How could I possibly help myself
The death wish from a psychiatric point of view
Mag. Claudia Umschaden
Status: March 2003 (updated December 2019)
The term “death wish” is misleading. Especially with old people it can happen that, due to a long, fulfilling life and age-related ailments and limitations, comments such as "I want to die" "I would be the same to die" are made. But they would never lay hands on themselves and do not seriously think about suicide or (stranger) killing on request.
The term suicide (sui caedere = to kill oneself) and the suicidality derived from it, on the other hand, contain a state of mind in which there is a risk that the person concerned will do something to himself that may lead to death.
A person's desire to end their life represents a pathological condition.
But everyone wants to live. The psychiatrist or psychologist is challenged here to work out which traits in the individual mental life move a person not to cope with life problems courageously and with the support of others, but instead to think about suicide. Its task is to help the suicide on the way to a constructive problem solution.
Through modern anthropology, biology, psychology and sociology it is well proven that humans are born with a highly differentiated disposition to the social way of life. In a familiar interrelationship with the mother, father, siblings, grandparents and other caregivers, he can grow into an independent, relational personality. So from the beginning he is designed to connect with you and not an autonomous individual. This natural connection means nothing else than the inner alignment of the person towards the other and the full development of his personality with and through social cooperation. This cooperation has to be taken up, encouraged and developed in the interpersonal relationship in the child, whereby the child helps to shape it with his temperament and his own activity.
Self-employment includes taking on social responsibility, developing compassion, as well as being able to accept help as part of life. The successful process of personality or character development is based on the "basic trust" acquired in the first relationships, which enables people to hope for human help later in the most difficult life situations and to actively seek and take advantage of it. Such a person will not see his worth and dignity in question by accepting help.
It is a natural human need to want to live. In this sense, a person's desire to end their life is always a pathological state that arises when an external life situation (loss, separation, financial problem, political pressure situation, emotional offense, but also fear of exams, fear of coping with a Work or similar) seems unmanageable to a person with his "inner equipment".
Erwin Ringel differentiates between the cause and the cause of the suicide: Although external circumstances have an influence on the suicide, they cannot explain how it came about. “They are important triggering factors. (...) Ultimately, however, the suicide can only be explained by the human personality. "1 Viktor Frankl sees suicide as “a no to the question of meaning” and explains that this question cannot be: “What else can I expect from life? - but can only read: what does life expect from me? "2
Alfred Adler used the sense of community as a measure of mental health. This is shown in how a person copes with his tasks in the areas of work, community and love.
Although external circumstances have an influence on the suicide, they cannot explain how the suicide occurred.
When it comes to suicidality, it is crucial how a person with his or her individual character approaches these three life questions - especially when difficulties arise.
For example, a person can set himself the goal in life of always wanting to be perfect. In doing so, he repeatedly comes into conflict with the sense of community, i.e. with equal cooperation with the other and acting for the common good. For example, a successful manager may feel neglected and become suicidal if they favor someone else in a promotion. Or an old person who is no longer as productive as before because of an illness, has the feeling of losing his worth, according to his character of wanting to be perfect and being able to do so. An active no longer wanting to live, because you no longer see any possibility of continuing your life plan of perfectionism.
Suicide arises from the confrontation of a lifestyle with reality. There is no natural death wish or the death drive postulated by Freud. The individual psychological approach explains how an irritation in the character of the individual can lead to a tendency to suicide, which when various unfavorable factors come together ultimately narrows the field of vision of the person concerned and ultimately leads to the suicide attempt via the suicide fantasy.
Results from suicide research
Suicidality is thus evoked in connection with a misdirected tendency in the character, even if this may not be recognizable at first. Thoughts or attempts at suicide do not arise from an actual death wish, but are an expression of a “not wanting to live like this”. This is also shown by the fact that when people who were rescued after a serious suicide attempt were followed up, 85 to 100% did not die of suicide within the follow-up examination period3 and the vast majority were happy to have been saved.
Suicide attempts do not arise from an actual wish to die, but are an expression of a “not wanting to live like this”.
In almost all cases examined (in 90 to 95% of the suicides) a psychiatric diagnosis could be made for the time of the suicide attempt.4 This also applies to the elderly and the seriously ill, in whom suicide attempts are not significantly more common than in the general population.5 Alcohol or drugs play a role in up to 50% of suicide cases.6 A connection between suicides and men, delayed development in childhood, behavioral disorders in adolescence, impulsiveness of character and instability as well as school difficulties could be demonstrated.7 Various studies show that, especially in old age, loneliness, inadequate palliative care and inadequate treatment of mental illnesses lead to suicidality. Heuft speaks of the “socio-cultural vulnerability of old people” and means “devaluation in the political arena, secularization, loss of partners, death of the circle of friends, mobility of children and grandchildren or childlessness, relocation, low level of education, material lack of prospects”.8 This is v. a. in older male widowers more often associated with social withdrawal and increased suicidality.
The problem of old age depression is often underestimated. This is shown by the results of a survey in Germany (2019). The disease is often treated incorrectly or not at all in the elderly, which contributes to the drastically increased suicide rates in old age. In fact, 35 percent of all suicides in Germany are committed by people over 65 years of age, although their share of the population is 21 percent.
A society that no longer consistently and with all efforts opposes those who want to commit suicide, loses its humanity.
The public euthanasia debate and the effective media action of euthanasia organizations such as Exit and Dignitas contribute to the reduction of natural rejection of suicide. They give instructions on suicide, provide aids and, by affirming the suicide as a “solution”, exert pressure on the doubting suicide. After the publication of the book “Final Exit”, which instructs people to commit suicide by suffocation with a plastic bag and poisoning with drugs, the number of suicides with plastic bags increased by 31% and drug poisoning by 5.4% within one year. After the media-effective suicide of the Swiss writer Sandra Paretti, exit suicides quadrupled, according to a statement by the exit vice-president at the time9 ("Werther Effect").
Suicidality is curable
However, 70 to 80% of those affected share their emotional distress10 and thus give us the opportunity to intervene to help. Adequate assistance requires the supervisors and companions to have a precise understanding of why the individual's will to live is weakened. Mental illnesses, especially depression, need to be recognized and treated. Pain and other physical symptoms need to be taken seriously and corrected or alleviated as much as possible. The importance of external stress factors must also be recognized and correctly assessed in connection with the personality of the person at risk.
For example, the loss or impairment of vision for a well-read and politically interested person can result in a loss of scope that is difficult for him to deal with. Increasing hearing loss can isolate a person who does not want to be a burden, as he can no longer participate in many conversations if he does not draw attention to his or her ailment. Particularly in the case of able-bodied people, the loss of performance through age or illness harbors the risk of feeling inferior and useless.
You have to know that today's performance-oriented social development can generate enormous external pressure in which people who otherwise would have managed their lives can become suicidal. The public discussion of costs in the health care system suggests that the elderly and the sick are a burden for the general public, both financially and personally. Euthanasia and assisted suicide are constantly being discussed in the media and suggested as acceptable, if not even desirable.
A society that no longer consistently and with all efforts opposes those who want to commit suicide, loses its humanity and, from a psychological point of view, goes in a sick direction. Only the certainty that every effort will be made to provide adequate help to every person, be they old, weak, sick or desperate, enables a calm and peaceful coexistence of all.
Social approval of suicide as well as killing on demand would lead to devastating psychological consequences. A clear statement on these questions is also of the utmost importance to the patient. If the caregiver even remotely regards suicide as a “rational and feasible solution” or even suggests it, he cannot help the person willing to die, but on the contrary reinforces his suicide wish.
It takes the ability to relate and empathy to acquire the suicidal person's trust and to grasp his inner situation. On this basis of trust, the aim is to develop with him, oriented to reality, what his meaning and task in life is or can be. Older and sick people, whose physical independence is diminishing, run the risk of developing a feeling of meaninglessness and worthlessness and a fear of being a burden to others. We can counteract these feelings if we feel genuine interest and joy in their personality, regardless of their ability to perform. In equal treatment, the sick old person also experiences his importance as a fellow human being for us and his environment. The elderly can e.g. For example, they can be strengthened when their prayers contribute to the support of the family. Relatives, caregivers and medical supervisors can make them aware of where the individual z. B. as a grandfather, as a partner, as a work colleague, as a person with life experience with his biography and his knowledge of many contemporary events is important.
- Ringel E., The suicide, Verlag Dieter Klotz, 6th edition, Eschborn (1997), p. 11
- Frankl V., The question of meaning in psychotherapy, R. Piper Verlag, 6th edition, Munich (1996), p. 22ff
- Ernst C., Exposé on recent epidemiological studies on suicide, February 1999, p. 5
- ibid., p. 1
- ibid., pp. 6-11
- Hawton K., van Heeringen K. (Eds.), The International Handbook of Suicide and attempted Suicide, Wiley & Sons, Chicester (2000). Quoted from: Michel K., The doctor and the suicidal patient, Part 2, Switzerland. Med. Forum No. 31, July 31, 2002, p. 732
- Neeleman J. et al., Predictors of suicide, accidental death and premature natural death in a general population, Lancet 351 (1998): pp. 93-97
- Quoted from: Teising M., Old and tired of life, Ernst Reinhardt Verlag, Munich, Basel (1992), p. 43
- Kuhn M., in Radio
, September 29, 1997, Talk in Z. Quoted from: Hippocratic Society Switzerland (1999)
- Ernst C., Epidemiology of suicide and attempted suicide, Hospitalis 64, No. 5 (1994), p. 212
- Germany Depression Barometer of the German Depression Aid Foundation (2019)
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