I’m also skeptical that suicide risk in the elderly is related to repeated suicide attempts over a lifetime. Anecdotally, when I have seen serious suicidal acts in elderly people, these have occurred ‘de novo’ in people without much psychiatric history.
Yes, I found these arguments bizarre. Joiner really tried too hard to fit all the data into his model. It's hard to square "no impulsive suicides" with findings like your coal-gas link (thanks!), safety nets/fences on bridges, and medication packaging.
Re: de novo suicide -- if we look at at least some suicide as a "rational response to circumstances as interpreted by the subject" rather than NECESSARILY disordered in its "essence", then at least some suicide in the elderly becomes similar to suicide (including assisted suicide/voluntary euthanasia) in terminally ill. A loss of hope seems to me like a perfectly reasonable response to end of life circumstances.
It feels to me that looking at suicide as a single phenomenon with consistent etiology just seems... Unlikely? Surely it MUST be a behavioural end point of various paths.
If chronic pain and feeling burdensome are contributing factors, then better pain management options and more affordable caretaking options also seem promising.
I agree! Balancing subjective pain management with actual improvement in people's function is difficult, though. And strong agree on better caretaking options. I only know about the US, but long-term care insurance or a government program is going to be necessary at some point.
If we can possibly differentiate between attempts vs completed suicides (I'm too indoctrinated into not using the word "success" even though I'm largely a suicide libertarian in principle) as being qualitatively different and ALSO if there's a good case for suicide NOT being a linear (or otherwise systematically related) function of mental illness or distress; what about the relationship between "suicidality" and suicide attempts and completed suicides?
Is it possible that either generally or for particular groups (perhaps, for example, young women who grew up in a culture valuing emotional disclosure / declarative vulnerability and where there are clear social benefits to being seen as having some types of mental disorder or even garden variety distress) the link between "suicidal ideation / thoughts" and "attempting" or "completing" suicide is becoming more tenous and unclear?
Following from that: if "the act of suicide is being destigmatized" (undoubtedly true), then the disclosure of suicidal feelings or thoughts will be even more destigmatised -- with the resulting increases in disclosure?
There's also a question of active help seeking (with professionals) vs population level (survey) measures: how do they compare?
I agree that voicing suicidal ideation is even more "destigmatized" than suicidal behavior, and it some demographics is almost a generally accepted practice. This is unfortunate. I agree that this sort of expressed SI may not correlate with behavior. Young women who are not impulsive or acting out types are still very low risk. I think that constantly talking and asking about suicidal ideation make it more acceptable to use as a generic distress call.
I think the elephant in the room is completely ignored, and the author comforts himself with over-rationalisation. The elephant in the room is that suicide rates has risen ONLY in the USA. It has decreased in every other developed country, and even in undeveloped countries. The author should look what makes USA culture unique that it predisposes people to suicide.
I’m as surprised as you are that the author doesn’t believe in impulsive suicide. For me this explains why restricting access to lethal means reduced suicide rates https://www.ncbi.nlm.nih.gov/pmc/articles/PMC478945/pdf/brjprevsmed00022-0018.pdf
I’m also skeptical that suicide risk in the elderly is related to repeated suicide attempts over a lifetime. Anecdotally, when I have seen serious suicidal acts in elderly people, these have occurred ‘de novo’ in people without much psychiatric history.
Yes, I found these arguments bizarre. Joiner really tried too hard to fit all the data into his model. It's hard to square "no impulsive suicides" with findings like your coal-gas link (thanks!), safety nets/fences on bridges, and medication packaging.
Do people with ADHD have fewer attempts once medicated?
Yes!
https://pubmed.ncbi.nlm.nih.gov/31987492/
Nice, I hadn't seen this paper. Thanks.
Well, then!
Re: de novo suicide -- if we look at at least some suicide as a "rational response to circumstances as interpreted by the subject" rather than NECESSARILY disordered in its "essence", then at least some suicide in the elderly becomes similar to suicide (including assisted suicide/voluntary euthanasia) in terminally ill. A loss of hope seems to me like a perfectly reasonable response to end of life circumstances.
It feels to me that looking at suicide as a single phenomenon with consistent etiology just seems... Unlikely? Surely it MUST be a behavioural end point of various paths.
Thank you, I’m glad I found your substack.
If chronic pain and feeling burdensome are contributing factors, then better pain management options and more affordable caretaking options also seem promising.
I agree! Balancing subjective pain management with actual improvement in people's function is difficult, though. And strong agree on better caretaking options. I only know about the US, but long-term care insurance or a government program is going to be necessary at some point.
If we can possibly differentiate between attempts vs completed suicides (I'm too indoctrinated into not using the word "success" even though I'm largely a suicide libertarian in principle) as being qualitatively different and ALSO if there's a good case for suicide NOT being a linear (or otherwise systematically related) function of mental illness or distress; what about the relationship between "suicidality" and suicide attempts and completed suicides?
Is it possible that either generally or for particular groups (perhaps, for example, young women who grew up in a culture valuing emotional disclosure / declarative vulnerability and where there are clear social benefits to being seen as having some types of mental disorder or even garden variety distress) the link between "suicidal ideation / thoughts" and "attempting" or "completing" suicide is becoming more tenous and unclear?
Following from that: if "the act of suicide is being destigmatized" (undoubtedly true), then the disclosure of suicidal feelings or thoughts will be even more destigmatised -- with the resulting increases in disclosure?
There's also a question of active help seeking (with professionals) vs population level (survey) measures: how do they compare?
I agree that voicing suicidal ideation is even more "destigmatized" than suicidal behavior, and it some demographics is almost a generally accepted practice. This is unfortunate. I agree that this sort of expressed SI may not correlate with behavior. Young women who are not impulsive or acting out types are still very low risk. I think that constantly talking and asking about suicidal ideation make it more acceptable to use as a generic distress call.
I think the elephant in the room is completely ignored, and the author comforts himself with over-rationalisation. The elephant in the room is that suicide rates has risen ONLY in the USA. It has decreased in every other developed country, and even in undeveloped countries. The author should look what makes USA culture unique that it predisposes people to suicide.