Suicide

"Deathwish" redirects here. For other uses, see Death Wish (disambiguation).

For other uses, see Suicide (disambiguation).

A painting of the English romantic poet Thomas Chatterton, believed to have killed himself with arsenic in 1770

Suicide (Latin suicidium, from sui caedere, to kill oneself) is the intentional taking of one's own life. Many dictionaries also note the metaphorical sense of "willful destruction of one's self-interest" (e.g., "political suicide"). Suicide may occur for a number of reasons, including depression, shame, guilt, desperation, physical pain, emotional pressure, anxiety, financial difficulties, or other undesirable situations. The World Health Organization noted that over one million people commit suicide every year, and that it is one of the leading causes of death among teenagers and adults under 35. There are an estimated 10 to 20 million non-fatal attempted suicides every year worldwide.

Views on suicide have been influenced by cultural views on existential themes such as religion, honor, and the meaning of life. The Abrahamic religions consider suicide an offense towards God due to religious belief in the sanctity of life. In the West it was often regarded as a serious crime. Japanese views on honor and religion led to seppuku, one of the most painful methods of suicide, to be respected as a means to atone for mistakes or failure, or as a form of protest during the samurai era. In the 20th century, suicide in the form of self-immolation has been used as a form of protest, and in the form of kamikaze and suicide bombing as a military or terrorist tactic. Sati is a Hindu funeral practice in which the widow would immolate herself on her husband's funeral pyre, either willingly, or under pressure from the family and in-laws.

Medically assisted suicide (euthanasia, or the right to die) is currently a controversial ethical issue involving people who are terminally ill, in extreme pain, and/or have minimal quality of life through injury or illness. Self-sacrifice for others is not usually considered suicide, as the goal is not to kill oneself but to save another.

The predominant view of modern medicine is that suicide is a mental health concern, associated with psychological factors such as the difficulty of coping with depression, inescapable suffering or fear, or other mental disorders and pressures. A suicide attempt is sometimes interpreted as a "cry for help" and attention, or to express despair and the wish to escape, rather than a genuine intent to die. Most people who attempt suicide do not complete suicide on a first attempt; those who later gain a history of repetitions have a significantly higher probability of eventual completion of suicide.

Epidemiology

Main article: Epidemiology of suicide

According to official statistics, about a million people die by suicide annually, more than those murdered or killed in war. According to 2005 data, suicides in the U.S. outnumber homicides by nearly 2 to 1 and ranks as the 11th leading cause of death in the country, ahead of liver disease and Parkinson's disease. According to a 2008 report from the Johns Hopkins Bloomberg School of Public Health's, Center for Injury Research and Policy, the rate of suicide in the United States is increasing for the first time in a decade. The increase in the overall suicide rate between 1999 and 2005 was due primarily to an increase in suicides among whites aged 40–64, with white middle-aged women experiencing the largest annual increase. Worldwide suicide rates have increased by 60% in the past 50 years, mainly in the developing countries. Most suicides in the world occur in Asia, which is estimated to account for up to 60% of all suicides. According to the World Health Organization, China, India and Japan may account for 40% of all world suicides.

Gender and suicide: In the Western world, males die much more often by means of suicide than do females, although females attempt suicide more often. This pattern has held for at least a century. Some medical professionals believe this stems from the fact that males are more likely to end their lives through effective violent means (guns, knives, hanging, etc.), while women primarily use more failure-prone methods such as overdosing on medications.

United States suicide rates for white men, by Health Service Area, 1988–1992. This map and the map at right use the same color scale: note the large difference in rates between men and women. The regional patterns for men and women are similar, but not the same.

United States suicide rates for white women, by Health Service Area, 1988–1992.

Others ascribe the disparity to inherent differences in male/female psychology. Greater social stigma against male depression and a lack of social networks of support and help with depression are often identified as key reasons for men's disproportionately higher level of suicides, since suicide as a "cry for help" is not seen by men as an equally viable option. Typically males die from suicide three to four times more often as females, and not unusually five or more times as often. CALM, the Campaign Against Living Miserably is a charity in the UK that attempts to highlight this issue for public discussion.

Excess male mortality from suicide is also evident from data from non-western countries. In 1979–81, 74 territories reported one or more cases of suicides. Two of these reported equal rates for both sexes: Seychelles and Kenya. Three territories reported female rates exceeding male rates: Papua New Guinea, Macau, French Guiana. The remaining 69 territories had male suicide rates greater than female suicide rates.

Barraclough found that the female rates of those aged 5–14 equaled or exceeded the male rates only in 14 countries, mainly in South America and Asia. China is the only country in the world where more women than men take their own lives, with female suicides representing 58 percent of the total.

Suicides per 100,000 people per year

Rank	Country	Males	Females	Total	Year
1	Lithuania	68.1	12.9	38.6	2005
2	Belarus	63.3	10.3	35.1	2003
3	Russia	58.1	9.8	32.2	2005
4	South Africa	—	—	30.0	2004
5	Slovenia	42.1	11.1	26.3	2006
6	Hungary	42.3	11.2	26.0	2005
7	Kazakhstan	45.0	8.1	25.9	2005
8	Latvia	42.0	9.6	24.5	2005

National suicide rates: Some studies show that national suicide rates are generally stable, but differ significantly between countries.

Suicides in the U.S. by gender, age, and racial or ethnic group, 1999–2005.

Ethnic groups and suicide: In the USA, Caucasians die by suicide more often than African Americans do. This is true for both genders. Non-Hispanic Caucasians are nearly 2.5 times more likely to kill themselves than are African Americans or Hispanics.

Age and suicide: In the USA, males over the age of seventy die by suicide more often than younger males. There is no such trend for females. Older non-Hispanic Caucasian men are much more likely to kill themselves than older men or women of any other group.

Season and suicide: People die by suicide more often during spring and summer. The idea that suicide is more common during Christmas is a common misconception. There is also potential risk of suicide in some people experiencing Seasonal Affective Disorder. Some studies have found that elderly people are more likely to commit suicide around their birthdays.

Related phenomena

Euthanasia and assisted suicide

Euthanasia machine invented by Dr. Philip Nitschke, on display at Science Museum, London.

Main article: Euthanasia

Individuals who wish to end their own life may enlist the assistance of another person to achieve death. The other person, usually a family member or physician, may help carry out the act if the individual lacks the physical capacity to do so even with the supplied means. Assisted suicide is a contentious moral and political issue in many countries, as seen in the scandal surrounding Dr. Jack Kevorkian, a medical practitioner who supported euthanasia, was found to have helped patients end their own lives, and was sentenced to prison time.

Murder-suicide

A murder-suicide is an act in which an individual kills one or more other persons immediately before or at the same time as him or herself.

The combination of murder and suicide can take various forms, including:

• Suicide to facilitate murder, as in suicide bombing
• Suicide after murder to escape punishment
• Suicide after murder as a form of self-punishment due to guilt
• Having a combined objective of suicide and murder
• Considering one's suicide as the main act, but murdering one's children first, to avoid them becoming orphans, to be together in an expected afterlife, in the context of severe depression where the person feels he is sparing his loved ones from a horrible life, or simply just to experience the act
• Joint suicide in the form of killing the other with consent, and then killing oneself
• Punishment - taking revenge on those deemed responsible and escaping the world seen as a terrible place, as in many school shootings
• Committing suicide using a method that results in the deaths of others such as crashing an aeroplane, such a suicide was famously attempted in FedEx Flight 705
• Some cases of cult suicide may also involve murder. Conversely, many spree killings have ended in suicide.

The motivation for the murder in murder-suicide can be purely criminal in nature or be perceived by the perpetrator as an act of care for loved ones in the context of severe depression. The severely depressed person may see the world as a terrible place and can feel that they are helping those they care about by removing them from it.

Suicide attack

Main article: Suicide attack

A suicide attack is when an attacker perpetrates an act of violence against others, typically to achieve a military or political goal, that results in his or her own death as well. Suicide bombings are often regarded as an act of terrorism. Historical examples include the assassination of Czar Alexander II and the in part successful kamikaze attacks by Japanese air pilots during the Second World War.

Self-injury

Main article: Self-injury

Self-injury is not a suicide attempt; however, initially self-injury was erroneously classified as a suicide attempt. There is a non-causal correlation between self-harm and suicide; both are most commonly a joint effect of depression.

Suicide locations

Some landmarks have become known for high-levels of suicide attempts. Two of the most popular locations in the world are reportedly San Francisco’s Golden Gate Bridge and Japan's Aokigahara Forest. In 2005, the Golden Gate Bridge had a count exceeding 1,200 jumpers since its construction in 1937, while Aokigahara has had a record of 78 bodies found within the forest in 2002, replacing the previous record of 73 in 1998. The suicide rate of both places is so high that numerous signs, urging potential victims of suicide to seek help, have been posted. Beachy Head, in the United Kingdom, is another popular suicide location.

Suicide methods

Percent of suicides that are by firearm in the United States, by gender and age, 1999–2005. Data from the CDC.

Main article: Suicide methods

According to Professor Keith Hawton, of the Centre for Suicide Research, at Oxford University, "“All research suggests that showing, in detail, methods of suicide does result in an increase of those methods immediately afterwards, so portrayal of methods of suicide is ill-advised.” (Article in The Times 21 October 2006, 'Audiences are haunted by a film that shows the suicide leaps of real people'). According to Mr Mike Cobb, of The Samaritans, an organisation which works with people contemplating suicide, "Even showing a method on Casualty has led to an increase" (same article in The Times 21 October 2006, 'Audiences are haunted by a film that shows the suicide leaps of real people'). According to the Irish Association of Suicidology [3], "Copy cat suicides account for about six per cent of all suicides".

In countries where firearms are readily available, many suicides involve the use of firearms. Over 52% of suicides that occurred in the United States in 2005 were by firearm. Asphyxiation methods (including hanging) and toxification (poisoning and overdose) are fairly common as well. Together they comprised about 40% of U.S. suicides during the same time period. Other methods of suicide include blunt force trauma (jumping from a building or bridge, self-defenestrating, stepping in front of a train, or car collision, for example). Exsanguination or bloodletting (slitting one's wrist or throat), intentional drowning, self-immolation, electrocution, and intentional starvation are other suicide methods. Individuals may also intentionally provoke another person into administering lethal action against them, as in suicide by cop.

Suicide and mental illness

Studies show a high incidence of mental disorders in suicide victims at the time of their death with the total figure ranging from 98% to 87.3% with mood disorders and substance abuse being the two most common. A person diagnosed with schizophrenia may commit suicide for a number of reasons, including because of depression. Suicide among people suffering from bipolar disorder is often an impulse, which is due to the sufferer's extreme mood swings (one of the main symptoms of bipolar disorder), or also possibly an outcome of delusions occurring during an episode of mania or psychotic depression. Major depressive disorder is associated with a higher than average rate of suicide, especially in men.

World map of suicide rates per 100,000.

Controversial criticism

Many studies measuring incidence of psychiatric disorder in suicides employ after-the-fact diagnosis. Such studies are often criticized for lack of objectivity. The main argument is that a decision of the psychiatrist is biased if he believes that suicidal people must be mentally ill. This bias is indirectly confirmed by statistics: "the highest estimate of mental illness when a sample had been diagnosed before suicide was 22 percent. Afterward the highest estimate was 90 percent."

Use of after-the-fact diagnosis may lead to a kind of tautology. In simple words, "We say, in essence, 'All people who attempt suicide are mentally ill.' If someone asks, 'How do you know they are mentally ill?' the implied answer is, 'Because only mentally ill persons would try to commit suicide.'

Other reasons

Suicide as a form of defiance and protest

In the 1960s, Buddhist monks, most notably Thích Quảng Đức in South Vietnam, drew Western attention to their protests against President Ngô Đình Diệm by burning themselves to death. Also in the 1960s, Quaker Norman Morrison committed suicide by self-immolation to protest the United States involvement in the Vietnam War. In Ireland there exists a long tradition of hunger strike to the death against British rule, predominantly in Northern Ireland during the infamous 1981 hunger strikes, led by Bobby Sands, which resulted in 10 deaths. The period caused international outrage as shown by the Indian parliament standing for two minutes of silence and the Iranian government renaming the street in Tehran on which the British Embassy stands to "Bobby Sands Street".

Judicial suicide

A person who has committed a crime may commit suicide to avoid prosecution and disgrace:

• Hermann Göring, high-ranked Nazi and head of the Luftwaffe, committed suicide with cyanide capsules rather than be hanged after his conviction at the Nuremberg Trials.
• Irish revolutionary Theobald Wolfe Tone cut his throat rather than be hanged, after his request for a firing squad (a death worthy of a soldier) was denied.
• Colonel Alfred Redl was presented with the evidence of his espionage and shot himself to avoid a trial.
• Budd Dwyer, a Treasurer of Pennsylvania, killed himself on January 22, 1987 while on live television after being convicted (wrongly, he claimed) of financial crimes, in order to draw attention to his case and to enable his widow to draw survivor benefits (since he died before being removed from office).
• More recently, Deborah Jeane Palfrey, dubbed the DC Madam by the media, was convicted on April 15, 2008 of racketeering, using the mail for illegal purposes, and money laundering. On May 1, 2008 she was found dead by hanging, an apparent suicide.

Military suicide

Main pages: Suicide attack and Category:Military personnel who committed suicide

A kamikaze attack on the escort carrier USS White Plains

In the final days of World War II, some Japanese pilots volunteered for kamikaze missions in an attempt to forestall defeat for the Empire. Near the end of WW2 the Japanese designed a small aircraft whose only purpose was kamikaze missions. In Nazi Germany, many soldiers and government officials (including Adolf Hitler) killed themselves rather than surrender to Allied forces. The Japanese also built one-man "human torpedo" suicide submarines called Kaitens.

Dutiful suicide

Dutiful suicide is an act, or non-fatal attempt at the act, of fatal self-violence at one's own hands done in the belief that it will secure a greater good, rather than to escape harsh or impossible conditions. It can be voluntary, to relieve some dishonor or punishment, or imposed by threats of death or reprisals on one's family or reputation (a kind of murder by remote control). It can be culturally traditional or generally abhorred; it can be heavily ritualized as in seppuku or purely functional. Dutiful suicide can be distinguished from a kamikaze or suicide bomb attack, in which a fighter consumes his own life in delivering a weapon to the enemy. An example of dutiful suicide is a soldier in a foxhole throwing his body on a live grenade to save the lives of his comrades.

Examples

• Disgraced Roman aristocrats were sometimes allowed to commit suicide to spare themselves a trial and penalties against their families. An example of this was Emperor Nero who reportedly committed forced suicide following a large fire that burned through much of Rome.
• Erwin Rommel, found to have foreknowledge of the July 20 Plot on Hitler's life, was threatened with public trial, execution and reprisals on his family unless he killed himself, which he did.

Impact of suicide

It is estimated that each suicide in the United States leaves an average of six people intimately affected by the death, either as a spouse, parent, significant other, sibling, or child of the deceased person. These people are referred to as survivors.

It is estimated that 80% of all in home suicide scenes are cleaned up by a close friend, significant other, or a family member. Those that cleanup a suicide scene of a close friend, significant other, or a family member are 75% more likely to commit suicide later on in life.

Views on suicide

Medical

Main article: Suicide intervention

In the United States, individuals who express the intent to harm themselves are automatically determined to lack the present mental capacity to refuse treatment, and can be transported to the emergency department against their will. An emergency physician will determine whether inpatient care at a mental health care facility is warranted. This is sometimes referred to as being "committed". A court hearing may be held to determine the individual's competence. In most states, a psychiatrist may hold the person for a specific time period without a judicial order. If the psychiatrist determines the person to be a threat to himself or others, the person may be admitted involuntarily to a psychiatric treatment facility. This period is usually of three days duration. After this time the person must be discharged or appear in front of a judge. As in any judicial proceeding this person has a right to legal counsel.

Switzerland has recently taken steps to legalize assisted suicide for the chronically mentally ill. The high court in Lausanne, in a 2006 ruling, granted an anonymous individual with longstanding psychiatric difficulties the right to end his own life. At least one leading American bioethicist, Jacob Appel of Brown University, has argued that the American medical community ought to condone suicide in certain individuals with mental illness.

Criminal

Main article: Legal views of suicide

In some jurisdictions, an act or incomplete act of suicide is considered to be a crime. More commonly, a surviving party member who assisted in the suicide attempt will face criminal charges.

In Brazil, if the help is directed to a minor, the penalty is applied in its double and not considered as homicide. In Italy and Canada, instigating another to suicide is also a criminal offense. In Singapore, assisting in the suicide of a mentally handicapped person is a capital offense. In India, abetting suicide of a minor or a mentally challenged person can result in a maximum 1 year prison term with a possible fine.

A tantō knife prepared for seppuku

In Germany, the following laws apply to cases of suicide:

• Active euthanasia (killing on request) is prohibited by article 216 of the StGB (Strafgesetzbuch, German Criminal Code), punishable with six months to five years in jail
• German law interprets suicide as an accident and anyone present during suicide may be prosecuted for failure to render aid in an emergency. A suicide legally becomes emergency when a suicidal person loses consciousness. Failure to render aid is punishable under article 323c of the StGB, with a maximum one year jail sentence.

Cultural

Main article: Cultural views of suicide

In the Warring States Period and the Edo period of Japan, samurai who disgraced their honor chose to end their own lives by seppuku, a method in which the samurai takes a sword and slices into his abdomen, causing a fatal injury. The cut is usually performed diagonally from the top corner of the samurai's writing hand, and has long been considered an honorable form of death (even when done to punish dishonor). Though such a wound would be fatal, seppuku was not always technically suicide, as the samurai's assistant (the kaishaku) would usually stand by to cut short any suffering by quickly administering a fatal cut to the back of the neck (just short of decapitation), sometimes as soon as the first tiny incision into the abdomen was made.

Religious

Main article: Religious views of suicide

In most forms of Christianity, suicide is considered a sin, based mainly on the writings of influential Christian thinkers of the Middle Ages, such as St. Augustine and St. Thomas Aquinas; suicide was not considered a sin under the Byzantine Christian code of Justinian, for instance. The argument is based on the commandment "Thou shalt not kill" (made applicable under the New Covenant by Jesus in Matthew 19:18), as well as the idea that life is a gift given by God which should not be spurned, and that suicide is against the "natural order" and thus interferes with God's master plan for the world. However, it is believed that mental illness or grave fear of suffering diminishes the responsibility of the one completing suicide. Counter-arguments include the following: that the sixth commandment is more accurately translated as "thou shalt not murder", not necessarily applying to the self; that taking one's own life no more violates God's law than does curing a disease; and that a number of suicides by followers of God are recorded in the Bible with no dire condemnation.

Judaism focuses on the importance of valuing this life, and as such, suicide is tantamount to denying God's goodness in the world. Despite this, under extreme circumstances when there has seemed no choice but to either be killed or forced to betray their religion, Jews have committed individual suicide or mass suicide (see Masada, First French persecution of the Jews, and York Castle for examples) and as a grim reminder there is even a prayer in the Jewish liturgy for "when the knife is at the throat", for those dying "to sanctify God's Name". (See: Martyrdom). These acts have received mixed responses by Jewish authorities, regarded both as examples of heroic martyrdom, whilst others state that it was wrong for them to take their own lives in anticipation of martyrdom.

Suicide is not allowed in the religion of Islam; however, martyring oneself for Allah (during combat) is not the same as completing suicide. Suicide in Islam is seen as a sign of disbelief in God. The use of suicide attacks is strictly forbidden in Islam, however it is practised by Radical groups such as Hamas and Al-Qaeda in Iraq.

In Hinduism, suicide is frowned upon and is considered equally sinful as murdering another. Hindu Scriptures state that one who commits suicide will become part of the spirit world, wandering earth until the time one would have otherwise died, had one not committed suicide.

Philosophical

Main article: Philosophical views of suicide

The Way Out, or Suicidal Ideation: George Grie, 2007

Some see suicide as a legitimate matter of personal choice and a human right (colloquially known as the right to die movement), and maintain that no one should be forced to suffer against their will, particularly from conditions such as incurable disease, mental illness, and old age that have no possibility of improvement. Proponents of this view reject the belief that suicide is always irrational, arguing instead that it can be a valid last resort for those enduring major pain or trauma. This perspective is most popular in continental Europe, where euthanasia and other such topics are commonly discussed in parliament, although it has a good deal of support.

A narrower segment of this group considers suicide something between a grave but condonable choice in some circumstances and a sacrosanct right for anyone (even a young and healthy person) who believes they have rationally and conscientiously come to the decision to end their own lives. Notable supporters of this school of thought include German pessimist philosopher Arthur Schopenhauer, and Scottish empiricist David Hume. Adherents of this view often advocate the abrogation of statutes that restrict the liberties of people known to be suicidal, such as laws permitting their involuntary commitment to mental hospitals.

Peer encouragement of suicide

Some suicides are done under peer pressure. It can take place with as few as two people, in a "suicide pact", in which two people pledge to die together, or with larger amounts of people, as in a cult, as the mass suicide/massacre that took place in Jonestown, Guyana. Others have been encouraged to commit suicide. In 2008, a Florida teen committed suicide in front of a live webcam stream. Some onlookers encouraged him to do so, although they were not all proven to have been aware that it was not simply a false teen prank. Most thought he was merely play acting.

See also

• American Foundation for Suicide Prevention
• CALM, Campaign Against Living Miserably
• Cult suicide
• National Suicide Prevention Lifeline
• Mass suicide
• Mercy killing
• The Myth of Sisyphus
• Jack Kevorkian
• Quantum suicide
• Samaritans (charity)
• Senicide
• Suicide Act 1961
• Suicide attack
• Suicide bridge
• Suicide methods
• Suicide note
• Suicide Prevention Action Network USA
• Suicide watch

Books

• The Complete Manual of Suicide
• The Peaceful Pill Handbook
• Final Exit
• Suicide (book)

Lists

• List of countries by suicide rate
• List of suicide sites
• List of suicides

Further reading

• Gambotto, Antonella (2004). The Eclipse: A Memoir of Suicide. Australia: Broken Ankle Books. pp. 197pgs. ISBN 0-975-1075-1-8.
• Jamison, Kay Redfield (2000). Night Falls Fast: Understanding Suicide. New York: Vintage. pp. 448pgs.
• Simpson, George Gaylord; Durkheim, Emile (1997). Suicide: a study in sociology. New York: Free Press. ISBN 0-684-83632-7.{{cite book}}: CS1 maint: multiple names: authors list (link)
• McDowell, Eugene E.; Stillion, Judith M. (1996). Suicide across the life span: premature exits. Washington, DC: Taylor & Francis. ISBN 1-56032-304-3.{{cite book}}: CS1 maint: multiple names: authors list (link)
• Stone, Geo (2001). Suicide and attempted suicide. New York, NY: Carroll & Graf. ISBN 0-7867-0940-5.
• Hakim, David (2008). Man Down CineSource Magazine. {{cite book}}: External link in |title= (help)

External links

• American Foundation for Suicide Prevention
• Suicide at Curlie
• Stamp Out Suicide! Information resource for those in the UK and Ireland
• Avshalom Elitzur and Haim Omer, What Would You Say to the Person on the Roof?, with comments from Israel Orbach