Is Cognitive-Behavioral Therapy (CBT) the Answer to Suicide?

A Historical Perspective on Suicide

The etymological roots of the word ‘suicide’ are derived from the Latin word suicidium; sui, ‘of oneself’ and cidium, ‘a killing.’ The term was first used by the abbots Prevost in 1734 and Desfontaines in 1737 (Sarro & de la Cruz, 1991) but it is likely that suicide has been a human phenomenon ever since man began to organize himself into tribes.

Recent anthropological studies (Washburn, 2004), have in fact, shown, that it was not uncommon for a hunter to sacrifice himself by acting as bait during the hunt for wild animals, in order to allow his fellow tribesmen a better chance of making a kill.  Whether the act was committed for romantic, rational or philosophical reasons or more commonly due to desperation, this form of suicide, known today as ‘altruistic suicide’ (Durkheim, 1897), has been present throughout the history of mankind.

From Socrates to Judas Iscariot, from Hemingway to Deleuze, a number of culturally influential people have committed suicide, but as yet the more profound reason for this act remains elusive to scholars (Leenaars, 1996), with Giner and Leal (1982) stating that “suicide seems to be the most personal act that a man could perform.”

Suicide may be viewed either as the best solution to a problem faced or as a choice, rational or irrational as it may be, that a person makes when they believe that there is no better alternative at that point in their life (Baechler, 1996). Such a scenario can be seen in the explanation of a person who attempted suicide by shooting himself in the head:

“I could not find peace. I did everything I could, but was still suffering. I spent hours and hours looking for the answers, but only heard the silent wind, nothing more. The answer was in my head: die.” (Shneidman, A Conspectus of the Suicidal Scenario, 1992).

However, although suicidal behavior occurs in a unique encounter between the patient’s personal and situational factors, it does not arise from nothing; it is usually the end result of a long and tragic process (Farberow, 1994) which has been the subject of much debate and study.

A Clinical Approach to Suicide

The clinical approach to the study of suicide includes four main models (Neimeyer, 1984): a) complex adaptive systems, b) psychoanalytic, c) nosological, and d) cognitive, from which I shall concentrate on the latter. The cognitive model (Kelly, 1961; Beck, Rush, Shaw, & Emery, 1979; Neimeyer, 1984; Baumeister, 1990; Lennings, 1994) assumes that suicide is the result of early negative experiences, which cause the development of disturbed cognitive schemata.

Once activated by current experiences (which frustrate the basic needs of the individual), these schemes cause a state of cognitive ‘constriction’ and emotional disturbance, which lead the person to see death as the only way out. Therefore, a purely cognitive-behavioral approach allows for the possibility of intervention, both on the current dysfunctional cognitive mechanisms, as well as on the unconscious patterns that disrupt the way the person views himself, the world and his future (Beck A. T., 1996).

Cognitive-behavioral interventions can operate in sync with other, more traditional approaches (Linehan, Heard, & Armstrong, Naturalistic Follow up of a Behavioral Treatment for Chronically Parasuicidal Borderline Patients, 1993), enhancing their performance while providing a greater degree of protection against future suicidal behavior.

References

Baechler, J. (1996). A strategic theory of suicide. L’ Encéphale, vol. 22, NS4 (59 p.) (bibl.: dissem.), pp. 4-9.

Baumeister, R. (1990). Suicide as Escape from Self. Psychological Review, vol.97: 90-113.

Beck, A. T. (1996). Beyond Belief: A Theory of Modes, Personality, and Psychotherapy. In P. Salkovskis, Frontiers qf Cognitive Therapy (pp. 1-26). New York: Guilford Press.

Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press.

Durkheim, É. (1897). Le Suicide – Étude de sociologie. Paris: Les Presses universitaires de France.

Farberow, N. (1994). The Los Angeles Survivors: After-Suicide Program. In Shneidman, Farberow, & Litman, The Psychology of Suicide: A Clinician’s Guide to Evaluation and Treatment. New Jersey: Jason Aronson.

Giner, J., & Leal, C. (1982). Conducta Suicida. In A. López-Ibor, O. Ruiz, & S. Barcia, Psiquiatría (pp. 1120-1130). Barcelona: Toray.

Kelly, G. (1961). Theory and Therapy in Suicide: The Personal Construct Point of View. In E. Shneidman, & N. Farberow, The Cry for Help (pp. 255-280). New York: MacGraw Hill.

Leenaars, A. A. (1996). Suicide: a multidimensional malaise. Suicide and Life-Threatening Behavior, Volume 26, Issue 3, pages 221–236.

Lennings, C. (1994). Cognitive Understanding of Adolescent Suicide. Genetic, Social & General Prychology Monographs, 120: 289-301.

Linehan, M. M., Heard, H., & Armstrong, H. (1993). Naturalistic Follow up of a Behavioral Treatment for Chronically Parasuicidal Borderline Patients. Arch Gen Psychiatry, vol.50, pp.971-974.

Neimeyer, R. (1984). Toward a Personal Construct Conceptualization of Depression and Suicide. In F. R. Epting, & R. Neimeyer, Personal Meaning of Death (pp. 127-174). New York: Hemisphere.

Sarro, B., & de la Cruz, C. (1991). Los Suicidios. Barcelona: Martinez Roca.

Shneidman, E. (1992). A Conspectus of the Suicidal Scenario. In Maris, Berman, Maltsberger, & Yufit, Assessment and Prediction of Suicide. New York: Guilford Press.

Washburn, S. L. (2004). Social Life of Early Man. Routledge.