Chapter 8 - Crisis of Lethality

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FOCUS OF LETHALITY

1.
2.

Instrumental - Acts of homicide that occur for some
financial or other concrete gain
Expressive - Acts designed to reduce psychological
pain (emotionally distraught, helpless, etc.)

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SCOPE OF SUICIDE CASES
In the U.S.:
* 30,000 to 35,000 every year
* May be underreported (many may be reported as accidental)
* May be as high as 60,000 per year
* 300,000-600,000 Attempts per year (19,000 survivors
permanently disabled)
* 10th -11th leading cause of death

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SCOPE OF SUICIDE CASES

In the U.S.:
* Age 15-24, largest increase in past 30 years
* Men, 4 times the rate than women
* Elderly (10% of US population) - 25% of all suicides
occur in the over 65 group, and much higher after 70

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SCOPE OF SUICIDE CASES
"If you are planning to become a mental
health professional, the odds are about 1
in 4 that you will come face to face with a
suicide."

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EUTHANASIA
* Assisted suicide - someone else provide the means
(lethal agent) but the person who is dying administers it
* Euthanasia - Someone else administers it.
"The appropriate role of the crisis worker
is to intervene and attempt to prevent all
suicides and homicides that he or she
possibly can."

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PSYCHOLOGICAL THEORIES OF SUICIDE
* Freudian Inward Aggression (Intrapsychic conflict when dealing with
psychological stress) Depressions becomes self-destructive
* Developmental ( one does not navigate life stages and are unable to
cope)
* Deficiencies (mental deficiency caused risk factors)
* Escape (Flight from situation that is intolerable)
* Hopelessness (there is nothing one can do to change a situation)
*Psychache (psych-ache) - (one has intolerable psychological pain)

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SOCIOLOGICAL THEORIES OF SUICIDE
* Durkheim's Social Integration
Societal integration - degree to which people are
bound together in social networks
Social regulation - degree to which the individual's
desires and emotions are regulated by societal norms and
customs

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SOCIOLOGICAL THEORIES OF SUICIDE
Durkheim's Social Integration
* Egoistic suicide - ones lack of integration or identification with a group
* Anomic suicide - a perceived or real breakdown in the norms of society
(such as financial and economic ruin)
* Altruistic suicide - perceived or real social solidarity, (such as 'hara-kiri'

or mid eastern extremist groups)
* Fatalistic suicide - when a person sees no way out of an intolerable or
oppressive situation (such as confined n a concentration camp)

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SOCIOLOGICAL THEORIES OF SUICIDE
Suicide Trajectory Model - considers multiple factors,
* biological (substance abuse, being male , genetic predisposition
to depression)
* psychological (low self-concept, hopelessness, borderline
personality disorder)
* cognitive (rigid, dogmatic, irrational, all-or-none thinking)
* environmental (access to firearms, stressful occupations, loss,
family)

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SOCIOLOGICAL THEORIES OF SUICIDE
Interpersonal Theory (three
components)
1. People acquire suicidal capability (decreasing fear of
death)
2. People perceive burdensomeness to others
3. Failed belongingness

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SOCIOLOGICAL THEORIES OF SUICIDE
Existential-Constructivist Framework
-Trigger events that come from suicide trajectory risk
factors
- combine to form the critical mass that allows the
individual to construct a worldview that it
- is a better choice to no longer view the world at all

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OTHER EXPLANATIONS
1. Accident (pushing their luck
2. Biochemical or neurochemical malfunction
3. Chaos (unpredictable behavior can occur within predictable
systems)
4. Dying with Dignity/rational suicide
5. Ecological/integrative (painful intrapsychic factors interact
with negative interpersonal/societal issues
6. Interactional - suicide because of external rage toward
another

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OTHER EXPLANATIONS
7. Ludic suicides - having the desire to experience an ordeal or a way to
prove oneself in gamesmanship (Russian roulette, tribal rite of passage)
8. Oblative suicides - Those that are sacrificial in nature and seen to put one

in a 'higher' place (LSD user who 'wants to meet God, or Buddhist monks
who set themselves on fire)
9. Overlap Model - Lack of social support, biological propensity to suicide,
and presence of psychiatric disorders (the more of these areas over-lap the
greater the potential for suicide
10 Parasuicide - (acts that closely resemble suicide, self injurious behavior,
risky behavior that could cause death)
11. Suicide by cop

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6 COMMON CHARACTERISTICS OF PEOPLE WHO
COMMIT SUICIDE

1. Situational Characteristics (unendurable psychological pain)
2. Motivational characteristics (The purpose is to see solution)
3. Affective characteristics (emotions of hopelessness and helplessness)
4. Cognitive characteristics (1. ambivalence between doing it and wanting
to be saved, (2. and perception of limited options
5. Relational characteristics 1) Communication of intention, 2) have the
right to get out of 'pain'
6. Serial characteristic - lifelong patterns of coping with pain

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SIMILARITIES BETWEEN SUICIDE AND HOMICIDE

* Often, the person who is suicidal is also homicidal

* 30% of violent individuals have a history of selfdestructive behavior
*10-20% of percent of suicidal persons have a history of
violent behavior

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MYTHS ABOUT SUICIDE
Read pages 216-217

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ASSESSMENT USING SUICIDE CLUES
1. Verbal clues - spoken or written, (I'm of no use to
anyone anymore)
2. Behavioral clues - purchasing a grave marker, slashing
wrist
3. Situational clues - bankruptcy, death of a spouse,
divorce, terminal illness
4. Syndromatic clues - severe depression, loneliness,
hopelessness, dependence, dissatisfaction with life

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WARNING SIGNS
IS PATH WARM:
Ideation
Substance Abuse

Purposelessness
Anxiety and agitation
(Feeling) Trapped
Hopelessness
Withdrawal
Anger
Recklessness
Mood fluctuations
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AAS
American Association of Suicidology

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ASSESSMENT INSTRUMENTS
"Are most helpful when backed up by a
clinical interview and third-party
collateral information."

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CLINICAL INTERVIEW
Page 219-220: When a person
manifests four or five of these risk
factors, it should be an immediate signal
for the crisis worker to treat the person

as high risk in terms of suicide potential.
* Some have more weight than others. (previous attempts
or having a concrete plan)
* As these risk factors add up, the potential increases.

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ASSESSING LETHALITY
When intervening client in acute
crises ....
* Never omit an assessment for suicide
lethality
* Do not hesitate to ask
* Don't sugarcoat
* Page 221: SIMPLE STEPS - step-by-step method
to assess lethality and get a good read on the client

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INTERVENTION STRATEGIES
Perturbations - Anxiety: mental
uneasiness
* A cause of such anxiety or uneasiness
* Synonyms: disturbance, trouble,
agitation, unrest, anxiety
Suicide Intervention strategies involve
"interrupting a suicide attempt that is
imminent or in the process of occurring"

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CRISIS INTERVENTION STRATEGIES
Two Categories
1. Dealing with perturbations (using The
Three I's)
2. Reducing lethality levels
When perturbation level is lowered and
some control and hope is restored in the
person's life, lethality will drop below the
explosive level.
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