SPECIAL TYPES OF SUICIDES

YOUTH SUICIDES

The government classifies a youth suicide as one in which the victim is 14 to 25 years old. On that basis, there are 2000 youth suicide attempts recorded in Minnesota annually, and about 100 successes. That includes only those that were officially recorded. Undoubtably many more actually happened. Some researchers claim that youth attempts are under-reported by a factor of 10! And most gatherers of such statistics agree that many intentionally self-inflicted deaths are not recorded as suicides.

Official youth suicide numbers have increased 3-fold in the past 40 years. There is disagreement over how much of this is just better reporting, and how much reflects a real increase. The youth suicide rate used to be much lower than the overall rate. It has held steady since 1977 at around 13 per 100,000 per year, just slightly higher than the overall rate. Slight increases in the youth rate in 1988 to 1990 may be the beginning of a new trend.

Suicide is the leading cause of death for youth urban black females, and for young male indians who live outside the tribal structure. It is the second leading cause of death for white youths, behind accidents. There is substantial circumstantial evidence that enough of the fatal "accidents" were in fact suicidal deaths, to make suicide the leading cause of death for white youths, too.

Some researchers claim that 25% of all college students will at least consider suicide. One researcher found that 1 out of every 33 high school students, had attempted suicide every month. Another claimed that about 30% of all homosexual youths had attempted suicide at least once. While individual researchers have come up with some questionable but alarming numbers, it is a fact that about a quarter of all suicides are people in the youth category.

A youth suicide looks pretty much like any other suicide to the officer. The physical, circumstantial and psychiatric evidence should look the same, after allowing for the normal differences in the lifestyles and thought styles of youth.

Young people are more impulsive and passionate that older people. Impulsiveness is a behavior pattern which shows up in all aspects of life, so it is not surprising if a youth suicide shows some signs of impulsiveness. Even impulsive acts are consistent with a person's regular thought patterns, and impulsive suicides are the result of long-term thoughts about and interest in suicide. Interviews of unsuccessful youth suicide attempters who supposedly acted on sudden impulses, have revealed that they show the same symptoms of psychiatric disorder as planned suicides.

Young people lead active, energetic lives. The fatigue and lack of mental energy typical of UAD does not necessarily translate into a passive, stay-at-home lifestyle in a young person. Peer pressure may drag them into their normal social and school activities. They do not have the mental energy make decsions to change their normal lifestyle. They will show a decrease in their normal level of interest, however, and get less pleasure from the things they used to enjoy. Their grades and work performance may suffer for several months prior to the suicide.

Peer pressure is a big thing for young people. Most young victims of UAD don't know they have it, and the kids just can't understand why they are "different" from their friends. The realization that something is "wrong with me" is crushing and even more stressful to a teenager. Despite their misery and fatigue, they still want to be one of the gang. So outwardly, they may show little change in their habits and social life, despite the serious malfunctioning of their affective system.

Pop Music.... Despite several serious attempts to do so, nobody has shown a link between heavy-metal music and suicide (or any other kind of violence). Suicidally inclined kids may like such music, but nobody has shown that non-suicidal kids develop an interest in suicide because of it. They tend to treat it as a novelty, not a role definer.

In a 1987 Arizona court case, the jury didn't buy the notion that pop music had caused a rash of local suicides. One positive decision came out of the case, though. The judge ruled that the "secret-coded subliminal messages" allegedly embedded within some pop music is not protected by the first amendment.

Cognitive Constriction....

Kids usually have imaginative problem-solving techniques, and see lots of options for dealing with life. Suicidal kids are more fatalistic and do not see choices. They begin to see things in just one aspect, without nuance, and have a rigid, inflexible thought pattern. They see relatively minor or normal problems as overwhelming. They become overly concerned with the "problem", blaming all of their pain on it.

This narrowing of view point is called Cognitive Constriction. It is fairly common in youth suicides. It is common for the parents to say, "he was depressed over his lost girlfriend", or something similar. They may have noticed no other signs of depression, and be convinced that the victim's sole motive was the personal problem.

What causes constricted cognition is not known. Researchers have found that this closing of the mind is a reliable sign of impending suicide.

Substance abuse....

There is an obvious connection between drug abuse and suicide. That drugs cause suicide is a popular belief. More than an average number of suicides are regular drug and alcohol abusers. The common illegal psychotropic drugs interfere with the affective system in the short term; it would seem reasonable that they could mess it up in the long term.

Suicidologists believe that the same misery that leads to suicide thoughts, leads to chemical abuse. They do not believe that recreational drugs actually cause suicide. (I have found no research that actually proves that, however.) Certainly, intoxication makes the commission of the suicidal act easier.

a name=clusters>CLUSTER SUICIDES

Cluster suicides are suicides that happen in bunches, committed by people (usually teenagers) who appear to be imitating each other. There have been a few highly-publicized cluster suicides in recent years. The media may have given the impression that this is something new, but it isn't. Cluster suicides happen all the time. Even Duluth had a mini-cluster in 1988-89; a high school kid killed himself, and within a year, one of his friends, and another classmate also died by suicide. In 1991, a well-known West Duluth woman hung herself, and 4 more West Duluth people had killed themselves within a month; a mammouth increase in the normal Duluth rate of one per month.

The recent publicity was given to two residential areas (Westchester County, New York, and a suburb of Milwaukee) that, because of their wealth, were able to draw more attention and resources to their cluster. As with many media events, experts surfaced out of nowhere and gave talks. A good deal of nonsense was published along with the professional advise.

Cluster suicides seem to be triggered by a sensational incident, in which the victim is romanticized. Other suicidal youths in the school, neighborhood, town, or region take encouragement and validation from the original suicide. However, each victim, in those cases that have been studied, showed the symptoms of one of the disorders mentioned above. It does not seem that the cluster provides the motive for suicide, it just seems to make it easier to justify it to oneself.

Prevention...

To prevent cluster suicides, every suicide of a young person should be scrutinized. So should adult suicides, if the victim is associated with a large number of youths. Examples might be a popular high school teacher, counselor, coach or minister, or even a well-known parent. If the total circumstances suggest that the details of such an incident will become common knowledge and/or sensationalized, there is justification for special precautions.

Proper action must be taken after the first suicide. The details of the suicide should not be widely circulated, but rumors should be debunked. The fact the suicide has happened should not be concealed. The original suicide should not be romanticized, nor harshly criticized. School should not be let out for the funeral, nor any special school functions set up to commemorate the victim. The school paper should run a matter-of-fact death notice, but no special articles about the victim. If the student editors want to treat the suicide as a news item, they should be instructed to keep glorification, dramatization and romanticization to a minimum, and emphathize the nature of suicide and its causes and prevention. Special classes about the causes and prevention of suicide might be instituted.

School officials and counsellors should emphathize the sadness of the family, friends and school. The discussion of grief should center on the sufferring it causes the living, not the tribute it pays to the dead. That the victim could have been helped should also be emphathized. Open discussion about suicide in general should be encouraged, but steer the talk away from specific suicides.

Counsellors should make a special attempt to identify and seek out students who show the signs of impending suicide, or who have attempted suicide in the past. Law enforcement may be able to assist them by providing printouts of juvenile suicide attempters. But the best leads will come from concerned fellow students. The school will have to be proactive in contacting these students; it is unlikely that those really at risk will come in for help. UAD victims want help, but they tend to distrust and reject it. They do not have the mental energy to create change in their life. School officials must find and go after them, or educate the parents to the signs to watch for and steps to be taken.

Within a school, the suicide of a classmate affects all the kids, not just the other suicidal one. The councelors need to deal with all of the kids; the grief and confusion that follows the death of a classmate can cause a wide range of problems, not just more suicides. But the kids at risk for copy- cat suicide are those who were considering it anyhow. The way to prevent cluster suicides is to identify, seek out, and help the high-risk kids.

CHILD SUICIDES

There has not been enough good-quality research into child suicide, because there are very few recorded suicides for children under the age of 14. Yet psychiatrists find what they identify as suicidal behavior in children as young as 5. They find UAD (but not BAD or schizophrenia) in children as young as 5, too. The fact that death certificates do not list many child deaths as suicide may be a result of incompetent death investigations.

Stressors on children are usually abuse and neglect in the family, or the unrealisticly high expectations of the parents. Children's self-reporting of suicidal and pre-suicidal symptoms is felt to be pretty accurate, but their parents may have distorted recollections of it.

A child suicide usually takes the form of an accident, such as a pedestrian traffic accident where the child unexpectedly bolts in front of a car. Falling/jumping accidents and firearms accidents are common means also, as is hanging, pill taking, and plastic bags. The impulsiveness of children makes it tough to judge the death intent of such "accidents". Neglected children frequently act out dangerous behaviors to get attention, and all children do impulsive things now and then.

Whether a child can form an intent to commit suicide at all is arguable. Before the age of 9 they do not have a good idea of the finality of death. Even after that, it is difficult to say with assurance, that they realized the consequences of their death.

All that having been said, childhood "accidental/suicidal" deaths do have a typical profile, which might at least be of some use in helping to judge the probability of homicide. Self-inflicted childhood deaths seem to be a response to rage against the parent. The child feels badly treated and wishes to punish the parent (babysitter, teacher, etc) by making them feel sad. The child tends to be from a very bad family situation, and to have a very sick mother incapable of caring for him/her. The child usually has a learning or reading disability, is socially isolated and has no close friends.

The child suicide usually (70% of the time) occurs while at least one parent is in the home. There was a known previous death attempt or seriou accident in 80% of the cases. 90% occur in the home.

JAILHOUSE SUICIDES

Suicide is the leading cause of death in jails and prisons. Most successful jailhouse suicides are by hanging. But the most common suicide attempt in a jail is by wrist cutting.

Most jailhouse suicides occur after some upsetting but relatively minor incident, and have a degree of impulsiveness to them. However, they are intentional acts, that have been preceded by at least several days of suicidal thoughts. The motives for jailhouse suicide are the same as for other suicides; depression, or an unacceptable physical condition. Of course the actual hopelessness of the incarceration makes suicide that much more reasonable and attractive. But psychiatricly healthy prisoners rarely commit suicide.

Compounding the hopelessness of their situation, depressed prisoners are even less able to seek help than other UAD victims. By voicing suicidal thoughts, a prisoner risks further "security" restrictions on his freedom. Furthermore, prison and jail guards notoriously view suicide threats as an attempt by the prisoner to manipulate them. (Interestingly, parents feel the same way about their children's suicide threats.)

Warning signs...

For county jails and other pre-sentence, short term facilities, the most likely suicide risk is the first-time arrestee, who has been arrested for an intoxication- related offense. If the prisoner has had prior suicide attempts, a history of depression, or is from out of the area, the suicide risk is greater. 27% of all jailhouse suicides happen within the first 3 hours, and 50% within the first day, of incarceration.

Among longer-term prisoners, there are a set of behaviors which lead up to the suicide attempt. Again the risks are greater for prisoners from out of the area. 75% of successful jailhouse suicides will have made a prior attempt in jail. The prisoner typically has made medical complaints within the week of his suicide, and asked for psychotropic medicines. He will have isolated himself from the other prisoners, and will have appeared anxious and stressed-out. He will have had the usual sleep and appetite disorders common to UAD.

Prevention....

The best prevention against suicide in a county jail is the employment of a qualified social worker, separate from the security staff.

Prisoners should be screened upon admission for suicidal tendencies. He should be specificly asked if he has had suicidal thoughts, or prior suicidal attempts. Questions about the symptoms of UAD should be asked, and about illnesses, delusions, and schizophrenia.

The jail's records, and those of other jails where the prisoner has spent any time, should be checked for prior suicide attempts by the prisoner, within the hour.

There is an obvious need for additional security for a prisoner who is at risk of suicide. However, additional security usually means additional isolation and humiliation for the prisoner. This makes a suicide attempt more likely. Furthermore, the fear of additional security restrictions may discourage suicidally inclined prisoners from making suicide threats, which is the best warning sign of impending suicide.

Legal issues....

A jail with a reasonable policy of suicide prevention is not likely to be found liable for the suicide of one of its prisoners. The usual legal challenges have been based on federal "denial of civil rights" issues, "gross negligence or deliberate indifference" issues, and "cruel and unusual" issues.

The federal courts have not agreed that the self-inflicted death of a prisoner constitutes denial of civil rights by the prison staff. They have also refused to call it cruel and unusual punishment.

Negligence suits must meet a high standard, in showing that the jail policy makers showed a deliberate indifference to the impending suicide, so callous as to "shock the conscience". Courts have generally held that failure to detect a suicidal tendency is not gross negligence in and of itself. The suitor must show that the jail staff deliberately ignored a suicidal tendency, or deliberately avoided knowing about it. However, some state courts have held jails to a higher standard of diligence, when the suicide was committed by a pre-trial detainee.

To protect itself from liability, every jail should have a suicide detection and prevention policy, updated regularly as more becomes known about suicide. The staff should be trained in the policy, and educated about suicide in general. Special precautions should be taken with intoxicated prisoners, and others who are at a higher identifiable risk for suicide. The employee hiring process should attempt to screen out jailers who have unusual callousness to others.

Investigation....

Jailhouse suicides are unique in that there are lots of potential witnesses. Unfortunately, they are almost all hostile to the jail staff. For this reason, investigators should interview ever prisoner who could have seen or heard anything, immediately, on tape. Opinions differ as to whether this would require a Miranda waiver, but you could be in trouble if your "suicide witness" breaks down and confesses to the murder.

MURDER-SUICIDES

Suicides in which the "victim" first murders someone else are common (roughly 5% of all suicides, and 10% of all murders)but still sensational. Studies have determined that the primary motivation for the actor is the suicide, with the murder being incidental. The base motive for the suicide is as described above, but the murderer blames the victim for his pain. Such incidents take the form of either a mass murder followed by suicide during the ensuing confrontation with the police (like the recent post office killings) or a murder of one's love partner, followed immediately by suicide. The second form is characterized by two distinct patterns and motivations:

Murder-Suicide between couples....suicidal subject with obsessive jealousy

This type of incident has a different profile than the typical domestic murder. The murderers are almost always men (as opposed to about half of non-suicidal domestic murderers). The murderers are usually middle-aged, and show a behavior pattern of morbid jealousy and paranoia, symptoms of UAD or BAD, and symptoms of personality disorder.

The couple usually has had a long-term relationship. However it is a discordant relationship with a history of frequent break-ups and reunions. The relationship is abusive, with the murderer being the abuser, but not extremely abusive. They are a middle class or higher couple. The incident happens while they are in a breaking-up phase, and while the women is in a period of personal growth (new job, going back to school, etc).

Regular domestic murder in which the only original intent was to kill the victim, tend to happen within short-term relationships, and within very abusive or controlling relationships.

The fatal episode usually goes like this. The couple breaks up, triggering a depressive episode in the murderer. He becomes hostile and aggressive in his depression, and may harass the victim. At some point the victim tells the murderer that the relationship is definitely over, or that she has a new boyfriend, or something like that. The murderer gets drunk, and goes to confront the victim, with a plan of murder-suicide. He provokes a confrontation with severe verbal and/or physical abuse. He murders the victim, and follows quickly by killing himself. The murder does not look like a typical "lust murder".

(As with all behavioral profiles, don't be overly alarmed if your case does not match it exactly.)

Murder-suicide between couples....devoted older couple under stress

Occasionally a devoted older couple will commit a murder-suicide. This is an entirely different profile from the sick relationship described above. In this case, the couple will be older, and will have had a life-long secure relationship free of overt discord or abuse. The suicide decision will be preceded by a serious illness in the murder victim, extreme financial stress, or some similar unhappy condition which destroys the nature of the relationship. The incident will show considerable planning and forethought, and a quick, painless death for the suicide victim.

Mass murder-suicides....

Due to the highly sensational nature of these incidents, there is a lot of unfounded opinion written about them. There is no consensus on the causes, personalities, or psychiatry involved, or on the behaviors that preceed the incidents. As a matter of common sense, one would suspect that both organic and personality disorders are involved in the motiviation of such incidents.

News media reports seem to indicate that most of the perpetrators were gun-nuts. Perhaps some authoritative work will be done in the near future that will give us some insight into the cause and prevention of these incidents.