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christian counseling today
Vol. 21 no. 2
61
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also be seen as a lack of connectedness
or increased social alienation. In short,
people lose the ability to feel any real
connection to others.
Yet, disconnection alone does not
seem to be enough. Joiner’s model also
includes a sense of “perceived burden-
someness” to others. That is, suicidal
individuals see themselves as a burden
to loved ones and truly believe their
families, friends and the world would
be better off without them.
7
This strikes
at the heart of the common belief that
those who die by suicide are selfish and
considering only their own needs. By
no means do we suggest that family and
friends would be better off without the
suicidal individual. In fact, we recognize
the incredible burden that this kind of
tragedy leaves on survivors. However, it
is the perception of the deeply troubled
person that is the focus here. Most who
consider taking their lives maintain the
distorted belief that they are a burden
to those around them and the choice
to end their lives is a charitable act. In
order to intervene and treat the suicidal
person, we must understand what is
going on in his or her mind. Attacking
and challenging these distortions are
critical to effective intervention.
The final element in the
Interpersonal-Psychological Theory of
Suicidal Behavior is the acquired ability
to enact lethal self-injury. As previously
mentioned, the drive toward self-pres-
ervation is hardwired into our brains.
The flight or fight response is a natural
survival mechanism that means we are
programmed to act to protect our lives,
not harm ourselves. This is a neuro-
logical reflex, not a voluntary response
requiring thought. It is the act of self-
harm that requires us to override our
natural instincts. Joiner proposes this
ability to enact lethal self-injury can be
acquired through specific types of life
events. To better understand the risk for
suicide, we must screen for those types
of experiences. Many of the elements
Joiner describes are, indeed, risk factors
that show up in the data and with high
correlations to completed suicide.
8
Risk Factors
The list of risk factors for suicide is too
long to be comprehensively outlined
in this article, so we recommend
additional study to provide a fuller
understanding of what puts people
at risk. However, we will describe a
few of the most significant factors
and those which tie into Dr. Joiner’s
theory of how people acquire the ability
to enact lethal self-injury. Previous
suicide attempts and behaviors remain
the highest predictor of death in this
manner. Having a close friend or family
member who has completed suicide
significantly increases the risk. Intake
procedures should always examine
previous suicidal thoughts or attempts
when completing a psychosocial
history. It is not just actual attempts
that increase risk—mental rehearsing
of suicide also acclimates individuals
to self-injury, so it is critical that we
discuss how often people have played
out the suicide scenarios in their minds
and how much time they have spent
thinking these thoughts throughout
their lives.
Acts of self-injury, such as cutting
and burning, are behaviors associated
… up to
90% of those who complete suicide
have a
treatable mental illness
at the
time of their deaths. Presenting problems such as major
depression, bipolar disorder, schizophrenia, and post-
traumatic stress are what bring many suicidal people
to the point of desperation.