Mental Disorder and Suicide

Mental Disorder

Suicide- Mental Disorder

Beginning with a historical analysis of suicide, the psychopathology of suicide is analyzed. Empirical findings are also presented to address probable causes of suicide. This paper addresses the psychopathology of suicide starting with its historical backdrop. It additionally contemplates the probable reasons leading to this pathology founded on latest empirical results. Control of suicidal behaviors and ideation are addressed, along with prevention and treatment strategies. Finally, the religious and cultural purviews with respect to suicide are considered based upon current research in the field.

Globally, suicide is one of the major causes of death. As many as 36,000 commit suicide in the United States annually and estimates suggest that 1 million individuals commit suicide in the rest of the world. While the Diagnostic and Statistical Manual of Mental Disorders (DSM) does not classify suicide as a mental disorder (DSM-IV-TR), practitioners recognize the correlation between psychological dysfunction and suicide, particularly with respect to perturbed orientation towards life, emotional confusion, and poor skills in ordinary coping with circumstances (Comer, 2013).

The precise definition of a suicide attempt is that it is an action which the individual has initiated with at least a partial goal of ending their own life. This act may or may not result in medical consequences and/or injury. Factors that impact the actual result of the suicide attempt include: low intentionality and/or ambivalence, chance intervention during the attempted act, incomplete knowledge about the method chosen for the suicide, and poor planning (American Psychiatric Association, 2013).

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) states that suicidal behavior includes at least one suicide attempt by the individual. An attempt made at suicide by an individual, even if they changed their mind and/or there was a timely intervention, is considered suicidal behavior. As an example, some suicide attempts include the use of poison and/or medications. The individual may begin taking these substances but then might be stopped by another person, or may choose to stop themselves. However, should the individual not actually initiate the suicidal behavior, whether due to stopping themselves and/or an intervention, it is recommended that this person not be diagnosed as suicidal (American Psychiatric Association, 2013).

Historical Perspective

In 1642, Sir Thomas Browne first used the word suicide in his book 'Religio Medici'. This word comes from the Latin sui and cida 'one who kills oneself'. While suicidal numbers are high at present, the act itself seems to have been recorded throughout history. Prior to the introduction of word 'Suicide', other terms used included self-destruction, self-killing and self-murder. Beck and colleagues defined suicide as a willful self-infliction of an act that is life-threatening (Pooja & Kochar, n.d.).

Historically, the societal view of suicide has varied with the culture. For example, the traditions of the feudal Japanese held suicide to be an honorable act by which a family or clan were protected from dishonor by the acts of one family member. The view of many in the ancient Roman Empire was that the act of committing suicide was an act of glory, and a demonstration of superior wisdom. Indeed, often in former historical periods it appears that the deliberate choice of death before one was enfeebled was 'dying with dignity' (Barnes, 2010). To some extent then, and particularly prior to the 1600's when the actual term 'suicide' entered into conversational use, this act was considered to be merely a different form of death.

An early stigmatization of suicide as an unforgivable sin came from Saint Augustine, and his followers, and much of Western Christianity, viewed suicide as a sinful act. Suicide was considered to be an act of murder, and thus direct violation of one of the Ten Commandments. Accordingly, individuals who committed suicide were not permitted a church burial. Furthermore, in some cases other acts expressing the societal and moral disapproval included the dragging of the bodies of suicides through town to impress the wrongness of the act upon the community, and possibly also to punish and/or humiliate the family of the individual (Barnes, 2010).

While there were often penalties and disgrace for families of suicides, classification of an individual as mentally disturbed began, during the 1800s, to change the societal purview of suicide. The societal status of a family was of significant importance in that time period, and both reputation and family dignity were considered priorities; thus having a suicide in the family was considered disgraceful. Having a family member who was mentally ill was also considered disgraceful, and the stigma attached led to the development of a taboo against suicide in Western culture. In contrast, suicide is today spoken of almost openly, and disgrace is not necessarily concomitant with the sorrow of a lost loved one to suicide. Along with the disappearance of the need for secrecy, the view of the individual who has committed suicide has changed from being a 'sinner' to being a 'victim' (Barnes, 2010).

Causes of suicide

Different purviews as to the causes of suicide come from the biological, psychodynamic, and socio-cultural perspectives.

The Biological View

Analysis of the families, close relatives and parents, of individuals who commit suicide, has shown that there is a higher rate of suicide in many cases. These data have indicated the possibility of biological and/or genetic factors in the ideation that leads to suicide. Indeed, twin studies also support these data as well (Comer, 2013).

Over the last thirty years, there have been increasing laboratory and clinical studies into suicide. For example, the neurotransmitter serotonin has been studied. For individuals with low levels of serotonin, impulsive behavior and aggressive activity are observed. As well, for individuals diagnosed as clinically depressed, there is evidence that aggressive tendencies may be, in part, a consequence of low serotonin activity. The result is that such individuals may be at particular risk to consideration and action upon suicidal thoughts (Comer, 2013).

The Psychodynamic View

In terms of psychodynamic theory, it has been suggested that suicidal behavior is derived from unresolved anger at other people as well as from depressed mental states, where the individual redirects the external anger inwards. One theory considers that individuals 'introject' the persona of a lost loved one, whether that loss has been real, as in a death, or merely consists of a dysfunctional relationship and lost personal contact. This act of introjection occurs as an unconscious incorporation of the other person into the self-identity, along with feelings towards oneself akin to those formerly held towards the other person. These feelings can include anger towards the other person, now experienced as self-hatred. This anger at the other person can then be expressed as extreme anger towards oneself as well as significant depression. The extreme expression of this self-punishment and self-hatred is then acted out as suicide.

The Socio-cultural Perspective

One analysis of the probability and origins of suicide, that of Durkheim (Comer, 2103), focuses on the integration of the individual into societal groups, including the community, the family, and religious institutions. This perspective suggests that lack of integration is more often a factor in suicidal ideation, whereas more-closely integrated individuals have an inherently decreased risk of suicide. The socio-cultural perspective includes at least three categories of suicidal individual: altruistic, anomic, and egoistic suicide (Comer, 2013).

The category of altruistic suicides includes those individuals who are apparently well-integrated into society, and actually consider that the sacrifice of their lives is a contribution to the well-being of society. Anomic suicides, based on the definition of the word anomie (a lack of normal ethical and societal standards) is a category of suicidal individuals whom Durkheim proposes lack meaning in life. Their individual circumstances, whether through family, religion, or friends, does not provide sufficient stability to provide 'meaning to life'. The category of egoistic suicides includes individuals who are iconoclastic in general, and are neither well-integrated into the social fabric, nor responsive to societal mores and norms (Comer, 2013).

Other factors

Early life factors

There are a variety of factors that can lead to suicidal risks and behaviors. Among these, traumatic life experiences, abuse (whether physical, mental, or sexual), childhood adversity, and parental neglect (inadequate care, death, separation, divorce) are all factors that can contribute to the development of suicidal risk behaviors as well as mental disorders, regardless of age of the individual. Furthermore, it appears that physiological factors, genetically derived, may also contribute to suicidal ideation, as certain individuals are thus more prone to neuro-cognitive deficits, neuroticism, and impulsive aggression (Draper, 2014).

Personality traits

There are specific personality traits that have been linked to an increased risk of suicide. Of these, neuroticism is dominant, although this trait is less common in suicidal attempts among middle-aged individuals. There are some suggestions that neurotic behavior is associated with, or a proxy for, undetected depression. Indeed, a clinical study found that once older individuals who had attempted suicide were treated for major depression their neurotic behavior also decreased (Draper, 2014).

Suicide and Age

Evidence exists that suicide-likelihood has an age-dependent factor. Generally, suicide is not observed for children, although unfortunately there is an increase in suicide for this group. In contrast, for adolescents, suicide is a far more common occurrence, although in this group there has been a decade-long decrease in 'successful' suicides. For adolescents, the act of suicide is linked not only to adolescent life, but also to major stress, impulsiveness, clinical depression and to anger. Indeed, suicide attempts by adolescents are numerous, and many factors concerning this observation are being considered. For example, the population of adolescents and young adults is increasing, psycho-active drug usage and drug availability have been increasing, family ties are generally recognized to be severely weakened, and as well, there is considerable media coverage of suicidal behaviors and acts by adolescents. Presently in Western society, the prevalence of suicide is largest among the mature and/or elderly population. Factors related to these data include emotional feelings of loneliness, depression, hopelessness, and even inevitability of death itself. As well, other factors involved in aging such as the loss of control, loss of social status, loss of health, and loss of friends to death and age all contribute to a larger incidence of suicide in older populations (Comer, 2013).

Effective therapy approaches for treatment of suicide

For successful treatment of suicidal patients and/or clients, several new methodological approaches have proven effective. A brief analysis of treatment approaches for which a sound empirical basis exists is described below.

• Cognitive therapy is an approach to treatment of suicidal individuals that was first developed by Aaron Beck and Gregory Brown. One unique aspect of Cognitive therapy is that it is open-ended, working with the client/patient until that individual is deemed able to handle distressing emotional issues on their own. While there are other Cognitive Behavioral treatment methods, many of these are time-limited. The technique focuses on the observation that suicidal individuals cannot always access emotional-management skills when they are facing a perceived crisis. The inability to use the newly acquired skills during a crisis potentially renders them inactive and useless. To address this weakness, the approach of Cognitive Therapy is to use sessions with the client/patient to evoke the crisis and train the client to test and apply newly developed coping skills while the therapist is present to offer support. Once a client/patient demonstrates that the skills can indeed be utilized in crisis, then the client can 'graduate' from treatment.

• Dialectical behavior therapy (DBT) is an approach designed to address and treat suicidal behavior and difficulties of an individual with emotional regulation. DBT works, in part, via training of the individual and 'skill-building', with a focus on learning healthy approaches to affect regulation, development of tolerance to stress and distress, and improving the overall approach to emotional regulation. Healthy affect regulation is essential for the suicidal individual to use in place of formerly unhealthy emotional approaches.

• Metalizing treatment is a therapeutic approach that focuses on expression and regulation of emotions. Assisting clients in observation, tolerance, and regulation of emotions occurs through training in the capability to metalize: to observe and seek to understand not only one's own mind, but also the minds of others. Thus by observing what Firestone calls the mind behind the behavior, one develops a broader and deeper understanding of emotional affect and its power as well as developing the ability to regulate emotions instead of being at their mercy (Firestone, n.d.).

Prevention Strategies

Roascoat & Beck (2013) described three types of successful interventions preventing suicide. These include: [1] the implementation of emergency call centers; [2] limiting patient access to means of suicide; and [3] pro-active follow-up of patients who have been admitted to the hospital due to a suicide attempt. Evidence suggests that blocking access to lethal means may be one of the best approaches to suicide prevention. By reduction of consumer access to products that are dangerous, the risk of suicide is decreased. This can be done at local and national levels, as well as focusing on the individual level, securing the home environment of the person who has previously attempted suicide. For both adolescents and adults, follow-up contact after hospitalization has had a positive, protective effect against future suicide attempts.