Why Depression is the Precursor of a Vast Majority of Suicides
SUICIDE
Individuals may be genetically vulnerable to manic-depressive illness.
Manic-depressive individuals are more often found in families in which
successive generations have experienced depression or manic-depression.
Unipolar depressives are more usually found in families with no history of
manic or depressive disorders (Winokur and Clayton, 1976). A disorder can
run in families either because it is inherited or because family members
share a similar environment. Twin data can help decide between these alternatives,
since identical twins share all their genes, but
fraternal twins share only half their genes. When an identical twin is
manic depressive, the probability that his co-twin will also be manic-depressive is
higher than it is for fraternal twins (Allen, 1976). This suggests that the disorder
is partially inherited. The mechanism of such genetic transmission
and the existence of stressors that set off manic-depression when combined
with genetic vulnerability are still matters of speculation and controversy.
TREATMENT
By and large, manic-depressive illness can be successfully contained by lithium
salts. Lithium was originally used as a table salt substitute. In 1949,
John Cade, an Australian physician, having found that lithium made guinea
pigs lethargic, tried it to dampen mania in humans and found that lithium
ended severe manic attacks. Since that time, lithium carbonate has been
used extensively with manic-depression. Over the last thirty years, lithium
has been shown to be an effective treatment both for mania and for the depressive
aspects of manic-depression. Approximately 80 percent of manic
depressives will show a full or partial alleviation of symptoms during
lithium administration. It is also clear, however, that the other 20 percent of
bipolar depressives do not respond (Depue, 1979). Lithium has also been
used as a preventative treatment for manic-depression, and repeated dosage
with lithium in a vulnerable individual may prevent manic-depressive relapses
(Depue, 1979). While lithium can be viewed as a miracle drug for
manic-depression, its side effects, particularly its cardiovascular, digestive,
and central nervous system effects can be quite serious. Close medical supervision
should always accompany the administration of lithium. Both the
evidence on the effectiveness of lithium and the evidence on genetic vulnerability
suggest that manic-depression is best understood within the framework
of the biological model.
SUICIDE
Suicide is the most disastrous consequence of depression, bipolar or unipolar.
Depression is the precursor of a vast majority of suicides. Death only
rarely results directly from other psychological disorders: the anorexic patient
who refuses food; the hallucinating schizophrenic, who believing he is
Christ, attempts to walk on water; the heroin addict who administers an
overdose. But it is depression that most frequently results in irreversible
harm…death by suicide.
Suicide is the second most frequent cause of death among college students.
Further, it is on the rise in this age group. The death of a young person,
because of all his unfulfilled promise, is a keenly felt tragedy. As a young man
before composing his second symphony, Beethoven almost
took his own life. What held him back was the thought that he had not yet
produced the best that might be inside him.
Suicide is an act that most societies forbid. Many religions regard it as a
sin; and it is, astonishingly, a crime in several states. No act leaves such a
bitter and lasting legacy among friends and relatives. It leaves in its wake
bewilderment, guilt, shame, and stigma that relatives may carry to their own graves.
Suicide is occasionally an act of high rationality. Seneca, the first century
Roman stoic, said:
Living is not good, hut living well. The wise man, therefore, lives as well as he
should, not as long as he can ... He will always think of life in terms of quality,
not quantity ... Dying early or late is of no relevance, dying well or ill is... Even
if it is true that while there is life, there is hope, life is not to be bought at any cost.
(Seneca Epistle #70)
~~~~~~~~~~~~~~~~~~~~~~~~~~~
More often, however, even though the decision seems rational to the individual
who takes his life, he is usually strongly ambivalent about the decision.
One vote can tip the balance, as in a declaration of war (see Table
13-2). For example, when a physician canceled an appointment with a patient,
this last straw in a series of disappointments tipped the balance toward suicidal death.
The ethical quandaries of suicide are immensely difficult. Does an individual
have a right to take .his own life, not interfered with by others, just as
he has a right to dispose, unimpeded, of his own property? (Szasz, 1974).
WHO Is AT RISK FOR SUICIDE?
The list of famous suicides is very long: Marilyn Monroe, Samson, Ernest
Hemingway, Cleopatra, Sid Vicious, Virginia Woolf, Jack London, Modigliani,
Adolph Hitler, Jim Jones and his People's Temple victims, to name a
very few. At the very least, 25,000 people end their lives by suicide every
year in the United States. There are also estimated to be at least ten times as
many suicide attempts as successful suicides, and it has been estimated that
in the United States today, five million people are alive who have attempted suicide.
The estimate of 25,000 suicidal deaths per year in the United States is
highly conservative, and the real number is probably between 50,000 and
100,000. There are several reasons for the under reporting of suicide. Such
stigma attaches to the act that the influential can often get coroners to label a
relative's death as an accident rather than a suicide, and there is often family
pressure on physicians not to report deaths as suicides. Many one-car
accidents on clear roads are suicides, but they are usually labeled accidental
death. Those individuals who flirt with death by high-risk hobbies or occupations,
by adopting lethal habits such as heavy smoking, drinking, and
drugs, as well as the physically ill who terminate their own life by discontinuing
medication are not counted as suicidal deaths. In subcultures in which
suicide is seen as feminine and passive, but murder is seen as active and masculine,
"victim-induced homicide"-for example, an adolescent provoking
a policeman to kill him-is not counted as a suicide (Schyler, 1974; Diggory,
1976; Linden and Breed, 1976).
Depression and Suicide
Depressed individuals are the single group most at risk for suicide. While
suicide occasionally occurs in the absence of depression and the large majority
of depressed people do not commit suicide, depression is a strong predisposing
factor to suicide. An estimated 80 percent of suicidal patients are
significantly depressed. Depressed patients ultimately commit suicide at a
rate that is at least twenty-five times as high as control populations (Pokorny,
1964; Flood and Seager, 1968; Robins and Guze, 1972).
Sex Differences and Suicide
Women make roughly three times as many suicide attempts as men, but
men actually succeed in killing themselves three times more often than
women. These discrepancies seem to have diminished a bit over the last few
years. The greater rate of suicide attempts in women is probably related to
the fact that more depression occurs in women, whereas the greater completed
suicide rate in men probably has to do with choice of methods:
Women tend to choose less lethal means, such as cutting their wrists and
overdosing on sleeping pills; whereas men tend to shoot themselves and
jump off buildings. The suicide rate for both men and women is higher
among individuals who have been divorced and widowed; loneliness as well
as a sense of failure in interpersonal affairs surely contributes to this statistic.
Men who kill themselves tend to be motivated by failure at work, and
women who kill themselves tend to be motivated by failure at love (Mendels,
1970; Linden and Breed, 1976; Schneidman, 1976). As one female patient
who tried to find surcease in suicide after being rejected by her lover
said, "There's no sense in living. There's nothing here for me. I need love
and I don't have it anymore. I can't be happy without love-only miserable.
It will just be the same misery, day in and day out. It's senseless to go on" (Beck,1976).
Cultural Differences and Suicide
Race, religion, and nationality contribute somewhat to vulnerability to suicide.
The suicide rate of young black and white men is approximately the
same (Hendin, 1l969; Linden and Breed, 1976), but black women and older
black men probably kill themselves less often than whites (Swanson and
Breed, 1976). There is some evidence that American Indians may have a
higher suicide rate than the rest of the population (Frederick, 1978). Religion,
at least in the United States, does not offer any protection against suicide
in spite of varyingly strong strictures against it. Also, the rate of suicide
is roughly the same whether the individual is nonreligious, or Catholic,
Protestant, or Jewish.
Suicide occurs in all cultures, even primitive ones, but it seems to be more
common in industrialized countries. At the present time, the countries of
central Europe seem to have the highest suicide rate, with Hungary, Austria,
and Czechoslovakia ranking respectively first, third, and fourth. Ireland and
Egypt have very low suicide rates, perhaps because suicide is considered a
mortal sin in these cultures. West Berlin has the highest suicide rate in the
world, more than twice that of West Germany as a whole. The United States
has, on the world scale, an average suicide rate. Sweden has a middling high
rate of suicide. Some have blamed this on the lack of incentive provided by
its social welfare system, but its suicide rate has remained the same since
about 1910, before the introduction of social welfare (Schneidman, 1976).
Age and Suicide
One is more likely to commit suicide when one is older. In children, suicide
is rare, with probably fewer than 200 suicides committed in a year in the
United States by children who are under the age of fourteen.
~~~~~~~~~~~~~~~~~~~~~~~
Discussing her wish to die, Michelle, age nine, talks with Joaquim
Puig-Antich, a leading expert on childhood depression:
JOAQUIM PUIG-ANTICH: Do you feel you should be punished?
MICHELLE: Yes.
JPA: Why?
M: I don't know.
JPA: Have you ever had the thought that you might want to hurt yourself'? M: Yes.
JPA: How would you hurt yourself?
M: By drinking a lot of alcohol, or jumping off the balcony.
.I PA: Have you ever tried to jump?
M: I once stood on the edge of the terrace and put one leg over the railing, but
my mother caught me.
JPA: Did you really want to jump?
M: Yes.
JPA: What would have happened if you had jumped?
M: I would have killed myself.
JPA: Did you want to get killed?
M: Uh-huh.
JPA: Why?
M: Because I don't like the life I live.
JPA: What kind of life do you live?
M: A sad and miserable life.
(Jerome, 1979)
Suicide rate rises dramatically through middle age and into old age. Increasing
depression, loneliness, moving to a strange setting, loss of a meaningful
role in family and society, and loss of people they love all surely
contribute to the high rate of suicide among old people. In cultures and
communities in which the aged are revered and remain important in the life
of the family, suicide is infrequent.
Within two years of the death of her beloved husband with whom she had
spent fifty joyous years, Mrs. K_ committed suicide. "Alan," she told her son
a few days before, "I wasn't made to sleep alone." Percy Bridgman, Nobel
Prize winner in physics and famous American positivist, shot himself at age
eighty. He had cancer and was in great pain. The day before he killed himself,
he mailed the index for his collected works to the Harvard University
Press. He had repeatedly asked for euthanasia and had been, of course, refused.
His suicide note was published in the Bulletin of the Atomic Scientists (1962):
"It is indecent for Society to make a man do this thing himself. Probably
this is the last day I will be able to do it myself. PWB" (Schneidman,1976).
THE Motivation FOR SUICIDE
In the first major modern study of suicide, the French sociologist Emile
Durkheim (1858-1917) distinguished three motivations for suicide, all of
them intimately related to the way an individual sees his place in society. He
called these motives anomie, egoistic, and altruistic. Anomie suicide is
precipitated by a shattering break in an individual's relationship to his society:
the loss of a job, economic depression, even sudden wealth. Egoistic suicide
occurs when the individual has too few ties to his fellow humans. Societal
demands, principal among them the demand to live, do not reach the egoistic
individual. Finally, altruistic suicide is required by the society. The individual
takes his own life in order to benefit his community. Hara-kiri is an
altruistic suicide. The Buddhist monks who burned themselves to death to
protest the injustices of the Vietnam War are recent reminders of individuals
who committed altruistic suicide.
Modern thinkers see two more fundamental motivations for suicide: surcease
and manipulation. Those who wish surcease have simply given up.
Their emotional distress is intolerable, and they see no alternative solution.
In death, they see an end to their problems, sleep, or nothingness. Fifty-six
percent of the suicide attempts observed in a systematic study were classified
as individuals trying to achieve surcease. These suicide attempts involved
more depression, more hopelessness, and they tended to be more
lethal than the remaining suicide attempts (Beck et aI., 1976).
The other motivation for suicide is the wish to manipulate other people
by a suicide attempt. Some wish to manipulate the world that remains by
dying: to have the final word in an argument, revenge on a rejecting lover, to
ruin the life of another person. More commonly in manipulative suicide,
the individual intends to remain alive, but by showing the seriousness of his
dilemma, he is crying for help from those who are important to him. Trying
to prevent a lover from leaving, getting into the hospital and having a
temporary respite from problems, and being taken seriously are all manipulative
motives for suicide with intent to live.
Thirteen percent of suicide attempts were found to be manipulative; these
involved less depression, less hopelessness, and less lethal means than did
the surcease attempts (Beck, 1976). Those suicides that are manipulative are
clearly cries for help, but it should be apparent that all suicides are not cries
for help (see Box 13-4). The individual who wishes to escape because life is
SUICIDE NOTES
About one-sixth of those individuals who die by their own hand leave suicide
notes. A romantic view would lead us to expect that these final words, like those
that are supposed to be uttered on the deathbed, would be masterful summaries
of a life that preceded them and of the reasons for dying. Only occasionally are
they, "There should be little sadness, and no searching for who is at fault;
...for the act and result are not sad, and no one is at fault.
..My only sorrow is for my parents who will not easily be able to accept that this
is so much better for me. Please, folks, it's all right, really it is.
"I wanted to be too many things, and greatness besides-it was a hopeless
task. I never managed to really love another person-only to make the sounds of
it. I never could believe what my society taught me to believe, yet I could never
manage to quite find the truth.
"Two-fifteen p.m.-I'm about to will myself to stop my heartbeat and respiration.
This is a very mystical experience. I have no fear. That surprises me,
I thought I would be terrified. Soon I will know what death is like-how many people out there can say that?"
But much more often the notes are commonplace. Creative, unique, and expansive
pieces of writing are rare in suicide notes,the individual is usually constricted, his field of
consciousness has narrowed, and he is in despair. This is not a state conducive to creativity:
"Dearest darling I want you to know that you are the only one in my life I love you so much I could not do without you please forgive me I drove myself sick honey please believe me I love you, you again and the baby honey don't be mean with me please I've lived 50 years since I met you, I love you-I love you, Dearest darling I love you, I love you. Please don't discriminate me darling I know that I will die don't be mean with me please I love you more than you will ever know, Darling please and honey, Tom, I don't tell Tom why his daddy said goodbye honey. Can't stand it anymore. Darling I love you. Darling I love you."
A good number of suicide notes merely contain instructions and directions:
"Dear Mary, I am writing you, as our divorce is not final, and will not be til next month, so the way things stand now you are still my wife, which makes you entitled to the things which belong to me, and I want you to have them, Don't let anyone take them from you as they are yours. Please see a lawyer and get them as soon as you can. I am listing some of the things, they are: a blue davenport and choir, a Magic Chef Stove, a large mattress, and electrolux cleaner, a 9 x 12 rug, reddish flower design and pad, All the things listed above are almost new. Then there is my 30-30 rifle, books, typewriter, tools and a hand contract for a house in Chicago, a savings account in Boston, Massachusetts, Your husband,"
And some are simple and starkly practical. A workman before hanging himself
in an abandoned house chalked his suicide note on the wall outside,
"Sorry about this. There's a corpse in here. Inform police."
Source. Adopted from Schneidman, 1976.
Not worth living is not crying out for help, but for an end to his troubles.
The remaining 31 percent of suicide attempts combine surcease and
manipulative motivation. Here the individual is not at all sure whether he
wishes to live or die, whether he wishes surcease or a change in the world.
In this undecided group, the more hopeless and the more depressed the individual
is, the stronger are the surcease reasons for the suicide attempt (Beck, Rush, Shaw, and Emery, 1979).
Treating:
Depression
Post-Traumatic Stress Disorder (PTSD)
Social Anxiety
Generalized Anxiety
Panic Disorder
Major Depression Disorder
Agoraphobia
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
For the Therapy I recommend click here:
The Liberator Method
Individuals may be genetically vulnerable to manic-depressive illness.
Manic-depressive individuals are more often found in families in which
successive generations have experienced depression or manic-depression.
Unipolar depressives are more usually found in families with no history of
manic or depressive disorders (Winokur and Clayton, 1976). A disorder can
run in families either because it is inherited or because family members
share a similar environment. Twin data can help decide between these alternatives,
since identical twins share all their genes, but
fraternal twins share only half their genes. When an identical twin is
manic depressive, the probability that his co-twin will also be manic-depressive is
higher than it is for fraternal twins (Allen, 1976). This suggests that the disorder
is partially inherited. The mechanism of such genetic transmission
and the existence of stressors that set off manic-depression when combined
with genetic vulnerability are still matters of speculation and controversy.
TREATMENT
By and large, manic-depressive illness can be successfully contained by lithium
salts. Lithium was originally used as a table salt substitute. In 1949,
John Cade, an Australian physician, having found that lithium made guinea
pigs lethargic, tried it to dampen mania in humans and found that lithium
ended severe manic attacks. Since that time, lithium carbonate has been
used extensively with manic-depression. Over the last thirty years, lithium
has been shown to be an effective treatment both for mania and for the depressive
aspects of manic-depression. Approximately 80 percent of manic
depressives will show a full or partial alleviation of symptoms during
lithium administration. It is also clear, however, that the other 20 percent of
bipolar depressives do not respond (Depue, 1979). Lithium has also been
used as a preventative treatment for manic-depression, and repeated dosage
with lithium in a vulnerable individual may prevent manic-depressive relapses
(Depue, 1979). While lithium can be viewed as a miracle drug for
manic-depression, its side effects, particularly its cardiovascular, digestive,
and central nervous system effects can be quite serious. Close medical supervision
should always accompany the administration of lithium. Both the
evidence on the effectiveness of lithium and the evidence on genetic vulnerability
suggest that manic-depression is best understood within the framework
of the biological model.
SUICIDE
Suicide is the most disastrous consequence of depression, bipolar or unipolar.
Depression is the precursor of a vast majority of suicides. Death only
rarely results directly from other psychological disorders: the anorexic patient
who refuses food; the hallucinating schizophrenic, who believing he is
Christ, attempts to walk on water; the heroin addict who administers an
overdose. But it is depression that most frequently results in irreversible
harm…death by suicide.
Suicide is the second most frequent cause of death among college students.
Further, it is on the rise in this age group. The death of a young person,
because of all his unfulfilled promise, is a keenly felt tragedy. As a young man
before composing his second symphony, Beethoven almost
took his own life. What held him back was the thought that he had not yet
produced the best that might be inside him.
Suicide is an act that most societies forbid. Many religions regard it as a
sin; and it is, astonishingly, a crime in several states. No act leaves such a
bitter and lasting legacy among friends and relatives. It leaves in its wake
bewilderment, guilt, shame, and stigma that relatives may carry to their own graves.
Suicide is occasionally an act of high rationality. Seneca, the first century
Roman stoic, said:
Living is not good, hut living well. The wise man, therefore, lives as well as he
should, not as long as he can ... He will always think of life in terms of quality,
not quantity ... Dying early or late is of no relevance, dying well or ill is... Even
if it is true that while there is life, there is hope, life is not to be bought at any cost.
(Seneca Epistle #70)
~~~~~~~~~~~~~~~~~~~~~~~~~~~
More often, however, even though the decision seems rational to the individual
who takes his life, he is usually strongly ambivalent about the decision.
One vote can tip the balance, as in a declaration of war (see Table
13-2). For example, when a physician canceled an appointment with a patient,
this last straw in a series of disappointments tipped the balance toward suicidal death.
The ethical quandaries of suicide are immensely difficult. Does an individual
have a right to take .his own life, not interfered with by others, just as
he has a right to dispose, unimpeded, of his own property? (Szasz, 1974).
WHO Is AT RISK FOR SUICIDE?
The list of famous suicides is very long: Marilyn Monroe, Samson, Ernest
Hemingway, Cleopatra, Sid Vicious, Virginia Woolf, Jack London, Modigliani,
Adolph Hitler, Jim Jones and his People's Temple victims, to name a
very few. At the very least, 25,000 people end their lives by suicide every
year in the United States. There are also estimated to be at least ten times as
many suicide attempts as successful suicides, and it has been estimated that
in the United States today, five million people are alive who have attempted suicide.
The estimate of 25,000 suicidal deaths per year in the United States is
highly conservative, and the real number is probably between 50,000 and
100,000. There are several reasons for the under reporting of suicide. Such
stigma attaches to the act that the influential can often get coroners to label a
relative's death as an accident rather than a suicide, and there is often family
pressure on physicians not to report deaths as suicides. Many one-car
accidents on clear roads are suicides, but they are usually labeled accidental
death. Those individuals who flirt with death by high-risk hobbies or occupations,
by adopting lethal habits such as heavy smoking, drinking, and
drugs, as well as the physically ill who terminate their own life by discontinuing
medication are not counted as suicidal deaths. In subcultures in which
suicide is seen as feminine and passive, but murder is seen as active and masculine,
"victim-induced homicide"-for example, an adolescent provoking
a policeman to kill him-is not counted as a suicide (Schyler, 1974; Diggory,
1976; Linden and Breed, 1976).
Depression and Suicide
Depressed individuals are the single group most at risk for suicide. While
suicide occasionally occurs in the absence of depression and the large majority
of depressed people do not commit suicide, depression is a strong predisposing
factor to suicide. An estimated 80 percent of suicidal patients are
significantly depressed. Depressed patients ultimately commit suicide at a
rate that is at least twenty-five times as high as control populations (Pokorny,
1964; Flood and Seager, 1968; Robins and Guze, 1972).
Sex Differences and Suicide
Women make roughly three times as many suicide attempts as men, but
men actually succeed in killing themselves three times more often than
women. These discrepancies seem to have diminished a bit over the last few
years. The greater rate of suicide attempts in women is probably related to
the fact that more depression occurs in women, whereas the greater completed
suicide rate in men probably has to do with choice of methods:
Women tend to choose less lethal means, such as cutting their wrists and
overdosing on sleeping pills; whereas men tend to shoot themselves and
jump off buildings. The suicide rate for both men and women is higher
among individuals who have been divorced and widowed; loneliness as well
as a sense of failure in interpersonal affairs surely contributes to this statistic.
Men who kill themselves tend to be motivated by failure at work, and
women who kill themselves tend to be motivated by failure at love (Mendels,
1970; Linden and Breed, 1976; Schneidman, 1976). As one female patient
who tried to find surcease in suicide after being rejected by her lover
said, "There's no sense in living. There's nothing here for me. I need love
and I don't have it anymore. I can't be happy without love-only miserable.
It will just be the same misery, day in and day out. It's senseless to go on" (Beck,1976).
Cultural Differences and Suicide
Race, religion, and nationality contribute somewhat to vulnerability to suicide.
The suicide rate of young black and white men is approximately the
same (Hendin, 1l969; Linden and Breed, 1976), but black women and older
black men probably kill themselves less often than whites (Swanson and
Breed, 1976). There is some evidence that American Indians may have a
higher suicide rate than the rest of the population (Frederick, 1978). Religion,
at least in the United States, does not offer any protection against suicide
in spite of varyingly strong strictures against it. Also, the rate of suicide
is roughly the same whether the individual is nonreligious, or Catholic,
Protestant, or Jewish.
Suicide occurs in all cultures, even primitive ones, but it seems to be more
common in industrialized countries. At the present time, the countries of
central Europe seem to have the highest suicide rate, with Hungary, Austria,
and Czechoslovakia ranking respectively first, third, and fourth. Ireland and
Egypt have very low suicide rates, perhaps because suicide is considered a
mortal sin in these cultures. West Berlin has the highest suicide rate in the
world, more than twice that of West Germany as a whole. The United States
has, on the world scale, an average suicide rate. Sweden has a middling high
rate of suicide. Some have blamed this on the lack of incentive provided by
its social welfare system, but its suicide rate has remained the same since
about 1910, before the introduction of social welfare (Schneidman, 1976).
Age and Suicide
One is more likely to commit suicide when one is older. In children, suicide
is rare, with probably fewer than 200 suicides committed in a year in the
United States by children who are under the age of fourteen.
~~~~~~~~~~~~~~~~~~~~~~~
Discussing her wish to die, Michelle, age nine, talks with Joaquim
Puig-Antich, a leading expert on childhood depression:
JOAQUIM PUIG-ANTICH: Do you feel you should be punished?
MICHELLE: Yes.
JPA: Why?
M: I don't know.
JPA: Have you ever had the thought that you might want to hurt yourself'? M: Yes.
JPA: How would you hurt yourself?
M: By drinking a lot of alcohol, or jumping off the balcony.
.I PA: Have you ever tried to jump?
M: I once stood on the edge of the terrace and put one leg over the railing, but
my mother caught me.
JPA: Did you really want to jump?
M: Yes.
JPA: What would have happened if you had jumped?
M: I would have killed myself.
JPA: Did you want to get killed?
M: Uh-huh.
JPA: Why?
M: Because I don't like the life I live.
JPA: What kind of life do you live?
M: A sad and miserable life.
(Jerome, 1979)
Suicide rate rises dramatically through middle age and into old age. Increasing
depression, loneliness, moving to a strange setting, loss of a meaningful
role in family and society, and loss of people they love all surely
contribute to the high rate of suicide among old people. In cultures and
communities in which the aged are revered and remain important in the life
of the family, suicide is infrequent.
Within two years of the death of her beloved husband with whom she had
spent fifty joyous years, Mrs. K_ committed suicide. "Alan," she told her son
a few days before, "I wasn't made to sleep alone." Percy Bridgman, Nobel
Prize winner in physics and famous American positivist, shot himself at age
eighty. He had cancer and was in great pain. The day before he killed himself,
he mailed the index for his collected works to the Harvard University
Press. He had repeatedly asked for euthanasia and had been, of course, refused.
His suicide note was published in the Bulletin of the Atomic Scientists (1962):
"It is indecent for Society to make a man do this thing himself. Probably
this is the last day I will be able to do it myself. PWB" (Schneidman,1976).
THE Motivation FOR SUICIDE
In the first major modern study of suicide, the French sociologist Emile
Durkheim (1858-1917) distinguished three motivations for suicide, all of
them intimately related to the way an individual sees his place in society. He
called these motives anomie, egoistic, and altruistic. Anomie suicide is
precipitated by a shattering break in an individual's relationship to his society:
the loss of a job, economic depression, even sudden wealth. Egoistic suicide
occurs when the individual has too few ties to his fellow humans. Societal
demands, principal among them the demand to live, do not reach the egoistic
individual. Finally, altruistic suicide is required by the society. The individual
takes his own life in order to benefit his community. Hara-kiri is an
altruistic suicide. The Buddhist monks who burned themselves to death to
protest the injustices of the Vietnam War are recent reminders of individuals
who committed altruistic suicide.
Modern thinkers see two more fundamental motivations for suicide: surcease
and manipulation. Those who wish surcease have simply given up.
Their emotional distress is intolerable, and they see no alternative solution.
In death, they see an end to their problems, sleep, or nothingness. Fifty-six
percent of the suicide attempts observed in a systematic study were classified
as individuals trying to achieve surcease. These suicide attempts involved
more depression, more hopelessness, and they tended to be more
lethal than the remaining suicide attempts (Beck et aI., 1976).
The other motivation for suicide is the wish to manipulate other people
by a suicide attempt. Some wish to manipulate the world that remains by
dying: to have the final word in an argument, revenge on a rejecting lover, to
ruin the life of another person. More commonly in manipulative suicide,
the individual intends to remain alive, but by showing the seriousness of his
dilemma, he is crying for help from those who are important to him. Trying
to prevent a lover from leaving, getting into the hospital and having a
temporary respite from problems, and being taken seriously are all manipulative
motives for suicide with intent to live.
Thirteen percent of suicide attempts were found to be manipulative; these
involved less depression, less hopelessness, and less lethal means than did
the surcease attempts (Beck, 1976). Those suicides that are manipulative are
clearly cries for help, but it should be apparent that all suicides are not cries
for help (see Box 13-4). The individual who wishes to escape because life is
SUICIDE NOTES
About one-sixth of those individuals who die by their own hand leave suicide
notes. A romantic view would lead us to expect that these final words, like those
that are supposed to be uttered on the deathbed, would be masterful summaries
of a life that preceded them and of the reasons for dying. Only occasionally are
they, "There should be little sadness, and no searching for who is at fault;
...for the act and result are not sad, and no one is at fault.
..My only sorrow is for my parents who will not easily be able to accept that this
is so much better for me. Please, folks, it's all right, really it is.
"I wanted to be too many things, and greatness besides-it was a hopeless
task. I never managed to really love another person-only to make the sounds of
it. I never could believe what my society taught me to believe, yet I could never
manage to quite find the truth.
"Two-fifteen p.m.-I'm about to will myself to stop my heartbeat and respiration.
This is a very mystical experience. I have no fear. That surprises me,
I thought I would be terrified. Soon I will know what death is like-how many people out there can say that?"
But much more often the notes are commonplace. Creative, unique, and expansive
pieces of writing are rare in suicide notes,the individual is usually constricted, his field of
consciousness has narrowed, and he is in despair. This is not a state conducive to creativity:
"Dearest darling I want you to know that you are the only one in my life I love you so much I could not do without you please forgive me I drove myself sick honey please believe me I love you, you again and the baby honey don't be mean with me please I've lived 50 years since I met you, I love you-I love you, Dearest darling I love you, I love you. Please don't discriminate me darling I know that I will die don't be mean with me please I love you more than you will ever know, Darling please and honey, Tom, I don't tell Tom why his daddy said goodbye honey. Can't stand it anymore. Darling I love you. Darling I love you."
A good number of suicide notes merely contain instructions and directions:
"Dear Mary, I am writing you, as our divorce is not final, and will not be til next month, so the way things stand now you are still my wife, which makes you entitled to the things which belong to me, and I want you to have them, Don't let anyone take them from you as they are yours. Please see a lawyer and get them as soon as you can. I am listing some of the things, they are: a blue davenport and choir, a Magic Chef Stove, a large mattress, and electrolux cleaner, a 9 x 12 rug, reddish flower design and pad, All the things listed above are almost new. Then there is my 30-30 rifle, books, typewriter, tools and a hand contract for a house in Chicago, a savings account in Boston, Massachusetts, Your husband,"
And some are simple and starkly practical. A workman before hanging himself
in an abandoned house chalked his suicide note on the wall outside,
"Sorry about this. There's a corpse in here. Inform police."
Source. Adopted from Schneidman, 1976.
Not worth living is not crying out for help, but for an end to his troubles.
The remaining 31 percent of suicide attempts combine surcease and
manipulative motivation. Here the individual is not at all sure whether he
wishes to live or die, whether he wishes surcease or a change in the world.
In this undecided group, the more hopeless and the more depressed the individual
is, the stronger are the surcease reasons for the suicide attempt (Beck, Rush, Shaw, and Emery, 1979).
Treating:
Depression
Post-Traumatic Stress Disorder (PTSD)
Social Anxiety
Generalized Anxiety
Panic Disorder
Major Depression Disorder
Agoraphobia
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For the Therapy I recommend click here:
The Liberator Method