Suicide Among Gifted Children and Adolescents- Second Edition

Among the various theories associated with suicide, we have come to prefer two: Stillion and McDowell’s (1996) suicide trajectory model and Shneidman’s (1993) psychache. These two models seem to provide considerable explanatory power about suicidal behavior.

Stillion and McDowell (1996) developed a theory-based model of suicide called the suicide trajectory model (STM; see Table 11), which includes associated risk factors. The emphasis of the theory is to predict risk for suicidal behavior.

The STM groups correlates of suicide into four categories (biological, psychological, cognitive, and environmental) that provide considerable breadth. This makes conceptual understanding of the numerous predictors of suicide in a theoretical manner manageable. It provides a conception of suicide that offers professionals numerous handles upon which to grasp as they try to prevent deaths. Metaphorically, it provides a categorical system of potential weights that lead the suicidal person in the direction of suicide. The theory attempts to coherently tie together the categories of factors. Stillion and McDowell (1996) stated:

Table 11
Suicide Trajectory Model Categories and Associated Risk Factors

Category	Risk Factors
Biological	Gender (male) Race (Native American, White) Genetic bases (parental psychopathy) Sexual orientation (homosexual, bisexual) Serotonin dysfunction
Psychological	Low self-esteem Depressed mood Feelings of hopelessness/helplessness Aggressive-impulsive tendencies Poor coping strategies Existential questions
Cognitive	Poor social problem solving Inflexible thinking Negative self-talk Rigidity of thought
Environmental	Familial dysfunction (impaired parent-child relationships) Social isolation Stressful life circumstances (interpersonal loss) Presence of lethal methods Exposure to suicide completers (friends/family)

As we move through life, we encounter situations and events that add their weight to each risk factor category. When the combined weight of these risk factors reaches the point where coping skills are threatened with collapse, suicidal ideation is born. Once present, suicidal ideation seems to feed upon itself. It may be exhibited in warning signs and may be intensified by trigger events. In the final analysis, however, when the suicide attempt is made, it occurs because of the contributions of the four risk categories. (p. 21)

The limitation to the STM, however, is that it is largely made up of correlations or variables associated with suicidal behavior with limited influence from within the person. This is where Shneidman’s (1993) work picked up, as he moved the conversation from descriptive epidemiology and prediction with some explanation to a theory that has been empirically validated focusing on the subjective experiences of the suicidal person. We believe this to be the most important contribution to research on the suicidal mind.

I never thought I’d die alone

I laughed the loudest who’d have known?

I trace the cord back to the wall

No wonder it was never plugged in at all

I took my time, I hurried up

The choice was mine, I didn’t think enough

I’m too depressed to go on

You’ll be sorry when I’m gone

–“Adam’s Song” by Blink 182

Edwin Shneidman was a clinical psychologist and arguably the father of suicidology and thanatology (the study of death and the care of the dying) in the U.S., who died in 2009. He spent his career focused on suicide, authoring 20 books and numerous articles about suicide, including one wherein he focused on survivors of suicide—1998’s The Suicidal Mind. This book provides considerable information about the lived experience of suicide attempters: one of the three died, the second lived for several months before dying of infections, and the third survived but was disfigured by the attempt. Shneidman began the American Association of Suicidology and the journal Suicide and Life Threatening Behavior. He also coined the term psychological autopsy.

Psychological autopsy, while often used to determine equivocal deaths, has become an invaluable approach to studying the life of a person who completed suicide. Tracy and his colleagues employed this approach in their early research (Cross, Cook, & Dixon, 1996) and again later (Cross, Gust-Brey, & Ball, 2002). From his many years in the field working with clients and from previous research, Shneidman’s (1993) theory asserted that suicide attempts come from the desire on the part of the person to escape intolerable psychological pain. He called this pain psychache. This profound pain’s etiology includes several potential pathways and factors. Ultimately, when the pain is unbearable, suicide becomes the path to escape it.

Shneidman (1993) believed that suicide has four elements: (a) heightened inimicality (hostility), (b) exacerbation of perturbation, (c) increased constriction of intellectual focus, and (d) cessation. Shneidman (1981) described inimicality as “qualities within the individual that are unfriendly towards the self” (p. 222). Perturbation “reflects how ‘shook up’, ill at ease, or mentally upset the person is” (p. 223). Constriction reflects the suicidal person’s dichotomous thinking and unwillingness to consider the effects of suicide on others. Cessation occurs due to the belief that ending one’s life will end the unbearable pain (psychache).

Over the years, Shneidman and others grew increasingly interested in the role that hopelessness plays in suicidal behavior. A few others picked up on this idea. For example, a study by DeLisle and Holden (2009) revealed that psychache and hopelessness both contribute variance to the prediction of suicide. This suggests that each can be valuable to understanding and preventing suicide.

Rudd et al. (2006) attempted to distinguish between the risk factors and warning signs of suicide. They claimed that risk factors tend to be stable characteristics, such as age, history of attempts, and psychiatric diagnosis. Risk factors are thought to be distally related to suicide. On the other hand, warning signs such as psychache and hopelessness are thought to be proximally associated with suicidal behavior and suggest potentially imminent risk. Distal risk factors are thought to be the initial causative factors in the original environment, while proximal causes are current causative factors (Rudd et al., 2006).

Combining prevalence rates, correlates, and risk factors with the STM, Shneidman’s (1993) theory of psychache, and the very recent research on hopelessness paints an increasingly comprehensive picture of the nature of suicide among the general population of the U.S. Despite the increasingly sophisticated level of understanding, it has proven to be very difficult to accurately predict suicide attempts and completions.

The STM provides us the capacity to look for students in distress. Shneidman’s concept of psychache, plus the recent research on hopelessness, provides us with an excellent basic roadmap for understanding some of the salient aspects of the lived experience of suicidal behavior. When all of the variables are taken together, strategies and techniques for preventing suicide in school can be put in place. This will be explored later in the book in Chapter 8. But first, we will describe research that pertains to students with gifts and talents.

KEY POINTS

images Stillion and McDowell’s (1996) theory-based suicide trajectory model includes associated risk factors that are grouped into four categories (biological, psychological, cognitive, and environmental).

images Edwin Shneidman’s (1993) work on suicide moves from descriptive epidemiology and prediction to a theory that has been empirically validated focusing on the subjective experiences of the suicidal person.

images The importance of Edwin Shneidman’s input into suicidology and thanatology was discussed.

images Shneidman’s (1993) theory asserts that suicide attempts come from the desire on the part of the person to escape intolerable psychological pain.

images Four elements of suicide as defined by Shneidman (1993) are: (a) heightened inimicality (hostility), (b) exacerbation of perturbation, (c) increased constriction of intellectual focus, and (d) cessation.

images Rudd et al. (2006) attempted to distinguish between the risk factors (distally related to suicide) and warning signs (proximally associated with suicidal behavior) of suicide.

images Understanding the nature of suicide will help us to develop and use strategies and techniques for preventing suicide in schools.