Introduction: This article will address the topic of suicide, specifically suicide in adolescents and young adults. I will discuss a personal suicide intervention of a young adult which I made recently, and the movie, Girl Interrupted (1999), as an example of social suicidal causes. I will explain Durkheim’s (1897) sociological model of suicide, and the role of mental illness in suicide. Lastly, I will offer my personal view of suicide, and introduce a mitigating factor in prevention of suicide of young adults.
Suicide is an aspect of being a mental health counselor that is an inevitable reality. At some point, every counselor will encounter a client who not only is toying with the idea of suicide, but who has intent and a method arranged. In the event of a suicidal client, it is important to take swift action to prevent a death; the trained counselor will know to intervene, and will do so almost automatically. As an example, this year I received an emergency call from a college-aged adult who found my therapy services on the internet. She told me she was severely depressed, had not slept for 3 days, and was planning take her life. I saw her that day. She informed me she was planning on returning home where she had a loaded gun; she explained in detail her plan of execution to end her life. She was a sexual abuse survivor who was being emotionally abused daily by her perpetrator, and her family. She was clearly both clinically depressed and psychotic. Our appointment concluded by driving her to the local hospital emergency room, and staying with her until she could be evaluated by the hospital’s social worker. The social worker admitted her to our state’s psychiatric hospital. Although most suicidal ideation is not this urgent, the truth is, a counselor may be called on to save a life (or lives) in her career at any time. Therefore, it is imperative that counselors understand suicide, and know when to intervene.
Suicidal behavior has complex origins: the client’s mental health, their present life circumstances, and even the society and culture they are a part of. In Durkheim’s (1897) etiological model of suicide, industrialization was seen as the cause of increased suicides. Durkheim rejected mental illness as a cause; it was society (and not the individual’s neurology) who was to blame. Durkheim (1897) explained three motivations for suicide: anomic, egoistic, and altruistic. Any suicide which followed the “breakdown” of social order was labeled, ‘anomic’ (Robertson, 2006). By definition, anomia is the breakdown of the individual’s role within society: when he no longer feels necessary and important to the whole of his community, he becomes a “displaced person,” and can drift out of relationship with his community and society. In addition to societal standards of behavior, Durkheim (1897) believed that society has “collective goals and aspirations which integrate an individual’s actions and thoughts with those of other members of society…in these periods, suicides are lower” (Robertson, 2006). When individuals do not participate in the social norms and function outside of them, Durkheim termed this behavior “egoist.” “As the egoist depends less on the group and more upon himself or herself, their own interests…there is a loss of a meaning beyond their individual perspective” (Robertson, 2006). If excessive individualization increases, suicidal ideation may seem like an answer to the isolation and separation. In contrast to egotism, excessive altruism can lead to suicide. In the case of Mother Teresa of Calcutta, her excessive benevolence led to a 50-year crisis of faith. She wrote, “The damned of hell suffer eternal punishment because they experiment with the loss of God. In my own soul, I feel the terrible pain of this loss. I feel that God does not want me, that God is not God and that he does not really exist” (Johnston, 2002). “Like all suicides, the altruistic individual kills himself or herself out of hopelessness and despair. The egoist sees nothing real beyond him or herself, the anomic in untouched or disintegrated with reality, while the altruist is dedicated to a bigger cause than him or herself” (Robertson, 2006). As in the case of Mother Teresa, “The altruist commits himself to a goal beyond this world, and henceforth this world is an obstacle and burden to him…” (Jones, 1986). While Durkheim’s model explained suicide as a sociological problem, current neuroscience and the Western medical model have explained suicide as a medical problem. While suicide is influenced by society, it is also influenced by mental illness: of psychiatric disorders, “Major depression, Bipolar Disorder, Schizophrenia, Alcohol and Drug abuse, Eating Disorders, and Personality Disorders, especially Borderline Personality Disorder and Anti-Social Personality Disorder” (American Foundation For Suicide Prevention, 2012) are top suicide risk-factors. “90% of people who die by suicide have a diagnosable and treatable psychiatric disorder…mental illness, while a most important risk factor, is neither a sufficient nor a necessary cause of suicidal behavior” (Mishara, 2006). Other individual risk factors include: “(a) Past history of suicidal attempt (b) Genetic predisposition to mental illness (c) Neurotransmitter problems: low serotonin can result in suicidal ideation or completed suicide (d) Impulsivity: Impulsive adults are more likely to act on suicidal impulses (e) Demographics: males are 3-5 times more likely to die by suicide than females, and elderly Caucasian males have the highest suicide rates. However, while men are more likely to die by suicide than women, women attempt suicide 3 times as often as men” (American Foundation for Suicide Prevention, 2012).
Because suicide is neither wholly attributable to mental illness nor societal factors, “The inclusion of suicidal behaviors among mental disorders would be very controversial from many points of view, as suicidologists consider it “not a disorder,” but a death caused by a self-inflicted intentional action or behavior” (Silverman, Maris, 1995). Therefore, I conclude that suicide’s etiology can either be nature or nurture, or a combination of both environmental and neurological factors.
In the 1999 movie, Girl Interrupted, teen girls find themselves locked in battle in a psychiatric ward; against themselves, against each other, and against hospital staff. When a delusional girl who is being sexually abused by her father denies what is happening to her, suicide is the only way for her to escape reality. In this girl’s case, her father’s unrelenting pedophilia is what drives “Daisy” to take her life. Among adolescents and young adults, “Suicide rates are the third leading cause of death, behind injuries and homicides, for persons 15-24 years” (Centers For Disease Prevention, 2004). While ethnic groups vary in suicidal rates and help-seeking behavior, in one study of 10-19 year olds, which included: African American, Latino, Asian and American Indian/Alaskan Natives, suicide attempts are highest among American Indian/Alaska Native females, followed by Latinas, American Indian/Alaskan Native males and Asian females. They are lowest among African American and White adolescent males. Overall, girls attempt suicide in larger numbers than do boys (Goldston et al., 2008). Society then, as Durkheim believed, plays an important role in suicidal and help-seeking behavior. “Risk and protective factors for suicidal behavior may be influenced by cultural contexts. For example, acculturative stress among Latino adolescents is associated with high levels of thoughts about suicide” (Honey, King, 1996). Additionally, “Culture may affect each of the stages of help-seeking behaviors (Cauce et al., 2002) that lead to utilization of mental health services for prevention or treatment of suicidal behaviors” (Goldston et al., 2008). In other words, “Suicidal behavior and help-seeking behavior occur in a cultural context” (Goldston et al., 2008) as Durkheim concluded.
I consider myself to be a spiritual person; although I am an existentialist, I do believe there is life after death. Because I believe in a spiritual world, I also believe that life has purpose and meaning beyond life’s immediate circumstances. Because I believe humans are intrinsically spiritual beings, ending a life by suicide equates to ending the soul’s journey prematurely. Total spiritual well-being and religious well-being (high existential well-being) among college students, is correlative to lower levels of suicide ideation, hopelessness and depression (Taliaferro et al., 2009). Studies have shown that spirituality protects against suicide risk by increasing young people’s capacity to find meaning and purpose in life: “African American students are significantly more likely to report higher levels of religious and total spiritual well-being than are students of other ethnicities/races, and greater religious involvement in organized religion” (Mishara, 2006). The question mental healthcare providers must ask is: why? What health factors contained in spiritual and religious beliefs promote a healthier outlook on life?
“Ellison and Levin outlined several possible explanatory mechanisms through which religiosity and over-all spiritual well-being may lead to positive health outcomes. They include (1) regulation of individual lifestyles and health behaviors (2) provision of social resources (social ties, formal and informal support) (3) promotion of positive self-perceptions (self-esteem, feelings of personal mastery), (4) provision of specific coping resources (cognitive or behavioral responses to stress) (5) positive emotions (love, forgiveness) (6) promotion of healthy beliefs and (7) existence of healing bioenergy” (Taliaferro et al., 2009). Existentialist psychiatrist Viktor Frankl suggests that, “Individuals who feel helpless to control a situation they perceive as hopeless can rise above them, grow beyond themselves, and by so doing, change themselves. People can turn personal tragedy into triumph” (Frankl, 1981).
We have seen that suicidal behavior is a complex subject, in that it is influenced by both neurological, and sociological factors. In the movie, Girl Interrupted, Hollywood gave American audiences a taste of what environmental pathology could drive a girl to commit suicide. In my opinion, environmental stress can “kindle” a predisposition for mental illness into a psychiatric disorder (most usually Clinical Depression). If untreated for long enough, the hopelessness and helplessness of depression can get the upper hand, resulting in suicide. Durheim’s model of suicide appeals to me for two reasons: (a) because it illustrates that not all suicidal motivations are alike, and (b) that societal/cultural/environmental factors play a part in creating, or in alleviating suicidal behavior. Adolescents, like the girls portrayed in Girl Interrupted, are subject to environmental stress, and some deal with dysfunctional home environments. This stress may add up to suicidal behaviors as a “cry for help.” As counselors, we will be called upon to provide preventative counseling and interventions for suicidal behavior. A young person may consider “interrupting” their lives via suicide when the stress and dysfunction of their environment becomes too overwhelming, or when they are suffering from a mental illness. Understanding the risk factors and societal motivations for suicide will equip us to do a more comprehensive job of facilitating clients through a suicidal crisis, and assisting them back to psychological wholeness.
References:
Columbia Pictures Corporation. (1999). Girl Interrupted. Retrieved from the World Wide Web: http://www.imdb.com/title/tt0172493/
Robertson, M. (2006). Books reconsidered: Emile Durkheim, Le Suicide. Australian Psychiatry, Vol. 14, Issue 4, p. 365-368.
Johnston, B. (2002). Mother Teresa’s diary reveals her crisis of faith. ReligionNewsBlog: Religion news articles about religious cults, sects, world religions, and related issues. Retrieved from the World Wide Web: www.religionnewsblog.com/1315/mother-teresas-diary-reveals-her-crisis-of-faith
Jones, R. A. (1986). Emile Durkheim: An Introduction to Four Major Works. Beverly Hills, CA. Sage Publications, p. 100.
American Foundation for Suicide Prevention. (2012). Facts and Figures. Retrieved from the World Wide Web: http://www.afsp.org/index.cfm?page_id=04EA1254-BD31-1FA3-C549D77E6CA6AA37
Mishara, B.L. (2006). Cultural specificity and universality of suicide: Challenges for the international association for suicide. Crisis: The Journal of Crisis intervention and Suicide Prevention, Vol. 27 (1), p. 1-3.
Silverman, M.M., Maris, R.W. (1995). The prevention of suicidal behaviors: An overview. Suicide and Life-Threatening Behavior, 5, p. 10-21.
Center for Disease Prevention. (2004). Suicide trends among youths and young adults aged 10-24 years. United States, 1990-2004. MMWR. 2007, 56: 905-908.
Goldston D.B., Molock, S.D., Whitbeck, L.B., Murakami, J.L., Zayas, L.H., Hall, Gorden C. Nagayama. (2008). Cultural considerations in adolescent suicide prevention and psychosocial treatment. Vol. 63 (1), p. 14-31.
Taliaferro, L.A., Rienzo, B.A., Pigg, R.M., Miller, M.D., Dodd, V.J. (2009). Spiritual well-being and suicidal ideation among college students. Journal of American College Health, Vol. 58 (1), Jul-Aug, 2009. p. 83-90
Frankl, V. (1981). Man’s Search for Meaning. New York, NY: Simon and Schuster.
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