Kantian defenders of suicide for the soon-to-be demented claim that killing oneself would protect rather than violate a person’s inherent worth. The loss of cognitive functions reduces someone to a lower moral status, so they believe that suicide is a way of preserving or preventing the loss of dignity. I argue that they misinterpret Kant’s examples and fail to appreciate the reasons behind his absolute prohibition on suicide. Although Kant says that one may have to sacrifice (...) one’s life to fulfill a moral duty, suicide is not morally equivalent to self-sacrifice because it involves treating oneself merely as a means. Furthermore, people facing the onset of dementia would not protect their dignity by killing themselves while they are still rational and would not avoid a demeaning existence. (shrink)

There is a need to understand more of the risk factors involved in the process from suicide ideation to suicide attempt. Cognitive control processes may be important factors in assessing vulnerability to suicide. A version of the Stroop procedure, Delis–Kaplan Executive Function System Color–Word Interference Test and Behavior Rating Inventory of Executive Function were used in this study to test attention control and cognitive shift, as well as to assess everyday executive function of 98 acute (...) suicidal psychiatric patients. The Columbia Suicide History Form was used to identify a group of suicide ideators and suicide attempters. Results showed that suicide attempters scored lower on attention control than suicide ideators who had no history of attempted suicide. The self-report in the BRIEF-A inventory did not reflect any cognitive differences between suicide ideators and suicide attempters. A logistic regression analysis showed that a poorer attention control score was associated with the suicide attempt group, whereas a poorer cognitive shift score was associated with the suicide ideation group. The results found in this study suggest that suicide attempters may struggle with control of attention or inhibiting competing responses but not with cognitive flexibility. (shrink)

In Europe the elderly population is projected to increase from 18.5% (93.9 million) in 2014 to 28.7% (149.1 million) by 2080. In the USA it is estimated that by the year 2030 more than 20% of the population will be aged 65 years or over. This specific population is at high risk of unrecognised or untreated psychiatric illnesses and suicide. It is well known that completed suicide rate increases with age in both men and women. Although elderly people (...) attempt suicide less often than other age groups, they show a higher completion rate. Generally the methods chosen by elderly are more lethal, the intent is more serious, they are more determined and they show fewer warning sign than the younger population. A recent systematic review and meta-analysis of psychosocial intervention following self-harm in adults found that cognitive behavioural therapy was the most effective in these patients. Unfortunately there have been few reported trials of other potentially effective interventions. Because the scientific literature on psychosocial suicide prevention interventions in the elderly is still scant we decided to conduct a mini-review in order to take stock of the situation. Studies were identified through electronic searches of the Cochrane library, MEDLINE, Scopus and Web of Science databases. PRISMA guidelines were followed and only 7 articles met the inclusion criteria. No firm conclusions can be drawn about this topic because there is still little data and studies used inconsistent outcome measures and designs. Nonetheless, the existing data suggests that psychosocial interventions are promising. (shrink)

Recently, psychologists have developed indirect measurement procedures to predict suicidal behavior. A prominent example is the Death/Suicide Implicit Association Test (DS-IAT). In this paper, I argue that there is something special about the DS-IAT which distinguishes it from different IAT measures. I argue that the DS-IAT does not measure weak or strong associations between the implicit self-concept and the abstract concept of death. In contrast, assuming a goal-system approach, I suggest that sorting death-related to self-related words takes effort because (...) death-related words trigger avoidance-impulses, which suicide ideation weakens. The DS-IAT taps into weakened automatic responses from the self-preservation system. Additionally, the suggested cognitive structure, illuminated with the selfish-goal theory, explains predictable suicidal behavior. (shrink)

State statutes, case law, and professional codes of ethics in the mental health professions typically stress either a duty or the permissibility of disclosing confidential information in order to prevent clients from seriously harming themselves. These sources are intended to address cases where clients are deemed to be suffering from cognitive dysfunction for which paternalistic intervention, including involuntary hospitalization, is considered necessary to prevent self-destructive behavior.The counselor’s moral and legal responsibility is less apparent when mentally competent clients desire (...) class='Hi'>suicide as release from irremediable suffering due to severe physical illness, and this desire is defensible within these clients’ value systems. This paper will explore moral and legal dimensions of a counselor’s decision not to intervene in such cases. The concept of permitted suicide will be introduced and defined, and guidelines for its application developed. (shrink)

Many people believe that only humans have the cognitive and behavioral capacities needed for suicidal behavior, such as reflexive subjectivity, free will, intentionality, or awareness of death. Three counterarguments — based on (i) negative emotions and psychopathologies among nonhuman animals, (ii) the nature of self-destructive behavior, and (iii) the problem of model fidelity in suicide research — suggest that self-destructive and self-injurious behaviors among human and nonhuman animals vary along a continuum.

Objectives: To discover what factors affect lay people’s judgments of the acceptability of physician assisted suicide and euthanasia and how these factors interact.Design: Participants rated the acceptability of either physician assisted suicide or euthanasia for 72 patient vignettes with a five factor design—that is, all combinations of patient’s age ; curability of illness ; degree of suffering ; patient’s mental status , and extent of patient’s requests for the procedure .Participants: Convenience sample of 66 young adults, 62 middle (...) aged adults, and 66 older adults living in western France.Main measurements: In accordance with the functional theory of cognition of N H Anderson, main effects, and interactions among patient factors and participants’ characteristics were investigated by means of both graphs and ANOVA.Results: Patient requests were the most potent determinant of acceptability. Euthanasia was generally less acceptable than physician assisted suicide, but this difference disappeared when requests were repetitive. As their own age increased, participants placed more weight on patient age as a criterion of acceptability.Conclusions: People’s judgments concur with legislation to require a repetition of patients’ requests for a life ending act. Younger people, who frequently are decision makers for elderly relatives, place less emphasis on patient’s age itself than do older people. (shrink)

Kant’s conception of remorse has not received focused discussion in the literature. I argue that he thinks we ought to experience remorse for both retributivist and consequentialist reasons. This account casts helpful light on his ideas of conversion and the descent into the hell of self-cognition. But while he prescribes a heartbreakingly painful experience of remorse, he acknowledges that excess remorse can threaten rational agency through distraction and suicide, and this raises questions about whether actual human beings ought to (...) cultivate their consciences in such a way as to experience remorse on his model. (shrink)

Non-suicidal self-injury is a complex behaviour, routinely engaged for emotion regulatory purposes. As such, a number of theoretical accounts regarding the aetiology and maintenance of NSSI are grounded in models of emotion regulation; the role that cognition plays in the behaviour is less well known. In this paper, we summarise four models of emotion regulation that have repeatedly been related to NSSI and identify the core components across them. We then draw on social cognitive theory to unite models of (...) cognition and models of emotion in developing a new cognitive-emotional model of NSSI. Our model articulates how emotion regulation and cognition can work in concert to govern NSSI, and offers several new research questions that can be addressed within this framework. (shrink)

The purpose of this study was to determine whether certain self-discrepancies predicted the extent to which individuals experienced suicidal ideation. The Selves Questionnaire (an idiographic measure of self-beliefs) was administered to 152 undergraduate participants, who also completed measures of hopelessness, depression, and suicidal ideation. Three kinds of self-discrepancies were associated with suicidal ideation: actual:ideal, actual:ought, and actual:ideal:future. Covariance structure analyses indicated a best-fitting model suggesting that, actual:ideal and actual:ideal:future self-discrepancies contribute to hopelessness, which in turn contributes to depression and suicidal (...) ideation. The findings suggest that self-discrepancy, as a form of negative self-evaluation, may contribute to an individual's risk for suicidal ideation. Moreover, the findings point to an integration of self-discrepancy theory with hopelessness theory. (shrink)

Objective: To explore the experiences of people with a “terminal illness”, focusing on the patients’ perspective of euthanasia and assisted suicide.Method: A qualitative study using narrative interviews was conducted throughout the UK. The views of the 18 people who discussed euthanasia and assisted suicide were explored. These were drawn from a maximum variation sample, who said that they had a “terminal” illness, malignant or non-malignant.Results: That UK law should be changed to allow assisted suicide or voluntary euthanasia (...) was felt strongly by most people. Those who had seen others die were particularly convinced that this should be a right. Some had multiple reasons, including pain and anticipated pain, fear of indignity, loss of control and cognitive impairment. Those who did not want to be a burden also had other reasons for wanting euthanasia. Suicide was contemplated by a few, who would have preferred a change in the law to allow them to end their lives with medical help and in the company of family or friends. The few who opposed a change in UK law, or who felt ambivalent, focused on involuntary euthanasia, cited religious reasons or worried that new legislation might be open to abuse.Conclusion: Qualitative research conducted on people who know they are nearing death is an important addition to the international debate on euthanasia and assisted suicide. Those who had seen others die were particularly convinced that the law should be changed to allow assisted death. (shrink)

ABSTRACTAnxiety and depression diagnoses are associated with suicidal thoughts and behaviours. However, a categorical understanding of these associations limits insight into identifying dimensional mechanisms of suicide risk. This study investigated anxious and depressive features through a lens of suicide risk, independent of diagnosis. Latent class analysis of 97 depression, anxiety, and suicidality-related items among 616 psychiatric outpatients indicated a 3-class solution, specifically: a higher suicide-risk class uniquely differentiated from both other classes by high reported levels of depression (...) and anxious arousal; a lower suicide-risk class that reported levels of anxiety sensitivity and generalised worry comparable to Class 1, but lower levels of depression and anxious arousal; and a low to non-suicidal class that reported relatively low levels across all depression and anxiety measures. Discriminants of the higher suicide-risk class included borderline personality disorder; report... (shrink)

I argue alongside some other scholars that there is a plausible reading of Spinoza’s philosophy of suicide which holds both of the following tenets: first, that suicides occur because of external conditions, and second, that there are at least some suicides which are rational. These two tenets require special attention because they seem to be the source of significant tension. For Spinoza, if one’s cognitions are to be the most adequate, they must be “disposed internally” (E2p29s/G II 114), or (...) determined more from one’s own mental nature than from “fortuitous encounters” with other things (E2p29s/G II 114). It may seem there is a conflict, then, in saying both that there are rational suicides in the Spinozist framework, and that suicides must always be a result of external conditions: it seems a suicide simply cannot be rational if it is the result of external conditions. But this tension, it will be shown, can be dissolved. Once this tension is dealt with, I offer some brief closing arguments. I explain how this reading of Spinoza’s philosophy of suicide can satisfy a call for new suicide research which avoids forms of over-individualism and epistemic injustice, and which encourages us to abolish oppressive conditions that lead to rational suicides. (shrink)

The lifetime prevalence of major depressive disorder in adolescents is reported to be as high as 20%; thus, MDD constitutes a significant social and public health burden. MDD is often associated with nonsuicidal self-injury behavior, but the contributing factors including cognitive function have not been investigated in detail. To this end, the present study evaluated cognitive impairment and psychosocial factors in associated with MDD with NSSI behavior. Eighteen and 21 drug-naïve patients with first-episode MDD with or without NSSI (...) and 24 healthy control subjects were enrolled in the study. The Hamilton Anxiety Scale, Hamilton Depression Scale, Adolescent Self-injury Questionnaire, Beck Scale for Suicide Ideation–Chinese Version, Shame Scale for Middle School Students, Sensation Seeking Scale and Childhood Trauma Questionnaire were used to assess depression-related behaviors, and event-related potentials were recorded as a measure of cognitive function. The latency of the N1, N2, P3a, P3b, and P50 components of ERPs at the Cz electrode point; P50 amplitude and P50 inhibition showed significant differences between the 3 groups. CTQ scores also differed across three groups, and the NSSI– and NSSI+ groups showed significant differences in scores on the Shame Scale for Middle School Students. Thus, cognitive function was impaired in adolescents with MDD with NSSI behavior, which was mainly manifested as memory decline, attention and executive function deficits, and low anti-interference ability. We also found that childhood abuse, lack of social support, and a sense of shame contributed to NSSI behavior. These findings provide insight into the risk factors for MDD with NSSI behavior, which can help mental health workers more effectively diagnose and treat these patients. (shrink)

ABSTRACTGrounded in Emotional Cascade Theory, we explored whether rumination and multisensory imagery-based cognitions moderated the relationships between affect and both odds of non-suicidal self-injury, and frequency of the behaviour. A sample of 393 university students completed self-report questionnaires assessing the constructs of interest. Contrary to expectations, rumination did not emerge as a significant moderator of the affect-NSSI relationship. However, the relationship between affect and frequency of NSSI was moderated by the use of imagery. Further, the relationship between negative affect and (...) NSSI was moderated by positive affect, underscoring the need to consider both negative and positive affect in models of NSSI. Most youth who self-injured reported thinking in images while the urge to self-injure was strong, with 53% thinking in images at least half the time. Future work is needed to explore how positive and negative affect work in concert to govern NSSI, and how imagery might eit... (shrink)

In contrast to the fruitful relationship between psychoanalysis/psychoanalysts and the humanities, institutionalized psychoanalysis has been largely resistant to the integration of psychoanalysis with other empirical branches of knowledge, as well as clinical ones [primarily cognitive-behavioral therapy ]. Drawing from two decades of theoretical and empirical work on psychopathology, psychotherapy, and psychoanalysis, the author aims to show how a reformulation of object relations theory using psychological science may enhance a clinical-psychoanalytic understanding and treatment of suicidal depression, which constitutes one of (...) the most formidable health challenges of our time. Specifically, he rewrote the notion of Melanie Klein positions—primarily the depressive position—using extant knowledge of structure of emotions, the centrality of mental representations of the future and the toxic nature of criticism-based emotions. This reformulation enables a dialog between clinical psychoanalysis and other therapeutic schools of thought and sheds light on the understanding and treatment of suicidal depression. (shrink)

Objective: The aim of the study was to identify clinical variables associated with changes in specific domains of self-reported depression during treatment by antidepressant and/or repetitive Transcranial Magnetic Stimulation in patients with Major Depressive Disorder.Methods: Data from a trial involving 170 patients with MDD receiving either venlafaxine, rTMS or both were re-analyzed. Depressive symptoms were assessed each week during the 2 to 6 weeks of treatment with the 13-item Beck Depression Inventory. Associations between depression changes on BDI13 domains, treatment arm, (...) time, and clinical variables were tested in a mixed linear model.Results: A significant decrease of self-reported depressive symptoms was observed over time. The main characteristics associated with persistent higher depressive symptomatology on Negative Self-Reference domain of the BDI13 were personality disorders, a past history of suicide attempt, age under 65 years old, and female sex.Conclusions: Early cognitive intervention targeting specifically negative self-referencing process could be considered during pharmacological or rTMS treatment for patients with personality disorders and past history of suicide attempt. (shrink)

According to objective self-awareness theory, when individuals are in a state of self-awareness, they tend to compare themselves to their standards. Self-to-standard comparison often yields unfavorable results and can be assimilated to a failure, activating an escape motivation. Building on recent research on the link between failure and suicide thought accessibility, the present experiment tested the hypothesis that mirror exposure alone provokes an increase in suicide thought accessibility. Participants were exposed to their mirror reflection while completing a lexical (...) decision task with suicide-related words. Self-to-standard discrepancy salience was manipulated by asking participants to list actual and ideal traits before versus after the lexical decision task. As predicted, mirror-exposed participants recognized suicide-related words quicker than those unexposed to their mirror image. Self-to-standard discrepancy salience did not moderate this effect. Discussion focuses on the role of the motivation to escape self-awareness in the availability of suicide-related ideas. (shrink)

The article draws from a personal clinical experience of two suicides, not far removed from each other in time. The first patient was a 33-year-old intellectual suffering from depression with narcissistic traits but no psychotic elements, while the second patient was a 21-year-old student with a manifest psychotic episode behind him and with characteristics of post-psychotic depression at the time of suicide. The two suicides had very different impacts on the therapist: the first left open some “space” for reflection, (...) communication, and working-through, while the second closed such a “space,” leaving only a tiny door to the existential roots of human beings and suffering. The therapist was able to find some “shelter” by talking to supervisors, colleagues, and friends in the first case; in the second, the only possible “shelter” was glimpsed in the philosophy of groundlessness (Ungrund) of the Russian existentialist Nicolai Berdyaev. The personal experiences of the therapist, along with some theoretical interpretations of the after-effects of both suicides, are presented using a psychodynamic and existential–phenomenological understanding of the therapeutic relationship with a psychotic and a non-psychotic patient. The main dilemmas exposed by a patient’s suicide, especially if the patient suffers from psychosis, are difficult to deal with in the usual clinical settings and call for resources beyond it. The authors propose that these can be found in philosophical and theological insights. (shrink)

Cognitive Behavioural Therapy (CBT), is a therapy based on cognitive manipulation which denies the existence of ontological truth. Merleau-Ponty warned of such a development which he labelled a “decadent psychoanalysis.” Merleau-Ponty believed in the existence of ontological truth, not as a matter of cognitive representation nor as something that can be designated by positive indices such as those of psychometric measures or statistical analysis, but as an ontological dimension of the pre-cognitive world. Openness to this pre-reflective (...) truth differentiates a therapy based on truth from one based on suggestion and manipulation. When a suicidal patient, approaches a psychotherapist for help and is told that he or she can feel better by adjusting his or her dysfunctional thinking in normative directions, this truth of lived experience is denied, and so is the opportunity for patient and therapist to recognise their shared ontological pre-reflective connection in which truth may find a way to express itself safely, that is, intersubjectively. (shrink)

ObjectivePeer victimization is a substantial early life stressor linked to psychiatric symptoms and poor academic performance. However, the sex-specific cognitive or behavioral outcomes of bullying have not been well-described in preadolescent children.MethodsUsing the baseline dataset of the Adolescent Brain Cognitive Development Study 2.0.1 data repository, we evaluated associations between parent-reported bullying victimization, suicidality, and non-suicidal self-injury, as well as internalizing and externalizing behavioral problems, cognition, and academic performance.ResultsOf the 11,015 9-10-year-old children included in the analyses, 15.3% experienced bullying (...) victimization, as reported by the primary caregiver. Of these, boys were more likely to be bullied than girls. Children who were bullied were more likely to display NSSI or passive suicidality and active suicidality. Bullied children also had lower cognitive scores, greater behavioral problems, and poorer grades. Across all participants, boys had poorer grades and greater behavioral problems than girls; however, bullied boys had greater behavioral problems than girls in several areas. Compared to their non-bullied peers, bullied children with greater non-suicidal self-injury or suicidality also had greater behavioral problems and poorer grades.ConclusionThese findings highlight the sex-specific effects of bullying, and the negative associations of bullying victimization with cognitive performance, behavioral problems, and academic performance. Future longitudinal studies will identify the natural history and neural correlates of these deficits during adolescence. (shrink)

There is growing evidence that some individuals engage in both self-harm and aggression during the course of their lifetime. The co-occurrence of self-harm and aggression is termed dual-harm. Individuals who engage in dual-harm may represent a high-risk group with unique characteristics and pattern of harmful behaviours. Nevertheless, there is an absence of clinical guidelines for the treatment and prevention of dual-harm and a lack of agreed theoretical framework that accounts for why people may engage in this behaviour. The present work (...) aimed to address this gap in the literature by providing a narrative review of previous research of self-harm, aggression and dual-harm, and through doing so, presenting an evidence-based theory of dual-harm – the cognitive-emotional model of dual-harm. This model draws from previous studies and theories, including the General Aggression Model, diathesis-stress models and emotional dysregulation theories. The cognitive-emotional model highlights the potential distal, proximal and feedback processes of dual-harm, the role of personality style and the possible emotional regulation and interpersonal functions of this behaviour. In line with our theory, various clinical and research implications for dual-harm are suggested, including hypotheses to be tested by future studies. (shrink)

This article explores the limits of social constructionism and criticizes the `demiurgic conception of society' associated with it. It contemplates the possibility of sociological realism by investigating the intrinsic and objective properties of action, cognition and morality. The incorporation of intrinsic meanings and intentions in social actions, the objective information supporting cognitive processes and human sensitivity to pleasure and pain as well as the normative rejection of undue suffering, delineate the objective core of social facts, which can be interpreted (...) or influenced, but not arbitrarily or capriciously constructed or manipulated. This general argument is supported by various illustrations drawn from the semantics of social actions and classical puzzles of interpretative sociology such as the meaning of suicide or the morality of social sanctions. (shrink)

Since Darwin, the idea of psychological continuity between humans and other animals has dominated theory and research in investigating the minds of other species. Indeed, the field of comparative psychology was founded on two assumptions. First, it was assumed that introspection could provide humans with reliable knowledge about the causal connection between specific mental states and specific behaviors. Second, it was assumed that in those cases in which other species exhibited behaviors similar to our own, similar psychological causes were at (...) work. In this paper. we show how this argument by analogy is flowed with respect to the case of second-order mental states. As a test case, we focus on the question of how other species conceive of visual attention, and in particular whether chimpanzees interpret seeing as a mentalistic event involving internal states of perception, attention, and belief. We conclude that chimpanzees do not reason about seeing in this manner, and indeed, there is considerable reason to suppose that they do not harbor representations of mental states in general. We propose a reinterpretation model in which the majority of the rich social behaviors that humans and other primates share in common emerged long before the human lineage evolved the psychological means of interpreting those behaviors in mentalistic terms. Although humans, chimpanzees, and most other species may be said to possess mental states, humans alone may have evolved a cognitive specialization for reasoning about such states. (shrink)