Model for Interpreting Suicidal Behaviour - Essay Example

Framework /Model for Interpreting Suicidal Behaviour Introduction Suicide is one of the most alarming consequences of mental health problems and disorders. It is an issue which speaks of deeply rooted emotional problems and coping inabilities which consequently manifest in the form of self-destructive behaviour. Unfortunately, for some self-destructive individuals, the consequences are sometimes fatal. The current rates for suicide according to the World Health Organization sets forth that on an annual scale, about one million die from suicide; we actually have a global mortality rate of 16 deaths per 100,000, or one death every 40 seconds (WHO, 2009). The World Health Organization (2009) also sets forth that for the last 45 years, worldwide suicide rates have increased by 60%; suicide is one of the leading causes of death in the 15-44 age-range in some countries; and it is the second leading cause of death in the 10-24 age group (WHO, 2009). Suicide attempts have also increased to 20 times in frequency. Moreover, the rates of suicide among the young people have also increased and have garnered much attention for being the most at-risk age group in both developed and in developing countries (WHO, 2009). In Europe and much of North America, mental disorders like depression and alcohol use disorders are the most common causes of suicide. In the UK, from 1991 to 2008, suicide rates in people aged 15 years and above decreased; a sharp increase was however seen in 2008 (Office of National Statistics, 2010). All over the world and in the UK, suicides are more prevalent among males than females with numbers peaking in 2007 and 2008 for both genders. Considering the above scenario of this health problem and risk, this paper shall now critically appraise a framework for interpreting suicidal behaviour and to understand it usage within a particular context. This paper shall compare and contrast this framework with other frameworks or models; identity advantages/disadvantages and strengths/weaknesses of the chosen framework. This paper shall use different journals, books, and scholarly articles in order to arrive at a comprehensive and reliable evaluation of the subject matter. This paper is being conducted in the hope of understanding suicidal behaviour as a multifaceted phenomenon. Through this paper a more academic and evidence-based understanding of suicide is hoped. Discussion The Social or Sociological Theories/Framework (Durkheim theory) The social theory or framework is one of the most popular theories or frameworks being used to interpret suicidal behaviour. A focus on Durkheim’s social theory shall be made for this study. Durkheim basically sets forth that “the societal suicide rate as determined by a society’s level of societal integration (that is the degree to which the people are bound together in social networks) and the level of social regulation (that is, the degree to which individual’s desires and emotions are regulated by societal norms and customs)” (Lester, 2001, p. 10). This theory also considers such other factors like birth rates, female participation in the labour force, divorce, and immigration in order to interpret suicidal behaviour. In some instances, these factors impact on a person’s coping ability and may consequently lead to suicidal behaviour. Durkheim also identified four types of suicide which are enumerated as follows: egoistic, anomic, altruistic, and fatalistic (James, 2008). An egoistic suicide is described by Durkheim as one which is related to a lack of integration or identification with a group (James, 2008). An anomic suicide is one which is said to be caused by the breakdown of norms in society, as in the Great Depression (James, 2008). An altruistic suicide is one which is mostly caused by the perceived solidarity such as the Hara Kiri and the episodes of suicide attacks (James, 2008). In a fatalistic suicide, a person “sees no way out of an intolerable or oppressive situation, such as being confined in a concentration camp” (James, 2008, p. 183). Durkheim also emphasized two elements which ultimately contributed to suicidal behaviour. These are: social integration and social regulation. In cases where the social integration was high, altruistic suicide often resulted; and when the social regulation was high, fatalistic suicide resulted (Joiner & Rudd, 2000). Where social integration was low, egoistic suicide often resulted; and in cases of low social regulation, anomic suicide was seen (Joiner & Rudd, 2000). These factors when taken in together help explain probable causes and explanations for suicidal behaviour. Durkheim further explains that some social structures are favourable to suicide. The situation which exists within the structure often induces and creates an environment which, in some ways, nourishes mental and emotional needs which may later lead to suicide. “Elite military groups, cults, and deeply committed religious groups often exhibit high suicide rates” (Hamilton, 1990, p. 201). In effect, the Hindu wife who commits suicide after the death of her husband is likened to members of the People’s Temple of Guyana who committed suicide after the urging of their leader (Hamilton, 1990). In other words, the suicide was committed because it is a behaviour which has already become part of the person’s world or something which has now been viewed as a reasonable request (Hamilton, 1990). Other instances throughout history help illustrate how social integration, social structure, and social change can be in a person’s suicidal behaviour. Hamilton cites the case of Buddhist monks who immolated themselves in Saigon in order to protest the Vietnam War; and the Masada people who killed themselves in order to preserve their religious beliefs (Hamilton, 1990). Durkheim displays the opposite motivation for suicide in the egoistic type. In this type, Durkheim explains how people prone to commit suicide are isolated and unaffected by the social structure. They tend to be narcissistic and self-oriented and they are uncaring for the social implications of suicide, the laws, and the religious restrictions against this practice, and so during times of stress, they feel no moral, social, or legal restrictions against suicide (Hamilton, 1990). The implication is that “the suicidal impulse is universal, or nearly so, when the individual experiences stress. What prevents suicide is adherence of the individual to social norms identifying suicide is wrong” (Hamilton, 1990, p. 202). Some studies claim that high suicide rates seen among the divorced, the mentally ill and those who belong to the deviant population are actually identified as egoistic suicides (Hamilton, 1990). Durkheim goes on to describe what happens in anomic suicides and he points out that the term translates to ‘without a name’ (Hamilton, 1990). This may be understood as an abrupt loss of role, an abrupt change, and the panic that people sometimes feel while adjusting to these changes. A case assessed by Hamilton (1990) sets forth how a former POW had trouble returning and readjusting to his former ‘normal’ life. He was suspicious of the faintest sound or of the events going on in his neighbourhood. His neighbours and his family were unable to recognize his anxiety and his depressive symptoms and to lend him support later brought forth fatal consequences for the POW who committed suicide (Hamilton, 1990). Through the above discussions and analysis by Durkheim, we understand how social factors and elements affect a person’s psyche and coping ability and eventually how such factors can later lead to the fatal consequences of suicide. Compare/contrast with other frameworks/models The physiological, psychological, and composition frameworks are other models which are also used in order to interpret suicidal behaviour (Lester, 2001). The physiological model focuses on the biological processes which may affect a person’s behaviour. Physiological processes may include inherited psychiatric diseases; brain concentrations of serotonin, which is the neurotransmitter affecting manifestation of depression; and certain blood interactions may also contribute to the interpretation of suicidal behaviour (Lester, 2001). Studies from about 8 nations indicated that in countries or areas with lower levels of Type O blood and higher levels of Type AB blood, people were likely to experience higher prevalence rates of suicide (Lester, 2001). In comparing this theory with Durkheim’s sociological theory, the physiological theory uses a more scientific and biological approach to explaining suicidal behaviour. A paper by Maris (2002) focuses on the physiological process involved in the possible manifestation of depression which may later lead to suicide among sufferers. And he gives a lengthy discussion of how patients who commit suicide manifest with lower levels of serotonin; he also explains how these patients have fewer serotonin transporter sites and how these patterns in the neurotransmitter processes are those seen in excessive stress responses leading to norepinephrine depletion (Maris, 2002). In relation to the composition theories, the basis of suicidal behaviour is mostly an assessment of proportion of the population. The simplest explanation for seemingly increased rates of suicidal behaviour may lie in the fact that the population is composed of say the elderly population which, in most instances and in most nations, often have higher levels of suicides (Lester, 2001). In comparing this theory with the social theory, the composition theory is even less scientifically based because it does not study patterns of behaviour based on evidence. The psychological theory attempts to interpret suicidal behaviour in terms of prevalence rates of other psychological or mental health disorders like depression, neuroticism, anxiety and emotional instability (Lester, 2001). Various studies also emphasize how “psychiatric disorders of any kind appear to increase the risk of suicide, with affective disorders and substance abuse leading the list” (Lester, 2001, p. 11). It is also important to note that alcohol abuse and drug abuse are behaviours which have a strong correlation to suicidal behaviour. These are behaviours which are actually already self-destructive behaviours in themselves, but they are also factors which are often present in instances of attempted and completed instances of suicides (Lester, 2001). Identify advantages and disadvantages and/or strengths and weaknesses of the selected framework The social or sociological theory has various advantages and disadvantages or strengths and weaknesses and these strengths or weaknesses often affect the appropriateness of application of the theory in explaining suicidal behaviour. First, in discussing the strengths or advantages of the Durkheim’s framework, it is important to point out that Durkheim is one of the first theorists and social scientists who evaluated suicide – its causes and its patterns. His work is important because “he examined suicide from social and societal perspectives rather than religious or psychological one” (Holmes & Holmes, 2005, p. 27). When Durkheim’s theory came out, it was a period when suicide was viewed as a religious offence which many theorists also assessed in terms of a person’s inability to cope with mental health and coping problems. The relationship and interaction with the environment and with the society are taken into consideration in the social theory (Holmes & Holmes, 2005). The social elements are assessed as contributory to the overall mental and emotional well-being of the patient. A person is then understood in terms of his environment and in terms of the people that surround him, not just in terms of his neurosis, anxiety, feelings, and lack of faith. The social theory was, at the time of its introduction, a fresh outlook on suicidal behaviour. It was strong in proposing the importance of evaluating a person’s behaviour in terms of a larger and less isolated concept. Durkheim strongly pointed out that men who committed suicides have a high degree of sorrow and disappointments in their life, “but we have seen that these individual peculiarities could not explain the social suicide rate; for the latter varies in considerable proportions, whereas the different combinations of circumstances which constitute the immediate antecedents of individual cases of suicide retain approximately the same frequency” (Maris, Berman, Silverman & Bongar, 2000, p. 242). Durkheim also accurately pointed out that the collective reasons for suicidal incidents may not actually reflect the individual reasons for suicidal behaviour. Through this analysis, Durkheim took on a more holistic assessment of suicidal behaviour – one which did not depend too much on what may be prevalent in society. Durkheim’s theory however is rife with various disadvantages and weaknesses as discussed by other authors and theorists. Some critics point out that no definite studies have been taken on the statements as set forth by Durkheim on the effect of the social phenomenon on suicidal behaviour. Hawton (2005, p. 47) points out that “to date, no studies in this area have identified whether these associations are due to high concentrations of at-risk individuals living in particular areas (compositional effects) or in accordance with Durkheim’s hypothesis – discrete area (contextual) influences on suicide”. No definite distinctions have so far been made; and this lessens the credibility and appropriateness of Durkheim’s theory explaining suicidal behaviour. Theorist Gibbs has also taken issue with Durkheim’s theory claiming that the latter’s theory on social integration was not operationally defined and therefore could not be tested (as cited by Maris, Berman, Silverman, and Bongar, 2000). Gibbs was insistent on the use of his empirical theory in explaining suicide. In his book (co-authored with Martin) he claims that “properly done empirical tests will demonstrate that suicide rates are negatively related to status integration” (Maris, Berman, Silverman, & Bongar, 2000, p. 245). Gibbs rejection of Durkheim’s theory is however more based on his insistence of his theory, not on a point by point refutation of Durkheim’s theory. Lester (as cited by Joiner & Rudd, 2000) sets forth detailed points to refute Durkheim’s theory. Firstly, he also points out that Durkheim’s theory has never actually been tested, and that societies can differ in their regulation and integration and may not follow similar patterns of behaviour contributing to suicide. Secondly, Durkheim’s theory, like other sociological theories, tends to gain the status of religion. “When social science becomes a religion, the classic books as written become similar to the “Bible,” and anyone who modifies the theory is viewed as a heretic” (Lester, as cited by Joiner & Rudd, 2000, p. 10). This is not an encouraging process because it interferes with scientific progression in studies. Although Durkheim’s theory seems to portray sound principles and discussions which adequately explain suicidal behaviour, its ideas indeed have not been tested thoroughly in a more scientific set-up. Suicide is best understood not with the use of a single phenomenon or approach. “It cannot be clinically understood or prevented without careful individual psychological study of the particular person’s suffering” (Simon, Hales & American Psychiatric Association, 2006, p. 108). It cannot also be assumed that suicide is a natural consequence of depression; many individuals who suffer from depression often come out of it and not end up committing suicide. The assessment of suicide as a multifaceted phenomenon was further explained in a paper by Butler, Novy, Kagan, and Gates (1994) when they attempted to evaluate suicidal behaviour among the youth. The authors noted that suicide rates have increased and have manifested among the younger age group regardless of their income and self-esteem levels. The authors noted various factors like socioeconomic status, geographic region, psychological emotional factors like depression, anger, anxiety, hopelessness, and the interaction of these variables as crucial elements in evaluating suicidal behaviour (Butler, Novy, Kagan & Gates, 1994). Cognitive factors, peer group activity, and accumulated stressors have also been considered as important variables in the analysis of suicidal behaviour. All these factors when taken together and when triggered by a traumatic or emotionally affective event may, in some instances, lead to suicidal behaviour. Conclusion Suicide is one of the most alarming consequences of mental health and emotional problems. Its prevalence rates around the world have also increased and have registered with alarming figures. Different explanations for suicidal behaviour have been proposed and these theories have all managed to confine and define suicidal ideation and behaviour in terms of the various factors and elements present in a person’s life. Durkheim’s theory explains how suicidal behaviour can be explained in terms of society’s level of integration and social regulation -- and how a deficiency or excess of such elements may trigger suicidal behaviour. Durkheim’s theory has been considered a welcome alternative from the psychological explanation of suicidal behaviour. His theory however has not been thoroughly and scientifically tested and therefore cannot be fully adapted as a theory for explaining social behaviour. Other theories, like the physiological theories, the psychological, and the composition theories are alternate frameworks for suicidal behaviour which portray viable explanations for suicidal behaviour. And these theories all present different angles or viewpoints on suicidal behaviour which lead most theorists and scientists to accept the fact that in order to understand suicidal behaviour, a multi-faceted approach to suicide has to be applied. The evaluation of suicidal behaviour must be taken into context -- on a personal, environmental, cognitive, social, and cultural arena. Works Cited Butler, J., Novy, D., Kagan, N. & Gates, G. (1994) An Investigation of Differences in Attitudes between Suicidal and Nonsuicidal Student Ideators. Adolescence, volume 29, number 115, pp. 1-12. Hamilton, P. (1990) Emile Durkheim: critical assessments, Volume 2. London: Routledge Publishing Hawton, K. (2005) Prevention and treatment of suicidal behaviour: from science to practice. Oxford: Oxford University Press Holmes, R. & Holmes, S. (2005) Suicide: theory, practice, and investigation. London: Sage Publications James, R. (2008) Crisis intervention strategies. California: Thomson Higher Education Joiner, T. & Rudd, D. (2000) Suicide science: expanding the boundaries. Massachusetts: Kluwer Academic Publishers Lester, D. (2001) Suicide Prevention: Resources for the Millennium. England: Routledge Publishing Maris, R. & American Association of Suicidology (1992) Assessment and prediction of suicide. New York: Guilford Press Maris, R. (2002) Suicide. The Lancet, volume 360, pp. 319-326 Maris, R., Berman, A., Silverman, M., Bongar, B. (2000) Comprehensive textbook of suicidology. New York: Guilford Press Simon, R., Hales, R., & American Psychological Association (2006) The American Psychiatric Publishing textbook of suicide assessment and Management.Virginia: American Psychiatric Publishing Suicides: UK suicides increase in 2008 (28 January 2010) Office for National Statistics, General Register Office for Scotland, Northern Ireland Statistics and Research Agency. Retrieved 04 April 2010 from http://www.statistics.gov.uk/cci/nugget.asp?id=1092 Suicide Prevention (SUPRE) (2009). World Health Organization. Retrieved 04 April 2010 from http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/ Read More