Suicide

Molnos, A.

Suicide can be a self-sacrifice, an altruistic, heroic act to save other people's lives, the family's honour (e.g. harakiri in Japan). However, in today's world it is mostly a form of acting out of destructive anger. Every psychotherapist wants to recognise early on signs of suicidal risk. There are many questions one can ask in the assessment interview or later, if and when danger signals appear. Here are a few:

When you wake up in the morning, can you face the day? Would you like to go to sleep and not to wake up? Have you thought of harming yourself, of putting an end to it all? If the patient answers yes, then one has to inquire further: What ways have you thought of harming yourself? What means would you use? Specific plans should alert the therapist to a serious risk. Also the patient's extreme sense of worthlessness or guilt or any expression such as "my children/partner would be better off without me", should ring alarm bells. Patients often say: "I would never kill myself because of what it would do to my family/children". This statement carries hope for survival.

Although the thought of suicide crosses most people's minds at one time or another of their lives, comparatively few attempt it in earnest. There is the often mentioned group of those who attempt suicide, but who have other goals than dying (e.g. attention-seeking, getting help, punishing others, etc.) This group has to be taken seriously too, because they put themselves in danger and things might go wrong.

See also ACTING OUT, ANGER, ASSESSMENT, DEPRESSION, DESTRUCTIVE ANGER, GUILT, HOPE, SELF-SABOTAGE, SHAME