Surviving Suicide: What To Know
Abstract
In a world that values life, it is inconceivable
to choose death—it provokes an argument between the value of life versus the
quality of life (Heyd & Bloch, 2009). Those who survive a suicide attempt
are left in the wake of silence, shame, and stigma. As an isolated and personal
experience, it is necessary to define attempted suicide and understand the
scope of this epidemic. Suicidality, or suicide as a whole, is influenced by
countless biopsychosocial factors, of which places everyone at risk. Protective
factors, although vague, provide insight into prevention. This social problem
is a significant ethical dilemma of which challenges the National Association
of Social Worker’s Code of Ethics (2017), and therefore benefits from
discussion.
Keywords: attempted suicide, suicide
attempt, stigma, ethics
Surviving
a Suicide Attempt
Introduction
The
diversity of the human race is infinite, yet one sense we share is our
existence—the cycle of life and death. Furthermore, the value of life is understood
as intrinsic to our being. Thus, the act of suicide challenges the beliefs that
unite us (Heyd & Bloch, 2009; Mishna, Antle, & Regehr, 2002). That
challenge intensifies and creates an inevitable stigma. Those who have survived
a suicide attempt encounter a discouraging aftermath making the chance of
recovery uncertain. The stigma causes shame, invalidation, and silence. Suicidality
is a social problem that lacks empirical research and defies ethical
explanation, and social workers have a responsibility to face the stigma and
break the silence.
Definition
To break the
silence, it is necessary to dissect the term suicide attempt. The word attempt
carries a range of meanings—such as fulfilling an intent, or an effort made
towards an objective. There is an expectancy in the prospect of an attempt. On
the other hand, suicide is an
intentional effort to end one’s life. Thus, the collective definition of suicide attempt is, “a non-fatal,
self-directed, potentially injurious behavior with intent to die as a result of
the behavior,” (Suicide Prevention Resource Center [SPRC] Topics and terms; National Institute of Mental Health [NIMH], 2018).
In other words, attempted suicide is a self-inflicted behavior with the
expectancy of death, which opposes the universal value of life.
We hear about
completed suicides often, and the numbers are increasing, yet attempted suicide
goes relatively unnoticed. The frequency of attempted suicides, however, reveals
the widespread effect in the United States. In 2016, approximately 1.3 million
adults (18 and older) attempted suicide within the past year, which is
staggering compared to the 45,000 people who completed suicide in 2016 (NIMH,
2018). The American Foundation for Suicide Prevention (2016) estimated that for
every completed suicide, 25 more individuals attempt.
Such
statistics suggest that this social problem affects a much larger population,
yet there is the effect of stigma which inadvertently hinders recovery. Stigma
revolves around a negative perception towards a certain group—for example,
individuals who have survived a suicide attempt may be considered
“attention-seeking, immoral, and potentially contagious” (Sheehan, Dubke, &
Corrigan, 2017).
Sheehan et al.
(2017) conducted a survey where participants were assessed on responses to
vignettes regarding suicide-specific stigma. One of the findings indicated that
there was limited variance of public stigma measured between those who
attempted suicide and those who completed suicide. This expands the implication
that survival of an attempted suicide contributes to the likelihood of stigma,
and vice versa.
Typically, leading
up to a suicide attempt, there are biopsychosocial—risk and protective— factors
present. These factors provide clarification and insight into the mind
struggling with suicidality while also providing clues for prevention and
intervention.
Risk
Factors
Suicidal behavior
is a deeply personal experience that lacks a common cause, and therefore, all
demographics are at risk (NIMH, 2017). More often than not, a suicide attempt
is likely to occur when a combination of risk factors are present. SPRC and
Rodgers (2011) also mentions the tipping
point, an event elevating stress that may generate suicidality. For
example, losing a job may cause financial or relationship strain increasing suicidal
ideations.
Despite the
general susceptibility, women are more likely to attempt suicide than men,
though men die by suicide more often
than women. Men tend to choose more lethal means, while women are inclined to
attempt through poisoning (NIMH, 2017). Data from the Substance Abuse and
Mental Health Services Administration (2016) depicted that young adults (18-25)
attempted suicide more often than any other age group (as cited in NIMH, 2018).
While suicide attempts decrease after the age of 25, the suicide completion
tends to increase with age (SPRC, Suicidal
thoughts and suicide attempts). Race and ethnicity play a role due to
historical trauma (e.g. American Indians and Alaska Natives). Discrimination in
the form of rejection, oppression, or aggression influence suicide attempts as
well (SPRC, Risk and protective factors).
Non-demographic
factors include, but are not limited to: previous suicide attempts, having a suicide
plan, substance abuse, mental disorders, access the lethal means, losing
someone to suicide, social isolation, chronic disease or disability, and lack
of access to behavioral health care (SPRC & Rodgers, 2011).
Unfortunately, most
risk factors for suicidality are inadequate in effectively predicting and
preventing a suicide attempt. Binnix, Rambo, Abrutyn, and Mueller (2018)
contributed to introducing alternative risk factors through narratives from
attempted suicide survivors. Three themes were discovered that impact an
individual after a suicide attempt—stigma, silence, and misunderstanding—which
fuel a never-ending cycle. A participant, Veronica, shared being silenced in fear
of the misunderstanding related to stigma:
…If you’re serious
about it, and it does scare you, then you don’t go tell people
about it. And
then, that isolates you further. And that contributes to the fear, and
you wanting to
isolate yourself. You don’t want other people to feel the fear, so
you kind of just
take it on yourself, and you’re like, ‘well, I don’t want to freak
everybody else
out, because I’m freaked out.’
Protective
Factors
Protective factors
decrease the chance of a suicide attempt. Typical factors include: effective
mental health care, social support, life skills (resilience, coping, reflection),
sense of worth and purpose, as well as a belief system (SPRC & Rodgers,
2011). Individuals who have a reliable support from family and/or friends are
less likely to feel isolated or hopeless, which contributes to an improved
self-worth. Within a support system a protective factor might simply be the
power of conversation. It allows for understanding and validation, but it also
depends on the positive or negative influence of said support. Practicing
personal beliefs allow for awareness in life’s purpose and a greater meaning,
thus restoring a will to live
All factors are specific to an
individual, and therefore it is necessary to collect research directly from
sufferers. A survey conducted by Pirkis, Burgess, Meadows, and Dunt (2001) established
three needs—counseling, medication, and information—as reported by suicidal
persons. Participants were surveyed to determine the relationship between
perceived needs and the degree of fulfillment. A majority of attempted suicide
survivors reported one or more needs were not adequately met.
Relevance
to NASW
The point has been
made that suicidality is an ethical issue, and therefore, challenges every
fiber of the National Association of Social Work’s Code of Ethics. Attempted
suicide is an escalating social problem that exceeds the constructs provided by
the Code of Ethics. Ultimately, this leaves social workers in a position of confronting
core values with overwhelming discretion.
Society values life,
and so attempting suicide is stigmatized as illogical. Survivors remain
vulnerable and silenced; and the world lacks adequate information and awareness.
A social worker is committed to provide competent service to those in need and
also address social injustice. The NASW Code of Ethics (2017) identifies six
principle values—service, social justice, dignity and worth, human
relationships, integrity, and competence—that overlap in response to attempted
suicide survivors.
The value of
service only begins after developing a stable bond with the client. This
requires a commitment to the overall well-being of the client, as well as including
the client in recovery. Social workers need to ensure a confidential
relationship with a client who shares details of a suicide attempt. Therefore,
it is necessary to reinforce the dignity and worth of a survivor. The shame
following an attempt is enough to silence anyone—it takes an unbelievable
amount of courage and strength to share the experience at all.
Additionally,
social workers must face social injustice. In the case of suicidality, the
silence and stigma perpetuate the struggle of recovery after a suicide attempt.
The NASW Code of Ethics (2017) states that social workers not only engage
clients in the recovery process, but to also advocate and educate society to
“promote sensitivity” (p. 5).
Conclusion
Attempted
suicide is frequently overlooked in comparison to completed suicides. The
prevalence of suicide attempts exceeds completed suicides, and therefore makes
it the most concrete risk factor to predict future suicides (NIMH, 2018). Demographic
precursors are few and far between—suicide does not discriminate (NIMH, 2017). Recovery
is uncertain, and the ethical responsibilities fall under the role of social
workers, who often are the primary source of contact for an individual who has
attempted suicide. The NASW Code of Ethics (2017) aims to guide competent
decision-making and service in the case of an attempted suicide. Furthermore, it
outlines the value of supporting individual dignity, worth, and right to
self-determination. Regardless of stigma, those who have attempted suicide
should be praised for surviving.
References
American Foundation for Suicide
Prevention. (2016). Suicide statistics. Retrieved from
https://afsp.org/about-suicide/suicide-statistics/
Binnix, T. M., Rambo, C., Abrutyn, S., & Mueller, A. S. (2018). The
dialectics of stigma,
silence, and misunderstanding in suicidality survival
narratives. Deviant Behavior, 39(8),
1095–1106. Retrieved
from https://doi-org.proxy.library.vcu.edu/10.1080/01639625.2017.1399753
Heyd, D., & Bloch, S. (2009).
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Psychiatric ethics—3rd
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