Sunday, October 21, 2012

Profiling approach for identification of potential suicidal behavior

Profiling approach for identification of potential suicidal behavior

(instead of "risk factors")

the same or similar way FBI profiles criminal behaviors

(Morally, in most religions, especially in the Abrahamic ones, it is considered a very serious violation: "you are the slave of God and He only can take your life from you, because it was Him, who granted it to you"; and also on the books in many jurisdictions, still.)

- history of previous suicidal attempts
- history of self-injurious behavior

- Externalised - Internalised Aggression Scale and Index: EA/IA = 1 (+ - 0.5)

- signs of anxiety and depression
- changes in overt behavior

- Socialisation styles: loner or family problems

- Personality styles and vulnerabilities

- "Real Life Problems": financial, family, others

References and Links

profiling - GS


Do we want just to improve the statistics to look better or do we want to address the problem "in-depth"? Or both? Of course both: one purpose does not exclude the other at all; it would be a "false dichotomy". But the statistics have to be truthful. They should be cleaned of "lies and damn lies" as much as possible, otherwise they mislead, which is dangerous epistemologically: the search for truthful and more or less "scientific" explanations has to be based on "clean" and adequately collected factual and data sets.

Seriously consider and explore the possibilities and advantages of Dance Therapy - GS

Saturday, October 20, 2012

Some preliminary conclusions on research into the "psychiatric epidemic" of suicide in the miltary 2000 - 2012

Some preliminary conclusions on research into the "psychiatric epidemic" of suicide in the military 2000 - 2012

The true picture, including the epidemiological one, in the area of suicides in the military and the true state of affairs in the military mental health field is not known to us yet. The deaths suspicious of suicide and the incidents of self-injurious behavior, as well as homicides and other relevant occurrences should be included into the statistics. The sophisticated data collection system needs to be established, socio - and psychometric instruments to be developed and used; theoretical models conceptualised and tested, etc. The riddle might not be solved to provide more or less satisfactory causal explanation for some time, if at all; in the end, all attempts at the explanation are just interpretational hypotheses, due to the specifics of the subject matter: suicide, and the mental health field. Regardless of all the possible hypothetical explanations (which do have to be developed and tested), the general sociotherapeutic sanation measures, including the changes in the military subculture, if needed, should be implemented and continuously improved and refined, with the aim of improving, making more healthy and humane and maximally consistent with the values and norms of larger, mainstream culture, the general emotional climate in military communities and units, and providing the range of various relevant services. This approach might be just as, if not more productive, than the specific "suicide prevention measures", which can continue to stay in place.

Military Psychiatry and Psychology Review

Military Psychiatry and Psychology Review

Suicidology Review: Durkheim, Typology of Suicides

Military Suicidology Review

Topics Review:

Unit Cohesion

Individual and Groups

Military Groups

Structure and Function of Hierarchies

Protective and destructive effects of groups | Typology of Suicides | Suicidal Behaviors as an Escape and Emotional and Social Protest

Protective and destructive effects of groups - GS

The sociological hypothesis of military suicides causation as a destructive effect of a military group (1): a conflict between an individual soldier and his group, his military unit; does not contradict the Durkheim hypothesis of protective effect of groups, as the authors try to prove, but confirms it as a more general paradigm. The authors of this interesting and valuable paper base their thinking on Durkheim's theory and try to disprove it in a particular case of suicides in the military "from within": by operating this theory's own postulates and general conceptual framework (a "paradigm"). This reminds a proverbial "fight with your own shadow". The whole Durkheim's typology of suicides and its value and utility, especially for clinical purposes, should be questioned. It is not used in practical clinical settings. It seems to me that the the simple division of suicides into psychotic and nonpsychotic might be introduced (whatever these terms mean). Suicides in the military are mostly nonpsychotic. They should be divided further, according to the relative preponderance of causative factors into:
- Situational:
caused mostly by external circumstances and as an escape from them.
- Emotional:
due to severe and continuous stresses of various kinds, when the capacity for psychological resilience is stretched to a limit, to a "breaking point". Suicide thus, paradoxically, saves the psyche's integrity, protects the"immortal soul" from its destruction by pain and demoralisation.
- As a form of a conscientious social (and/or political) protest
The latter two are interconnected and practically are the same, since they have both components.
The circumstances of various kinds are also almost always present. Therefore we can try to conceptualise various forms of suicidal behaviors as an Escape and as an Emotional and Social Protest.
Therapeutic intervention should be attempted in all three dimensions and geared specifically to them. For example, a soldier with suicidal thoughts, if they are in any way detected or suspected, might be helped with his/her bank loan, offered individual or family therapy for his/her personal and/or family problems and offered to attend an educational group if he/she does not agree with certain policies or attitudes; overtly or covertly, with the understanding that his/her disagreements or grievances will be heard and their input in resolution of the general issues like these will be appreciated.
The interventions should be attempted at earlier stages, when it did not come to suicidal thoughts yet, and should be of general, mass and routine nature. In other words this is an issue of general and preventive sanation of emotional climate in a military unit or community, including the attitudes, policies and relationships.
Due to centralised structure of military services, the TeleTherapy option with centrally managed referral, recordkeeping, sophisticated data collections and training and and research departments might be the most beneficial option.

References and Links


Individual and Groups

Military Groups

Structure and Function of Hierarchies


Typology of Suicides

Friday, October 19, 2012

The Vulnerability of Desire: Samson syndrome and other stories | Suicides in military history

The Vulnerability of Desire: Samson syndrome and other stories | Suicides in military history

Mark Atteberry (Author) 

Book Description

April 3, 2003

The story of Samson is the perfect vehicle to reveal the twelve tendencies that can bring down strong men: disregarding their boundaries, struggling with lust, ignoring good advice, overestimating their own cleverness, and others.
Written in a compassionate, funny, and practical style, The Samson Syndrome offers readers powerful ideas for making sure they use their greatest strengths to honor God in every situation.



Hadrian sexuality - GS

Shakespear sexuality - GS

Lincoln sexuality - GS

Reflections in a Golden Eye - GS

Stoicism on Desire - GS

Suicidal behaviors in military history: the claim to liberty and victory amidst defeat

Scholarly articles for Suicidal behaviors in military history

Search Results
  1. Largest Ever Study Of Suicide In The Military
    18 Jul 2009 – Historically, the suicide rate has been lower in the military than among ... for research to address, suicidal behavior is a complex phenomenon.
Comments: This is a very important and valuable sociological paper on the subject:

Suicide, Social Integration, and Masculinity in the US Military ...
Nevertheless, the history of suicide within Western military populations provides ..... Understanding suicidal behavior in the military: an evaluation of Joiner's ... 

"These increases in military suicide rates have been striking, even given the notorious difficulties in determining accurate statistics for military suicide. First, suicides among military personnel are frequently misclassified as deaths from accidents or undetermined causes; such classification errors may lead military suicide totals to be as much as 21% higher than reported (Carr, Hoge, Gardner, & Potter,2004, p. 233)."

"These increases in military suicide rates have led a number of experts and commentators to refer to military suicide as a “hidden epidemic” (Sklar,2007). The origins of this epidemic have proven difficult to detect."

"Investigators of military suicide have been cautious about attributing this putative epidemic to a single cause (Stewart, 2009)."

"Finally, the military’s “warrior culture” has been thought to discourage soldiers from speaking openly about their psychological and emotional fragility (Alvarez, 2009;Dinges & Mueller, 2009). This inhibits the ability of mental health practitioners to recognize suicidal individuals and hinders the healing process necessary to overcome suicidal ideation and post-traumatic stress disorder (PTSD) (Alvarez, 2009; Dinges & Mueller,2009). The lethality of all of these factors is significantly magnified by the ready access to firearms characteristic of military life (Mahon, Tobin, Cusack, Kelleher, & Malone, 2005; Martin,Ghahramanlou-Holloway, Lou, & Tucciarone, 2009)."

"Durkheim’s theory of the protective nature of social integration forms the foundation for what has become known as social capital theory..."

"Identity itself is rewritten through the “depersonalization and deindividuation in which the military, in the form of drills sergeants, must strip the individual of all previous self-definition” (Herbert, 1998, p. 9).

Comments: One of the important factors might be general rigidity of military subculture, code of conduct, discipline and training which place a significantly stringent demands on individual capacity for integrating this image and social role of "ideal (or idealised) soldier" with complexities, paradoxes, contradictions and general "harmoniously chaotic" nature of individual emotional life and deep instinctual drives, with individual "Animula Vagula Blandula"; and more so if it is covered by a mask of omnipotent strength and toughness. One of my clinical observations is that suicides occur more often in those, in whom you relatively suspect and expect it the least, because 1) when you suspect it, you do something to prevent it and 2) the more rigid and inflexible is the mask, designed to convey the sense of invulnerability and health, the more vulnerable and fragile is its carrier and the more chances are there for the "breaking point".

"Gender identity is central to the formation of social capital in the military. Even Stewart (1991, p. 89), whose study does not employ “gender” as a central analytic, describes the military as a “cult of masculinity”.  Melissa S.Herbert (1998, p. 7), in her study of female soldiers, notes that the masculine nature of military society has been so widely recognized that there is “little dispute” over the matter. She argues that the specificity of the military is that it is “structured along the lines of gender, not age, race, or physical fitness” (Herbert,1998,p.7). It is by emphasizing masculinity and rigidly separating the male from the female that the military creates social capital from a group of soldiers whose economic statuses, ethnicities, and ideologies might otherwise place them in conflict with one another (Herbert, 1998; Stewart, 1991). Masculine unity thus forms the “cementing principle” of military life (Harrison, 2003, p. 75)."

Comments: Generally speaking military mentality might be viewed as the expression of the need (and necessity) for masculine (male) control and domination. Hence the historical phenomenon of mass rapes (including the less frequent in recent times, but probably quite wide spread in the past occurrences of male rapes [as a substitute for killing]; turning the defeated male enemy into a woman, both symbolically and to a certain degree in a real sense; thus neutralising and neutering this enemy's threat to the conqueror's own masculinity). Thus for those who viewed gays as "women in male bodies" (and therefore as the potential objects of psychosexual domination and rape), the destruction and deprivation of this institutional notion and image constitute a blow to their own idealised self-image and a social role as dominant heterosexual male warriors and might lead towards unraveling of the deep intrapsychic conflict, especially if the elements of latent homosexuality are present.

"As Whitworth (2008,p.119) notes “recent studies in the USA indicate that between 43 and 60 percent of female enlisted personnel experience some form of physical or sexual harassment or violence”. This physical and sexual abuse attests to the exclusion of women within the military."

Comments: These statistics are truly shocking and feel almost inconceivable. Is it not an indication that something, at some level is deeply wrong with the subculture and prevailing attitudes, and the need for change is ripe?

 "As a result of their exclusion, women in the military may be more prone to externalize their frustration via homicide, rather than internalizing it (as do men) via suicide."

"Tapering the effect of masculine fatalism on suicidal behavior will thus entail addressing military culture directly."

Comments: Apparently, the maximal approximation of military subculture to the norms, values and attitudes of the mainstream culture of the great country would the most healthy, productive and promising approach.


Research Efforts Toward Reducing Suicide Behavior Among Military ...
File Format: PDF/Adobe Acrobat - Quick View
Reducing Suicide Behavior. Among Military Servicemembers and Veterans. U.S. Army Medical Research and Materiel Command. Military Operational Medicine ...

  1. [PDF]

    Strategic Direction for the Prevention of Suicidal Behavior
    File Format: PDF/Adobe Acrobat - Quick View
    Prevention's (CDC) work to prevent fatal and nonfatal suicidal behavior. ..... and active or retired military personnel.2 ... turation, and disconnection from history ...

Marcus Antonius and Cleopathra - GS


Thursday, October 18, 2012

Military Psychology Links

Military Psychology Links

 Gustave Le Bon was a French social psychologist whose seminal study, The Crowd: A Study of the Popular Mind (1896) led to the development of group psychology.
Crowd psychology - from Wikipedia

Sigmund Freud: Group Psychology and the Analysis of the Ego

"What, then, is a ‘group’? How does it acquire the capacity for exercising such a decisive influence over the mental life of the individual? And what is the nature of the mental change which it forces upon the individual?

Adorno - Freudian Theory and the Pattern of Fascist Propaganda

(Theodor Adorno reprised Freud's essay in 1951 with his Freudian Theory and the Pattern of Fascist Propaganda, and said that "It is not an overstatement if we say that Freud, though he was hardly interested in the political phase of the problem, clearly foresaw the rise and nature of fascist mass movements in purely psychological categories."[7]  ) - Social psychology - From Wikipedia

group psychology - GS

10 Rules That Govern Groups


Freud and the Institution of Psychoanalytic Knowledge - By Sarah Winter - Google Books

Freud all male institutions psychology - GS

Military Psychology - GS

  2. Military Psychology,Second Edition: Clinical and Operational Applications [Carrie H. Kennedy,Eric A. Zillmer] on *FREE* super saver shipping on ...
  3. › ... › Psychology & CounselingCached
    Janice H. Laurence, Ph.D., is Associate Professor of Adult & Organizational Development, Temple University, and editor of the journal Military Psychology.
  4. › MedicalPsychiatryGeneral
During wartime, the need for mental health professionals intensifies, and the role they play is increasingly important. This comprehensive professional reference ...

Saturday, October 13, 2012

Psychometric Assessment of Suicidal Risk: Suicidal Ideation Self-Report Scale

 Psychometric Assessment of Suicidal Risk


Suicidal Ideation Self-Report Scale 

0 - Disagree, not at all
1 - A little
2 - Definitely
3 - Strongly, very much

Overt Suicidal Ideation Items:
  • Others will be better off without me
  • Sometimes the death is the best solution for all problems
  • Sometimes you have to die to prove your point
  • To die is the sign of strength, not weakness
  • I have thoughts about killing myself almost every day
  • This life is not worth living
  • I have nothing to live for
  • I did try to kill myself in the past
  • There is no hope for me
  • They will be sorry when I die
  • They will learn that they were wrong when I die
  • I can prove them wrong only by killing myself
  • Death is the only way out
  • I think about death a lot
  • I think about killing myself almost every day
  • I do have a plan to kill myself
  • I want to kill myself and I know how to do it

Projected Suicidal Ideation Items:
  • When people are useless to others they do not deserve to live

Depression Items:
  • I feel sad, blue, down in the dumps all the time
  • I have problems with my sleep
  • I do not feel rested and refreshed in the morning after a night sleep
  • Some nights I wake up early in the morning and cannot go back to sleep
  • It is difficult for me to fall asleep
  • Lately I do not have much of an appetite and do not eat as much as I used to
  • Lately I feel increased need for food and I overeat
  • I feel tired all the time
  • I do not have much energy to do things
  • I do not enjoy sex as much as before
  • Nothing brings me joy
  • I do not really enjoy much of anything lately
  • I feel trapped
  • Sometimes I feel that I want to harm myself
  • Sometimes I feel that I want to harm others
  • I feel very angry almost every day
  • Others have to be punished for their wrong deeds and words
  • Sometimes I feel tense and tearful without a particular reason
  • Lately I am not able to remember things as easily as before
  • Sometimes it is difficult for me to keep track of things and to concentrate on work or tasks
  • Lately it is difficult for me to make decisions
  • I know that I am not worth much
  • Lately I feel very guilty about many different things I did in the past

Latent Psychoticism Items:
  • Sometimes I hear someone talking when no one is around me
  • I believe that someone wants to harm me
  • I have to be on my guard all the time
  • I have to watch my ass all the time
  • They will always try to harm you if you let them
  • Someone plays games with me

Risk Taking Items:
  • I do quite risky things lately
  • Lately I fight with others verbally or physically more than before
  • Lately I do things that harm or could harm me

Social Withdrawal and Isolation Items
  • I do not feel like talking much with anyone
  • I do not feel like seeing anyone much
  • I do not have any friends
  • I do not need any friends
  • My family does not understand me
  • I do not feel like seeing my family or my friends as much as before
  • I do not need anyone
  • I do not need any friends
  • People do not understand me
  • I do not fit in
  • If I cannot shape up I have to ship out

Substance Abuse Items:
  • Lately I drink alcohol more than usually
  • I do drugs more often than I should

Latent Homosexual Ideation Items:
  • Faggots and sissies are all around me
  • They want to turn me into a homosexual
  • I think that it is wrong to let gays to serve in the military
  • Men who have sex with men are like animals
  • Men who have sex with men will burn in hell
  • Male bodies do not interest or excite me at all
  • Female bodies do not interest or excite me at all
  • I hate gays
  • Gays are our main problem these days
  • If not for gays life would be much better everywhere
  • I believe that homosexuality is a sin
  • Gays ought to be killed
  • Gays belong in prisons
  • If I feel sexually excited by people of the same sex, it means that devil plays games with me

© Copyright 2012 Michael Novakhov, M.D. and NISBS

Review of existing instruments

Psychometric Assessment of Suicidal Risk - Google Search


  page 1 of 3

Scale of Suicidal Ideation
Original references:
Beck AT Kovacs M Weissman A. Assessment of suicidal intention: The scale of suicide ideation. J Consult Clin Psychology. 1979; 47: 343-352.
Beck AT Steer RA Rantieri WF. Scale for suicide ideation: Psychometric properties of a self-report version. J Clin Psychology. 1988; 44: 499-505.

The scale of suicidal ideation consists of 19 items, scored 0 to 2, which can be used to evaluate a patient's suicidal intentions. It can also be used to monitor a patient's response to interventions over time.

Item Response
1. Wish to live moderate to strong


2. Wish to die none


moderate to strong
3. Reasons for living/dying for living outweigh for dying

about equal

for dying outweigh for living
4. Desire to make active suicide attempt none


moderate to strong
5. Passive suicidal desire would take precautions to save life

would leave life/death to chance

would avoid steps necessary to save or maintain life
6. Duration of suicide ideation/wish brief fleeting periods

longer periods

continuous (chronic) or almost continuous
7. Frequency of suicide ideation rare occasional


persistent or continuous
8. Attitude toward ideation/wish rejecting

ambivalent indifferent


go to page 2
obtained from

  page 2 of 3
Scale of Suicidal Ideation

Item Response
9. Control over suicidal action/acting-out wish has sense of control

unsure of control

has no sense of control
10. Deterrents to active attempt would not attempt because of a deterrent

some concern about deterrents

minimal or no concern about deterrents
11. Reason for contemplated attempt to manipulate the environment; get attention or revenge

combination of desire to manipulate and to escape

escape surcease solve problems
12. Method: specificity or planning of contemplated attempt not considered

considered but details not worked out

details worked out and well-formulated
13. Method: availability or opportunity for contemplated attempt method not available or no opportunity

method would take time or effort; opportunity not readily available

method and opportunity available

future opportunity or availability of method anticipated
14. Sense of "capability" to carry out attempt no courage too weak afraid incompetent

unsure of courage or competence

sure of competence courage
15. Expectancy/anticipation of actual attempt no

uncertain not sure

16. Actual preparation for contemplated attempt none



obtained from

  page 3 of 3
Scale of Suicidal Ideation

Item Response
17. Suicide note none

started but not completed; only thought about

18. Final acts in anticipation of death none

thought about or made some arrangements

made definite plans or completed arrangements
19. Deception or concealment of contemplated suicide revealed ideas openly

Scoring:The total score for the 19 items is calculated.
Minimum score = 0
Maximum score = 38
Higher scores indicate greater suicidal ideation

obtained from 


Sunday, October 7, 2012

Suicidology - Links List

Suicidology - Links List

suicide epidemiology

suicidal signs

psychometric assessment of suicidal risk - Google Search

suicide research - GS

Military Suicide Research Consortium


Sexual orientation and suicide
The likelihood of suicide attempts are increased in both gay males and lesbians, as well as bisexuals of both sexes when compared to their heterosexual counterparts.[19][20][21] The trend of having a higher incident rate among females is no exception with lesbians or bisexual females and when compared with homosexual males, lesbians are more likely to attempt than gay or bisexual males.[22]
Studies vary with just how increased the risk is compared to heterosexuals with a low of 0.8-1.1 times more likely for females[23] and 1.5-2.5 times more likely for males.[24][25] The highs reach 4.6 more likely in females[26] and 14.6 more likely in males.[27] 


Historical trends
Historical data show lower suicide rates during periods of war.[45][46][47]


suicide epidemic - Google Search


military suicide epidemilogy


Military Psychiatry - Google Search

military psychiatrist - Google Search



The War Within: Preventing Suicide in the U.S. Military
File Format: PDF/Adobe Acrobat
by P SAFETY - Related articles
Review the current evidence detailing suicide epidemiology in the military. • Identify “best-practice” suicide-prevention programs. • Describe and catalog ...

military suicidology

The John Snow Handle

 psychiatric epidemiology

exponential fashion


Suicide as epiphenomenon 



Recognizing the Warning Signs of Suicide


SUICIDE WARNING -- Depression carries a high risk of suicide. Anybody who expresses suicidal thoughts or intentions should be taken very seriously. Do not hesitate to call your local suicide hotline immediately. Call 800-SUICIDE (800-784-2433) or 800-273-TALK (800-273-8255) or the deaf hotline at 800-799-4889.
The best way to minimize the risk of suicide is to know the risk factors and to recognize the warning signs of suicide. Take these signs seriously. Know how to respond to them. It could save someone's life.

How Prevalent Is Suicide?

Suicide is a potentially preventable public health problem. In 2009, the last year for which statistics are available, suicide was the 10th leading cause of death in the U.S. That year, there were nearly 37,000 suicides, and 1 million people attempted suicide, according to the Centers for Disease Control.
Men take their lives nearly four times the rate of women, accounting for 79% of suicides in the U.S.

Are There Risk Factors for Suicide?

Risk factors for suicide vary by age, gender, and ethnic group. And risk factors often occur in combinations.
Over 90% of people who die by suicide have clinical depression or another diagnosable mental disorder. Many times, people who die by suicide have a substance abuse problem. Often they have that problem in combination with other mental disorders.
Adverse or traumatic life events in combination with other risk factors, such as clinical depression, may lead to suicide. But suicide and suicidal behavior are never normal responses to stress.
Other risk factors for suicide include:
  • One or more prior suicide attempts
  • Family history of mental disorder or substance abuse
  • Family history of suicide
  • Family violence
  • Physical or sexual abuse
  • Keeping firearms in the home
  • Chronic physical illness, including chronic pain
  • Incarceration
  • Exposure to the suicidal behavior of others

Are There Warning Signs of Suicide?

Warning signs that someone may be thinking about or planning to commit suicide include:
  • Always talking or thinking about death
  • Clinical depression -- deep sadness, loss of interest, trouble sleeping and eating -- that gets worse
  • Having a "death wish," tempting fate by taking risks that could lead to death, such as driving fast or running red lights
  • Losing interest in things one used to care about
  • Making comments about being hopeless, helpless, or worthless
  • Putting affairs in order, tying up loose ends, changing a will
  • Saying things like "it would be better if I wasn't here" or "I want out"
  • Sudden, unexpected switch from being very sad to being very calm or appearing to be happy
  • Talking about suicide or killing one's self
  • Visiting or calling people to say goodbye
Be especially concerned if a person is exhibiting any of these warning signs and has attempted suicide in the past. According to the American Foundation for Suicide Prevention, between 20% and 50% of people who commit suicide have had a previous attempt.

 American Foundation for Suicide Prevention 



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Youth Suicide
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Suicide Prevention
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Alexander, Paul. Rough magic: A biography of Sylvia Plath. New York: Penguin Group, 1991.
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Hoch, Paul H. and Zubin, Joseph. Depression. New York: Grune & Stratton, 1954.
Klerman, Gerald L., Weissman, Myrna M., Rounsaville, Bruce J., and Chevron, Eve S. Interpersonal psychotherapy of depression. Basic Books, 1984.
Lesser, Rika. All we need of hell: Poems. Texas: University of North Texas Press, 1995.
McIntosh, John L., Santos, John F., Hubbard, Richard W., and Overholser, James C. Elder suicide: Research, theory and treatment. Washington, D.C.: American Psychiatric Association, 1994.
Mufson, Laura, Moreau, Donna, Weissman, Myrna M., and Klerman, Gerald L. Interpersonal psychotherapy for depressed adolescents. Guilford Press, 1995.
Papolos, Demitri and Papolos, Janice. Overcoming depression. New York: Harper & Row, 1987.
Roy, Alec (Ed.). Suicide. Williams & Wilkins, 1986.
Shneidman, Edwin S., Farberow, Norman L. and Litman, Robert E.The Psychology of Suicide. New York: Science House, 1970.
Slaby, Andrew and Garfinkel, Lili F. No one saw my pain: Why teens kill themselves. W.W. Norton & Company, 1994.
Styron, William. Darkness visible: A memoir of madness.New York: Random House, 1990.

Other Topics
Alexander, Paul. Rough magic: A biography of Sylvia Plath. New York: Penguin Books, 1991.

Canetto, Silvia. Women and suicidal behavior. Springer Publications, 1994.
Hendin, Herbert. Seduced by death: Doctors, patients, and the Dutch cure. New York: W.W. Norton, 1996.
Jamison, Kay. Touched with fire: Manic-depressive illness and the artistic temperament. New York: The Free Press, 1993.
McIntosh, John. Elder suicide: Research, theory, and treatment. American Psychological Assoc., 1994.
Pfeffer, Cynthia. The suicidal child. New York: Guilford Publications, 1986.
Rosenberg, Mark and Mary Ann Fenly (Eds.) Violence in America: A public health approach. New York: Oxford Press, 1991.
Styron, William. Darkness visible. New York: Random House, 1990.


The latest data available from the Centers for Disease Control and Prevention indicates that 38,364 suicide deaths were reported in the U.S. in 2010. This latest rise places suicide again as the 10th leading cause of death in the U.S. Nationally, the suicide rate increased 3.9 percent over 2009 to equal approximately 12.4 suicides per 100,000 people. The rate of suicide has been increasing since 2000. This is the highest rate of suicide in 15 years.


  • Psychiatric Disorders
    At least 90 percent of people who kill themselves have a diagnosable and treatable psychiatric illnesses -- such as major depression, bipolar depression, or some other depressive illness, including:
    Alcohol or drug abuse, particularly when combined with depression
    Posttraumatic Stress Disorder, or some other anxiety disorder
    Bulimia or anorexia nervosa
    Personality disorders especially borderline or antisocial
  • Past History of Attempted Suicide
    Between 20 and 50 percent of people who kill themselves had previously attempted suicide. Those who have made serious suicide attempts are at a much higher risk for actually taking their lives.
  • Genetic Predisposition
    Family history of suicide, suicide attempts, depression or other psychiatric illness.
  • Neurotransmitters
    A clear relationship has been demonstrated between low concentrations of the serotonin metabolite 5-hydroxyindoleactic acid (5-HIAA) in cerebrospinal fluid and an increased incidence of attempted and completed suicide in psychiatric patients.
  • Impulsivity
    Impulsive individuals are more apt to act on suicidal impulses.
  • Demographics
    Males are three to five times more likely to die by suicide than females.
    Age: Elderly Caucasian males have the highest suicide rates.
Suicide Crisis
A suicide crisis is a time-limited occurrence signaling immediate danger of suicide. Suicide risk, by contrast, is a broader term that includes the above factors such as age and sex, psychiatric diagnosis, past suicide attempts, and traits like impulsivity. The signs of crisis are:
  • Precipitating Event
    A recent event that is particularly distressing such as loss of loved one or career failure. Sometimes the individuals own behavior precipitates the event: for example, a man's abusive behavior while drinking causes his wife to leave him.
  • Intense Affective State in Addition to Depression
    Desperation (anguish plus urgency regarding need for relief), rage, psychic pain or inner tension, anxiety, guilt, hopelessness, acute sense of abandonment.
  • Changes in Behavior
    suggesting the individual is close to suicide. Such speech may be indirect. Be alert to such statements as, "My family would be better off without me." Sometimes those contemplating suicide talk as if they are saying goodbye or going away.
    Actions ranging from buying a gun to suddenly putting one's affairs in order.
    Deterioration in functioning at work or socially, increasing use of alcohol, other self-destructive behavior, loss of control, rage explosions.

Warning Signs of Suicide

Suicide can be prevented. While some suicides occur without any outward warning, most people who are suicidal do give warnings. Prevent the suicide of loved ones by learning to recognize the signs of someone at risk, taking those signs seriously and knowing how to respond to them.

Warning signs of suicide include:
  • Observable signs of serious depression:
    Unrelenting low mood
    Anxiety, psychic pain and inner tension
    Sleep problems
  • Increased alcohol and/or other drug use
  • Recent impulsiveness and taking unnecessary risks
  • Threatening suicide or expressing a strong wish to die
  • Making a plan:
    Giving away prized possessions
    Sudden or impulsive purchase of a firearm
    Obtaining other means of killing oneself such as poisons or medications
  • Unexpected rage or anger
The emotional crises that usually precede suicide are often recognizable and treatable. Although most depressed people are not suicidal, most suicidal people are depressed. Serious depression can be manifested in obvious sadness, but often it is rather expressed as a loss of pleasure or withdrawal from activities that had been enjoyable. One can help prevent suicide through early recognition and treatment of depression and other psychiatric illnesses.


When You Fear Someone May Take Their Life 

Most suicidal individuals give some warning of their intentions. The most effective way to prevent a friend or loved one from taking his or her life is to recognize the factors that put people at risk for suicide, take warning signs seriously and know how to respond.

Know the Facts

More than 90 percent of people who kill themselves are suffering from one or more psychiatric disorders, in particular:
  • Major depression (especially when combined with alcohol and/or drug abuse)
  • Bipolar depression
  • Alcohol abuse and dependence
  • Drug abuse and dependence
  • Schizophrenia
  • Post Traumatic Stress Disorder (PTSD)
  • Eating disorders
  • Personality disorders
Depression and the other mental disorders that may lead to suicide are -- in most cases -- both recognizable and treatable. Remember, depression can be lethal.
The core symptoms of major depression are a "down" or depressed mood most of the day or a loss of interest or pleasure in activities that were previously enjoyed for at least two weeks, as well as:
  • Changes in sleeping patterns
  • Change in appetite or weight
  • Intense anxiety, agitation, restlessness or being slowed down
  • Fatigue or loss of energy
  • Decreased concentration, indecisiveness or poorer memory
  • Feelings of hopelessness, worthlessness, self-reproach or excessive or inappropriate guilt
  • Recurrent thoughts of death or suicide
Between 25 and 50 percent of people who kill themselves had previously attempted suicide. Those who have made suicide attempts are at higher risk for actually taking their own lives.
Availability of means
  • In the presence of depression and other risk factors, ready access to guns and other weapons, medications or other methods of self-harm increases suicide risk.

Recognize the Imminent Dangers

The signs that most directly warn of suicide include:
  • Threatening to hurt or kill oneself
  • Looking for ways to kill oneself (weapons, pills or other means)
  • Talking or writing about death, dying or suicide
  • Has made plans or preparations for a potentially serious attempt
Other warning signs include expressions or other indications of certain intense feelings in addition to depression, in particular:
  • Insomnia
  • Intense anxiety, usually exhibited as psychic pain or internal tension, as well as panic attacks
  • Feeling desperate or trapped -- like there's no way out
  • Feeling hopeless
  • Feeling there's no reason or purpose to live
  • Rage or anger
Certain behaviors can also serve as warning signs, particularly when they are not characteristic of the person's normal behavior. These include:
  • Acting reckless or engaging in risky activities
  • Engaging in violent or self-destructive behavior
  • Increasing alcohol or drug use
  • Withdrawing from friends or family

Take it Seriously

  • Fifty to 75 percent of all suicides give some warning of their intentions to a friend or family member.
  • Imminent signs must be taken seriously.