To summarize the social impact ofsuicide in America.Learning ObjectivesAfter this lecture, you should be able to complete the following Learning Outcomes6.1
6.1 The Impact of SuicideStatistics Reflecting the Impact of Suicide• Approximately 80 suicides each day in America.• Approximately 300,000 Americans survive a suicide attempteach day.• Around 116,000 people who survive a suicide attempt eachyear require hospitalization, with an average cost per stay of$15,000.• Of those who survive an attempt, an estimated 19,000 areleft permanently disabled at a cost per patient of $127,000annually for their continued care.• About 1-percent of Americans end their lives by suicide. It isthe eight-leading cause of death in America.
6.1 The Impact of SuicideThe Criminal Justice Response• Large amounts of resources are committed each day tosaving the lives of those who would rather die. Police officersare routinely dispatched to threatened suicides, and suicide isa daily occurrence in America’s prisons and jails. For firstresponders, threatened suicides can be a very dangeroustype of intervention. The person in crisis may try to provoke thepolice into shooting them, and if desperate enough, maythreaten violence against anyone attempting to prevent theirfinal act.
To list and explain the predominanttheories of suicide.Learning ObjectivesAfter this lecture, you should be able to complete the following Learning Outcomes6.2
6.2 Theories of SuicideEmile Durkheim’s Sociological Theory (1897)• One of the first theories of suicide. Durkheim was a sociologist.• Durkheim based his suicide typologies on an imbalancebetween two social forces:Social IntegrationThe extent to which an individual or group of individuals feels accepted as full members ofthe larger society.(ex: minority groups in America have traditionally been less integrated, and thus the rate ofdespair and suicide is higher)Moral RegulationThe rules and norms established by society that set limits on what are otherwise limitless anddestructive desires.(ex: a lack of moral regulation on the accumulation of wealth leads to exploitation andpoverty in the lower socioeconomic classes, and with it an increase in suicide among thosegroups)
6.2 Theories of SuicideDurkheim’s Suicide Typologies• EGOISTIC SUICIDEResults from too little social integration. They lack the values, traditions, andnorms of the dominant society, and therefore lack a sense of belongingness tosocial groups and other social supports. Leads to despair and a socially-drivensense of hopelessness.• ALTRUISTIC SUICIDEResults from too much social integration. They sacrifice for the good of the group.An example is the soldier who commits suicide because he believes he failed histroops.• FATALISTIC SUICIDEResults from excessive moral regulation, usually connected to pervasiveoppression. This may include military personnel who can’t escape theirduty, prison inmates, and people trapped in unhealthy relationships they feelthey cannot escape.• ANOMIC SUICIDESee next slide….
6.2 Theories of SuicideDurkheim’s Suicide Typologies• ANOMIC SUICIDEResults from a lack of moral regulation. Durkheim proposed four subtypes:1. Acute economic anomieResults when traditional institutions (church, government, commerce) are no longer sufficientto meet the individual’s needs. Despair results.2. Chronic economic anomieOccurs when wealth and prosperity themselves are insufficient to replace the lost regulatorsof society. Accounts for the high rate of suicide among the rich. “You can’t buy happiness.”3. Acute domestic anomieOccurs when a sudden change takes place on a personal level that leaves the individualunable to adapt to meet their needs (i.e., divorce, widowhood, unemployment)4. Chronic domestic anomieOccurs only in men, according to Durkheim. He believed that marriage plays an importantrole in society. Unmarried men lack that important regulator. High rates of risky behavior.
6.2 Theories of SuicideSigmund Freud’s Psychoanalytic TheoryFreud believed we enter the word with two basic instincts that work together tocompel all behavior. The first, EROS, or the life instinct, seeks pleasure, eitherphysical or psychological, and moves us forward in a goal-oriented manner.When this instinct is allowed expression then psychic equilibrium results. When itis not allowed expression, then anxiety and frustration result.Freud’s second instinct is THANATOS, or the death instinct. He believed we areborn with a biological need to return to the quiet calm of the womb. Put anotherway, we are born with the need for equilibrium. When it is lost, then THANATOSseeks to regain it, even through aggression.EGO is the component of personality that seeks to maintain a balance betweenthe two instincts.Freud believed suicide results when EROS is no longer able to achievepleasure, and THANATOS is no longer able to diminish the resultingdisequilibrium. The result is despair and hopelessness, or what Freud might callEGO DEATH.
6.2 Theories of SuicideSigmund Freud’s Psychoanalytic TheoryEGOEGOEGOEROSPleasureTHANATOSEquilibriumThe biological need for equilibriumThanatos serves as a counter-weight toEROS whenever it is allowed too much ortoo little expression.The biological need for pleasureToo much expression of EROS will causedisequilibrium in the form of shame and guilt.Too little expression will lead to disequilibriumin the form of frustration, anger, and despair.The psychological mechanism by which we keep thetwo in balanceEGO is constantly shifting its center of gravity in an effort tomaintain or regain equilibrium. It does this primarily throughthe use of cognitive or physical mediation, includingaggression.Suicide occurs when EROS loses its capacity to seek expression, and EGOloses its ability to regain equilibrium through cognitive or physical mediation
To define a typology scheme forsuicide, and to summarize thedangers associated with each tothose who respond to this type ofcrisis.Learning ObjectivesAfter this lecture, you should be able to complete the following Learning Outcomes6.3
6.3 Suicide TypologiesFor those who respond to threatened suicides, a unified theory is less important than anunderstanding of the various types of suicide, and the risks they each pose for responders.SuicideTypes of Suicide
6.3 Suicide Typologies• SELF-CONTEMPTSuicide resulting from a hatred or dislike directed inwardly.Examples may include the alcoholic who cannot stop drinking, orthe former soldier who committed war crimes and is nowsuccumbing to extreme guilt. Another example might be theindividual facing extreme financial hardship and feels they failedtheir family.• REVENGESuicide resulting from a desire to exact revenge on anotherperson. An example is the man who kills himself and his childrenfollowing a divorce, or the teenager who kills himself as an act ofrevenge against his parents.ANGER SUICIDE
6.3 Suicide Typologies• CHRONIC PHYSICALSuicide resulting from unending physical pain and suffering. Manyassisted suicides fall into this category. The person simply wantsrelieved of their constant suffering.• CHRONIC EMOTIONALRelated to extreme depression. Like the chronic physicalsuicide, this person simply wants to end their suffering. Someassisted suicides have fallen into this category, however, becausementally ill people are not terminally ill, assisted suicide for thisreason is illegal.DESPAIR SUICIDE
6.3 Suicide Typologies• ACUTE SITUATIONALSuicide resulting from a sudden event that causes a deteriorationof the person’s self-identity. Examples include the man who loseshis career, the wife who loses her husband in an unwanteddivorce, or perhaps the pastor of a church caught trading childpornography on the internet.• ABANDONMENTOne of the most complex emotions in the human repertoire. Itresults from an insecure attachment during childhood beingtransferred to a significant other in adulthood. Suicide results froman inability to emotionally separate from a significant other whohas already made the decision to do so. Many murder-suicidesfall in this category.EGOISTIC SUICIDE
6.3 Suicide Typologies• RITUALISTICSuicide resulting from reasons external to the individual. They are seen assacrificial acts carried out for religious, spiritual, or political reasons.Examples include the Kamikaze pilots of WWII Japan, and the variousmass suicides that have taken place among cults.• ALTRUISTICSuicides resulting from a desire to avoid becoming a burden on others.For example, the terminally ill patient who does not want his family tobear the physical and financial hardship of caring for him.• PRE-EMPTIVESuicides resulting from a person’s desire to end their life before theirpersonal circumstances worsen, such as a terminally ill individual orsomeone sentenced to prison.PROACTIVE SUICIDE
To list and summarize the techniquesand protocols for responding to andde-escalating suicide.Learning ObjectivesAfter this lecture, you should be able to complete the following Learning Outcomes6.4
6.4 De-escalating Suicide1. ENGAGEMENT2. ESTABLISH RAPPORT3. LISTEN4. OFFER HELP5. GAIN COMMITMENTTHE FIVE STEPS OF INTERVENTION
6.4 De-escalating SuicideThe primary responsibility of a criminal justice professionalresponding to a threatened suicide is to prevent the individualfrom carrying it out. Their second priority is to get the individualthe psychiatric help they need.Essentially all states have involuntary commitment laws. In moststates the police have the statutory authority to transport anindividual threatening suicide to a hospital or mental healthcenter for an involuntary commitment of 24 to 120 hours. Duringthis time the individual will be examined by a psychiatrist todetermine if they should be committed for a longer period oftime. If not, then they are released. Anyone committedinvoluntarily for longer periods of time will be afforded dueprocess in a court of law.INVOLVUNTARY COMMITMENTS
To summarize the special classes ofsuicide.Learning ObjectivesAfter this lecture, you should be able to complete the following Learning Outcomes6.5
6.5 Special ClassesWhen an individual provokes the police into shooting them tofulfill their desire to commit suicide. Some do it because theylack the courage to do it themselves. Others do it to justify theirfeelings of self-contempt and a perceived need forpersecution.One study by the L.A. County Sheriff’s Department determinedthat 11% of police shootings, and 13% of those that werefatal, involved people who desired to end their lives.Extremely dangerous for the responding officers. One Floridastudy found that 60% of those killed by the police in thismanner either used or attempted to use their own weapons.SUICIDE BY COP
6.5 Special ClassesUnlike adult suicide, most teen suicides are preventable ifparents, teachers, and police officers recognized the warningsigns…• Talking or joking about death and suicide• Writing poetry or drawing pictures related to death and suicide• Withdrawing from family and friends• Giving away possessions• Significant changes in eating and sleeping habits• Academic failure and a refusal to discuss academic plans• A sudden interest in guns or other weapons• Expressing feelings of hopelessness• Self-mutilating behaviors• Telling friends they are planning something “big”• having trouble concentratingTEEN SUICIDE
6.5 Special ClassesAlmost all adolescent suicides result from problems related toATTACHMENT and IDENTITY-FORMATION.ATTACHMENT = THE NEED TO BE LOVED BY OTHERSIDENTITY-FORMATION = THE NEED TO LOVE ONESELFUnlike adult suicide, teen suicide is almost always precipitatedby a particularly stressful event. They simply don’t have the lifeexperience to adequately process such an event andconsider available options. Instead, many times they process itagainst the symbolism of songs, movies, and video games.This can be extremely dangerous because the line betweenreality and fantasy becomes blurred.TEEN SUICIDE
6.5 Special Classes• Suicide in America is highest among men 85 years of ageand older…twice as high as the rate for all men combined.• Almost always men.• Almost all elder suicides result from poor health or the loss ofa loved one.• Seldom an impulsive act like adolescent suicide. Final plansand preparations are typically made.• Many police departments now have “Elder Services” officerswho are trained to deal with this and other elder-related issues.ELDER SUICIDE
6.5 Special Classes• SUICIDE PROFILESThere are two profiles that are used to help identify suiciderisks in jails…Pretrial inmate- 20-25 year old males- unmarried, first time offenders- 24 hours following their initial lockup- Just before final disposition of the case (sentencing)Sentenced Inmate- Already convicted and sentenced to prison- 30-35 year old males- Sentenced for a longer period- Loss of an appeal- A fight with another inmate- Victim of a sexual assault- Learning of negative news about family- Emotional breakdown related to isolationSUICIDE IN PRISONS AND JAILS
6.5 Special Classes• INMATE SCREENINGTo reduce the risk of suicide in jails, corrections officers nowscreen inmates to determine a risk classification. The mostcommon suicide risk indicators are:1. The individual is intoxicated2. They have a history of mental health treatment or previous suicide3. they are very emotional, and express shame or guilt for their actions4. The individual has been in prison before and states that he will not return5. The individual has limited social support, and says no one cares about him6. The individual is prescribed an anti-depressant or other psychotropic drugsSUICIDE IN PRISONS AND JAILS