Suicidal mind and suicidal brain

A vignette

About six months back a retired government executive and his wife came to my consulting office and narrated the story of his son Mr. S.’s alcohol addiction and sought for my help in rescuing him from the clutches of the liquor. I interviewed the couple in detail and got an idea how his son became alcohol addict. The couple reluctantly narrated the story. Mr. S. married a beautiful girl, Ms. V., by arrangement. They had had a son, who is now 7 years old. Ms. V. started an affair with one of the common friends of the young couple. Mr. S. came know about his wife’s affair accidentally. Ms. V. confessed, apologized, and promised to eschew the affair forthwith. Mr. S. agreed to continue the marital relationship, but he started drinking to immerse the agony. He became mentally and physically dependent on alcohol. I asked the couple who narrated tragic story to bring his son to the deaddiction centre for the treatment of alcoholism. I also warned them of the suicidal risk of their son. I explained to them that morbid jealousy and associated depression may prompt their son to commit suicide. Added to it alcoholism doubled the risk of suicide. He required treatment for alcoholism and cognitive psychotherapy for his depression. I requested them bring their son to me even if he is not willing to get admitted for deaddiction treatment, because the urgent need is psychotherapy to avert the suicidal risk. The senior couple didn’t turn up again, nor did they bring their son to me. Recently I came to know about the sad news of Mr. S.’s suicide by hanging.    

Changing views on suicide

The term ‘suicide’ has only a relatively recent history. Roy O’Connor, fellow of the International Academy for Suicide Research and a member of the American Association of Suicidology, says there is no recorded use before the year 1634. Previously the act of suicide was referred to in various forms including self-destruction and self-killing. In the Old Testament and New Testament of the Bible there are many examples of self-killing. The Bible mentions six specific people who committed suicide: Abimelech (Judges 9:54), Saul (1 Samuel 31:4), Saul's armor-bearer (1 Samuel 31:4-6), Ahithophel (2 Samuel 17:23), Zimri (1 Kings 16:18), and Judas (Matthew 27:5). Five of them were wicked, sinful men (not enough is said regarding Saul's armor-bearer to make a judgment as to his character). Some consider Samson an instance of suicide (Judges 16:26-31), but Samson's goal was to kill the Philistines, not himself. These instances are just neutral descriptions without any positive or negative allusions.  According to the Bible, suicide is not what determines whether a person gains entrance into heaven. 

For the ancient Greeks, suicide was seen as acceptable if it were undertaken for reasons that were viewed as justifiable, such as grief or to avoid dishonor. The Romans too viewed suicide without judgment.

From around 400 Common Era (CE), the Christian Church began to express disquiet about the act of suicide. In the Council of Braga (now in Portugal) held in 566 CE “prohibited masses to be said for the souls of those dying by suicide and the comfort for them of a Christian burial in hallowed ground.” (Discovering God’s Will For Your Life by Ray Pritchard p.10) In the fifteenth century suicide led to sever sanctions due to the influence of the Christian Church. The Church’s moral objection to suicide seemed to centre on what was believed to be a loss or rejection of hope, and thus taking a ‘stand’ against God.

The development of psychiatry as a distinct discipline within medicine  brought suicide into the realm of illness.

Types of suicide

Emile Durkheim

One of the most influential writers on suicide was the French sociologist Emil Durkheim. He asserted that suicide did not take place in isolation, but was  instead a consequence of interplay between the individual and societal pressures and influences. In his writing he proposed four ‘types’ of suicides:

1. Egoistic suicide. Suicide occurs due to marginalization, with little social support and a sense of estrangement from society. The greater the disconnection between individual and society, the greater is the risk of suicide.
2. Altruistic suicide. It might be accurate to describe altruistic suicide as the opposite of egoistic suicide, in that suicide occurs when the individual has become too integrated within society. That is, the experience of societal expectation and pressure becomes too great, with the individual feeling unable to meet these demands.  
3. Anomic suicide. An individual is in need of stability. He/she should be in equilibrium with his/her status within the society. External changes, such as loss of status cause emotional distress for the individual, who no longer has a sense of containment and clarity regarding his/her role. Increase in suicides during times of economic recession has a link with this type of suicide.
4. Fatalistic suicide. Opposite to anomic suicide, fatalistic suicide occurs when  and individual  feels excessively controlled, with little or no sense of control over their own future or destiny.

Suicide has prominence in other cultural and religious beliefs. In the Hindu religion suicide is not seen as acceptable for males, whereas for females the idea of suicide after bereavement as honourable is held, though it is prohibited now.

Prevention of suicide

1.         EdwinS. Shneidman (1918 - 2009) father of contemporary suicidology (the branch of science which study suicides) suggested that the key to preventing suicide is in the direct study of the human emotions. On the other hand Professor C. Van Heeringen, stressed the importance of understanding suicidal brain.(British Journal of Psychiatry 2003, 183:282-284) 

Cognitive process leading to suicide

A large number of studies have evidenced the existence of dysfunctional cognitive processes which are associated to a vulnerability to suicide, for example decision making and problem resolving processes. These deficits could represent factors associated to stress sensitivity, notably social. In stressful situations, they could increase the individual’s risk of experiencing feelings of despair, psychological pain, ruminations, and suicidal ideation; and in certain cases, to commit suicide.

Aron T. Beck

According to the American psychiatrist Aron T. Beck, who is considered as the father of cognitive behaviour therapy (CBT), the critical role that hopelessness plays in suicide is illustrated in the sequence of events that leads a depressed individual to commit suicide. The person systematically construes his or her experience in a negative way and anticipates dire outcomes for his or her problems. Ultimately, the person is drawn into an idea of suicide as way out of his or her “insoluble problems”. (Relationship Between Hopelessness AndUltimate Suicide by Aron T. Beck) The central role of hopelessness in suicidal idea formation has been established by empirical researches.

Suicidal brain

Frontal Cortex (orange)

It has been shown that these cognitive difficulties are associated to the dysfunction of particular brain regions such as the prefrontal cortex and other regions. The frontal lobes appear to be essential, with the right frontal lobe having a central role in the neural network for social cognition, including inferences about feelings of others. The ventral medial frontal regions are also important, possibly through their connections with the amygdala and other limbic structures which give them a key role in the neural network for behavioural modulation based upon emotion and drives. It has been difficult to dissociate social cognitive processes from the behavioural expression of these processes, but information is rapidly increasing based upon recent neuropsychological and neuro-imaging studies. Brain regions shown to be involved in suicidal behaviour constitute what may be called the ‘suicidal brain’.