Tuesday, 17 February 2009
Suicide protective factors
Often in suicide assessment workshops people are taught about the lists of protective factors.
For instance no history of mental illness, or no history of substance use, or no history of prior suicide attempts. These are seen as good signs and thus the person is less likely to attempt suicide and is more ‘protected’ in that way.
Another one which I have always found a bit dodgy is that family is seen as a protective factor. That is the person who has family of some kind and is involved with and included in the family is more protected. The person with no family and family support is seen as being at a greater risk of suicide.
Family as a protective factor is seen to work in two ways. First a person who belongs to some form of group such as a family is usually in a better psychological state that the person who is isolated in this way. There is truth to this but that involves any group and it does not have to be a family. The other protective feature of a family works on the component of guilt. It is seen that the person will not attempt to take their own life because it will hurt those left behind and thus they feel guilty about attempting suicide.
It is on this second component that in my view it is over rated as a protective factor. To the average person who is not too suicidal they will often think such things like, “I could never do it because it would hurt the kids too much”. But this person is unlikely to attempt suicide in the first place anyway
The kids
From what I have seen if a person gets to the point of seriously contemplating a suicide then the family left behind is of little concern. So in this way suicide could be seen as a selfish or narcissistic act. The guilt feelings carry very little weight in the decision making of a person in this frame of mind
I was working with a guy recently who got very close, about a year ago, to making a serious suicide attempt. It was well planned, well thought out, he had the necessary implements and he was a DSR. The kind of guy who when he decided to do something it would get done and done properly. When I asked about his family left behind he stated, “They would be better off without me”.
This was not a glib comment but a realistically reasoned out statement. They would grieve and be considerably hurt in the shorter term but in the longer term their lives would be less dragged down and of less poor quality if he was not there. And indeed there was some truth to that.
Amy would be a wonderful to have in the family!
So in this case family was not a protective factor but a factor that actually increased the likelihood of a suicide attempt.
Graffiti
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Comments
What's a DSR, Tony??
The hardest client I ever worked with was the one who truly believed that her very small daughter was better off without her. For her, the "family" was not a protective factor. Even when she complained about the child's father and her own family, she firmly believed that the child would be better off with them than with her.
Posted by: gezunda | Tuesday, 17 February 2009
Hi Gez,
For DSR go to
http://www.ynot1.com.au/blogs/Deliberate%20suicide%20risk.cwk%20(WP).pdf
The situation you describe sounds similar to the one I explained as well. But on the one hand they can be right.
Graffiti
Posted by: Graffiti | Tuesday, 17 February 2009
That's the scary bit, isn't it? That they could be right. I don't think I would be game to tell a client that. Judging by the parenting she got, I don't think she was.
I worked out what you meant by the link you gave me !!
Posted by: gezunda | Tuesday, 17 February 2009
I remember reading about 20 years ago a book on death / grief.
I dont remember the title or author, but I do remember this one chapter on suicide.
The first part was addressed to those who new someone who had killed themselves. It was basically saying that suicide was a selfish act, and that the loved one shouldnt feel guilty about anything etc etc. That the person was mentally ill, etc etc.
The second, more interesting part, was addressed to those who feel like suiciding. It said that if they were thinking that no-one loved or cared about you, it was probably true. Cos
if someone cared about you then you wouldnt be feeling like that.
It tickled my humour. Cos on the one hand it was telling the bereaved what they wanted to hear, and on the other hand telling the suicider what they thought was true. Or maybe wanted to hear.
Suicide is such a taboo subject.
Posted by: Kahless | Wednesday, 18 February 2009
If someone wants to end it that's fine. Its their life after all. I don't think suicide is a selfish move at all - its a decision made prior to death. What matters to me is that it must be a decision made prior to death and not some spontaneous event that happens because of a lack of thought clouded by emotion and feelings by the person.
I like spontaneity but when its dealing with hair - it can grow out or be re-dyed, or a wall colour in a house can be painted over and so forth. But death, in my mind, is a fairly perminant thing. Perhaps an amount of clear, objective thought is handy in such a decision making process.
If then the person chooses logically and sensibly to die then surely that is ok... isn't it?
Its not something that i understand, and i doubt whether i should be commenting on such a thing, but i did anyway. Comments aren't usually a perminent thing. They can be deleted, dismissed and/or forgotten quickly.
I don't know what the moral stand point is either. It depends on who's moral stand point it is.
Maybe my moral stand point is that i would like suicide if any to be a decision made after some serious thought and weighing up of pros and cons prior to the death of the person. It makes sense then, when it happens, and is easier to understand for others. The person can then prepare their loved ones for the coming event and that may help the people left behind to deal with guilt or regretts.
I've noticed that loved ones are rarely prepared fully, but i think it may help. We're all going to die one day.
Posted by: roses | Wednesday, 18 February 2009
That does sound like and interesting book Kahless.
It seems it likes to have a bet each way.
The second part sounds like it would not have been much help but such is life.
yes it is a bit of a taboo subject as you say
Tony
Posted by: Tony | Wednesday, 18 February 2009
Thanks for your comments roses,
Your last sentence seems true that we will all die one day.
Unfortunately the thinking of the suicidal individual is usually clouded by emotion because they are just feeling such bad and intense emotions.
there are some (minority) like the man I described who can still maintain good Adult thinking even with such powerful emotions going on inside him. Hence we get the DSR person.
Roses you can't tell someone (loved ones) before hand because if you do then you are admitted to special care or some form of suicide watch. Useful in many cases for sure but it also stops the person like the DSR from saying anything because they don't want such 'special care'. So it puts the most suicidal group at even more risk.
Thanks to the government for such insightful legislation!!
Tony
Posted by: Tony | Wednesday, 18 February 2009
I would only commit suicide if I could make it totally convincing that it is an accident, and if no one in my family would find my dead body. Which means I would never do it. I don't think I'll ever get to the point where my self loathing is greater than my fear of hurting my kids for life, even though they are teenagers. I know a couple of people whose parents committed suicide and they have never gotten over it. They continue to think they somehow contributed to their parents' decision to end their lives.
Posted by: Harriet | Wednesday, 18 February 2009
Hello Harriet,
You are not alone at all in that many seek to make it look like an accident rather than a suicide. I would suggest that a significant number of car accident deaths are in fact car suicide deaths.
Some life insurances don't pay out on suicides but do for accidents as well.
As for getting over a loved one who has died by suicide. Well it certainly is possible Harriet, but some people will just not psychologically let go of the deceased, but that is their issue and has nothing to do with the deceased
Cheers
Tony
Posted by: Tony | Wednesday, 18 February 2009
Well that's dumb! But can't the suicidal person just wait and die later? I don't understand what locking someone up and druging them would do to help.
Hang on, i'll go read what you've written...
Posted by: roses | Wednesday, 18 February 2009
Ok. So what's the big problem?
If people want to die, just let them for goodness sakes!
Come on! You've got to admit that not existing would be so great! Sheesh! Honesly i can't see what or where the problem is. Why can't people leave other people alone. Isn't an individual life there's alone? By the way the answer to that question is - YES!
So, the big problem here is the same as 'owning' someone again? "S" can't make her own decisions because s/he is not the owner of his/her life?
I thought taxes were bad and land rates. When ever we develope a piece of land we pay water, sewer, garbage rates. But we also pay 'open space' rates too. We pay someone for 'open space' on/over our land!
So we walk around pretending that we believe we can own something - anything - on this planet and now we are beginning to realise we don't even own our own life??
That sucks!
To not exist... sounds fairly real to me.
Posted by: roses | Wednesday, 18 February 2009
I have been reading your thread with interest Roses.
A large part of me agrees with choice.
Yet. If someone I know says they want to destroy themselves, then I would certainly take the time to listen and to understand. Why? Ultimately probably to disuade if I could.
Tell, me. If one of your kids were about to kill themselves. ,,, would you just let them do what they wanted and excercise their choice. Or would you have a different view?
And suicide is selfish. Selfish defined as motive thinking of self only. There is nothing wrong with being selfish.
This is a complex subject. A see-saw of opinions. No right or wrong.
Posted by: Kahless | Wednesday, 18 February 2009
Kahless,
I would be devastated if my kids or even their kids or a friend chose to kill self. There are times when i fear they are already walking that road. There are however some people that i would not disuade if they spoke of it but you are correct in saying that because there are many i would ask for somekind of word or promise till i visited/contacted them at a later date. I would just check to see if they've actually thought about it or not - that's all i can do really.
There is nothing i can do to stop someone working their way to the completion of a well made decision - and i feel that often, perhaps its not my place to do so.
I guess i don't understand a lot so it seems simple to me. We're so busy fighting for the dying (and those who want to die) to live longer, and allowing so many living (and wanting to live) to die in the thousands. I can see it, but i can't seem to understand it. There must be a reason for it. There must be.
Suicide is not as selfish as people who will not allow others to die because its a sad thing. Its no where near as selfish as keeping someone alive - whether they want to be alive or not - just because grief is too big a thing to deal with (the sadness of grief is a dreadfully frightening thing and it frightens me to have to face it one day).
You know what? I don't agree with abortion or allowing a child to die for what ever reason. Perhaps its not so much that i don't agree - more that i don't like the idea. I don't like to think about it but many people do need to and make decisions on half information and half truths. I don't like to think of the elderly or sick wanting to die and having friends and family helping them to do so. Lots of people have to deal with this stuff every day until it happens or not.
I'm reasonably healthy (though obese) but i don't like pain. I want to live but only if i can actually 'live'.
It is easy to state one thing but think many opposing things all at the same time. Weighing up all the 'yes' and 'no's is something i think we do all day every day - even in our dreams as we rest at night.
I have, since i've seen death in the animal world, wondered what it must be to be dead. It intrigues me - fascinating stuff.
Posted by: roses | Wednesday, 18 February 2009
Yes Roses,
they can and they do.
The person who wants to suicide and tends to be quiet about it can just say all the right things and get 'released' from suicide watch and go and do it.
Posted by: Tony | Wednesday, 18 February 2009
My view on suicide and selfishness tends to be the same as you Roses,
If a person wants to die what right do I have to say "no" especially when my reason (at least in part) is so I can avoid the pain of my grief. If that person is so despairing and hopeless then I understand their decision.
If I wanted to make such a decision then I hope others would respect that for me and not pressure me just so they can avoid their own psychological pain.
Tony
Posted by: Tony | Wednesday, 18 February 2009
I've nursed people who have had absolutely no quality of life, people who we had to feed and do everything for, even to turning them every couple of hours. They have been kept alive by Dr's and relatives making the decision to give them anti-biotics, when they couldn't protest that decision. Their prognosis was that they were elderly and would never recover any quality of life. I could never understand the reason behind not allowing them to quietly slip away. I used to get so angry for them and so did the other nurses who had to watch these people struggle with life day after day. I agree that people would rather hang on to someone sometimes than allow them to die with dignity.
I think where suicide is concerned I am glad there are people who will be there for someone to talk to and help get some of the emotional turmoil out in the open. That's all someone needs sometimes, to feel someone is there and everything isn't hopeless. Ultimately I don't think you can stop someone who is determined to comit suicide but I like to think that if it can be prevented and a decision not made when they are in a lot of emotional pain, to end their lives, then all the better.
Posted by: KazzaB | Wednesday, 18 February 2009
My aunt (and godmother) killed herself.
I have no issue with her decision, even though I dont know all the facts as I was a kid at the time. I dont need to know them.
Her life.
Her death.
She must have had her reasons.
I find it somewhat, well odd I suppose for want of a better word, that to me, I saw my families main concern was about how they could swing it that she was buried on consecrated land.
How odd indeed.
Posted by: Kahless | Wednesday, 18 February 2009
Tony,
I think you'll find that i found my view of suicide and selfishness from you. I don't think you can know how grateful i am to you. But that's ok too.
Your roses
Posted by: roses | Thursday, 19 February 2009
Kahless,
That sounds like what Tony has blogged about before. When traumatic things happen, we go back to what we usually do when things like that happen and it looks like they've gone back to making something they believe to be 'wrong' as 'right' as they possibly can.
Sounds religious - that's all.
But you've waken a thought inside of me. I say thing's like... 'so strange' and 'so weird' just as you have used the word 'odd'.
I use those words mostly - that i can remember - when its about something (an idea or belief from someone else) that has been (for want of a better word) planted in me that i now am in the process of rejecting as my thought. I've come to recognise it as 'their thought' in my head and i don't want it there anymore.
Me seeing this and saying it about me is not at all a suggestion that its what is going on in you. But you sparked something in me and i want to thank you for that.
I wonder if it would be better for me, rather than using my energy to pretend that those 'foreign ideas and beliefs' aren't in my head at all and instead recognise them for what they are and deal with them or learn to understand and see them as simply - other people's ideas and beliefs that can be found inside my head.
I'm sorry if none of this ramble makes sense but i needed to write it down now so i could come back to it and see what i thought at this time.
Thanks for that Kahless. I had not seen that about me before. The defensive anger that kind of slithers out rather than be rationally dealt with. What a waste of perfectly good energy! Bumma!
Posted by: roses | Thursday, 19 February 2009
I agree that for some people having young children could stop them from suicide. And it's not necessarily only out of guilt, it is also due to worrying what might happen to them without their parents there to take the best possible care of them. Even so, I can see how a person might love their children very much, but have trouble that is so deep and persistent that they just cannot keep living.
Posted by: Lynn | Thursday, 19 February 2009
Thank you Roses,
For your kind comment. It is appreciated
Tony
Posted by: Tony | Thursday, 19 February 2009
To KazzaB and others,
Perhaps I need to just clarify a bit.
If a person came to see me and was suicidal and they were 20 years old there is no way I would say to them that it was their choice. I would strongly suggesting that they seek some kind of counsel to turn the feelings around.
If a 55 year old saw me and has been battling with mind crushing depression and anxiety for the past 25 years and has done every concievable therapy known. Then I disagree with some who say, "There is always hope".
I would not tell the person to give up but if they were questioning that perhaps at some point treatment or therapy is of no more use or hope then I might facilitate them in going that path.
Thanks for the comments the have been most useful to me
Tony
Posted by: Tony | Thursday, 19 February 2009
Tony,
I also understand that i don't fully understand your view on anything and i'm willing to assume that you don't understand me either. I had never really thought of this stuff in any kind of clear or open way before i met you.
My view on suicide and selfishness is merely what is reflected from what i've watched you think about in this short time of our relationship. I have no or very little experience in most life areas - but there are a few i guess.
You have helped me to not be afraid to think and speak openly about 'touchy subjects' and since then, i've been learning so much! Voluntary thought can be so fun.
Every now and again i remember to thank you for it. I'm glad you appreciate it - you don't have to, but that you choose to is lovely. Thank you...
Posted by: roses | Thursday, 19 February 2009
Well thank you again Roses,
I have certainly see you speak openly and speak your mind at times in the blogosphere!
If I have played a part in that then that is even better!
best wishes to you
Graffiti
Posted by: Tony | Thursday, 19 February 2009
Tony, this was a great blog entry... I find this to be really true with anorexia... i've had several clients who genuinely believed their families would be relieved if they were totally 'erased' and so they want to vanish.... angrily...
Posted by: Cheryl | Friday, 20 February 2009
That is an interesting point about anorexia you make Cheryl and is consistent evidence I suppose.
I went and had a look at your website and it looks great. I recall that young girl I knew 15 to 20 years ago, and then the young woman and now it seems you have become an active and competent psychotherapist engaged in some interesting approaches.
Great to hear from you and see what you are doing with your work life
Tony
Posted by: Tony | Friday, 20 February 2009
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