Suicide prevention

“ THE PREVENTION OF SUICIDE, AND THE TREATMENT OF THE SUICIDAL TENDENCY IN THE INSANE.
It is a terrible thought that our much boasted civilisation and modern educational advantages bring with them a suicide rate which nothing so far has been found to check.
The struggle for existence, at our present high pressure, ends in the survival of the strongest and most able; the weaker in body, and the feebler in mind, get pushed aside and pass away before their due time by disease and self-destruction. ”

“ For the elderly (among whom depression and suicide rates are very high) crisis intervention resources, and suicide prevention and risk- reduction depends on leaders and staff of health care institutions, administrators and staff in retirement residence and convalescent communities, senior centers, AARP chapters, and anywhere the elderly gather. The reality would also depend on the elderly themselves, individually and collectively, e.g., to get past the long history they inherited of bigotry, superstition, and ignorance when it comes to mental health, suicide, and helping survivors of suicide. ”

“ Modern understanding of stress-vulnerability mechanisms based on genetic predispositions, early life development, level of exposure to stress and stress-reactivity together with interpersonal aspects may help to build more effective suicide prevention programs based on universal/selective/indicated prevention principles. ”

“ Mental health experts have come to accept paraprofessional-level suicide intervention and prevention workers as among those in the forefront of primary resources. The view is that their intervention might reduce the lethality of a person contemplating suicide, and even influence someone who has actually initiated an act of suicide. ”

“ For our purpose, then, it will suffice to consider, on the one hand, what means are necessary to restrain patients who are acknowledged to be insane; and on the other hand, what measures are permissible to dissuade and prevent those in trouble or pain from taking their own lives; such means will be equally available whether we think these sufferers sane in their deaths, or insane from the time when they attempt the destruction of their lives.
There are doubtless cases of suicide in which it is impossible to decide as to the mental state of the patient ”

“ In general, if a second attempt be made, after a fruitless effort, and especially after recovery from injury, the patient is insane. Attempts at suicide by cutting very frequently fail, as do attempts by the use of fire-arms; but on the other hand, death is much more certain if drowning or hanging has been the means used. ”

“ The difficulty might never have arisen, but for this unfortunate straining of the word insanity to cover all cases of suicide.
On the Continent, in many States, this injudicious mode of regarding suicides does not exist; when madmen kill themselves, their madness is registered; and when persons whom no one has ever noticed to be unable to manage their affairs, and whose mental state has not been disturbed, until they have preferred death to life, on account of some loss or annoyance, their voluntary deaths are registered as such. ”

“ Whether it be true that the injury to survivors is generally small is, perhaps, open to question; especially in cases where the suicide is the sole means for the maintenance of others, a wife and family, for instance; in such a case, if suicide be not a crime, it is at least a cowardly neglect of duty. ”

“ The varying rates of suicidal death in asylums depend very much on the qualities of the nurses on the staff, and on the relative number of patients attached to each attendant, for nothing but a constant and lynx-eyed survey will prevent the self-destruction of a large proportion of lunatics, when they have a wave of suicidal tendency passing over their minds. ”

“ It will be very necessary, however, to bear in mind that the onset of a disease is generally of a nature quite removed from the influence of the will; while, on the other hand, suicide is voluntary, the result of a distinct action, following a direct determination. It is the determination which is led up to by states of predisposition, whether they be cosmic, racial, or mental.
One large class, perhaps one-third of all suicides, are of a different nature; these are the effect of an insane act; the predisposition is lunacy ”

“ And this is a very fair example of many instances of voluntary death, but whether it forms a good public policy to call those sufferers insane is questionable: personally, I think that such persons are encouraged by the neglect to stigmatise them as criminals.
It is not every suicide from a dangerous height that is caused by imitation; there does undoubtedly exist a peculiar form of fascination, apt to arise from a sense of insecurity, such as occurs to a person standing on a cliff or a house top, and I am convinced that this fascination does cause many involuntary suicides. ”

“ Under public causes he classes suicide to save public honour of a government, to avenge the disgrace of one’s country, to defend the honour of others, and suicide in despair of the state of public affairs. ”

“ Nuns, convent maids, and lay sisters, all numerous classes in Italy, give very few suicides.
In the higher walks of education the rates are all96 higher. Men of science, doctors, lawyers, military men, and the governing officials, all are very prone to self-destruction.
In those counties of France where there is the greatest attention paid to trade, agriculture, and commerce, the suicide rate is the highest; in counties where the development of business is slight the rate is lower. ”

“ But it seems probable that in the minds of many suicides there has been, below any religious faith, or philosophical dogma, the deeply-rooted conviction that death was a sleep and permanent rest, an eternal oblivion in the grave, and they consequently came to regard it as the grand solatium for present heart-breaking grief of mind, or intolerable pain of body. ”

“ Blandford, in his work on “Insanity,” states: “That sane people commit suicide is a fact that must be apparent to every one who exercises common sense in looking upon the subject. The hundreds of poor persons who are brought to our hospitals, half drowned, or with throats half cut, are not insane in any medical sense of the word. Of course there are insane persons who are suicidal.”
M. Leuret epigrammatically sums up the causes of self-murder in the three words, madness, want, and crime. ”

“ For example, in mania, sudden outbursts of violence may either end in instant self-destruction, or the sudden violence causes such precautions to be at once taken, that suicide is not practicable. In melancholia the chances of a self-inflicted death being allowed to occur, are much greater, because the patient is inoffensive, and the disease is124 of long continuance; the sufferer has often daily opportunities for months ”

“ I have already alluded to the debated question as to the tendencies of religion and education.
Statistics seem to point so clearly to development of the mind and mental tension as a cause of voluntary death, that it is probably of no use to look to education as a cure for the suicidal tendency in individuals.
The cultivation of a religious conviction of the sanctity of life, and the sin of a self-inflicted death is a more certain hindrance to suicide. ”

“ In England it is not practicable to form any reliable estimate of the true proportion of insane suicides, as compared with those occurring from disease and mental trouble. On the Continent an attempt is made in most States to assign the proportion ”

“ Every effort should be made to secure full occupation for the mind of a composing character if possible; ennui or tædium vitæ is an important predisposing influence.
Of the numerous French authors on suicide, the first rank is held by Brierre de Boismont; his suggestions for the prevention of suicide, among reasonable persons, i.e., not insane, are to avoid sadness, to procure a family, and to follow some business; and with regard to religion, he advises the confessional and the cloister. Ebrard also extols these two means of cure ”

“ The more prominent causes of male suicide are the108 vices, money troubles, and tædium vitæ; whilst females are more often driven to take their lives by the passions, mental weaknesses, remorse, and shame.
It is a peculiarity of female self-destruction that Sunday is very frequently chosen as the day for its commission; on the other hand, males avoid Sunday very markedly. ”

“ And again, the existence of insanity cannot be affirmed in those suicides, which have taken place in every age of the world, and are not quite obsolete even now,─those cases of voluntary death among natives of uncivilized countries, which form a part of either their political, social, or religious institutions. ”

“ Moral: idleness, bad company, gambling, debauchery, theatrical plays, evil imaginings, evil literature; and Physical: insanity, hypochondriasis, ennui, nostalgia, alcoholism, celibacy, with such data as climate, age, temperament, heredity.
To Class 3 he allots bodily diseases, pain, misery, privation, slavery, loss of fortune, fear of punishment, and envy.
In Class 4, under personal, he places, offended vanity, despair, remorse, suicide to expiate a fault, suicide to secure virtue or personal purity or honour, impatience to obtain the future life, and the vanity of dying for nothing. ”

“ When the tendency is the result of alcoholism, we are met by this difficulty; restraint is needed, and yet no one has the power to enforce restraint; the physician succeeds well enough in relieving the alcoholic delirium and coincident risk of suicide, perhaps time after time; but is powerless to prevent a succeeding attack. Unless a sufferer can be induced to volunteer his entry into a retreat, there are no means of saving him from himself. So long as a man is sensible when sober, be it only for an hour a day, he is beyond the reach of compulsory cure. ”

“ Unfortunately, I never settled, as you know, a farthing on my wife; and as for my life-insurance, they illogically and unreasonably exclude suicide from their list of casualties. Your ordinary suicide does not compass his own death any more doggedly than the man who persists in living in an undrained house, or in drinking brandy until his brain gives way, or in lighting his pipe in a coal-mine. ”

“ The State does not dispute that each faced a passage to death more agonizing both mentally and physically, and more protracted over time, than death by suicide with a physician's help, or that each would have chosen such a suicide for the sake of personal dignity, apart even from relief from pain. ”

“ Surprising as it may seem, prosperity always brings an addition to the number of suicides. Stranger still, during hard times the number of suicides decreases to a noteworthy degree. It is not those who are suffering most from physical conditions who most frequently commit suicide. Our suicides come, as a rule, from among the better-to-do classes of people. While suicide might seem to be quite beyond the province of the physician, it is a duty of the psychotherapeutist to prevent not only the further increase of suicides in general but to save particular patients from themselves in this matter. ”

“ A 1993 study of 16,000 high school students conducted by the CDC found that an astonishing 1 in 12 said that he or she had attempted suicide the previous year.
Camouflage is not unusual: suicide preparations may be arranged so that the act will appear as an accident. An ailing individual might suddenly stop taking life-saving medication; or family members, friends, or 'significant others' might goad or exert harsh psychological pressures on an emotionally distraught person so that suicide becomes the only escape. ”

“ The same two modes of preventive influence that we have over disease in general can be applied to suicide. The physician can modify the mental attitude in individual cases and thus save people from themselves and then he can, by his influence in various ways upon public opinion, lessen the death rate from suicide. For this purpose, just as with regard to infectious disease, it is important for him to appreciate the social and individual conditions that predispose to suicide, as well as the factors that are more directly causative. ”

“ But few patients are constantly determined to commit suicide. The opportunity offered, as a bath-room door left open, a rope, a knife, often prompts the desire and allows the accomplishment of the deed.
Attendants must remember that it takes but a few minutes to commit suicide, by drowning or hanging—but a moment to cut the throat; that persons can drown themselves in a pail of water, hang themselves by the hem of the sheets, cut their throat with a piece of glass or tin. ”

“ With such an impractical, childish mother and failure of a father, uncongenial brothers and sisters, almost hating each other, with bad heredity on both sides and a hellish environment, a shy nervous, suspicious disposition, extremes of ecstasy and despair, ungratified passions, alone and friendless, how could I end otherwise than a suicide?
I claim that any man who commits suicide of necessity suffers more than any who continues to live. I don’t want to die. ”

“ This makes clear the role of psychotherapy with regard to suicide, and there is no doubt that many people on the verge of self-murder can be brought to a more rational view and then live happy, useful lives afterwards. For this purpose, however, it is important that the physician should come to be looked upon as a refuge by those to whom the thought of suicide has become an obsession. ”