○ Laws and consistency of enforcement of laws and rules about behavior (e.g., limiting alcohol, tobacco, and other drugs; violent behavior). ○ Low residential mobility. ○ Low exposure to violence in media. ○ Not living in poverty. (UCLA, 2016) ● Family and peer protective factors ○ Parental and/or sibling negative attitudes toward drug use. ○ Attachment/bonding to family. ○ Attachment to prosocial others. ○ Family management practices (e.g., frequent monitoring and consistent supervision). ○ Effective clinical care for mental, physical, and substance abuse disorders. ○ Family and community support (connectedness). ○ Support from ongoing medical and mental health-care relationships. ○ A discipline practice. (UCLA, 2016)
Often, patients who have attempted suicide are discharged with no community support or appropriate follow-up, leaving them vulnerable to further attempts. In low-resource settings, geographic inaccessibility to health-care facilities and the absence of trained professionals have been identified as potential obstacles. Thus, there are a number of important factors that can both buffer against suicidal behavior, as well as improve an individual’s potential to flourish. Careful consideration of these factors should be made when working in a treatment setting, and they can be helpful and informative in an assessment setting. However, it must be cautioned that the predictive capacity of protective factors to prevent suicidal behavior is substantially reduced relative to the predictiveness of negative risk factors (Holman & Williams, 2020). This means that if an individual is reporting protective factors in the same context as other high-risk factors (e.g., multiple past suicide attempts), then decisions on suicide risk should be based solely on the negative risk factors. In other words, protective factors do not outweigh negative risk factors, and clinicians should keep this important fact in mind when making risk determinations.
THEORIES OF SUICIDAL BEHAVIOR
Theories about why people die by suicide have been considered for centuries, with historical conceptualizations of suicide often being unfairly harsh, judgmental, or derogatory toward the afflicted individual. Today, the act of attempting or dying by suicide itself can be viewed as a medical problem and one of the leading preventable causes of death. As such, people exhibiting suicidal concerns should be treated with empathy, compassion, and respect. Nonetheless, many researchers, clinicians, and families still desire to understand what factors may lead an individual to engage in, and in many tragic cases, die from suicidal behavior. Theories of suicide are often a function of the lens through which the theory writer views behavior more broadly. For sociologists, the function of suicide may point to broader dysfunction in Durkheim’s sociological theory of suicide French sociologist Emile Durkheim was one of the first to publish his views on suicide in 1897. Unique in his time, Durkheim reported on occurrences of suicide across groups of individuals. Some of his findings remain true to this day (e.g., suicide rates are higher among men than women, and suicide rates are higher among soldiers than civilians). Perhaps his greatest contribution to the field was his definition of four types of suicides (listed below), derived from the imbalance between social integration and moral regulation: ● Egoistic suicide : Refers to a suicide resulting from a sense of detachment from society, a lack of belongingness or integration with a community. Apathy and meaninglessness may result. ● Altruistic suicide : Occurs when an individual is overwhelmed by society’s goals and beliefs and finds the achievement Shneidman’s theory of the suicidal mind Clinical psychologist Edwin Shneidman, PhD, together with Norman Farberow and Robert Litman, founded the Los Angeles Suicide Prevention Center in 1958, where the three were instrumental in beginning a line of research on suicide and developing a crisis center and interventions to prevent death. Shneidman also founded the American Association of Suicidology and its journal, S uicide and Life-Threatening Behavior . He was the first professor of thanatology (the scientific study of death and dying) at UCLA. While Shneidman’s writings on suicide transcended numerous texts, he summarized much of his work in The Suicidal Mind (1996). Borrowing from the work of
society. For biological and medically-oriented approaches, suicide may be viewed as either a function of genetic risk or neurophysiological dysfunction (Miller & Prinstein, 2019). For psychologists, suicidal behavior may be viewed as a behavioral reaction to difficult emotional and interpersonal stressors. In any regard, suicidal behavior remains one of the more debated topics at the crossroads of public health, philosophy, and bioethics (Malhi, 2019). Common to all theories of suicide, however, is the premise that the person experiencing the suicidal crisis desires to die, and hopefully, in better understanding what causes this desire, healthcare providers can improve suicide prevention and recovery efforts. This next section briefly reviews some key historical and modern theories of suicide. of these goals to be more important than his or her own individual life, such as suicide bombers and other soldiers in war. Thus, in an altruistic society, individuals would have no need for suicide, except in cases where it is expected that the individual kill themself on behalf of society. ● Anomic suicide : Results from moral deregulation and lack of social restraint. The individual does not appear to understand how he fits into society. He is unaware of the limits to desire and is constantly left feeling disappointed. ● Fatalistic suicide : Is the opposite of anomic suicide and occurs when individuals feel societally oppressed, as if their futures are hopelessly directed for them. In these cases, the individual believes it is better to die than to continue to live within that society. (Durkheim, 1951) his mentor Henry Murray, Shneidman (1996) extrapolated how unmet and thwarted needs contribute to suicide and proposed 10 commonalities in all suicide deaths. He further asserted that an aspect of each of these commonalities among thoughts, feelings, or behaviors occurs in almost every case of suicide death, regardless of age, gender, psychiatric illness, or any other demographic. Table 3 reviews these 10 commonalities of suicide. Shneidman concluded that intolerable psychological pain, or what he termed “psychache,” is the key commonality in all suicides.
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