Chapter Six

© 2013 by Pearson Higher Education, IncUpper Saddle River, New Jersey 07458 • All Rights Reserved

Crisis InterventionWilliam Harmening

Roosevelt University

Harmening, Crisis Intervention: The Criminal Justice Response to Chaos, Mayhem, and Disaster

Chapter 6SUICIDE AND THE PSYCHOLOGY OF SELF DESTRUCTION


6.1

6.2

6.3

6.4

To summarize the social impact of suicide in America.

To list and explain the predominant theories of suicide.

To define a typology scheme for suicide, and to summarize the dangers associated with each to those

who respond to this type of crisis.

To list and summarize the techniques and protocols for responding to and de-escalating suicide.

CHAPTER OBJECTIVES

6.5 To summarize the special classes of suicide.

To summarize the social impact of suicide in America.

Learning ObjectivesAfter this lecture, you should be able to complete the following Learning Outcomes

6.1

6.1 The Impact of Suicide

Statistics Reflecting the Impact of Suicide

• Approximately 80 suicides each day in America.

• Approximately 300,000 Americans survive a suicide attempt each day.

• Around 116,000 people who survive a suicide attempt each year require hospitalization, with an average cost per stay of $15,000.

• Of those who survive an attempt, an estimated 19,000 are left permanently disabled at a cost per patient of $127,000 annually for their continued care.

• About 1-percent of Americans end their lives by suicide. It is the eight-leading cause of death in America.

6.1 The Impact of Suicide

The Criminal Justice Response

• Large amounts of resources are committed each day to saving the lives of those who would rather die. Police officers are routinely dispatched to threatened suicides, and suicide is a daily occurrence in America’s prisons and jails. For first responders, threatened suicides can be a very dangerous type of intervention. The person in crisis may try to provoke the police into shooting them, and if desperate enough, may threaten violence against anyone attempting to prevent their final act.

To list and explain the predominant theories of suicide.


6.2

6.2 Theories of Suicide

Emile Durkheim’s Sociological Theory (1897)

• One of the first theories of suicide. Durkheim was a sociologist.

• Durkheim based his suicide typologies on an imbalance between two social forces:

Social IntegrationThe extent to which an individual or group of individuals feels accepted as full members of the larger society.

(ex: minority groups in America have traditionally been less integrated, and thus the rate of despair and suicide is higher)

Moral RegulationThe rules and norms established by society that set limits on what are otherwise limitless and destructive desires.

(ex: a lack of moral regulation on the accumulation of wealth leads to exploitation and poverty in the lower socioeconomic classes, and with it an increase in suicide among those groups)


Durkheim’s Suicide Typologies

• EGOISTIC SUICIDEResults from too little social integration. They lack the values, traditions, and norms of the dominant society, and therefore lack a sense of belongingness to social groups and other social supports. Leads to despair and a socially-driven sense 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 his troops.

• FATALISTIC SUICIDEResults from excessive moral regulation, usually connected to pervasive oppression. This may include military personnel who can’t escape their duty, prison inmates, and people trapped in unhealthy relationships they feel they cannot escape.

• ANOMIC SUICIDESee next slide….


Durkheim’s Suicide Typologies

• ANOMIC SUICIDEResults from a lack of moral regulation. Durkheim proposed four subtypes:

1. Acute economic anomie

Results when traditional institutions (church, government, commerce) are no longer sufficient to meet the individual’s needs. Despair results.

2. Chronic economic anomie

Occurs when wealth and prosperity themselves are insufficient to replace the lost regulators of society. Accounts for the high rate of suicide among the rich. “You can’t buy happiness.”

3. Acute domestic anomie

Occurs when a sudden change takes place on a personal level that leaves the individual unable to adapt to meet their needs (i.e., divorce, widowhood,

unemployment)

4. Chronic domestic anomie

Occurs only in men, according to Durkheim. He believed that marriage plays an important role in society. Unmarried men lack that important regulator. High rates of risky behavior.


Sigmund Freud’s Psychoanalytic Theory

Freud believed we enter the word with two basic instincts that work together to compel all behavior. The first, EROS, or the life instinct, seeks pleasure, either physical or psychological, and moves us forward in a goal-oriented manner. When this instinct is allowed expression then psychic equilibrium results. When it is not allowed expression, then anxiety and frustration result.

Freud’s second instinct is THANATOS, or the death instinct. He believed we are born with a biological need to return to the quiet calm of the womb. Put another way, we are born with the need for equilibrium. When it is lost, then THANATOS seeks to regain it, even through aggression.

EGO is the component of personality that seeks to maintain a balance between the two instincts.

Freud believed suicide results when EROS is no longer able to achieve pleasure, and THANATOS is no longer able to diminish the resulting disequilibrium. The result is despair and hopelessness, or what Freud might call EGO DEATH.


Sigmund Freud’s Psychoanalytic Theory

EGOEGOEGO

EROSPleasure

THANATOSEquilibrium

EROS

Pleasure

THANATO

S

Equilibriu

mEROS

Pleasure

THANATOS

Equilibrium

The biological need for equilibriumThanatos serves as a counter-weight to EROS whenever it is allowed too much or too little expression.

The biological need for pleasureToo much expression of EROS will cause disequilibrium in the form of shame and guilt. Too little expression will lead to disequilibrium in the form of frustration, anger, and despair.

The psychological mechanism by which we keep the two in balanceEGO is constantly shifting its center of gravity in an effort to maintain or regain equilibrium. It does this primarily through the use of cognitive or physical mediation, including aggression.

Suicide occurs when EROS loses its capacity to seek expression, and EGO loses its ability to regain equilibrium through cognitive or physical mediation

To define a typology scheme for suicide, and to summarize the dangers associated with each to those who respond to this type of crisis.


6.3

6.3 Suicide Typologies

For those who respond to threatened suicides, a unified theory is less important than an understanding of the various types of suicide, and the risks they each pose for responders.

Anger

Despair

Egoist

ic Proactive

Altruistic

Preemptive

Acute Situational

Self-contempt ChronicEmotionalC

hronic

PhysicalR

even

ge

Ritualistic

Aba

ndon

men

t

Suicide

Types of Suicide


• SELF-CONTEMPT

Suicide resulting from a hatred or dislike directed inwardly. Examples may include the alcoholic who cannot stop drinking, or the former soldier who committed war crimes and is now succumbing to extreme guilt. Another example might be the individual facing extreme financial hardship and feels they failed their family.

• REVENGE

Suicide resulting from a desire to exact revenge on another person. An example is the man who kills himself and his children following a divorce, or the teenager who kills himself as an act of revenge against his parents.

ANGER SUICIDE


• CHRONIC PHYSICAL

Suicide resulting from unending physical pain and suffering. Many assisted suicides fall into this category. The person simply wants relieved of their constant suffering.

• CHRONIC EMOTIONAL

Related to extreme depression. Like the chronic physical suicide, this person simply wants to end their suffering. Some assisted suicides have fallen into this category, however, because mentally ill people are not terminally ill, assisted suicide for this reason is illegal.

DESPAIR SUICIDE


• ACUTE SITUATIONAL

Suicide resulting from a sudden event that causes a deterioration of the person’s self-identity. Examples include the man who loses his career, the wife who loses her husband in an unwanted divorce, or perhaps the pastor of a church caught trading child pornography on the internet.

• ABANDONMENT

One of the most complex emotions in the human repertoire. It results from an insecure attachment during childhood being transferred to a significant other in adulthood. Suicide results from an inability to emotionally separate from a significant other who has already made the decision to do so. Many murder-suicides fall in this category.

EGOISTIC SUICIDE


• RITUALISTIC

Suicide resulting from reasons external to the individual. They are seen as sacrificial acts carried out for religious, spiritual, or political reasons. Examples include the Kamikaze pilots of WWII Japan, and the various mass suicides that have taken place among cults.

• ALTRUISTIC

Suicides resulting from a desire to avoid becoming a burden on others. For example, the terminally ill patient who does not want his family to bear the physical and financial hardship of caring for him.

• PRE-EMPTIVE

Suicides resulting from a person’s desire to end their life before their personal circumstances worsen, such as a terminally ill individual or someone sentenced to prison.

PROACTIVE SUICIDE

To list and summarize the techniques and protocols for responding to and de-escalating suicide.


6.4

6.4 De-escalating Suicide

1. ENGAGEMENT

2. ESTABLISH RAPPORT

3. LISTEN

4. OFFER HELP

5. GAIN COMMITMENT

THE FIVE STEPS OF INTERVENTION

6.4 De-escalating Suicide

The primary responsibility of a criminal justice professional

responding to a threatened suicide is to prevent the individual from carrying it out. Their second priority is to get the individual the psychiatric help they need.

Essentially all states have involuntary commitment laws. In most states the police have the statutory authority to transport an individual threatening suicide to a hospital or mental health center for an involuntary commitment of 24 to 120 hours. During this time the individual will be examined by a psychiatrist to determine if they should be committed for a longer period of time. If not, then they are released. Anyone committed involuntarily for longer periods of time will be afforded due process in a court of law.

INVOLVUNTARY COMMITMENTS

To summarize the special classes of suicide.


6.5

6.5 Special Classes

When an individual provokes the police into shooting them to fulfill their desire to commit suicide. Some do it because they lack the courage to do it themselves. Others do it to justify their feelings of self-contempt and a perceived need for persecution.

One study by the L.A. County Sheriff’s Department determined that 11% of police shootings, and 13% of those that were fatal, involved people who desired to end their lives.

Extremely dangerous for the responding officers. One Florida study found that 60% of those killed by the police in this manner either used or attempted to use their own weapons.

SUICIDE BY COP

6.5 Special Classes

Unlike adult suicide, most teen suicides are preventable if parents, teachers, and police officers recognized the warning signs…

• 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 concentrating

TEEN SUICIDE

6.5 Special Classes

Almost all adolescent suicides result from problems related to ATTACHMENT and IDENTITY-FORMATION.

ATTACHMENT = THE NEED TO BE LOVED BY OTHERS

IDENTITY-FORMATION = THE NEED TO LOVE ONESELF

Unlike adult suicide, teen suicide is almost always precipitated by a particularly stressful event. They simply don’t have the life experience to adequately process such an event and consider available options. Instead, many times they process it against the symbolism of songs, movies, and video games. This can be extremely dangerous because the line between reality and fantasy becomes blurred.

TEEN SUICIDE

6.5 Special Classes

• Suicide in America is highest among men 85 years of age and 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 of a loved one.

• Seldom an impulsive act like adolescent suicide. Final plans and preparations are typically made.

• Many police departments now have “Elder Services” officers who are trained to deal with this and other elder-related issues.

ELDER SUICIDE

6.5 Special Classes

• SUICIDE PROFILES

There are two profiles that are used to help identify suicide risks 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 isolation

SUICIDE IN PRISONS AND JAILS

6.5 Special Classes

• INMATE SCREENING

To reduce the risk of suicide in jails, corrections officers now screen inmates to determine a risk classification. The most common suicide risk indicators are:

1. The individual is intoxicated 2. They have a history of mental health treatment or previous suicide 3. they are very emotional, and express shame or guilt for their actions 4. The individual has been in prison before and states that he will not return 5. The individual has limited social support, and says no one cares about him 6. The individual is prescribed an anti-depressant or other psychotropic drugs

SUICIDE IN PRISONS AND JAILS


Suicide is the 8th leading cause of death in the U.S. The personal and economic toll it takes is devastating.

There are many theories that attempt to explain suicide. Some, such as Durkheim’s, look for external sociological causes. Others, such as Freud’s, look for

internal psychological factors.

There are certain intervention skills that are critical to de-escalating suicide. They include ENGAGEMENT,

RAPPORT, LISTENING, OFFERING HELP, and GAINING COMMITMENT.

Special classes of suicide that must be understood by criminal justice professionals include TEEN SUICIDE,

ELDER SUICIDE, and suicide in prisons and jails. There are warning signs for each.

CHAPTER SUMMARY

6.1

6.2

6.4

6.5

Suicides can be typed as either PROACTIVE, EGOISTIC, ANGER, or DESPAIR, with various subtypes under each.6.3


DISCUSSION QUESTIONS

1. Why should the criminal justice system concern itself to the extent it does with the crisis of suicide? Shouldn’t people have the right to end their lives?

2. Discuss whether you believe suicide is primarily the result of external sociological conditions and circumstances, or more the result of internal psychological factors. Or is it a combination of both?

3. Discuss some of the major differences between teen suicide and adult suicide.

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Chapter Six