Providentia

After the L'Aquila Earthquake

Given the well-documented acute increase in psychopathology after disasters as well as the greater likelihood of suicide among persons with psychopathology, it may be expected that suicide rates also rise after such events. A research paper published recently in the joural Crisis investigated  investigated the suicide rate 1 year after the April 2009 earthquake that struck L’Aquila (Italy).  Suicide rates were collected from administrative data sets of the Italian National Institute of Statistics for the years 2004 through 2009. Results showed that the number and rate of suicides during 2009 are the lowest since 2004—and significantly lower than the two prequake years. The findings suggest that an investigation of resilience and posttraumatic personal growth might be useful in guiding public health efforts on suicidal prevention in the aftermath of disasters.

For the abstract

Bulgarian Government Seeks to Stop Self-Immolations

Reacting to six deaths from self-immolation in different parts of the country, the Bulgarian Ministry of Health ordered health authorities to provide psychological support to prevent further deaths.   In the most recent case,  41-year old Todor Yovchev poured gasoline on himself and set himself on fire on March 20.   After being rushed to hospital with burns to 90% of his body, Yovchev died of his injuries two days later and is the sixth case of self-immolation in Bulgaria since February.

The first self-immolation, 26-year old Traian Marechkov, occurred on February 18 and he reportedly described himself as having too much despair to live on.  Other cases have laid the blame of economic hardship or as a form of political protest.   In one case, 52-year old Dimitar Dimitrov set himself on fire in front of the Presidential building in Sofia, Bulgaria's capital city.   Security guards extinguished the flames and took him to hospital with burns to 25% of his body.    Though Dimitrov and another man, Ventsislav Vasilev, have survived their self-immolation to date, they are both hospitalized and considered to be still in danger.   Along with the self-immolations, Bulgaria is experiencing a sharp upsurge in suicides with daily reports of deaths from hanging, jumping from bridges and high-rise buildings, and throwing themselves under trains.  

Bulgaria is still reeling from massive protests over poverty, corruption and extremely high utility bills and the centre-right GERB government was forced to resign March 12 as a result.  The current caretaker government, installed by President Rosen Plevneliev, is attempting to deal with the economic crisis as well as implementing new health measures to stem the current rash of suicides.    Among the initiatives being considered is using psychologists and health inspectors to identify risk factors which may predict future deaths.

Although self-immolations are more commonly associated with political protests in Tibet and, more recently, with ritual suicides in India, a 2004 study by Medecins Sans Frontiers examining self-immolation cases over a 20-year period has yielded a disturbing pattern in many countries around the world.     According to the study, Bulgaria has the highest rate of self-immolation deaths of all European countries with an average of 7.4 cases a year between 1983 and 2002.    Establishing the motivation for self-immolation, whether due to mental illness or political protest, is not a simple task though self-immolation in mental patients is most common in European, North American, and Middle Eastern countries.   In the case of Bulgarian self-immolators, the percentage involving known mental illness is relatively low compared to neighbouring European countries and may be more clearly linked to the current economic recession.

The current Bulgarian epidemic may represent a suicide cluster involving copycat behaviour which began in February and peaked in March.   While there have been no new cases in the past two weeks, it is likely premature to suggest that the cluster has run its course.  In the meantime, Bulgarian health officials continue to watch for new incidents and to provide better treatment to prevent more deaths.  Whether this will be enough remains to be seen.

For more infomation.

Do Suicide Barriers Prevent Deaths?

The Golden Gate Bridge (GGB) is a well-known “suicide magnet” and the site of approximately 30 suicides per year. Recently, a suicide barrier was approved to prevent further suicides.  To estimate the cost-effectiveness of the proposed suicide barrier, the authors of an article recently published in the journal Crisis compared the proposed costs of the barrier over a 20-year period ($51.6 million) to estimated reductions in mortality.  They reviewed San Francisco and Golden Gate Bridge suicides over a 70-year period (1936–2006).  Their research assumed that all suicides prevented by the barrier would attempt suicide with alternative methods and estimated the mortality reduction based on the difference in lethality between GGB jumps and other suicide methods. Cost/benefit analyses utilized estimates of value of statistical life (VSL) used in highway projects. Results showed that GGB suicides occur at a rate of approximately 30 per year, with a lethality of 98%. Jumping from other structures has an average lethality of 47%. Assuming that unsuccessful suicides eventually committed suicide at previously reported (12–13%) rates, approximately 286 lives would be saved over a 20-year period at an average cost/life of approximately $180,419 i.e., roughly 6% of US Department of Transportation minimal VSL estimate ($3.2 million).  In conclusion, cost-benefit analysis suggests that a suicide barrier on the GGB would result in a highly cost-effective reduction in suicide mortality in the San Francisco Bay Area.

For the abstract

When Suicide is Listed in Obituaries

Historically, people who die by suicide and those who survive them have been perceived more negatively than those affected by other types of death (e.g., Reynolds & Cimbolic, 1988). Yet, it is unclear whether these negative perceptions actually lead to decreased social and emotional support for people bereaved by suicide.  A study published in Crisis: The Journal of Crisis Intervention and Suicide Prevention examined whether specifying suicide as the cause of death in an obituary impacts perceptions of a decedent and willingness to provide support to the decedent’s family. A group of 253 participants were randomly assigned to read one of three fictional obituaries that were identical except for the stated cause of death (suicide, cancer, or drug overdose). Participants responded to questions about the decedent and behaviors toward the family. Results showed that people depicted as dying by suicide were viewed more negatively than decedents depicted as dying due to cancer. Contrary to the research prediction, participants endorsed similar levels of willingness to provide support to the bereaved family regardless of the type of death specified in the obituary.  The findings suggest that, even though those who die by suicide are viewed more negatively, their survivors may receive support that is similar to people bereaved by other types of death.

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Preventing Suicide with Post-Discharge Follow-ups

The time period following discharge from inpatient psychiatry and emergency department (ED) treatment is one of heightened risk for repeat suicide attempts for patients. Evidence reported in the literature shows that follow-up contacts might reduce suicide risk, although there has not been a comprehensive and critical review of the evidence to date.  A new study published in Crisis: The Journal of Crisis Intervention and Suicide Prevention evaluates evidence for the effectiveness of suicide prevention interventions that involve follow-up contacts with patients. The study used published empirical studies of follow-up interventions with suicidal behaviors (suicide, attempts, and ideation) as outcomes were searched. Study populations were inpatient psychiatric or ED patients being discharged to home. Contact modalities included phone, postal letter, postcards, in-person, and technology-based methods (e-mail and texting). Results showed that eight original studies, two follow-up studies, and one secondary analysis study met inclusion criteria. Five studies showed a statistically significant reduction in suicidal behavior. Four studies showed mixed results with trends toward a preventative effect and two studies did not show a preventative effect. The authors concluded that repeated follow-up contacts appear to reduce suicidal behavior. More research is needed, however, especially randomized controlled trials, to determine what specific factors might make follow-up contact modalities or methods more effective than others.

For the abstract.

The Volcano Suicides

It all began on February 11, 1933 when a 21-year old student named Kiyoko Matsumoto committed suicide by throwing herself into the volcanic crater of Mount Mihara on the Japanese island of Izu Oshima.    Matsumoto, a student at Tokyo's Jissan College,  developed an infatuation with fellow student Masako Tomita.    In a poignant letter, she wrote "Dearest, I am bewildered to distraction by the perplexities of maturing womanhood. I can stand the strain no longer. What shall I do? I should like to jump into a volcano."   As it happened, Tomita knew just the ideal spot for such a romantic gesture.  Since lesbian relationships were considered taboo in Japanese culture at the time, both she and Tomita decided to travel together to the volcano so that Matsumoto could end her life there.  

Mount Mihara was already a well-known suicide site  since an observation post near the top of the volcanic cone allowed visitors to look straight down into the lava.  Even as early as the 1920s, people could commit suicide by jumping into the volcano despite being relatively rare.    Up until 1933, there were more practical alternatives including jumping off one of Tokyo's skyscrapers.  Unfortunately for Matsumoto, business owners had recently put a stop to high-rise suicides by placing security barriers at the top of those buildings where suicides had taken place.   Though determined jumpers could still find accessible buildings, Masako Tomito telling all her friends at school about Matsumoto's death would establish Mount Mihara as a new suicide venue.   Along with the poignant goodbye note  she had left behind, the story of a young student ending her life that way would eventually inspire a series of copycat suicides.    Kiyoko Matsumoto's suicide became a media sensation across Japan as news agencies picked up the story and made her a celebrity.    Her goodbye note was reprinted in the newspapers and Mount Mihara suddenly attracted a new wave of tourists and curiosity seekers.    Masako Tomita became a celebrity as well and, according to a Times news article from 1935,  died not long afterward though the cause of death was not given.   

To profit from Izu Oshima's new popularity,  Jinnojo Hayashi, president of Tokyo Bay Steamship Company set up a daily steamship line to the island and the brim of Mount Mihara picked up the new name of "Suicide Point".   Visitors wishing to visit the volcano could ride donkeys and horses up the steep mountain so they could look into the lava for themselves.   The poor fishing community at the foot of the volcano prospered with the new tourist trade.   Though authorities were already becoming alarmed by the prospect of copycat deaths, they did little to discourage it at first (suicide was not illegal under Japanese law).   In 1933 alone, 944 people (804 men, 140 women) would jump into the crater.   In the two years that followed saw an additional 350 suicides and 1386 attempted suicides on Mount Mihara and visitors would often travel there just to watch people jump.

Newspapers also played on Kiyoko Matsumoto's sexual orientation and "lesbian suicide" became a new cultural meme in Japan.   Even before Matsumoto's death, suicide was hardly uncommon in women facing problems coming to terms with their sexuality,   For lesbians in particular,  living in a country with little tolerance for sexual minorities provided few options except for suffering in silence.    The rise in suicides among women was alarming enough for Nobuko Jo of the Old Women's Home in Kobe, Japan to establish a widescale movement designed to prevent further deaths.   Setting up shelters which she called "Wait-a-bits" where would could reconsider killing themselves.   "The pause for reflection is vital," she said in one public statement, "Achieve that and the unfortunate woman generally saves herself. The thing is to ease their hysteria, if only for a few hours, and get them away from hysterical friends."   Along with Wait-a-bits, she also established shelters for homeless women across Japan and credited her movement with preventing thousands of deaths. 

There was also the romantic aspect of Matsumoto's death and Mount Mihara also became a popular spot for mutual suicide pacts (known as shinjuu in Japan).   Until the outbreak of World War 2, as many as 45 couples would commit suicide each year by throwing themselves into the volcano.   In one shinjuu case from 1956,  27-year old Fumisuke Onodera and 21-year old Chieko Numakura of Tokyo both decided on suicide after learning of Numakura's bone tuberculosis.   Though they both jumped into the volcano, they actually landed on a ledge about ten metres (30 feet) above the lava.   After reconsidering their suicide decision, Onodera tried to climb out with Numakura on his back though he could not manage to get her out alone.  He eventually made it to the top by himself and arranged for her rescue.   Though badly burned, they both survived.

The Mount Mihara suicide epidemic eventually ended through enhanced security to prevent suicides and making it a criminal offense to purchase a one-way ticket to the island.  While suicide is likely still possible for someone sufficently determined, there are usually more accessible places available.   Even today, suicide in Japan remains a major social issue and the suicide rate is one of the highest in the world.   While methods tend to vary (and certain places such as Japan's Aokigahara Forest remain popular), authorities stay alert to the possibility of copycat suicides following high-profile deaths.   In recent years, the suicides of musicians Yukiko Okada and hide triggered small copycat suicide clusters although nothing on the scale following Kiyoko Matsumoto's death.  

Still, the rapid rise of suicides in Japan during the 1990s (1998 saw a 34.7% increase from the previous year) and the number of suicides linked to the recent economic downturn has led to a call for stronger action.   A new government initiative has been put into place to reduce suicides  20% by 2017 with billions of yen being allocated for anti-suicide measures including greater access to counseling.   Though early signs are encouraging, the popularity of internet suicide websites listing different ways of committing suicide using household chemicals demonstrate that the suicide epidemic is far from over.

 

 

 

 

 

 

 

 

The HMS Beagle Curse

When the 235-ton sailing ship that would be christened the H.M.S. Beagle was first constructed in 1819 at the shipyards in Woolwich, England, no one had any idea of that small ship's strange destiny.  Or the tragedy that would later strike two of its most famous captains.

In 1825, the Beagle was selected to be part of an ambitious long-term voyage of exploration. Along with a larger ship, the H.M.S. Adventure under the command of Captain Philip Parker King, the Beagle would carry out the in-depth charting of the southern coast of South America.  In addition to the relatively routine mapping, the ships would also explore the complex channel and island geography around Tierra del Fuego at South America’s southernmost tip. Considering the length of time both ships would be at least (more than two years), the captain and crew of both ships needed to be carefully selected to avoid the kind of personality issues that might contribute to poor morale and the failure of the voyage.

From the perspective of Captain King and the other Royal Navy commanders who commissioned the voyage, there was already an ideal candidate available to serve as the Beagle’s captain. Though relatively young to serve as captain (he was 32 when given the commission), Commander Pringle Stokes had a stellar reputation as an able seaman and had been part of the Royal Navy since he was twelve years old.    

Having already traveled on long voyages to West Africa and South America as well as being promoted to Commander through his work combating the slave trade, Stokes seemed well suited for the task.   While he was not trained as a professional scientist (the main point of the voyage),  he had arranged for his own educational upgrading in Edinburgh to prepare for what lay ahead.   Along with Stokes, the Beagle's crew also had its own share of scientists including Robert Fitzroy who acted as the ship's meteorologist.

The Beagle and the Adventure left Plymouth, England on November 19, 1826 with Montevideo, Uruguay as their first port of call.   The careful charting of the South American coastline was an ambitious task considering the uncertain weather conditions around the tip of South America and the shortage of available ports at the time.   The ship also encountered many native tribes, often for the first time ever, and Stokes seemed up to the task as the months dragged on.    In the extensive logs which he kept during his voyage, Stokes described his encounters with some of the native, including commenting on the primitive conditions he found in Tierra del Fuego and Patagonia.

The ships also faced enormous changes in weather ranging from terrible storms to unfavourable winds that left them unable to proceed at times.   The weather was often overcast as well which made astronomical and meteorological observations impossible at times.  There were also various crises along the way including having to rescue the crew of a sealing ship, the Prince of Saxe Cobourg.   Captain Stokes personally took part in that rescue.  Despite the best efforts of both captains, there were also deaths along the way.   Not only were both ships facing unknown dangers but the crew were left exposed to various tropical diseases with little in the way of medicine except what the ship's doctors had available.

By 1828, the Beagle had been at sea for more than two years and the rigours of the long voyage began having a negative effect on the entire crew, especially the ship's captain.   Though Stokes had been on long voyages before,  his naturally gloomy disposition had been badly affected by the voyage and knowing that it would be a long time before he could ever return to England.   In his journal of the voyage, Captain King reported that one of the Beagle's crew told him that Captain Stokes had been confined to his cabin because of illness.   On visiting Stokes, he found him "looking very ill and, in low spirits.  He expressed himself much distressed by the hardships the officers and crew under him had suffered, and I was alarmed at the desponding tone of his conversation."    Though Captain King's visit appeared to rally him somewhat, the worst was yet to come.

By mid-July, Stokes mental state was at an all-time low and he was largely confined to his cabin while his second-in-command, Lieutenant William Skyring, effectively took over the ship.   On August 1, Captain Pringle Stokes shot himself in the head with his own revolver.   The wound was not immediately fatal but medical doctors from the Adventure could do little to keep him alive since gangrene had already set in.    Over the next four days, Captain Stokes was often delirious and raved at length about the Beagle's voyage and all the dangers that they had faced.   Although he recovered from this delirium and managed to be somewhat lucid,  nobody had any real hope of his survival.   He died in extreme agony on the morning of August 12th. 

As Captain King noted in his journal: 

Thus shockingly and prematurely perished an active, intelligent, and most energetic officer, in the prime of life. The severe hardships of the cruize, the dreadful weather experienced, and the dangerous situations in which they were so constantly exposed—caused, as I was afterwards informed, such intense anxiety in his excitable mind, that it became at times so disordered, as to cause the greatest apprehension for the consequences. On the return of the Beagle he got better; and the officers were so sanguine in hoping for his complete restoration to health, on account of his progressive recovery, that nothing which had transpired was communicated to me until after his decease.

The log which Captain Stokes had been keeping faithfully up until his death provides the best evidence of the mental deterioration that he underwent in the final weeks of his life.   In one memorable passage that he wrote in June, he commented on the tedium of the voyage.   "Nothing can be more dreary than the scene around us.  The lofty, bleak, and barren heights that surround the inhospitable shores of this inlet, were covered, even low down their sides, with dense clouds, upon which the fierce squalls that assailed us beat, without causing any change..."   More ominously, he ended the log entry by saying that "The weather was that in which... "the soul of man dies in him."  

After Stokes' suicide, William Skyrigg commanded the ship until it returned to Montevideo for repairs.   While there, the Commander-in-Chief, Sir Robert Otway decided that Lieutenant Robert Fitzroy should be the Beagle's new captain.   Fitzroy took over command of the Beagle on December 15, 1828 and completed the rest of the mapping mission before returning to Great Britain in 1830.    As for Pringle Stokes, his body was buried in the "English cemetary" in Puerto del Hambre (Port Famine) and his gravestone is now on display at a nearby museum.    Captain King used his log of the voyage up to the time of the suicide to prepare the official report of the voyage although the circumstances of his death were largely ignored.

Except by Robert Fitzroy...

Bothered by his predecessor's suicide and worried about the possibility of hereditary suicide in his own family (his uncle Viscount Castlereagh had committed suicide some time previously), Fitzroy decided to take special precautions in preparing for the Beagle's second voyage.    Along with extensively refitting the ship (and moving his own captain's cabin as far away from Stokes' cabin as possible), he also requested that a full-time scientific gentleman would be allowed to accompany him on the voyage.   The idea would be that the companion would share his own scientific ideas, provide intellectual companionship, and generally keep him from falling into the same depression that had doomed Captain Stokes.   After several other candidates turned down the position, Fitzroy eventually settled on a young naturalist named Charles Darwin.   Fitzroy had early misgivings about Darwin since, according to his ideas about physiognomy, the shape of Darwin's nose suggested he had "insuffiicient energy and determination".   Darwin was eventually able to persuade him, though.

It was that second voyage of the Beagle which lasted from 1831 to 1834 that would eventually transform biology as we know it.  Based on his naturalistic observations during the voyage, Charles Darwin would eventually publish On The Origin of Species in 1859.   The book, which outlined his groundbreaking theory of evolution, would face tremendous controversy.   Ironically, one of his most ardent critics would be Robert Fitzroy himself who, as a staunch creationist, would publicly admit his own guilt at the role he had inadvertently played in the development of evolution.   That guilt, along with his own fears of becoming insane would eventually lead to his graphic suicide in 1865.

But that's another story.

 

"Neighbours from Hell" Blamed in U.K. Suicide

Three weeks after sending a three-page letter to her local borough council on September 15, 2011 descibing her three-year battle with "neighbours from hell" who had done their best to destroy her life, Dr. Suzanne Dow took an overdose of prescription medication and died in her sleep.   Dow, a 33-year old professor of languages at the University of Nottingham, had received advanced degrees at Oxford University and had already gained international recognition for her work, including a soon-to-be published translation.    Her problems apparently began with her next-door neighbours at the Browtoxe Borough complex in Nottinghamshire where she had been living since 2008.  

The neighbours, Daryl Robinson, his sister Gaynor and her son Liam, had apparently operated a crack den which drew habitual drug users.  Both Robinsons had criminal records and police had been called to the house on repeated occasions though they took no real action against them.   In the time that she lived next to the Robinson, Dr. Dow had made frequent complaints against them for damage to her property, vulgar language,  noise, and even physical threats against her.   Daryl Robinson had been jailed for eleven days in 2011 for threatening Dr. Dow but had returned to the house afterward.   Described as a "hulking and intimidating figure", he had also spent 28 days in jail for assaulting a man in the street and damaging a police cell.

In her final letter to the Borough Council, she stated that she had reached the limits of her tolerance, both with her neighbours and how the Borough Council had handled the case.   "The situation is seriously affecting my physical and mental health," she added.   "I am frequently unable to sleep, and it often prevents me from doing my job (I often work from home). I cannot enjoy the outside space due to noise, foul language, verbal abuse and talk of drugs. I live in fear of my property being damaged (again), and even for my own physical safety whilst in my own home."   On September 10, just five days before writing the letter, she reported that the youngest Robinson, Liam Peach, had verbally abused and threatened her.   Dr. Dow's repeated pleas to the Council to evict the Robinsons had been repeatedly ignored.   Police had also been called to her house on five separate occasions with little real progress.

On one occasion, after filing a police report about an assault she had witnessed on the Robinson property, she had been intimidated by Gaynor Robinson into dropping the complaint.  There was also frequent vandalizing of Dr. Dow's property including graffiti on her walls and the wiring outside her house being slashed.   According to her mother, Maureen Dow, her daughter often phoned her in tears because she was too frightened to get to sleep.  "No one should have to live in that situation, they let her down,"  she added.

While Dr. Dow had other emotional problems in her life, including the recent ending of a love affair with a fellow faculty member and posttraumatic issues stemming from childhood sexual abuse, the coroner investigating her death has demanded fundamental changes in how Nottinghamshire authorities deal with "neighbours from hell".   The coroner also released her final letter to the press to highlight the issues that had led to Dr. Dow's death and described police attitudes in responding to her complaints as "appalling" and "outrageous".    In responding to the coroner's comments, a Council representative stated that “The council cares a great deal about its tenants and residents and it will review the findings of the case and learn any lessons it needs to learn. This was a complex case and the council now knows all those involved were extremely vulnerable.”  

The Robinsons have since been relocated although their new neighbours have reported that police involvement is ongoing.

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When Cancer Patients Commit Suicide

Cancer patients appear at higher risk of accidental death and suicide. The reasons for this and how suicide and accidental death relate remain unclear. A recent research study published in Crisis: The Journal of Crisis Intervention and Suicide Prevention examined risk factors for such deaths among cancer patients.  Using the SEER registries (1973–2007), an  analysis was conducted on 4,449,957 cancer patients comparing all causes of death (COD) to accidental and suicidal deaths through competing hazards, relative risk and proportional hazards models. SEER did not provide psychological assessments; the analysis was confined to their standard epidemiological and clinicopathological parameters. Results showed that 2,557,385 overall deaths yielded 16,879 (0.66%) accidents and 6,589 (0.26%) suicides. Mortality reached its highest incidence immediately after diagnosis and obeyed Pareto type II distributions. The major identifiable risk factor for suicide was male gender; for accidental death, First Nations ethnicity; and all COD, metastases. Minor factors for suicide included metastases, advanced age, and respiratory as well as head and neck tumors, whereas for accidental death they were male gender, metastases, advanced age, and brain tumors.  Differences were observed in the risk patterns of suicide and accidental death, suggesting distinct etiologies. A high incidence of suicides and accidental deaths following diagnosis (attributed by some to stress from the diagnosis of cancer) correlated here with overall mortality and indicators of physical morbidity. Cancer patients with the above identifiable risk factors warrant supportive attention.

For the abstract.

Contacting a Suicide Prevention Helpline

Helplines are a significant phenomenon in the mixed economy of health and social care. Given the often anonymous and fleeting nature of caller contact, it is difficult to obtain data about their impact and how users perceive their value.  A recent paper in Crisis: The Journal of Crisis Intervention and Suicide Prevention reports findings from an online survey of callers contacting a UK-based emotional support service helpline. The purpose of the study was to explore the (self-reported) characteristics of callers using a national suicide prevention helpline and their reasons given for contacting the service, and to present the users’ evaluations of the service they received. Using an online survey of a self-selected sample of callers,  1,309 responses were received between May 2008 and May 2009. There were high incidences of expressed suicidality and mental health issues. Regular and ongoing use of the service was common. Respondents used the service for complex and varied reasons and often as part of a network of support.  Respondents reported high levels of satisfaction with the service and perceived contact to be helpful. Although the Samaritans helpline aims to provide a crisis service, many callers do not access this in isolation or as a last resort, instead contacting the organization selectively and often in tandem with other types of support.

For the abstract.