Causes and treatment of suicidal behavior
Bronisch and Wittchen reported that of the people diagnosed with depression they sampled
Suicide is not an emotional disorder. It's not just related to depression. However, it is a serious problem and is more strongly associated with depression than any of the mental health disorders mentioned in this section. That is why in this chapter we discuss the issue of suicide.
Suicide rates vary from country to country. For example, every year in Russia 40/100,000 people commit suicide, while in Greece the rate is much less, about 4/100,000 people (World Health Organization: www.who.int). Suicide rates also change over time. among British women, suicide rates have been falling since the 1970s; for men, the decline in suicide rates in the 1960s-1975s was replaced by a sharp increase in the following 10 years (McClure 2000). In 2000, the UK suicide rate was 11.7/100,000 for men and 3.3/100,000 for women - a significant difference. Suicidal behavior is particularly common among young people: two-thirds of all suicides are under the age of 35 (Hawton, 1997).
Half of those who attempt suicide have a specific mental health problem, most commonly depression, substance abuse disorders, and schizophrenia. About 15% of people with the disorder attempt suicide (Melzer 1998). Suicide is more associated with moderate depression than with major depression because people with major depression don't even have the will to influence how they feel. In fact, people with depression may commit suicide as their illness begins to improve; because, on the one hand, they are still desperate, but on the other hand, in them, a certain motive and impulse is increased.
Bronisch and Wittchen (1994) reported that of the people diagnosed with depression that they sampled, 56% reported thoughts of death, 37% wanted to die, and 69% had suicidal thoughts. However, these thoughts were not exclusive to depressed patients: 8% of people in a control group (never diagnosed with a mental illness) expressed suicidal ideation, and 2% expressed suicidal thoughts. had committed suicide. Suicide in people with schizophrenia is often the result of emotional blunting rather than paranoia or hallucinations. Other risk factors include being single, living alone, sleep deprivation, impaired memory, and self-indulgence (Bronisch, 1996).
Wolfersdorf (1995) summarized the psychological characteristics that lead individuals to suicidal behavior, including thoughts such as worthlessness, guilt, hopelessness, depressive symptoms, hallucinations, and irrationality. internally stable and agitated. People who attempt suicide may also be those with pre-pathological personality traits such as high levels of impulsivity, excitability, opposition, and aggression (Bronisch, 1996).
Causes of suicide
Cultural and social factors
The suicide rate is lowest among people who are married or living together and highest among people who are divorced. Women commit suicide 3 times more than men; In contrast, the suicide success rate in men is three times higher than in women. Approximately 60% of suicides occur after the individual has recently consumed alcohol (Royal College of Psychiatrists, 1986).
The problems that drive individuals to commit suicide to vary by age. The Hawton (1997) review found that among adults who had experienced suicidal thoughts or behaviors, 72% had problems with interpersonal relationships, and 26% had problems with their relationships. employment, 26% have difficulties with their children, while 19% have financial problems. During adolescence, emotional instability may be a particular cause of suicide. Sexual problems may also be a specific risk factor for adolescents. For example, Remafedi et al. (1998) found that 28% of homosexual male adolescents had committed suicide, compared with 4% of normal male adolescents. For women, the equivalent figure is 21 and 15%. In the elderly, suicide may occur as a result of increased feelings of worthlessness/incompetence: 44% of the elderly studied attempted suicide to avoid being admitted to a nursing home (Loebel et al. 1991). Suicide is also common among people who have recently lost a loved one.
A more theoretical social model of suicide was developed by Durkheim ( 1951). He identified three types of suicide: for not belonging to an organization (anomic), for others (altruistic) and for self (egoistic). According to Durkheim, non-organizational suicide occurs when the social structure in which the individual lives fails to provide the individual with adequate support, and the individual loses the sense of belonging. somewhere - what Durkheim calls disorganization/anomie. High levels of disorganization occur at a time of both social and human change, including stresses over economic issues, immigration, and unrest. Suicide for others occurs when an individual intentionally sacrifices himself or herself for the well-being of others or the community. Final,
The Psychoanalytic Interpretation
According to Freud ( 1990), suicide represents a pent-up desire - to destroy a lost loved one and is an act of revenge. Hendin (1992) identifies a variety of psychoanalytic processes that can lead to suicide, including the idea of reincarnation or re-association with the lost or re-encountering object, as well as self-punishment and redemption. sin.
Interpretation of the Cognitive
Many people with suicidal behavior lack memory and problem-solving skills, even when compared with depressive patients who do not commit suicide (Schotte and Clum, 1987). These deficits make it difficult for individuals to cope successfully and effectively with stressful situations; it also predisposes the individual to use inappropriate coping strategies, including suicide.
Rudd (2000) developed a more elaborate cognitive model of depression, based on his own clinical experiences and Beck's model of affective disorder. According to Rudd, the components of the latent cognitive triad include self (worthlessness, unloved, incompetent, and hopeless), others (rejection, abuse, judgment) and future (desperation). The key are perfectionist assumptions (“If I am perfect, people will accept me”), which have the behavioral consequence of becoming a slave to relationships and relationships. excessive perfectionism. In contrast to depression, where sadness predominates, the suicidal individual may experience a range of emotions, including sadness, guilt, and anger. Thoughts may focus on revenge, but this does not directly lead to suicidal behavior. Thoughts and feelings associated with suicide occur at the same time as physiologically high arousal and agitation: individuals who are not deeply aroused by depression have no incentive to commit suicide. The risk of suicide varies over time, with low-risk episodes sporadically occurring. The risk is high when many risk factors work at the same time. These factors may include situational stress, activation of negative cognitive maps, emotional confusion, and lack of coping/coping skills. The risk is high when many risk factors work at the same time. These factors may include situational stress, activation of negative cognitive maps, emotional confusion, and lack of coping/coping skills. The risk is high when many risk factors work at the same time. These factors may include situational stress, activation of negative cognitive maps, emotional confusion, and lack of coping/coping skills.
Here are the desperate words of a married woman who is trying to commit suicide; For this person, events from many years ago continue to have an adverse effect:
“I can't go on…I'm spoiled…I'm dirty…What I did before was terrible…I did things I shouldn't do with a man when I was 6 years old… I'm a child… whore...So when I was 11 years old I was raped…I was filthy…bad…a whore…and I couldn't be nice. Loving anyone I make them feel disgusted because I am me…because I am dirty. There's nothing I can do to change… because I'm spoiled, dirty…”
“I can't find a way out of everything. I've been trying for 30 years, not to be bad. But I couldn't stop it. There are so many things I've done that make me bad…I can't make myself any better.”
“Nothing is worth living anymore. My husband and daughter…They would be better off without me. They don't need me. I make them unhappy and when I go they will be happy again. They don't deserve my pain. So the best thing that can be done is to commit suicide…end suffering for both me and them.”
Suicidal behavior therapy
For people who are suicidal and have a mental disorder, it is possible to take advantage of the disorder's own treatment without worrying about its effect on their mood or behavior. Or therapy can be directed at the factors that motivate them to commit suicide. One of the therapeutic approaches is through the development of effective coping strategies for the problems they face. Key elements in this approach include:
Both the client and the therapist have an accurate understanding of the nature of the problem.
Determine where the situation can be improved: identify the desired goal (like a better relationship with your boyfriend).
Identify strategies to achieve these goals (e.g., talk more, hang out, etc.).
This approach can apply to individuals as well as couples and even families. It is possible to maintain a high frequency of therapy sessions in the early stages, then gradually space them out as individuals begin to better cope with their problems. This therapy requires a moderate number of sessions: partly because it is perhaps the only acceptable form of therapy for people with suicidal behavior, partly to promote self-reliance. owner from the outset (Hawton, 1997).
Overall effectiveness reviews have supported the use of this approach. In fact, in a meta-analysis of psychosocial interventions for suicidal behavior, van der Sande (van der Sande et al. 1997) found that cognitive-behavioral intervention focused on the problem. were the only methods that proved to be effective for this group. Salkovskis et al. (1990) made a small comparison: on the one hand, a 5-session therapy process applying cognitive-behavioral and problem-solving approaches; On the one hand is the usual daily outpatient treatment. Over the next 6 months, 25% of people in the active intervention group had at least one more suicidal behavior, compared with 50% in the group who received no intervention.