Mind Matters:Suicide risk factors

“Why do
people consider suicide?” Not an easy topic to address, but Norman Weissberg,
Ph.D., a psychologist from New York did so recently to a group of
psychotherapists.

What he
called the “flip” answer he gave first: because these people are experiencing
intolerable psychological pain. “It hurt too much to live,” noted one survivor
of an attempt. And, further, the “flip” answer to what moves some people to
action, says Weissberg, is that they can—they have the means and the
capability.

However,
Weissberg enjoins us to look further than the quick answer. He asks why are the
people in such psychological pain. It appears, according to Thomas Joiner,
Ph.D., in his research on suicide, that two factors may drive the death wish.
One, there is a perceived burdensomeness. That is, the individual believes that
he/she is defective and flawed and therefore a burden to family and perhaps
even to country—the sense of “everyone will be better off without me.”

Two, there
is, in addition to feeling a burden, there is a sense of failed belonging. This
belief carries with it a feeling of isolation, of “standing apart from all the
people in my life.” This is not about objective reality: the individual indeed
may be a part of a club or a group, e.g., yet internally feel isolated.

According to
Weissberg’s study of the data, we do not have good predictors of suicide. Suicidal
ideation and a plan by itself are not predictors of attempts. The Substance
Abuse Mental Health Administration of our federal government notes that four
percent of the adult population of the U.S. has acknowledged suicidal thoughts
in the past year. Of those 8.3 million people, 2.3 million had made a plan, and
1.1 million had made an attempt.

The
important question for suicide prevention is what prompts a person to go beyond
the ideation and make an attempt. Our built-in resource, Weissberg reminds us, is
self-preservation: “The body tries to keep us alive.” Humans generally fear the
pain of severe self-injury. The theory is that persons can undergo experiences
to desensitize them to fear and override pain. Then exhilaration replaces fear
and risky activity can promote fearlessness.

Because a
person overcomes fear of suicide by attempting it, Weissberg reports that a
prior attempt of suicide is the simple, best predictor of completing the act.

It was
thought that cutting (the act of self-injuring, self-mutilation) was not at all
related to suicide because the cutter acts to regulate his or her emotions,
suicide not being the motivation. However, cutters, in their experience of
pain, are de-sensitizing themselves to pain, thereby habituating to
self-injury. So it is now found that there is a correlation between cutting and
suicide and, in fact, 70 percent of cutters report suicide attempts. Weissberg
notes that watching violent films (and I would add video games, etc.),
football, hockey—anything that entails pain in which we get habituated and
de-sensitized—provides the capability to override the pain of suicide.
Weissberg also reminds us that those habituated to pain and who inflict pain on
others are physicians and dentists.

Capability
includes having the means. Weissberg recommends that if there is any indication
of suicidality to remove the methods—such as medicines in a cabinet, guns in
the closet.

Fortunately,
suicide risk involves more than capability. Present research points to two
other factors that need to converge with capability: perceived burdensomeness
and failed belongingness.

Antidotes to
these three factors of suicidal risk are what are defined as buffers: the
relationships, beliefs, value systems—whatever might reinforce the will to
live. Immediate supports include friends, family, social groups, pets. Plans
for the future are also buffers, yet sometimes a person plans for the future
even in the midst of planning suicide. Weissberg remarks that suicide is most
often an ambivalent act. (Of course, this is little comfort to the grievers.)

Sometimes a
person may manifest preparatory behavior—an adolescent may start to clean up
his/her messy room and give things away; adults may do likewise.

Often,
however, there are no outward warnings; and in the aftermath of a suicide,
loved ones might blame themselves for not seeing any danger signs. Given the
ambivalence of the person in such psychological pain as to consider suicide and
given the simple, most accurate predictor of suicide is a past attempt, it is
an excruciating acknowledgement that a completed suicide is beyond our control.

So what of
suicide prevention? Consider promoting a sense of belonging and connectedness,
supporting options for relieving psychological pain other than death,
developing a caring supportive network.

Please note:
National Suicide Hotline
(800) 273-TALK (800)
273-8255

Also note:
The 12th Annual Survivor of Suicide Day Program
November 20, 2010, morning
held in both Newark, DE, and Milford, DE
(register athttp://www.deolc.org/events)

* Kayta Curzie Gajdos holds a doctorate in
counseling psychology and is in private practice in Chadds Ford, Pennsylvania.
She welcomes comments at
MindMatters@DrGajdos.com or (610)388-2888. Past columns
are posted to
www.drgajdos.com.

About Kayta Gajdos

Dr. Kathleen Curzie Gajdos ("Kayta") is a licensed psychologist (Pennsylvania and Delaware) who has worked with individuals, couples, and families with a spectrum of problems. She has experience and training in the fields of alcohol and drug addictions, hypnosis, family therapy, Jungian theory, Gestalt therapy, EMDR, and bereavement. Dr. Gajdos developed a private practice in the Pittsburgh area, and was affiliated with the Family Therapy Institute of Western Psychiatric Institute and Clinic, having written numerous articles for the Family Therapy Newsletter there. She has published in the American Psychological Association Bulletin, the Family Psychologist, and in the Swedenborgian publications, Chrysalis and The Messenger. Dr. Gajdos has taught at the college level, most recently for West Chester University and Wilmington College, and has served as field faculty for Vermont College of Norwich University the Union Institute's Center for Distance Learning, Cincinnati, Ohio. She has also served as consulting psychologist to the Irene Stacy Community MH/MR Center in Western Pennsylvania where she supervised psychologists in training. Currently active in disaster relief, Dr. Gajdos serves with the American Red Cross and participated in Hurricane Katrina relief efforts as a member of teams from the Department of Health and Human Services' Substance Abuse and Mental Health Services Administration.Now living in Chadds Ford, in the Brandywine Valley of eastern Pennsylvania, Dr. Gajdos combines her private practice working with individuals, couples and families, with leading workshops on such topics as grief and healing, the impact of multigenerational grief and trauma shame, the shadow and self, Women Who Run with the Wolves, motherless daughters, and mediation and relaxation. Each year at Temenos Retreat Center in West Chester, PA she leads a griefs of birthing ritual for those who have suffered losses of procreation (abortions, miscarriages, infertility, etc.); she also holds yearly A Day of Re-Collection at Temenos.Dr. Gajdos holds Master's degrees in both philosophy and clinical psychology and received her Ph.D. in counseling at the University of Pittsburgh. Among her professional affiliations, she includes having been a founding member and board member of the C.G. Jung Educational Center of Pittsburgh, as well as being listed in Who's Who of American Women. Currently, she is a member of the American Psychological Association, The Pennsylvania Psychological Association, the Delaware Psychological Association, the American Family Therapy Academy, The Association for Death Education and Counseling, and the Delaware County Mental Health and Mental Retardation Board. Woven into her professional career are Dr. Gajdos' pursuits of dancing, singing, and writing poetry.

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