Any failure can be associated with the thought of death, and withdrawal from life - it seems to be a kind of attempt to solve the difficulties. But if increased importance is attributed to the situation, the opportunities realized by the person are insufficient and the person prefers to deprive himself of life as the only way out, then his behavior is assessed as suicidal.
Myths and reality of suicide
The seriousness and complexity of resolving a problem gives rise to myths and prejudices. Non-specialists have a simplified opinion regarding suicide, seek to explain it with mental disorders.
As studies show, suicidal individuals are absolutely healthy people who have fallen into acute traumatic situations. Among those discussing the possibility of death in their personal diaries are well-known, quite successful personalities: I. S. Turgenev and M. Gorky, Romain Rolland, Napoleon, John Stuart Mill, Thomas Mann, Anthony Trollop.
A person is faced with a depression of such magnitude that all the previous experience of life seems insufficient to get out of it. A crisis can occur suddenly, combining several types of different emotions. They provoke anxiety, followed by hopelessness. Belief in oneself is lost, strength disappears to overcome troubles. There is a feeling of loss of the meaning of life.
The basis of suicidal behavior is conflict, and its composition includes:
- objective requirements of the situation
- awareness of its significance by the subject,
- assessment of opportunities to overcome difficulties,
- real actions of the individual regarding the situation.
Denial of myths by reality:
- “Suicide occurs due to a deviation of the psyche from the norm”: in fact, about 85% of people who committed suicidal acts were healthy individuals.
- “Suicide cannot be prevented”: the crisis has a certain duration, and the need to commit suicide is temporary, the person who received support in a difficult period of life changes his mind.
- “There is a category of people prone to suicide”: in reality, individuals of various psychotypes commit suicide, the outcome depends on an individual assessment of the intolerance and severity of the situation.
- “There are no signs confirming the intention of suicide”: this is preceded by unusual behavior, which will attract the attention of people from the immediate environment of the suicidal individual.
- “A person declaring his desire to commit suicide will never do this”: many on the eve of the planned actions informed their relatives and colleagues about their intentions, but they did not attach any serious significance to this.
- "The decision to kill oneself comes suddenly": as analysis shows, suicidal actions are the result of prolonged trauma to the psyche, a crisis can last for weeks and months.
- “Suicide attempt is not repeated”: in fact, the risk of repeated action is very high, the highest probability - in the first couple of months.
- “Suicidal tendencies are inherited”: the statement is not proven, if there were cases of suicide in the close circle of a person, the likelihood of their committing by family members increases.
- "Education helps reduce suicide": studies have shown that reports of deaths activate suicide. In fact, it is necessary to talk about ways out of conflicts.
- "Alcohol reduces suicidal feelings": drinking alcohol has the opposite effect, as it increases anxiety, increases the significance of the conflict, which is why the likelihood of suicide is approaching.
Causes of Suicidal Behavior
The combination of external and internal factors provokes suicide attempts.
Prerequisites for suicidal behavior are:
- biological reasons: a decrease in the level of serotonin in the blood, a violation of the hypothalamic-pituitary axis,
- psychological reasons: low stress tolerance, egocentrism, dependence on the opinions of others, emotional lability, inability to fulfill the need for security, in love,
- medical factors: alcoholism, drug addiction, mental disorders, oncological pathologies, AIDS, somatic diseases with disability, fatal outcome.
Potential factors that increase the risk of suicide:
- religious factors: suicide in some cults is regarded as purification and sacrifice, in certain movements autocratic death is seen as a gesture of romanticism,
- family factors: children and adolescents from single-parent, asocial families, brought up in conditions of violence, humiliation, exclusion,
- the influence of society: a conflict atmosphere in communication with peers, problems of love relationships.
The immediate causes of suicide attempts are:
- stress: death of loved ones, accidental observation of suicide, rejection by a team, acquaintances, condition as a result of rape,
- the availability of suicide in a specific condition increases the risk of their use.
Types of Conflict
Conflicts underlying suicidal behavior can be classified:
- conflicts on the basis of professional activity and social interaction, including interpersonal conflicts, individual difficulties of an adaptive nature,
- regulated by the specifics of personal and family relationships (unrequited love, betrayal, divorce, illness or death of loved ones, sexual failure),
- in connection with antisocial behavior: fear of criminal liability, shame,
- due to health status: physical, mental illness, chronic illness,
- due to financial difficulties
- other varieties of conflict.
A suicidal situation is created by the interaction of conflicts of various kinds. The loss of life values is accompanied by an individual assessment, judgment, worldview. There is no personality structure specific to suicidal behavior.
The most vulnerable are individuals with psychopathic traits. In difficult conditions, against the backdrop of an age crisis, with the pointedness of certain qualities, a person comes to maladaptation.
Classification of suicidal behavior
Of the many classifications of suicidal behavior, attempts are related to goals and reasons.
There are three types of suicidal actions:
- True: carefully planned actions, which are preceded by the formation of appropriate statements, behavior, the decision is made on the basis of long thoughts about the meaning of life, purpose, futility of existence, signs of suicidal behavior dominate, other emotions and character traits remain in the shadow, and the goal of dying is achieved.
- Demonstrative: suicide attempts are reminiscent of theatrical action, can be a way of dialogue with loved ones. Signs of demonstrative suicidal behavior - that they are made with the expectation of "the viewer", and their goal is to attract attention, to be heard, to receive help. Death is possible due to poor prudence.
- Masked: suicidal behavior of minors involves indirect methods of suicide - extreme sports, high-speed transport, dangerous trips, the use of psychotropic substances, most often the real goal is not completely recognized.
A sign of adult suicidal behavior is inward anger. Heavy losses, poor state of affairs, lack of hope and options for help may indicate it. Another symptom is an all-consuming feeling of hopelessness, as well as, in fact, an attempt to escape from life.
Recognizing the signs of suicidal behavior, you can save a person’s life. Loss of energy, a constant feeling of boredom, fatigue, prolonged disturbances in sleep and appetite, nightmares with pictures of disasters, evil creatures, loss of life - all this is included in the list of common symptoms.
Other signs: increased self-criticism, severe guilt, insolvency, shame, fear, anxiety, insecurity, deliberate audacity, aggression. Depression manifests itself in the form of melancholy, as well as in insomnia, anxiety, resulting in "fatigue from life."
Signs of adult suicidal behavior:
- planning for a murder, voicing an intention to commit an act against himself or another person,
- the presence of a murder tool - a pistol and the like, access to it,
- loss of connection with reality (psychosis), auditory hallucinations,
- the use of psychotropic substances,
- talk about methods and objects of causing physical harm,
- strong desire to be alone
- giving away personal belongings
- aggression or inadequate calm.
Any statement regarding suicide must be taken seriously. Observing the signs of suicidal behavior, it is necessary to find out as soon as possible whether a person has weapons, medicines to carry out the planned actions, whether the time of this act is determined and whether there is an alternative to him, another way to alleviate the pain.
If you cannot help, you must report the threat to the police and the hospital. It is recommended that you attend with someone who needs support and ask others to trust to do so. It is necessary to convince a person that he needs professional supervision of specialists.
Signs of suicidal behavior in children and adolescents
Attempted suicide is preceded by isolation, depression. As for the signs of suicidal behavior in children, this is accompanied by a loss of interest in games, entertainment, food. They prefer loneliness, refuse friendly activities, activities that brought them pleasure, visits to kindergarten.
Depressive manifestations look like physical activity disorders: body pains, sleep disturbances, appetite, and digestion appear. In boys, irritability is more often observed, in girls - tearfulness, depression. Death can be perceived as a dream or a temporary phenomenon.
The suicidal behavior of a child is expressed in his drawings and invented stories. Children can talk about the advantages and disadvantages of one way or another way of leaving life. They can discuss the dangers of drugs, falling from a height, drowning, or suffocation. Moreover, the child has no interests in the present, plans for the future. There is lethargy, poor performance at school, insomnia, impaired appetite, and decreased body weight.
Among the signs of suicidal behavior in adolescents there are frank statements, phrases: "I do not want to live," "I want to die," "life is over." This obsession continues with the desire to watch movies or read books about committing suicide, to search for information on the Web. Any kind of work contains themes of death.
Other signs of suicidal behavior in adolescents:
- leaving home
- instability of emotions, aggressiveness, rudeness,
- indifference to their appearance,
- estrangement from relatives, friends, although relations can be stable, school attendance - regular,
- dangerous hobbies
- driving while intoxicated,
- demonstrative contradiction to others,
- hazardous behavior for health and life.
Dangerous symptoms include:
- past suicide attempts
- family suicide intentions
- the presence of depression, schizophrenia, bipolar disorder.
Identification of signs of suicidal behavior in children and adolescents is carried out by a psychiatrist, clinical psychologist. After the parents make complaints about the emotional state of the child - lethargy, depression - the doctor suggests the presence of depression and a tendency to suicide.
- conversation: the psychiatrist clarifies the time of manifestation and severity of symptoms, their duration,
- questionnaires, testing: a variety of techniques are used, including direct questions about thoughts and attempts at suicide (Eysenck's questionnaire "Self-assessment of mental states of personality"),
- projective methods: used for children of primary school age, adolescents who are not aware of suicidal tendencies (Luscher test, tests using drawings, "signal", the method of unfinished sentences).
As a result of a comprehensive examination of personality activity, signs of suicidal behavior in children are revealed, including hysteric, sensitive, excitable, accented, emotionally labile traits. The combination of depression, imbalance, impulsiveness is an indication of a significant risk of suicide attempts.
Complications of Suicidal Behavior
Suicidal behavior, which did not end with the death, is complicated by specific diseases. These are various injuries, cuts, severe injuries, injuries to the hands, feet, ribs, larynx, esophagus, impaired liver and kidney function.
After suicide attempts, such people need hospitalization, and injuries can lead to disability and restrictions, leaving a heavy psychological imprint on later life. There is a risk of social maladjustment.
Methods of suicide in different countries have a certain degree of prevalence:
- hanging: a leading method worldwide
- firearms: in the USA it is assigned 60% of the popularity, in Canada - 30%,
- poisoning: overdose of drugs, in the USA - makes up 18% of all suicides,
- Accident with a single victim: about 17%,
- farewell notes with the laying on of hands: 15-25%.
Tasks of a specialist, consultant
Crisis services relate to suicide in different ways. Some aim to find the location of the client and to prevent the killing. They can independently transfer customer information to medical and police services. In order to prevent juvenile suicidal behavior, a special professional approach is needed.
The tasks of the hotline consultant are as follows:
- recognize signs of suicidal thoughts and tendencies,
- assess the degree of danger of behavior,
- show delicate customer care.
The principles of conversation with the client:
- do not neglect suicidal remarks,
- express interest in the person and fate of the interlocutor,
- questions should be asked calmly and sincerely, actively listening,
- accurately find out the patient's ideas and plan of suicidal actions,
- find out if such thoughts were present in the past,
- find out the causes and conditions for the formation of suicidal thoughts,
- Encourage the interlocutor to express feelings in connection with the painful sphere.
Prohibited first aid measures:
- not to enter into direct confrontation with the client when he is declared about suicidal intentions,
- do not show your shock from what you hear,
- not enter into a discussion about the validity of the action,
- do not resort to argumentation, given the depressed state of the client,
- not guarantee what cannot be done (family assistance),
- do not judge, show sincerity,
- do not offer simplified schemes, like: "you just have to relax,"
- Do not focus on negative factors, try to consolidate optimistic trends.
The priority action in assisting a suicidal client is the ability to maintain a conversation with him as long as possible. In further work, you should allow the client to express himself, throw out feelings, promise to be useful in the conversation, help structure the origins of the problem in his mind, and lead to the idea that such situations are quite common.
Forecast and Prevention
The prognosis and prevention of suicidal behavior of adolescents have a positive trend with the integrated assistance of doctors, psychologists, and the participation of parents. The relapse rate approaches 50%, and repeated attempts are made only by individuals with mental illness who are members of dysfunctional families.
Confidence and a family-friendly atmosphere are important for coping with stress. If there are signs of suspicious behavior, you need to notify the psychologist, with significant deviations in behavior - the psychiatrist.
At the individual level, specialist assistance consists in promoting a positive attitude towards life and a negative attitude toward death, expanding ways to resolve conflict situations, effective methods of psychological defense, and increasing the level of socialization of a person.
Forms of expression of anti-suicidal personality factors:
- emotional affection for loved ones
- responsibilities of parents
- call of Duty,
- fear of causing bodily suffering
- an idea of the baseness of suicide,
- analysis of unused life opportunities.
Чем большее количество антисуицидальных факторов насчитывается, тем мощнее барьер в плане совершения самоубийства. Значимую роль играет полнота и своевременность выявления потенциальных намерений.
The severity and relevance of the problems of suicidal behavior requires specialists to understand the essence of the phenomenon, to master methods for its diagnosis and to organize preventive methods.
Mental and emotional symptoms.
Recognize the thinking patterns of potential suicides. If someone tells you that they are experiencing one or more of the symptoms described below, this is a cause for concern.
· The appearance of obsessive thoughts.
· The final loss of hope.
· Thoughts about the meaninglessness of life or the complete loss of control over it.
· The appearance of a sensation that the brain is “clouded” or the appearance of difficulties with concentration.
Recognize the emotional states of potential suicides.
· Sharp mood swings.
· Strong anger, rage, or a sense of revenge.
A strong sense of anxiety or irritation.
· A strong sense of guilt or shame (a person begins to feel that he has become a burden for other people).
A feeling of loneliness (even in the company of other people) and a feeling of shame or humiliation.
Recognize the speech turns (phrases or sentences) inherent in potential suicides. For example, if someone talks a lot about death, then this is a sign of such a person having suicidal intentions.
· “It is too late” or “I can’t take it anymore”
· “I don’t need to live”
· “I'm so tired / tired of life”
· “Nobody cares about me”
· “There is no way out”
· “They do not want to have anything to do with me”
· “I am standing on the edge of the abyss”
· "Everyone is only better without me"
· “I just want this pain to stop”
· “Nobody needs me / I need”
· "You do not understand!"
Do not be fooled by a sudden improvement in a person with suicidal thoughts.
· If you notice a person with the symptoms listed above, and then he suddenly turned from a depressed person to a cheerful person, this does not mean that he pulled himself together and returned to normal life.
· A sharp change in the direction of a seemingly happy state may indicate that a person has come to terms with the idea of suicide.
People planning suicide may try to complete all their earthly affairs before committing suicide. For example, they can do the following:
· Give property (that is, a person believes that he no longer needs material wealth).
· Saying goodbye. People who are about to commit suicide may suddenly say goodbye to others, it would seem, for no particular reason.
Watch for signs of reckless or dangerous behavior. Since potential suicides do not want to live, they can consciously put themselves at risk, for example, it is dangerous to drive a car. Here are some examples of this behavior:
· Overuse of drugs and alcohol.
· Dangerous driving, for example, at high speed or while intoxicated.
Unsafe sex, often with multiple partners.
Look for suicide tools like firearms or pills.
· If, for no apparent reason, a person has acquired a firearm or bought a new medicine, act immediately, as he can commit suicide at any time.
Do not allow a person to fall into a situation of social isolation (a situation where a potential suicide avoids or refuses to communicate with relatives, friends or colleagues).
· Take action if the person tells you: “I want to be left alone.”
Pay attention to the sharp loss of interest in hobbies and hobbies.
· If hobbies, hobbies, work, to which a person devoted all his time, have ceased to interest him, this may mean that a person feels miserable, depressed, or perhaps close to suicide.
Pay attention to the apathetic behavior inherent in potential suicides. Here are some signs of this behavior:
· Difficulties in making decisions on the most ordinary issues.
· Loss of interest in sex.
· Total energy loss (eg, staying in bed all day).
Watch for signs of suicidal intent in adolescents (in addition to the signs described above, adolescents have some additional symptoms).
· Troubles with the law or bad relationships with family.
· A break with a loved one, loss of a close friend, non-admission to university.
· Lack of friends or problems in relationships with other people.
· Starving or overeating, lack of concern for appearance (for example, a teenager who suddenly stops using makeup or jewelry).
· Drawing scenes of death.
A sudden change in normal behavior, such as poor school performance (if the teenager did well) or rebellious behavior (if the teenager was calm).
Eating disorders, such as anorexia or bulimia, can lead to depression, anxiety, and possibly suicide. Risk factors
Tragic life events can prompt a person to commit suicide.
· Losing a loved one, losing a job, a serious illness (especially associated with chronic ongoing pain) and other stressful life events (conflict in relationships, threats or harassment) can lead to suicide.
· If a person has tried to commit suicide before, then he is in a high-risk group and may make a second attempt. 20% of suicides have repeatedly tried to do this.
· A person who has experienced physical or sexual abuse is more likely to commit suicide.
Find out if a person is suffering from mental or emotional distress. Very often, suicide is the result of a mental illness (depression, bipolar disorder, schizophrenia, paranoia, and the like). 90% of suicides are related to depression or other mental illness, and 66% of people who are seriously thinking about suicide have some kind of mental disorder.
Disorders characterized by anxiety or anxiety (e.g., post-traumatic stress) and poor control of actions (e.g., bipolar disorder) are major risk factors for suicide.
Symptoms of mental illness that increase the risk of suicide include severe anxiety, panic, despair, hopelessness, loneliness, loss of interest and pleasure, delusional thoughts.
· Most suicides suffered from chronic depression.
· People with multiple mental disorders are particularly at risk of suicide. Having two or three mental disorders doubles or triples the risk of suicide.
If a person's ancestors or relatives committed suicide, then he is also at suicidal risk (although this has not yet been fully studied).
· At least some studies show that there is a genetic predisposition to suicidal intentions. Also, intrafamily relationships influence such intentions.
Learn the demographics of suicides. Of course, it is difficult to identify a potential suicide, but statistics claim that some social groups are more prone to suicide.
· Men commit suicide more often than women (four times). 79% of all suicides are men.
· Regardless of gender, people belonging to the LGBT community (homosexual, bisexual and transgender people) are four times more likely to commit suicide.
· Older people are more likely to commit suicide. In the number of suicides, people between the ages of 45 and 59 take the lead (followed by people over 74).
· Caucasians are more likely to commit suicide than members of other races.
· If a person does not fall into any of these risk groups, this does not mean that you should not worry about him. If a person shows suicidal symptoms regardless of gender and age, take this seriously. However, if someone is at risk, then the risk of suicide only increases.
Conversation with a Suicidal Man
Choose the right tone. If someone from your family or friends shows signs of suicide, be sure to talk to such a person in an unbiased and friendly manner.
· Be a good listener. Look at the person you are talking to and subtly respond to his words.
Go straight to the point. At the beginning of the conversation, ask: “I noticed that you have been depressed lately. And I am very worried about that. Do you have suicidal thoughts? ”
· If a person says that he has such thoughts, ask him: “Have you planned suicide?”
· If the person answers in the affirmative, immediately call for emergency assistance. Do not leave the person until help arrives.
Try not to complicate the situation. You may think that some of your words will improve the situation, but in reality they can only complicate it. For example, do not say the following:
· “Tomorrow will be a new day and you will feel better”
· "It could be worse. You should be glad that you have "
· “You have a whole life ahead”
· "Do not worry. Everything will be OK"
Do not make dismissive statements. A person with suicidal thoughts may decide that you do not take his intentions seriously. Avoid the following phrases:
· “The situation is not so difficult”
· “Don’t hurt yourself”
· “I also had difficulties, but I dealt with them”
If someone told you a secret that he was planning a suicide, do not hide it.
· Such a person needs urgent help. Keeping his intentions secret, you will only aggravate the situation.
If you think that someone is preparing for suicide, immediately call 112.
Call the emergency psychological service (or hotline). These services help both potential suicides and people trying to prevent suicide.
· Such a service will tell you what to do to prevent suicide. Specialists will help you resolve the situation or take other actions.
Help a person with suicidal thoughts get help from a mental health professional as soon as possible. You can find professional psychologists or psychiatrists from the phone numbers given above, or you can find a specialist on the Internet.
· By helping someone get help, you will prevent suicide and save someone’s life.
· Do not waste time. Sometimes it takes several days or even hours to prevent suicide, so the sooner a potential suicide gets the necessary help, the better.
Inform the family of the person with suicidal thoughts about his intentions.
Relatives of a potential suicide will help you prevent suicide.
· The involvement of relatives in suicide prevention will demonstrate to a person with suicidal intentions that he is not alone and that other people care about him.
Get rid of the tools of suicide. Throw away pills and drugs, hide a firearm or any other weapon.
· Be careful. People can kill themselves with objects that you did not even think about.
· Rat poison, cleaning products, cutlery can be used when attempting suicide.
· 25% of suicides are committed by hanging. So hide your ties, belts, ropes, sheets.
· Tell the potential suicide that you hid these things and that you are following him.
Keep in touch with the person whose suicide you prevented. Even if the worst is over, support the person, as he did not get rid of depression and feelings of loneliness. Call him, visit him and just keep in touch with him. Here are some other ways to support a person:
· Make sure that the person is talking to doctors. To do this, offer to give him a lift to the doctor to personally verify that he is receiving the necessary medical care.
· Make sure the person is taking all prescribed medications.
· Do not offer a person to drink or try drugs. Potential suicides should not drink or use drugs.
· Help the person make a plan of action to prevent suicide in case they again have suicidal thoughts. For example, call relatives, or go to friends, or even go to the hospital.
Prevention of one's own suicide
Call 112. If you have suicidal thoughts or have a plan and means to commit suicide, call 112 immediately. You need medical attention.
Before the arrival of the ambulance, call the emergency psychological assistance service (phone numbers are listed above). Communicating with a person will reduce the risk of suicide.
Talk to mental health professionals. If you simply have suicidal thoughts, seek help from a psychotherapist.
· If you’ve turned from thoughts to suicide planning, call 112.
· Do not wait for someone to come up to you and say, “I want to kill myself.” Most of those who want to commit suicide do not speak about their intention to others. You should see signs of suicidal thoughts, support a person so that he truly reveals itself to you.
· Some have only implicit signs. Be attentive to people at risk (people who have experienced severe psychological trauma, people with drug addiction, people with mental illness) to notice even slight signs of suicidal thoughts.
· Do not forget that many people do not show clear signs of suicidal intent. About 25% of suicides had no suicidal symptoms at all.
· Do not attempt to prevent suicide without assistance. If someone planned to commit suicide, then such a person needs professional medical help (which you most likely cannot provide).
· It’s very difficult for some people to reach. If you have done everything possible, but the person has nevertheless accomplished what was intended - do not blame yourself.
Psychiatrist, Nizhnevartovsk Regional Hospital