GFVM 1045

Matters of Life and Death

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By Kwong Chak, Yeung

Objectives of today: To let you know

1. Definition of Suicide
2. Situation around the world and Hong Kong
3. Causes of suicide from practical experience
4. Theories on Suicide: Freud, Durhelm
5. Signs of Suicide
6. Preventive measures
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INTRODUCTION:
What is the point of living?
躁鬱症纏繞 盧凱彤 2015 年公
開患病經過 自爆想過死
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Other celebrities

SHINee 鐘鉉

張國榮 leslie cheung

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Chester Bennington

Suicide Prevention: Choose to Stay

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As a starting question from

Albert Camus
“There is only one really serious philosophical problem, and that
is suicide” The Myth of Sisyphus

The Greek legend of Sisyphus, who is condemned by the gods for eternity to
repeatedly roll a boulder up a hill only to have it roll down again once he got
it to the top, as a metaphor for the individual’s persistent struggle against the
essential absurdity of life.

The meaning of life: there isn’t one and we can’t make one
either

- Absurdity of life
- lives are meaningless and will remain so
- No a priori meaning => Life is a choice
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Definition
Suicide has been an object of fundamental concern to all cultures, though the importance given
to suicide itself, as well as the degree to which it has entered into other concerns, has varied
greatly from one period to another.

Def: Suicide is the voluntary and intentional act of taking of one’s life.

3 pts for clarification and discussion.

1. Suicide and Suicide attempt 自殺與自殺未遂

Suicide is when people direct violence at themselves with the intent to end their lives, and they
die because of their actions. It’s best to avoid the use of terms like “committing suicide” or a
“successful suicide” when referring to a death by suicide as these terms often carry negative
connotations.

A suicide attempt is when people harm themselves with the intent to end their lives, but they do
not die because of their actions.
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2. Voluntary or compelled
Def: Suicide is the voluntary and intentional act of taking of one’s life.

Discussion 1:

Q. Suicide vs homicide

Q. Some are compelled to die by tradition and custom. But these cases are still considered to be
suicide case. Imamura Shōhei’s The Ballad of Narayama (1983《楢山节考》 )

【最新香港預告 - 4K 全新修復 】楢山節考 The Ballad of Narayama - 8 月 30 日棄母求生

3. Coward or Hero
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Coward? Some kinds of suicide are considered as a courageous act in some cultures.

How about “Martyrs”(烈士) for some sacred causes?

Suicide in traditional Western culture is often considered an atrocity, because we see suicide as
a cowardly selfish move. Suicide in the West is about abandoning your duties and your loved
ones.

Kamikaze (神風敢死隊)
Suicide in Japan could be the inverse. There, it could be considered honorable and altruistic. They see
dying by your own hand as more altruistic for your family's honor or your superior's honor. The
same was with Celtic and Nordic mythologies, and a trend can still be seen in Scandinavian
countries.
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However, the main trend in the Western world has always regarded suicide as fundamentally
problematic. Possibly because suicide in the West has nearly always been interpreted as
voluntary self-destruction, with no element of social constraint or obligation. Philosophers from
Plato to Camus have used it as a starting point for reflection on the eternal problems of human
existence although they came out with very different interpretations.

Indeed, ambivalence toward the fact of his own existence is one of Western man’s most
persistent characteristics; life and death, the relation of man to man, and the relation of man to
himself have been subject to continual questioning, and suicide has been seen as relevant to all
of these. In such a climate of thought, it is not surprising that neither settled opinion nor
emotional consensus has ever been reached concerning the nature of suicide.

Suicide is not a personal matter

https://youtu.be/PDUsyfJvcj8

Suicide around the World

and HK

Suicide rate around globe

http://apps.who.int/gho/data/view.main.MHSUICIDEASDRREGv?lang=en
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Suicide Rate in HK

Suicide is also the third leading cause of death among young people.

Among people with suicidal tendencies, high school students account for nearly 30% and junior
high school students close to 15%. In addition, psychologists with clinical experience should be
aware that with regard to suicide statistics, many people with passive suicidal ideation can
hardly be included in the statistics, so the actual situation will only get worse.
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II. Who is most likely to

commit suicide?

In Hong Kong, the suicide rates are highest in teens, young adults, and the elderly. People over
the age of 65 have the highest rate of suicide. Although women are more likely to attempt
suicide, men are more likely to be successful. Suicide risk also is higher in the following groups:

Older people who have lost a spouse through death or divorce

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People who have attempted suicide in the past

People with a family history of suicide

People with a friend or co-worker who committed suicide

People with a history of physical, emotional, or sexual abuse

People who are unmarried or in an unhappy relationship, unskilled, or unemployed.

People with long-term pain, or a disabling or terminal illness.

People who are inclined to violent or impulsive behavior.

People who have recently been released from a psychiatric hospitalization are often a very
frightening transition period.

People in certain professions, such as police officers and health care providers who work with
terminally ill patients

and People with abuse problems.

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Two classical explanations:

Freud and Durkheim
S. Freud: Psychology 佛洛伊德心理分析學派

E. Durkheim: Sociology 涂爾幹社會學

Freud is an Austrian neurologist and the founder of psychoanalysis, a clinical method for treating
psychopathology through dialogue between a patient and a psychoanalyst.

PSYCHOTHERAPY - Sigmund Freud

Freud believed our personality is governed by three personality structures, namely, the Id, ego
and superego. Id, Ego, Superego
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Superego 超我

EGO
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Freud's psychoanalytic theory of suicide had two major hypotheses

● The first being his theory of depression which basically views suicide as murder.
● The second being based on Thanatos, the death instinct.

Freud identified that normal individuals can control their death instinct and direct it outward.
Suicidal individuals on the other hand may turn this death instinct inwards which could result in
the individual taking their own life.

=> Pleasure principle v.s. Reality principle >>> Death Drive

The typology of and theories on suicidal behavior are reviewed to integrate various points of
view in terms of the paranoid process.

Freud's theory of internalized aggression, the relation of suicide impulses to depression, and the
operation of narcissistic components in the complex motivation of suicide are related to the
concept of the victim-introject as central to the pathology of suicide. Suicidal patterns play out
the dynamics inherent in the victim-introject and its correlative component the aggressor-
introject.
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Death Instinct
Urge to Return to the peace

● Aggressive tendency => eliminate the other to make peace

● Suicidal tendency => eliminate the self-being to make peace
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Émile Durkheim

Émile Durkheim's Sociological Theory of suicide identifies three different types of suicide -
egoistic, altruistic, and anomic.

Egoistic suicide victims feel that they have too few ties to society and the community. They feel
alienated from others and cut off from the social supports that are important to keep them
functioning adaptively as social beings.

Altruistic suicides are responses to societal demands. Individuals feel part of a group and
sacrifice themselves for what they take to be the good of society. Some altruistic suicides are
literally required as the only honorable recourse in the circumstances.

Anomic suicide is triggered by a sudden change in a person's relation to society. Anomie can
pervade society in disequilibrium, making suicide more likely.
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Durkheim’s 4 types of suicide

● Altruistic suicide (利他主義) – individual has little value compared to the group e.g. suicide
bombers 神風特攻隊（Kamikaze）
● Egoistic suicide (自我主義) – not well integrated through social institutions such as the family,
marriage, etc.
● Anomic suicide (無規範)– when social guidelines are unclear, people feel lost e.g. ‘crisis
of masculinity’
● Fatalistic suicide (宿命論) – too much control, feel trapped e.g. prison

● Criticisms of Durkheim:
Hallbachs suggested that Durheim put too much emphasis on religion at the expense of
features of urban and rural life.
Too vague in defining social integration and ways of measuring it.
Validity of statistics.
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I. Suicide resulted from failing to get out from difficulties

(especially psychological)

1. Unbearable pain: One might feel physical or emotional pain that is simply unendurable and
there's a firm belief that it will never end, and if anything only gets worse.
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2. Distorted thinking: When someone‘s depressed, very often than not, they aren't thinking
straight – their perspective is distorted –

● they can't remember anything good;

● they can't enjoy anything,
● they are unable to perceive positive emotion from others.

Everything appears dark and hurtful. Even attempts to help that person may be painful to them
because instead of seeing it as a sign that someone cares, some of them get the wrong
message. Some feel that they are being looked down on, or that they are a burden, or that
others are trying to control them.

Afraid even of being noticed leads them to avoid interacting with the others.

3. Self-worthless: Someone might feel that they're a burden to others.

One might feel so hurt by the other that they lose all sense of self worth. One might have lost so
much function (like an athlete having both legs cut off or a singer that gets throat cancer) that
everything that they were can no longer be, and they can't imagine what else they are capable
of. It's hard to have the courage to live on when there is absolutely no hope whatsoever.
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4. Loss of Hope: For some, being suicidal is a loss of hope on many levels – no hope for one's
self, the world, or the future. No light at the end of the dark tunnel.
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How Can Suicide Be

Prevented?

The majority of suicides can be prevented. There are a number of measures that can be taken
at community and national levels to reduce the risk, including:

Reducing access to the means of suicide (e.g. pesticides, medication, guns).

Treating people with mental disorders (particularly those with depression, alcoholism, and schizophrenia,
精神分裂症 a serious mental illness in which someone cannot understand what is real and what is
imaginary; the state of having qualities or attitudes that are different from each other and do not work well
together).

Providing follow-up support to people who have made suicide attempts.

Responsible media reporting.

Training primary health care workers.

Mental health promotion.

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What are the warning signs

for suicide?
https://youtu.be/soQoEkuUc9s

Following are some of the possible warning signs that a person may be at risk for suicide:

1. Excessive sadness or moodiness: Long-lasting sadness and mood swings

can be symptoms of depression, a major risk factor for suicide. Depression
is the primary risk factor.

2. Sudden calmness: Suddenly becoming calm after a period of depression

or moodiness can be a sign that the person has made a decision to end his
or her life.
See, “Recognizing Suicidal Behavior" in Cleveland Clinic, Ohio. 2019.
https://my.clevelandclinic.org/health/articles/11352-recognizing-suicidal-behavior
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3. Withdrawal: Choosing to be alone and avoiding friends or social

activities also are possible symptoms of depression. This includes the loss
of interest or pleasure in activities the person previously enjoyed. Or
simply, the loss of energy in doing anything. Anything that is easy before
turns out to be very difficult or burdensome.

4. Changes in personality and/or appearance: A person who is considering

suicide might exhibit a change in attitude or behavior, such as speaking or
moving with unusual speed or slowness. In addition, the person might
suddenly become less concerned about his or her personal appearance.

5. Dangerous or self-harmful behavior: Potentially dangerous behavior,

such as reckless driving, engaging in unsafe sex, and increased use of
drugs and/or alcohol might indicate that the person no longer values his
or her life.
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6. Recent trauma or life crisis: A major life crisis might trigger a suicide
attempt. Crises include the death of a loved one or pet, divorce or break-
up of a relationship, diagnosis of a major illness, loss of a job, or serious
financial problems.

7. Making preparations: Often, a person considering suicide will begin to

put his or her personal business in order. This might include visiting
friends and family members, giving away personal possessions, making a
will, and cleaning up his or her room or home. Some people will write a
note before committing suicide.

8. Threatening suicide: Not everyone who is considering suicide will say

so, and not everyone who threatens suicide will follow through with it.
However, every threat of suicide should be taken seriously.

9. Eating and/or sleeping disorder.

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Can suicide be prevented?

In many cases, suicide can be prevented. Research suggests that the best way to prevent
suicide is to know the risk factors, be alert to the signs of depression and other mental disorders,
recognize the warning signs for suicide, and intervene before the person can complete the
process of self-destruction.

People who receive support from caring friends and family, and who have access to mental
health services are less likely to act on their suicidal impulses than are those who are isolated
from sources of care and support. If someone you know is exhibiting warning signs for suicide,
don’t be afraid to ask if he or she is depressed or thinking about suicide. In some cases, the
person just needs to know that someone cares and is looking for the chance to talk about his or
her feelings. You can then encourage the person to seek professional help.

How To Lose Weight in 4 Easy Steps!

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What should I do if someone I know is thinking about

committing suicide?
If someone you know is threatening suicide, take the threat seriously. The 3 primary things you
should do:

1. Appropriate sweets and favorite foods

When you are in a bad mood, appropriate sweets or your favorite food can increase your
happiness and ease your emotions.

A small amount of sugar intake can increase the content of tryptophan in the brain, which has a
stabilizing effect. But remember not to eat too much, or it will be counterproductive. Excessive
sugar intake can cause blood sugar levels to rise, the body secretes insulin, which in turn leads
to mood swings.
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2. Moderate exercise

Exercise is a good way to improve your mood. Studies have shown that exercise can help
secrete dopamine and improve mood. It is worth mentioning that aerobic exercise and anaerobic
exercise will trigger different blood sugar and cortisol concentration changes, which will also
affect our emotional feelings.

Choose aerobic exercises such as jogging or anaerobic exercises such as iron lifting? Which is
more effective varies from person to person. You can try it according to your physical condition
and personal preference.
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3. Get more sun

Data shows that the incidence of depression is higher in areas with shorter light hours. Further
studies have found that light can affect the transport efficiency of serotonin transporters, thereby
increasing the content of serotonin between synapses (serotonin Hypofunction and depression
have a very significant association).

There is even a therapy based on this, called "light therapy", which puts depressed patients
under artificially controlled light sources. This is also the most common auxiliary therapy for
depression. Therefore, when the weather is good, it is also a good choice to go out and bask in
the sun.
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4. Regular schedule

On the one hand, regular work and rest can help us maintain our health. Irregular work and rest
have a great impact on hormone secretion in the body, and hormone levels are directly related
to emotions.

On the other hand, it can also help us gain a sense of control. There are many causes of
depression, and lack of control is one of them, especially for young people who are not yet
independent. We can start with small things, such as regular work and rest, and find the lives
that we can control.
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4. Tidy up the room

Cleaning up the room can help us in at least three ways:

One is to improve the environment. A mess and a clean and tidy room, which one would you
like? The comfort of the environment also helps us adjust to mood swings.

The second is to divert attention. In many cases, it is not that we cannot deal with the problem,
but we are caught in an emotional vortex, unable to see the direction. At this time, we need to
temporarily divert attention, and cleaning the room is a good choice.

The third is to start action.

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5. Three column table

The three-column table is one of the core techniques in cognitive behavioral therapy.

Simply put, it is your own recall of "what happened to me at the time, what emotions I have at
the time, and what thoughts I had flashed at the time" .

You can use it as a special diary. Whenever you encounter something unhappy, you can record
and clarify your thoughts and feelings in this way. In this way, you can clearly see the changes
in your heart, release your emotions, and think calmly, instead of letting your mind be messed
up by emotions.

情境 自動化思維 情緒及其强度

Situation Automated thinking Emotion and intensity

尋致不悅的事件 寫下情緒出現時的自動化思 A.標註悲傷、憤怒、焦慮等

維 情緒
Real events that cause
unpleasant emotions Write down the a. Mark sadness, anger,
automated thinking anxiety and other
when emotions appear emotions

b.為情緒強度打分（0-100)

b. Score the emotional

intensity (0-100

例：見到高中化學老師，他 例：他覺得我很醜。 例：
說你變了好多。
He thinks I am ugly 難過 Sad（80）
Your Highschool Teacher
尷尬 Embarrassed（70）
Said you changed a lot.

The scenario is the event that makes you feel painful, and the automated thinking is the thought
you generate at that moment. These automated thoughts are often extreme and irrational, and
our emotions will also be affected by this.
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6.Catharsis

In fact, many of the above-mentioned methods, such as three-column tables, etc., all have the
effect of emotional catharsis, but emotional catharsis is only a "by-product" of those methods,
and there are also methods specifically used to vent emotions.

One is behavior catharsis

Going to the valley to yell and go to the boxing room to beat sandbags are all acts of catharsis.
We can express, transmit, and vent our emotions through behavior (of course, on the premise of
not hurting or disturbing others) . The consultants of Dance Therapy pay particular attention to
this point. They believe that most of the emotions and distress can be relieved through physical
stretching and exertion. Therefore, when conditions permit (the consultation room is on the
first floor and there is no one around and the visitor is willing), we occasionally take the visitor
to jump up and stomp.

The second is emotional venting

That is, not through behavior, but directly expressing emotions. This is especially effective for
sadness, because we have a gift from heaven, tears. Crying is one of the most effective ways to
vent your emotions. If you feel sad, find a separate room, watch some touching movies, and cry
happily.
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7.Chat and hug by friends or family

As animals that evolved from ancient apes, our essence is social animals, and interpersonal
communication is very important to us. Rehabilitation studies on depression have found that
good social support and interpersonal interaction are very effective in relieving symptoms,
which is why consultants often say that "talking itself has a healing effect."
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8.keep a pet

There is a psychological term called "pet effect", which means that keeping pets can make
people happier and healthier. There is even a special treatment that uses animals to help
depressed patients, called "animal-assisted therapy", the most common of which is "horse-
assisted therapy." Of course, for most people, raising a horse is not realistic, but fluffy kittens or
puppies are also good choices.

It should be noted that patients with severe depression are unable to keep pets. If someone
around you suffers from severe depression, it is better to send him a pet when he recovers.
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9. Go to the hospital

Going to the hospital may be the most direct and effective way, but many people refuse to rule
it out because of their fear of "psychiatric drugs." In fact, psychotropic drugs are
divided into five categories, namely "antipsychotics"(抗精神病藥),
"antidepressants"(抗抑鬱藥), "mood stabilizers"(心境穩定劑), "sedative
hypnotics"(鎮靜催眠藥) and "cholinesterase inhibitors"(膽鹼酯酶抑製劑).

"Antidepressants"(抗抑鬱藥) prescribed to improve depression can improve the

emotional state by adjusting the level of transmitters, which is not uncommon in oral
medications. As for the side effects, the doctor will start with a small dose, which can avoid
most of the adverse reactions. Once it occurs, you can change the medicine on the doctor’s
recommendation. Second, the side effects of antidepressants are not unique, but the vast
majority The sleepiness, nausea and other problems common to drugs are not serious and often
disappear within a few weeks.
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10.Seek counseling

All symptoms will be considered from the three dimensions of psychological, physical and
social environment, and depression is no exception. If medicine is to intervene from a
physiological perspective, then consultation is to intervene from a psychological perspective
(including psychotherapy).

Like drugs, psychological counseling, which is also developed under the modern scientific
system, has also undergone many tests and studies, and finally proved effective. Generally
speaking, consultation is a good choice for those who do not meet the diagnostic criteria for
symptoms. The trouble of reaching the diagnostic criteria requires psychological treatment
with the assistance of drugs.
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What can we do?

Short term?

Long Term?

Personal Level

Seeking help in time is critical in suicide prevention, yet many at risk, especially youth, are often
unaware of the assistance available or reluctant to get it even when there is a need.

Community engagement

To enhance awareness of the importance of timely intervention, we can help in reaching out and
inspiring lives by sharing positive experiences online or offline.

Cross-sectoral support has always been important in efforts for suicide prevention. Need to Gain
support from our partners in the community, such as those from the media, Hong Kong Police
Force, Fire Service Department, and Hong Kong Poison Information Centre.
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Tutorial Practice:

情境 自動化思維 情緒及其强度 自動化思維原因 合理性質疑

Situation Automated Emotion and Reason Plausibility

thinking intensity behind questioning
Automated
thinking

6 Dimensions: From the Beginning to the End of life, and after

- 創造生命 Creation of Life - neo-biology
- 中止生命 Suspension of Life - Suicide/abortion
- 發展生命 Development of Life - Positive and Negative developments
- 善終生命 End of Life - Euthanasia/Hospice care
- 撫慰生命 Soothing of Life - Recognizing grief and bereavement
- 安息生命 Ritual of Life - Religious/Symbolic farewell