Understanding suicide as an action.

Abstract

In 1763, Johann Bernhard Merian (1723-1807), a Swiss philosopher, introduced the concept of suicide as illness, stating that suicide is not a criminal act but a mental illness. In 1838, Jean Etienne Dominique Esquirol (1772-1840), a French psychiatrist, described suicide as a symptom of mental illness. These contributions represent important steps in freeing the discussion of suicide from a criminal, religious, and moral perspective and moving it to a treatment context (Maltsberger & Goldblatt, 1996; see also Chapter 2, this volume). Indeed, treating suicide within an illness paradigm continues to prevail to the present day (Jobes, 2006). However, should we continue to understand suicide solely as a symptom of a mental disorder? As much as this approach may be helpful, it hinders us in truly seeing suicidal persons as actively constructing their lives and potentially their suicidal behavior therein.The biomedical illness model implies that the health professional has to find the cause of the patient's pathology and then treat the disorder. However, suicide and attempted suicide are both actions that are often planned in advance or show a sequence of steps to achieve the fatal outcome largely conscious to the individual. They are not mere signs of illness and pathology. A patient-oriented understanding of the reasons for suicidal thoughts or deliberate Each victim of suicide gives his act a personal stamp which expresses his temperament, the special conditions in which he is involved, and which, consequently, cannot be explained by the social and general causes of the phenomenon.- Durkheim (1951, p. 277) Men often act knowingly against their interest.-Hume (2003, p. 297)

The Role of Self-Organization in the Suicidal Process

“…Furthermore, 69% of the sample experienced only fluctuating or no suicidal thoughts at all. Moreover, Valach, Young, and Michel (2011) provided a case example of a female suicide attempter (to which we will refer back later in more detail), where controlling and monitoring the suicidal behavior seemed subjectively to be impossible for the patient.…”

“…Furthermore, behavior (output function) can be self-organized, so that when triggered by a perceived environmental stimulus, the action differs from what was initially intended (Kugler & Turvey, 1987). The first illustration of this model and especially this link between perception, and behavior is the case example of a female suicide attempter provided by Valach et al. (2011).…”

“…My sister’s flat had a terrace to which the door was open, and I thought that the door should be closed, because I had the feeling that I was like being pushed out through the door. (Valach et al., 2011, pp. 140–141)

Figure 3.Self-organization embedded in a feedback-control-model.

…”

“…My sister saw me at the last moment and asked what I was doing and then I jumped. (Valach et al., 2011, p. 141)Finally, self-organized processes took place on the level of behavior (output function). It seems that the behavior ran without the explicit goal of killing herself, rather being triggered by a perceptual input to reduce high-inner tension.…”

States of Self as Agents of Self-Killing: An Egogram-based Suicide Note Analysis Study in Russia

“…Ringel's (1976) concept of 'the presuicidal syndrome' emphasised similar cognitive and emotional experience of a suicidal individual: increasing personal-situative and dynamic-affective constraint; rigidity of perception, association, behaviour patterns, affect and defense mechanisms; narrowing of interpersonal relationships and sense of values; inhibition of aggressive feelings and directing them to one's own self (autoaggression); feelings of isolation; and suicidal fantasies that occur spontaneously, beyond the person's control. Similar to Shneidman (1985), Valach, Young & Michel (2011) believed that people on the edge of suicide experienced unbearable psychological pain (psychache) associated with altered consciousness, dissociation, automatisms, and analgesia, which prompted suicide action as an attempt to sustain one's identity and positive self-image. Skogman Pavulans, Bolmsjo, Edberg Kidder & Öjehagen (2012) considered an "acute suicidal state of mind" as the experience of "being past the point of no return" (p. 8).…”