Death and Dying Test #3

Sense of failure

"I am no good. Never will be. I am nothing"

Schoolyard bullies

increase the suicide risk or their victims and often are themselves more vulnerable because of their own depression and insecurity

Suicide as "The Great Death"

influence remained strong enough through the centuries to enlist the self sacrifices of Kamikaze pilots in WWII

Suicide as criminal

intertwining of church and state once made it easy to regard suicide as both criminal and sinful; interpretation is waning; criminal laws have been erased from the books; insurance companies

Suicide can be prevented only by a psychiatrist or mental hospital

Myth; some of the most successful suicide prevention efforts are being made by a variety of people in the community who bring concern, stamina, and sensitivity to the task

Hospice stats

-about 1 million to 1.5 million terminally ill Americans receive hospice at the end of their lives -2 out of 5 terminally ill people select hospice care -5,000 hospice programs throughout the US

Indicators of possible suicide risk among the elderly

1. sad, dejected, flat mood 2. stooped, withdrawn, fatigued, lack of eye contact 3. carelessness in grooming and dress 4. restlessness, handwringing, constant motor activity 5. inattention, lack of concentration, losing the thread of conversation 6. loss of appetite/weight 7. sleep disturbance, insomnia or oversleeping 8. loss of interest in activities that previously were pleasurable 9. loss of interest in other people 10. preoccupied with vague and shifting physical complaints (50% of people had seen doctor within a month of their death)

When suicidal people show improvements, the danger is over

Myth; the period following apparent improvement is actually one special danger- may be discharged and now have the opportunity; may also be related to a recovery of enough energy to take action

Children's progression toward a lethal suicide attempt

1. starts with a harmless attempt-tests ability to cope with fear of death 2. A second attempt often follows the first-especially if there is only minimal response from social environment - Adults simply don't believe what they say or do 3. This may progress from harmless to serious and lethal attempts

Suicide rate is higher among people who:

1. suffer from depression or other psychiatric problems 2. use of alcohol while depressed 3. suffer from physical, especially irreversible illness 4. deal with challenges and frustrations in an impulsive way 5. Are divorced 6. Have lost an important relationship through breakup or death

High-risk Situations

1. suicides often increase after a natural or man-made disaster 2. People with HIV/AIDs 3. Gambling 4. Schoolyard bullies

Children with parental bereavement

1. tend to be more submissive, dependent, and introverted 2. show a higher frequency of maladjustment and emotional disturbance (including suicidality) 3. show a higher frequency of delinquent and criminal behavior 4. perform less adequately in school and on tests of cognitive functioning 5. experience more physical symptoms

Hospice throughout the world

1. the largest number of hospice patients fall within 60-79 age group 2. Only about 1 patient in 9 is under the age of 40 3. Men and Women using hospice services more or less equally (some local variations) 4. Home care is the type of service most often received by hospice clients in every world region 5. Pain relief remains the central objective

Three hypotheses to understand gun violence

1. young males who engage in these acts have not developed a sense of identification with the human race, little awareness of how others think and feel; little empathy; other people are objects 2. Peer acceptance is a dominating motivation when plans and prospects for the future seem bleak 3, Guns and automobiles provide remote devices for dealing death-one can be a "man" by killing another human

Greatest loss of life from earthquakes

1556- Shaanix, China- 830,000 died 1976- Tangshan, China- 242,000 died 2008- Chengdu, China - 50,000 died Japan and India have had quakes with more than 200,000 fatalities

Helping children cope with bereavement

1 develop and maintain an open communication pattern with children 2. give children the opportunity to decide about attending the funeral 3. Check out what the child is thinking and feeling 4. encourage the expression of feelings 5. provide convincing assurance that there will always be somebody to love and look after the child 6. Professional counseling deserves consideration if bereaved children are at special risk

Staff-orientated Standards

1. A caregiver should have adequate time to form and maintain personal relationships with the patients 2. A mutual support network should exist among the staff

Problems observed in well siblings (Bluebond-Langner)

1. Confusion about what role they are supposed to play in the family 2. A feeling of being deceived or rejected by their parents 3. Uncertainty about the future 4. Changes in the relationships among the siblings 5. feeling of guilt and ambivalence 6. Frustration in not being able to express their feeling because everyone is preoccupied with the dying child *not all children show these feelings, nor did feelings occur all the time

Family-oriented Standards

1. Families should have the opportunity to discuss dying, death, and related emotional needs with the staff 2. Family should have the opportunity for privacy with the dying person both while living and immediately after death

Findings of research on case histories (Kastenbaum)

1. Family death education seems to be viewed as something for "the woman" to handle 2. it is the death of particular people of animals that enlist the child's concern (not the topic of death in general) 3. There may be several different orientations toward death within the same household (differ in their openness to discuss death) 4. There is now a transitional generation of parents who are trying to communicate in an open manner with their children although their experience was of family silence 5. Children don't have to comprehend death in its most abstract aspects to recognize that it threatens their relationships with the people who are important to them

5 stages of terminally ill children

1. I have a serious illness 2. I know what drugs I am receiving and what they are supposed to do 3. I know the relationship between my symptoms and the kind of treatment I am getting 4. I realize now that I am going through a cycle of feeling worse, getting better, then getting worse again; the medicines don't work all the time 5. I know that this won't go on forever; there's an end to the remission and relapses and to the kind of medicine they have for me; when the drugs stop working, I will die pretty soon

Patient-oriented Standards

1. Remission of symptoms is a treatment goal-relieve pain and suffering 2. Patient's intentions should be respected as expressed in a living will 3. Patients should feel safe emotionally 4. Opportunities should be provided for leave-taking with the people most important to the patient and for experiencing the final moments in a way that is meaningful to the patient

Murder stats

1. U.S. has highest rate in the world 2. Firearms used in 2 of every 3 homicides - knives are next common 3. southern states have highest rate, northeastern states the lowest 4. Metropolitan areas have higher rate than smaller cities and rural counties because of gang-related violence 5. Men most often both killers and victims 6. People between ages 25-44 are at most risk 7. Often committed by killers who are the same race as their victim 8. 3 out of 5 murders are committed by people who are relatives, lovers, neighbors, or colleagues of the victims

Youth suicide facts

1. academic pressure seems related to suicide among college students 2. Most of those who commit suicide had expressed their despondency to others and made explicit comments about their intentions 3. Counseling is often effective to prevent 4. Alcohol is frequent contributor 5. Loss of valued relationship is often a trigger 6.frequent change in place of residence puts them at greater risk 7. Family patterns

Basic facts of suicide

1. completed suicides occur most often among white males at every age 2. White male suicide rate increases with age 3. 3rd leading cause of death among youth ages 15-24 4. Bad economic times usually associated with an increase in suicide rates 5. often an impulsive act, especially among young people, and alcohol is a contributing factor at all adult ages

Special risks

1. death of both parents 2. death for which the children might feel they are somehow to blame 3. children who suffer parental bereavement under traumatic and stressful conditions 4. suicide- "if Daddy love me, why did he leave me?"- children have to cope with the loss of a parent and the puzzle and possible stigma of suicide

St. Joseph's Hospital

1905 London- introduced improvements in pain relief and general medical care; Cicely Saunders- a medical officer at St. Joseph's improved pain control for dying patients

Hall study

1922, asked adults to recall their earliest experience with death experiences were recalled in vivid detail- immobility of the face and body, no answering, half-open eye, silence, tearfulness of friends, funeral and burial scenes were often the very earliest memories-remains true for many people today

Cicely Saunders

1967, founded St. Christopher's Hospice in London which has served as the inspiration and model for many others; started as a nurse, became a social worker, then became a physician

International Work group on death and dying (IWG)

1975, recognized the need to develop guidelines for hospice patients, Included Saunders and Kubler-Ross

Lonetto study

1980, younger children expressed more separation anxiety, happy smiles of the dead; older children (10+) expressed more sadness about death itself, no separation anxiety was expressed, more likely to depict death as scary and anxious; by age 11, more use of abstract symbols in drawings (Valentine with tears rolling down its face, use of black color)

Dickinson

1992, found college students had intense memories of their early childhood experiences with death; Anger toward a parent who had killed the pet animal, unsatisfactory explanations given to them-most often that a deceased person/pet had gone to heaven

Statistics of suicide

200,000 people are closely affected by a suicidal death each year, 6 million people in the U.S. have lost a family member or friend to suicide; older white males have the highest rate in U.S.; 11th most common cause of death in the U.S.; approximately 33,000 certified suicides a year; not the highest rate in the world

Ratio of attempts to completion young adults

20:1

9/11 death toll

3251 people died

Youth suicide stats

3rd leading cause of death between ages 15-24 (exceeded only by car crashes and homicide)

Ratio of attempts to completion elderly

4:1

Percent of terminally ill people that experience pain

50%

amount of officers law enforcement officers who are killed in the line of duty by young men

9 out of 10

Female suicide rates

African Americans 1.5 White 4.8

Male suicide rates

African Americans 9.1 White 19.9

Palliative Care

interventions to reduce pain and other symptoms to protect the quality of life; offered as an alternative to traditional medical care

Stage 2

Age 5-9, interpretation- death is final (but one might escape it; death is seen as a person; personifications such as a skeleton, circus clown, angels; the realization of deaths finality but the clever and fortunate person might not be caught by the "death man"

Stage 3

Age 9- adulthood, interpretation- death is personal, universal, final, and inevitable

Airline Catastrophes

American airlines jet crashed in Colombia on December 1995; All but 4 (of 163) were killed; captain had entered an incorrect one letter into the computer command that sent the jet into a mountain

HIV/AIDs

American foundation for suicide prevention estimates that the risk of suicide is up to 20 times greater than for the general population; the feeling of being isolated and rejected can contribute more to suicidality that the disease itself

Parasuicide stats

Nearly 8.3 million adults report having serious thoughts of suicide in the past year; more than 1 million had actually made an attempt; younger adults (18-25) were most likely to have seriously considered suicide; substance abuse added a major risk factor as expressed in suicidal thought planning, and attempts

Siblings of the Dying child

Anxiety and sorrow about the dying child leads to neglect of family needs; leads to problems

National policy

it would be National Policy to destroy the terrorists and improve protective measures (airport security, border security, establish Homeland security), the nation transformed from passive victim to aggressive crusader

Basic suicidal syndrome

Breed, not all people who fail commit suicide; Rigidity, shame, and isolation; sense of failure

Why siblings are at risk?

Children live in houses of chronic sorrow; signs of sorrow, illness, and death are everywhere, whether or not they are spoken of; the signs are written on parent's faces; the signs are there in hushed conversations

Four problem areas

Children, youth, elderly, ethnic and racial minorities

Elderly suicide

the elderly white man is most vulnerable to suicide; in recent decades the largest increase in the suicide rate has been among people 85 years of age and older, often doesn't receive attention

Young men with guns

the guns that kill are almost always in the hands of men and most of them are young; those aged 15-24 have the highest rate of committing homicides and the highest rate of becoming a victim of homicide; occurrence

Why an increase in school shootings?

killing has gained more acceptance as a way of solving problems (manhood and guns have a powerful link); there is no other way to deal with rejection, frustration, and loss; the world is divided between Us and Them (or Me and All of you)

Neonaticide

killing of a newborn baby; most women who commit this act are young, white, unmarried, uneducated, poor, have little social support and are suffering from depression; sometimes concealed their pregnancy and had made no plans for the birth or care of the child; some young women may leave the baby at a clinic or child-care center but many are placed in a plastic bag and thrown in the trash

Additional factors

lack of parenting skills. mental disorders, replacement father syndrome

Geography

lack of social support and connectedness seems to be key factors

Persistent hospice problem throughout the world

late referral of patients to hospice care by most physicians; sometimes refereed to hospice when they only have a few days or hours to live

Domestic violence

law enforcement are aware they are at peril when they respond to calls about a family disturbance

Battered women

legal protection and social support for battered women is still in progress in the US, there is more awareness, peer support, and shelters though not enough to meet the need; stronger legal defense needed

Triple perspective

liberated Saunders from seeing the dying person from any one health provider standpoint

Natural disasters in the U.S. and elsewhere

locations at high risk for natural disasters are more popular; ex. ocean-side homes, homes in forests, earthquakes in LA

Standards of Care for the Terminal Patient

IWG, Hidden standards, proposed guidelines

Long-term effects of childhood bereavement

loss of significant person in childhood has an important effect on subsequent development; major physical and mental illnesses occur more often in the adult lives of those who were bereaved as children; often demonstrate resilience

dysfunctional families

the inability to care for their children is in turn attributed to unemployment, alcohol and drug use, abandonment of mothers and children by the father; most infant/child homicides occur in the home, using weapons of opportunities that include household objects, killers often parents or other caregivers

Ku Klux Klan (KKK)

started in 1868; terrorist organization that formed in the U.S.; engaged in property destruction, threats, beatings, and lynchings

"Auntie Death's" Pioneering Study

Maria Nagy, psychologist who was called his by her subjects; found 3 age-related stages

Neglect

starvation, dehydration, lack of physical care

Gambling

Las Vegas has the highest levels of suicide in the nation for both residents and visitors; visitors to and residents of major gambling communities experience elevated suicide rates

Suicide has simple cases that are easily established

Myth

People who talk about suicide will not actually take their own lives

Myth; 3 out of 4 people who eventually kill themselves give some detectable hint ahead of time whether by less serious attempts or by verbal statements

Suicidal tendencies are inherited

Myth; little evidence for a hereditary basis, even in studies of monozygotic twins

Asking people about suicide will put that thought in their minds and encourage suicide attempts

Myth; many lives have been saved by opening communication of the prospect of suicide

People who are under a physician's care or who are hospitalized are not suicidal risks

Myth; many people who commit suicide have received some form of medical or psychiatric attention within 6 months preceding the act

Only a specific class of people commit suicide

Myth; people in all income brackets and social classes commit suicide

Only depressed people commit suicide

Myth; people may not even seem to be especially unhappy immediately before fatal action

Only crazy or insane people commit suicide

Myth; rational people can also feel overwhelmed by circumstances and without effective means of coping

School shootings

students who feel rejected, mistreated, and misunderstood have the temptation to make themselves somebody through an act of violence; the ready availability of guns and recipes for bomb making has opened a dangerous avenue of expression of grievances

Orbach et al (1988)

studied children who "do not want to live"; identified a typical progression toward a potentially lethal suicide attempt

Adults reunion fantasies

Some adults remain relatively childlike in their dependency on others and feel very much the same way when separated by death

History of hospice

St. Joseph's Hospital; Cicely Saunders

Cultural meanings of suicide

suicide as sinful, suicide as criminal, suicide as weakness or madness, Suicide as "The Great Death", suicide as a rational alternative to continuing a miserable existence

Suicide as sinful

The catholic church has condemned suicide since at least the 5th century; The 6th commandment is "Thou shall not kill"; St. Thomas Aquinas; Old and new Testaments

Since "Auntie death"

The tendency to personify death between 5-9 seems to have diminished greatly, seems to be a tendency for children in the U.S. today to move through the stages at an earlier age

Choosing hospice

available as an optional program under Medicare (part A) in the US; physician required to certify the patient has a life expectancy of 6 months or less, when certificate is made the patient must sign it; Medicare benefit replaces the standard Medicare benefit, extensive coverage- physicians, nurses, home health aides, rentals of equipment, medications; may be some expenses associated with in-hospital stays

Hospice for children

basic philosophy is the same as with hospice care in general; helps the dying person experience the highest quality of life possible under the circumstances

Abuse

beating, shaking, burning, throwing downstairs or against a wall

Suicide as outcome of weakness

became salient as a spin-off of the survival-of-the-fittest doctrine of Darwin; regarded as some as one of nature's ways to preserve the species by weeding out the less fit, not endorsed by Darwin; still see it in operation

Parasuicide

suicide attempts; difficult to determine frequency as many never show up in official documents

Demographic risk factors

being while, male, older than 65, living alone, residing in a rural area, isolated, depression, physical illness, high alcohol use, failure to cope with stress, loss of relationships

Give opportunity to decide about attending the funeral

by being included in the family drama, children felt acknowledged and supported by their families, could fell close to their parent for one last time and be part of the family in doing this; child who decides against attending the funeral shouldn't be forced to do so against his/her wishes

African Americans

suicide rate lower than the white majority; religious belief and social support contribute to a style of acting together that provides a strong barrier against suicidality; suicide often regarded as a failure of faith and an offense against God

People who kill children

abuse, neglect, dysfunctional families

Public perception of mass killing

accurate; a person who feels rejected by society, angry at real or imagined mistreatment, motivated to get back at all that has oppressed him, rarely a hardened criminal, killing sometimes follows a period of frustration when an event triggers sudden rage

St. Thomas Aquinas

added another objection to suicide, only God has the power to grant life and death

Stage 1

ages 3-5 years, interpretation- the dead are less alive, very curious about death; dead are simply less alive (they cannot see or hear, at least not very well); being dead and being asleep are much the same, but nor exactly; death is temporary- the youngest children; were full of questions about details of the funeral, the coffin, the cemetery; might be scary and lonely

Firemen and other first responders

also expected to save people; dedicated themselves to honoring the fallen and providing closure for families by recovering and identifying the victims

Witnesses

appalled as they watched people leap to their death rather than die in flame and smoke

Day of 9/11 attack

survivors, first responders, witnesses quickly realized that things would never be the same; two other terrorist attacks were just as deadly to jetliner passengers and crew; chaos won

Home care

children and adults often feel more secure within their own homes

Do children commit suicide?

children do think about death; yes-children do commit suicide, suicidal orientations may develop in childhood and have their fatal outcomes later in life

The dying child

children with life threatening illnesses are keenly aware of their predicaments; hesitate to share concerns because of the fear that this would make their parents feel worse; may take on parental role to try to protect adults from anxiety and sorrow; each day is a new threat or challenge; feel abandonment, some adults distance themselves from the child; child become sophisticated about hospital routines; work hard to understand what is happening to them

Recent studies

children with superior intellectual and verbal skills demonstrate more advanced concepts of death than other children of the same age; this related to developmental level rather than chronological level; more maturity= less death anxiety

The people 9/11

compassion arose throughout the U.S. and many other nations; churches reported higher attendance and flags went on display throughout the nation

Post 9/11

compassion, altruism, sense of unity often prominent in the early response to a disaster; as in other post-disaster situations, the early mood faded over a short time

Low suicide rate

competitive, crowded, fast-moving places, high-density states ex. New York, New Jersey, Massachusetts; difficult to not bump into people all the time

6th Amendment

condemnation of suicide as a violation of this is difficult to square with the warfare and violent death that has at times been actively pursued by defenders of the faith; religious wars and the persecution of heretics repeatedly have violated this commandment

manslaughter

contributing to a death without intending to have done so

Provide assurance that their will always be someone to love and look after the child

death of a parent arouses fears that the surviving parent and other important people may also abandon the child; children become anxious when the surviving parent is out of sight or hasn't come home at the expected time; adult relatives and friends who spend time with the children are helping the surviving parent to provide reassurance that there will always be someone there for them

Subintentional deaths

deaths not certified as suicides, but those who are familiar with the situation believe the person contributed to the death in a significant indirect manner; probable that many elderly women contributed to their deaths by not looking after their health, not taking medications

Antisocial personality

do not feel affection or empathy for others, uses others without remorse, explode in rage when things go wrong

Immediate response on 9/11

doctors and nurses; firemen and other first responders

Patterns of murder

domestic violence; men and women who kill their partners; people who kill children; Neonaticide; children who kill parents; young men with guns; school shootings; mass and serial killers

Check out what the child is thinking and feeling

don't assume we know what the death means to him or her; never interpret a head nod when you are explaining something to them as you would with an adult, they have learned the gesture from adults but frequently for a child it is simply the easiest way to get the adult to leave them alone; always gently ask the child to tell you what they have just heard and to explain it in their own words

The Old and New Testaments

don't directly prohibit suicide nor do they even seem to find this action particularly remarkable

Women who kill their husbands

especially when they have suffered long-term humiliation, abuse, and injury at the hands of a man

Family patterns

families with rigid rules, poor communication, father or mother absence, alcoholism, mental illness, and incest can lead to increased rate of suicide

Early warning signs of serial killers

the child who takes pleasure in tormenting animals could be on the watch list for future serial killers

Hidden or implicit standards of care

first identified unspoken assumptions 1. A successful death is quiet and uneventful 2. Few people are on the scene- staff spared discomfort of grieving people 3. leave-taking behavior is at a minimum (no painful/emotional goodbyes) 4. the physician doesn't have to involve him/herself intimately 5. Staff makes few technical errors 6. Attention is focused on the body during caregiving processes- little effort is wasted on the personality of the terminally ill person 7. The patient expresses gratitude for excellent care 8. The person dies at the right time- range of medical interventions have been tried 9. Family expresses gratitude for the care 10. Staff says :we did everything we could" 11. Physical remains are made available for research, organ donation, etc. 12. A financial gift is made to the hospital in the name of the deceased 13. Money was not wasted on the person whose life was beyond saving or the hospital came out ahead

International survey of hospice programs

found hospice programs are growing rapidly throughout much of the world; still some resistance, education is a high priority

Kinzel study

found hospital -based nurses and physicians didn't have the correct facts about pain relief in terminally ill people even though they held generally favorably attitudes toward hospice; did not know they lacked competence in giving pain relief

female serial killers

gain less attention because they use poison and other "quiet" methods and often have financial motive

Accidents

have always been a major cause of death; the number of unintentional-injury deaths has stayed fairly constant; population increased while rates decreased

Devastating accidents

have been primed by human error, indifference, or greed; airline catastrophes

Care of the dying child

hospice approach has extended to include children; hospital stay sometimes necessary but focus is on home care ; much in common with the situation of bereaved children

Murder

if a court rules the killing intentional and unlawful

China

major exception to the rule; most of these suicides seem to be motivated by a sense of hopelessness; painful and frustration experiences have led many Chinese women to feel they have little or no chance of a good life; the situation is especially desperate in rural areas where government policies-including limiting married couple to having one child- have disrupted traditional family patterns and increased the stress of life

Bluebond-Langner

many terminally ill children passed through 5 stages in the acquisition of information

Lack of parenting skills

many who become threats to their children have themselves had little opportunities to learn how to be caring and effective parents

Alternative techniques to relieve pain

massage, heat, cold, menthol, electrical nerve stimulation to the skin, careful positioning, exercising, hypnosis, guided imagery, aroma therapy, animal therapy

Memorial services 9/11

memorial services and media coverage were exception in their recognition of individuals who lost their lives at all of the attack sites

Children and death

more observant of life and death than many adults have supposed; understandable that adults want to protect children, however, no child is spared the possibility of losing loved ones

Female suicides

more often relate to real or perceived failures in relationships

Men and women who kill their partners

more than 1,000 women are killed each month by their partner; battered women who resist abuse or fight back are more likely to be killed than those who suffer in silence; control is the issue; batters have an obsessive need to control the lives of the women with who they share intimate relationships

Accident stats

more than 100000 accidents deaths occur in the U.S. annually; an injury accident occurs in the U.S. every 2 sec and death occurs every 6 minutes; most common type is motor vehicle accidents

Psychotic mass killers

most are not psychotic but have an antisocial personality (sociopath or psychopath)

Loss of valued relationship

most common triggering events for youth suicide; death of a parent, breakup, death of a pet; past experiences of loss, rejection, and unworthiness makes some youths more vulnerable to suicide when new interpersonal problems arise

Patterns of parricide

most of the murdered parents and stepparents are white and non-Hispanic; victims usually in their late 40s and 50s; most of the killers are white, non-Hispanic males; most of the juveniles who kill their parents had been victims of severe abuse by those parents- felt isolated and had few outlets

Elderly males and females

most often choose firearms as their mode of suicide; elderly males less likely to give clear warnings

Workplace violence

murder is the leading cause of death for women in the workplace; killer is usually male; may be because of increasing competition

Parricides

murder of a parent; each year about 300 parents killed by their children in the U.S.; more often committed by sons and adolescents

Ethnic and racial minorities

native Americans, African Americans

Motor vehicle accidents

occur every 16 sec; alcohol intoxication is a major factor in motor vehicular fatalities and is involved in 2 of every 5 deaths; most common type of accidental death from age 10 to 75; #1 cause of all deaths between ages 10 and 24

Insurance companies

once common to treat suicide as a crime intended to defraud the underwriters

Mass killing

one in which several die in a single episode; typically involves firearms and are the work of a lone killer (a male); most often the killer knows few, if any, of his victims; typically a white male in his late 20s or 30s

Care of child is like situation of bereaved children

opportunity to express their concerns through conversation, play, drawing, writing, shared reading, etc.; conformation that they are still normal and valuable people despite the impairments and limitations imposed by illness; assurance that family members and other people will not abandon them, no matter what happens; reassurance that they will not be forgotten

Relief of pain and suffering (hospice and palliative)

pain is a stressful experience; remains difficult to assess level of pain and level of relief because it is a subjective experience; can't be measured precisely; research has demonstrated that most people can receive significant relief from pain

Anxiety and sorrow leads to neglect of other family needs

parents may not give adequate attention to their own health, increased irritability and distraction even on the part of the most devoted parents, the brothers and sisters of dying children may be at particular risk

Natural or man-made disaster

pattern has been found among victims of floods, earthquakes, and hurricanes in 377 nations

Psychiatric conditions

people diagnosed as depressive psychotics tend to have highest rates of completed suicides; many people go through disturbed periods without attempting suicide; tempting to believe that a person has to be crazy to commit suicide but not true

Suicide

people who contemplate, attempt and sometimes complete suicide cannot be reduced t a simple stereotype; the notion that only a certain kind of person commits suicide is a distancing strategy; however there are general risk factors; can be the outcome of individual's stressful and frustrating experiences, often lubricated by alcohol or drugs; has often been a collective response to an unbearable situation (Jewish, cult suicides)

Rigidity

persistence in following the same goals and methods; there is only one goal, one level of expectation, and only one way to achieve it; keep doing it the same way despite failing

Serial killer

person who commits murder on repeated occasions

homicide

person who takes the life of another, all murders are homicides, some homicides are murder

Mental disorders

postpartum psychosis and impulse-control deficits that lead to violent actions against their children

Serial killer victims

prostitutes have long been at special risk; others have targeted children or hospital patients; others target any available target

Native Americans

rate is exceptionally high-highest rate of any ethnic or racial subpopulations; Rate is 19.3; more than 1/3 higher than that of the general population; alcohol is a major factor; heavy alcohol consumption associated with 2/3 of the suicides among Native Americans; among the young that depression, alcoholism, and suicide are at their peak; low average life expectancy

Natural Disaster

refers to an episode that occurs within a limited period of time (earthquakes, storms , floods, fires)

"Suicide by Cop"

refers to incidents in which an armed suicidal person confronts a police officer with the intention of forcing the officer to shoot in self-defense; type of encounter is very stressful for officers before and after the shooting; those seeking suicide by cop often have been found to have strong homicidal and self-destructive impulses

College students

related to academic pressure, many undergrads who commit suicide had a higher gpa than their peers however they had performed below what they took to be their parents expectations

Replacement father syndrome

responsible for many instances of severe and repeated child abuse; a women is left to cope alone with her children, she takes a new lover, for this man, the children are in the way, unwanted distractions and responsibilities , the man is set off by the infants crying or young child's disobedience; during an episode of stress or alcohol/drug clouded thinking, the new lover attacks the child/children

Doctors and nurses

rushed to NYC hospitals and clinics and the call went out for blood donations; where were the patients? Gradually the almost unbelievable situation became clear- those directly affected by the attack were beyond medical assistance

High suicide rate

scenic and spacious states; low density states; rural areas that offer few opportunities for social interaction and support; ex. Western state, Wyoming, Alaska, Montana

Mothers who lost their mother in childhood

showed symptoms of depression, worried about their own deaths, were over protective, perfectionists; many were effective mothers, responded to the challenge of their own parental role by completing their own unfinished grieving over the deaths of their mothers

Suicide as a mistake

some people kill themselves even though there is good reason to believe they hadn't meant to do so; individual contemplating suicide has two minds

Suicide for revenge

some people repeatedly feel that they are treated unfairly and their achievements never seem to be recognized no matter how hard they try, love and appreciation are withheld; the lover is rejected, the employee is passed over for promotion, another child is preferred and pampered; suicide attempts are efforts to punish others by punishing themselves

Suicide as a weakness or madness

some people who commit suicide can be classified as psychotic or severely disturbed- but not all; if have a diagnosed psychiatric conditions have a higher suicide rate than the populations at large; belief that suicide is an outcome of weakness

Psychological autopsy technique

special case review; often finds that adult male suicides have occurred after the person was fired, demoted, or passed over for a promotion

Suicide for reunion

the loss of a loved one can be experienced as so unbearable that the survivor is tempted to "join" the deceased; desperate longing may impel a person to follow the dead all the way to the other side if the relationship has been marked by extreme dependency; reunion fantasies may have some temporary value while bereaved individuals reconstruct their lives but also lead to suicidal actions; children vulnerable

The typical episode

the male was in rage again (rages were sudden and unprovoked) and in a drugged or alcohol state; female feared for her life, or her children's life

Violent death

the world is not safe for those who fall victim to murder, terrorism, genocide, disaster, or accident; deaths stun and enrage and increase our fear of disorder and vulnerability; distinctions are not always clear cut; one person's terrorism might be another person's legitimate war; murder, terrorism, accidents and disasters

Warning signs of youth suicide

there have been suicidal attempts by other members of the family; the person him/herself has made a previous attempt; recent changes in the person's behavior (sleeping, eating, chores, social activity, use of alcohol/drugs); sense of hopelessness; explicit or implicit statements; abrupt flashes of anger

Firefighters

those who had experienced many disasters were overwhelmed by the sight and sounds of bodies hitting the pavement; body recovery efforts persisted long after the hope of rescuing a live person had vanished

Children 9/11

those who lost a family member remain at increased risk for emotional and stress-related problems

Earthquakes

through the centuries they have been responsible for some of the most devastating disasters

Hospice

to qualify for Medicare benefits a patient must have a life expectancy of six weeks or less; not always concluded by death, enhances quality of life, provides a full range of services to all patients (including AIDs patients)

Develop and maintain an open communication pattern

unrealistic to wait until a crisis situation develops

Justifiable homicide

use of lethal force to protect your own life

Individual meanings of Suicide

various states of mind with which people approach a suicidal action; suicide for reunion, for rest and refuge, for revenge, suicide as a penalty for failure, as a mistake

Suicide as the Penalty for Failure

victims often the victim of unfulfilled self-expectations; sense of failure is prominent among many people who take their own lives; often has experienced repeated failure on personal relationships and occupations

Terrorism

violence or threat of violence in which civilians are the target; long and diverse history; 9/11; Oklahoma bombing; KKK; seldom do terrorist organizations or movements achieve their objectives

Children reunion fantasies

vulnerable; child is still in the process of attempting to establish identity as an individual; the parent or older sibling who has gone off to heaven has left the survivor with painful feelings of incompleteness and yearning

Proposed guidelines

were incorporated into Medicare and the National Hospice and Palliative Care Organization; patient, family, and staff orientated

Gender and Suicide

women are less likely than men to commit suicide in the U.S. and most other countries

Suicide for rest and refuge

worn down by tribulations, a person may long for a "good rest" or a "secure harbor"; long for a vacation far away from the grinding routine life may be too exhausting and burdensome

Encourage expression of feelings

young children can express themselves through play and drawings, often enhanced by storytelling

negligent homicide

your carelessness resulted in the death of another person