Are Suicidal Ideas and Acts Always Indicative of Psychopathology?

[Nous]

I thought this would be a nice cheery topic for the holiday season.

The American Psychiatric Association has always included suicidal ideation and any suicide attempt as a criterion for Major Depressive Disorder:

9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.​

There are no further qualifications or the suggestion that thoughts, desires, plans or attempts to commit suicide could ever be not a symptom of Major Depression.

In DSM-5, the APA has also proposed a new mental disorder, Suicidal Behavior Disorder, applicable to anyone (with some exceptions) who has attempted suicide during the past 2 years.

Yet in recent years several US states have enacted laws that, under specific conditions, allow physicians to prescribe drugs in order for a person to end his/her life. In other words, laws have been enacted that allow physicians to assist a person to engage in an act that the APA considers pathological--i.e., the DSM does not exempt suicidality as a criterion for a mental disorder even when those specific conditions for legal physician-assisted suicide (such as having a terminal illness with 6 months or less to live) are met.

Numerous other countries have laws that allow physician assistance in suicide, including, in a few such countries, even when the person does not have a terminal illness.

So my questions are: Do desires, plans or attempts to commit suicide or completions of suicide (a) always, (b) sometimes, or (c) never indicate psychopathology?

If you say that suicidality and suicide are sometimes symptomatic of mental illness, then what are the distinguishing marks between pathological and non-pathological suicidality or suicide?

 

[Revoltingest]

If someone is at the end of life & in pain,
suicide is a rational & healthy choice.

 

[YmirGF]

If someone is at the end of life & in pain,
suicide is a rational & healthy choice.

and that would be pretty much the only exception.

 

[Revoltingest]

and that would be pretty much the only exception.

I can also see someone who isn't at life's end
considering suicide if life is too burdensome.
Imagine being totally paralyzed & in pain.
Suicide looks like a reasonable choice for some.

 

[BSM1]

If someone is at the end of life & in pain,
suicide is a rational & healthy choice.

And it should have a different designation than "suicide".

 

[Revoltingest]

And it should have a different designation than "suicide".

"Self-euthanasia"?
Nah..."suicide" is best.

 

[Laika]

I thought this would be a nice cheery topic for the holiday season.

Its a pretty appropriate topic if you are a Turkey though...

 

[jonathan180iq]

I think the thoughts themselves are actually a completely normal part of self-awareness and contemplation.

 

[ChristineM]

Taking your life if you are in chronic pain and there is no cure is a sensible alternative to long term suffering.

It also relieves stress on reletives who have to watch a loved one in constant agony.

 

[sun rise]

"recurrent thoughts of death" is normal for people who are getting very old. Such people may still be cheerful as they plan for their inevitable demise especially those who believe that there is some form of life after death.

 

[David T]

The church created it as a sin because so many people were killing themselves. If you do an action pull the trigger we Consider that suicide. If you do an action that causes someone else to pull the trigger then that's considered either murder or self defense hmmm curious. If a man stands up with intent to be shot is that suicide!

 

[Nous]

If someone is at the end of life & in pain,
suicide is a rational & healthy choice.

and that would be pretty much the only exception.

I can also see someone who isn't at life's end
considering suicide if life is too burdensome.
Imagine being totally paralyzed & in pain.
Suicide looks like a reasonable choice for some.

And it should have a different designation than "suicide".

Taking your life if you are in chronic pain and there is no cure is a sensible alternative to long term suffering.

It also relieves stress on reletives who have to watch a loved one in constant agony.

So does "psychological pain" count (if there is such thing as "psychological pain")?

What about when one is facing the rest of one's life in prison without possibility of parole (and one is pretty)? Is that not a non-pathological reason to want to end one's life?

A lot of people commit suicide due to financial ruin, where they reasonably foresee being homeless (actually homeless, not homeless in a city where one can go to a shelter and sleep on a cot in a room full of other people). Are plans to commit suicide a symptom of a mental disorder in that situation?

 

[ChristineM]

So does "psychological pain" count (if there is such thing as "psychological pain")?

What about when one is facing the rest of one's life in prison without possibility of parole (and one is pretty)? Is that not a non-pathological reason to want to end one's life?

A lot of people commit suicide due to financial ruin, where they reasonably foresee being homeless (actually homeless, not homeless in a city where one can go to a shelter and sleep on a cot in a room full of other people). Are plans to commit suicide a symptom of a mental disorder in that situation?

I was quite specific.

 

[Nous]

I think the thoughts themselves are actually a completely normal part of self-awareness and contemplation.

I think so too. The DSM says "recurrent suicide ideation," without quantifying "recurrent". I wonder when or if "recurrent" becomes pathological?

 

[Nous]

The church created it as a sin because so many people were killing themselves.

Yeah, "mental disorder" is the modern word for "sin".

 

[BSM1]

So does "psychological pain" count (if there is such thing as "psychological pain")?

What about when one is facing the rest of one's life in prison without possibility of parole (and one is pretty)? Is that not a non-pathological reason to want to end one's life?

A lot of people commit suicide due to financial ruin, where they reasonably foresee being homeless (actually homeless, not homeless in a city where one can go to a shelter and sleep on a cot in a room full of other people). Are plans to commit suicide a symptom of a mental disorder in that situation?

I think any adult should be free to opt out for any reason without being questioned. BTW it's not illegal to commit suicide, it's just illegal to try and fail.

 

[Nous]

I think any adult should be free to opt out for any reason without being questioned. BTW it's not illegal to commit suicide, it's just illegal to try and fail.

I'm not aware that in any US state it remains illegal to attempt suicide. But one generally will lose certain freedoms, at least for a few weeks, if one does attempt and fail or even threaten to kill oneself.

In any case, I was asking about the issue of psychopathology, not the legalities.

 

[David T]

The church created it as a sin because so many people were killing themselves. If you do an action pull the trigger we Consider that suicide. If you do an action that causes someone else to pull the trigger then that's considered either murder or self defense hmmm curious. If a man stands up with intent to be shot is that suicide!

Yeah, "mental disorder" is the modern word for "sin".

Indeed. Homo sexuality was a mental disorder till 1974. We evolve how exactly!!!! I might say contrary to darwin it's not survival of the fittest it's making every possible mistake we arrive and proclaim we are brilliant. When in fact it was an inch. I exaggerate a quark length.

 

[Nous]

Indeed. Homo sexuality was a mental disorder till 1974. We evolve how exactly!!!! I might say contrary to darwin it's not survival of the fittest it's making every possible mistake we arrive and proclaim we are brilliant. When in fact it was an inch. I exaggerate a quark length.

In a thread a little while ago I noted some of the many mental disorders that are no longer mental disorders: When Are Designations of Mental Disorders Just Expressions of Prejudice?

Americans would be healthier if the AMA would just make cancer no longer a disorder.

 

[Vee]

So my questions are: Do desires, plans or attempts to commit suicide or completions of suicide (a) always, (b) sometimes, or (c) never indicate psychopathology?

If you say that suicidality and suicide are sometimes symptomatic of mental illness, then what are the distinguishing marks between pathological and non-pathological suicidality or suicide?

Some people who are suicidal have mental disorders, but many have simply more pain than they can bare and for them, death becomes an escape: the end of that pain.

I'm not a doctor with psychiatry training but it seems logical that in if the person's suicidal thoughts are not coming from mental illness, they have another source that needs to be found and addressed before the person ends their life.

I remember a lady who lived in the village where I grew up, who committed suicide. She had been a victim of domestic abuse for years. Her husband alternated between beating her and raping her, sometimes both. Everyone knew , including the authorities who did nothing for her. She became so desperate she drank poison and ended her life. In her case it wasn't mental illness, it was desperation, it was not seeing a way out for her problems. How many more are there in similar situations?