Suicide is the act of intentionally causing one's own death. Mental disorders, including depression, bipolar disorder, schizophrenia, personality disorders, anxiety disorders, and substance abuse—including alcoholism and the use of benzodiazepines—are risk factors.
Some suicides are impulsive acts due to stress, such as from financial difficulties, relationship problems such as breakups, or bullying.
Those who have previously attempted suicide are at a higher risk for future attempts.
The most commonly used method of suicide varies between countries, and is partly related to the availability of effective means.
Suicides resulted in 828,000 global deaths in 2015, an increase from 712,000 deaths in 1990. This makes suicide the 10th leading cause of death worldwide.
Views on suicide have been influenced by broad existential themes such as religion, honor, and the meaning of life. The Abrahamic religions traditionally consider suicide as an offense towards God, due to the belief in the sanctity of life.
During the samurai era in Japan, a form of suicide known as seppuku (harakiri) was respected as a means of making up for failure or as a form of protest.
Sati, a practice outlawed by the British Raj, expected the Indian widow to kill herself on her husband's funeral fire, either willingly or under pressure from her family and society.
Suicide and attempted suicide, while previously illegal, are no longer so in most Western countries. It remains a criminal offense in many countries.
In the 20th and 21st centuries, suicide has been used on rare occasions as a form of protest, and kamikaze and suicide bombings have been used as a military or terrorist tactic.
Suicidal ideation, also known as suicidal thoughts, is thinking about, considering, or planning suicide. The range of suicidal ideation varies from fleeting thoughts, to extensive thoughts, to detailed planning.
Most people who have suicidal thoughts do not go on to make suicide attempts, but suicidal thoughts are considered a risk factor.
Suicidal ideation is generally associated with depression and other mood disorders; however, it seems to have associations with many other mental disorders, life events, and family events, all of which may increase the risk of suicidal ideation.
For example, many individuals with borderline personality disorder exhibit recurrent suicidal behaviour and suicidal thoughts. One study found that 73% of patients with borderline personality disorder have attempted suicide, with the average patient having 3.4 attempts.
Some symptoms or co-morbid conditions may include unintentional weight loss, feeling helpless, feeling alone, excessive fatigue, low self-esteem, presence of consistent mania, excessively talkative, intent on previously dormant goals, feel like one's mind is racing.
The onset of symptoms like these with an inability to get rid of or cope with their effects, a possible form of psychological inflexibility, is one possible trait associated with suicidal ideation. They may also cause psychological distress, which is another symptom associated with suicidal ideation.
Symptoms like these related with psychological inflexibility, recurring patterns, or psychological distress may in some cases lead to the onset of suicidal ideation. Other possible symptoms and warning signs include:
- Hopelessness
- Anhedonia
- Insomnia or oversleeping
- Loss of appetite or overeating
- Depression
- Severe anxiety
- Impaired concentration
- Psychomotor agitation
- Panic attack
- Loneliness
There are numerous indicators that one can look for when trying to detect suicidal ideation. There are also situations in which the risk for suicidal ideation may be heightened. The risk factors for suicidal ideation can be divided into three categories: psychiatric disorders, life events, and family history.
There are several psychiatric disorders that appear to be comorbid with suicidal ideation or considerably increase the risk of suicidal ideation.
- Attention deficit hyperactivity disorder (ADHD)
- Post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (C-PTSD)
- Personality disorders
- Psychosis (detachment from reality)
- Paranoia
- Schizophrenia
- Substance use disorders, inhalant use disorder
- Body dysmorphic disorder
- Nightmare disorder
- Gender dysphoria
The list includes the disorders that have been shown to be the strongest predictors of suicidal ideation. These are not the only disorders that can increase risk of suicidal ideation.
Some prescription drugs, such as selective serotonin re-uptake inhibitors (SSRIs), can have suicidal ideation as a side effect. Moreover, these drugs' intended effects, can themselves have unintended consequence of an increased individual risk and collective rate of suicidal behavior.
Among this subset, a "sub-subset" may find that the medication alleviates their physiological symptoms (such as lack of energy) and secondary psychological symptoms (e.g., lack of motivation) before or at lower doses than it alleviates their primary psychological symptom of depressed mood.
Among this group of persons, the desire for suicide or its effects persists even as major obstacles to suicidal action are removed, with the effect that the incidences of suicide attempt and of completed suicide increase.
Life events are strong predictors of increased risk for suicidal ideation. Furthermore, life events can also lead to or be comorbid with the previous listed psychiatric disorders and predict suicidal ideation through those means. Life events that adults and children face can be dissimilar and for this reason, the list of events that increase risk can vary in adults and children.
According to a study conducted by Ruth X. Liu of San Diego State University, a significant connection was found between the parent–child relationships of adolescents in early, middle and late adolescence and their likelihood of suicidal ideation.
The study consisted of measuring relationships between mothers and daughters, fathers and sons, mothers and sons, and fathers and daughters. The relationships between fathers and sons during early and middle adolescence show an inverse relationship to suicidal ideation. Closeness with the father in late adolescence is "significantly related to suicidal ideation".
Liu goes on to explain the relationship found between closeness with the opposite sex parent and the child's risk of suicidal thoughts. It was found that boys are better protected from suicidal ideation if they are close to their mothers through early and late adolescence; whereas girls are better protected by having a close relationship with their father during middle adolescence.
Early detection and treatment are the best ways to prevent suicidal ideation and suicide attempts. If signs, symptoms, or risk factors are detected early then the individual might seek treatment and help before attempting to take their own life. In a study of individuals who did commit suicide, 91% of them likely suffered from one or more mental illnesses.
Another study investigated strictly suicidal ideation in adolescents. This study found that depression symptoms in adolescents early as 9th grade is a predictor of suicidal ideation. Most people with long-term suicidal ideation do not seek professional help.
Treatment of suicidal ideation can be problematic due to the fact that several medications have actually been linked to increasing or causing suicidal ideation in patients. Therefore, several alternative means of treating suicidal ideation are often used. The main treatments include: therapy, hospitalization, outpatient treatment, and medication or other modalities.
In psychotherapy a person explores the issues that make them feel suicidal and learns skills to help manage emotions more effectively.
Outpatient treatment allows individuals to remain at their place of residence and receive treatment when needed or on a scheduled basis. Being at home may improve quality of life for some patients, because they will have access to their personal belongings, and be able to come and go freely.
Prescribing medication to treat suicidal ideation can be difficult. One reason for this is that many medications lift patients' energy levels before lifting their mood. This puts them at greater risk of following through with attempting suicide. Additionally, if a person has a comorbid psychiatric disorder, it may be difficult to find a medication that addresses both the psychiatric disorder and suicidal ideation.
Existential nihilism is the philosophical theory that life has no intrinsic meaning or value. With respect to the universe, existential nihilism suggests that a single human or even the entire human species is insignificant, without purpose and unlikely to change in the totality of existence.
According to the theory, each individual is an isolated being born into the universe, barred from knowing ‘why’. The inherent meaninglessness of life is largely explored in the philosophical school of existentialism, where one can potentially create their own subjective ’meaning’ or ’purpose’. Of all types of nihilism, existential nihilism has received the most literary and philosophical attention.
The theory purports to describe the human situation to create a life outlook and create meaning, which has been summarized as, "Strut, fret, and delude ourselves as we may, our lives are of no significance, and it is futile to seek or to affirm meaning where none can be found." Existential nihilists claim that, to be honest, one must face the absurdity of existence, that he/she will eventually die, and that both religion and metaphysics are simply results of the fear of death.
"There is no justification for life, but also no reason not to live. Those who claim to find meaning in their lives are either dishonest or deluded. In either case, they fail to face up to the harsh reality of the human situations".
The concept of nihilism was discussed by the Buddha (563 B.C. to 483 B.C.), as recorded in the Theravada and Mahayana Tripiṭaka. The Tripiṭaka, originally written in Pali, refers to nihilism as ‘natthikavāda’ and the nihilist view as ’micchādiṭṭhi’.
Various sutras within it describe a multiplicity of views held by different sects of ascetics while the Buddha was alive, some of which were viewed by him to be morally nihilistic.
In the Doctrine of Nihilism in the Apannaka Sutta, the Buddha describes moral nihilists as holding the following views:
- Giving produces no beneficial results
- Good and bad actions produce no results
- After death, beings are not reborn into the present world or into another world
- There is no one in the world who, through direct knowledge, can confirm that beings are reborn into this world or into another world
The Buddha then states that those who hold these views will not see the danger in misconduct and the blessings in good conduct and will, therefore, avoid good bodily, verbal and mental conduct; practicing misconduct instead.
The culmination of the path that the Buddha taught was Nirvana, "a place of nothingness... nonpossession and... non-attachment... [which is] the total end of death and decay".
A practising Buddhist monk of more than 30 years, observes that in English 'nothingness' can sound like nihilism. However the word could be emphasized in a different way, so that it becomes 'no-thingness', indicating that Nirvana is not a thing you can find, but rather a state where you experience the reality of non-grasping.
In the Alagaddupama Sutta, the Buddha describes how some individuals feared his teaching because they believe that their 'self' would be destroyed if they followed it. He describes this as an anxiety caused by the false belief in an unchanging, everlasting 'self'.
All things are subject to change and taking any impermanent phenomena to be a 'self' causes suffering. Nonetheless, his critics called him a nihilist who teaches the annihilation and extermination of an existing being.
The Buddha's response was that he only teaches the cessation of suffering. When an individual has given up craving and the conceit of 'I am' their mind is liberated, they no longer come into any state of 'being' and are no longer born again.
The Aggivacchagotta Sutta records a conversation between the Buddha and an individual named Vaccha that further elaborates on this. In it Vaccha asks the Buddha to confirm one of the following, with respect to the existence of the Buddha after death:
- After death a Buddha reappears somewhere else
- After death a Buddha does not reappear
- After death a Buddha both does and does not reappear
- After death a Buddha neither does nor does not reappear
To all four questions, the Buddha answers that the terms 'appear', 'not appear', 'does and does not reappear' and 'neither does nor does not reappear' do not apply.
When Vaccha expresses puzzlement, the Buddha asks Vaccha a counter question to the effect of: if a fire were to go out and someone were to ask you whether the fire went north, south, east or west, how would you reply? Vaccha replies that the question does not apply and that an extinguished fire can only be classified as 'out'.
Thanissaro Bikkhu elaborates on the classification problem around the words 'reappear' etc. with respect to the Buddha and Nirvana by stating that a "person who has attained the goal [Nirvana] is thus indescribable because [they have] abandoned all things by which [they] could be described".
The Suttas themselves describe the liberated mind as 'untraceable' or as 'consciousness without feature', making no distinction between the mind of a liberated being that is alive and the mind of one that is no longer alive.
A distinct feature of Nirvana in Buddhism is that an individual attaining it is no longer subject to rebirth.
Søren Kierkegaard (1813–1855) posited an early form of nihilism, which he referred to as leveling. He saw leveling as the process of suppressing individuality to a point where an individual's uniqueness becomes non-existent and nothing meaningful in one's existence can be affirmed
Levelling at its maximum is like the stillness of death, where one can hear one's own heartbeat, a stillness like death, into which nothing can penetrate, in which everything sinks, powerless.
One person can head a rebellion, but one person cannot head this levelling process, for that would make him a leader and he would avoid being levelled. Each individual can in his little circle participate in this levelling, but it is an abstract process, and levelling is abstraction conquering individuality.
Leveling is a social process in which the uniqueness of the individual is rendered non-existent by assigning equal value to all aspects of human endeavours, thus missing all the intricacies and subtle complexities of human identity.
Certain depictions of suicide may increase its occurrence, with high-volume, prominent, repetitive coverage glorifying or romanticizing suicide having the most impact. When detailed descriptions of how to kill oneself by a specific means are portrayed, this method of suicide may increase in the population as a whole.
It is unclear if searching for information about suicide on the Internet relates to the risk of suicide.
Trauma is a risk factor for suicidality in both children and adults. Some may take their own lives to escape bullying or prejudice. A history of childhood sexual abuse and time spent in foster care are also risk factors.
Sexual abuse is believed to contribute to approximately 20% of the overall risk. Significant adversity early in life has a negative effect on problem-solving skills and memory, both of which are implicated in suicidality.
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