Psychological aspects of dependant, suicidal behavior, tanatology and eutanasia.
Psychohygiene, psychoprophylaxis, basics of psychotherapy.
Suicidal behavior
Attempted suicide is a potentially self-injurious act committed with at least some intent to die as a result of the act.
HISTORY OF SUICIDE
The modern era of the study of suicide—at least in the Western world—began around the turn of the twentieth century, with two main threads of investigation, the sociological and psychological, associated primarily with the names of Emile Durkheim (1858–1917) and Sigmund Freud (1856–1939), respectively. Much earlier, during the classical Greek era, suicide was viewed in very specific ways, but almost always negatively. Pythagoras of Samos (around 530 BC), who introduced the theory of number to understand man and the universe (“Number is all things and all things are number”), proposed that suicide would upset the spiritual mathematics of all things. All was measurable by number, and to exit by suicide might result in an imbalance, unlike other deaths that were in harmony with all things. Plato’s position (428–348 BC), best expressed in the Phaedo in his quotation from Socrates, is as follows: Cebes, I believe . . . that the gods are our keepers, and we men are one of their possessions. Don’t you think so?Yes, I do, said Cebes. Then take your own case. If one of your possessions were to destroy itself without intimation from you that you wanted it to die, wouldn’t you be angry with it and punish it, if you had any means of doing so? Certainly.
So if you look at it in this way I suppose it is not unreasonable to say that we must not put an end to ourselves . . . There are, however, provisions for exceptions. The above quotation continues: . . . until God sends some compulsion like the one which we are facing now. The compulsion, of course, was the condemnation by the Athenian court of Socrates for “corrupting the minds of the young and of believing in deities of his own invention instead of the gods recognised by the state” (Apology). Socrates then drank poison, hemlock.
Although Plato allowed for exceptions, he echoed Pythagoras; suicide was wrong and against the state. He writes in The Laws: But what of him . . . whose violence frustrates the decree of Destiny by self-slaughter though no sentence of the state required this of him, no stress of cruel and inevitable calamity has driven him to the act, and he has been involved io desperate and intolerable disgrace, the man who thus gives unrighteous sentence against himself from mere poltroonery and unmanly cowardice? Well, in such a case, what further rites must be observed, in the way of purification and ceremonies of burial, it is for Heaven to say; the next of kin should consult the official canonists as well as the laws on the subject, and act according to their direction. But the graves of such as perish thus must, in the first place, be solitary . . . further they must be buried ignominiously in waste and nameless spots . . . and the tomb shall be marked by neither headstone nor name.
Aristotle (384–322 BC), Plato’s most famous but rebellious student, also espoused the view that suicide was against the State and, therefore, wrong. Man was answerable to the State and thus liable for wrongdoing and was to be punished for wrongful acts. Suicide is one such act. In book 3 of the Nicomachean Ethics, Aristotle noted that: . . . to die to escape from poverty or love or anything painful is not the mark of a brave man, but rather of a coward; for it is softness to fly from what is troublesome, and such a man endures death not because it is noble but to fly from evil. Suicide is categorically seen as unjust. The suicide is “the worst man”. In the only other reference on suicide, Aristotle is explicit; in book 5 of the Ethics he writes: . . . one class of just acts are those acts in accordance with any virtue which are prescribed by the law; e.g., the law does not expressly permit suicide, and what it does not expressly permit it forbids. Again, when a man in violation of the law harms another (otherwise than in retaliation) voluntarily, he acts unjustly, and a voluntary agent is one who knows both the person he is affecting by his action and the instrument he is using; and he who through anger voluntarily stabs himself does this contrary to the right rule of life, and this the law does not allow; therefore he is acting unjustly. But towards whom? Surely towards the state, not towards himself. For he suffers voluntarily, but no one is voluntarily treated unjustly. This is also the reason why the state punishes; a certain loss of civil rights attaches to the man who destroys himself, on the ground that he’s treating the state unjustly.
Epicurus (341–270 BC), another well-known Greek philosopher, was also opposed to suicide. He stated, “. . . the many at one moment shun death as the greatest of all evils, and another yearn for it as a respite from the evils of life.”
In classical Rome, in the centuries just before the Christian era, life was held rather cheap and suicide was viewed either neutrally or, by some, positively. The Roman Stoic, Seneca (4 BC–65 AD), in one of his famous “Letters to Lucilius” wrote, Living is not as long as he can . . . He will always think of life in terms of quality not quantity . . . Dying early or late is of no relevance, dying well or ill is . . . even if it is true that while there is life there is hope, life is not to be bought at any cost. Zeno (around 490 BC), a Greek and the founder of Stoic philosophy, hanged himself after putting his toe out of joint in a fall at age 98. The history of Rome is filled with such incidences, where life was given up for seemingly trivial reasons. Seneca went as far as to call self-murder a “great freedom”. Seneca’s wish: “Death lies near at hand.” Seneca killed himself (by opening his veins). The emperor Nero, had ordered his death because Seneca was accused of plotting against him; and Seneca’s death became glorified and respected with great reverence at that time (Van Hooff, 1990).
The history of Rome’s civilization itself was, indeed, inimical; the life-style in Rome truncated that civilization’s very existence, and this can be summed up in Zeno’s most famous appeal for suicide: To sum up, remember the door is open. Be not a greater coward than the children, but do as they do. When things do not please them, they say, “I will not play anymore.” So when things seem to you to reach that point, just say “I will not play anymore” and so depart, instead of staying to make moan.
The Old Testament does not directly forbid suicide, but in Jewish law suicide is wrong. Life had value. In the Old Testament one finds only six cases of suicide: Abimelech, Samson, Saul, Saul’s armour-bearer, Ahithapel, and Zimni. The New Testament, like the Old, did not directly forbid suicide. During the early Christian years, in fact, there was excessive martyrdom and tendency towards suicide, resulting in considerable concern on the part of the Church Fathers. Suicide by these early martyrs was seen as redemption and thus, to stop the suicides, the Fathers began increasingly to associate sin and suicide. In the fourth century, suicide was categorically rejected by St Augustine (354–430). Suicide was considered a sin because it precluded the possibility of repentance and because it violated the Sixth Commandment, “Thou shalt not kill.” Suicide was a greater sin than any other sin. One might wish to avoid suicide, more than any other sin. This view was elaborated by St Thomas Aquinas (1225–1274) who emphasized that suicide was not only unnatural and antisocial, but also a mortal sin in that it usurped God’s power over man’s life and death (echoing the views of Aristotle, but now suicide is not against the State, but against God, the Church). By 693, the Church, at the Council of Toledo, proclaimed that individuals who attempted suicide were to be excommunicated. The notion of suicide as sin took firm hold and for hundreds of years played an important part inWestern man’s view of self-destruction.
Only during the Renaissance and the Reformation did a different view emerge, although, as Farberow (1972) has documented, the Church remained powerful and opposed to suicide among the lower classes into the twentieth century, although it was not the only view. “In theWestern world” philosophy was presenting different perspectives.
The writers and philosophers from the 1500s began to change the views on suicide. William Shakespeare (1564–1616), for example, has provided us with an excellent array of insights. Minois (1999), in his review of the history of suicide in Western culture, underscores that Shakespeare illustrates how “dramatically” the attitudes had changed by this time. Shakespeare wrote a number of tragedies, with 52 suicides occurring in his plays (Minois, 1999). Shakespeare was a superb suicidologist.
SUICIDE FACTS AND MYTHS
The lore about suicide contains a large number of interesting and esoteric items. People in general are not only perplexed and bewildered by self-destructive behaviour, but they also believe a number of misconceptions of suicide. Here are some common fables and facts about suicide, formulated by Shneidman around 1952 and incorporated into a number of publications (e.g., Shneidman & Mandelkorn, 1967):
1. Fable: People who talk about suicide don’t commit suicide.
Fact: Of any 10 persons who kill themselves, 8 have given definite warnings of their suicidal intentions.
2. Fable: Suicide happens without warning.
Fact: Studies reveal that the suicidal person gives many clues and warnings regarding suicidal intentions.
3. Fable: Suicidal people are fully intent on dying.
Fact: Most suicidal people are undecided about living or dying, and they “gamble with death”, leaving it to others to save them. Almost no one commits suicide without letting others know how they are feeling.
4. Fable: Once a person is suicidal he or she is suicidal forever.
Fact: Individuals who wish to kill themselves are suicidal only for a limited
period of time.
5. Fable: Improvement following a suicidal crisis means that the suicidal risk is over.
Fact: Most suicides occur within about three months following the beginning of “improvement”, when the individual has the energy to put his or her morbid thoughts and feelings into effect.
6. Fable: Suicide strikes much more often among the rich—or, conversely, it occurs most exclusively among the poor.
Fact: Suicide is neither the rich person’s disease nor the poor person’s curse. Suicide is very “democratic” and is represented proportionately among all levels of society.
7. Fable: Suicide is inherited.
Fact: Suicide is not inherited. It is an individual pattern.
8. Fable: All suicidal individuals are mentally ill, and suicide always is the act of a psychotic person.
Fact: Studies of hundreds of genuine suicide notes indicate that although the suicidal person is extremely unhappy, he or she is not necessarily mentally ill.
There is also the misconception that we talk about “myths” as if we know what people believe. Studies by McIntosh et al. (1983) and Leenaars et al. (1988) addressed this topic. Their findings support the belief that people’s knowledge regardingsome facts of the above are quite high and generally well above what was anticipated from the previous anecdotal literature. People with direct experience of suicide seem to know more (Durocher et al., 1989). On the other hand, older people seem to fare the poorest in their knowledge (Leenaars et al., 1991).Yet, the series of studies also raised some questions, for example, “is ‘suicide is inherited’ always a fable?” As we will learn, this is a legitimate question, somewhat different from the views held in the 1950s.
Suicide may be:
1. A form of behavior designed to deal with and solve a problem.
2. A goal-oriented coping method.
3. A way to take control.
4. The ultimate revenge.
5. A cry for help
6. An attempt at manipulation
7. An expression of anger
8. An act of desperation
9. An attempt to gain sympathy/love/compassion
10. Deadly
Why do People Commit Suicide?
I. PRIMARY REASONS
A. Hopelessness
B. Helplessness
II. PRE-SUICIDAL SITUATIONS
A. Sudden loss
B. Social isolation
C. Deep loneliness
D. Illness and pain
E. Changes in life style
F. Burden to others
G. Unfulfilled, unrealistic expectations
Individuals of all races, creeds, incomes, and educational levels die by suicide. There is no typical suicide victim.
Some Common Characteristics of Suicidal People
A. Feelings of helplessness-sees the situation as intolerable and feels helpless to change it.
B. Feeling of hopelessness-sees the situation as having no solution therefore is unable to change it.
C. The individual experiences ambivalence-feels like dying but likes living at the same time. Ambivalence is the key in the intervention process. You must offer hope and strength to the side that wants to live, but also hear and understand the part seeking relief in the form of death. Never deny or ignore the side that wants to die. This will make the individual defensive and he/she will withdraw.
D. Suicide is rarely a spontaneous activity. It is usually a long drawn out process of depression and loss of ability to cope with stress, disappointment, etc.
Some Verbal and Behavioral Clues to Suicide Risk
Remember: Any one clue does not equate suicide but a cluster of clues definitely warrants caution and intervention. Suicidal individuals give clues of their intent. These are verbal, blatant or coded, and behavioral messages we can listen for or be aware of.
Warning signs that an individual is imminently planning to kill themselves may include the person making a will, getting his or her affairs in order, suddenly visiting friends or family members (one last time), buying instruments of suicide like a gun, hose, rope, pills or other forms of medications, a sudden and significant decline or improvement in mood, or writing a suicide note. Contrary to popular belief, many people who complete suicide do not tell their therapist or any other mental-health professional they plan to kill themselves in the months before they do so. If they communicate their plan to anyone, it is more likely to be someone with whom they are personally close, like a friend or family member.
Individuals who take their lives tend to suffer from severe anxiety or depression, symptoms of which may include moderate alcohol abuse, insomnia, severe agitation, loss of interest in activities they used to enjoy (anhedonia), hopelessness, and persistent thoughts about the possibility of something bad happening. Since suicidal behaviors are often quite impulsive, removing guns, medications, knives, and other instruments people often use to kill themselves from the immediate environment can allow the individual time to think more clearly and perhaps choose a more rational way of coping with their pain.
Verbal:
A. I’m going to kill myself.
B. My family would be better off without me.
C. I can’t go on any longer.
D. I’m going on a trip/going to leave.
E. Please tell my family good-bye.
F. I wish I’d never been born.
G. You’re going to be sorry when I’m gone.
H. I want to go to sleep and never wake up.
Behavioral:
A. Some abrupt behavior change in appearance, socialization, use/non-use of money, lessening of caution in dangerous situations.
B. A previous suicide attempt.
C. Giving away prized possessions
D. Putting business affairs in order.
E. Quick, unexpected recovery from deep depression.
F. A suicide note (some are written way before the attempt), death-related poems/stories/essays/journal entries.
There are several theories of suicide:
Communication:
1. Aggressive retaliation.
2. Way of relieving guilt.
2.Sociopsychological:
1. Unsatisfactory relationships
2. Outcome of unsatisfactory social interaction.
3. Effort to solve problems of living.
Risk Factors For Suicide
• Psychiatric disorders
• Past suicide attempts
• Symptom risk factors
• Sociodemographic risk factors
• Environmental risk factors
•
The risk assessment for suicidal thoughts and behaviors performed by mental-health professionals often involves an evaluation of the presence, severity, and duration of suicidal feelings in the individuals they treat as part of a comprehensive evaluation of the person’s mental health. Therefore, in addition to asking questions about family mental-health history and about the symptoms of a variety of emotional problems (for example, anxiety, depression, mood swings, bizarre thoughts, substance abuse, eating disorders, and any history of being traumatized), practitioners frequently ask the people they evaluate about any past or present suicidal thoughts, dreams, intent, and plans. If the individual has ever attempted suicide, information about the circumstances surrounding the attempt, as well as the level of dangerousness of the method and the outcome of the attempt, may be explored. Any other history of violent behavior might be evaluated. The person’s current circumstances, like recent stressors (for example, end of a relationship, family problems), sources of support, and accessibility of weapons are often probed. What treatment the person may be receiving and how he or she has responded to treatment recently and in the past, are other issues mental-health professionals tend to explore during an evaluation.
Psychiatric Disorders
Major depressive disorder and bipolar disorder are associated with at least 60% of suicides. The lifetime risk of suicide of people with major depression is 3.4%, this is much lower than the commonly cited 15%, but still considerably higher than that of people free of psychiatric disorder. Up to 83% of people who perform suicide have had contact with a physician in the year before their death.
Research groups dedicated to the understanding and prevention of suicide conduct “psychological autopsies”, sifting through all the information available regarding the events of the individual’s life prior to suicide. They report evidence of diagnosable mental disorder in almost 90% of those who suicide and argue that the remaining 10% probably suffered a mental disorder which they were unable to detect.
The prevention strategy drawn from these observations is for “improved screening of depressed patients by primary care physicians and better treatment of major depression”. Suicide rates peak immediately after admission and discharge from psychiatric wards. The prevention strategy drawn from these observations is for “enhanced follow-up”.
Schizophrenia is associated with a lifetime risk of completed suicide of 9 -13 and may be more lethal than depression. Other diagnoses, including anxiety, are also associated with greater risk psychiatric disorder leading to hospitalization was the most prominent risk factor, but unemployment, low income, marital status, and family history of suicide additional important risk factors
Most common psychiatric risk factors resulting in suicide:
· Depression
· Major Depression
· Bipolar Depression
· Alcohol abuse and dependence
· Drug abuse and dependence
· Schizophrenia
Other psychiatric risk factors with potential to result in suicide:
• Post Traumatic Stress Disorder (PTSD)
• Eating disorders
• Borderline personality disorder
• Antisocial personality disorder
• Past suicide attempt
After a suicide attempt that is seen in the ER about 1% per year take their own life, up to approximately 10% within 10 years. More recent research followed attempters for 22 years and saw 7% die by suicide.
Symptom Risk Factors During Depressive Episode:
• Desperation
• Hopelessness
• Anxiety/psychic anxiety/panic attacks
• Aggressive or impulsive personality
• Has made preparations for a potentially serious suicide attempt or has rehearsed a plan during a previous episode
• Recent hospitalization for depression
• Psychotic symptoms (especially in hospitalized depression)
• Major physical illness, especially recent
• Chronic physical pain
• History of childhood trauma or abuse, or of being bullied
• Family history of death by suicide
• Drinking/Drug use
• Being a smoker
Sociodemographic and Environmental Risk Factors
Egoistic suicide occurs when an individual is inadequately integrated into society, and is lonely and socially isolated. Altruistic suicide occurs when the individual is too tightly integrated into society and places the needs of the society above his or her own; examples include the Kamikaze pilot or the suicide bomber.
Anomic suicide is the most common and occurs when anomie occurs. Anomie is the condition where social and/or moral norms are confused, unclear, or simply not present . Durkheim observed anomie and the loss of traditional values, as a result of industrialization. This is also evident in current society, in which we are increasingly separated and divided by computer technology, the internet, increasing bureaucracy, and specialization in the workplace. Durkheim rejected pathological mental states as a class of causes of suicide. At most he would concede that a pathological mental state may predispose an individual to commit suicide. The causes, he maintained, were social. In a reassessment of “Suicide”, Durkheim’s dismissal of mental illness as a key determinant of suicide has been described as “baseless”, but his conceptualization of anomic, egoistic and altruistic suicide has been accepted as providing “a means of comprehending recent trends in suicidal behavior” (Robertson, 2006).
The impact of social factors (in particular, anomie) on suicide rates is currently well demonstrated in the North AmericaIndians, who have the highest suicide rate of all ethnic groups in the United States. This culture is under extreme pressure and family conflict, alcohol abuse and hopelessness are believed to be important factors leading to suicide.
The 2003 SARS epidemic in Hong Kong was associated with a marked increase in the suicide rate of the elderly, and biopsychosocial factors have been implicated. Psychosocial stresses have been associated with the suicidal behavior of adolescents in rural china.
The importance of social factors in suicide was recently highlighted in Australia. Page et al (2006) found that across the period 1979 -2003, socioeconomic status differentials in suicide persisted for both men and women. Low socioeconomic status was consistently associated with higher suicide rates, high socioeconomic status was consistently associated with lower rates and middle socioeconomic status was consistently associated with a suicide rate between these extremes.
The SAD PERSONS Scale, which identifies risk factors for suicide as follows:
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Sex (male) |
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Age younger than 19 or older than 45 years of age |
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Depression (severe enough to be considered clinically significant) |
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Previous suicide attempt or received mental-health services of any kind |
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Excessive alcohol or other drug use |
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Rational thinking lost |
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Separated, divorced, or widowed (or other ending of significant relationship) |
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Organized suicide plan or serious attempt |
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No or little social support |
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Sickness or chronic medical illness |
Acute risk of suicide
Suicide risk may increase rapidly (acute suicide risk) as a result of sudden overpowering distress, in people both with and without mental disorder.
Wyder (2004) examined individuals who had survived a suicide attempt; 51% reported acting after thinking about their actions for 10 minutes or less. Of those who had been affected by alcohol, 93% had thought about their actions for 10 minutes or less. Impulsive acts make prevention problematic.
Acute suicide risk may occur in mental disorders, particularly psychotic depression, in which delusions of guilt and loss are prominent features. Mental disorders may be complicated by personality difficulties and the ready availability of alcohol.
Dumais et al (2005) investigated cases in which suicide was completed during an episode of major depression. They found that impulsive-aggressive personality disorders and alcohol abuse/dependence were two important independent predictors of suicide in major depression.
Chronic risk of suicide
Chronic risk is a common feature of personality disorder, particularly borderline personality disorder . The personality disorders differ from conditions such as major depressive disorder, which manifest episodes of difficulties. “Personality” refers to the characteristic (long-term) manner in which the individual responds to the environment.
While personality disorder is a chronic condition, there may be superimposed periods of more acute distress and risk of suicide. Borderline personality disorder , characterized by a pervasive pattern of instability of interpersonal relationships and mood, and marked impulsivity, has a 10% lifetime risk of suicide. Impulsive suicide is usually triggered by adverse life events.
Illustration. Thich Quang Duc burned himself to death in Saigon (Vietnam) in 1963. He was protesting the way, in his view, the government was oppressing the Buddhist religion.
PSYCHOLOGICAL THEORIES OF SUICIDE
The modern era of the psychological study of suicide began around the turn of the twentieth century with the investigations of Sigmund Freud. Freud’s clinical research suggested to him that the root cause of suicide, within a developmental context, was the experience of loss or rejection of a significant, highly cathected object (i.e., a person). In 1920, Freud further developed what he termed a “deeper interpretation” of what leads someone to kill himself after such a loss or rejection. He stated: Probably no one finds the mental energy to kill himself unless, in the first place, in doing so he is at the same time killing an object with whom he has identified himself and, in the second place, is turning against himself a death wish which had been directed against someone else. (Freud, 1974i, p. 162).
Freud—eschewing the two popular notions about suicide at the turn of the twentieth century—sin and crime—placed the focus of blame on the person; specifically, in the person’s unconscious. Since around 1900, there have been a host of psychological theories besides Freud’s that have attempted to define suicide. Indeed, a—if not the—major advance in the psychology of suicide in the last century was the development of various models beyond Freud’s that have attempted to understand this complicated human act, the most noteworthy of which has been Edwin Shneidman.
Suicide is open to various psychological constructions. In his famous experiment on volume where the experimenter pours fluid from a short, fat beaker into a tall, thin one, Piaget (1970) has demonstrated that the young child will say there is more fluid in either the first or second beaker. The child is centred on only one dimension to the exclusion of others. Later in human development, the child can take into account both dimensions simultaneously and use multiple perspective on the same event. To be decentred in general is to be able to take an abstract view of things, rather than to be influenced totally by the characteristics of concrete particulars (“stimulus bound”). To view suicide only from Freud’s original view is perhaps to be too concrete and stimulus bound. To introject only Freud’s or any other specific view may be seen as acting like the young preconservative child, i.e., centred. Although Freud provided a sound basis in the very early years of suicidology, what we have discovered thus far about suicide is that it may best be defined from multiple perspectives: not being concrete but also not being overinclusive. In this sense, it may be wise to follow Kelly’s (1955) dictate of constructive alternativism: We take the stand that there are always some alternative constructions available to choose among in dealing with the world. No one needs to paint himself into a corner; no one needs to be completely hemmed in by circumstances; no one needs to be the victim of his biography. (p. 15)
Here, I have decided to present four points of view: psychoanalytic (Freud); cognitive-behavioural (Beck); social learning (Lester); and multidimensional (Shneidman). I hope in some way to clarify the central issue—understanding why human beings commit suicide. Let me begin with a few remarks by Shneidman on the topic of theory in general.
Shneidman (1985) suggests that a psychological theory regarding suicide should begin with the question, “What are the interesting common psychological dimensions of committed suicide?”, not “What kind of people commit suicide?”. This question, according to Shneidman, is critical; for they (the common dimensions) are what suicide is. Not necessarily the universal, but certainly the most frequent or common characteristics provide us with a meaningful conceptualization regarding suicide.
Most frequently, non-professionals identify external causes (e.g., ill health, being left by a lover, losing one’s fortune, etc.) as what is common in suicide. A recent downhill course (e.g., drop in income, sudden acute alcoholism, a change in work, and divorce or separation) can, indeed, be identified in suicide. However, although there are always situational aspects in every suicidal act, these are only the precipitating events. Suicide is more complex. Suicide is a multidetermined event. How can we understand these psychological complexities?
Suicide is a multidimensional malaise. It is an intrapsychic drama on an interpersonal stage. From this psychological view (Leenaars, 1988a, 1989a, 1989b, 1994) we will define suicide with the key ideas of the four suicidal theories mentioned above: Psychoanalytic (Sigmund Freud), Cognitive-Behavioural (Aaron T. Beck), Social Learning (David Lester), and Multidimensional (Edwin Shneidman). The four perspectives will be presented in the form of protocol sentences or what might be construed to be aphorisms. Protocol sentences are testable hypotheses, and in that sense they are like aphorisms. An aphorism is a short statement stating a truth. It is a principle expressed tersely in a few telling words. A major difference between protocol sentences and aphorisms is that the latter tend to be general.
Although protocol sentences may be general, they must be testable (although some form of specificity is implied for the sentence to be testable). One must be able to determine the truth or falsity of the statement. Aphorisms, if they are true, should also be subject to the possibility of verification (falsifiability). The protocol procedure was first introduced by Carnap (1959) and applied in my own research in suicide for over three decades. Protocol sentences (or aphorisms) are one means of defining an event. It is obvious, as Shneidman (1984) noted, that one way to discuss suicide is to do so aphoristically.
Psychoanalytic
As I have already mentioned, Sigmund Freud first formulated the psychoanalytic perspective early in the twentieth century. Other noteworthy suicidologists in this tradition are Karl Menninger, Henry A. Murray, and Gregory Zilboorg. Here are some protocol sentences (or aphorisms) derived from Freud’s work.
1. Suicide is motivated by unconscious intentions. Even if the person communicates that he or she has consciously planned suicide, the focus of the action is in the unconscious.
2. The root cause of suicide is the experience of loss and rejection of a significant highly cathected object (i.e., a person)—the person, in fact, is singly preoccupied with this loss/rejection.
3. The suicidal person feels quite ambivalent. He/she is both affectionate and hostile towards a lost/rejecting person.
4. The suicidal person is, in some direct or indirect fashion, identifying with a rejecting or lost person. Attachment, based upon an important emotional tie, is the meaning of identification.
5. The suicidal person exhibits an overly regressive attachment—“narcissistic identification”—with the object. He/she behaves as if he/she were reacting to another person.
6. The suicidal person is angry at the object although the feelings and/or ideas of vengefulness and aggression are directed towards him/herself.
7. The suicidal person turns back upon him/herself murderous wishes/ impulses/needs that had been directed against the object.
8. Suicide is a fulfilment of punishment; i.e., self-punishment.
9. The suicidal person experiences a sense of guilt or self-criticism. The person develops prohibitions of extraordinary harshness and severity towards him/herself.
10. The suicidal person’s organization of experiences is impaired. He/she is nolonger capable of any c oherent synthesis of his/her experience.
Cognitive-Behavioural
The cognitive-behavioural perspective is most widely associated with Aaron T. Beck and his colleagues (1963, 1967, 1971, 1975a, 1975b, 1976, 1978, 1979a, 1979b). George Kelly, Albert Ellis, and Don Meichenbaum are also associated with this view.
The following 10 protocol sentences are deduced from Beck’s writings:
1. Suicide is associated with depression. The critical link between depression and suicidal intent is hopelessness.
2. Hopelessness, defined operationally in terms of negative expectations, appears to be the critical factor in the suicide. The suicidal person views suicide as the only possible solution to his/her desperate and hopelessly unsolvable problem (situation).
3. The suicidal person views the future as negative, often unrealistically. He/she anticipates more suffering, more hardship, more frustration, more deprivation, etc.
4. The suicidal person’s view of him/herself is negative, often unrealistically. He/she views him/herself as incurable, incompetent, and helpless, often with self-criticism, self-blame, and reproaches against the self (with expressions of guilt and regret) accompanying this low self-evaluation.
5. The suicidal person views him/herself as deprived, often unrealistically. Thoughts of being alone, unwanted, unloved, and perhaps materially deprived are possible examples of such deprivation.
6. Although the suicidal person’s thoughts (interpretations) are arbitrary, he/she considers no alternative, accepting the validity (accuracy) of the cognitions.
7. The suicidal person’s thoughts, which are often automatic and involuntary, are characterized by a number of possible errors, some so gross as to constitute distortion; e.g., preservation, overgeneralization, magnification/minimization, inexact labelling, selective abstraction, negative bias.
8. The suicidal person’s affective reaction is proportional to the labelling of the traumatic situation, regardless of the actual intensity of the event.
9. Irrespective of whether the affect is sadness, anger, anxiety, or euphoria, the more intense the affect the greater the perceived plausibility of the associated cognitions.
10. The suicidal person, being hopeless and not wanting to tolerate the pain (suffering), desires to escape. Death is thought of as more desirable than life.
Social Learning
The social learning view has been summarized by Lester (1987): Albert Bandura and psychologists in the classical (Pavlov) and operant (Skinner) traditions are the best-known theorists in this view. The 10 aphorisms of this paradigm are as follows:
1. Suicide is a learned behaviour. Childhood experiences and forces in the environment shape the suicidal person and precipitate the act.
2. Child-rearing practices are critical, especially the child’s experiences of punishment. Specifically, the suicidal person has learned to inhibit the expression of aggression outward and simultaneously learned to turn it inward upon him/herself.
3. The suicide can be predicted based on the basic laws of learning. Suicide is shaped behaviour—the behaviour was and is reinforced in his/her environment.
4. The suicidal person’s thoughts provide the stimuli; suicide (response) is imagined. Cognitions (such as self-praise) can be reinforcers for the act.
5. The suicidal person’s expectancies play a critical role in the suicide—he/she expects reinforcement (reward) by the act.
6. Depression, especially the cognitive components, is strongly associated with the suicide. Depression goes far towards explaining suicide. For example, depression maybe caused by a lack of reinforcement, learned helplessness, and/or rewarded.
7. Suicide can be a manipulative act. Others reinforce this.
8. Suicide is not eliminated by means of punishment.
9. The suicidal person is non-socialized. He/she has not been sufficiently socialized into traditional culture. The suicidal person has failed to learn the normal cultural values, especially towards life and death.
10. The suicide can be reinforced by a number of environmental factors, for example, subcultural norms, suggestions on television, gender preferences for specific methods, suicide in significant others (modelling), a network of family and friends, cultural patterns.
Multidimensional
The psychologist who has consistently argued for a multidimensional view is Shneidman (1967, 1973, 1980, 1981a, 1982a, 1985, 1991, 1993—see Leenaars, 1999a). Here is a brief summary, utilizing our previous procedure, of his work:
1. The suicidal person is in unbearable psychological pain. The person is focused almost entirely on this unbearable emotion (pain), and especially one specific (an arbitrarily selected) way to escape from it.
2. The suicidal person experienced a situation that is traumatic (e.g., poor health, rejection the spouse, being married to a non-supportive spouse). What is implied is that some needs are unfulfilled, thwarted, or frustrated.
3. For the suicidal person, the idea of cessation (death, stopping, or eternal sleep) provides the solution. It permits him/her to resolve the unbearable state of self-destructiveness, disturbance, and isolation.
4. By the suicide, the person wishes to end all conscious experience. The goal of suicide is cessation of consciousness and the person behaves in order to achieve this end.
5. The suicidal person is in a state of heightened disturbance (perturbation), e.g., he/she feels boxed in, rejected, harassed, unsuccessful, and especially hopeless and helpless.
6. The suicidal person’s internal attitude is ambivalence. The suicidal person experiences complications, concomitant contradictory feelings, attitudes and/or thrusts (not only towards him/herself and other people but towards the actitself).
7. The suicidal person’s cognitive state is constriction (tunnel vision, a narrowing of the mind’s eye). He/she is figuratively intoxicated or drugged by his/her overpowering emotions and constricted logic and perception.
8. The suicidal persoeeds or wishes to egress. He/she wants to leave (the scene), to exit, to get out, to get away, to be gone, not to be around, to be “elsewhere”. . . not to be.
9. There is a serial pattern to the suicide. The suicidal person exhibits patterns of behaviour that diminish or truncate his/her life, which subtract from its length or reduce its scope.
10. The person’s suicide has unconscious psychodynamic implications.
Summary
To summarize, suicide is best understood as a multidimensional human malaise. What we have discovered so far is that suicide can be defined differently from various psychological points of view. I do not mean to suggest that all these views are mutually exclusive or equally accurate or helpful for psychotherapy—we do not have to follow the cognitive processes of the suicidal person. Nor do I believe that my protocol (aphorism) method is the only way to outline a point of view; indeed, it may well lose some of the complexity in the theories themselves. It is, however, one way to understand the event.
Prediction and prevention
The majority of cases, the prediction and prevention of suicide is not possible.
Three Basic Steps:
1. Show you care
2. Ask about suicide
3. Get help
Step one: Show you care
Take all talk of suicide seriously. If you are concerned that someone may take their life, trust your judgment!
Listen Carefully.
Reflect what you hear.
Use language appropriate for age of person involved. Do not worry about doing or saying exactly the “right” thing. Your genuine interest is what is most important.
Be Genuine. Let the person know you really care.
Talk about your feelings and ask about his or hers.
• “I’m concerned about you… how do you feel?“
• “Tell me about your pain.“
• “You mean a lot to me and I want to help.“
• “I care about you, about how you’re holding up.“
• “I’m on your side…we’ll get through this.”
Intervention
Step Two: Ask About Suicide
Be direct but non-confrontational.
Talking with people about suicide won’t put the idea in their heads.
Chances are, if you’ve observed any of the warning signs, they’re already thinking about it. Be direct in a caring, non-confrontational way.
Get the conversation started.
You do not need to solve all of the person’s problems – just engage them. Questions to ask:
• Are you thinking about suicide?
• What thoughts or plans do you have?
• Are you thinking about harming yourself, ending your life?
• How long have you been thinking about suicide?
• Have you thought about how you would do it?
• Do you have __? (Insert the lethal means they have mentioned)
• Do you really want to die? Or do you want the pain to go away?
Ask about treatment:
• Do you have a therapist/doctor?
• Are you seeing him/her?
• Are you taking your medications?
Step three: Reassure the person that help is available and that you will help them get help:
• “Together I know we can figure something out to make you feel better.”
• “I know where we can get some help.”
• “I can go with you to where we can get help.”
• “Let’s talk to someone who can help . . . Let’s call the crisis line now.”
Encourage the suicidal person to identify other people in their life who can also help: Parent/Family Members, Favorite Teacher, School Counselor, School Nurse, Religious Leader, Family doctor.
Those who treat people who attempt suicide tend to adapt immediate treatment to the person’s individual needs. Those who have a responsive and intact family, good friendships, generally good social supports, and who have a history of being hopeful and have a desire to resolve conflicts may need only a brief crisis-oriented intervention. However, those who have made previous suicide attempts, have shown a high degree of intent to kill themselves, seem to be suffering from either severe depression or other mental illness, are abusing alcohol or other drugs, have trouble controlling their impulses, or have families who are unwilling to commit to counseling are at higher risk and may need psychiatric hospitalization and long-term outpatient mental-health services.
In the effort to cope with suicidal thoughts, silence is the enemy. Suggestions for helping people survive suicidal thinking include engaging the help of a doctor or other health professional, a spiritual advisor, or by immediately calling a suicide hotline or going to the closest emergency room or mental-health crisis center. In order to prevent acting on thoughts of suicide, it is often suggested that individuals who have experienced suicidal thinking keep a written or mental list of people to call in the event that suicidal thoughts come back. Other strategies include having someone hold all medications to prevent overdose, removing knives, guns, and other weapons from the home, scheduling stress-relieving activities every day, getting together with others to prevent isolation, writing down feelings, including positive ones, and avoiding the use of alcohol or other drugs
Grief that is associated with the death of a loved one from suicide presents intense and unique challenges. In addition to the already significant pain endured by anyone who loses a loved one, suicide survivors may feel guilty about having not been able to prevent their loved one from killing themselves and the myriad conflicting emotions already discussed. Friends and family may be more likely to experience regret about whatever conflicts or other problems they had in their relationship with the deceased, and they may even feel guilty about living while their loved one is not. Therefore, individuals who lose a loved one from suicide are more at risk for becoming preoccupied with the reason for the suicide while perhaps wanting to deny or hide the cause of death, wondering if they could have prevented it, feeling blamed for the problems that preceded the suicide, feeling rejected by their loved one and stigmatized by others.
Some self-help techniques for coping with the suicide of a loved one include avoiding isolation by staying involved with others, sharing the experience by joining a support group or keeping a journal, thinking of ways to handle it when other life experiences trigger painful memories about the loss, understanding that getting better involves feeling better some days and worse on other days, resisting pressure to get over the loss, and the suicide survivor’s doing what is right for them in their efforts to recover. Many people, particularly parents of children who commit suicide, take some comfort in being able to use this terrible experience as a way to establish a memorial to their loved one. That can take the form of everything from planting a tree or painting a mural in honor of the departed to establishing a scholarship fund in their loved one’s name to teaching others about surviving child suicide. Generally, coping tips for grieving a death through suicide are nearly as different and numerous as there are bereaved individuals. The bereaved person’s caring for him- or herself through continuing nutritious and regular eating habits and getting extra, although not excessive, rest can help strengthen their ability to endure this very difficult event.
Quite valuable tips for journaling as an effective way of managing bereavement rather than just stirring up painful feelings are provided by the Center for Journal Therapy. While encouraging those who choose to write a journal to apply no strict rules to the process as part of suicide recovery, some of the ideas encouraged include limiting the time journaling to 15 minutes per day or less to decrease the likelihood of worsening grief, writing how one imagines his or her life will be a year from the date of the suicide, and clearly identifying feelings to allow for easier tracking of the individual’s grief process.
To help children and adolescents cope emotionally with the suicide of a friend or family member, it is important to ensure they receive consistent caretaking and frequent interaction with supportive adults. All children and teens can benefit from being reassured they did not cause their loved one to kill themselves, going a long way toward lessening the developmentally appropriate tendency children and adolescents have for blaming themselves and any angry feelings they may have harbored against their lost loved one for the suicide. For school-aged and older children, appropriate participation in school, social, and extracurricular activities is necessary to a successful resolution of grief. For adolescents, maintaining positive relationships with peers becomes important in helping teens figure out how to deal with a loved one’s suicide. Depending on the adolescent, they even may find interactions with peers and family more helpful than formal sources of support like their school counselor.
Psychohygiene. Psychoprophylaxis. Psychotherapy.
Psychohygiene is a complex of measures to provide normal development of a person, preservation and strengthening mental health, maintenance of the most desired conditions for human mental activity.
Mental health means (WHO):
1.Absence of the evident mental frustrations.
2.The certain reserve of forces of the man with the help of which he can overcome stresses, difficulties in unexpected circumstances.
3.Condition of balance between a person and his environment in society, coexistence of the person’s experience with the experiences of other people concerning «objective reality».
Mental health means absence of mental diseases, normal mental development and desired functioning of supreme parts of CNS. For children it means normal abilities to master knowledges and skills, answer the requirements of school system, follow the norms of behaviour in relations with mates and teachers. Normal development can be defined as harmonic, appropriate to age, normal functioning and intellectual activity, positive emotional state.
Parts of psychology are systematised according to comparative age peculiarities of mentality. There are the following aspects of psychohygiene: psychohygiene of childhood, play activity, education, training, sexual desire, youth, work, family, sexual life, marriage.
Contemporary society is characterised by significant changes in human social activity; thus the requirements to his health and organisation of his physical and intellectual functions are increased. Contemporary person can be characterised by decreasing of his adaptive abilities and functional reserves of organism, disturbed mechanisms of self-regulation. This causes active spread of non-infectious diseases. Subsequently its correction and prophylaxis are required. At the same time possibilities of contemporary medicine do not suit the overcoming of mental and somatic problems. Traditionally these problems in medicine were solved by the experts in hygiene. Main attention was paid to diagnosis of adverse physical and social factors worsening health condition and causing occurrence and distribution of diseases. The given strategy is based oormalization of the environmental factors. However, this strategy does not aim at definition of a health state and development of measures on its improvement. These problems are in focus of valeology, a science about laws, ways and mechanisms of formation, preservation, strengthening and reproduction of human health. Appearance and development of valeology is determined by the necessity of new trends and strategies on preservation and strengthening of human health.
Valeology caot be opposed to clinical, nosologic medicine. Moreover, it is a part of it. Common theory of medicine should be based only on the doctrine of illness (pathology) and doctrine of health (valeology). The use of valeological principles increase the efficiency of diagnosis and primary prophylaxis of a number of non-infectious diseases based on revealing adverse risk factors. The basic method of diagnosis in these cases is screening, i.e. examing of practically healthy people, allocation of risk groups among them and maintenance of the appropriate measures directed on counteraction to risk factors.
The main tasks of valeology:
1.Development and performance of the notions concerning the state of health, construction of diagnostic models and methods of its estimation and prognosis.
2.Quantitative analysis of the health of a quite healthy man, its prognosis, characteristics of the quality of life.
3.Formation of health psychology, correcting the way of the life by the individual with the purposes of strengthening health.
4.Perfomance of the individual health-improving programs, initial and secondary prophylaxis of diseases, estimation of efficiency of health improving programs.
Scientific field of health has been developed for a long time. Such famous scholars as Avicenna, Hippocrate, Galen, I.M. Sechenov, S.P. Botkin, I.P. Pavlov dealt with this problem. In last decades – N.M. Amosov, R.M. Baevskij, G.L. Apanasenko, V.P. Kaznacheev, etc. The term «valeology» was offered by I.I. Brehman (1982, 1987). He suggested science about health should be complex, based on achievement of medicine, psychology, ecology, biology, pedagogics and other sciences.
During all its history valeology was aimed at solving the following problems. First of all it was the definition of a notion of individual and public health, healthy way of life. Then it was evaluation of an active strategy of health formation. Integrative character of valeology is a result of combining variety of initial sciences and different directions of work and methods of research used in its formation. Thus, development of the physical state of the person is connected with physical education and sports, public health services, system of rehabilitation measures. Intellectual potential is strengthened by the system of education and science; development of spiritual potential is defined by religion, art and literature.
Valeology is closely connected with other sciences about the human being: with medicine, biology, psychology, pedagogics. Prevention of disease development and preservation of human health is the basic task of hygiene. It is revealing and prophylaxis of adverse influence of natural and social factors on human health. First of all, valeological influence deals with strengthening of individual health and increasing human ability to resist the adverse factors.
Valeopedagogics (pedagogics of health) is a new trend in a pedagogical science, on which system of health education should be based. The purpose of valeopedagogics is to increase the level of human health.
Valeopsychology is a scientific-practical discipline which study the regulations of mental processes and central mechanisms of mental self-regulation. This processes and mechanisms provide normal functioning and development of mentality, help a human being to satisfy the basic needs, open abilities, preserve and improve health.
The subject of valeology is an individual health, mechanisms and laws of its formation.
According to the Code of WHO, health is defined not only as an absence of illnesses or physical defects, but as a state of complete physical, spiritual and social well-being.
There are the following components of health:
1)physical (physical activity, physical well-being, physical limits);
2)mental (mental well-being, control of behaviour and emotional reactions, functioning of cognitive processes) ;
3)social (interpersonal communication);
4)role (ability to perform socially accepted roles at home and at work);
5)general estimation of health.
There are three interconnected aspects of health, necessary for correct planning of valeological measures and based on the appropriate levels of personality: somatic, mental and spiritual. The spiritual aspect of health is a motivation for a healthy way of life, long and happy life, independent activity in formation and strengthening of person’s health, careful attitude to life and health of others.
Commonly there are 5 groups of health:
1.Healthy persons with normal development and normal functioning.
2.Healthy persons with functional or some morphological deviations and reduced resistance to acute and chronic diseases.
3.Patients with chronic diseases in a condition of compensation with the preserved functioning of organism.
4.Patients with chronic diseases in a condition of sub-compensation with reduced functional abilities.
5.Patients with chronic diseases in a condition of decompensation with considerably reduced functional abilities of organism.
An important aspect of valeology is prenosological diagnosis, i.e. recognition of the states of organism, which are betweeorm and pathology. The subject of prenosological diagnosis is the process of organism adaptation to inadequate conditions of environment, which can lead to complete or partial adaptation to environment without violation of homeostasis, insufficient or unsatisfactory adaptation, failure of adaptation with homeostasis violation.
Basic objects of prenosological diagnosis:
1. Chronic boundary or transitive condition of the organism.
2. Being under strain (short-term).
3. Overstrain.
4. State before the disease in a stage of an exhaustion of regulator mechanisms with homeostasis disturbance, or in a stage of subclinical forms of the diseases.
The main task of psychohygiene is creation of favourable conditions for harmonic development and performance of all human mental abilities (stable family, normal meals, good financial situation and house conditions, etc.).
Children’s psychohygiene of preschool age (period of formation of personality’s basis) includes:
1.Maintenance of a reasonable shedule of the day, meals, employment, play activity, rest, sleep, etc.
2.Providing of a normal psychological situation in family and children’s educational environment, normal care and requirements.
3.Problem of completeness of the family, its well-being (incomplete families, divorces, single mothers, emotional stresses, alcohol, etc.), habitation (conflicts, early sexual experience, etc.), financial support, etc.
Extra attention should be paid to the problems of school psychohygiene (pre-teenage, teenage and youthful), because of increasing number of mental diseases in this period.
The adverse influence is set with the following general school problems:
1.Inability to study well due to abnormal and complex educational programs.
2.Hostile attitude of the teacher to “bad” schoolboys, injustice to all or to separate persons; mutual antipathy, etc.
Changes in school collective, necessity to adapt to the schoolmates and teachers, to the already existed environment.
4. Hostility in children’s collective, complexity of the emotional relations in children’s collective, meaning of sympathies and antipathies, aspiration to be a leader and independent person, special role of traits of character, etc.
The following common psychological problems take place:
1.Learning psychological sexual distinctions in pre-school and school age – sense of belonging to a certain gender, to the certain labour and economic orientation, family orientation, etc.
2.Sexual physiological and psychological problems in teenage and youthful age – puberty, occurrence of secondary sexual characters, change of appearance, difficulties in professional orientation, aspiration to occupy the appropriate social status to be independent, etc.
In providing of psychohygiene of a family, which can be regarded as a background of normal mental development the following factors are important: mutual respect and support, mutual aid in home affairs, the psychologically rational solutions of conflicts, involving all members of the family in discussing the important family decisions, maintenance of a healthy way of life (without harmful habits), care about child’s modesty, honesty, diligence (on an own example), etc.
Psychohygiene plays a significant role in preservation of mental health (rational organization of intellectual and physical work, way of work and rest, optimum load, favourable psychological atmosphere in labour collective, positive emotional attitude to work, adequate choice of a profession, etc.).
Psychoprophylaxis is a complex of measures to prevent mental frustration and diseases (initial psychoprophylaxis), and also recurrences of the mental diseases (secondary psychoprophylaxis).
There is primary, secondary and tertiary prophylaxis. Primary prophylaxis means protection of health of future children, genetic consultations, measures directed to improvement of the women’s health, organization of obstetric aid, early revealing of malformations in the new-born, medical pedagogical correction.
The secondary prophylaxis is early diagnosis, prognosis and prevention of dangerous states, early beginning of treatment, using adequate methods of correction, long supporting therapy.
Tertiary prophylaxis is a system of measures aimed at the prevention of physical inability at chronic diseases.
Psychoprophylaxy consists in the following measures:
1.Prevention of psychoviolating influences at home and at work (basis of prophylaxis of neurosis, psychopathy and some other mental pathologies).
2.Prevention of iatrogeny and didactogeny.
3.Providing with necessary treatment and psychotherapeutic care for somatic and recovering patients (attention, goodwill, etc.).
4.Individual approach to the definition of industrial amount of work after illness, regulation of working conditions and life.
5. Performance of antirecurrent therapy after illness. Besides the mentioned ones, the especially important place in
psychoprophylaxis is occupied by creation of correct dietary regimen and resting time, favourable psychological atmosphere at home, medical establishment and at work, psychotherapeutic training of all medical stuff and appropriate approach to the patients.
Psychotherapy means a kind of interpersonal interaction when the patients are treated with psychological means to solve mental problems and difficulties (term as the physiological and medical factor belongs to K.I. Platonov). From the set of psychotherapeutic methods the extra attention should be paid to rational psychotherapy, suggestive psychotherapy, auto-training, psychoanalytic psychotherapy.
Rational psychotherapy is the method aimed at logic ability of the patient to compare, to do conclusions, to prove their validity. The basic stages of rational psychotherapy are:
1.Explanation.
2.Persuasion.
3.Reorientation.
Rational psychotherapy can be carried out as individual or group psychotherapy.
Suggestive psychotherapy is a number of methods, based on such medical factor as hypnosis or autohypnosis. Hypnosis is used in vigil condition, hypnotic sleep (hypnopsychotherapy), narcotic sleep (narcopsychotherapy). Among the methods of autohypnosis autotraining is the most popular one.
HOW AND WHY HYPNOSIS WORKS (Thomas Yarnell)
Modern hypnosis has been used for hundreds of years to build self-confidence, change habits, lose weight with weight loss programs, stop smoking, improve memory, end behavior problems in children and eliminate anxiety, fear and phobias.
The question is, WHAT IS HYPNOSIS? Hypnosis is a state of mind characterized by relaxed brain waves and a state of hyper-suggestibility. Hypnosis and hypnotic suggestions have played a major role in healing for thousands of years. According to the World Health Organization, 90% of the general population can be hypnotized. Hypnosis is a perfectly normal state that just about everyone has experienced. What we call “highway hypnosis” is a natural hypnotic state. You drive somewhere and don’t remember driving or even remember seeing the usual landmarks. You are on automatic pilot. The natural hypnotic state also exists when you become so involved in a book, TV show or some other activity that everything else is blocked out. Someone can talk to you and you don’t even see or hear them. Whenever you concentrate that strongly, you automatically slip into the natural hypnotic state.The hypnotic state, by itself, is only useful for the relaxation it produces. The real importance of hypnosis to the healing and emotional change process is that while you are in the hypnotic state, your mind is open and receptive to suggestions. Positive and healing suggestions are able to sink deeply into your mind much more quickly and strongly than when you are in a normal, awake state of mind. I say positive suggestions because all research has demonstrated that while in the hypnotic state, you cannot be made to do anything against your moral values.
All of our habitual and behavior controlling thoughts reside in what is called our subconscious mind. It’s called that because it is deeper than our conscious mind. It’s below our level of consciousness. We are unaware of the thoughts and feelings that reside there. Did you ever forget you had a dental appointment or some other appointment that you really didn’t want to keep? Your subconscious mind is where that thought or memory that you had to go to the dentist at 2 PM went when you forgot you had the appointment. Once it was too late to go, your conscious mind relaxed and the memory came back.
Imagine that there is a trap door between your conscious mind and your subconscious mind. Normally, the trap door is closed until your brain waves slow down to a relaxed, alpha brain wave level. This happens when you are asleep. The door opens for short periods of time and ideas, images and thoughts come out of your subconscious mind. We call what comes out in your sleep, “dreams”. When you are in a state of hypnosis, the door also opens so helpful suggestions can be directed into your subconscious mind or forgotten memories can be retrieved.
The hypnotic induction that hypnotists use is simply a way to focus your attention and concentration so you will go into that natural, normal hypnotic state. Once in the state of hypnosis, the trap door opens and suggestions to help you can be given. The list of ways hypnosis has been used to help children, adolescents and adults is practically endless s but does include: weight loss, stopping smoking, building self-confidence and self-esteem, improving academic performance at every age level, improving test taking ability from children through high school, college, medical and law school as well as the National Teacher Certification Exam, pain management, eliminating anxiety, fear and phobias, stress management, insomnia and other sleep problems and helping to heal physical problems.
The Three Keys to the successful use of hypnosis for self improvement and personal growth are self motivation, repetition and believable suggestions.
1. The motivation to change must come from within you. If you are trying to change because someone else wants you to “lose weight” or “stop smoking”, the chances are greately reduced that the hypnosis will work. For example, I’ve worked with many people for weight loss or to quit smoking who came to me because their physician or spouse wanted them to change. These people do not respond as well to the hypnosis as those who really want to change. Those who came because they wanted to quit smoking or lose weight responded quickly and easily. Before you start to use hypnosis for your self improvement, you should get it clear in your own mind why you want to change. This clear intention to change will help the hypnotic suggestions to take hold and manifest themselves in your everyday life.
2. To really work well, suggestions must be reinforced by repetition. Most of the habits, feelings and emotions we want to change are deeply implanted in our subconscious mind and ero-entertainer will not just “go away” with one set of suggestions. Most of the time, the hypnotic suggestions need to be repeated on a regular basis until you notice a change. This is one reason that most specialists in hypnosis give clients cassette tapes of their sessions so they can listen to them every day. It’s also the reason why hypnosis tapes you buy can work so well. You get to listen to them every day or often enough that the suggestions become permanently a part of you. There is no way to predict how long it will take to see change. It will depend partly on your motivation and commitment.
3. The third key to the successful use of hypnosis for personal change is believable suggestions. If you are to accept a suggestion, your mind must first accept it as a real possibility. Telling a chocoholic that chocolate will be disgusting to them and will make them sick is too big a stretch for the imagination. If a suggestion like this even took hold, it would only last a short time because it would be so unbelievable to a real chocolate lover. In cases like this, one of the successful weight loss suggestions I use is that the next time the individual eats chocolate, it will not taste quite as good as the time before. This is far more acceptable and believable to most people. Then, with enough repetition over a period of time, chocolate loses much of it’s positive taste and control over that person.
One final note is that HYPNOSIS IS NOT DANGEROUS. There are almost no risks when used by trained professionals. You cannot be made to do anything that is against your moral values. An amateur or stage hypnotist might give you suggestions that might embarrass you, might not work or that might make you feel uncomfortable or self-conscious at the time. To avoid this, stick with professionally trained hypnosis specialists. The one risk I know about involves falling asleep. If you are tired or if you become too relaxed, you may move from the state of hypnosis to the normal sleep state. This is fine if you were going to go to sleep right after the trance but if you have other plans after listening to a hypnosis tape, you may want to set an alarm clock just in case you fall asleep. I’ve even had students fall asleep because they became too relaxed. In relation to this, never listen to a hypnosis tape while driving. It is very dangerous for you and everyone else on the road. Don’t even listen to it if you are a passanger as the relaxation suggestions could make the driver fall asleep.
Over the years, self improvement and personal growth using hypnosis has helped millions of people change their lives permanently because it is a safe and powerful tool for changing your thoughts, feelings and habits.
Auto-training is an active method of psychotherapy, psycho-prophylaxis and psychohygiene. It is directed to recovering of dynamic balance of the homeostatic system of self-regulating mechanisms damaged in stressful situation.
Psychoanalysis is a psychotherapeutic method developed by Z. Freid. Basic focus is upon unconscious mental processes. Psychotherapeutic methods are used for their analysis. Classical psychoanalysis includes theories of common mental development, psychological origin of neurosis and psychoanalytic therapy.
Social labour rehabilitation includes a complex of measures on maintenance and restoration of social communications and professional skills of the patient after illness. Drug treatment (supporting therapy) is also included.
The task of rehabilitation is to adapt the patient to former or varied working and home environment by training of the preserved abilities of the patient.
Labour rehabilitation restores work capacity of the patient with the help of drugs, physiotherapeutic procedures.
Social rehabilitation is creation of the appropriate environment in family (improvement of living conditions, financial support), restoration of the contacts with others, restoration of the social status of the patient.
