suicide

Suicide (from Latin sui caedere, to kill oneself) is the willful act of killing oneself. Suicide can also refer to an individual who has killed him or herself.

Suicidal phenomena

Suicide crisis

Main article: Suicide crisis

A suicide being attempted, or a situation in which a person is seriously contemplating suicide or has strong suicidal thoughts. It is considered by public safety authorities, medical practice, and emergency services to be a medical emergency, requiring immediate suicide intervention and emergency medical treatment.

Suicidal ideation

Main article: Suicidal ideation

Suicidal ideation is defined as considering or fantasizing about taking one’s own life. Ideation may range from vague or unformed urges to meticulously detailed plans and posthumous instructions.

Suicidal gestures and attempts

Sometimes, a person will make actions resembling suicide attempts while not being fully committed, or in a deliberate attempt to have others notice. This is called a suicidal gesture (also known as a "cry for help"). Prototypical methods might be a non-lethal method of self-harm that leaves obvious signs of the attempt, or simply a lethal action at a time when the person considers it likely that he/she will be rescued or prevented from fully carrying it out.

On the other hand, a person who genuinely wishes to die may fail, due to lack of knowledge about what they are doing, unwillingness to try methods that may end in permanent damage if they fail or harm others, or an unanticipated rescue, among other reasons. This is referred to as a suicide attempt.

Distinguishing between a suicidal attempt and a suicidal gesture may be difficult. Intent and motivation are not always fully discernible since so many people in a suicidal state are genuinely conflicted over whether they wish to end their lives. One approach, assuming that a sufficiently strong intent will ensure success, considers all near-suicides to be suicidal gestures. This however does not explain why so many people who fail at suicide end up with severe injuries, often permanent, which are most likely undesirable to those who are making a suicidal gesture. Another possibility is those wishing merely to make a suicidal gesture may end up accidentally killing themselves, perhaps by underestimating the lethality of the method chosen or by overestimating the possibility of external intervention by others. Suicide-like acts should generally be treated as seriously as possible because if there is an insufficiently strong reaction from loved ones from a suicidal gesture, this may motivate future, and ultimately more committed attempts.

In the technical literature the use of the terms parasuicide, or deliberate self-harm (DSH) are preferred – both of these terms avoid the question of the intent of the actions.

Parasuicide

Main article: parasuicide

Many suicidal people engage in suicidal activities that do not result in death. These activities fall under the clinical designation of parasuicide. Those with a history of such attempts are almost 23 times more likely to eventually end their own lives than those who don't participate in such activities.^[1]

Suicide note

Main article: Suicide note

A written message left by someone who attempts or commits suicide is known as a suicide note. The practice is fairly common, occurring in approximately one out of three suicides in the United States.[2] Motivations for leaving one range from seeking closure with loved ones to exacting revenge against others by blaming them for the decision.

Assisted suicide

Main article: Euthanasia

A suicidal individual who lacks the physical capacity to take their own life may enlist someone else to carry out the act on their behalf, frequently a family member or physician. This may or may not be considered a form of suicide according to different moral views of the practice, with opponents regarding it instead as akin to murder. Assisted suicide is a contentious moral and political issue in many countries.

Murder-suicide

Main article: Murder-suicide

Since crime just prior to suicide is often perceived as being without consequences, it is not uncommon for suicide to be linked with homicide. Motivations may range from guilt to evading punishment, insanity, and killing others as part of a suicide pact.

Fake suicide

Main article: Pseudocide

People sometimes fake suicide, usually in order to escape legal, financial, or relationship difficulties and start a new life. In order to explain the absence of a body, it is common to fake suicide by drowning. The term pseudocide covers not only fake suicide, but other fake deaths too (primarily fake murder).

Relation of suicide to self-harm

Main article: self-harm

Self-harm is not a suicide attempt. There is a non-causal correlation between self-harm and suicide; both are most commonly a joint effect of depression. Deliberate self-harm (DSH) is far more common than suicide, and the majority of DSH participants are females aged under 35, lacking any significant physical illnesses. Social issues are key as DSH is most common among those living in overcrowded conditions, in conflict with their families, with disrupted childhoods and history of drinking and violence. Borderline personality disorder is another frequent psychological factor. Individuals under these stresses become anxious and depressed and then, usually in reaction to a single particular crisis, they attempt to harm themselves. The motivation may be a desire for relief from emotional pain or a desire for attention, although the motivation will often be complex and confused. DSH may also result from an inner conflict between the desire to end life and the desire to continue living.

Reasons for suicide

Causes of suicide

No single factor has gained acceptance as a universal cause of suicide. However, depression is a common phenomenon amongst those who commit suicide. Other factors that may be related are as follows (Note that this is not meant as a comprehensive list, but rather as a summary of notable causes):

• Pain (e.g. physical or emotional agony that is not correctable)
• Stress (e.g. Grief after a death, guilt, failure in school/exams)
• Crime (e.g. escaping judicial punishment and dehumanisation, boredom of incarceration)
• Mental illness and disability (e.g. depression, bipolar disorder, trauma, obsessive compulsive disorder, body dysmorphic disorder, schizophrenia, or "losing it" after a traumatic event)
• Catastrophic injury (e.g. paralysis, disfigurement, loss of limb)
• Substance abuse
• Adverse environment (e.g. sexual abuse, domestic abuse, poverty, homelessness, discrimination, bullying, fear of murder and/or torture)
• Financial loss (e.g. gambling addiction, loss of job/assets, stock market crash, debts)
• Unresolved sexual issues (e.g. sexual orientation,^[2] gender dysphoria, unrequited love, aftermath of a break up)
• To avoid shame or dishonour (e.g. Under the Bushido ideal, if a samurai failed to uphold his honour, he could regain it by performing seppuku.)
• Old age^[3]
• Terrorism can also be a motive for suicide, especially when related to religion (e.g., suicide bombings)
• Extreme nationalism (e.g., the Kamikaze, Selbstopfer, and Kaiten suicide weapons)

Epidemiology

Main article: Epidemiology and methodology of suicide

According to official statistics, about a million people commit suicide annually, more than those murdered or killed in war.^[4] As of 2001 in the USA, suicides outnumber homicides by 3 to 2 and deaths from AIDS by 2 to 1^[5]

Gender and suicide: In the Western world, males die much more often than females by suicide, while females attempt suicide more often. Some medical professionals believe this is due to the fact that males are more likely to end their life through violent means (guns, knives, hanging, drowning, etc.), while women primarily overdose on medications or use other ineffective methods. Others ascribe the difference to inherent differences in male/female psychology, with men having more of an operational mindset and women being more aware of social nuance.^[6] Greater social stigma against male depression and a lack of social networks of support and help with depression is often identified as a key reason for men's disproportionately higher level of suicides, since "suicide as a cry for help" is not seen as an equally viable option by men. Typically males die from suicide 3 to 4 times as often as females, and not unusually 5 or more times as often.

Excess male mortality from suicide is also evident from data from non-western countries. In 1979-81, 74 territories reported one or more cases of suicides. Two of these reported equal rates for the sexes: Seychelles and Kenya. Three territories reported female rates exceeding male rates: Papua-New Guinea, Macau, French Guiana. The remaining 69 territories had male suicide rates greater than female suicide rates.^[7]

Barraclough found that the female rates of those aged 5-14 equaled or exceeded the male rates only in 14 countries, mainly in South America and Asia.^[8]

National suicide rates sometimes tend to be stable. For example, the 1975 rates for Australia, Denmark, England, France, Norway, and Switzerland, were within 3.0 per 100,000 of population from the 1875 rates (Australian Bureau of Statistics, 1983; Lester, Patterns, 1996, p. 21). The rates in 1910-14 and in 1960 differed less than 2.5 per 100,000 of population in Australia, Belgium, Denmark, England & Wales, Ireland, Japan, New Zealand, Norway, Scotland, South Africa, Spain, Sweden, and The Netherlands (Lester, Patterns, 1996, p. 22).

There are considerable differences between national suicide rates. Findings from two studies showed a range from 0.0 to more than 40 suicides per 100,000 of population.^[9]

National suicide rates, apparently universally, show an upward long-term trend. This trend has been well documented for European countries.^[10] The trend for national suicide rates to rise slowly over time might be an indirect result of the gradual reduction in deaths from other causes, i.e. falling death rates from causes other than suicide uncover a previously hidden predisposition towards suicide.^[11][12]

Race and suicide. At least in the USA, Caucasians commit suicide more often than African Americans do. This is true for both genders. Non-Hispanic Caucasians are nearly 2.5 times more likely to kill themselves than are African Americans or Hispanics.^[13]

Age and suicide At least in the USA, males over 70 commit suicide more often than younger males. There is no such trend for females. Older non-Hispanic Caucasian men are much more likely to kill themselves than older men or women of any other group, which contributes to the relatively high suicide rate among Caucasians. Caucasian men in their 20s, conversely, kill themselves only slightly more often than African American or Hispanic men in the same age group.^{citation needed]}

Season and suicide People commit suicide more often during spring and summer. The idea that suicide is more common during the winter holidays (including Christmas in the northern hemisphere) is a common misconception.^[14]

Other reasons

Suicide as a form of defiance and protest

Heroic suicide, for the greater good of others, is often celebrated. For instance, Mahatma Gandhi went on a hunger strike to prevent fighting between Hindus and Muslims, and, although he was stopped before dying, it appeared he would have willingly succumbed to starvation. This attracted attention to Gandhi's cause, and generated a great deal of respect for him as a spiritual leader. In the 1960s, Buddhist monks, most notably Thích Quảng Đức, in South Vietnam drew Western attention to their protests against President Ngô Đình Diệm by burning themselves to death. Similar events were reported during the Cold War in eastern Europe, such as the death of Jan Palach following the Soviet invasion of Czechoslovakia, or Romas Kalanta's self-immolation in the main street of Kaunas, Lithuania in 1972. More recently, an American anti-war activist, Malachi Ritscher committed suicide by self-immolation as a protest against the Iraq war. Critics may see such suicides as counter-productive, arguing that these people would probably achieve a comparable or greater result by spending the rest of their lives in active struggle. Suicide or attempted suicide as a means of effecting social or political change is related to martyrdom.

Military suicide

In the desperate final days of World War II, many Japanese pilots volunteered for kamikaze missions in an attempt to forestall defeat for the Empire. In Nazi Germany, Luftwaffe squadrons were formed to smash into American B-17s during daylight bombing missions, in order to delay the highly-probable Allied victory, although in this case, inspiration was primarily the Soviet and Polish taran ramming attacks, and death of the pilot was not a desired outcome. The degree to which such a pilot was engaging in a heroic, selfless action or whether they faced immense social pressure is a matter of historical debate. The Japanese also built one-man "human torpedo" suicide submarines.

However, suicide has been fairly common in warfare throughout history. Soldiers and civilians committed suicide to avoid capture and slavery (including the wave of German and Japanese suicides in the last days of World War II). Commanders committed suicide rather than accept defeat. Behaviour that could be seen as suicidal occurred often in battle. For instance, soldiers under cannon fire at the Battle of Waterloo took fatal hits rather than duck and place their comrades in harm's way.^{verification needed]} The Charge of the Light Brigade in the Crimean War, Pickett's Charge at Gettysburg in the American Civil War , and the charge of the French cavalry at the Battle of Sedan in the Franco-Prussian War were assaults that continued even after it was obvious to participants that the attacks were unlikely to succeed and would probably be fatal to most of the attackers. Japanese infantrymen usually fought to the last man, launched "banzai" suicide charges, and committed suicide during the Pacific island battles in World War II. In Saipan and Okinawa, civilians joined in the suicides. Suicidal attacks by pilots were common in the 20th century: the attack by U.S. torpedo planes at the Battle of Midway was very similar to a kamikaze attack.

Impact of suicide

It is estimated that an average of six people are suicide "survivors" for each suicide that occurs in the United States.^[15] It is important to note that in the context of suicide, the word "survivors" refers to the family and friends of the person who has died by suicide; this figure therefore does not represent the total number of people who may be affected. For example, the suicide of a child may leave the school and their entire community left to make sense of the act.

As with any death, family and friends of a suicide victim feel grief associated with loss. These suicide survivors are often overwhelmed with psychological trauma as well, depending on many factors associated with the event. This trauma can leave survivors feeling guilty, angry, remorseful, helpless, and confused. It can be especially difficult for survivors because many of their questions as to why the victim felt the need to take his or her own life are left unanswered. Moreover, survivors often feel that they have failed or that they should have intervened in some way. Given these complex sets of emotions associated with a loved one's suicide, survivors usually find it difficult to discuss the death with others, causing them to feel isolated from their own network of family and friends and often making them reluctant to form new relationships as well.^[16]

"Survivor groups" can offer counseling and help bring many of the issues associated with suicide out into the open. They can also help survivors reach out to their own friends and family who may be feeling similarly and thus begin the healing process. In addition, counseling services and therapy can provide invaluable support to the bereaved. Some such groups can be found online, providing a forum for discussion amongst survivors of suicide (see Support Groups for Survivors section below).

Suicide methods

Main article: Suicide methods

In countries where firearms are readily available, many suicides involve the use of firearms. In fact, just over 55% of suicides committed in the United States in 2001 were by firearm.^[17] Asphyxiation methods (including hanging) and toxification (poisoning and overdose) are fairly common as well. Each comprised about 20% of suicides in the US during the same time period. Other methods of suicide include blunt force trauma (jumping from a building or bridge, or stepping in front of a train, for example), exsanguination or bloodletting (slitting one's wrist or throat), self-immolation, electrocution, car collision and intentional starvation.

Other views of suicide

Medical

Main article: Suicide intervention

Modern medicine treats suicide as a mental health issue. Overwhelming or persistent suicidal thoughts are considered a medical emergency. Medical professionals advise that people who have expressed plans to kill themselves be encouraged to seek medical attention immediately. This is especially relevant if the means (weapons, drugs, or other methods) are available, or if the patient has crafted a detailed plan for executing the suicide. Medical personnel frequently receive special training to look for suicidal signs in patients. Individuals suffering from depression are considered a high-risk group for suicidal behavior. Suicide hotlines are widely available for people seeking help. However, the negative and often too clinical reception that many suicidal people receive after relating their feelings to health professionals (e.g. threats of institutionalization, increased dosages of medication, the social stigma) may cause patients to remain more guarded about their mental health history or suicidal urges and ideation.

In the United States, individuals who express the intent to harm themselves are automatically determined to lack the present mental capacity to refuse treatment, and can be transported to the emergency department against their will. An emergency physician will determine whether or not inpatient care at a mental health care facility is warranted. This is sometimes referred to as being "committed." A court hearing may be held to determine the patient's competence.

Criminal

Main article: Legal views of suicide

In some jurisdictions, an act or failed act of suicide is considered to be a crime. Some places consider failure to be attempted murder, with the victim being oneself, and will prosecute such offenders for attempted murder.^{citation needed]} More commonly, a surviving party member who assisted in the suicide attempt will face criminal charges.

In Brazil, suicide is not a crime, but willfully instigating or assisting in its completion is. If the help is directed to a minor, the penalty is applied in its double and not considered as homicide. In Italy and Canada, instigating another to commit suicide is also a criminal offence. In Singapore, assisting in the suicide of a mentally-handicapped person is a capital offense.

Cultural

Main article: Cultural views of suicide

In the Warring States Period and the Edo period of Japan, samurai who disgraced their honor chose to end their own lives by harakiri (or seppuku), a method in which the samurai takes a sword and slices into his abdomen, causing a fatal injury. The cut is usually performed diagonally from the top corner of the samurai's writing hand, and has long been considered an honorable form of death (even when done to punish dishonor). Though obviously such a wound would be fatal, seppuku was not always technically suicide, as the samurai's assistant (the kaishaku) would stand by to cut short any suffering by quickly administering decapitation -- sometimes as soon as the first tiny incision into the abdomen was made.

Religious

Main article: Religious views of suicide

In Christianity, suicide is considered a sin by most modern sects, including the Catholic Church, based largely off of the writings of influential middle ages Christian philosophers St. Augustine and St. Thomas Aquinas-- suicide was not considered a sin under the Byzantine christian code of Justinian, for instance[3]. Their arguments are based largely around the sixth commandment, "thou shalt not kill" (made applicable under the New Covenant by Christ in Matthew 19:18), and the ideas that life is a gift given by God that should not be spurned, and that suicide is against the "natural order" and thus interferes with God's master plan for the world[4]. Counter-arguments include that the sixth commandment is more accurately translated as "thou shalt not murder", not applying to the self; that taking one's own life is no more violating God's plan than curing a disease; and that a number of suicides of followers of God are recorded in the Bible with no dire condemnation[5].

Debate over suicide

Main article: Philosophical views of suicide

Some see suicide as a legitimate matter of personal choice and a human right (colloquially known as the right to die movement), and maintain that no one should be forced to suffer against their will, particularly from conditions such as incurable disease, mental illness, and old age that have no possibility of improvement. Proponents of this view reject the belief that suicide is always irrational, arguing instead that it can be a valid, albeit drastic, last resort for those enduring major pain or trauma. This perspective is most popular in Continental Europe[6], where euthanasia and other such topics are commonly discussed in parliament, although it has a good deal of support in the United States as well.

A narrower segment of this group considers suicide something between a grave but condonable choice in some circumstances and a sacrosanct right for anyone (even a young and healthy person) who believes they have rationally and conscientiously come to the decision to end their own lives. Notable supporters of this school of thought include German pessimist philosopher Arthur Schopenhauer[7], and British empiricist David Hume[8]. Adherents of this view often advocate the abrogation of statutes that restrict the liberties of people known to be suicidal, such as laws permitting their involuntary commitment to mental hospitals. Critics may argue that suicidal impulses are inherently products of mental illness and therefore not a valid exercise of rational self-interest, and that because of the gravity and irreversibility of the decision to take one's life it is more prudent for society to err on the side of caution and protect suicidal individuals from themselves.