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THEORIES OF SUICIDE

THEORIES OF SUICIDE. Dr Saman Yousuf. 14 June 2011. Perspectives. 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)

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THEORIES OF SUICIDE

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  1. THEORIES OF SUICIDE Dr Saman Yousuf 14 June 2011

  2. Perspectives • 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

  3. 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

  4. 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)

  5. 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

  6. Psychological theories • Sigmund Freud Death instinct “Thanatos” and this drive is in harmony with “Eros” • David Malan Results from accumulated trauma

  7. 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

  8. 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

  9. Thomas Joiner (2005) – Interpersonal-psychological theory

  10. 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 DEATH BY SUICIDE 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

  11. Some psychosocial theories • Halbwachs (1930) • Henry and Short (1954) • Giddens (1966) • Douglas (1967) • Baechler (1975) • Taylor (1978)

  12. 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

  13. GENES & FAMILY • 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)

  14. NEUROIMAGING

  15. Stress-Diathesis Model Holmes & Rahe 1967 • Combines psychological and biological factors

  16. Holmes & Rahe 1967 STRESS DIATHESIS • 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 intoxication Acute psychiatric condition • Innate vulnerability or predisposition (in the form of traits) for developing the suicidal state Familial / genetic influences Chronic multiple psychiatric problems Hopelessness Being male / loneliness

  17. THEORIES OF DELIBERATE SELF HARM

  18. 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

  19. 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

  20. 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

  21. 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

  22. 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

  23. Genetics • Rare genetic syndrome – Lesch-Nyhan (HG-PRT deficiency) • Large turnover of purines • Characterized by self harm • Link largely still unclear

  24. THANK YOU

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