Background
In the year 2000 an estimated 815000 people diedfrom suicide around the world. This represents anannual global mortality rate of about 14.5 per100000 population – or one death about every40 seconds. Suicide is the thirteenth leading causeof death worldwide (see Statistical annex). Amongthose aged 15–44 years, self-inflicted injuries arethe fourth leading cause of death and the sixthleading cause of ill-health and disability (
1
).
Deaths from suicide are only a part of this veryseriousproblem.Inaddition tothose whodie,manymore people survive attempts to take their own livesor harm themselves, often seriously enough torequire medical attention (
2
). Furthermore, everyperson who kills himself or herself leaves behindmany others – family and friends – whose lives areprofoundly affected emotionally, socially and eco-nomically. The economic costs associated with self-inflicted death or injuries are estimated to be in thebillions of US dollars a year (
3
).
How is suicide defined?
Suicidal behaviour ranges in degree from merelythinking about ending one’s life, through devel-oping a plan to commit suicide and obtaining themeans to do so, attempting to kill oneself, to finallycarrying out the act (‘‘completed suicide’’).The term ‘‘suicide’’ in itself evokes directreference to violence and aggressiveness. Appar-ently, Sir Thomas Browne was the first to coin theword ‘‘suicide’’ in his
Religio medici
(1642). Aphysician and a philosopher, Browne based theword on the Latin
sui
(of oneself) and
caedere
(tokill). The new term reflected a desire to distinguishbetween the homicide of oneself and the killing of another (
4
).A well-known definition of suicide is the onethat appears in the 1973 edition of the Encyclo-paedia Britannica, quoted by Shneidman: ‘‘thehuman act of self-inflicting one’s own life cessa-tion’’(
5
).Certainlyinanydefinitionofsuicide,theintention to die is a key element. However, it isoftenextremelydifficulttoreconstructthethoughtsof people who commit suicide unless they havemadeclearstatements beforetheirdeathabouttheirintentions or left a suicide note. Not all those whosurvive a suicidal act intended to live, nor are allsuicidal deaths planned. To make a correlationbetween intent and outcome can therefore beproblematic. In many legal systems, a death iscertified as suicide if the circumstances areconsistent with suicide and if murder, accidentaldeath and natural causes can all be ruled out.There has been much disagreement about themost suitable terminology to describe suicidalbehaviour.Recently,theoutcome-basedterm‘‘fatalsuicidal behaviour’’ has been proposed for suicidalacts that result in death – and similarly ‘‘non-fatalsuicidal behaviour’’ for suicidal actions that do notresultindeath(
6
).Suchactionsarealsooftencalled‘‘attemptedsuicide’’(atermcommonintheUnitedStates of America), ‘‘parasuicide’’ and ‘‘deliberateself-harm’’ (terms which are common in Europe).The term ‘‘suicidal ideation’’ is often used in thetechnicalliterature, and refers to thoughts of killingoneself, in varying degrees of intensity andelaboration. In the literature, the term also refersto a feeling of being tired of life, a belief that life isnot worth living, and a desire not to wake fromsleep (
7, 8
). Although these different feelings – orideations – express different degrees of severity,there is not necessarily acontinuum between them.Furthermore, the intention to die is not a necessarycriterion for non-fatal suicidal behaviour.Another common form of self-directed violenceis self-mutilation. This is the direct and deliberatedestruction or alteration of parts of the bodywithout conscious suicidal intention. Favazza (
9
)has proposed three main categories:
.
Major self-mutilation – including self-blind-ing and the amputation of fingers, hands,arms, limbs, feet or genitalia.
.
Stereotypicalself-mutilation–suchasbangingone’s head, biting oneself, hitting one’s arm,gouging one’s eyes or throat, or pulling one’shair.
.
Superficial-to-moderate self-mutilation – suchas cutting, scratching or burning one’s skin,sticking needles into one’s skin, or pullingone’s hair compulsively.
CHAPTER 7. SELF-DIRECTED VIOLENCE
.
185
Leave a Comment