Suicide and Psychology

In this text, you can learn more information about what psychology and psychoanalysis say about suicide.

Clinical features

According to Kaplan et al (1997), the most common factors associated with suicide are:

– Men commit suicide three times more often than women. However, women try four times as hard as men.

– This higher success rate among males is associated with the methods used. They usually do it using a firearm, hanging or jumping from high places, while women tend to do it by taking excessive doses of medication or poison.

– Suicide rates increase with age. Among men, the number of completed suicides is higher after the age of 45. Among women, this rate increases after age 55. Most suicides occur between the ages of 15 and 44.

– Among races: White men commit suicide twice as often as non-white men. Two out of three suicides are white men.

– Marriage, reinforced by children, significantly decreases the risk of suicide. Single, never-married people commit suicide twice as often as married people. However, previously married people are twice as likely to commit suicide as never-married people. These rates peak among divorced men at 69 per 100,000.

Family history of suicide and social isolation increase the risk of suicide.

Among professions, the higher the social position, the greater the risk of suicide, but work in general protects against suicide, which is higher among unemployed people than among employed people.

Etiology

In recent decades, scientific production on suicide has been predominantly pragmatic and technical. In this line, studies that seek to identify risk factors, breaking down the event into multiple variables at the biological, psychological and social levels, predominate.

Sociological Factors

The etiology of suicide involves social factors, such as those proposed by Durkheim (1982), a sociologist who contributed to the study of social and cultural influences on suicide. According to this author, there are those that occur after the dissolution of a bond (anomic suicide); those committed on behalf of others to lighten the burden of someone who has to care for them, a way to regain honor (altruistic suicide); and the feeling of not being part of society, having no place in society (selfish suicide).

Neurochemical Factors

The importance of genetics in suicide may be related to the chromosomal information for serotonin synthesis and secretion. Interestingly, females have a higher mean level of brain serotonin than males, and a lower incidence of suicide.

Depressed patients with low levels of 5-hydroxyndelacetic acid (derived from Serotonin) are at increased risk for suicide. High levels of 17 urinary hydrocorticosteroids also increase the risk of suicide. People with a low level of platelet monoamine oxidase have an eight times higher prevalence of suicide in their families than people with a high level of this enzyme (Kaplan et al, 1997)

Newer neuroimaging technologies, such as positron emission tomography (PET), offer an opportunity to visualize serotonin function “in vivo” directly. These technologies may provide the possibility of earlier and more timely therapeutic intervention in patients at high risk for suicide.

Psychological factors of suicide

Psychoanalysis

Several areas are interested in the study and prevention of suicide. The tendency is to look at it through the multidisciplinarity in which several factors are considered Psychoanalysis, Freud’s theory, is one of them, as it is interested in the study of the constitution of the subject from its first object relations – mother/child, family context , extending more recently to social interactions in order to deeply understand human causes, through complex psychic processes. Freud believed, that suicide occurs after a repressed desire to kill another person. (Laplanche, 1983).

For psychoanalysis, suicide is a psychotic situation. This does not mean that the person is psychotic, but that, at the time of the act, psychotic nuclei and components of the personality were activated that remained inactive and neutralized by the non-psychotic parts of the personality and that ended up manifesting themselves at a given moment of the crisis. The attempt is usually associated with the fantasies that each person has in relation to death: the search for another life, the desire for resurrection, reunion with the dead, return to the mother’s womb and return to intrauterine life, aggression and punishment of the environment (Cassolar, 1991).

Menninger’s theory

We can seek etiological explanations, also in Menninger’s theory, in which suicide is a retroflexive murder, a rage against another person, which is turned towards oneself. The relationship between two factors is considered: an unfavorable environment and the individual’s constitution, emphasizing the depression resulting from mourning and melancholy, the role of the lost object, the masochistic deformation of the personality and the internalization of environmental aggressions. From the synthesis of the two factors, a self-destructive personality could emerge. In suicide, according to this theory, there is the desire to kill, the desire to be killed and the desire to die (Kaplan et al, 1997)

phenomenological theory

Sampaio et al (2000) explored the ideas of phenomenology, particularly the thinking of the philosopher Heidegger. The understanding of the person who decides to put an end to their existence can be constituted, from the perspective of this study, as a path for rebuilding and resizing their existential perspectives.

Suicide and Mental Health

Behind a suicidal act, there is usually a triggering motivation. In the literature in general, several possible explanations are found for this motivation that drives the suicidal act.

In the descriptions of psychopathological conditions, for example, the risk of suicide is highlighted, among other symptoms: in borderline patients, in schizophrenic psychosis, in manic-depressive states, in postpartum depression, in depression resulting from a

General Medical Condition, in drug users, in alcoholism, in cases of HIV, in loss of limbs, vision loss, teenage pregnancy, suicide as a result of certain medications, which would interfere with the psyche; suicide due to lack of adherence to certain common treatments for diabetes and hypertension, among others.

We find in the various literatures in the area that, however, the occurrence of suicide can also be of moral motivation, in which among the triggering reasons may be ideological causes, religious reasons, shame, guilt, love losses, loss of object relations, and even suicide as a way of wanting to continue existing in the desire of the other or arising from the desire of that other. Although there is an occurrence of suicide in these situations mentioned, it is clear that not all people affected by these conditions commit suicide.

Among patients who commit suicide, nearly 95% have a diagnosed mental illness, 80% have a mood disorder, 25% are alcohol dependent, and 15% of patients who have one of these disorders die by suicide.

Despite being a less common illness, schizophrenia accounts for approximately 10% of suicides. Patients with delusional depression are at the highest risk for suicide. The risk of suicide among psychiatric patients is 3 to 12 times higher than in the rest of the population. The age of suicide varies around 30 years, which is partly due to the early onset of schizophrenia (Kaplan et al, 1997)

Among the factors capable of increasing the risk of suicide in schizophrenic patients, the following stand out: social isolation, not being married, unemployed, previous history of suicide attempt, strong socio-family expectations of good performance, chronic course of the disease and with many acute relapses, multiple hospitalizations, difficulties at work, a history of past depression, and, of course, present depression. This last factor is of even greater risk, when the prominent symptom is persistent depressed mood and hopelessness (Kaplan et al, 1997)

When a psychiatric patient is hospitalized, there is an increased risk of suicidal ideation. The period after discharge is especially dangerous. After three to five weeks of hospitalization, the suicide rate returns to be equal to that of the general population. The psychotic patient tends to destroy the social support network, and when he returns to the community, he is weakly integrated into society. Social isolation, some new adversity or the return of previous problems can make you discouraged, impotent and hopeless, an ideal mood to put suicide into practice. (Kaplan et al., 1997)

Among the psychiatric factors associated with suicide, in first place is depression, the predominant affective change in the suicidal act, from its ideation, intention to actual suicide. Most depressive patients commit suicide early in the course of the illness, being mostly male, single, separated, widowed or recently bereaved, and tend to be in middle age or old age.

Suicide in depression is not usually spontaneous or impulsive, as happens in some cases of schizophrenia, pathological drunkenness or explosive personality disorder. In depression, suicide is usually elaborated in detail, with the choice of means of killing oneself, time and place of the act, (Kaplan et al, 1997).

In a Major Depressive episode, there may often be thoughts of death, suicidal ideation, or a suicide attempt. The frequency, intensity, and lethality of these thoughts can be quite variable. Less severely suicidal individuals may report transient (1 to 2 minutes) and recurrent (once or twice a week) thoughts.

More severely suicidal people may have purchased materials (eg, rope or firearm) to use in the suicide attempt and may have established a place and time when they will be isolated from others so that they can complete the suicide. Studies show that it is not possible to accurately predict whether or when a particular individual with depression will attempt suicide. Motivations for suicide may include a desire to give up in the face of obstacles or an intense desire to end a painful emotional state perceived by the person as unending (Kaplan et al, 1997).

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