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Section 9
Suicide Risk Factors

Question 9 | Test | Table of Contents

I was once asked to participate in investigating the suicide of an old man (in his eighties), in the terminal stages of cancer, who took the tubes and needles out of himself, somehow got the bedrail down, summoned the strength to lift the heavy window in his hospital room, and threw himself out the window to his death. I puzzled over him (as I do over all suicides). What was his great hurry? If he had done nothing, he would have been dead in a few days. He was a veteran of World War II and there was a full record on him. The relatively few "social" (occupational, marital, educational, military) facts were especially illuminating. This was a man married several times. sparsely educated, a rather itinerant fellow who was never fired by a boss or divorced by a spouse. Rather, it was he who quit the job before he was fired. His wives did not walk out on him; he left them. Before a possible court martial, he got himself transferred. His life seemed like a series of precipitous departures. Death by cancer was not going to get him; he would die in his own way, when he decided. In 20/20 retrospect, his suicide seemed totally predictable from an extrapolation of his character.

To repeat: People are very consistent with themselves. But I hasten to add that no possible future suicide is set in stone, and the capacity for change is our great hallmark as human beings. It is probably next to impossible to behave "out of character," but what is possible, and happens all the time, is for changes in character-growth and maturity-to occur, and for transiently overwhelming psychache to be resisted and survived.

Some of our most beloved novels weave suicide into their plots. I am thinking of Kate Chopin's The Awakening, Flaubert's Madame Bovary, Goethe's The Sorrows of Young Werther, Lagerqvist's The Dwarf, Tolstoy's Anna Karenina, to name a handful. What is interesting about them (aside from their gorgeous writing) is the consistency of the chief characters, and our acceptance of their deaths as almost-fitting endings to their lives. The suicidal outcome is not a De Maupassant-like surprise, but rather an understandable outcome within the confines of that character, a lamentable but psychological "necessity," given the unhappy circumstances and unhappy deficiencies of that person. Can anybody commit suicide? Not likely. But if you are an Anna or an Emma or an Edna, then you must be very careful how you turn life's pages and into what corners you paint yourself.

There are also certain questions we might pose to help get a person out of a constricted suicidal state: Where do you hurt? What is going on? What is it that you feel you have to solve or get out of? Do you have any formed plans to do anything harmful to yourself, and what might those plans be? What would it take to keep you alive? Have you ever before been in a situation in any way similar to this, and what did you do and how was it resolved?

You should be thinking how to help the suicidal person generate alternatives to suicide, first by rethinking (and restating) the problem, and then by looking at possible other courses of action. New conceptualizations may not totally solve the problem the way it was formulated, but they can offer a solution the person can live with. And that is the primary goal of working with a suicidal person.
- Shneidman, Edwin, The Suicidal Mind, Oxford University Press: New York, 1996.

Personal Reflection Exercise Explanation
The Goal of this Home Study Course is to create a learning experience that enhances your clinical skills. Thus, space has been provided for you to make personal notes as you apply Course Concepts to your practice. Affix extra Journaling paper to the end of this Course Content Manual. We encourage you to discuss the Personal Reflection Journaling Activities, found at the end of each Section, with your colleagues. Thus, you are provided with an opportunity for a Group Discussion experience. Case Study examples might include: family background, socioeconomic status, education, occupation, social/emotional issues, legal/financial issues, death/dying/health, home management, parenting, etc. as you deem appropriate. A Case Study is to be approximately 50 words in length. However, since the content of these “Personal Reflection” Journaling Exercises is intended for your future reference, they may contain confidential information and are to be applied as a “work in progress”. You will not be required to provide us with these Journaling Activities. Only the Test is to be returned to the Institute.

Personal Reflection Exercise #3
The preceding section contained information about commonalities in suicide. Write three case study examples regarding how you might use the content of this section in your practice.

Update
Understanding Protective Factors for Men
at Risk of Suicide Using the CHIME Framework:
The Primacy of Relational Connectedness

- Boydell, K. M., Nicolopoulos, A., Macdonald, D., Habak, S., & Christensen, H. (2023). Understanding Protective Factors for Men at Risk of Suicide Using the CHIME Framework: The Primacy of Relational Connectedness. International journal of environmental research and public health, 20(3), 2259.

Peer-Reviewed Journal Article References:
Levi-Belz, Y., & Feigelman, W. (2021). Pulling together—The protective role of belongingness for depression, suicidal ideation and behavior among suicide-bereaved individuals. Crisis: The Journal of Crisis Intervention and Suicide Prevention.

Picard, E. H., & Rosenfeld, B. (2021). How clinicians incorporate suicide risk factors into suicide risk assessment. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 42(2), 100–106.

Winkler, L., & Wetterauer, C. (2021). Provide access to information on assisted suicide for a patient with a diagnosis of depression? An ethics consultation. GeroPsych: The Journal of Gerontopsychology and Geriatric Psychiatry, 34(2), 57–62.

QUESTION 9
What are six questions you might pose to help get a client out of a constricted suicidal state? Record the letter of the correct answer the Test.

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