Suicide & Attempted Suicide: Understanding the Cry of Pain

276 Pages·2002·73.981 MB·English

by  Mark Williams

S U I C I D E A N D
A T T E M P T E D S U I C I D E
MARK WILLIAMS
‘An important book that
deserves a wide readership’
Simon Armson, Chief Executive, -
THE SAMARITANS

SUICIDE AND ATTEMPTED SUICIDE
Mark Williams was bom in 1952 and educated at Stockton-on-Tees
Grammar School and St Peter’s College, Oxford. Between 1979 and 1982
he was Lecturer in Applied Psychology at the University of Newcastle
upon Tyne and from 1983 to 1991 was Research Scientist at the Medical
Research Council’s Applied Psychology Unit in Cambridge. Since 1991
he has been Professor of Clinical Psychology at the University of Wales,
Bangor, and, since 1997, Director of the University’s Institute of Medical
and Social Care Research. His other books include The Psychological
Treatment of Depression, Cognitive Psychology and Emotional Disorders (with
F. Watts, C. MacLeod and A. Mathews), and, with Z. Segal and J.
Teasdale, Mindfulness-based Cognitive Therapy for Depression.
Professor Williams is married and has one son and two daughters.
0041486617

Suicide and
Attempted
Suicide
Understanding the Cry of Pain
MARK WILL IAM S
/ CD
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PENGUIN BOOKS
To Phyllis, Rob, Jennie and Annie.
PENGUIN BOOKS
Published by the Penguin Group
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Penguin Books Ltd, Registered Offices: 80 Strand, London WC2R orl, England
First published 1997
Previously published under the title Cry of Pain,
new edition published under the present title 2001
2
Copyright © J. M. G. Williams, 1997, 2001
All rights reserved
The moral right of the author has been asserted
Set in 10/12.5 pt Monotype Dante
Typeset by Rowland Phototypesetting Ltd, Bury St Edmunds, Suffolk
Figures drawn by Nigel Andrews
Printed in England by Clays Ltd, St Ives pic
Except in the United States of America, this book is sold subject
to the condition that it shall not, by way of trade or otherwise, be lent,
re-sold, hired out, or otherwise circulated without the publisher’s
prior consent in any form of binding or cover other than that in
which it is published and without a similar condition including this
condition being imposed on the subsequent purchaser
Contents
List of Text Figures vi
List of Tables viii
Preface to the New Edition ix
Acknowledgements xi
Introduction xiii
1 A Brief History of Suicide i
2 Suicide: Facts and Figures 18
3 Psychiatric and Social Factors in Suicide 45
4 Attempted Suicide: Facts and Figures 63
5 The Causes of Attempted Suicide 81
6 Rational Suicide, Euthanasia and Martyrdom 98
7 Psychodynamics, Biology and Genetics 115
8 The Effect of the Media 127
9 The Cry of Pain 136
10 Memory Traps 155
11 The Prevention of Suicidal Behaviour 174
12 Therapy for Suicidal Feelings and Behaviour 195
13 Final Thoughts 217
Notes and References 225
Index 243
List of Text Figures
2.1 Number of suicide deaths by gender, 1911-99, England and
Wales. 21
Recorded suicide deaths: rate per million population by gender
2.2
and age, 1983-95, England and Wales. 22
2-3 Comparison of suicide rates for men and women for different
ethnic groups in the United States, 1950-96. 26
2.4 Distribution of recorded suicides by gender, year of death and
method, England and Wales. 27
2.5 Number and percentages of suicide method by gender, US rate
1996. 30
4.1 Episodes of attempted suicide referred to the John Radcliffe
Hospital, Oxford, 1976-99. 68
4.2 Oxford City attempted suicides, 1999, by age and gender. 69
4.3 Methods of self-poisoning, Oxford: changes between 1976 and
1999- 70
4-4 Rates of attempted suicide (per 100,000), 1989-93, across
European centres. 71
10.1 Time taken to recall specific autobiographical memories. 160
10.2 Stages in retrieval of specific autobiographical memory. 163
10.3 Effect of aborting search for specific memory. This results in
many repetitions of intermediate stage, resulting in over­
elaborated self-descriptive categories (‘mnemonic interlock’). 163
11.1 Suicide rates in Gotland and the mainland of Sweden, during
and after systematic education of Gotland GPs on diagnosis and
treatment of depressive disorders. 178
List of Text Figures
Dummy data illustrating effect of hypothetical intervention to
II.2
reduce death-rate. 180
Graph illustrating effect of applying five-year moving average to
ii-3
data in Figure 11.2 if moving average is not stopped prior to
intervention. 180
11.4 Graph showing the smoothed means of actual Gotland data
retaining a five-year moving average but stopping the window
prior to intervention. 181
12.1 Number of episodes of self-harm in borderline personality
clients at three phases of treatment. 209
12.2 Mean number of episodes of self-harm in year following DBT
for borderline personality disorder clients. 210
12.3 Mean number of days in psychiatric hospital in year following
DBT for borderline personality disorder clients. 211
12.4 Mean number of medically treated episodes of self-harm in year
following DBT for borderline personality disorder clients. 212
13.1 At important points in the causal pathway to suicidal behaviour
a judgement by the individual allows scope for bias in estimates
of the aversiveness of stress, its controllability, and how much
social support is available. 221
List of Tables
2.1 Suicide rates for a sample of countries reporting to the World
Health Organization. 24
2.2 Distribution of ‘other methods', England and Wales. 29
2.3 Deaths from suicide among men (aged 16-64) in different social
classes, England and Wales, 1979-90. 32
3.1 Suicide vulnerability and psychiatric status. 48
3.2 Factors associated with suicide rates among 15-29-year-olds in
Europe, 1960-80. 57
4.1 Proportions of people endorsing Bancroft & Hawton’s ‘reasons
for overdose'. 76
5.1 Sample of items from Marsha Linehan’s Reasons for Living
Inventory. 93
10.1 Responses to cue words given by overdose and matched
control subjects. 161
10.2 Scenarios used to cue memories. 164
10.3 Situations used from the Means-Ends Problem Solving
Test. 168
10.4 Ratings of effectiveness of problem solutions. 169
10.5 Ratings of specificity of future images. 171
11.1 Predictors of suicide. 182