Suicide/Suicidal Behavior

The act of taking one's own life voluntarily and intentionally.

The annual death toll from suicide worldwide is 120,000, and it is the eighth leading cause of death in the United States, accounting for one percent of all deaths. Between 240,000 and 600,000 people in the U.S. and Canada attempt suicide every year, and over 30,000 succeed. The suicide rate is three times higher for men than for women in the United States, although females make three times as many suicide attempts as males. Traditionally, men over 45 and living alone are the demographic group at greatest risk for suicide. However, in the past 30 years, youth suicides have risen alarmingly, tripling for people aged 15 to 24. The suicide rate among persons aged 10 to 24 between 1980 and 1992 rose an average of 177%. Suicide among women has also increased dramatically since 1960, when the ratio of male to female suicides was 4 to 1. Suicide rates vary significantly among different ethnic groups in the United States; Native Americans have the highest rate at 13.6 per 100,000 (although there are sizable variations among tribes), compared with 12.9 for European-Americans, and 5.7 for African-Americans.

Attitudes toward suicide have varied throughout history. The ancient Greeks considered it an offense against the state, which was deprived of contributions by potentially useful citizens. The Romans, by comparison, thought that suicide could be a noble form of death, although they legislated against persons taking their own lives before an impending criminal conviction in order to insure their families' financial inheritance. Early Christianity, which downplayed the importance of life on earth, was not critical of suicide until the fourth century, when St. Augustine condemned it as a sin because it violated the sixth commandment ("Thou shalt not kill"). Eventually, the Roman Catholic Church excommunicated and even denied funeral rites to people who killed themselves. The medieval theologian St. Thomas Aquinas condemned suicide because it usurped God's power over life and death, and in The Divine Comedy, the great writer Dante placed suicides in one of the lowest circles of Hell. The view of suicide as a sin prevailed in Western societies for hundreds of years, and many people are still influenced by it, either consciously or unconsciously. Suicide was a felony and attempted suicide a misdemeanor in England until 1961.

One of the greatest influences on 20th-century notions about suicide has been French sociologist Emile Durkheim's 1897 work Le suicide. Analyzing French statistics on suicide, Durkheim concluded that suicide is primarily a function of the strength or weakness of a person's ties to family, religion, and community. Persons with weak social ties and those for whom such ties have been disrupted (such as divorced or widowed people) are the most vulnerable to suicide. Durkheim also categorized suicide into four types. Altruistic suicide is actually mandated by society, as in the case of suttee, where an Indian wife commits suicide by throwing herself on her husband's funeral pyre. In egoistic suicide, individuals kill themselves because they lack the social ties that could motivate them to go on living. Anomic suicide occurs following the loss of a spouse, child, job, or other significant connection to the community, and fatalistic suicides are committed by people driven to despair by dire external circumstances from which there appears to be no escape.

Twenty years after the publication of Durkheim's work, Sigmund Freud provided the first theory that addressed suicide in terms of one's inner mental and emotional state. In Mourning and Melancholia (1917), he proposed that suicide was the result of turning hostility toward a loved one back on oneself. In Man Against Himself (1936), Karl Menninger extended Freud's contribution to the psychodynamic study of suicide, relating it to other forms of self-destructive behavior such as alcoholism.

Today, many possible contributing factors are associated with suicide. Psychological disorders linked to suicide include depression, schizophrenia, and panic disorder. A variety of research studies indicate a possible physiological predisposition to suicide as well. In a study of the Amish of southeastern Pennsylvania—a population whose close-knit community structure and isolation from such influences as drugs and alcohol make suicide extremely infrequent—four families accounted for 73 percent of suicides between 1880 and 1980, suggesting a hereditary tendency toward self-destructive impulses. Separate studies have found a correlation between suicide and levels of the neurotransmitter serotonin in the brain. Personality features associated with suicide include low self-esteem, impulsiveness, and what social learning theorists call an "external locus of control"—an orientation toward believing that one's fate is determined by forces beyond one's control.

Social scientists have found that media coverage of suicides can spur imitative behavior. In the 1970s, sociologist David P. Phillips found that increased numbers of people killed themselves following front-page coverage of suicides. He also observed that such articles had a "copycat" effect, primarily in the geographic area where the original suicides took place, and that the more publicity, the greater the effect of the suicide. The issue of whether fictional accounts of suicide in movies or television influence real life behavior is more controversial and harder to document, but evidence has been found to link increases in both attempted and completed suicide to the release of televised movies featuring suicide. Probably the best-known examples of this phenomenon are the 37 deaths by "Russian roulette" linked to the movie The Deer Hunter.

Suicide is the third leading cause of death among all adolescents and the second leading cause among college students. The rate of suicide is highest at the beginning of the school year and at the end of each academic term. Teenagers who contemplate or commit suicide are likely to have family problems, such as an alcoholic parent, an unwanted stepparent, or some other ongoing source of conflict. The breakup of romantic relationships is among the most common triggering factors—one study found over a third of suicidal teens were involved in the final stages of a relationship. Teen pregnancy can be another contributing factor. Drug and alcohol problems are closely related to teen suicide—one study found that drinking had preceded about a third of all suicide attempts by teenagers. In another study, almost half of all teens between the ages of 15 and 19 who committed suicide in a particular geographic area were found to have had alcohol in their blood.

Various harmful myths have been perpetuated about suicide. One is that people who talk about killing themselves do not actually do it—in fact, one of the main warning signs of suicide is thinking and talking about it. Another myth is the fatalistic idea that people who want to kill themselves will keep trying until they eventually succeed. For many people, the suicidal urge is related to a temporary crisis that will pass. Of all people who attempt suicide, 90 percent never try again. Yet another myth is the idea that nothing can be done to stop someone who is bent on suicide. Most people who feel suicidal are ambivalent about their intentions. Mental health professionals claim that all persons contemplating suicide give at least one warning, and 80 percent provide repeated warnings. If these warnings are heeded, potential suicides can be averted. Common warning signs include giving away prized possessions; changes in eating or sleeping habits; social withdrawal; declining performance at work or in school; and violent or rebellious behavior.

Suicide can be averted when family members or friends recognize these and other warnings and actively seek help for a loved one contemplating suicide. Suicide hotlines staffed by paraprofessional volunteers are an important source of support and assistance to people who are thinking of killing themselves. Psychotherapy can help a troubled person build self-esteem, frustration tolerance, and goal orientation. In cases of severe depression, antidepressant medication is an important resource; electroconvulsive therapy is recommended for persons who have not been helped by medication or who are so severely suicidal that it is considered too risky to wait until medication can take effect.