Gary Speed, hanged himself in the garage last week and Phoebe Prince also committed suicide after being bullied by her school classmates. It just broke my heart to think that another poor innocent child has committed suicide due to being a victim of his/her peers. Then, I started thinking about these suicide attempts and why was it not preventable. It is astonishing that we have many technological and medical advances and suicidal behaviour has been studied for years and yet clinicians have yet to possess precise diagnostic criteria that can adequately detect high risk suicidal individuals at an early stage. Therapists still cannot say which client only has suicidal ideations and who will eventually attempt suicide.
For clarity sake I should define the terms. Suicidal ideations refer to cognitive preoccupation with thoughts of committing suicide. The construct also includes ideas such as a specific plan of self-injurious behaviour, expectations of outcome, the meaning given to suicide and implications of suicidal behavior (Reynolds, 1991). Intensity of ideations varies from fleeting thoughts to intense and concrete plans of killing oneself. Suicidal behaviour is a term that refers to a continuum which starts with suicidal ideations and is followed by suicide contemplation. Suicide contemplation includes planning and preparations for the deed. The following stage is suicide attempts and the final and most extreme point of the continuum is suicide completion. The path to suicide behaviour is multidimensional. The underlying components are dynamic and interactive.
The fatality and the extreme fragility of suicide attempters make suicide a very challenging topic to research. An additional obstacle to suicide research is low self-disclosure. The subject of suicide is still a taboo in our society. It generates shame, fear, guilt and disgrace. People feel uncomfortable acknowledging and discussing its existence. Individuals who think of suicide try to deny, ignore and avoid their own thoughts. Confronting the existence of the thoughts is a shocking and a painful experience. Self-disclosure is imperative for the clinician. Low self-disclosure limits diagnosis and the application of preventive strategies. The relationship between low self-disclosure levels and suicidality is mediated by anxiety and depression. Low self-disclosure can predict the lethality and seriousness of the suicide attempt (Apter et al., 2001). Low self-disclosure is a more important risk factor for near lethal suicide attempts than psychiatric illness and the presence of mental pain (Levi et al., 2008).
A few years ago many Israeli soldiers and veterans attempted suicide within a short period. The stereotype of the suicidal veterans at the time was a white male, who suffers from depression, alcoholism, physical problems and receives low social support. I decided that more specific scientific assessment must be made. I had the innovative idea to use content analysis, in order to discover the psychological states, which may increase suicidal risk and which is not necessarily also explicitly reported by the veterans. Content analysis is based on the hypothesis that words that people choose can contain information about their psychological states (Viney, 1983). Analyzing verbal communication can help to interpret the way a person experiences him/herself and the surroundings on conscious and unconscious levels. The use of content analysis thus prevents the veterans from feeling overexposed, while at the same time unveils important information, which otherwise may not have been revealed. I used the PCAD 2000 to examined anxiety, hostility, personal disorganization or schizophrenia, depression, cognitive and intellectual impairment, hope, hopelessness, human relations, self-accusation, somatic concerns, achievement strivings, psychomotor retardation, support, dependency strivings and frustrated dependency strivings, deterrents, health-sickness and quality of life (Gottschalk & Bechtel 1998-2003). By analyzing, comparing and making a distinction between suicide attempters and suicide ideators, I determined the potential risk factors, which enhance the risk of an escalation of suicidal ideations towards a suicide attempt. The result of the research can be read at:
Galor, S., & Hentschel, U. (2009). Analysis of suicidal behaviour in Israeli veterans and terror victims with PTSD by using the computerised Gottschalk-Gleser scales. Clinical psychologist, 13, 3, 102-110.
I want to use this opportunity to shout out to all the researchers to do something about this problem. The DSM-IV would not exist without the acquirement of specific diagnostic criteria to the many pathologies and suicidal behaviour should not be an exception. Think big when designing your research. Don’t just study one or two variables; put the effort and innovation into your design and think of patterns and clusters of psychological variables. We need to find more population specific vulnerability factors that could alert diagnosticians and therapists to the risk of suicide attempts much quicker. Suicidal ideation is a transient phase. By recognizing and detecting the presence of the suicide attempt risk variables among suicide ideators, preventive measures could be taken in time. It is up to the researches to arm the clinicians with the right tools that will enable them to battle suicidal behaviour and save lives. This precious information must not only be found but also spread.
Apter, A., Horesh, N., Gothelf, D., Graffi, H., & Lepkifker, E. (2001). Relationshipbetween self-disclosure and serious suicidal behavior. Comprehensive Psychiatry, 42, 1, 70-75.
Gottschalk, L. A., & Bechtel, R. J. (1998-2003). PCAD 2000 – Psychiatric Content Analysis and Diagnosis. Corona del Mari, CA: GB software.
Levi, Y., Horesh, N., Fischel, T., Treves, I., Or, E., & Apter, A.( 2008). Mental pain and it’s communication in medically serious suicide attemptes: an impossible situation. Journal of Affective Disorders, 111, 2, 244-250.
Reynold, W. M. (1991). Psychometric characteristic of the adult suicidal ideation questionnaire in college students. Journal of Personality Assessment, 56, 2, 289-307.
Viney, L. L. (1983). The assessment of psychological states through content analysis of verbal communications. Psychological Bulletin, 94, 3, 542-563.