FAMILIES IN CRISIS Chapter 8 - Crisis of Lethality 1.

FAMILIES IN CRISIS

Chapter 8 - Crisis of Lethality

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FOCUS OF LETHALITY

1. Instrumental - Acts of homicide that occur for some financial or other concrete gain

2. Expressive - Acts designed to reduce psychological pain (emotionally distraught, helpless, etc.)

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SCOPE OF SUICIDE CASES

In the U.S.: * 30,000 to 35,000 every year * May be underreported (many may be reported as accidental)* May be as high as 60,000 per year* 300,000-600,000 Attempts per year (19,000 survivors permanently disabled)* 10th -11th leading cause of death

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In the U.S.: * Age 15-24, largest increase in past 30 years* Men, 4 times the rate than women* Elderly (10% of US population) - 25% of all suicides occur in the over 65 group, and much higher after 70

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"If you are planning to become a mental health professional, the odds are about 1 in 4 that you will come face to face with a suicide."

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EUTHANASIA

* Assisted suicide - someone else provide the means (lethal agent) but the person who is dying administers it* Euthanasia - Someone else administers it.

"The appropriate role of the crisis worker is to intervene and attempt to prevent all suicides and homicides that he or she possibly can."

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PSYCHOLOGICAL THEORIES OF SUICIDE

* Freudian Inward Aggression (Intrapsychic conflict when dealing with psychological stress) Depressions becomes self-destructive * Developmental ( one does not navigate life stages and are unable to cope) * Deficiencies (mental deficiency caused risk factors) * Escape (Flight from situation that is intolerable) * Hopelessness (there is nothing one can do to change a situation) *Psychache (psych-ache) - (one has intolerable psychological pain)

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SOCIOLOGICAL THEORIES OF SUICIDE

* Durkheim's Social IntegrationSocietal integration - degree to which

people are bound together in social networks Social regulation - degree to which the individual's desires and emotions are regulated by societal norms and customs

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Durkheim's Social Integration* Egoistic suicide - ones lack of integration or identification with a group* Anomic suicide - a perceived or real breakdown in the norms of society (such as financial and economic ruin)* Altruistic suicide - perceived or real social solidarity, (such as 'hara-kiri' or mid eastern extremist groups)* Fatalistic suicide - when a person sees no way out of an intolerable or oppressive situation (such as confined n a concentration camp)

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Suicide Trajectory Model - considers multiple factors, * biological (substance abuse, being male , genetic predisposition to depression)* psychological (low self-concept, hopelessness, borderline personality disorder)* cognitive (rigid, dogmatic, irrational, all-or-none thinking)* environmental (access to firearms, stressful occupations, loss, family)

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Interpersonal Theory (three components)1. People acquire suicidal capability (decreasing fear of death)2. People perceive burdensomeness to others3. Failed belongingness

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Existential-Constructivist Framework-Trigger events that come from suicide trajectory risk factors- combine to form the critical mass that allows the individual to construct a worldview that it- is a better choice to no longer view the world at all

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OTHER EXPLANATIONS

1. Accident (pushing their luck2. Biochemical or neurochemical malfunction3. Chaos (unpredictable behavior can occur within predictable systems)4. Dying with Dignity/rational suicide5. Ecological/integrative (painful intrapsychic factors interact with negative interpersonal/societal issues6. Interactional - suicide because of external rage toward another

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OTHER EXPLANATIONS

7. Ludic suicides - having the desire to experience an ordeal or a way to prove oneself in gamesmanship (Russian roulette, tribal rite of passage)8. Oblative suicides - Those that are sacrificial in nature and seen to put one in a 'higher' place (LSD user who 'wants to meet God, or Buddhist monks who set themselves on fire)9. Overlap Model - Lack of social support, biological propensity to suicide, and presence of psychiatric disorders (the more of these areas over-lap the greater the potential for suicide10 Parasuicide - (acts that closely resemble suicide, self injurious behavior, risky behavior that could cause death)11. Suicide by cop

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6 COMMON CHARACTERISTICS OF PEOPLE WHO COMMIT SUICIDE

1. Situational Characteristics (unendurable psychological pain)2. Motivational characteristics (The purpose is to see solution)3. Affective characteristics (emotions of hopelessness and helplessness)4. Cognitive characteristics (1. ambivalence between doing it and wanting to be saved, (2. and perception of limited options5. Relational characteristics 1) Communication of intention, 2) have the right to get out of 'pain'6. Serial characteristic - lifelong patterns of coping with pain

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SIMILARITIES BETWEEN SUICIDE AND HOMICIDE

* Often, the person who is suicidal is also homicidal* 30% of violent individuals have a history of self-destructive behavior*10-20% of percent of suicidal persons have a history of violent behavior

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MYTHS ABOUT SUICIDE

Read pages 216-217

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ASSESSMENT USING SUICIDE CLUES

1. Verbal clues - spoken or written, (I'm of no use to anyone anymore)2. Behavioral clues - purchasing a grave marker, slashing wrist3. Situational clues - bankruptcy, death of a spouse, divorce, terminal illness4. Syndromatic clues - severe depression, loneliness, hopelessness, dependence, dissatisfaction with life

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WARNING SIGNS

IS PATH WARM:IdeationSubstance AbusePurposelessnessAnxiety and agitation(Feeling) TrappedHopelessnessWithdrawalAngerRecklessnessMood fluctuations

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AAS

American Association of Suicidology

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ASSESSMENT INSTRUMENTS

"Are most helpful when backed up by a clinical interview and third-party collateral information."

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CLINICAL INTERVIEW

Page 219-220: When a person manifests four or five of these risk factors, it should be an immediate signal for the crisis worker to treat the person as high risk in terms of suicide potential.* Some have more weight than others. (previous attempts or having a concrete plan)* As these risk factors add up, the potential increases.

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ASSESSING LETHALITY

When intervening client in acute crises ....* Never omit an assessment for suicide lethality* Do not hesitate to ask* Don't sugarcoat* Page 221: SIMPLE STEPS - step-by-step method to assess lethality and get a good read on the client

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INTERVENTION STRATEGIES

Perturbations - Anxiety: mental uneasiness* A cause of such anxiety or uneasiness* Synonyms: disturbance, trouble, agitation, unrest, anxiety

Suicide Intervention strategies involve "interrupting a suicide attempt that is imminent or in the process of occurring"

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CRISIS INTERVENTION STRATEGIES

Two Categories1. Dealing with perturbations (using The Three I's)2. Reducing lethality levels

When perturbation level is lowered and some control and hope is restored in the person's life, lethality will drop below the explosive level.

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THE THREE I'S

The major causes of perturbation have to do with the three I's.The person confronts a situation he or she believes to be * Inescapable (can' t get away from it)* Intolerable (can't stand it any longer)* Interminable (it won't end)

After establishing rapport and trust, crisis work with deal with 3 I's actively.

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OLDER ADULTS

Highly neglected area in the entire field of suicidology.

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OLDER ADULTS ASSESSMENT

Ego-Weakening Factors:* chronic and acute physical and mental illness* elder abuse* alcoholism* prolonged stress* failure to respond to medical treatment* complicated/prolonged grief

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Social Factors:* fewer friends* living alone* being excluded or living away from social and family events* getting separated from family

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Psychodynamic Factors:* Stress or strain of various losses (spouse, friends, work roles and income)* Thinking "I am just growing old"

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HOMICIDE/SUICIDES OF ELDERLY

Not "mutual, dying together pacts" Not Impulsive actsOften acts of desperation, anger, and depression

1. Aggressive - (violence, marital problems, financial, health problems)2. Dependent-protective caregiver - (isolation, helplessness, fears of losing control)3. Symbiotic - (highly dependent, usually sick)

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FAMILY, FRIENDS, AND ASSOCIATES

Best help is educational.Help them learn about risk factors, cues, and cries for helpCan be a part of treatment.Help them become aware of the suicidal persons feelings and actions that reciprocally influence each other.Do not deal with the past issues, at least while in crisis mode.

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POSTVENTION (SURVIVORS OF SUICIDE)

Vulnerable to physical and mental health problems.Faced with guilt, shock, trauma, police interrogation, legal issues, shame sleep difficulties, concentration problems, denial, family relationship problems, complicated long-term grief.Anger that they 'skipped out' on responsibilities.

Especially serious for child survivors and parent survivors.

* Support Groups are very helpful.

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FAMILIES IN CRISIS Chapter 8 - Crisis of Lethality 1.

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