CHAPTER 21. SUICIDE
Suicide is the deliberate taking of one's own life.
On the average around 28,000 Americans kills themselves each year (Thio, 1988:275), but it can be as high as 100,000 in one year. It is the tenth leading cause of death in the United States, and the third leading cause among 15 to 25 year olds. Around 18 teenagers kill themselves everyday in America (Campbell 1989:704). It is even higher among people of old age, with males constituting about 90 percent of these. For every successful suicide, there are eight unsuccessful suicide attempts. In 1982 the suicide rate was 27 percent higher than the murder rate. Suicide rates are actually higher in many other western nations and Japan.
We have seen how the Puritans insisted that suicide resulted from individual free choice, this in spite of the doctrine of predestination, and that suicide remained a crime in Massachusetts until the late nineteenth century. The medicalization of suicide, while still largely moralistic in nature, was a definite improvement over strict puritanical moralism.
There are those who say that those who commit suicide are moral cowards. This, however, is nothing more than moralistic name calling.
Just how much politics is involved in medicine is illustrated by the case of Dr. Daniel Kavorkian of Michigan, who helped a number of people to commit suicide. In order to receive the doctor's help, these people had to be free of any congenital depression. Rather, their depression had to be the result of their deteriorating health situation. Dr. Kavorkian helped those who wished to commit suicide in a relatively painless manner and with dignity. Michigan had no law to punish those who assisted in suicide, but did so in response to Kavorkian's assisted suicides. (And this is in spite of the fact that as early as 1977 the Gallup polls (Thio 1988:288) were showing that a majority of Americans thought that suicide was justifiable when a person was faced with an incurable disease or continual pain.)
The fear that assisted suicide will lead to widespread euthanasia is an obvious exaggeration for political purposes and also more of a diversion from the determining topic of whose values will actually hold power in the state of Michigan. Those who believe in the religious model take the stance that the person who wants to commit suicide must not receive any help from the state, for to receive help from the state would call into question the supremacy of religious systems over the state. The state must acknowledge its secondary importance to religion.
There is definitely a role for heredity in suicidal behavior. Tsuang (1983, cited in Roy, 1990:51) found that first-degree relatives of psychiatric patients had a risk of suicide almost eight times greater than the risk in the relatives of normal controls. He also found that first-degree relatives of depressed patients were significantly more at risk of suicide than the relatives of either schizophrenic or manic patients. Schulsinger et al (1979, cited in Roy, 1990:54) in a study at the Psykologisk Institut in Denmark used the register of the 5,483 adoptions that occurred in greater Copenhagen between 1924 and 1947. The researchers found that 57 of these adoptees eventually committed suicide. Twelve of them had relatives who had committed suicide, compared to only 3 of the 269 biological relatives of the 57 adopted controls. None of the adopting relatives of either the suicide or control group had committed suicide.
True to the anti-biological bias of sociology, Thio (1988:276) says that one of the myths of suicide is that those who commit suicide are mentally ill. This, however, is a completely inadequate statement for, as we shall see, certain imbalances in neurotransmitters are involved in suicide. Campbell (1989:704) estimates that 90 percent of suicides involve mental or emotional disorders, including depression, alcoholism, drug dependency, and schizophrenia. In investigating the etiology of suicide, we start with the go aspect and then cover the stop aspect of the go-stop model.
Depressive disorders are found in the vast majority of those who commit suicide. In a study among the Lancaster Amish, Egeland and Sussex (1985, cited in Roy, 1990:51) found an association between affective disorders and suicide. There were, however, many families with high occurrences of affective disorder but without suicides. Korn, et. al. (1990:65) found that suicide risk was best predicted by depression, hopelessness and the number of life problems. Among the immediate precipitants of the act of suicide are physical illness (especially significant in elderly males), loss of a loved one, alcohol abuse (15 to 25 percent of suicides are alcoholics), and drug addiction (the rate of suicide among narcotic addicts is five times the average rate for the general population). Most significant of all triggering factors, however, is a feeling of overwhelming hopelessness (Restak, 1988:174).
Suicide is common among patients with convulsive disorders, such as epilepsy. The prevalence rate of suicidal individuals in the epileptic populations is 32.5/1,000. This is five times the prevalence rate of individuals attempting suicide in the general population. The fact that epileptic patients have a very high incidence of depressive illness and easy access to drugs such as anticonvulsants means that these people are especially prone to suicide (Lechtenberg, 1982:84-85).
Turning to the stop aspect of the go-stop model of chemical imbalance, Kety (1986) has suggested that the genetic factor in suicide is an inability to control impulsive behavior. This factor probably acts independently of psychiatric disorder. Affective disorder or environmental stress may set off the impulsive behavior, pushing the person to suicide.
The inability to control impulsive behavior may be due to diminished amounts of serotonin (Roy, 1990:54-55). Researchers have found an association between low levels of serotonin metabolite 5-hydroxy-indoleacetic acid (5-HIAA) in the lumbar cerebrospinal fluid (CSF) and violent suicidal death, by such means as hanging, drowning, shooting, gassing, or several deep cuts. Traskman et al (1981) reported significantly lower levels of the serotonin metabolite only among those patients who had made a violent suicide attempt. (This finding is supported by Banki et. al., 1983; reported in Roy, 1990:40-43.)
Some studies (Traskman et al., 1981) have also reported lower CSF levels of the dopamine metabolite homovanillic acid (HVA) among patients who have attempted suicide. But the reduction of CSF HVA was significantly greater among depressed suicide attempters. This may indicate that low CSF HVA levels are more related to depression than to suicide (Roy, 1990:43-46; backed up by Agren, 1983).
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