Loginova Olga: Consulting Psychologist specializing in Positive Psychology. Art
Therapist, Trainer of NLP
The full text in Russian and English languages
"I do not want to live". The acquaintance to the person who does not see the way out of the difficult life situation...
the WAY OUT ALWAYS exists,
This article is intended for parents, teachers, beginning psychologists and for all those who value the LIFE!
Suicide is a self-murder, the intended self deprivation of life. This is a reaction of the person to a problem appearing insuperable, as, for example, alienation, death of the relatives etc.
Suicidality is a distress signal, the call of help indicating the desperate conflict situation. In each case the suicidality needs therapeutic efforts.
The direct reason for attempt of suicide lasts from several minutes to several hours, rarely several days, before the doing is fulfilled. It is important to know this reason, and whenever possible also the reasons for the previous attempts of suicide to find access to more latent problems of the patient.
Who is in the risk group?
1. The persons, suffering mental alienations, and also having the age crisis.
2. Suicides on the basis of the endogenous psychoses. Complete suicides make 1/3 of all cases. In case of the endogenous depressions the special threat of the suicide is observed at the beginning and at the end of the depressive phase. The endogenous depressive people form the biggest group of "post-suicidal" patients.
3. The persons suffering senile depression.
4. Diseased with schizophrenia.
5. Diseased teenagers the leading syndrome for whom is their disability to communication. They often originate from the disadvantaged families, emotionally unbalanced, weak, mentally unbalanced, and separated. At the critical phase of life the risk of the suicide can become especially big as a result of separation from parents, and also in case of the insignificant disorders.
6. In the climacteric period the suicide threat is also higher than during the other periods of the life.
7. In case of alcoholism.
8. In case of the cancer diseases.
9. Unexpected approach of the disease in case of the real or imagined threat to the professional career.
The problem of suicides is now essential both among the adults and the children.
Cross-cultural aspect and epidemiology
According to Goskomstat (State Statistics Body of Russia) on the average about 6000 suicides were taking place per year in RSFSR in 70-80’s. Today this quantity increased to 30 000 cases per year. 25 % of all victims are young men, 17 % are girls. Level of suicides among the Russian teenagers is one of the highest in the world. The world statistics shows that during the last years, suicide level in many countries is raising or keeps high enough.
In the book "Psychosomatic medicine and positive psychotherapy" in the section "Suicidal attempts" N.Pezeshkian writes that the highest number of suicides in the world has been registered in 1988 in Hungary, the second place was given to Finland, and France was on the third place. In the USA annually about 30000 persons commit suicide. Great number of suicides takes place in Japan. The lowest indicators belong to Greece and Saudi Arabia.
Suicides never take place among the aboriginals of Australia and Tierra del Fuego. In India the suicide happens in the form of self-immolation on the holy sites.
Suicide often takes place among the Eskimos as they get to the senile age or in case of the chronic diseases.
Edwin Schneidman enumerated 10 general psychological characteristics of suicides.
· The suicide general purpose is the decision finding.
· The suicide general purpose consists in the consciousness termination.
· The general stimulus for suicide is the intolerable mental anguish.
· The general stress factor for suicide is the frustrated psychological needs.
· The general emotional emotion is the feebleness-hopelessness.
· The general action at suicide is an escape.
· The general communicative action at suicide is the report on the intention.
Seyr describes the emotional complex underlying the suicidal behavior:
- Isolation (feeling that nobody understands you, nobody has interest in you);
- Feebleness (feeling that you cannot control the life, everything depends not on you);
- Hopelessness (when nothing good shall be expected from the future);
- Feeling of self- insignificance (the hurt self-respect, low self-appraisal, anxiety of incompetence, shame for yourself).
I.Purich-Peykovich and D.Dunyich found the symbolical sense in the suicide method.
· Jump from the window, from the terrace, from the bridge – flight.
· Drowning – purification, return to the pleasure of the womb, association with the mythical contents.
· Hanging – the most dramatic experience of the first breath, the first struggle between the life and death, its analog is the spheresthesia in the throat.
· Self-immolation – mystical secret and power of the fire, the total disappearance, punishment of those who remains to live.
· Shot in the head – manifestation of the heroic morals and honorable death.
Long-term researches in the features of the various groups of the people attempting the suicide found the certain demographic, medical and other characteristics bound with the suicidal behavior. Knowing these factors is necessary for estimation of the risk of suicidal behavior.
Social and demographic factors
1. Sex – males.
2. The age – teenagers and young men of both sexes from 12 to 24 years, men of 20-30 years, both sexes of 50 y.o. and older and especially after the age of 60. There were registered the cases when children of the early age committed suicide attempts. It is also connected with the idea that the child thinks it will fall asleep, and then again will revive, like it sees in some cartoon films and fairy tales.
3. Marital status – the people never married, dissolved, widowed, childless and living in loneliness.
4. Education and the professional status – the unemployed, and also persons with higher education and the high professional status.
Occupation or professions: military men of conscription service, doctors:
psychiatrists and anesthesiologists, teacher etc. Women-doctors commit suicides
much more often, than the representatives of the other occupations.
1. Mental pathology:
• Depression now or the depressive attack in the past;
• Alcohol addiction;
• Addiction to any other psychoactive substances;
• Schizophrenia. Suicidal attempts happen against easy schizophrenic changes of the personality when the patients as if carry out the "experiment" («it would be interesting to look what happens … »), it is rather difficult to expect such suicide;
• Disorder of the personality.
2. The somatic pathology – serious chronic progressing disease:
• Oncologic diseases; intolerable pains.
• Cardiovascular diseases;
• Diseases of the respiratory organs (asthma, tuberculosis);
• Congenital or acquired deformities;
• Loss of physiological functions (loss of hearing, ability to move, loss of sexual function, sterility);
• Condition after serious operations;
• Condition after transplantation of donor organs and tissues.
• Homosexual orientation.
• Suicidal thoughts, intentions, attempts in the past.
• Suicidal behavior of the relatives, close friends, other significant people.
Frequent reasons for the suicide:
• Adultery, family conflicts, divorce, illnesses or losses of relatives. Depth of the conflict depends on the depth of the communication. In case of the superficial communication the deep conflicts do not happen.
• Alcoholism and narcomania. Mothers of children-alcoholics are very upset about this fact, even if their children are already 40-60 years old. They are trying to solve this problem in different ways, including end of life.
• Loss of work and financial failures. The big unpaid debt when the situation seems hopeless.
• Internal conflict.
• Retirement. High level of suicides among people of 50-59. They have an acute suffering from feeling of loneliness, mental anguish, feeling of self-uselessness, sensitivity. In this period the volume of contacts with the other people reduces. On the other hand the irritability, conflictness, aggression in relation to people around rises. The suicidal attempts of the elderly people end with death more often, than among the young people.
• Enforced social isolation (emigration, compelled resettlement, imprisonment).
• Sex violence.
• Physical or psychological violence.
• Excitability, aggression.
• Unwillingness to take help from associates.
• Game and computer addiction. It includes the pathological players having the great money debt from 100 thousand rbl. and up to 1 000000 rbl.
The reasons for the suicide among the teenagers
As we mentioned already, the statistics says that suicide happens among the men more often than among the women.
They registered the cases when parents take their children life before to end their own life.
The statistical data show a high percentage of mortality among the graduates of orphan asylums and boarding schools – approximately 10 % of them commit suicide. It is connected with the life difficulties, unpreparedness to the world outside of orphanage and boarding school walls. Absence of life experience in resolution of the problems, supports of the relatives, feeling of loneliness etc.
The reasons for the suicide among schoolboys may include the school problems connected with the over study, poor progress, conflicts to the teachers or peers. Movement to a new place of residence. Conflict relations with the parents. High expectations of parents to the child who cannot realize them, may lead to suicidal attempts. Though these attempts can have demonstrative character. The child tries to settle accounts with the life when he believes that he can be saved. He commits suicide at the moment when adults should come for them to save his life. Suicide in the face of people around etc.
The other reasons of suicide among teenagers can include:
- Undesired pregnancy.
- Humiliation and shame from schoolmates.
- Sexual orientation: homosexuality. Teenagers of both sexes. Teenagers suffer when their peers and parents turn away from them.
- Another reason for the suicides are mental diseases among which we can point out: depression, schizophrenia, anorexia.
- As a separate article Starshenbaum G. V. marked out the dysmorphophobia or dysmorphomania in the teenage and youthful age (strong dissatisfaction with the appearance). Dysmorphophobia is shown in the form of the deep concern in imaginary or insignificant disadvantages of the appearance or body smells, ostensibly repellent for the people around. Most often the patients worry because of the wrinkles, maculae and hair on the skin, size of their nose, width of hips, size of the foot etc. According to the American researchers about 30 % of people with such disorders isolated themselves from the external world, 17 % undertook suicide attempts.
Methods for settling the accounts with the life, descending:
• Jump from the window or the balcony;
• Cutting veins;
• Psychotropic substances;
• Gunshot wound;
• Drowning, jumping from the high bridge;
• Toxic gas poisoning etc.
All these methods do not always lead to complete suicide. There are cases when people jumped off from 10-11 floor and remained alive, but handicapped for the whole life with numerous fractures and in the wheelchair.
Besides there are also the latent forms of suicide.
This is refusal from meals.
Occupations connected with the risk for life.
Fast driving in the car etc.
Signs of the suicidal risk
E.I. Krukovich as well as the other authors underlines that indicators of suicidal risk are the following factors:
1. Abusing alcohol and psychoactive substances;
2. Leaving home;
3. Self-isolation from the other people and life;
4. Sudden depression of daily activity;
5. Change in habits, for example non-observance of personal hygiene, care of appearance;
6. Preference of the conversation and reading topics to those connected with the death and suicides;
7. Existence of the suicidal thoughts, intentions, plans. (For example, "It would be nice to fall asleep and never to wake up").
8. "Tunnel vision" - disability to see any other variants of the problem resolution except for the suicide
9. Frequent listening of mourning or sad music.
10. "Arranging formalities" (making a will, settlement of conflicts, letters to the relatives and friends, gifting the personal things).
In the other cases the patient on the contrary consciously tries to quarrel with all friends and relatives forming so the artificial self-isolation. The aged parents can prevent from the suicide attempt as otherwise there is no one to care about them.
Suicidal risk in depression
It is thought that serious depressions are the most frequent reason for suicides in psychiatric practice. Depressive mood: indifference to the life, depression, hopelessness, feebleness, despair. These patients have a specific voice, look.
Of the total number of those committing the suicides about 60 % cases are caused by the depression. And the cases committed by men are 2-4 times more often that those committed by women.
In case of the endogenous depression the suicidal tendencies are found out in every second patient, and suicidal attempts - in every fourth. Suicide is the reason of death for 20 % of depressive patients. The highest level of complete suicides is observed in the age interval of 35-49 years.
In 65 % of cases the formation of suicidal behavior is preceded by the death of the dear people, conflicts in the family, break with the beloved person, the child-handicapped. Suicidal attempts are more often made during the anxious-melancholy affect. The excruciating sleeplessness along with increase of the depressive symptomatology during early morning hours is the frequent reason for suicides in the early morning hours. The first 5 years of disease are especially dangerous in respect of the suicide.
To estimate the depression they use the Beck psychometric inventory. Testing can be held in the groups and with the individuals. Results of questionnaire shall be precisely correlated with the personal and situational uneasiness and alexithimia.
The depression reasons
Psychoanalysts mark out such personal protection means typical for the depression as replacement of the hatred and projection of it («they do not love me»).
Z.Freud and K.Abraham linked the development of the depression to the anxiety and worries in the childhood caused by appearance of the second child in the family and early losses. The people feeling the insufficient or excessive parent love in the childhood reveal the special predisposition to depression. These both types of people can devote their life to deserve love or approval of people around.
The person suffering the state of the depression: feels melancholy, is in the state of oppression and hopelessness, anxiety, fear or apathy, sadness, boredom. Feeling of guilt, shame and ignominy is strongly developed. Almost all patients with depression endure the feeling of senselessness of their life, are waiting for the end of it.
It is important to know that the patient with depression should be under control during the whole period of the melancholy mood. Especially in the morning, when depression is most serious. According to psychiatrists the relatives of the patient should not wave away from words of the patient when he speaks about suicide even when he speaks playful manner.
The general psychological features characterizing the suicidal behavior:
• Auto aggression
• Pessimistic personal attitude to the prospects to overcoming the crisis
Herbs and products with antidepressive action:
• St. John's wort;
• Camomile Aster ;
• Integral grains;
• Raw vegetables and fruits;
• Vitamin C.
Before any herbs are used we recommend to see the attending physician. So the overdose or allergic reaction to the herbs can cause the negative result.
For mood improvement it is recommended to move a lot, to prolong the duration of the sleep, before going to bed it is recommended to take warm shower, but not to wipe the skin dry.
For treatment of the seasonal depression the phototherapy (solarium) is effective. To make ski walks in the winter.
In the flat interior it is desirable to use light wall-paper and furniture. Now some people have a tendency to use the dark tones in the flats. Some designers offer to use the black tiles in the bathroom. The flat interior consists of black paints. It seems stylish and modern, but after a while the person can have nervous exhaustion. Besides the depressive patients often do not open the curtains in the flats. And the person is constantly in the shaded flat with no sunlight.
Depressive patients are recommended to make pictures of the clouds, especially in solar weather. To be in the air.
Art therapy: isotherapy (creative expression through drawing), molding, phototherapy (photographing and creation of collages), for women it can be the embroidery, knitting, sewing.
Keeping diaries helps a lot as it is necessary to reflect all the good things happening within the day, what meetings happened that day.
The most important thing is that the patient should be given a strong incitement to life. To talk about the sense of the life, about plans for the future, for the day, month, year. To find out for the sake of what or whom the person is ready to live, what can be the advancement catalyst to the future, irrespective of the age of this person. The main thing is to interest the person in life again at any cost.
Playing sports, swimming, run, pedestrian walks help a lot.
Engagement in the favorite doing.
Listening of music pieces.
Resources of the patient are those strong points of the person which form his basis of viability and increase the probability to overcome crisis with positive balance.
• self-preservation instinct;
• social experience;
• communicative potential;
• positive experience of the problems resolution.
• support by the family and friends;
• stable work;
• adherence to religion;
• steady financial position;
• medical aid;
the individual psychotherapeutic program.
Help in case of the potential suicide
The therapy purpose is to resolve the problems causing the suicidality instead of to aspire to prevent the suicide at any cost.
The psychotherapy held with the suicide sets as the purpose to convince him about the availability of the optimistic possibilities. According to the German psychiatrists, approximately 70 % of the persons committing one suicidal attempt are successfully achieving the formation of the new life purposes. 30 % repeat the attempt of suicide, and half of them with the lethal outcome.
The first important therapeutic step is the attempt to get into contact to the patient. The first question could sound this way: «What forced you to despair that you decided living has no sense anymore?»
First help in case of the suicidal danger is to ask the person questions on suicide, not to avoid this theme. To show interest and at the same time not to condemn and not to try to make the interlocutor to change his mind.
During the conversation it is necessary to reveal the problem situation, to express the interest in the personality and destiny of the interlocutor, liking for him.
To find out, whether there is a suicidal plan, a place and time for execution, means for plan realization.
What suicidal thoughts and attempts were in the past. What is the self-appraisal of his suicide probability?
To try to find out what was the reason and the condition for formation of suicidal intentions.
To try to induce the person to express the feelings with regard to this problem.
To specify, whether the person told to someone earlier what he is saying now.
The psychotherapist or the psychiatrist, the psychologist-counselor should hold conversation with the person ready for the suicidal attempts. Hospitalization in psychiatric institution with the further medicament treatment is recommended in certain cases. Work with such patients can sometimes last for one year.
In work with such patients it is allowed to use the methods of art therapy, fairy-tale therapy, bibliotherapy, sand therapy, the method of positive psychotherapy. The autogenic training gave good results etc. It is important to show, that even of the difficult situation one can always find a way out. To broaden the vision of the person, to show variants to resolve the current situation. To try to generate the purposes for the nearest future maybe several days, then months, year. To wake the person up for the life. To rethink his life, to find new sense of the life.
Treatment of teenagers is made in the form of conversations, for children in most cases they use play therapy.
(questionnaire by B.Lyuban-Plozz with coauthors)
1. Did you think of suicide recently?
2. If yes, was is frequent?
3. Did such thoughts come involuntarily?
4. Do you have an exact idea about how you would prefer to end the life?
5. Did you begin preparation for it?
6. Have you already told to somebody about the suicidal intentions?
7. Have you ever tried to end your life?
8. Did you have in your family or circle of friends any suicide cases?
9. Do you find your situation remediless?
10. Is it difficult for you to distract from the problems?
11. Has your communications with the relatives and friends decreased recently?
12. Do you still have interest to what in happening in your occupation and environment? Do you still have an interest to your hobbies?
13. Do you have someone to speak frankly and confidentially about the problems?
14. Do you live with the family or friends?
15. Do you still have the strong emotional links with the family or professional duties?
16. Do you feel the steady accessory to any religious or other world outlook community?
Zharikov N.M., Tyulpin Yu.G. Psychiatry: Textbook. – М: «Medical news agency» LLC, 2009. – 832 p.
Malkina-Pykh I.G.Psychosomatic medicine. - М: Eksmo, 2008. - 1024 p.
Starshenbaum G.V. Suicidology and crisis psychotherapy. М: "Kogito-center", 2005. – 375 p.
Sinyagina Yu.V., Sinyagina N.Yu. Child's suicide: psychological view. – SPb.: KARO 2006. – 176 p.
Psychiatry, psychosomatic medicine, psychotherapy / K.P.Kisker, G.Freiberger, G.K.Roze, E.Woolf. М: Aleteya, 1999. – 504 p.
Romek V. G, Kontorovich V. A, Krukovich E.I. psychological help in crisis
situations. - SPb.: Rech 2007. - 256 p.
© 2005-2015 Loginova Olga: Author’s Project ‘Personality and Psychology’
® All rights reserved. The materials of the site may be reproduced partially or in full only stating the full name of the author(s) of the article.