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Myths

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									  Myths About Suicide

      Thomas Joiner, Ph.D.
The Robert O. Lawton Distinguished
     Professor of Psychology
    Department of Psychology
     Florida State University
       joiner@psy.fsu.edu
Suicide may just be the most
 stigmatized of human
 activities – it is even more
 stigmatized than appalling
 things like slavery and murder
 – and therefore a powerful
 mythology has arisen around
 it.
The stigma can be
 seen in many ways:
 Bereaved
 experience a change
 in their address
 books, as people
 they thought they
 could count on
 avoid them.
So let’s just do away with
 stigma, right?
Not only is it not easy, but

stigma = fear + ignorance
Some things in nature should be feared,
 do deserve a healthy dose of respect
Fears are wired into us, and this wiring
 can be sensitive
Moreover, the lack of fear
 characterizes some of our most
 deranged and dangerous
 individuals.
Further still, in my book Why
 People Die By Suicide, I argued
 that the loss of fear – at least of
 physical pain, physical injury,
 and death – removes a barrier to
 suicide, and is therefore
 dangerous.
 Cobain was temperamentally
 fearful – afraid of needles, afraid of
 heights, and, crucially, afraid of
 guns. Through repeated exposure,
 a person initially afraid of needles,
 heights, and guns later became a
 daily self-injecting drug user,
 someone who climbed and dangled
 from 30 foot scaling during
 concerts, and someone who
 enjoyed shooting guns.
    Regarding guns, Cobain initially felt
    that they were barbaric and wanted
    nothing to do with them; later he
    agreed to go with his friend to shoot
    guns but would not get out of the car;
    on later excursions, he got out of the
    car but would not touch the guns; and
    on still later trips, he agreed to let his
    friend show him how to aim and fire.
    He died by self-inflicted gunshot
    wound in 1994 at the age of 27.
 Mental  disorders,
 which spur death by
 suicide, are forces
 of nature, and thus
 deserve our respect
 and even fear (but
 not our
 resignation).
Let’s Leave Fear Be


 Stigma   = fear + ignorance
Decreasing Ignorance via
Dismantling of Myths

 Many myths about suicide
 are so ingrained that we may
 not be able to reduce
 ignorance until we undo these
 myths.
Categories of Myths

Myths about the suicidal mind

Myths about suicidal behavior

Myths about the nature of
 suicide
Myths About the Suicidal Mind
 MYTH: Suicide is primarily about
  – Cowardice – MYTH!!!
  – Weakness – MYTH!!!
  – Revenge – MYTH!!!
  – Selfishness – MYTH!!!
  – Self-Control – MYTH!!!
  – Impulsivity – MYTH!!!
Myths About Suicidal Behavior
 MYTH: Suicide is primarily
  characterized by
  – Note leaving – MYTH!!!
  – “Slow” forms of suicide (e.g., smoking) –
    MYTH!!!
  – “Rational” suicide – MYTH!!!
  – A cry for help – MYTH!!!
  – Complete resolve and intent to die –
    MYTH!!!
Myths About the Nature of Suicide
 MYTH: Suicide is
  – Limited to humans – MYTH!!!
  – Not seen in young children – MYTH!!!
  – Caused by things like breast
    augmentation – MYTH!!!
  – More common in winter – MYTH!!!
Myths About the Suicidal Mind
 MYTH: Suicide is primarily about
  – Cowardice – MYTH!!!
  – Weakness – MYTH!!!
  – Revenge – MYTH!!!
  – Selfishness – MYTH!!!
  – Self-Control – MYTH!!!
  – Impulsivity – MYTH!!!
Sketch of the Theory
 Those Who
Desire Suicide


   Perceived
Burdensomeness
                      Those Who Are
                    Capable of Suicide

   Thwarted
 Belongingness


     Serious Attempt or Death by Suicide
Suicide Requires Fearlessness;
Cowardice Will Prevent It
 Death by any means – including
  suicide – is fearsome and daunting.
  We are self-preserving creatures, wired
  in our cells and souls to fear death.
 Even intently and deeply suicidal
  people are subject to this fear, as we
  will see.
Suicide Requires Fearlessness;
Cowardice Will Prevent It

The fearlessness is specifically
  about physical pain, physical
  injury, and death, and this
  fearlessness is distinct from
  concepts like courage, bravery,
  and heroism.
Why I Jumped by Tina Zahn
 In the midst of a recurrent, very severe
 (at times near-catatonic) postpartum
 depression, Zahn decided to jump off a
 bridge near Green Bay, Wisconsin.
 She fled relatives in her car, who called
 police. Police clocked her at 120 mph.
 Still, she is ambivalent, some signs of
 which show up in the following video.
The Documentary The Bridge
 Photographer saves
 someone who is pondering
 jumping from the Golden
 Gate Bridge.
 Here too, behavioral
 indicators of ambivalence.
Incident at Train Tracks
Person balks at the last
 moment, thus saving her
 life.
Meriwether Lewis (of Lewis &
Clark fame)
   From Stephen Ambrose’s biography of
    Lewis, Undaunted Courage:
    – Lewis paced for several hours (agitation), as
      others could hear him all night as the floorboards
      creaked.
    – Two self-inflicted gunshot wounds, neither fatal.
    – Servants found him “busily cutting himself from
      head to foot.”
    – Lewis said to servants, “I am no coward, but I am
      strong, it is so hard to die.” He died a few hours
      later.
Hesitation Wounds
 What are they?
 Virtually everyone who dies by self-
  inflicted knife wound has hesitation
  wounds around the site of the lethal
  injury.
 Why do even intently suicidal people
  hesitate (and some are saved during
  hesitation)? They hesitate because
  they feel fear.
Suicide in Anorexia Nervosa
 Mortality is extremely high in anorexic
  women (SMR = ~60).
 It is an under-appreciated fact that,
  should an anorexic patient die
  prematurely, the cause of death is more
  likely to be suicide than complications
  arising from compromised nutritional
  status.
Suicide in Anorexia Nervosa
 There are at least two possible
 accounts of the high association
 between AN and suicide. In one view,
 anorexic women die by suicide at high
 rates because they are unable to
 survive relatively low lethality
 attempts and/or they may be less likely
 to be rescued after an attempt due to
 their socially isolated status.
Suicide in Anorexia Nervosa
 In another view, informed by my
 theory of suicidal behavior, anorexic
 women die by suicide at high rates
 because their histories of self-
 starvation habituate them to pain and
 inure them to fear of death, and they
 therefore make high lethality attempts
 with high intent-to-die.
Suicide in Anorexia Nervosa
 We pitted these two accounts against
 each other, in a study of 239 women
 with AN, followed over ~15 years.
 9 died by suicide, the leading cause of
 death among the sample.
 Of these 9, were they mostly highly
 lethal methods or not?
Suicide in Anorexia Nervosa
 The least lethal method: Ingestion of 12
 oz. of a household cleaning product,
 along with an unknown amount of a
 powerful sedative and alcohol (BAC =
 0.16%). Cause of death was gastric
 hemorrhaging due to hydrochloric acid
 in the cleaning product.
  – 911 (intently suicidal feel fear too).
  – Might Bitrix have prevented this?
Myths About the Suicidal Mind
 MYTH: Suicide is primarily about
  – Cowardice – MYTH!!!
  – Weakness – MYTH!!!
  – Revenge – MYTH!!!
  – Selfishness – MYTH!!!
  – Self-Control – MYTH!!!
  – Impulsivity – MYTH!!!
Myths About the Suicidal Mind

 The Impulsivity Myth
  – Three instructive incidents
     • Christine Chubbuck
     • David Foster Wallace
     • Skydiving incident
Christine Chubbuck
 MYTH: She died by suicide
 impulsively, on live TV, while
 reporting the local news.
Christine Chubbuck
 TRUTH: She died by suicide on live TV,
 while reporting the local news, after a very
 long process of planning and deliberation.
Christine Chubbuck

Suicide attempt four years before
 her death.
Frequent talk of suicide.
Asked police officer about lethality
 of wound site.
A week before death, bought a
 gun.
Christine Chubbuck

Days before death, she “joked”
 with colleague about shooting
 herself on the air.
Day of death, stowed gun in prop
 bag, and brought it to the
 newsdesk.
Christine Chubbuck
 TRUTH CONTINUED: One aspect of
 her death contained an impulsive
 element, the basis on which her death
 has been misunderstood.
David Foster Wallace

Severe major depressive
 disorder, very well
 controlled for nearly 20
 years by MAOI.
David Foster Wallace
When illness was well
  controlled, he did his life’s
  work, including Infinite Jest
  (all 1104 pages of it), work
  which in part won him a
  MacArthur fellowship.
David Foster Wallace

MYTH: He died
 by suicide
 impulsively; in a
 brief window of
 time when his wife
 left their house, he
 impulsively died
 by hanging.
David Foster Wallace
 TRUTH: He made
 the disastrous
 decision to go off of
 MAOI, could not
 get illness back
 under control, and
 died by suicide over
 a year later.
Intently Suicidal People Know
That Death Is Difficult to Enact
   Many documented cases of
    people who take planful
    steps to prevent their
    bodies from reacting and
    saving them (e.g., binding
    hands before death by
    hanging).
Skydiving Incident in New York
State
    MYTH: Man went with
    friends to take pictures as
    the friends skydived; he
    impulsively jumped to his
    death from the plane.
Skydiving Incident in New York
State
    TRUTH: Man was not
    friends with others; had asked
    pilot if he could board and
    take photos the week before;
    had asked others their
    preference between jumping
    from a building vs. a plane.
Sources of the Impulsivity Myth

Empirical link (correlation and
 causation).
“Out of the blue” appearance.
May ease bereavement.
Myths About the Suicidal Mind
 MYTH: Suicide is primarily about
  – Cowardice – MYTH!!!
  – Weakness – MYTH!!!
  – Revenge – MYTH!!!
  – Selfishness – MYTH!!!
  – Self-Control – MYTH!!!
  – Impulsivity – MYTH!!!
Misunderstanding Suicide as Selfish
    Suicide “is generally prompted
    by the most sordid and
    unworthy selfishness. It is a
    crime which sacrifices
    everything on the altar of
    individual feeling.” Samuel
    Miller, 1805, Presbyterian
    minister.
Sketch of the Theory
 Those Who
Desire Suicide


   Perceived
Burdensomeness
                      Those Who Are
                    Capable of Suicide

   Thwarted
 Belongingness


     Serious Attempt or Death by Suicide
Perceived Burdensomeness

Essential calculation:
 “My death is worth more
 than my life to my loved
 ones/family/society.”
Perceived Burdensomeness:
Empirical Evidence
 Many studies to date have directly
 tested this view; all support it.
  – For example, we trained raters to evaluate actual
    suicide notes regarding the following dimensions:
    perceived burdensomeness; hopelessness; and
    generalized emotional pain. Unknown to the raters,
    half of the notes were from people who died by
    suicide, and half were from people who attempted
    suicide and survived. The notes from those who died
    by suicide contained more perceived burdensomeness
    than notes from attempters; no effects were found
    regarding hopelessness and emotional pain.
  Joiner et al. (2002). Perceived burdensomeness and suicidality: Two
     studies on the suicide notes of those attempting and those completing
     suicide. Journal of Social & Clinical Psychology, 21, 531-545
Perceived Burdensomeness:
Empirical Evidence
Other research too has supported
 this link.
  – For example, Brown, Comtois, & Linehan
    (2000) reported that genuine suicide attempts
    were often characterized by a desire to make
    others better off, whereas non-suicidal self-
    injury was often characterized by desires to
    express anger or punish oneself.
  Brown, M.Z., Comtois, K.A., & Linehan, M.M. (2002). Reasons
    for suicide attempts and nonsuicidal self-injury in women with
    borderline personality disorder. Journal of Abnormal
    Psychology, 111, 198-202.
Perceived Burdensomeness:
Anecdotal Evidence
 Among the Yuit Eskimos of St.
 Lawrence Island, to become too sick,
 infirm, or old may threaten the
 group’s survival (i.e., burden the
 group); the explicit and socially
 sanctioned solution to this problem is
 ritual suicide. The ritual is graphic,
 often involving the family members’
 participation in the shooting or
 hanging of the victim
Perceived Burdensomeness:
Anecdotal Evidence
 Burn victim: "I felt my mind slip back
 into the same pattern of thinking I'd had
 when I was fourteen [when he
 attempted suicide]. I hate myself. I'm
 terrible. I'm not good at anything.
 There's no point in me hanging around
 here ruining other people's lives. I've
 got to get out of here. I've got to figure
 out a way to get out of my life."
Misunderstanding Selfishness

Confusing selfishness with
 cognitive constriction.
 –Car crash incident.
 –“Suicide is painless”
  incident.
Misunderstanding Selfishness
“Persons of great dignity and pride
 may find it necessary to destroy
 their own lives under circumstances
 in which those with a shallower
 scope of feeling can adjust with
 only moderate damage.”
  –Hervey Cleckley, 1941, The Mask
   of Sanity.
Speaking of Cleckley
 What is the most selfish mental disorder?
 “Cleckley psychopathy” (cf. DSM-5
 proposed revision).

 In what disorder do virtually no suicides
 occur? “Cleckley psychopathy.”

    - prisoner video
Speculations on the Suicidal Mind
   An inward gaze of bemused
    resignation and resolution.
Speculations on the Suicidal Mind
Speculations on the Suicidal Mind
 Death and Life Merging
Cobain: “I am my own
 parasite.”
 Plath: “The woman is perfected./ Her
 dead/Body wears the smile of
 accomplishment…/her bare/ feet seem to
 be saying: / we have come so far; it is
 over.”
Categories of Myths

Myths about the suicidal mind

Myths about suicidal behavior

Myths about the nature of
 suicide
Myths About Suicidal Behavior
 MYTH: Suicide is primarily
  characterized by
  – Note leaving – MYTH!!!
  – “Slow” forms of suicide (e.g., smoking) –
    MYTH!!!
  – “Rational” suicide – MYTH!!!
  – A cry for help – MYTH!!!
  – Complete resolve and intent to die –
    MYTH!!!
Suicide Notes
 MYTH: Those who die by suicide
  usually leave a note.

 TRUTH: Note-leaving is rare;
  approximately 20% of people who die
  by suicide leave a note.
Why Are Suicide Notes Rare?
 Alienation/isolation.
 Misery makes it hard to think straight
  and thus hard to write anything,
  especially something as momentous as
  a final goodbye.
 It’s not impulsivity – we already dealt
  with that, and, carefully planned deaths
  with no note are common.
Suicide Note Excerpts
 “I will give you $5000, that’s what I figured
  I owe you. I left your contract and listings
  on the desk;”
 “Please call the police before you open the
  door, I have shot myself;”
 “Police, my car keys are in my pocket.
  Please drive my car home. My daughter
  needs it to drive back-and-forth to work;”
 “You have my permission to withdraw all
  my savings etc. to pay off bills.”
Suicide Note Excerpts
 The commonality?
  – Concrete
  – Cognitively Constricted

  Compare to “Suicide is painless,” a
   fake note.
Myths About Suicidal Behavior
 MYTH: Suicide is primarily characterized
  by
  – Note leaving – MYTH!!!
  – “Slow” forms of suicide (e.g., smoking) –
    MYTH!!!
  – “Rational” suicide – MYTH!!!
  – A cry for help – MYTH!!!
  – Complete resolve and intent to die – MYTH!!!
“Slow” Suicide
“Slow” Suicide
Why did Farley (and so many
others, famous and lesser known
alike) continue very extensive use
of drugs that he had been told and
understood may well kill him? It
was not be because he liked death,
it was because he liked drugs – he
liked them so much that the risks
be damned.
“Slow” Suicide
Why do people who
know they should not
smoke anymore do so
anyway, at great risk to
their lives? It is not
because they like death,
it is because they like
smoking.
“Slow” Suicide

Why do anorexic women persist in
their behavior despite everyone
advising them not to? It is not
because they want to die, but
rather, they are “dying to be thin.”

- video
“Slow” Suicide

Crucial concept is intent.
Suicidal people intend to die
(though they retain ambivalence,
as we have seen).

Smokers, anorexics, etc., intend
other things.
Myths About Suicidal Behavior
 MYTH: Suicide is primarily
  characterized by
  – Note leaving – MYTH!!!
  – “Slow” forms of suicide (e.g., smoking) –
    MYTH!!!
  – “Rational” suicide – MYTH!!!
  – A cry for help – MYTH!!!
  – Complete resolve and intent to die–
    MYTH!!!
“Rational” Suicide
 “in the large proportion
  of cases, if not the
  majority, suicide is
  committed by sane
  people.” John Gray,
  1871, American
  Journal of Insanity.
 But what did he mean
  by “sane?”
“Rational” Suicide
By “sane,” he meant non-psychotic.


His view is thus compatible with
 mine: Virtually everyone, very
 close to 100%, who dies by suicide
 has a mental disorder or subclinical
 variant thereof at the time of death.
“Rational” Suicide
If “virtually everyone” is defined as
 greater than 90%, there is wide
 consensus on this point.
It is the remaining 10% or so that
 are in question. Some feel that
 some “rational” suicides occur in
 this subset; I believe this subset all
 have mental disorders.
“Rational” Suicide
What is a “partial syndrome” or
 “subclinical variant” of mental
 disorders?
Consider this case example:
  – Insomnia
  – Suicidal ideas
  – Feelings of sadness
“Rational” Suicide

Imagine further that the
 insomnia is noticed by the
 spouse but brushed off and
 dismissed because the person
 says “it’s nothing.” The suicidal
 ideas and feelings of sadness are
 not disclosed to anyone.
“Rational” Suicide
The person dies by suicide, leaving a
 note saying, “For the record, I do
 not have a mental disorder.”

Did he though?

And will the family believe his was a
 “rational” suicide (and that it was
 impulsive by the way)?
Myths About Suicidal Behavior
 MYTH: Suicide is primarily characterized
  by
  – Note leaving – MYTH!!!
  – “Slow” forms of suicide (e.g., smoking) –
    MYTH!!!
  – “Rational” suicide – MYTH!!!
  – A cry for help – MYTH!!!
  – Complete resolve and intent to die – MYTH!!!
The “Cry for Help” Myth
 Consider this statement, which contains a
  certain truth, but also may be misinterpreted
  to indirectly perpetuate the myth: “While in
  most suicide cases people have given verbal
  or behavioral clues that they intend to take
  their lives, suicide researchers agree that
  most people expressing verbal threats will
  not in fact attempt it” (Timmermans, 2006,
  p. 184).
The “Cry for Help” Myth
 The first part of the sentence is clear and right on
  target: When people give off clues about their
  impending suicide, it is a serious situation indeed.
  The second part of the sentence, read closely and
  literally, is true as well: Of all the people who
  experience the desire for suicide, even to the point
  of voicing it to others, only a proportion go on to
  actually die. This is quite right, just as it is quite
  right that, of all the people who experience severe
  chest pain, only a proportion (and a pretty small
  proportion at that) will go on to die from a heart
  attack.
The “Cry for Help” Myth
 A key point is that, in the case of severe chest pain,
  it is relatively rare for the reaction to be “he’s
  faking!” or “she’s just trying to get attention!”
  Indeed, most people would find these reactions
  cruel, rightly. And this despite the fact that a
  sizable proportion of chest pain scenarios actually
  are false alarms, with the discomfort caused by
  anxiety, a panic attack, esophageal problems, and
  so forth. In the case of suicide threat, it is common
  for the threat to be dismissed, and an under-
  appreciated fact is that this represents playing with
  fire, just as ignoring or dismissing chest pain can
  be.
The “Cry for Help” Myth

Gene from “The Bridge”
Myths About the Nature of Suicide
 MYTH: Suicide is
  – Limited to humans – MYTH!!!
  – Not seen in young children – MYTH!!!
  – Caused by things like breast
    augmentation – MYTH!!!
  – More common in winter – MYTH!!!
Perceived Burdensomeness: Self-
Sacrifice Across Species
Fire ants.
Pea aphids.
Lions.
Spiders


…. even bacteria and a palm tree.
 – Slime mold video
Perceived Burdensomeness: Self-
Sacrifice Across Species
 In several types of bacteria,
 there are cells that produce
 chemicals that kill both
 themselves and those genetically
 unrelated to the “suicidal”
 bacterium.
Strengthening Belongingness
 New CDC vision: Promote connectedness
  – The degree to which a person or group is
    socially close, interrelated, or shares resources
    with other persons or groups
      • Between individuals
      • Between individuals/families and community
        organizations
      • Among community organizations and social
        institutions
 Those Who
Desire Suicide


   Perceived
Burdensomeness
                      Those Who Are
                    Capable of Suicide

   Thwarted
 Belongingness


     Serious Attempt or Death by Suicide
                           100
Number of Daily Suicides




                           90




                           80




                           70




                           60




                                 1972             1976            1980          1984          1988
                                        Missing            1978          1982          1986          Missing
                                                         February 22 (1972-1989)
Going Back to Answer
Questions: Suicide Terrorists

 It is clear that suicide terrorists and
  bombers work up to the act, going
  through months and sometimes years of
  training and preparation for the act; in
  this way, they are consciously and
  deliberately attaining the capability for
  lethal behavior.
Suicide Terrorists & Bombers
 Moreover, they do
 appear to use a
 kind of calculation
 related to
 burdensomeness
 (i.e., their death is
 worth more to
 their community
 than their life).
Suicide Terrorists & Bombers
 Their sense of belongingness,
 however, seems quite high – another
 reason, from the perspective of the
 current model, to view their deaths as
 other than suicides, and many Muslim
 clerics concur that self-martyrdom
 and suicide are distinct (Kelsay,
 2002).
Suicide Terrorists & Bombers
 Even here, however, the current view has
  something to contribute. It is possible that
  death and life merge for suicide terrorists,
  such that they view death as a way to
  belong, and to belong more fully than by
  anything they could do in life. In fact, in
  his book entitled My Life is a Weapon,
  Reuter (2004) identifies belonging in the
  memories of family and society at large as
  perhaps the prime motive for suicide
  terrorists.
Suicide Terrorists & Bombers
 Japanese kamikaze pilots can be viewed
 similarly. Axell and Kase (2002)
 published excerpts from the pilots’ “how-
 to” manual. One excerpt read, “Just
 before the collision it is essential that you
 do not shut your eyes for a moment so as
 not to miss the target. Many have crashed
 into the targets with wide-open eyes. They
 will tell you what fun they had.”
 Suicide Terrorists & Bombers
A subsequent passage entitled
 “The moment of the crash” read,
 “You are two or three meters from
 the target. You can see clearly the
 muzzles of the enemy’s guns. You
 feel that you are suddenly floating
 in the air. At that moment, you see
 your mother’s face.”
 Suicide Terrorists & Bombers
 Also like the suicide bombers, high
  belongingness seemed to characterize the
  deaths of Kamikaze pilots. A relevant
  excerpt from their manual read, “Remember
  when diving into the enemy to shout at the
  top of your lungs: “Hissatsu!” (“Sink
  without fail!”) At that moment, all the
  cherry blossoms at Yasukuni shrine in
  Tokyo will smile brightly at you.”
 Suicide Terrorists & Bombers
According to my model, one
 interpretation of this is that the
 pilots’ need to belong has become
 met by death. Another
 interpretation, of course, is that
 their elevated sense of
 belongingness is a reason to define
 their deaths as other than suicides.
Thank you for your attention




joiner@psy.fsu.edu
Jackson Pollock’s Blue Poles (1952)
Jackson Pollock’s Blue Poles (1952)

 This work was conceived and
 begun in the midst of a serious,
 alcohol-related suicidal crisis, and
 eventually sold for more than $2
 million – at the time, only works
 by Rembrandt, Velazquez, and da
 Vinci had sold for more.
Jackson Pollock’s Blue Poles (1952)
 Poetic and
 romantic, right?

 Wrong: Pollock
 spent months
 undoing and
 redoing the work
 of the night of the
 crisis.
Jackson Pollock’s Blue Poles (1952)

Pollock’s career was cut short
when he died in an alcohol-related,
single car crash in Springs, New
York on August 11, 1956 at the age
of 44. One of his passengers also
died.
Barriers to Risk Assessment
Prodromality
Unaware/Latent Risk
Deceit/Demand
 Characteristics
Distillation of Risk Factors
 Talking about/planning suicide
  (safety planning)
 Agitation (benzos)
 Insomnia (sleep hygiene)
 Nightmares (rescripting)
 Marked social withdrawal (list of
  300).
   – Motivational Interviewing
Nightmares
 I could be bound in a nutshell
 And count myself a king of infinite
 space
 were it not that I have bad dreams.
    - from Hamlet
Distillation of Risk Factors
 Two others to consider (but
  less strongly):
   –Humiliation
   –Anger (marked increase)
Distillation of Risk Factors
 What’s not listed?
  –Sluggishness
     • Hopelessness
     • Depression
Charting

 Quod   non est in actis,
  non est in mundo
  (roughly, that which is
  not recorded did not
  happen).
 Informed Consent
“If you’re presenting with some form of
  suicidality (i.e. suicidal thinking or a suicide
  attempt), it’s important to recognize the risks
  inherent in treatment, as well as a decision not
  to seek treatment. Randomized controlled
  trials for the treatment of suicidality have
  found re-attempt rates during treatment as
  high as 47%, with a number of experimental
  treatments significantly reducing the rate of
  subsequent attempts by as much as half. The
  risk of a suicide attempt during treatment is
  greatest for those who have made multiple
  suicide attempts (i.e. two or more)…”
 Fascinating and Provocative
 Approach
“I tell my patients certain actions
 are evil - and if you do this - if
 you kill yourself or someone else
 - I'm going to come after you and
 drag you out of hell.”
    - quoted (anonymously) from an eminent
 psychiatrist.
  Fascinating and Provocative
  Approach
“My patients - to a man and woman - are both
 astonished that a psychiatrist would make a
 judgment about good and evil in the present
 day and are comforted that someone cares
 enough about them and their life to try to do
 everything possible to protect and sustain it.
 The point is usually being made in the midst
 of therapeutic planning and I back it up with
 my availability to them during the crisis and
 its resolution that has prompted their sense of
 despair. Try it, you'll like it.” - quoted
 (anonymously) from an eminent psychiatrist.
 An empirically validated
 treatment for resolving suicidal
 behavior (cont.)

“Assume a virtue if you have it not,
 for use can almost change the stamp
 of nature.”
        - From Shakespeare’s Hamlet
 An empirically validated
 treatment for resolving suicidal
 behavior (cont.)

“Change your behavior, change your
 brain.”
           - From a study on how behavior therapy
             for OCD leads to MRI-documented
             brain changes.
Thank You!



 joiner@psy.fsu.edu

								
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