murder.
Sri Lanka was a country torn apart by a bloody and bitter civil war.
During the 1980s it had one of the world's highest (certified) suicide
rates.
(Worldwide trends in suicide mortality, 1955–1989
C Vecchia, F Lucchini, F Levi - Acta Psychiatrica …, 1994 -
interscience.wiley.com
http://www3.interscience.wiley.com/journal/119967514/abstract)
It was treated through research, through a sustained attempt to reduce
the deaths. I think it worked but I haven't got that far in my reading.
If I asked someone to tell me what's the most common reason people with
a diagnosis of schizophrenia give for killing themselves I wonder what
it would be?
Instead I thought I'd Google it.
http://www.google.co.uk/search?sourceid=chrome&ie=UTF-8&q=why+do+people+with+schizophrenia+kill+themselves
<http://www.google.co.uk/search?sourceid=chrome&ie=UTF-8&q=why+do+people+with+schizophrenia+kill+themselves>
The 3rd link is interesting. It answers the question for all suicides.
"
http://www.cmha.ca/bins/content_page.asp?cid=4-40&lang=1#killthemselves
<http://www.cmha.ca/bins/content_page.asp?cid=4-40&lang=1#killthemselves>
"
I think what they're talking about is the work of Shniedman. He was a
guy who came across a bunch of suicide notes one day then spent the rest
of his life researching suicide and suicide notes. As far as I am aware
he'd never contemplated nor attempted suicide but I don't know much
about him. He coined the term "psychache" for the pain that leads to
suicide as he saw it from his work.
Conceptually there's a difference between depression, hopelessness and
psychache but I couldn't explain it.
From
http://mec.sagepub.com/cgi/content/abstract/42/1/46
Differentiating Between Depression, Hopelessness, and Psychache in
University Undergraduates
Michelle M. DeLisle
Measurement and Evaluation in Counseling and Development, Vol. 42, No.
1, 46-63 (2009)
has this abstract
"
The overlap between depression, hopelessness, and psychache constructs
was investigated using 587 undergraduates. Analyses indicated three
correlated dimensions; among these, psychache accounts for more variance
in depression and hopelessness than these latter variables account for
in psychache. All constructs demonstrated convergent validity, but
psychache was associated with the widest range of suicide criteria.
These findings support that psychache is a leading variable associated
with suicide risk.
"
Back to the question and the search: (btw. I'm being incredibly lazy and
not looking for a proper piece of qualitative research or popping to the
British Library to make a proper attempt at this blog post).
The priory.com has a page I like on schizophrenia however it doesn't
look very good. It's not by the Priory group.
http://priory.com/schizo.htm
Interesting later in the text the author says
"
Bleuler, in 1908, criticised the use of the term dementia praecox,
because he said that there was no global dementing process. He first
used the term schizophrenia and said that there were four characteristics:
blunted Affect
loosening of Associations
Ambivalence
Autism
"
I'm not sure this is true. Those are just a memory tool for doctors with
cognitive deficits. lol.
There's a lot of interesting stuff on the page but this is what I was
after.
"
A sixth of people with schizophrenia die by their own hand, often in
response to psychotic symptoms e.g. second person auditory
hallucinations telling them to kill themselves.
"
I was hoping to find a reference so I could get more informatjon but
there isn't a link to qualitative research. There's 3 case studies
though which are probably more elucidating into what schizophrenia means
to doctors.
Onwards...
On the second Google page there's some advice for counselling
schizophrenia from a Christian minister who uses quotes from the bible.
There's a bit at the bottom that I like that I'll summarise.
F. How can we help?
1. Help the weak: Start by listening carefully.
2. Admonish the Unruly. (I don't like this one but I'll leave it in.)
3. Encourage the fainthearted family. Families need support, prayer,
respite, logistics.
4. Be Patient with Everyone!
One of the links is a very interesting post. I've been looking for
information to try to find a solution to treating the suicide rate in
schizophrenia. This effort here is an example of what I do on a Sunday
night. This is an example of the amount of information I come across
that I find interesting. The content of this post itself isn't important.
From
http://advancedcognitivepsychology.blogspot.com/2009/02/why-do-some-people-kill-themselves.html
Why do some people kill themselves?
Robert Pool
There's some more information about the history of what other people
thought was the reason people killed themselves.
"
A century ago, both the sociologist Emile Durkheim and the psychoanalyst
Sigmund Freud came up with sweeping explanations. Durkheim, not
surprisingly, saw the roots of suicide in social factors, such as a
failure to integrate into society, while Freud rooted his explanation in
instinctual drives, particularly what he called the death instinct. More
recent explanations have tended to focus on factors such as depression,
hopelessness and emotional pain, but none of them have had much success
in answering the fundamental question about suicide: why do some people
kill themselves while others in seemingly identical circumstances do not?
"
What I'm going to take from that is the "sweeping explanations", which
means to me at the moment that I must avoid looking at the question I'm
trying to answer in a simplistic way.
The question I was meant to be looking to answer is why do people with a
diagnosis of schizophrenia kill themselves? The answer "because of the
delusions" is a sweeping statement. It was noted in the qualitative
research on clozapine that some patients felt the delusions were reduced
on clozapine. I can see why a doctor may consider the use of the
chemical cosh if it actually did that. Sadly the research was funded and
done by Sandoz who also make clozapine and there was little information
there about the adverse effects.
I would guess using that the delusions are the factor behind the
suicides early on in the course of schizophrenia. I think the reason why
people kill themselves afterwards may be for the same reasons as anyone
else if their life ended up the way living with psychosis can make it.
Perhaps. Treat that and clozapine can be withdrawn again.
There's something else worth noting. These links are from the first 20
on a google search. When I used to do this for a living I used to check
more than that. The point there is that it's worth going further than
the first page. It takes a bit of luck and experience to know which
sources to checkout but it also takes a bit of...openmindedness to find
the useful information. The religious minster's page was one that a lot
of people wouldn't bother to check but there's some good stuff on there.
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