Suicide – An Undiscovered Country? ‘The past is a foreign country: they do things differently there’ The Go-Between LP Hartley

Suicide – An Undiscovered Country? ‘Suicide is part of human nature. Everyone must confront it sometime and come to terms with it’ Johann Goethe

Suicide – An Undiscovered Country? Felo de se - a deliberate act of putting an end to one’s own existence, or committing any unlawful malicious act, the consequence of which is one’s own death Moral insanity (including suicidal mania) – where strong emotions and lack of willpower reduce the system, rendering it less capable of enduring fatigue, and thus depressing the vital powers.

Suicide – An Undiscovered Country? Psoric –highs and lows, struggles with outside world, fearing rejection, insecure (epilepsy, cancer, leprosy). Sycotic –secretive, defensive, suspicious, rigid, jealous (angina, anaemia, rheumatism). Syphilitic –destructive, quitting, self-harming, distorted thinking (gangrene, insanity, blindness) Tubercular –malcontented, dissatisfied, intolerant (caries, diabetes, malaria, pneumonia).

Suicide – An Undiscovered Country? ’To the person who commits suicide, it is a solution; to the observer, it is a problem’ Thomas Szasz

Suicide – An Undiscovered Country? Freud – thanatos, tobesfried, death drive, compulsion to repeat, aggression against the self. An act linked to inability to tolerate reality and to autoerotic regression NeoFreudians – Otto Fenichel, Karl Menninger, Heinz Hartmann, Melanie Klein, Jacques Lacan, Eric Berne

Suicide – An Undiscovered Country? Socrates – Wise Mind, Big Picture Voltaire – The Zone Macchiavelli – Mentalising Hume – Self knowledge Rousseau – Delayed Gratification Aristotle – Realism Pascal – Goals Hegel – Pragmatism Schopenauer – Satisfaction Bentham/Payne - Sharing

Suicide – An Undiscovered Country? ‘No more; and by a sleep to say we end the heartache, and the thousand natural shocks that flesh is heir to: tis a consummation devoutly to be wished. Who would grunt and sweat under a weary life, but that the dread of something after death, The undiscovered country from whose bourn No traveller returns, puzzles the will, and makes us rather bear those ills we have Than fly to others that we know not of?

Suicide – An Undiscovered Country? Multiple morbidity Prior attempts Hospitalisation Substances Discord Alienation Bullying Offending Contagion Abuse Gender

Suicide – An Undiscovered Country? Collapse of ego Self reproach Low self esteem Magic thinking Annihilation of internal persecutors Liberation Projection of guilt Punishment

Suicide – An Undiscovered Country? Anger – offence against the self Anxiety – threat to self Guilt – transgression of moral imperative Sadness – irrevocable loss Shame – falling short of ideal

Suicide – An Undiscovered Country? Threats of harm Abuse or victimisation Isolation Chaos Marginalisation Loss of control Disengagement Stunning Disintegration

Suicide – An Undiscovered Country? WHO Total Adolescents Ireland 4 (15) 3 (25) Russia/NZ 2 (80) 1 (60) Baltics 1 (100) 2 (60) Netherlands 3 (18) 4 (10) UK 5 (12) 5 (10) Latin 6 (6) 6 (8)

Suicide – A Shared Vision? Awareness Support Prescription Help seeking Coping Contracts Outreach Monitoring