By BEPPE MICALLEF-TRIGONO, MD
A Historical Perspective on Suicide
The etymological roots of the word ‘suicide’ are derived from the Latin word suicidium; sui, ‘of oneself’ and cidium, ‘a killing.’ The term was first used by the abbots Prevost in 1734 and Desfontaines in 1737 (Sarro & de la Cruz, 1991) but it is likely that suicide has been a human phenomenon ever since man began to organize himself into tribes.
Recent anthropological studies (Washburn, 2004), have in fact, shown, that it was not uncommon for a hunter to sacrifice himself by acting as bait during the hunt for wild animals, in order to allow his fellow tribesmen a better chance of making a kill. Whether the act was committed for romantic, rational or philosophical reasons or more commonly due to desperation, this form of suicide, known today as ‘altruistic suicide’ (Durkheim, 1897), has been present throughout the history of mankind.
From Socrates to Judas Iscariot, from Hemingway to Deleuze, a number of culturally influential people have committed suicide, but as yet the more profound reason for this act remains elusive to scholars (Leenaars, 1996), with Giner and Leal (1982) stating that “suicide seems to be the most personal act that a man could perform.”
Suicide may be viewed either as the best solution to a problem faced or as a choice, rational or irrational as it may be, that a person makes when they believe that there is no better alternative at that point in their life (Baechler, 1996). Such a scenario can be seen in the explanation of a person who attempted suicide by shooting himself in the head:
“I could not find peace. I did everything I could, but was still suffering. I spent hours and hours looking for the answers, but only heard the silent wind, nothing more. The answer was in my head: die.” (Shneidman, A Conspectus of the Suicidal Scenario, 1992).
However, although suicidal behavior occurs in a unique encounter between the patient’s personal and situational factors, it does not arise from nothing; it is usually the end result of a long and tragic process (Farberow, 1994) which has been the subject of much debate and study.
A Clinical Approach to Suicide
The clinical approach to the study of suicide includes four main models (Neimeyer, 1984): a) complex adaptive systems, b) psychoanalytic, c) nosological, and d) cognitive, from which I shall concentrate on the latter. The cognitive model (Kelly, 1961; Beck, Rush, Shaw, & Emery, 1979; Neimeyer, 1984; Baumeister, 1990; Lennings, 1994) assumes that suicide is the result of early negative experiences, which cause the development of disturbed cognitive schemata.
Once activated by current experiences (which frustrate the basic needs of the individual), these schemes cause a state of cognitive ‘constriction’ and emotional disturbance, which lead the person to see death as the only way out. Therefore, a purely cognitive-behavioral approach allows for the possibility of intervention, both on the current dysfunctional cognitive mechanisms, as well as on the unconscious patterns that disrupt the way the person views himself, the world and his future (Beck A. T., 1996).
Cognitive-behavioral interventions can operate in sync with other, more traditional approaches (Linehan, Heard, & Armstrong, Naturalistic Follow up of a Behavioral Treatment for Chronically Parasuicidal Borderline Patients, 1993), enhancing their performance while providing a greater degree of protection against future suicidal behavior.