2 times less likely, than adults of the same gender. The incidence of suicide among males over 75 years old is roughly twice that of other adult males.

While there are more male suicides than female, women are more likely to attempt suicide. Men also tend to use more violent and effective methods than do women.

Certain time trends can be related to the type of death. In the United Kingdom for example, the steady rise in suicides from 1945 to 1965 was curtailed following the removal of carbon monoxide from domestic gas supplies with the change from coal gas to natural gas. It seems that different cultures have different favorite methods, and the easy availability of lethal methods plays a role.

Higher levels of social and national cohesion reduce suicide rates. Suicide levels are highest among the retired, unemployed, divorced, the childless, urbanites and those living alone. The rate also rises during times of economic uncertainty (although poverty is not a direct cause). Widespread war is always associated with a steep fall in suicides; for example, during World War I and World War II the rate fell markedly, even in neutral countries. The majority of suicides also suffer from some psychological disorder. Depression in bipolar disorder is an especially common cause. Severe physical disease or infirmity are also recognized causes. There is no known association between economic class and suicide.

The idea that suicide is more common during the winter holidays (including Christmas) is actually a myth, generally reinforced by media coverage associating suicide with the holiday season. The National Center for Health Statistics found that suicides drop during the winter months, and peak during spring.

Motivations

Confrontation, alienation and criticism that demeans a person's self-esteem can sometimes exacerbate suicidal tendencies. Exposure to death, especially gruesome or traumatic death such as in war, seems to increase suicide rates among some groups. Social disgrace and or loss of a job often precede suicide. Employers or social groups are often unaware of suicides that follow triggering events involving social exile.

Suicide is more common among alcoholics, especially after loss of affectional relationships, such as the death of a spouse, a divorce, loss of a friend, parental alienation, or being left behind after a friend moves from a shared residence. But regardless statistical correlations, it is difficult to tell if affectional loss is causally associated with suicide among alcoholics or is a circumstance common among many alcoholics in general.

Perhaps contrary to intuitive assumptions, suicide is not often associated with a terminal illness. The presence of physical illness, though, is found in nearly half of suicides.

On an individual level the meaning of suicide varies across a range of common themes. Simply seeking an end is uncommon. Stated reasons include concepts such as a reunion with the dead (bereavement is an additional factor in some suicides), a need for change from an unbearable situation, a desire to cause pain through causing remorse or grief, or the belief that one can watch over the living after death. Multiple motives are common.

Copycat suicides

Suicide rates are influenced by publicity about suicide of famous people, and even the fictional suicide of a character in a popular drama can raise the suicide rate temporarily.

Copycat suicides are defined as duplications of suicides due to repeated accounts or depictions of the original suicide on television and in other media. The well-publicized suicide serves as a model, in the absence of protective factors, to the next suicide. They occasionally spread, like wildfire, through a school system, through a community, or in terms of a celebrity suicide wave, nationally.

Therefore it is customary in some countries that media do not report suicides, except in special cases.

In the book, Suicide Clusters (Boston/London: Faber and Faber, 1987), by Loren Coleman, many specific examples of copycat suicides are given.

Methodology

The means of achieving suicide varies and is greatly influenced by availiability, perceived effectiveness and final bodily state. For example, in the US firearms are relatively commonplace and suicide by this method is four times more common than the next method.

The common means of suicide, roughly in order of use (US), are by gunshot, asphyxia, hanging (there is often considerable overlap between hanging and asphyxia due to lack of expertise), drug overdose, carbon monoxide poisoning, jumping from height, stabbing or exsanguination from cuts, and drowning.[1]

Physician-assisted suicide (see euthanasia) is typically by a lethal dosage of a prescription drug supplied by the physician. It may be taken orally, or by intravenous drip or infusion pump with a switch operated by the patient.

Suicidal thoughts as a medical emergency

Severe suicidal thoughts are often considered to be a medical emergency. People seriously considering suicide are generally advised to seek help right away. This is especially true if the means (weapons, drugs, or other methods) are available, or if a detailed plan is in place.

Current medical advice is that people who are seriously considering suicide should go to the nearest Emergency Room, or call the emergency services. Severe suicidal ideation, according to this advice, is a condition that requires immediate emergency medical treatment.

Attempted Suicide

Nearly half of suicides are preceded by an attempt at suicide that does not end in death. Those with a history of such attempts are 100 times more likely to eventually end their own lives than those without.

A suicidal act that does not end in death is usually called a "suicide attempt" or a "suicidal gesture". Some people prefer the use of the neologism parasuicide, or describe such acts as "deliberate self-harm" - both of these terms avoid the question of the intent of the action. Those who attempt suicide are, as a group, quite different from those who actually commit suicide. Suicide attempts are far more common, and the vast majority are female and aged under 35. They are rarely physically ill and while psychological factors are highly significant, they are rarely clinically ill and severe depression is uncommon. Social issues are key -- attempted suicide is most common among those living in overcrowded conditions, in conflict with their families, with disrupted childhoods and history of drinking, criminal behavior and violence. Individuals under these stresses become anxious and depressed and then, usually in reaction to a single particular crisis, they attempt suicide. The motivation may be a desire for relief from emotional pain or to communicate feelings, although the motivation will often be complex and confused. Attempted suicides may also result from an inner conflict between the desire to end life and to continue living.

Suicide in history

Among the famous people who have died by suicide are Boudicca, Cleopatra VII of Egypt, Hannibal, Nero, Adolf Hitler, Ernest Hemingway, Alan Turing, Sylvia Plath, Marina Tsvetaeva, and Vincent van Gogh.

In the military

In ancient times, suicide sometimes followed defeat in battle, to avoid capture and possible subsequent torture, mutilation, or enslavement by the enemy. The Caesarian assassins Brutus and Cassius, for example, killed themselves after their defeat at the battle of Philippi. Insurgent Jews died in a mass suicide at Masada in 74 AD rather than face enslavement by the Romans.

In Roman society, suicide was an accepted means by which honor could be preserved. Those charged with capital crimes, for example, could prevent confiscation of their family's estate by taking their own lives before being convicted in court. It was sardonically said of the emperor Domitian that his way of showing mercy was to allow a condemned man to take his own life.

During World War II, Japanese units would often fight to the last man rather than surrender. Towards the end of the war, the Japanese navy sent kamikaze pilots to attack Allied ships. These tactics reflect the influence of the samurai warrior culture, where seppuku was often required after a loss of honor. It is also suggested that the Japanese treated Allied POWs harshly because, in Japanese eyes, by surrendering rather than fighting to the last man, these soldiers showed they were not worthy of honorable treatment.

Spies have carried suicide pills or pins to use when captured, partly to avoid the misery of captivity, but also to avoid being forced to disclose secrets. For the latter reason, spies may even have orders to kill themselves if captured - for example, Gary Powers had a suicide pin but did not use it when he was captured.

In philosophy

In the late 18th century, Goethe's Die Leiden des jungen Werthers, ("The Sorrows of Young Werther"), the romantic story of a young man who kills himself because his love proves unattainable, was reputed to have caused a wave of suicides in Germany.

Emile Durkheim, the founder of sociology, wrote a very famous study of suicide in the late 1800s.

Albert Camus saw the goal of existentialism in establishing whether suicide was necessary in a world without God.

A study of suicide in literature was written by the poet Al Alvarez, entitled The Savage God.

Jean Améry, in his book On Suicide: a Discourse on Voluntary Death (originally published in German in 1976), provides a moving insight into the suicidal mind. He argues forcefully and almost romantically that suicide represents the ultimate freedom of humanity, attempting to justify the act with phrases such as "we only arrive at ourselves in a freely chosen death", lamenting the "ridiculously everyday life and its alienation". He killed himself in 1978.

Ironically, the punishment for attempted suicide in some jurisdictions has been death. Although a person who has successfully committed suicide might be thought to be beyond the reach of the law, there could still be legal consequences. For example, in the UK prior to 1961 their estate was forfeit.

The United Kingdom abolished the crimes of suicide and attempted suicide in the suicide act of 1961. By the early 1990s only two USA states still listed suicide as a crime, and these have since removed that classification. Increasingly, the term commit suicide is being consciously avoided, as it implies that suicide is a crime by equating it with other acts that are committed, such as murder or burglary.

In many jurisdictions it is a crime to assist someone directly or indirectly in committing suicide. Sometimes an exception applies for physician assisted suicide (PAS), under strict conditions, see Euthanasia.

In the Netherlands, being present and giving moral support during someone's suicide is not a crime; neither is supplying general information on suicide techniques. However, it is a crime (except when the exception applies, see Euthanasia in The Netherlands) to carry out any act that is part of the preparation or execution, including putting an object or substance nearby and giving instructions.

Religious views of suicide

Buddhism

According to Buddhism, our past heavily influences our present. Furthermore, what an individual does in the present moment influences his or her future, in this life or the next. This is cause and effect, as taught by Gautama Buddha. Otherwise known as karma, intentional action by mind, body or speech has a reaction and its repercussion is the reason behind the conditions and differences we come across in the world.

One's suffering primarily originates from past negative deeds or just from being in samsara (the cycle of birth and death). Another reason for the prevalent suffering we experience is due to impermanence. Since everything is in a constant state of flux, we experience dissatisfaction with the fleeting events of life. To break out of samsara, one simply must realize their true nature, by Enlightenment in the present moment; this is Nirvana.

For Buddhists, since the first precept is to refrain from the destruction of life (including oneself), suicide is clearly considered a negative form of action. But despite this view, an ancient Asian ideology similar to seppuku (hara-kiri) persists to influence Buddhists by, when under oppression, committing the act of "honorable" suicide. In modern times, Tibetan monks have used this ideal in order to protest the Chinese occupation of Tibet and the People's Republic of China's human rights violations against Tibetans.

Christianity

Christianity is traditionally opposed to suicide, and assisted suicide.

In Catholicism specifically, suicide has been considered a grave and sometimes mortal sin. The chief Catholic argument is that one's life is the property of God, and that to destroy one's own life is to wrongly assert dominion over what is God's. This argument runs into a famous counter-argument by David Hume, who noted that if it is wrong to take life when a person would naturally live, it must be wrong to save life when a person would naturally die, as this too seems to be contravening God's will.

On a different line, many Christians believe in the sanctity of human life, a principle which, broadly speaking, says that all human life is sacred -- a wonderful, even miraculous creation of the divine God -- and every effort must be made to save and preserve it whenever possible.

Nevertheless, even while believing that suicide is generally wrong, liberal Christians may well recognise that people who commit suicide are severely distressed and so believe that the loving God of Christianity can forgive such an act.

Hinduism

In Hinduism, murdering one's own body is considered equally sinful as murdering another. However, under various circumstances it is considered acceptable to end one's life by fasting. This practice, known as prayopavesha, requires so much time and willpower that there is no danger of acting on an impulse. It also allows time for the individual to settle all worldly affairs, to ponder life and to draw close to God.


Islam

Like other Abrahamic religions, Islam views suicide strictly as sinful and detrimental to ones spiritual journey. However, human beings are said to be liable to committing mistakes, thus, Allah (God) forgives the sins and wipes them out if the individual is truly sincere in repentance, true to the causes and determined in intention.

For those who believed, but eventually disbelieved in God in the end, the result seems unambiguously negative. In the Qur'an, the holy book for Muslims, although Allah (God) is said to be 'the Most Merciful, the Most Kind' and forgives all sins, the great sin of unbelief is deemed unforgivable. According to the Sunnah (life and way of the Prophet Muhammad), any person who dies by suicide and shows no regret for his wrongdoing will spend an eternity in hell, re-enacting the act by which he took his own life. Some Islamic jurists hold the interpretation that hell is not eternal but indefinite and only remains to exist while the earth endures at its present state. Once the Day of Recompense passes, Hell will eventually be emptied.

Despite this, a small minority of Muslim scholars take the view that actions committed in the course of jihad where one's own death is assured (e.g. suicide bombing) are not considered suicide. Such acts are instead considered a form of martyrdom. There is Quranic evidence to the contrary, stating those involved in the killing of the innocent are wrongdoers and transgressors. Nevertheless, many claim Islam does permit the use of suicide - though only against the unjust and oppressors - if one feels there is absolutely no other option available and life otherwise would end in death.

Judaism

Judaism views suicide as one of the most serious of sins. Suicide has always been forbidden by Jewish law, except for three specific cases. If one is being forced by someone to commit murder, forced to commit an act of idolatry, or forced to commit adultery or incest, then in those cases alone would suicide be permissible. However, outside those cases, suicide is forbidden, and this includes taking part in assisted suicide. One may not ask someone to assist in killing themselves because killing oneself is forbidden and one is then making someone else an accomplice to a sin.

The Committee on Jewish Law and Standards, the body of scholars of Jewish law in Conservative Judaism, has published a teshuva on suicide and assisted suicide in the summer 1998 issue of "Conservative Judaism" Vol. L, No.4. It affirms the above stated prohibition, and then goes on to its real purpose -- to counter the growing trend of Americans and Europeans who are asking their friends and family to help kill themselves. As the Conservative teshuva points out, many people get sick, often with terminal illnesses, but most people don't try to kill themselves. So the committee believes that we are obligated to find out why some people do ask for help with suicide, and we are then obligated to remove these reasons so that people don't want to kill themselves in the first place.

The Conservative responsa states that:

"...those who commit suicide and those who aid others in doing so act out of a plethora of motives. Some of these reasons are less than noble, involving, for example, children's desires to see Mom or Dad die with dispatch so as not to squander their inheritance on 'futile' health care, or the desire of insurance companies to spend as little money as possible on the terminally ill."

The paper discusses the fact that some patients want to die because they are in pain, but they point out that the proper response to this is not suicide, but simply better pain control and more pain medication. The paper then points out that there is a crisis in the medical care of elderly and terminally ill patients: many doctors are deliberately keeping such patients in pain by refusing to grant them adequate amounts of pain killers. Some do this out of ignorance, others do it because they claim they want to avoid any possibility of the patient becoming a drug addict. Some doctors recommend a stoic attitude. The position of Conservative Judaism holds that all such forms of reasoning are "bizarre" and cruel. With today's medications, there is no reason for people to be in this kind of perpetual torture.

It then investigates the psychological reasons for the hopelessness felt by some patients. It points out that:

"Physicians or others asked to assist in dying should recognize that people contemplating suicide are often alone, without anyone taking an interest in their continued living. Rather than assist the patient in dying, the proper response to such circumstances is to provide the patient with a group of people who clearly and repeatedly reaffirm their interest in the patient's continued life... Requests to die, then, must be evaluated in the terms of degree of social support the patient has, for such requests are often withdrawn as soon as someone shows an interest in the patient staying alive. In this age of individualism and broken and scattered families, and in the antiseptic environment of hospitals where dying people usually find themselves, the mitzvah of visiting the sick (bikkur Holim) becomes all the more crucial in sustaining the will to live"

The pro-choice argument

In contrast to the views above, there are also arguments in favour of allowing an individual to choose between life and suicide. This view sees suicide as a valid option.

This line rejects the widespread belief that suicide is always or usually irrational, saying instead that it is a genuine, albeit severe, solution to real problems -- a line of last resort that can legitimately be taken when the alternative is considered worse.

Furthermore, the pro-choice position asserts, in the spirit of liberalism, that a person's life belongs only to him or her, and nobody else should try to enforce their own view that life must be lived on them. Rather, only the individual involved can make such an important decision, and whatever decision he or she does make, it should be respected.

Philosophical thinking in the 19th and 20th century has led, in some cases, beyond thinking in terms of pro-choice, to the point that suicide is no longer a last resort, or even something that one must justify, but something that one must justify not doing. Existentialist thinking essentially begins with the premise that life is objectively meaningless, and then poses the question "why not just kill oneself?" It then proceeds to answer this by suggesting the individual has the power to give personal meaning. Nihilist thinkers reject this emphasis on the power of the individual to create meaning, and acknowledge that all things are equally meaningless, including suicide.

Suicide prevention

Clinicians most often assert the only reliable preventive intervention for person at risk of suicide is hospitalization in a closed ward. But counsellors advise families, friends, teachers and social workers of approaches that offer the promise of discouraging a suicidal act.

The difficulty in finding effective approaches may be related to a lack of knowledge among the close associates of a potential suicide victim about the appropriate approach that will best help that particular victim. For a person with strong or at least definitive family or community ties, urgently providing information about who else would be hurt and the loss that they would feel can sometimes be effective. For a person suffering poor self-esteem, citing valuable and productive aspects of their life can be helpful. Sometimes provoking simple curiosity about the victim's own future can be helpful, but the approach may be less productive in a person suffering physical fatigue or nutritional deficiencies that would interfere with the development of normal curiosity.

Combination of murder and suicide

The combination of murder and suicide can take various forms, including:

  • suicide to facilitate murder, as in suicide bombing
  • suicide after murder to escape punishment, or perhaps having a combined objective of suicide and murder, e.g. Dunblane Massacre, Columbine High School massacre
  • suicide after murder as a form of self-punishment due to guilt
  • considering one's suicide as the main act, but murdering e.g. one's children first, to avoid their becoming orphans, and to be together in an expected afterlife
  • joint suicide in the form of killing the other with consent, and then killing oneself

See also

Readings

  • Frederick, C. J. TRENDS IN MENTAL HEALTH: SELF-DESTRUCTIVE BEHAVIOR AMONG YOUNGER AGE GROUPS. Rockville, MD: National Institute on Drug Abuse. 1976. ED 132 782.
  • Lipsitz, J. S. MAKING IT THE HARD WAY: ADOLESCENTS IN THE 1980S. Testimony presented to the Crisis Intervention Task Force of the House Select Committee on Children, Youth, and Families. 1983. ED 248 002.
  • McBrien, R. J. "Are You Thinking of Killing Yourself? Confronting Suicidal Thoughts." SCHOOL COUNSELOR 31 (1983): 75-82.
  • Ray, L. Y. "Adolescent Suicide." PERSONNEL AND GUIDANCE JOURNAL 62 (1983): 131-35.
  • Rosenkrantz, A. L. "A Note on Adolescent Suicide: Incidence, Dynamics and Some Suggestions for Treatment." ADOLESCENCE 13 (l978): 209-14.
  • Smith, R. M. ADOLESCENT SUICIDE AND INTERVENTION IN PERSPECTIVE. Paper presented at the annual meeting of the National Council on Family Relations, Boston, MA, August, 1979. ED 184 017.
  • SUICIDE AMONG SCHOOL AGE YOUTH. Albany, NY: The State Education Department of the University of the State of New York, 1984. ED 253 819.
  • SUICIDE AND ATTEMPTED SUICIDE IN YOUNG PEOPLE. REPORT ON A CONFERENCE. Geneva, Switzerland: World Health Organization, 1974. ED 162 204.
  • TEENAGERS IN CRISIS: ISSUES AND PROGRAMS. HEARING BEFORE THE SELECT COMMITTEE ON CHILDREN, YOUTH, AND FAMILIES. HOUSE OF REPRESENTATIVES NINETY-EIGHTH CONGRESS, FIRST SESSION. Washington, DC: Congress of the U. S., October, 1983. ED 248 445.

Support groups

For the rock band named Suicide, see Suicide (band).

A suicide is also a drink which consists of various sodas combined together from a soda fountain.


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