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A psychological approach to suicide

by J. Jeyaseelan, Department of Psychology, University of Peradeniya.



Drug addiction - factor in suicide

Turning the pages of daily newspapers in Sri Lanka, one is bombarded each day by the many reported cases of suicide. Report of attempted or completed suicide cases have become a regular theme in our newspapers.

How can we understand this phenomenon that confronts the people of this country in quite a serious way? In the psychological point of view, each suicide is a manifestation of a personal trauma in which there is always an inaccessible element of mystery. Any suicidal behaviour, whether completed or not, is always serious, and must never be taken for granted. Contemporary psychologists have spotlighted several factors that account for such behaviours.

Mental disorders

According to research findings, mental disorders are at the heart of, almost, all suicidal cases. Mental disorders tend to act as the chief causative element in suicides. According to psychologists all the other factors, including the social ones, play only a precipitating or predisposing role. It is believed that social factors such as poverty, the breakup of relationships and so on, can lead to suicide only if the individual is psychologically weak and shows symptoms of the presence of a mental disorder. Mental disorders are therefore the primary causative factors in suicide. The other social factors, coupled with them, may lead an individual to suicide. And therefore those factors can be considered precipitating factors.

In the opinion of psychologists the mental disorders linked most strongly to suicide are mood disorders. Depression and mania are the dominating emotions in mood disorders. Depression is a low, sad state in which life seems bleak and its challenges overwhelming. Mania is a state of breathless euphoria, and it is the extreme opposite of depression.

A second mental disorder related to suicide is schizophrenia. Schizophrenia is a severe mental illness characterised by gross distortion of reality, withdrawal from social interaction, and disorganisation of perception, thought and emotion. It is very difficult illness in which the person lives in his own world, created by him without any regard for reality. On an emotional level the symptoms can be lack of interest, indifference, passion for persons on television, abnormality of sexual behaviour, and so on. Depressive and maniac features also form part of the schizophrenic disorder.

They suffer from delusion, holding beliefs that are blatantly false and even bizarre. Schizophrenic patients also hear voices that are not actually present, which are called hallucinations. There is a popular belief that suicide by schizophrenic patients must be in response to imagined voices commanding self-destruction, or a delusion that suicide is a grand and noble gesture. Research indicates that although some persons with schizophrenia do display these kinds of symptoms at the time of suicide, more suicides by schizophrenic patients reflect feelings of demoralisation.

Stress

A suicide attempt can be triggered by a single event, or a series of stressful events in a person's life. Stress can originate from the loss of a loved one, an accident, divorce, the breakup of a love affair, rejection by peers or colleagues, loss of a job, repetitive failure in exams, and so on. Ronald Comer identifies four kinds of common stressors, which seem to increase the prospect of suicide in an individual:

Serious Illness

A painful or disabling illness is found to be at the heart of some suicide attempts. Person with cancer or frequent heart failures may come to feel that death is unavoidable and imminent, or that the sufferings and problems caused by their illness are more than they can endure. In such cases patients tend to end their lives by choosing to commit suicide.

Prisoners of war, abused spouses, abused children and prison inmates may attempt to commit suicide because of the abusive environment from which they have little or no hope of escape.

Some jobs create ongoing feelings of tension and dissatisfaction that can precipitate suicide attempts.

The different roles occupied by an individual spouse, teacher, parent and colleague, for example - may conflict, and can cause considerable stress, sometimes to the extent of leading one to suicide. Women who hold jobs outside the home often experience role conflict, a condition that might lead to severe stress.

So, different stressful events of life can give rise to suicidal tendencies. However, if the individual is strong enough to cope with the situation without too much panic and pessimism, the stressful events of life will play only a small role in leading to suicide. Therefore, the strength of one's ego, the ability of the personality to manage stressful situations and to remedy them with appropriate coping strategies can considerably reduce the prospect of suicide in an individual.

Everyone encounters stressful situations in life at one time or another, and not all commit suicide. Love affairs break up everywhere, and not all commit suicide. People are sacked, demoted and punished in their professional environment, and not all commit suicide. We all lose our near and dear ones somewhere in our lifetime, and do not all commit suicide unable to bear the stress. This means that the strength of one's personality can make a difference when met with a stress-producing life event.

The mass media

Psychologists believe modelling can predispose individuals to suicide attempts. That is why we hear of people trying to end their lives after observing or reading about a suicide. Perhaps they have been struggling with major problems, and another's suicide seems to reveal a possible solution. Or they have been contemplating suicide the another person's suicide seems to give permission or finally persuades them to act.

Because modelling can facilitate suicide, he media should play a responsible and thoughtful role by not making suicidal cases a big agenda. Strangely enough we can find an enormous amount of literature on suicide in both the print and the electronic media of Sri Lanka. One cannot really understand what kind of thrill these reports carry that people are so interested in such sensational news items. Is it not disturbing to see a lacerated body with scattered parts lying in a pool of blood? Even recently most of our newspapers carried a picture of the dead body of the Inspector who was shot dead in Dehiwela, lying in bed, flesh-torn, in a pool of blood, on the front page.

From a psychological perspective, the prevention of suicide can be thought of as a three-step process: the detection of the suicidal crisis, the assessment of the situation, and the defusing of the crisis.

Step 01: Detection of the suicidal crisis. How to detect a suicidal crisis? To do this we need to be on the alert. People who contemplate suicide might express their desire somehow, directly or indirectly, before they commit the act. If someone were to say, "It is better to be dead off instead of struggling with this mess of life," or "I think it's time for me to go to the eternal home," be careful; they might be direct expressions of a suicidal ideation. Expressions like "If I see you again" or "If I will be there to celebrate your next birthday" may be indirect expressions of an active death wish. Other symptoms include feeling useless, distributing personal souvenirs, discussion concerning bodily donations, desire for a long sleep, and discussions concerning funeral organisations. Being attentive to such symptoms is the first step in the prevention of suicide, from a psychological point of view.

Step 02: Assessment of the suicidal crisis. When the detection of the suicidal crisis is done, the second step in prevention is the assessment of the crisis. Assessment can be done in the form of an informal interview with the person concerned. More interviews may also be needed in order to assess the degree of the support of the family and the social network, the absence of which could be a possible co-factor in the suicide crisis. At this point, we need to assess whether the person has devised a suicide project, that is, a plan concerning how, when and where to commit the act. Questions regarding probability (whether the person will really commit suicide) and proximity (if so, when) should also be assessed.

Step 03: Defusing the suicidal crisis. When the assessment step is complete what remains is the third and final step of defusing the suicide crisis. To accomplish this step several measures have to be taken. Psychologists believe that if a person talks out the plan of suicide it is possible to avert the actual suicide attempt. Here the primary objective is to help these individuals regain their ability to cope with their immediate problems, and to do so as quickly as possible. Emphasis is usually placed on (1) maintaining contact with the person over a short period of time, (2) helping the person realise that acute distress is impairing his or her ability to assess the possible alternatives, (3) helping the person to see that there are other ways of dealing with the problem that are preferable to suicide, (4) taking a highly directive as well as supportive role by giving specific suggestions, and (5) helping the person to see that the present distress and emotional turmoil will not be endless.

Anther effective preventive measure would be to help the person resume ties with family, professional environment, peers, friends and others, if the person seems to be at loggerheads with them.

Through attempts to commit suicide people are conveying some message. It is the indication of some deeply disturbing turmoil with the person, which may be an outcome of some traumatic experience, an unpleasant atmosphere at home and professional institution and so on. Therefore, we have to do something immediately as a response to the message the individual has just sent. We can use hospitalisation as a solution since it can achieve the following ends. Firstly, it will help the person to take some time to think clearly about his/her decisions. Secondly, from there we can start some counselling sessions, which may be of help for the person to come out of his/her personal struggle.

Thirdly, people can visit the individual in the hospital as a gesture of their love and concern for him/her. This will give them the impression that people care about and for them.

Oftentimes there is a need to create a pleasant atmosphere for the verbalisation of the crisis by the individual in question. This means the counsellor or the person who is dealing with the person in crisis should help him or her to formulate in words the problem that is causing the distress. It is believed that by talking the crisis out through verbalisation and by giving meaning to it one can reduce the prospect of suicide.

Verbalisation also serves as an outlet for the horribly damaging pent-up emotional energy that has taken hold of them.

Now the question as to who will play this preventive role in society needs a solid answer. It would be easy to assign the task completely to professional psychologists, psychiatrists and counsellors.

Though their role may be impressive, and crucial in such situations, the prevention of suicide still requires several other participants - family, relatives, society, colleagues, religious leaders, medical practitioners, and the media - to do their part as well to contribute a solution to this problem. Further, those who work in this field point out a need for more counselling, emergency services, and hotline facilities.

It is up to the relevant officials to feel this need, and get the services of people, who are trained in the field of psychology, counselling and psychiatry, to work out effective means to prevent suicide.

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