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CHAPTER 11 ■ Suicide Prevention
suicide. Durkheim described three social categories of suicide: ■■ Egoistic suicide is the response of the individual who feels separate and apart from the mainstream of society. Integration is lacking, and the individual does not feel a part of any cohesive group (such as a family or a church). ■■ Altruistic suicide is the opposite of egoistic suicide. The individual who is prone to altruistic suicide is excessively integrated into the group. The group is often governed by cultural, religious, or political ties, and allegiance is so strong that the individual will sacrifice their life for the group. ■■ Anomic suicide occurs in response to changes in an individual’s life (e.g., divorce, loss of job) that dis- rupt feelings of relatedness to the group. An inter- ruption in the customary norms of behavior instills feelings of “separateness” and fears of being with- out support from the formerly cohesive group. Interpersonal Theory Thomas Joiner’s (2005) interpersonal theory of sui- cide supports some of the same principles advanced by Durkheim, which associated a lack of feeling of belonging with suicide risk. But Joiner’s theory intro- duces the concept that suicide ideation and suicide attempts need to be understood as distinct pro- cesses. He proposed that low connectedness and a high sense of one’s being a burden interact with each other to increase suicidal thoughts and desires, but those features in the presence of high capability for suicide are strongly associated with the move from ideation to lethal attempts. He advances the concept that people become less fearful (and therefore more capable) of self-destructive acts when they expose themselves repeatedly to painful or violent stimuli: a kind of “working up” to actually being capable of self- harm. The move from suicide ideation to attempts is not viewed as an impulsive act but rather a process of steps that, over time, create greater and greater risk. The Three-Step Theory Inspired by Joiner’s theory, Klonsky and May (2015a) found that impulsivity is elevated both in people who have made suicide attempts and those who have thoughts and have never made an attempt. The researchers therefore sought to identify the factors that elevate suicide ideation to an active risk for attempts. Their research supported the following three-step trajectory: 1. Pain (usually psychological pain) when combined with hopelessness significantly increases suicide
Hopelessness and Other Symptoms of Depression Hopelessness has long been identified as both a symptom of depression and an underlying factor in the predisposition to suicide. Although many of the symptoms that are identified in suicide risk assessment tools attempt to assess for seriousness of suicide ideation, current research is attempting to glean which symptoms might be more predictive of the move from ideation to attempts, and although hopelessness is identified as a contributing factor, the strength of the person’s intention to die may be more significant in triggering an attempt (Jobes, 2015). History of Aggression and Violence Outwardly directed aggression has been found to be associated with suicide attempts but not with suicide ideation, and among psychiatric patients outwardly directed aggression was associated with planned rather than unplanned attempts (Swogger et al., 2014). Some evidence suggests that impulsive traits are higher in individuals with suicide ideation but not necessarily associated with more attempts
(Klonsky & May, 2015b). Shame and Humiliation
Some individuals view suicide as a “face-saving” mechanism—a way to prevent public humiliation following a social defeat, such as a sudden loss of status or income. Both shame and humiliation may also interrupt one’s sense of connectedness with oth- ers, and sense of belonging and connectedness are considered protective against suicide. Evidence sup- ports that the experience of shame is pronounced in trauma survivors (Taylor, 2015) and in females with borderline personality disorder (Wiklander et al., 2012). These findings may explain some of the influ- encing factors for increased risk of suicide in these populations. Sociological Theories Sociological theories focus primarily on interper- sonal factors that influence risk for suicide. Lack of connectedness with others is a unifying theme among these theories. Durkheim’s Theory Durkheim classic work (1951) studied the inter- action of individuals with the society in which they lived. He believed that the more cohesive the soci- ety and the more that individuals felt an integrated part of society, the less likely they were to carry out
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