Sexual Violence and Suicide: Information and Prevention
Jewish Survivors of Childhood Sexual Abuse, Incest, Sexual Assault
If you are having thoughts about suicide, call 1.800.SUICIDE 800 (784-2433). Your call will be connected to a certified crisis center nearest your location.
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Ask Rabbi Simmons Burying a Suicide
Question: What is the Jewish attitude to burying a suicide?
Answer: Judaism regards suicide as a criminal act. Someone who commits suicide is considered a murderer. It matters not whether he kills someone else or himself. His soul is not his to extinguish.
Judaism's opposition to suicide is found in the story of Noah's Ark. After the flood, God says to Noah: Your blood which belongs to your souls I will demand; from the hand of every beast will I demand it. From the hand of every man; from the hand of every man who is his brother will I demand the life of man.(Genesis 9:5)
The Talmud (Baba Kama 90b) learns from the first part of the verse, "And surely the blood of your lives I will demand," that one may not wound his own body. All the more so, he may not take his own life.
There is also a deep spiritual consequence to suicide.
When a person commits suicide, the soul has nowhere to go. It cannot return to the body, because the body is destroyed. And it is not let in to any of the soul worlds, because its time has not come. This state of limbo is very painful. A person may commit suicide because he wants to escape, but in reality he is getting a far worse situation.
In this world, if we try hard enough sometimes we can solve the problem. But after death there are no solutions, only consequences.
When a Jew commits suicide, he is not permitted a full Jewish burial, and there is even a debate whether shiva (the seven-day mourning period) is observed or whether the kaddish prayer is said.
In practice today, however, suicide is usually treated as a normal death, since it is assumed that the person was not of a normal state of mind. But we still see the gravity by which Judaism views suicide.
With blessings from Jerusalem,
Rabbi Shraga Simmons
Rape victim slams society in suicide note
By Ruth Sinai, Haaretz Correspodnent
Haaretz - January 26, 2005 Shvat 16, 5765
http://www.haaretz.com/hasen/pages/ShArt.jhtml?itemNo=531977
A psychology student who committed suicide Monday in the Hebrew University dorms in Jerusalem wrote a letter last week in which she described the despair she felt as a victim of gang rape, because she could not find a suitable framework for treatment. The letter was revealed Tuesday by The Association of Rape Crisis Centers in Israel, which was in contact with the woman for a number of years, and requested that she describe her condition, in an effort to influence the municipalities to establish means of treatment for women like herself.
The woman, a 21-year-old former kibbutz resident, had tried to commit suicide twice in the past. After one of the attempts, she was hospitalized in a mental health institute.
In her letter, she describes her experience in the institute. "Someone pulled the hair of another patient. The staff pulled her quickly and said they would tie her up. She is crying, she doesn't want it. They are putting her in the room next to mine, and tying her up. I touch my ankle. It's been a while since no one tied ropes and chains to my body. It's great that I can move my hands. But what I see in the room next to me induces difficult flashbacks to what happened."
"I'm able to reach the doctor and explain the difficulty," she wrote. "The doctor is wonderful but she says she has no clue about these things. Later in the evening the nurses talk to me. They don't understand why I'm here". That the girls here are very ill, and that I was a commander in the army and that I'm a university student."
The woman left the closed ward and approached an open clinic, in a hospital, that treats post-trauma victims. But the participation of men in these groups only worsened the flashbacks that she suffered. After she tried to commit suicide again, she requested to stay at a closed mental health institute, but was rejected on the claim that the framework didn't suit her.
"I'm very suicidal," she wrote. "I'm holding a rope in my hand and want to hang myself in the shower. My feeling now is that there is no place for me in the world. Israeli society isn't willing to deal with post-trauma, with sexual abuse, incest, or gang rape. We must help victims of sexual violence, because we as a society allowed it to happen. I want to grow and be a good citizen and contribute to the state. Above all I want to live and not hurt myself. But I can't alone. I need help."
According to Hilla Kerner Soliman, the director of The Association of Rape Crisis Centers in Israel, the woman's letter is a "piercing indictment on society's failure, for not protecting her as a child, and not treating her as an adult."
"We see in it a will that obligates health and social affairs offices to establish wide-scale and specialized frameworks immediately for dealing with victims of sexual abuse," Kerner Soliman said.
Is there a Jewish Right to Commit
Suicide?
Temple Sinai of Sharon, Inc. and Rabbi Clifford E. Librach
Originally published in the January 1999 Temple Sinai Bulletin
http://www.temple-sinai.com/inmyview/9901_suicide.html
The Talmud tells the story of a rabbinic sage who returns to his old community after a long and lonely absence, exclaiming "either friendship or death!"
Every one of us is vulnerable the psychological dangers of loneliness. Each one of us is a person necessarily imbedded in a range of multiple relationships-we are all children, most of us have siblings and many of us have spouses and children in addition to friends and acquaintances.
Therefore, no one is really independent in anything but a relative sense-no one is truly and radically autonomous. Autonomy, in the Jewish view, can only be the property of a Force who is capable of creation out of nothing (creatio ex nihilo). Only God has this capacity; it is a capacity no creature should attempt to achieve, let alone assume that it already possesses.
To view any individual as being independent of all relationships is like viewing a point outside of a line.
So privacy and autonomy are relative terms in the classical Jewish view.
We have a right to privacy from the government in certain aspects of our lives-our family life, our political persuasion, our friendships, our religion. The state is entitled to intervene, however, when our family life becomes a shield for the abuse of children, when our friendships become a shield for criminal conspiracy, or when our religion becomes a shield for conduct which society deems immoral.
Why do we need the authority of government? For two reasons-polar opposites, in many ways. We need a state because so many human beings are selfish individuals inclined to (a) distrust each other and (b) to pursue their own self-interest without restraint. But in addition, we need a state so that we can properly order the mutual satisfaction of our personal needs and those of each other. It is not good for us to be alone (Genesis 2:18), which is why we are ultimately and intimately attached to each other (Genesis 2:23) in family, tribe, society and nation.
In either case, the state has as one of its prime responsibilities the intervention against behavior when there is a strong possibility that death might otherwise occur. Society-and its principal agent, state power-is charged to defend all innocent human life from destruction. Accordingly, there is really no difference between homicide and suicide. The killing of innocents is to be contained irrespective of who is killing and who is being killed.
The problem with seeing a "right" to suicide is not only that it suggests that we are responsible to no one (family, friends or God) but ourselves. In addition, we can (and, no doubt, will) be pressured to exercise that "right" when it would seem to us to be in the best interest of those in our immediate circle.
It was no accident that the suicide rate of German Jews, beginning in 1933, dramatically increased years before the actual "Final Solution" of the death camps was implemented. When the German society, of which most of them believed themselves to be integrated members, sent them so clear a message that their presence was to be removed at any cost, death became the last privacy to which they were consigned.
Suicide is an exaggerated scream of loneliness.
For Judaism, the proper medicine for loneliness is love, not death. We have no more "right" to murder ourselves than we do to murder each other.
Pain Relief and the Risk of Suicide: A Jewish
Perspective
Rabbi Aaron L. Mackler, Ph.D.
http://www.sfhs.edu/critint/v5_n2/mackler.htm
Jewish ethics values healing and the preservation of life as important goods and as activities mandated by God. The case presented, involving a 29 year old male with AIDS who requests large doses of analgesics and sedatives, may involve some degree of tension between these values: actions taken to relieve pain, supported by a mandate to heal, might contribute to a patient's death by suicide, ending life and violating a traditional Jewish norm.
Upon closer examination, it appears that thoughtful provision of pain relief and supportive care has the potential both to relieve the patient's suffering and to lessen the likelihood that he would feel compelled to end his life.
As I understand the Jewish tradition, life is appreciated as a blessing and a gift from God. Each human being is esteemed as created in God's image. Whatever the level of one's physical and mental abilities, and whatever the extent of dependence on others, each person has intrinsic dignity and value in God's eyes.
Judaism respects our bodies and lives as God's creation, which have graciously been entrusted to our care. We have the responsibility to care for ourselves and seek beneficial medical treatment--we owe that to ourselves, to our loved ones, and to God. In accordance with the tradition's respect for the life given by God, it rejects homicide, suicide, and assisted suicide.
Medical treatment that contributes to a patient's recovery is clearly supported by Jewish ethics. So is treatment intended to improve the patient's functioning or relieve pain. Humans are to act as God's partners in improving the world and helping persons in need. Scriptural support for these positions is seen in passages specifically discussing healing and in the general admonition to "love your neighbor as yourself" (Leviticus 19).
In appropriate cases, interventions such as surgery or medications to relieve pain may be mandated despite risks entailed.1,2,3 In the words of Rabbi Immanuel Jakobovits: "Analgesics may be administered, even at the risk of possibly shortening the patient's life, so long as they are given solely for the purpose of rendering him insensitive to acute pain."4 The judicious provision of medications intended to benefit the patient, even with the risk of side effects, is part of the enterprise of health care.
I understand the case presented as involving the provision of beneficial medication that poses the risk of hastening the patient's death by contributing to a suicide. The risk seems relatively modest in the case as described, and should not prevent the provision of needed pain relief. Since my intention as physician would be to relieve pain, I would seek to take reasonable precautions to lessen the risk of precipitating death.
For example, if one sedative (such as a benzodiazepine) would be as effective as another (such as a barbiturate) but would be less likely to be used in a completed suicide, I would prescribe the less risky medication. In an unusual case, I might limit the prescription to only a few days' or a week's supply, if this limitation would effectively reduce the risk of suicide, and if it would not prevent the patient from obtaining needed medication.
Perhaps more importantly, I would try to clarify for the patient my intention in providing the medication: to relieve pain, and not to assist in the ending of life. The prescription should not be taken as a judgment that the patient's life is not worth living, or that I am tired of caring for this patient who will not get better, or that I am giving my approval or "permission" for actively ending life. Rather, it should be seen in the context of the therapeutic relationship, as a manifestation of my commitment to care for, and never to abandon, the patient.
My commitment to care for the patient has other implications as well. As the physician in this case, I would be troubled that the patient is "in constant pain." It would be important for me to increase my knowledge of palliative care for AIDS patients, and perhaps to arrange for a consult by those with greater expertise in pain relief and/or HIV disease.
Review articles and handbooks suggest that much can be done to alleviate pain and other symptoms of patients with AIDS.5,6,7 I am mindful of studies suggesting that only 20 to 60 percent of cancer pain is treated adequately, even though adequate treatment is possible in at least 90 percent of cases, and even patients whose palliation is not "adequate" generally do not experience the constant pain described.6
Both the patient's report of constant pain, and any suggestions that the patient might commit suicide, dramatically signal the need for careful attention to the patient's suffering and possible responses. Clinical depression is relatively common among patients who are terminally ill or in pain, and correlates highly with suicide.
Contrary to popular misconception, major clinical depression is distinct from the sadness that typical accompanies terminal illness, and generally responds to psychiatric treatment, even in the absence of improvement of the underlying disease.6 Other issues may include inadequate social support, spiritual despair, or a fear of abandonment. Together with family members, other health care professionals, and other individuals who may be of help, I would explore and seek to alleviate the patient's suffering.
I would investigate in particular the possibilities for hospice care. I understand the patient's wish not to "spend his last days in a hospice" to refer to a free-standing hospice or other health care facility. Provision of hospice services to outpatients and those cared for at home is often available, however, and in fact is the primary way in which such services are provided in the United States. For information on resources, I might turn to local colleagues, or to organizations such as the National Hospice Association (800-658-8898).
The same principles would guide a decision to prescribe medicine that the patient says may well be used for a deliberate overdose within the next few days. Here the details of the case and my conversation with the patient would be crucial. Especially if the patient volunteers this information, what is superficially a request for palliation may be in fact a thinly veiled request for assisted suicide, or at least an invitation to discuss the issue.
In this case, I would not supply the prescription, but would address the patient's suffering and perceived need to end his life. If the medication was in fact needed to relieve the patient's severe pain, and this seemed to be the patient's primary motivation in requesting the prescription, I might well prescribe the medication. I would take especially extensive precautions to minimize the risk of suicide; for example, in my choice of drug and amount prescribed. I would take special care as well to ensure that my actions were not seen as a signal of approval for suicide.
Most importantly, if told that a desired prescription might well be used for suicide, I would redouble my efforts to explore and respond to the patient's suffering. Health care professionals with the greatest experience in caring for terminally ill patients report that when patients' suffering is taken seriously and efforts are made to alleviate it, the need to end life is no longer seen as compelling.
By providing the medication that is needed to alleviate pain in the context of a treatment plan of supportive care, I would likely alleviate the patient's suffering and lessen the risk of hastening death, by suicide or other means. Such a course of action would be supported by Judaism, as it would be by other approaches to health care ethics. Based on the reports of experts in palliative care, it appears that this course of alleviating suffering without contributing to the active causing of death is possible in virtually all cases. It certainly appears to be possible in the case at hand.
References
Bleich JD: Judaism and Healing. New York: Ktav, 1981. Dorff EN: A Jewish Approach to End-Stage Medical Care. Conservative Judaism 1991; 43: 3-51. 0 Reisner AI: A Halakhic Ethic of Care for the Terminally Ill. Conservative Judaism 1991; 43:52-89. O'Neill WM, Sherrard JS: Pain in Human Immunodeficiency Virus Disease: A Review. Pain 1993; 54: 3-14. New York State Task Force on Life and the Law: When Death is Sought: Assisted Suicide and Euthanasia in the Medical Context. New York: New York State Task Force on Life and the Law, 1994, pp 40-43. Washington State Medical Association: Pain Management and Care of the Terminal Patient. Seattle: Washington State Medical Association, 1992.
by Sid Bernstein, Esq.
http://www.aish.com/societywork/sciencenature/Stopping_a_Suicide.asp
Is stopping a suicide merely a question of public interest - or is it also a spiritual matter involving God?
Consider a man beset with multiple problems.
He is suffering from incurable cancer, has lost his job, is deep in debt, his wife wants a divorce, and he is estranged from his children. He decides to end his life and climbs over the rail of the Golden Gate Bridge.
As he is preparing to plunge into San Francisco Bay, he is spotted by police.
The police dispatch a highly trained psychologist, who talks to the man in an attempt to dissuade him from taking his life. In the meantime the police identify the man and confirm that all his problems are indeed true. He is not crazy, just distraught.
Should the police intervene? Whose life is it anyway?
THE FACTORS IN QUESTION
Is taking the man off the bridge is a legitimate use of police power?
Is it for or against the public interest to let people jump off bridges?
Is this a deeper issue concerning the preservation of life, or just a simple matter of public inconvenience?
Should society demand that he live - overriding his desire to end his own life?
Is there ever a time when suicide is justified, especially when a person is legally competent?
If a person has no choice about coming into the world, should they likewise have no choice when to go out?
.
JEWISH PERSPECTIVE
Judaism regards suicide as a criminal act. Someone who commits suicide is considered a murderer. It matters not whether he kills someone else or himself. His soul is not his to extinguish.
Judaism's opposition to suicide is found in the story of Noah's Ark. After the flood, God says to Noah:
Your blood which belongs to your souls I will demand; from the hand of every beast will I demand it. From the hand of every man; from the hand of every man who is his brother will I demand the life of man. (Genesis 9:5)
The Talmud (Baba Kama 90b) learns from the first part of the verse, "And surely the blood of your lives I will demand," that one may not wound his own body. All the more so, he may not take his own life.
METAPHYSICAL LAWS
There is a deep spiritual consequence to suicide.
When a person commits suicide, the soul has nowhere to go. It cannot return to the body, because the body is destroyed. And it is not let in to any of the soul worlds, because its time has not come. This state of limbo is very painful. A person may commit suicide because he wants to escape, but in reality he is getting a far worse situation.
In this world, if we try hard enough sometimes we can solve the problem. But after death there are no solutions, only consequences.
When a Jew commits suicide, he is not permitted a full Jewish burial, and there is even a debate whether shiva (the seven-day mourning period) is observed or whether the kaddish prayer is said.
(In practice today, however, suicide is usually treated as a normal death, since it is assumed that the person was not of a normal state of mind.)
THE SUICIDE OF KING SAUL
In the Bible we see an incident in which suicide seems to be permitted.
The Philistines were battling against Israel, and the men of Israel fled from before the Philistines and fell slain on Mount Gilboa. The Philistines overtook Saul and his sons, and they slew ... the sons of Saul. The battle then focused against Saul. The archers found him, and Saul was terrified of them. Saul said to his armor-bearer, "Draw your sword and stab me with it, lest these men come to stab and torture me." But his armor-bearer did not consent, for he was very afraid. So Saul took his sword and fell upon it. When the armor-bearer saw that Saul was dying, he also fell upon his sword and died with him. (Samuel II, 1:5-10)
The Sages offer a number of reasons why Saul's suicide was unique:
* Saul feared that his enemies would use torture to try to force him to worship other gods. (Ritva - 14th century)
* Suicide is permitted in the face of an attempt at forced conversion. (Rabbeinu Tam - 12th century)
* Suicide is permitted only if the lives of others would be in danger as a result of torture. (Rabbi Shlomo Luria - 16th century)
* Saul acted out of respect for the Israelite kingship, as he feared the Philistines would mockingly parade him through their cities. In other words, he committed suicide to sanctify God's name. (Y'dai Moshe - 20th century)
In summary, suicide is absolutely prohibited, unless there are unusual and extenuating circumstances - e.g. forced conversion, endangering the lives of others, or sanctifying the Name of God.
DISCLAIMER: This module discusses sources for the purpose of education. Any real-life situation must be discussed with a rabbi, well-versed in Jewish law.
Understanding and Helping The Suicidal
Person
American Association of Suicidology http://www.suicidology.org/displaycommon.cfm?an=2
Be Aware of the Warning Signs
There is no typical suicide victim. It happens to young and old, rich and poor. Fortunately there are some common warning signs which, when acted upon, can save lives. Here are some signs to look for:
A suicidal person might be suicidal if he or she:
* Talks about committing suicide
* Has trouble eating or sleeping
* Experiences drastic changes in behavior
* Withdraws from friends and/or social activities
* Loses interest in hobbies, work, school, etc.
* Prepares for death by making out a will and final arrangements
* Gives away prized possessions
* Has attempted suicide before
* Takes unnecessary risks
* Has had recent severe losses
* Is preoccupied with death and dying
* Loses interest in their personal appearance
* Increases their use of alcohol or drugs
What To Do
Here are some ways to be helpful to someone who is threatening suicide:
* Be direct. Talk openly and matter-of-factly about suicide.
* Be willing to listen. Allow expressions of feelings. Accept the feelings.
* Be non-judgmental. Don't debate whether suicide is right or wrong, or feelings are good or bad. Don't lecture on the value of life.
* Get involved. Become available. Show interest and support.
* Don't dare him or her to do it.
* Don't act shocked. This will put distance between you.
* Don't be sworn to secrecy. Seek support.
* Offer hope that alternatives are available but do not offer glib reassurance.
* Take action. Remove means, such as guns or stockpiled pills.
* Get help from persons or agencies specializing in crisis intervention and suicide prevention.
Be Aware of Feelings
Many people at some time in their lives think about committing suicide. Most decide to live, because they eventually come to realize that the crisis is temporary and death is permanent. On other hand, people having a crisis sometimes perceive their dilemma as inescapable and feel an utter loss of control. These are some of the feelings and things they experience:
* Can't stop the pain
* Can't think clearly
* Can't make decisions
* Can't see any way out
* Can't sleep, eat or work
* Can't get out of depression
* Can't make the sadness go away
* Can't see a future without pain
* Can't see themselves as worthwhile
* Can't get someone's attention
* Can't seem to get control
If you experience these feelings, get help!
If someone you know exhibits these symptoms, offer help!
Contact:
* A community mental health agency
* A private therapist or counselor
* A school counselor or psychologist
* A family physician
* A suicide prevention or crisis center
Beyond Surviving: Suggestions for
Survivors
by Iris M. Bolton
Suicide and its Aftermath (Dunne, McIntosh, Dunne-Maxim, Norton and Co., 1987)
1. Know you can survive. You may not think so, but you can.
2. Struggle with "why" it happened until you no longer need to know "why" or until you are satisfied with partial answers.
3. Know you may feel overwhelmed by the intensity of your feelings but all your feelings are normal.
4. Anger, guilt, confusion, forgetfulness are common responses. You are not crazy, your are in mourning.
5. Be aware you may feel appropriate anger at the person, at the world, at God, at yourself. It's okay to express it.
6. You may feel guilty for what you think you did or did not do. Guilt can turn into regret, through forgiveness.
7. Having suicidal thoughts is common. It does not mean that you will act on those thoughts.
8. Remember to take one moment or one day at a time.
9. Find a good listener with whom to share. Call someone if you need to talk.
10. Don't be afraid to cry. Tears are healing.
11. Give yourself time to heal.
12. Remember, the choice was not yours. No one is the sole influence in another's life.
13. Expect setbacks. If emotions return like a tidal wave, you may only be experiencing a remnant of grief, an unfinished piece.
14. Try to put off major decisions.
15. Give yourself permission to get professional help.
16. Be aware of the pain of your family and friends.
17. Be patient with yourself and others who may not understand.
18. Set your own limits and learn to say no.
19. Steer clear of people who want to tell you what or how to feel.
20. Know that there are support groups that can be helpful, such as Compassionate Friends or Survivors of Suicide groups. If not, ask a professional to start one.
21. Call on your personal faith to help you through.
22. It is common to experience physical reactions to your grief, e.g., headaches, loss of appetite, inability to sleep.
23. The willingness to laugh with others and at yourself is healing.
24. Wear out your questions, anger, guilt, or other feelings until you can let them go. Letting go doesn't mean forgetting.
25. Know that you will never be the same again, but you can survive and even go beyond just surviving.
Mental health correlates of criminal
victimization: A random community survey.
Journal of Consulting and Clinical Psychology, 53, 866-873 (1985)
by KILPATRICK, D.G., BEST, C.L., VERONEN, L.J., AMICK, A.E., VILLEPONTEAUX, L.A. & RUFF, G.A.
http://www.ncptsd.org/publications/rq/rqhtml/V1N3.html
A representative sample of 2,003 adult women was interviewed about victimization experiences and mental health problems. After classification of the women into victimization groups, the occurrence of three mental health problems was compared across type of crime. Rates of "nervous breakdowns," suicidal ideation, and suicide attempts were significantly higher for crime victims than for nonvictims. Victims of attempted rape, completed rape, and attempted sexual molestation had problems more frequently than did victims of attempted robbery, completed robbery, aggravated assault, or completed molestation. Problems were not mediated by income and were affected only marginally by age and race. Nearly one rape victim in five (19.2%) had attempted suicide, whereas only 2.2% of nonvictims had done so. Most sexual assault victims' mental health problems came after their victimization. Findings suggest that crime victims are at risk for the development of major mental health problems, some of which are life threatening in nature.
Suicide Linked To Sexual Abuse
Reuters, June 18, 1996
http://www.personalmd.com/news/a1996061806.shtml
NEW YORK (Reuters) -- People who have been sexually assaulted are more likely to attempt suicide. And the risk is even higher if the assault occurred during childhood, according to a new report.
"Sexual assault is associated with an increased lifetime rate of attempted suicide," wrote lead study author Dr. Jonathan R.T. Davidson, of Duke University Medical Center in Durham, North Carolina. "For women, the odds of attempting suicide were three to four times greater when the first reported sexual assault occurred prior to age 16 years, compared with age 16 years and older."
In the new study of almost 3,000 people in North Carolina, 67 reported having been sexually assaulted. About 15% of those people had attempted suicide, compared to less than 2% of those with no history of sexual assault, according to the report published in this month's issue of the Archives of General Psychiatry.
In almost one third of the people who had been sexually assaulted -- including two males -- the assault occurred before age 16.
While there were too few men in the study to make any conclusions about suicidal behavior, when the researchers looked at women, they found that those who had been assaulted before age 16 were much more likely to attempt suicide than others in the study.
"While major depression, substance abuse or dependence, and panic attacks are all separately associated with increased odds of suicide attempt, sexual assault remained significantly associated with suicidal behavior," Davidson said.
The study may have some limitations because it relied on the individual to report their past history and suicide attempts, information many people might feel uncomfortable about revealing, he noted.
However, the study results may direct doctors to ask people who have attempted suicide if they had been sexually abused. About 1 out of 10 people who attempt suicide go on to actually kill themselves, according to Davidson.
"The immensely damaging effect of such an event cannot be stressed too strongly, particularly in individuals with other vulnerability factors, such as family dysfunction, genetic or familial vulnerability to [psychological problems] and other developmental problems," he concluded.
By Betsy Bates
Clincial Psychiatry News (Los Angeles Bureau) - October 2003 · Volume 31 · Number 10
http://www2.eclinicalpsychiatrynews.com/scripts/om.dll/serve?article=aqc030311001c
WAIKOLOA, HAWAII — The 5% of adolescents who report attempting suicide more than once in the course of a year have a health risk profile "staggeringly" different from those who report trying to harm themselves once or not at all, according to a survey of thousands of New Hampshire high school students.
"Single [suicide] attempters appear to be signaling considerable pain and despair and may be at risk for future self-destructive behaviors," noted Harriet J. Rosenberg and Stanley D. Rosenberg, Ph.D., of Dartmouth Medical School in a poster presented at a meeting sponsored by the International College of Psychosomatic Medicine.
But despite saying they had tried to kill themselves, single suicide attempters showed no unique patterns of associated health risks, in stark contrast to teens who reported attempting suicide from 2 to 6 times.
This group was 13 times more likely than nonattempters to have symptoms of depression; 7 times more likely to have been sexually assaulted; and more than 6 times more likely to report weight problems. Multiple attempters were significantly more likely than other teens to be heavy users of drugs and alcohol. Boys in the group were more than 7 times more likely than others to report violent behavior, reported Dr. Rosenberg, professor of psychiatry.
"We found staggering differences between multiple attempters and other adolescents. They were at higher risk for every health risk we explored," said Ms. Rosenberg, instructor in psychiatry at the Lebanon, N.H., university, in an interview at the meeting.
"We really should just look for them."
Of particular clinical importance were health risks in multiple suicide attempters that did not seem directly related to suicidality, since these might be easier to detect in reticent teens, she added.
For example, the odds ratio for weight problems was 5 times greater among girls who repeatedly tried to harm themselves and nearly 7 times greater among boys who had made multiple suicide attempts. The powerful association between weight problems and multiple suicide attempts surprised the researchers and has not been previously reported.
"The 800-pound gorilla with suicidality is always depression, but these teens don't always come in and say they're depressed. They enter the dialogue [in] different ways," she said.
The Rosenbergs' study drew on findings from the 2001 New Hampshire Youth Risk Behavior Survey, which was administered to 16,664 teenagers in grades 9-12, in rural as well as urban public schools.
In all, 15% of students reported attempting suicide, with 10% of boys and 10% of girls saying they had tried to harm themselves once during the previous year. Multiple suicide attempts were reported by 4% of boys and 6% of girls.
Dr. Rosenberg noted that adolescents who reported a single suicide attempt demonstrated elevated risk over nonattempters in 10 health categories, especially depressed mood and sexual assault. However, one-time attempters were more similar to nonattempters than they were to multiple suicide attempters.
When the comparison was made between single and multiple suicide attempters, associated risk for depressed mood rose from 24% to 81%; sexual assault risk rose from 7% to 34%; physical assault risk rose from 11% to 33%; and risk for weight and body-image problems rose from 18% to 58%.
Abuse seen as cause of
suicides
By Bill Zajac wzajac@repub.com
The Republican - Sunday, June 12, 2005
http://www.masslive.com/springfield/republican/index.ssf?/base/news-0/111856260813740.xml&coll=1
When James E. Thibault tried to kill himself three years ago, he left a note that shocked his brother.
Thibault, then 53, revealed to his brother for the first time he was sexually abused as a child.
Thibault's brother, Kickapoo Thunder of Chicopee, won't reveal the perpetrator's name, but said it was a man in training for the priesthood who was later accused by others once he served as a priest in the Roman Catholic Diocese of Springfield.
Thibault's obituary, prepared by his family, said: "Jim was a victim of sexual assault as a child by people claiming to be Christians. Like so many of our families who have been affected so tragically, Jim could no longer live with this burden and tragically ended his life."
"It explained a lot about the trouble and pain my brother experienced in his life," Thunder said.
Several weeks ago, Thibault's remains were found along the Connecticut River after what his brother and police believe was a successful suicide attempt.
Thunder believes the suicide was the result of the sexual abuse.
Although no hard data is available, Thibault is just one of hundreds of people nationwide and a handful in Greater Springfield whose deaths are linked to clergy sexual abuse, according to family members and victim advocates.
"Sexual abuse - clergy or otherwise - is a life-and-death issue," said Janet E. Patterson of Conway Springs, Kan., who has been an advocate for clergy abuse victims since her son, Eric, killed himself at 29 in 1999.
Patterson later learned that four other men allegedly abused by her son's accused abuser also killed themselves. There would have been a sixth if a story about Patterson's son and the other men hadn't been published. "Up until the story was revealed, he thought he was the only one," said Patterson.
Patterson, who speaks to many support groups, says it is rare for a clergy abuse survivor not to suffer suicide ideation.
"A friend of mine who is a victim once said she was going to take her secret of abuse to the grave, but then she discovered her secret was taking her to the grave," Patterson said.
David Clohessy, executive director of the Survivors Network of Those Abused by Priests, believes the Catholic church should try to determine how many deaths can be linked to clergy sexual abuse. He said it could be done through annual internal and external audits.
"Victims' families want their loved ones to be counted. They want something to become of their pain. Families feel the need to recognize their pain in some meaningful way," he said.
One father, Allen Klump, believing his ex-Marine son killed himself as a result of abuse by a priest in the Diocese of St. Louis, filed a wrongful-death lawsuit against the diocese two years ago. The suit is still pending, according to Klump's lawyer, Patrick W. Noaker.
Similar suits have been filed in other states, according to various news reports.
Patterson, Clohessy and others say isolation often leads to suicide.
"The most important thing an abuse victim can do is to get help in counseling and find support," said Clohessy.
The organization's Web site displays a suicide hotline number, (800) SUICIDE (784-2433) that will connect a caller to the certified crisis center nearest the caller.
"Once someone seeks help, it is hard to imagine that it won't get better ... Sometimes I can see survivors getting better in months, not years," Clohessy said.
The Rev. James J. Scahill of East Longmeadow, a vocal critic of the Roman Catholic Diocese of Springfield's response to the clergy abuse crisis, agrees with Clohessy.
"The challenge is to get someone to counseling. I'm not a counselor. I am a friend, an advocate. I am someone trying to keep someone's oars in the water," said Scahill, who has been approached for help by many sexual abuse victims.
He said clergy abuse has its own unique effects. "Not only did these young people suffer a molestation of the body, but there was also a slaying of the spirit," Scahill said.
Greenfield lawyer John J. Stobierski, who has represented 60 or so alleged clergy abuse victims, said many victims become so depressed and despondent that suicide seems the only way to escape their pain.
"I have been on the phone many late nights trying to keep survivors alive," Stobierski said.
"The number of victims who have been suicidal at one time or another is not trivial. There is suicide when someone consciously ends their suffering. And then there is suicide by those who do it slowly with drugs, alcohol, and engaging in other risky behavior," Stobierski said.
Some survivors call it suicide "on the installment plan." Raymond J. Chelte of Chicopee believes his son Raymond J. Chelte Jr. falls into that category.
He said his son fatally overdosed on drugs four years after he was one of 17 alleged sexual abuse victims of former priest Richard Lavigne who settled a suit with the Roman Catholic Diocese of Springfield for $1.4 million in 1994.
Peter Bessone, an alleged victim of Lavigne who was part of the $1.4 settlement with other Lavigne victims in the mid 1990s, said his cousin David Bessone committed suicide more than 20 years ago because of the abuse he suffered at the hands of Lavigne.
David Bessone, who was in his mid-20s when he died, never filed a suit or reported the abuse to diocesan authorities. "He didn't want anyone to know about it. He was too ashamed. He was a teacher and didn't want to jeopardize his job," Peter Bessone said.
Clergy abuse survivor Martin P. Bono of Chicopee said he believes the death of fellow clergy abuse victim Shawn M. Dobbert last summer was a suicide.
"I don't care what the medical examiner's report says, Shawn killed himself," said Bono.
The death of Dobbert, within hours of signing papers to settle a suit against the Springfield diocese, was ruled accidental by Berkshire County Medical Examiner Dr. Benjamin Glick.
Bono said his daily thoughts of suicide were intense and frequent during more than one year of litigation with the diocese.
"At one point I had to change the route I took to work because I was fearful I was going to jump off a bridge I crossed each day," Bono said. "I had so much pain that I couldn't tell my wife and kids. I cried five to six times a day. I felt isolated and angry and saw suicide as my ticket out of it."
Therapy was the key to feeling better about life, he said.
Upon settling his suit, Bono, with the diocese's financial support, established a resource center to help victims with everything from therapy to career counseling.
He said he stills thinks about suicide, but the feelings are less intense and less frequent.
Stobierski feels that most clergy abuse victims feel victimized twice.
"First, the priest molests them. Then, they feel victimized by an institution that covered up the abuse and has not dealt with them fairly as adults," he said.
For some, Patterson said, even therapy and support from loved ones and other victims isn't enough to save them.
"This is such a traumatic thing that some can't climb out of the black hole of depression," she said.
However, Stobierski said most of his 46 clients that settled suits with the diocese last summer are emotionally healthier today.
"For those who have received a small piece of justice from the church, they have been able to gain some control of the demons of clergy abuse. Most are in better place than where they were when they first came forward to deal with it," Stobierski said.
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Last Updated: 05/17/2007
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