Suicide overview

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Suicide (Latin suicidium, from sui caedere, to kill oneself) is primarily the act of intentionally ending one's own life, though it is also used as a metaphor for the "willful destruction of one's self-interest" either as an individual or as a group. Suicide may occur for a number of reasons, including depression, shame, pain, financial difficulties, or other undesirable situations. Nearly one million people worldwide die by suicide annually. There are an estimated 10 to 20 million attempted suicides every year.

Views on suicide have been influenced by cultural views on existential themes such as religion, honor, and the meaning of life. Most Western and some Asian religions—the Abrahamic religions, Hinduism—consider suicide a dishonorable act; in the West it was regarded as a serious crime and an offense towards God due to religious belief in the sanctity of life. Japanese views on honor and religion led to seppuku, one of the most painful methods of suicide, to be respected as a means to atone for mistakes or failure or a form of protest during the samurai era. In the 20th century, suicide in the form of self-immolation has been used as a form of protest, and in the form of kamikaze and suicide bombing as a military or terrorist tactic. Sati was a Hindu funeral practice in which the widow would immolate herself on her husband’s funeral pyre.

Medically assisted suicide (euthanasia, or the right to die) is a controversial ethical issue involving people who are terminally ill, in extreme pain, and/or have minimal quality of life through injury or illness. Self-sacrifice for others is not usually considered suicide, as the goal is not to kill oneself but to save another.

The predominant view of modern medicine is that suicide is a mental health concern, associated with psychological factors such as the difficulty of coping with depression, inescapable suffering or fear, or other mental disorders and pressures. Suicide is sometimes interpreted in this framework as a "cry for help" and attention, or to express despair and the wish to escape, rather than a genuine intent to die. Most people who attempt suicide do not complete suicide on a first attempt; those who later gain a history of repetitions are significantly more at risk of eventual completion.

Historical Perspective

Suicide has been committed by people from all walks of life since the beginning of known history. Among the famous who have taken their own lives are Socrates, Boudicca, Brutus, Mark Antony, Cleopatra VII of Egypt, Judas Iscariot, Hannibal, Nero, Virginia Woolf, Sadeq Hedayat, Sigmund Freud, Adolf Hitler and Eva Braun, Ernest Hemingway, Alan Turing, Sylvia Plath, Marina Tsvetaeva, Yukio Mishima, Hunter S. Thompson, Ludwig Boltzmann, Kurt Cobain, and Vincent van Gogh.

Types of Suicide

Cult Suicide

A cult suicide is a mass suicide by the members of a cult. In some cases all, or nearly all members have committed suicide at the same time and place. Groups which have committed such mass suicides include Heaven's Gate, Order of the Solar Temple, Peoples Temple (in the Jonestown incident) and the Movement for the Restoration of the Ten Commandments of God. In other cases, such as Filippians and the Taiping, a group has apparently supported mass suicide but without necessarily encouraging all members to participate.

Euthanasia

Euthanasia (from Ancient Greek: ευθανασία, "good death"Template:Ref label) is the practice of ending the life of a human or animal who is incurably ill in a painless or minimally painful way, for the purpose of limiting suffering. Laws around the world vary greatly with regard to euthanasia, and are constantly subject to change as cultural values shift and better palliative care, or treatments become available. It is legal in some nations, while in others it may be criminalized.

Euthanasia can be conducted in various ways. In order to distinguish certain methods, more specific terminology may be used when discussing euthanasia.

Copycat Suicide

A copycat suicide is defined as a duplication or copycat of another suicide that the person attempting suicide knows about either from local knowledge or due to accounts or depictions of the original suicide on television and in other media. Sometimes this is known as a Werther effect, following the Werther novel of Goethe.

In the absence of protective factors, the well-known suicide serves as a model for the next suicide. This is referred to as suicide contagion. They occasionally spread through a school system, through a community, or in terms of a celebrity suicide wave, nationally. This is called a suicide cluster. Examples of celebrities whose suicides have inspired suicide clusters include the American musician Kurt Cobain and the Japanese musicians Hide and Yukiko Okada.

To prevent this type of suicide, it is customary in some countries for the media to discourage suicide reports except in special cases.

Familicide

A familicide is a type of murder or murder-suicide in which at least one spouse and one or more children are killed. In some cases all of the family members' lives are taken.

Of 909 cases of mass murder (defined as 4 or more victims within a 24-hour period) in the US from 1900 to 2000, more than half occurred within an immediate family. So that although the total number of familicide cases are relatively rare, they are the most common form of mass killings. However, statistical data is difficult to establish due to reporting discrepancies.

Familicide differs from mass murder in that the murder kills family members or loved ones rather than anonymous people. This has a different psychodynamic and psychiatric significance, but the distinction is not always made.

A study of 30 cases in Ohio found that most of the killings were motivated by a parent's desire to stop their children's suffering.

In Australia, a study was done of seven cases of filicide followed by suicide in which marital separation followed by custody and access disputes were identified as an issue. Some common factors such as marital discord, unhappiness, domestic violence, sexual abuse, threats of harm to self or others were found in varying degrees. It was not clear what could be done in terms of prevention.

Forced Suicide

Forced suicide is a method of execution where the victim is given the choice of committing suicide or facing an alternative they perceive as worse, such as suffering torture; having friends or family members imprisoned, tortured or killed; or losing honor, position or means.

Internet Suicide

An Internet suicide pact (cybersuicide pact) is a suicide pact made between individuals who meet on the Internet.

Mass Suicide

Mass suicide occurs when a number of people kill themselves together and/or for the same reason.

Epidemiology and Demographics

Studies show a high incidence of psychiatric disorders in suicide victims at the time of their death with the total figure ranging from 98% to 87.3% with mood disorders and substance abuse being the two most common. In schizophrenia suicide can be triggered by either the depression that is common with this disorder, or in response to command auditory hallucinations. Suicide among people suffering from bipolar disorder is often an impulse, which is due to the sufferer's extreme mood swings (one of the main symptoms of bipolar disorder), or also possibly an outcome of delusions occurring during an episode of mania or psychotic depression. Severe depression is considered a terminal illness due to the likelihood of suicide when left untreated.