Suicide

Suicide (from Latin sui caedere, to kill oneself) is the act of intentionally ending one's own life. It is considered a sin in many religions, and a crime in some jurisdictions. On the other hand, some cultures have viewed it as an honorable way to exit certain shameful or hopeless situations. Persons attempting or dying by suicide sometimes leave a suicide note.

To be considered suicide, the death must be a central component and intention of the act, not just a certain consequence; hence, suicide bombing is considered a kind of bombing rather than a kind of suicide, and martyrdom usually escapes religious or legal proscription. There are only legal consequences when there is death and proof of intent.

Epidemiology

It is probable that the incidence of suicide is widely under-reported due to both religious and social pressures, possibly by as much as 100% in some areas. Nevertheless, from the known suicides, certain trends are apparent. However, since the data are skewed, attempts to compare suicide rates between nations is statistically unwise.

A recent report by the World Health Organisation (WHO) states that nearly a million people take their own lives every year, more than those murdered or killed in war. WHO figures show a suicide takes place somewhere in the world every 40 seconds. The numbers are highest in Europe's Baltic states, where around 40 people per 100,000 die by suicide each year.

In the United States, males are four times more likely to die by suicide than females. Male suicide rates are higher than females in all age groups (the ratio varies from 3:1 to 10:1). In other western countries, males are also much more likely to die by suicide than females (usually by a factor of 3-4:1). The suicide rate in the USA is 0.02% per annum for males, and 0.005% per annum for females.

Children of either sex are 10-20 times less likely to die by suicide, and teenagers 1.5-2 times less likely, than adults of the same gender. The incidence of suicide among males over 75 years old is roughly twice that of other adult males.

While there are more male suicides than female, women are more likely to attempt suicide. One attempt at explaining this statistical phenomenon is that men tend to use more violent and effective methods than women - hence, the discrepancy in suicide rates and attempts between the two genders.

Certain time trends can be related to the type of death. In the United Kingdom, for example, the steady rise in suicides from 1945 to 1965 was curtailed following the removal of carbon monoxide from domestic gas supplies which occurred with the change from coal gas to natural gas. Methods vary across cultures, and the easy availability of lethal means plays a role.

Higher levels of social and national cohesion reduce suicide rates. Suicide levels are highest among the retired, unemployed, divorced, the childless, urbanites, empty nesters, and other people who live alone. Suicide rates also rise during times of economic uncertainty (although poverty is not a direct cause). Epidemiological studies generally show a relationship between suicide or suicidal behaviors and socio-economic disadvantage, including limited educational achievement, homelessness, unemployment, economic dependence and contact with the police or justice system.[1] War is always associated with a steep fall in suicides; for example, during World War I and World War II the rate fell markedly, even in neutral countries.

The majority of suicides suffer from some psychological disorder. Depression, either unipolar or as part of bipolar disorder, is an especially common cause. Substance abuse, severe physical disease or infirmity are also recognized causes.

The idea that suicide is more common during the winter holidays (including Christmas) is actually a myth, generally reinforced by media coverage associating suicide with the holiday season. The National Center for Health Statistics found that suicides drop during the winter months, and peak during spring.

It is estimated that global annual suicide fatalities could rise to 1.5 million by 2020.

Motivations

People choose to kill themselves for many reasons. Some common reasons might include:

Decrease in standard of living and/or enjoyment of life (Both material and mental)
Psychiatric conditions, such as depression or schizophrenia
To avoid a problem or situation (Such as a criminal proceeding or torture by enemy(s))

Theories of the effects of age on suicide have changed over time. Initially, it was believed that across all demographic populations, suicides increased with age. However, new research indicates that while this is true for men, suicide rates in women rate peak around the age of 35, plateau and only decline past the age of 85.

Theories about the effects of social status on suicide rates are diverse. This is partly due to difficulty in quantifying social status. Some theorists believe that suicide rates increase in direct proportion to social status. Others believe that the inverse is true.

Suicide is more common among alcoholics, especially after loss of intimate relationships, such as the death of a spouse, divorce, loss of a friend and parental alienation. However, it is difficult to ascertain whether suicide and experience of loss by an alcoholic are causally related, since no data regarding causal relationships between alcoholism itself and suicide exists.

Terminal illness has not been shown to be directly linked to higher suicide rates. Despite this, physical illness is found in nearly half of suicides.

On an individual level, the driving forces behind suicide vary across a range of themes. Common intentions behind suicidal actions include those of guilt, remorse, escapism and the provoking of guilt in those left behind. Media reports or local knowledge of a suicide can trigger copycat suicides in vulnerable people.

Evolutionary explanations

Evolutionists have developed several models to explain the apparent contradiction of suicide and evolutionary theory. Denys de Catanzaro has conducted a lot of research into this field. Others, such as Donald H. Rubinstein, and Anne Campbell have also done work in this field. The major difficulty for evolutionists is to explain why an organism would so deliberately harm its own potential reproductive capacity. Suicide seems to be perhaps the ultimate maladaptive trait, other than, perhaps, infanticide of your own children.

De Catanzaro begins to explain suicide by saying that differential reproduction is in fact much more important to evolution than is "survival of the fittest." That is to say, that mere survival is not particularly important to passing on genes. Even if someone is short lived, but reproduces a lot, they are likely to have more descendants than someone who lives a long time but does not reproduce very much. The other factor in explaining suicide from the evolutionary perspective is inclusive fitness. Since an individual will share many genes with their relatives, it is in their evolutionary interest to ensure their relatives' survival and reproduction. More of their genes will be present in subsequent generations.

De Catanzaro believes that a general theory of suicide can be formed based on a calculation of the "costs of an individual's immediate death to the propagation of his or her genes." He developed a very complex equation that takes the various factors of the subject's potential reproduction, such as dependency of children, remaining reproductive potential, dependance on kin, and others, into account and is able to predict the subject’s risk for suicide. Current research has been conducted mostly in the United States, with a large portion of the sample being young, educated, and religious.

According to de Catanzaro's variables, those at greatest risk of suicide include the elderly, especially those who are a burden on their family, anyone who is ostracized by their kin, someone unable to provide for their kin, dependent on their reproductively capable kin, or anyone who has difficulty relating with the opposite sex. All of these conditions will lead to emotional and psychological conditions that will make suicide more likely. De Catanzaro cites studies that show that emotions have a physiological basis to show that the self destructive response may be a natural, evolved response to their situation to ensure the continued propagation of one's genes.

According to this theory those mostly likely to kill themselves would be the elderly dependent on financially pressed children, or someone with little hope of reproducing who is also dependent of kin. Dr. de Catanzaro's theory can also be applied to general self preservation. It can be used to predict how likely a mother or father is to sacrifice herself to save their children, or other situations of that sort. De Catanzaro takes pains to recognize that his formula is only a base on which to predict likelihood of suicide or self sacrifice. He freely acknowledges that suicide is partially a learned behaviour, as is evidenced by the phenomenon of groupings of suicides occurring in short periods of time. He believes that there are many cultural phenomena that will affect any given individual. De Catanzaro also places strong emphasis on the fact that modern expressions of suicide may sometimes be unpredictable because we are in a different environment from that which we evolved in. He believes that there are many more suicides today than there would be in our "natural" environment due to stress and our confrontation with many situations that we have not been selected to deal with.

Another approach explains the differences between the sexes. One theory argues that men die of suicide more often than women because they do not value their lives as much as women. Since men are not essential to the survival of their offspring, and their potential for reproduction is much more varied, men have evolved to be less fearful of taking risks than women have. If a woman under natural conditions were to die, her children would most likely die as well. Therefore women have evolved to be more fearful of death and physical risk than men, and are therefore less likely to die of suicide. Under this theory suicide is just an expression of males' general willingness to take risks.

Methodology

The means of achieving suicide varies and is greatly influenced by availability, perceived effectiveness and final bodily state. For example, in the United States, firearms are relatively easy to obtain and suicide by this method is four times more common than the next method.

The common means of suicide, roughly in order of use (U.S.), are by gunshot (the so-called "Hemingway solution"), asphyxia, hanging (there is often considerable overlap between hanging and asphyxia due to lack of expertise), drug overdose, carbon monoxide poisoning, jumping from height, stabbing or exsanguination, and drowning.[2]

Physician-assisted suicide (see euthanasia) is typically by a lethal dosage of a prescription drug supplied by the physician. It may be taken orally, by intravenous drip, or infusion pump with a switch operated by the patient.

Suicidal thoughts as a medical emergency

Severe suicidal thoughts are often considered to be a medical emergency. People seriously considering suicide are generally advised to seek help right away. This is especially true if the means (weapons, drugs, or other methods) are available, or if a detailed plan is in place.

Current medical advice is that people who are seriously considering suicide should go to the nearest Emergency Room, or call the emergency services. Severe suicidal ideation, according to this advice, is a condition that requires immediate emergency medical treatment. If depression is a major factor then treatment usually leads to the disappearance of suicidal thoughts.

Attempted suicide

Nearly half of suicides are preceded by an attempt at suicide that does not end in death. Those with a history of such attempts are 100 times more likely to eventually end their own lives than those without.

A suicidal act that does not end in death is commonly called a "suicide attempt" or a "suicidal gesture." In the technical literature people prefer the use of the neologism parasuicide, or describe such acts as "deliberate self-harm" (DSH) – both of these terms avoid the question of the intent of the action. Those who attempt DSH are, as a group, quite different from those who actually die from suicide. DSH is far more common, and the vast majority are amongst females aged under 35. They are rarely physically ill and while psychological factors are highly significant, they are rarely clinically ill and severe depression is uncommon. Social issues are key — DSH is most common among those living in overcrowded conditions, in conflict with their families, with disrupted childhoods and history of drinking, criminal behavior and violence. Individuals under these stresses become anxious and depressed and then, usually in reaction to a single particular crisis, they attempt to harm themselves. The motivation may be a desire for relief from emotional pain or to communicate feelings, although the motivation will often be complex and confused. DSH may also result from an inner conflict between the desire to end life and to continue living.

Suicide in history

Among the famous people who have died by suicide are Boudicca, Cleopatra VII of Egypt, Hannibal, Nero, Adolf Hitler, Ernest Hemingway, Alan Turing, Sylvia Plath, Marina Tsvetaeva, Yukio Mishima, Vincent van Gogh and Kurt Cobain.

In the military

In ancient times, suicide sometimes followed defeat in battle, to avoid capture and possible subsequent torture, mutilation, or enslavement by the enemy. The Caesarian assassins Brutus and Cassius, for example, killed themselves after their defeat at the battle of Philippi. Insurgent Jews died in a mass suicide at Masada in 74 AD rather than face enslavement by the Romans.

In Roman society, suicide was an accepted means by which honor could be preserved. Those charged with capital crimes, for example, could prevent confiscation of their family's estate by taking their own lives before being convicted in court. It was sardonically said of the emperor Domitian that his way of showing mercy was to allow a condemned man to take his own life.

During World War II, Japanese units would often fight to the last man rather than surrender. Towards the end of the war, the Japanese navy sent kamikaze pilots to attack Allied ships. These tactics reflect the influence of the samurai warrior culture, where seppuku was often required after a loss of honor. It is also suggested that the Japanese treated Allied POWs harshly because, in Japanese eyes, by surrendering rather than fighting to the last man, these soldiers showed they were not worthy of honorable treatment.

Spies have carried suicide pills or pins to use when captured, partly to avoid the misery of captivity, but also to avoid being forced to disclose secrets. For the latter reason, spies may even have orders to kill themselves if captured - for example, Gary Powers had a suicide pin but did not use it when he was captured.

In philosophy

In the late 18th century, Goethe's Die Leiden des jungen Werthers, ("The Sorrows of Young Werther"), the romantic story of a young man who kills himself because his love proves unattainable, was reputed to have caused a wave of suicides in Germany.

Arthur Schopenhauer would be expected to take the subject seriously, due to his bleak view of life. His main work - The World as Will and Representation - constantly uses the act in its examples. He denied that suicide was immoral and saw it as one's right to take their life. In an interesting allegory, he compared ending one's life, when under great suffering, to waking up from sleep, when experiencing a terrible nightmare. However, most suicides were seen as an act of the will, as it takes place when one denies life's pains and is thus different from ascetic renunciation of the will, which denies life's pleasures. His ideas become confused when he talks about ascetic suicides; in one part, he claims that ascetic suicide can only occur through starvation, whilst, in another part, he talks of how ascetics have fed themselves to crocodiles and been buried alive. This seems somewhat contradictory - but it is clear that, all in all, Schopenhauer had a lot of sympathy for those who suicide.

Emile Durkheim, the founder of sociology, wrote a very famous study of suicide in the late 1800s.

Albert Camus saw the goal of existentialism in establishing whether suicide was necessary in a world without God.

A study of suicide in literature was written by the poet Al Alvarez, entitled The Savage God.

Jean Améry, in his book On Suicide: a Discourse on Voluntary Death (originally published in German in 1976), provides a moving insight into the suicidal mind. He argues forcefully and almost romantically that suicide represents the ultimate freedom of humanity, attempting to justify the act with phrases such as "we only arrive at ourselves in a freely chosen death", lamenting the "ridiculously everyday life and its alienation". He killed himself in 1978.

William Godwin showed his extreme optimism by stating that suicide was almost always a mistake, as more pleasure is to be gained by living. As he was a utilitarian, who saw moral judgements as based on the pleasure and pain they produced, he thus thought suicide to be immoral.

Ulrike Meinhof wrote that "suicide is the ultimate form of protest." In this she saw suicide as a political act, as a last resort to preserve one's sovereignty over one's body and life. She later died by suicide while under captivity (as did several of her Red Army Faction comrades). Among the most typical methods of suicide as a part of political action have been death by fire and hunger strike.

Legal views of suicide

Ironically, the punishment for attempted suicide in some jurisdictions has been death. In addition, suicide can have other legal consequences. For example, in the UK prior to 1961 their estate was forfeit.

The United Kingdom decriminalized suicide and attempted suicide in the Suicide Act of 1961. By the early 1990s only two USA states still listed suicide as a crime, and these have since removed that classification. Increasingly, the term commit suicide is being consciously avoided, as it implies that suicide is a crime by equating it with other acts that are committed, such as murder or burglary.

In many jurisdictions it is a crime to assist others, directly or indirectly, to take their own life. Sometimes an exception applies for physician assisted suicide (PAS), under strict conditions, see Euthanasia.

In the Netherlands, being present and giving moral support during someone's suicide is not a crime; neither is supplying general information on suicide techniques. However, it is a crime to participate in the preparation for or execution of a suicide, including supplying lethal means or instruction in their use. (Euthanasia may be an exception. See Euthanasia in The Netherlands.)

Religious views of suicide

Buddhism

According to Buddhism, our past heavily influences our present. Correspondingly, what one does in the present influences his or her future, in this life or the next. This is cause and effect as taught by Gautama Buddha. Otherwise known as karma, intentional action by mind, body or speech has a reaction. This reaction, or repercussion, is the cause of conditions and differences we come across in the world.

One's suffering primarily originates from past negative deeds or just from being in samsara (the cycle of birth and death). Another reason for the prevalent suffering we experience is impermanence. Since everything is in a constant state of flux, we experience dissatisfaction with the fleeting events of life. To break out of samsara, one simply must realize his or her true nature by Enlightenment in the present moment; this is Nirvana.

For Buddhists, since the first precept is to refrain from the destruction of life, including oneself, suicide is clearly considered a negative form of action. Despite this view, an ancient Asian ideology similar to seppuku (hara-kiri) continues to influence oppressed Buddhists to choose the act of "honorable" suicide. In modern times, Tibetan monks have used this perceived ideal to protest the Chinese occupation of Tibet and China's human rights violations against Tibetans.

Christianity

Christianity is traditionally opposed to suicide and assisted suicide. Many Christians believe in the sanctity of human life, seeing it as a creation of God and obliging every effort be made to preserve it whenever possible.

In Catholicism, suicide has been considered a grave and sometimes mortal sin. The chief Catholic argument is that one's life is the property of God, and to destroy that life is to wrongly assert dominion over what is God's. This argument runs into a famous counter-argument by David Hume, who held that if it is wrong to take life when a person would naturally live, it must be wrong to save life when a person would naturally die, as this too seems to be contravening God's will.

Conservative Christians (Evangelicals, Charismatics and Pentecostals) have often argued that because suicide involves self-murder, anyone who commits this sin goes to Hell.

A number of Biblical figures took their own lives, most notably Judas Iscariot, who hung himself after betraying Jesus. While suicide is certainly treated negatively in the Bible, there is no verse explicitly stating that suicide leads to Hell. As a result, there is a growing belief that Christians who choose suicide are still granted Eternal life.

Thus, even while believing that suicide is generally wrong, liberal Christians may hold that people who choose suicide are severely distressed and that the loving God of Christianity can forgive such an act.

Hinduism

In Hinduism, murdering one's own body is considered equally sinful as murdering another. However, under various circumstances it is considered acceptable to end one's life by fasting. This practice, known as prayopavesha, requires so much time and willpower that there is no danger of acting on an impulse. It also allows time for the individual to settle all worldly affairs, to ponder life and to draw close to God. It can also be argued that Hinduism is a more of a religious umbrella than a religion in itself, and that some Hindus would (not incorrectly) hold the belief that suicide was allowed by Hinduism.

Islam

Like other Abrahamic religions, Islam views suicide strictly as sinful and detrimental to one's spiritual journey. However, human beings are said to be liable to making mistakes, thus, Allah (God) forgives the sins and wipes them out if the individual is truly sincere in repentance, true to the causes and determined in intention.

For those who believed, but eventually disbelieved in God in the end, the result seems unambiguously negative. In the Qur'an, the holy book for Muslims, although Allah (God) is said to be 'the Most Merciful, the Most Kind' and forgives all sins, the great sin of unbelief is deemed unforgivable. According to the Sunnah (life and way of the Prophet Muhammad), any person who dies by suicide and shows no regret for his wrongdoing will spend an eternity in hell, re-enacting the act by which he took his own life. Some Islamic jurists hold the interpretation that hell is not eternal but indefinite and only remains to exist while the earth endures at its present state. Once the Day of Recompense passes, Hell will eventually be emptied.

Despite this, a small minority of Muslim scholars take the view that actions taken in the course of jihad where one's own death is assured (e.g. suicide bombing) are not considered suicide. Such acts are instead considered a form of martyrdom. There is Quranic evidence to the contrary, stating those involved in the killing of the innocent are wrongdoers and transgressors. Nevertheless, many claim Islam does permit the use of suicide - though only against the unjust and oppressors - if one feels there is absolutely no other option available and life otherwise would end in death.

Judaism

Judaism views suicide as one of the most serious of sins. Suicide has always been forbidden by Jewish law, except for three circumstances. It is seen as an acceptable alternative if one is being forced to commit an act of: murder; idolatry; adultery or incest. Beyond those cases suicide is forbidden, including assisting in suicide and requesting such assistance (thereby creating an accomplice to a sinful act).

The Committee on Jewish Law and Standards, the body of scholars of Jewish law in Conservative Judaism, has published a teshuva on suicide and assisted suicide in the Summer 1998 issue of Conservative Judaism, Vol. L, No. 4. It affirms the prohibition, then addresses the growing trend of Americans and Europeans to seek assistance with suicide. The Conservative teshuva notes that while many people get sick, often with terminal illnesses, most people don't try to kill themselves. The committee believes we are obligated to determine why some seek help with suicide and to ameliorate those circumstances.

The Conservative responsa states:

"...those who commit suicide and those who aid others in doing so act out of a plethora of motives. Some of these reasons are less than noble, involving, for example, children's desires to see Mom or Dad die with dispatch so as not to squander their inheritance on 'futile' health care, or the desire of insurance companies to spend as little money as possible on the terminally ill."

The paper says the proper response to severe pain is not suicide, but better pain control and more pain medication. Many doctors, it asserts, are deliberately keeping such patients in pain by refusing to administer sufficient pain medications: some out of ignorance; others to avoid possible drug addiction; others from a misguided sense of stoicism. Conservative Judaism holds that such forms of reasoning are "bizarre" and cruel, that with today's medications there is no reason for people to be in perpetual torture.

It then investigates the psychological roots of hopelessness felt by some patients, and asserts:

"Physicians or others asked to assist in dying should recognize that people contemplating suicide are often alone, without anyone taking an interest in their continued living. Rather than assist the patient in dying, the proper response to such circumstances is to provide the patient with a group of people who clearly and repeatedly reaffirm their interest in the patient's continued life... Requests to die, then, must be evaluated in the terms of degree of social support the patient has, for such requests are often withdrawn as soon as someone shows an interest in the patient staying alive. In this age of individualism and broken and scattered families, and in the antiseptic environment of hospitals where dying people usually find themselves, the mitzvah of visiting the sick (bikkur Holim) becomes all the more crucial in sustaining the will to live."

Arguments for Suicide

In contrast to the views above, there are also arguments in favour of allowing an individual to choose between life and suicide. This view sees suicide as a valid option.

This line rejects the widespread belief that suicide is always or usually irrational, saying instead that it is a genuine, albeit severe, solution to real problems -- a line of last resort that can legitimately be taken when the alternative is considered worse.

Furthermore, the pro-choice position asserts, in the spirit of liberalism, that a person's life belongs only to him or her, and nobody should try to force on someone their own view that life must be lived. Rather, only the individual involved can make such an important decision, and whatever decision he or she does make, it should be respected. See also free will.

Philosophical thinking in the 19th and 20th century has led, in some cases, beyond thinking in terms of pro-choice, to the point that suicide is no longer a last resort, or even something that one must justify, but something that one must justify not doing. Existentialist thinking essentially begins with the premise that life is objectively meaningless, and then poses the question "why not just kill oneself?" It then proceeds to answer this by suggesting the individual has the power to give personal meaning. Nihilist thinkers reject this emphasis on the power of the individual to create meaning, and acknowledge that all things are equally meaningless, including suicide.

Suicide prevention

Various suicide prevention strategies have been used:

Promoting mental resilience through optimism and connectedness.
Education about suicide, including risk factors, warning signs and the availability of help.
Increasing the proficiency of health and welfare services at responding to people in need. This includes better training for health professionals and employing crisis counseling organizations.
Reducing domestic violence and substance abuse are long-term strategies to reduce many mental health problems.
Reducing access to convenient means of suicide (e.g. toxic substances, handguns).
Reducing the quantity of dosages supplied in packages of non-prescription medicines e.g. aspirin.
Interventions targeted at high-risk groups.
Research.

Treatment

Treatment is directed at the underlying causes of suicidal thinking. Clinical depression is the major treatable cause with alcohol or drug abuse being the next major categories. Other psychiatric disorders associated with suicidal thinking include schizophrenia and anorexia nervosa. Suicidal thoughts provoked by crises will generally settle with time and counseling. For a person with strong or at least definitive family or community ties, urgently providing information about who else would be hurt and the loss that they would feel can sometimes be effective. For a person suffering poor self-esteem, citing valuable and productive aspects of their life can be helpful. Sometimes provoking simple curiosity about the victim's own future can be helpful.

During the acute phase the safety of the person is one of the prime factors considered by doctors and this can lead to admission to a psychiatric ward or even involuntary commitment.

Combination of murder and suicide

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, or perhaps having a combined objective of suicide and murder, e.g. Dunblane Massacre, Columbine High School massacre
suicide after murder as a form of self-punishment due to guilt
considering one's suicide as the main act, but murdering e.g. one's children first, to avoid their becoming orphans, and to be together in an expected afterlife
joint suicide in the form of killing the other with consent, and then killing oneself