THEORIES OF SUICIDE

Dr Saman Yousuf14 June 2011

PerspectivesPerspectives

Biological - TO UNDERSTAND HOW CAUSE OF SUICIDE

RELATES TO FUNCTIONING OF THE HUMAN BODY

Psychological – RELATION WITH FUNCTIONING OF THE HUMAN MIND (THOUGHTS, EMOTIONS, BEHAVIOR)

Sociological - RELATION OF SOCIAL FACTORS TO ILL

HEALTH AND SUICIDE OR SUICIDAL BEHAVIOR

Sociological theories

Emile Durkheim (1867) Le Suicide. Etude de Sociologie

Each society has a specific tendency toward suicide

Refuted contribution of

individual factors

Social integration /

Social regulation

Followers of Durkheim

Gibbs and Martin (1964) – Concept of social integration: when a society engenders status incompatibility and role conflicts suicide

Lester D (1989, 1997) – Operationalized social integration through indices of modernization of society(eg. birth rates, divorce rates)

Thomas Masaryk (1881)

An increase in non-religiosity deregulates the social organism, makes people feel unhappy and increases social disorganization. Suicide, as well as mental illnesses, can be seen as a measure of societal disturbances

Benjamin Wolman (1976)

Estrangement and contemporary societal mechanization, decline of family ties – aggression internalized and turned to self-criticism and self-hate

Psychological theories

Sigmund Freud Death instinct “Thanatos” and this drive is in harmony with “Eros”

David Malan Results from accumulated trauma

Edwin Scheidman:

explains ambivalence toward life and death, and feelings of hopelessness and helplessness -- “egotic suicide,” results from a conflict of internal aspects of self to which the only response is the ending of the personality

Krauss’s theory:

Unachieved goal or dysfunctional relationship – the internal representation of the “unattainable object” is killed

Eric Erikson:

Overwhelming feeling of guilt exceeds ability to cope

Aaron T. Beck – Cognitive Theory

Cognitions = Mental processes that are involved in information gathering, thinking, remembering etc and exists in three forms:

- Dysfunctional automatic thoughts skew perceptions of self, others and future

- Schemas: framework or concept that helps organize the information gathered

• Thomas Joiner (2005) – Interpersonal-psychological theory

DEATH BY SUICIDE

a sense on the part of the individual that he or she lacks meaningful connections to others, either because of a belief that nobody cares or a sense that, although others care, they cannot relate to the individual’s current situation (e.g., soldiers reintegrating into civilian life post-combat deployment)

a sense on the part of an individual that he or she makes no meaningful contributions to the world, serving instead as a liability to others

acquire the capability to do so through repeated exposure to painful and provocative experiences.Such repeated exposures result in habituation to physiological pain and a diminished fear of death, thereby enabling an individual to follow through with the inherently frightening and painful experience of a suicide attempt with a high rate of lethality

Some psychosocial theoriesSome psychosocial theories

Halbwachs (1930)

Henry and Short (1954)

Giddens (1966)

Douglas (1967)

Baechler (1975)

Taylor (1978)

Biological theories…

Post-mortem studies have shown changes in central neurotransmission of serotonin, nor-adrenaline and post-synaptic signal transduction

Dysfunction of Hypothalamic-pituitary-adrenal axis (stress response) predicts suicide in depressed patients

Increased suicide risk associated with low cholesterol levels

Reduced 5-HIAA levels in CSF of depressed patients who suicide

NEUROPHYSIOLOGICAL CHANGES

Family history of suicide increases the risk two-fold especially in women and children independent of family psychiatric history

Concordance rates of suicide higher among monozygotic twins

Adoption studies: a greater risk of suicide among biologic rather than adoptive relatives.

Genetic factors account for 45% of suicidal thoughts and behaviors: 7 types of genes have been focused on serotonin transporter(SERT), tryptophan hydroxylase (TPH) 1 and 2, three serotonin receptors (5-HTR1A, 5-HTR2A, and 5-HTR1B), and the monoamine oxidase promoter(MAOA)

Interaction between gene and environment (incl. intrauterine)

GENES & FAMILY

NEUROIMAGING

Stress-Diathesis ModelStress-Diathesis Model

Combines psychological and biological factors

Holmes & Rahe 1967

A force that disrupts the equilibrium or normal functioning of an individual’s mental or physical state. Different types of stressors may precipitate suicidal behavior.

Negative Life events Acute substance

intoxicationAcute psychiatric

condition

Innate vulnerability or predisposition (in the form of traits) for developing the suicidal state

Familial / genetic influences

Chronic multiple psychiatric problems

HopelessnessBeing male /

loneliness

STRESS DIATHESIS

Holmes & Rahe 1967

THEORIES OF DELIBERATE SELF HARM

A coping mechanism

Helps in short-term management of problematic emotions

Stress-relieving function

Consequences – disapproval by others and a sense of inability to solve problems

Regulation of unpleasant self-states (eg. depersonalization) common to people experiencing trauma

Sense of mastery and control for people who feel powerless or out of control

Babiker and Arnold, 1997; Gratz, 2003; Williams, 2001

Self-punishment

Re-enactment of past experience of trauma or abuse

Feelings of being evil and bad common

Self-punishment for being bad

Babiker and Arnold, 1997; Gratz, 2003; Williams, 2001

Validating the self

For people who have past experiences of trauma and abuse and there was no recognition of it or they were actively denied by people around them

Way of testifying to the experience – remembering it

Linehan (1993) – Chronic invalidation: feelings are bad or wrong

Miller (1994) – “Men act out while women act out by acting in”

Babiker and Arnold, 1997; Gratz, 2003; Williams, 2001

Influencing others

A way of communicating distress not heeded by words

To care for the person who has harmed

To keep others at a distance

To make the person cared about feel guilty

Babiker and Arnold, 1997; Gratz, 2003; Williams, 2001

Serotonin

Simeon et al. (1992) found that people who self-injure tend to be extremely angry, impulsive, anxious, and aggressive, and presented evidence that some of these traits may be linked to deficits in the brain's serotonin system

Favazza (1993) refers to this study and to work by Coccaro on irritability to posit that perhaps irritable people with relatively normal serotonin function express their irritation outwardly, by screaming or throwing things; people with low serotonin function turn the irritability inward by self-damaging or suicidal acts

Zweig-Frank et al. (1994) also suggest that degree of self-injury is related to serotonin dysfunction

Steiger et al. (2000), in a study of bulimics, found that serotonin function in bulimic women was significantly lower in bulimics who also engaged in self-harm

Genetics

Rare genetic syndrome – Lesch-Nyhan (HG-PRT deficiency)

Large turnover of purines

Characterized by self harm

Link largely still unclear

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