SUICIDAL BEHAVIOUR

Suicide does not just "happen". It has a history. This may be summarized by the term "suicidal process". It is of the utmost interest in the clinical management of patients with suicidal behaviour to investigate this process. A relationship between suicide ideas and suicidal acts as well as between suicide attempts and completed suicides has been assumed for a long time in clinical practise. Communicated suicide ideas have been regarded as signs of warning. Behind such considerations is an assumption that suicidal ideation develops from more diffuse feelings of meaninglessness through vague to more definitely formed suicidal plans, sometimes resulting in suicidal acts. An investigation of the progression of a suicidal process may be carried out according toPaykel et al. 1974, by asking questions such as: felt life was not worth living, wished you were dead, thoughts of taking life, seriously considered taking life, completed by detailed questions about when, where and by which method, cf also Schwab et al. 1972 and Pallis et al. 1975. Litman & Farberow 1965, point out that the more specific the suicidal plans and the more active the method considered the higher the risk of CS. Some aspects of this process are summarized in fig. 14.1. Critical situations which are difficult for the individual to control may, at an early stage, cause feelings of anxiety and ideas of suicide. In fact, the latter sometimes relieve anxiety there is at least "one way out". New critical situations may exaggerate such ideas, which may mature into a suicidal plan, ready to be put into operation if felt necessary. These thoughts may also be perceived by persons in the environment, and this often results in an intensive interaction (Shneidman & Farberow 1957, Delong & Robins 1961, Kovacs et al. 1975). Finally, the process can culminate in an attempted or completed suicide. The concept of a suicidal process implies that studies of completed suicide should not be restricted to an analysis of the present situation but should also include the development up to that situation. Many authors have, on the contrary, emphasized the differences rather than the similarities between persons, who have attempted and persons, who have committed suicide, i.a. Stengel & Cook 1958 and Kessel 1966. All agree, however, that suicidal behaviour is influenced by biological as well as intrapsychic, interpersonal and social factors. In the end it is an existential problem the value of life is questioned.