www.ssoar.info
Suicidology prevents the cultivation of suicide
Feldmann, Klaus
Erstveröffentlichung / Primary Publication
Arbeitspapier / working paper
Empfohlene Zitierung / Suggested Citation:
Feldmann, Klaus : Suicidology prevents the cultivation of suicide. 2014. URN: http://nbn-resolving.de/urn:nbn:de:0168ssoar-389008
Nutzungsbedingungen:
Dieser Text wird unter einer CC BY-NC-ND Lizenz
(Namensnennung-Nicht-kommerziell-Keine Bearbeitung) zur
Verfügung gestellt. Nähere Auskünfte zu den CC-Lizenzen finden
Sie hier:
http://creativecommons.org/licenses/
Terms of use:
This document is made available under a CC BY-NC-ND Licence
(Attribution Non Comercial-NoDerivatives). For more Information
see:
http://creativecommons.org/licenses/
Suicidology prevents the cultivation of suicide
Klaus Feldmann
2014
Abstract
Suicide is a socio-cultural phenomenon. Reports about suicide from different cultures and eras
support the opinion that suicide can be a cultivated and normatively recognized act. International
educated and scientific use of the term suicide produces, conveys and suggests a narrowing of
reflection. A medical deficit viewpoint has been established, and corresponding theories
constructed and ‘verified’ to justify the paternalistic interaction with suicidal people. The suicidal
person is discriminated and isolated on multiple levels in the suicide development process.
Psychological autopsy studies are driven by deficit- and illness-based approaches and are designed
and conducted on a low methodological level.
When suicidal actions are recognized as normal actions, or even interpreted as morally sound,
medical, political, religious and other guardians of morality and the ruling order oppose such
understanding and demand sovereignty of interpretation. The conflicts in the suicide field result
from diverging values and interests, whereby open, controversial and empirically-based public
discussions are generally avoided. There is a lack of reference in psychiatric and suicidology texts
to the fact that ‘free will’, ‘free choice’ or ‘free mind’ in modern society are not restricted
primarily by mental illness, but by socio-economic disadvantage and economic and political
decisions that lead, among other things, to mental disorders. Cultivation of suicide is not in
contradiction with prevention of suicide.
Keywords: suicide, suicidology, psychiatry
Suicide, a significant form of dying, is generally excluded from works and introductory overviews
on thanatology (e.g. Howarth, 2007; Clavandier, 2009). Suicidology, which is in essence a part of
a part (psychiatry) of the medical system, “neither a science nor a discipline” (Conwell, 2010, p.
59), but a field or a hierarchically ordered system of subfields (Bourdieu, 1998, 2000), sets store
by boundaries and exclusion, has its own journals and textbooks and does not concern itself with
general thanatological theories and research. The term suicidology as used in this text refers to
mainstream suicidology. A typical sentence encountered in the dominant doxa, the self-evident
discourse on practices and on which the field rules are based: “The focus of suicidology is not
necessary completed suicide but above all treatment of suicidal individuals” (Pompili, 2010, p. 1).
In Ancient Greek and Latin, there was no one specific term for the act referred to in all modernday advanced languages as suicide (van Hooff, 1990; Marsh, 2010, p. 79). The ‘matter’ was simply
addressed and referred to in different ways depending on the context, which also provided
people with greater flexibility in dealing with it. Commandingly protected and professionally
watched over, the unwavering international use of the term suicide in its modern form in contrast
produces, conveys and suggests pathologization and incapacitation. A medical deficit viewpoint
has been established, and corresponding theories constructed and ‘verified’ to justify the
paternalistic interaction with suicidal people. “…a desperate person is not only feeling despaired,
but her reflective abilities are altered. This feature of suicidal people is usually named as
‘‘narrowing’’ in psychiatric and psychological models and received empirical evidence”
(Schlimme, 2013, p. 214). While the ‘narrowing (of consciousness)’ construct might be applicable
to residents of nursing homes (cf. Whitaker, 2010), it does not really constitute a valid generalized
description of the mental states of suicidal individuals (Feldmann, 2010, p. 199).
1
“The stories we tell about acts that come to be labeled as suicidal are influenced by the
impoverished language and conceptual apparatus that is available to us. In most ‘suicide talk’
whether among professional or lay people, the whole range of acts engaged in by those whose
behavior is actually or potentially self-destructive are subsumed under the umbrella concept
suicide and a few variants: parasuicide, attempted suicide, failed suicide, and threatened suicide,
along with expressions like ‘cry for help’. This poverty of language and concepts reflects rather a
limited model of suicidal self-harm in which fine distinctions are not made, even in theory,
perhaps because they are difficult to make in practice. It is misleading and unhelpful in deciding
upon courses of action in relation to those who act in actually or potentially self-destructive ways
or are thought to be at risk of doing so” (Fairbairn, 1998, p. 157).
The catalog of terms and theories used to address actions and events that cause destruction to the
self or to others remains antiquated and unreflected: suicide, murder, death by natural causes,
accident, etc. The users of this semantic field share the illusion that suicide is a homogenous
phenomenon that can thus be unambiguously described, explained and assessed. “This fatal
reduction in complexity favors the simplification and ideologization of suicide that is
encountered not only in the medical debate, but also in the publications of legal and medical
practitioners, theologists and psychologists. Above all, the minority of suicide cases that could
provide a positive lesson for one part of humanity are ‘drowned’ by the easily diagnosable
majority.” (Feldmann, 2010, p. 179; translation by the author)
Attempts to differentiate the term suicide (or killing oneself) are avoided in the legal,
philosophical, theological and other debates, while the use of a whole range of terms to refer to
the act of killing someone else (e.g. murder, manslaughter, death penalty, act of self-defense, fatal
use of force, euthanasia, etc.) in turn adds greater flexibility to the debate. To surmount the
difficulties raised by the heterogeneity in case structures, contexts and views of the world, suicide
and its mainstream debate are subjected to a restricted actor model and decontextualized by
opinion leaders (cf. the reductionist context, theory and culture abstinent attempts at definition in
Silverman 2011). The psycho-social events that precede a suicide are operationalized into
normatively prescribed concepts and variables, while their communicative and interactive
processes and field structures are deconstructed and reconstructed using simple causal models.
Most suicide experts thus neglect methodological differences and theoretical options in their
claims that the vast majority of suicides are ‘caused’ by mental illness (cf. Hjelmeland et al. 2012;
Hjelmeland 2013, p. 7 - 8). Given the problems associated with the operationalization of the term
‘mental illness’, the lack of diagnosis and other factors, this constitutes an only seemingly wellproven hypothetical supposition or view, reinforcing the assumption that the dominant construct
of suicide based on the professional doxa of psychiatry lacks critical scientific rigour, serves
primarily to keep authority and professional privileges in place and is increasingly losing its
scientific and everyday viability. Indeed, we can now talk of a globalized hegemony, orthodoxy
and monopoly view in which science and symbolic capital is abused as legitimate means of
symbolic and structural violence.
The argumentation below primarily targets the scientific and professional ‘treatment’ of suicide.
But before we can discuss this further, we must first take a brief look at the state and governing
framework without which suicidology would not be able to consummate its work in a quasifundamentalist manner. The modern-day state has adopted elements of traditional moral and
governance ideology, which are administrated by various institutions (the law, education,
medicine, social work, etc.). “Laws against suicide or assisted suicide thus represent coercive
action by the government that imposes the rules of a particular morality, one that derives from
religion, over another morality with more secular derivations.” (Rubin, 2010, p. 811)
Bayatrizi (2008), Lester (2003, 2006) and Marsh (2010) deliver insights into the development and
establishment of the psychiatric ‘regime of truth’ based on functionaries and on suicide as an
intercultural and transdisciplinary phenomenon. With their largely symbolic capital, the main
2
advocates of mainstream suicidology in contrast promote their basic ideology as universal,
evidence-based, culturally, politically and economically neutral, and without alternative; they
dominate the debate in literature and in the quality media. Dogmatic statements and statements
of commitment are to be expected from the prominent players: “Suicide at any age is a tragedy
for the individual, his or her family and friends, and the communities of which they are a part”
(Conwell,Van Orden & Caine, 2011, p. 1).
A further observation concerns the reductionist (meta-)theory of suicide found in literature. The
following example refers to the group of patients who are ‘at the end of their lives’: “Yet for the
vast majority of these patients, the reason for suicide is not a decision made of their own free
will, but a frequently treatable mental disorder.” (Vollmann et al., 2008, p. 205; translation by the
author). This argument is clearly based on a simple ‘theory’: suicide is either a decision that is
made of our own free will or is caused by a mental disorder. The operationalization of the terms
suicide, mental disorder, free will and decision conforms to the prevailing medical and ruling
order, and the ‘theory’ that was ‘confirmed’ by partisan research is not subjected to any further
critical examination.
To the constant chagrin of the representatives of powerful institutions, including above all
medicine, the state, religion and the law, suicide is a battlefield in society that is not as well
ensnared in their professional grip as cancer or childbirth. “The ultimate threat to a legal order
built on death control is the individual who refuses to accept law’s prohibition and seeks to selfstyle her death.” (Hanafin, 2009, p. 85). While people who commit suicide are no longer subject
to criminal prosecution, most countries still punish people who help to organize a suicide without
the statutory authority or professional legitimation to do so. Furthermore, even in countries like
Germany where assisted suicide is formally exempted from official punishment, ostracism,
informal punishment, medicalization, stigmatization (Sudak et al., 2008) and mystification are still
demanded by many experts (psychiatrists, suicidologists, lawyers, etc.) and public speakers
(functionaries, journalists, etc.). The suicidal person is discriminated and isolated on multiple
levels. The people affected – and that can be quite a lot of people if suicidality is taken as an
overall phenomenon – maintain their silence in “doxic submission” (Bourdieu, 1998, p. 67, 81;
2000), or their attempts to communicate ultimately peter out. To strengthen the ideology,
selected examples are pushed through the filters and transformers of medicine, the media and
other modern forms of censorship and presented to the general public as deterrents.
Resistance to the pathologization, medicalization and depreciation of suicide was – and still is –
generally provided by outsiders, and ignored and symbolically destroyed by state and experts. The
people and groups who provide resistance are usually denied access to and denounced in the
media as sick or criminal (c.f. the attempts to bring criminal charges against the German branch
of the Swiss assisted suicide organization Dignitas) or classified as cultural, ethnic oder
ideological deviants, whereby this categorization must be gleaned from debate and practices,
since any public discussion is heavily restricted. These deviants, literati, artists and intellectuals,
are occasionally granted a ‘moderated’ niche platform, thus facilitating their segregation and
exclusion from ‘normal citizens’. They are also deemed to be irrational and romantic, while the
members of the white-coated suicide brigade are praised for their scientific, rational and
professional merit and have the financial backing to secrete their ritual claims into the media and
relevant commissions.
A counter-debate of romantic glorification and scientific marginalization that suits the
representatives of the fields of medicine and power is constructed. “However, the glorification of
suicide – suicide as rebellion and opposition against the dominant values of society – may also be
found in popular culture in the 20th and 21st century, such as rock music and film. The
glorification of individual resistance communicated by pro-suicide messages on the internet today
may be traced back to Stoicism and Romanticism, albeit in new forms and with new adversaries”
(Westerlund, 2012, p. 766). In contrast to this very restricted and calculating willingness to
3
‘recognize” the counter-debate, commendable scientific works offering a different understanding
of suicide (e.g. by Thomas S. Szasz, David Lester, Jack Douglas, Ursula Baumann or Dagmar
Fenner) are ignored in journals and medical education because they are not compatible with the
prescribed modelling and economics of suicide. Despite this suppression of alternative
perspectives by the professionals and the state, they are still being represented and applied in
many different forms by various individuals and groups. When such heterodox representations
reach the media, the messages they contain are written off by the experts as prejudicial, incorrect,
immoral, irrational and/or sick.
The effect of hidden power should also not be ignored. The following message to potential
suicides continues to remain effective: Do it in a way that is as off-putting and repulsive as possible! (c.f.
Feldmann, 1998). A further implicit message that is supported even by the high priests of
suicidology is as follows: When you commit suicide, you die a dishonorable death, no matter how you do it!
Different variations on these themes are transmitted in the messages sent by different senders:
medicine, religion, the law, the media and politics. These implicit and explicit messages have so
far succeeded in developing their stabilizing effect on prevailing discourse and practices to a
sufficient extent to prevent alternative discourse and practices from becoming the center of
attention. These assumptions and the hypotheses that can be derived from it have as yet not been
the subject of any quality empirical studies, and this situation is unlikely to change in the shortand medium term.
Notwithstanding this professional narrowing of the discourse, the study by Weaver (2009)
delivers excellent material for the description of suicide as socio-cultural phenomenon. Weaver
draws a multidimensional and multiparadigmatic network image of suicides in New Zealand and
Queensland in particular in the first half of the 20th century. He connects the manifold contexts,
motives, mental, social and physical conditions, (semi-)professional interventions, etc. in
impressive detail “…providing an intimate understanding of the personal and social
circumstances surrounding suicide…” (Bayatrizi, 2010, p. 171) and makes this information
available to readers for further interpretation. Prevailing perspectives and theories are thereby
relativized and make their way into semantic and pragmatic fields of conflict. “A myriad of
factors from temperament and personality to environment, learned coping mechanisms, biology
and life circumstances all create a complicated web of individuality. In light of this fact, perhaps
our concept of suicidality could be more appropriately viewed as a metaphorical tree.” (Mitchell,
2009, p. 30)
If depression and suicidal tendencies are recognized and categorized as ‘products’ of social
culture (cf. Pilgrim & Bentall, 1999; Yur'yev et al., 2013; Minagawa, 2013; Hjelmeland, 2013, p. 6),
the evidential authority of medical and psychological theories diminishes (cf. Marsh, 2010, p. 74
f). Depression is activated and changed by environmental factors and social processes (cf.
Rosenquist et al., 2011; Petersen, 2011). The environmental factors that encourage depression
include: social inequality, lack of high-quality democracy in political and economic institutions,
legal, education and healthcare systems based on privilege, etc. A favorable development in
society could alleviate most depressions to the extent that far fewer people would require medical
treatment and the number of suicide and attempted suicides would be significantly reduced. In
the current social setting, pathologization and medicalisation serve both to treat the afflicted and
sustain the illness and thus also to support the ruling forces, ‘social stability’, ideologization and
growth in the participating manufacturing and services sectors. The fact that modern medicine
and clinical psychology have been successful not only in treating the afflicted but also in their
humanization and normalization efforts should by no means be denied. Likewise, the dependence
of medicine and psychology on the field of power and the shortcomings in scientific education
when it comes to changing prejudices and stereotypes should also be taken into account in the
assessment of the arguments presented in this article.
4
Cultural and social change and suicidology
There are sufficient reports about suicide from different cultures and eras which do however
support the opinion that suicide can be a cultivated and normatively recognized act (cf. Baechler,
1979; Marsh, 2010; Tomasini, 2012). Many such examples can be found in Roman history and,
despite censorship, enough corresponding examples have also made it into public view in the
20th and 21st centuries. However, no group of scientists has as yet dared (or been given the
resources) to study this thesis from an intercultural and modern society perspective.
The physical or symbolic violent course of action against people who commit suicide and the
people who ‘sympathize’ with them stems from Western and other cultural traditions (c.f.
Baechler, 1979; Baumann, 2001; Bayatrizi, 2008; Feldmann, 2010, p. 192; Marsh, 2010). In
Western cultures, suicide generally has negative connotations: politics, the law, organized religion,
medicine and psychiatry are the most important institutions and subsystems which set
corresponding binding sanctions, prescribe debates and apply physical and symbolic force.
Emancipation efforts by organized and heterogeneous opponents of this militant truth regime
have achieved partial successes through the battles between the powers that define the debate
and practices. However, these successes are, of course, always at risk, since the disciplining of
suicide and (at least symbolic) destruction of its non-conformist supporters still remains on the
agenda of powerful conservative groups and organizations.
“… a contemporary ‘regime of truth’, one centering on a compulsory ontology of pathology in
relation to suicide” (Marsh, 2010, p. 4) or the contemporary approach to suicide in expert and
power debates and practices can be compared to the 19th century middle-class attitude to
sexuality: lack of reflection, over-policing and prudery on the one hand, inadequately cultivated
and correspondingly brutal social practices on the other, in what was, above all, a largely
unexplored territory.
In Western cultures, the concept and practice of suicide was formed and used to discipline and
stigmatize. Authoritarian regimes and groups, e.g. fundamentalist religious communities or
national socialism, condemn(ed) self-determined suicide that does (did) not serve the powers that
be draconically and without reflection. In contrast, ‘sacrificing’ oneself for the ‘true collective’, for
the ‘true god’ or for the ‘true leader’, which was officially not permitted to be referred to as
‘altruistic suicide’, was – and is – glorified. Mass murder at the orders of the respective ruling elite
was praised as being morally good and was also linked with varying good ‘chances of suicide’.
Representatives of state nobility, law lords, religious and medical leaders continue to regard a
suicide that is not linked to approved homicide with skepticism and hostility, since the person
committing suicide is ultimately being insubordinate and abusing his limited authority of selfdetermination. These representatives of ‘order’ use withdrawal of capital, defamation of
character, stigmatization and other tried and tested techniques to battle against people and groups
who openly support and publicly show acceptance for forms of suicide, e.g.physicians who
provide assistance with suicide in Oregon, where assisted suicide is legal.
Many psychiatrists and suicidologists have established justification systems in cooperation with
religious and state institutions to deny people who want to commit suicide symbolic capital and
the ability to make their own decisions (cf. Szasz, 1999). This approach has been more successful
in Europe and North America than in Japan, where certain forms of suicide have long been
cultivated and normalized (cf. Kitanaka, 2009). Educated Japanese can and may talk more openly
about suicide in public than their Western counterparts. “Traditionally, suicide has been
considered an expression of an individual’s free will in Japan (Cho, 2006; Takahashi, 1997, 2001).
The rhetoric of a ‘suicide of resolve’, still a very popular notion, suggests that suicide can be the
result of a rational decision by a freely choosing individual, and therefore is an option to be
respected when necessity calls for it (Kitanaka, 2006, 2008). Kitanaka argues ‘though psychiatry
has been institutionally established in Japan since the late nineteenth century, psychiatrists have
had little impact on the way Japanese have conceptualized suicide. This may be because Japanese
5
have long normalized suicide, even aestheticizing it at times as a culturally sanctioned act of
individual freedom’ (Kitanaka, 2008, 1)” (Ozawa-de Silva, 2010, p. 21-22).
The ‘understanding’ sold as ‘objective truth’ not inadequately confirmed hypothesis that only a
few suicides – e.g. one to five percent – are the result of ‘free will’ gives state bodies the
legitimization they need to take hold of suicide and bring fear and terror to the people involved.
This fear and barbarization of the field is being instrumentalized theoretically and empirically by
many psychiatrists and suicidologists to obtain ‘objective findings’ – a typical linking of ‘applied
science’ and power.
The suicide experts in the medical system have ‘civilized’, modernized and medicalized the
custom of post-mortem degradation of people who commit suicide. Even after death, they are
named and shamed as mentally ill, i.e. as inferior, irresponsible people, and are used as a
dishonorable and deterring reminder, albeit one mixed with pity. Their relatives are encouraged
to also place themselves in the care of physicians or psychiatrists. This ‘professional’, ideological
and economic context fosters a world view in which suicide as such – regardless of social and
cultural setting – has in almost all cases seriously disturbing and no positive effects on surviving
relatives or persons of reference. The confirmation of this normative hypothesis, which has never
been adequately tested, was questioned, for example, in the study by Barraclough and Hughes
(1987) (cf. Jordan, 2001, p. 97). Through social normalization and medicalization, suicides and
the mourning processes of the people they leave behind become events that distract from or
complicate the resolution of social and hegemonic problems. Psychosocial disorders can, of
course, emerge, when a person’s passing and death are not compatible with the interpretive
systems and practices of the people left behind. While suicides probably cause “complicated
grief” for many survivors, a successful cultivation and liberalization of self-determined dying
could reduce this potential strain (cf. Swarte et al., 2003). People are physically, mentally and
socially damaged and weakened by the social conditions, only to then receive ‘aid’ that doesn’t
make them ‘healthy’ and ‘happy’ but dependent and submissive.
When suicidal actions are recognized as normal actions or even interpreted as morally sound,
political, religious and other guardians of morality and the ruling order vehemently oppose such
understanding and demand sovereignty of interpretation (cf. Bayatrizi, 2008, p. 121). Suicide
messages that could be understood as a protest or criticism of the social, political or economic
regime should be ignored or reinterpreted – a process that has been seen in different forms
throughout European history (ibid., p. 117).
23 France Télécom employees took their own lives or attempted to commit suicide in 2008 and
2009. The suicide notes and the statements of the survivors clearly indicate that the working
environment was a central factor in their decision to commit suicide. Economic and social
exclusion (e.g. unemployment) contribute to raising suicide rates (cf. Yur’yev et al., 2013).
Suicide is a socio-cultural phenomenon (c.f. Chu et al., 2010; Hjelmeland, 2010) like war, financial
transactions, divorce and unmarked graves. Most people would shake their heads if physicians
and scientists were to say that war, financial transactions, divorce and unmarked graves are
inextricably linked with illness and incapacitation and assign them to the realms of medicine and
clinical psychology. The socio-cultural perspective is confirmed in intercultural studies (cf. the
reports in Culture, Medicine and Psychiatry, No. 2, 2012). “In conclusion, our findings suggest
that the ‘monolithic’ psychiatric discourse (Marsh 2010, p. 168) that dominates Western
suicidology, and that has been built largely on the basis of psychological autopsy interviews, is not
supported by a close reading of the personal narratives that are woven by bereaved kinfolk in the
course of those interviews.” (Owens & Lambert 2012, p. 369).
The autopsy of suicides
By studying suicides after the event, researchers endeavor to find out more about the causes of
such actions. Specific interpretations of the results of such ‘autopsy studies’ are used to
6
‘legitimize’ the dogmatic claim and taken for granted belief that mental illness is the cause in
almost all cases (Jamison, 1999, 100; Cording & Saß, 2009; Jox, 2011, p. 169). Psychological
autopsy studies are driven by deficit- and illness-based approaches, i.e. they deliver the results
from the desired perspectives (cf. Rogers & Lester, 2010, p. 13), and are designed and conducted
on a low methodological level. “PA [psychological autopsy] studies can therefore not serve as an
evidence base for the claim that most people who die by suicide are mentally ill.” (Hjelmeland et
al., 2012, 621) Competence, reflection, contextual relevance, alternative constructions of meaning
and the world and other epistemic, cultural and social aspects are blanked out or ‘neutralized’
from the start (cf. Fincham et al., 2011), and the narrow and theoretical weak operationalization
serves to justify scientifically dubious claims (cf. Pompili, 2011, p. 10 ff). “Cavanagh et al.’s (2003)
systematic review of psychological autopsy studies noted that evidence from these studies on
psycho-social factors is limited.” (Scourfield et al., 2012, p. 467)
Even the term ‘autopsy’ is itself deceptive: as if diffuse, prejudiced ‘gleanings’ might be
comparable to a (ideally) scientifically based post-mortem examination. Through this ‘scientific
tradition’ supported and sanctified by an illusion of validity (Kahneman, 2011, p. 211), valuable
information is hidden in constricted interpretative mantles or not made available to the public.
Through the autopsy of suicide, a living context is treated as a pathologized corpse. It is to be
presumed that one function of the psychological autopsy of suicides is to provide an ‘epistemic
cleansing’ of a dangerous alternative field for the doxic structures of medicine, politics and the
law.
In comparison to other studies from developed nations, autopsy studies in China find that mental
disorders account for a significantly lower proportion of the ‘causes’ of suicides (cf. the
references provided in Phillips, 2010). Phillips (2010) discusses this discrepancy in the expected
ideological and dogmatic manner. First, he sticks to the fiction of a universally objective
definition of ‘mental disorder’ and, second, he confirms without reflection the supervision
postulate: ‘suicide must be prevented regardless of its individual and group-specific
interpretation, even when it is not caused by a mental disorder!’
Epistemic and normative front and back stages in suicidology
In this section, the behavioral norms for psychiatrists and psychologists outlined in expert
literature or encountered in the attitudes and expectations of other people are confronted with
the assumed actual behavior of suicide therapists (behavior which still needs to be studied
empirically).
- The values of the potential suicide victim should be recognized. – Yet they are ‘interpreted’ and
‘transformed’ by the experts.
- The context should be determined. – Yet it must be boiled down to the “clinical conditions’.
- The potential suicide victim should be taken seriously. – Yet all tricks should be used to alter
the meaning and system that supports the suicidal tendencies.
- The potential suicide victim is cognitively and emotionally capable of carrying out a project that
the majority of people would not be able to do. – Yet in line with the professional doxa, he/she
must be ‘understood’ to be cognitively and emotionally deficient and incompetent.
- Some people in positions of responsibility recognize some acts of suicide as dignified and
purely personal. – Yet an orthodox suicidologist cannot recognize an act of suicide as dignified
and purely personal under any circumstances.
- The act of suicide can be planned and carried out on the basis of a strong moral decision. – The
suicidologist must class the moral and the conscience of the potential suicide victim as
secondary to the illness construct and thus devalue them.
- Each potential suicide victim and each suicide is unique, and hence a set of predefined actions
for professionals based on a model that offers no alternatives must be rejected. – Yet suicide
7
prevention has to address all suicides, regardless of understanding, context, values and other
aspects.
Values and freedom
The conflicts in the suicide field result from values and diverging interests, whereby open,
controversial and empirically based public discussions are generally avoided, even though suicide
is an important, multifunctional aspect of the life world especially in pluralistic knowledge
societies.
Some psychiatrists and suicidologists seek to preserve a sector-specific monopoly when it comes
to assessing freedom to act. Freedom is transformed into ability or competence, which is
established and measured by psychiatrists. They can then set standards, stigmatize people
legitimately as not free to exercise their own will and thus also recruit them for purposes of
political or economic gain as (forced) clients. The valuable ‘energy of suicidal tendencies’ is
medicalized through mainstream therapy and thus used to preserve the medical system, not to
further society.
A psychiatrist cannot ‘freely’ perceive and accept a potential suicide candidate. Psychiatrists are
forced to apply prescribed professional and institutional theories and practices. These constrained
secular priests protect and armor plate the prevailing ‘truth’, the law, the organization and other
powerful institutions from the ‘demons’.
Many suicidologists and psychiatrists unduly claim to have brought clarity to the 3,000-year-old
debate on free will. All the ignorant have to do is to contact them, and they will tell them if they
and others are acting of their own ‘free’ will or not. The ‘free will experts’ ignore the fact that free
will, ego, self, identity, person, subject, etc. are precarious, changing concepts and constructions
steered by money and power, dependent on perspectives, habitus, socio-cultural and other
conditions. The ‘theories’ they use, and the ‘empirical evidence’ they produce – when forced to
do so – do not of course meet the strict scientific criteria that should be applied in such
existential matters (cf. Wedler, 2008, 319). There is a lack of reference in psychiatric and
suicidology texts to the fact that ‘free will’, ‘free choice’ or ‘free mind’ in modern society are not
restricted primarily by mental illness, but by socio-economic disadvantage, the consolidation of
structures of privilege and economic and political decisions that lead, among other things, to
mental disorders. Guardians and protectors of suicide sell their specific ‘technologies of free will
and the self’ without drawing attention to (un)desired side effects (cf. Rose, 2007). There is also a
lack of recognition in psychiatry and suicidology that free will and autonomy discourses also
constitute goods, capital and weapons in a capitalist society – e.g. in the political or medical
business – framed by habitus and field, and that heteronomy and autonomy do not mill around
separately anywhere. A person can achieve autonomy through ‘restriction’ of awareness and can
be made dependent or turned into a submissive producer and consumer and defender of social
inequality by the purchase of freedom, e.g. in therapy.
‘Unfreedom’ of will and loss of self are achieved to a far greater extent by medical measures,
above all those to prolong dying, than they are by suicide. In dying processes in hospitals, care
homes, hospices and palliative wards, organizational reasons and the artificial prolongation of life
result for the clients in a forced reality and strong restrictions on their actions – a favorable
climate for suicidal thoughts. High quality empirical studies into this subject have so far been
avoided. The usual story told by the caregivers is that suicidal wishes do not arise under these
conditions. Yet these “experiences” are the result of a combination of the following elements:
firstly, that the patients no longer have the energy and courage for deviation and selfdetermination, secondly, that they are no longer being heard (or should no longer be heard) and
thirdly, the dismantling and destruction of their social and mental life world. Suicidal tendencies
in old people are often signs of a highly developed social and mental identity – which is usually
linked to an above-average ‘freedom as competence’ (cf. Applbaum, 2012; Baudelot & Establet
8
2008, p. 33-34). An important factor that favors suicidal tendencies is namely the obstruction of
autonomy and independence as a result of the context (cf. Ehrenberg, 1998). In care homes, the
competences required to live and die with dignity are already reduced to such an extent that only
suicidal quasi-acts remain possible, the interpretation and symbolic conversion of which is left to
the responsibility of the care staff.
Insights into the pathology of the psychiatric profession
Many physicians and psychiatrists are pulled in by their professionally laced corsets, and act in an
unreflective and ritualized manner. The following citations offer examples:
“It is estimated that close to 90% of people who suicide have a psychiatric diagnosis at the time
of their death … But, argue those in favour of physician-assisted suicide, this does not apply to
those with terminal illness. These are not people with despairing emotional states but rather
rational human beings wanting a sensible degree of control over the circumstances of their death
(Tucker and Steele, 2007). Again, the data simply do not support this. Patients with terminal
illness wanting to hasten their own death have been found to have higher rates of depressive
symptom scores, lower family cohesion and a greater sense of being a burden on their families
(Kelly et al., 2004). The strongest predictive factor for a wish to hasten death in those with
terminal illness is not pain, or health status, but hopelessness (Akechi et al., 2001; Breitbart et al.,
2000; Chochinov et al., 1998).” (Vamos, 2012, p. 85)
Elements of the ritualized argumentation: 90%, data, depression, burden, hopelessness. That it is
not about “data” but about doxa, that depression can also be a resource, that hopelessness does
not ‘exclude’ rational thought and behavior – these are all things that are not allowed to be
thought and written. According to a study by Kogan, Tucker & Porter (2011), social economic
burden is a central attitude factor, while psychiatrists vilify it as a symptom of illness – not least
because it serves only too well as a reminder of their own economic interests and those of their
clients.
“Patients who desire death during a serious or terminal illness are usually suffering from treatable
depression (Breitbart, 1987; Breitbart, 1990)” (Sher, 2012, p. 87). Implicit postulate: What’s
treatable, must be treated, even if the treatment is not adequate for the habitus or has a
depersonalizing effect. Implicit value judgment: if a depression is a ‘cause’ of the desire to
shorten the process of dying, the physician must act dogmatically against this wish regardless of
other considerations. Implicit scientific norm: deviating hypotheses must be concealed and
symbolically destroyed.
“A request for assisted suicide is usually a call for help and a sign of depression (Greene, 2006). It
is a call for positive alternatives as solutions for real, difficult problems.” (Sher, 2012, p. 87)
Implicit dogmatic understanding of reality (sign of inadequate scientific theory and professional
training): the physician knows better than the patient about the latter’s ‘whole person’. The
physician is a priest, only he can interpret such calls for help correctly.
“The wish to die is not stable over time. Suicidal intent is typically transient. Of those who
attempt suicide but are stopped, less than 4% go on commit suicide in the next 5 years (Rosen,
1976) and less than 11% will kill themselves over the next 35 years (Dahlgren, 1977).” (Sher,
2012, p. 88). Implicit insight: if stopped from committing suicide, a person who only has a few
weeks left to live would not kill himself/herself over the next 35 years. Implicit value judgment:
instable patient wishes should be disregarded by physicians.
“In some countries, governments and insurance companies may put pressure on physicians and
hospital administrators to avoid life-saving measures or recommend euthanasia or assisted
suicide.” (Sher, 2012, p. 88) Implicit unverified factual claim: in most cases, physicians act
without external social pressure primarily in the interests of their clients. Implicit standard:
external social pressure on physicians should be categorically assessed as negative.
9
The suicidologist Wolfersdorf (2007) lists overlapping types or forms of suicide without
convincing theoretical basis, but omits to name “rational suicide”or “accepted suicide” (p. 20).
The type of suicide discussed in this section (suicide that is legally and socially worth protecting)
corresponds most to Wolfersdorf’s category of “so-called Freitod” (killing oneself in the absence
of mental, somatic or social need)”. It goes without saying that this type is de facto non-existent.
Why suicide cannot be committed “of free will”, “rationally” and “socially accepted” ‘in the
presence of mental, somatic or social need’ remains a secret of the experts. “…the data do not
support the idea that suicide cannot be chosen rationally or that it is never chosen rationally, or
even that it is rarely chosen rationally.” (Luper, 2009, p. 181).
The following quote further emphasizes the professional tunnel vision: “Those people who
frequently encounter older people in suicidal crises or following an attempted suicide in their
work know that acts of suicide by older people are practically always caused by situations of
emotional suffering, frequently in combination with external misery, and are not the result of a
level-headed, rational decision (cf. Teising, 2001). What is dangerous is that the person who
interprets the suicidal considerations of an older person as ‘rational’ is less willing to provide
help.” (Wächtler, Erlemeier & Teising, 2008, p. 134; translation by the author)
The usual prejudices and stereotypes return: the intention to commit suicide is not ‘rational’.
Only if a suicidologist were to confirm the ‘rationality’ would acceptance perhaps be an option.
Only professional helpers can define what ‘help’ means. People who provide help that does not
conform to the dogma, e.g. who help someone to commit suicide, are threatened.
Even a suicidologist at the Max-Planck-Institute for Psychiatry submits to the accepted dogmatic
frame of reference: “It is ultimately the ambivalence of the actual person at risk of suicide that
contradicts the prerequisite for a suicide, namely a decision for death and against life that is made
of one’s own free will.” (Bronisch, 2007, p. 124; translation by the author). Bronisch uses the
term ‘ambivalence’ in an individual psychology or personality theory context. As the typical
suicide in line with the psychiatric construction, Bronisch champions a restricted
(monodisciplinary) perspective. Ambivalence and ambiguity are now normal phenomena in the
dying process (cf. Valentine, 2008, 36 f; Broom & Cavenagh, 2011). In this intricate situation,
insight is not gained from a psychiatric prophesy that indicates the profession’s conservative
ideology and epistemic dogmatic, but from multiperspective, transdisciplinary reflection.
Constitutive is an anthropological or existential ambivalence that has been worked on in all
cultures and for which there is no categorical ‘solution’ (cf. Hadders, 2011, p. 231). A cultural
ambivalence can be discerned in the two key Western death scenes, namely those of Socrates and
Jesus Christ (the latter of which was discussed by John Donne (1647/1982) as a suicide): a high
share of suicide with a simultaneous official emphasis on the legitimate or illegitimate killing
depending on the perspective. Social ambivalence would appear to be more relevant for today’s
situation, and is demonstrated in the fact that killing has been monopolized by the state and its
loyal servants, which is why killers who are not commissioned by state officials are subject to the
threat of severe punishment, while suicide is now no longer liable to prosecution. The
professional ambivalence can be seen in the attitudes and behavior of many psychiatrists and
suicidologists: officially providing help, unofficially misleading, punishing, humiliating,
constricting and weakening. These socio-cultural ambivalences are reflected in the appreciations
of many people and also emerge in study findings: an increasing number of people accept active
euthanasia, thus advocate individual mercy killing in a state-controlled setting, yet still have
concerns when it comes to suicide (cf., for example, Tännsjö, 2006). Tännsjö expresses his
astonishment over this result with social scientific naivety and philosophical arrogance: “My
interpretation of this discrepancy is that people generally have no well thought out opinion on
these matters.” (ibid. 44; translation by the author). Brock (1992, p. 21) maintains that people
seek active euthanasia or active assisted suicide because an (unassisted and unauthorized) suicide
would bring stigmatization to them and their loved ones.
10
Dogmatists, paternalists and believers in verification do not want or are unable to recognize that
more and more people are ambivalently and multivalently rejecting the purity ideals and
restrictions of autonomy in theological, medical, legal and philosophical treatises, church and
other pamphlets, medical association communiques and soap-box oratories (cf. Dawson, 2012).
A representative longitudinal study of the population over the age of 64 carried out in The
Netherlands from 2001 to 2009 shows that an increasing number of old people support actively
assisted suicide and easier access to the ‘end-of-life pill’. (Buiting et al., 2012).
We would like to close this section with another illustrative comparison. The findings of
empirical research into the attitudes of teachers to migrant children (Auernheimer, 2008, p. 461),
can be transferred astoundingly well to the attitudes of many psychiatrists and suicidologists to
people who (attempt to) commit suicide:
1.
2.
3.
4.
5.
6.
7.
8.
Fixation on other ‘mentalities’,
Blindness to difference (differences between groups and individuals),
Global suspicion of ‘fundamentalism’ (own ‘fundamentalism’ is transferred to the client),
Demand for assimilation and normalization,
Exclusive ‘tolerance’,
Mission (cure, prevention),
No questioning of individual perception and assessment patterns,
Infantilization, assumption of irrationality and immaturity.
Result of the diagnosis of the suicidological framework in psychiatric organizations: ritualized
practices and a dogmatic doxa are legitimized through a body of knowledge with an inadequate
theoretical and methodological base that is designed to maintain relations of power which
promote inequality and is immune to criticism.
The field of self-determined and externally-determined dying
Self-determination and external determination are analytical concepts, i.e. they can be changed
and adapted in accordance with theories, the context and personal semantics. When a person in a
care home refuses to eat, experts describe this as self-destructive behavior, although it could be
seen from a personal and from a scientific perspective as self-fulfilling behavior. Self-descriptions
provided by elderly, ill people, particularly those who have to live in total institutions, are
generally ignored and rarely recognized by the professionals, who reinterpret them in line with
their own ‘theories’ and interests. The apparently objective ‘diagnosis of reality’ by professionals
or even by other regulatory bodies, e.g. police officers or judges, transpires to be a dogmatic,
pseudo universal, perspectival external description.
From a critical, interdisciplinary perspective, suicidality is not just a consequence of the effect of
‘inner powers’ (psychology, medicine) or ‘external powers’ (sociology), it is a relation or habitus
disposition within a field (Bourdieu, 1998, 2000). Accordingly, understanding and explaining
suicidality is a pragmatic, dynamic and multiperspective activity on the micro-, meso- and macrolevels, the scientific observation of which is poor and lacking in current psychiatric theories (cf.
Rogers & Lester, 2010). A critical debate on suicide and its diversities attacks political, economic
and professional relations and demands a fair context for autonomy and humanization to unfold.
The recognition of self-determined planning of dying, in which suicide, assisted suicide and
euthanasia were options, would be a step on the path towards destigmatization, humanization
and liberalization. The rational suicide construct is, however, hardly suitable for such a cultivation
discourse, since it is used in the literature and expert debate in an oscillatory, interest-dependent
manner that dismisses empirical evidence (cf. Wittwer, 2003, 49; Fenner, 2008, p. 283).
Ultimately, the determining factor is not how rational a decision to commit suicide is to the
experts, but that the circumstances of life allow people to make decisions in their own interest –
either alone or with their loved ones or persons of reference – about whether to extend or
11
shorten their physical, psychic and social lives (cf. Feldmann, 2010, p. 126-139). Yet a structural
approach of this kind is marginalized in suicidology and psychiatry.
Prevention: There is no alternative! There is an alternative: Cultivation!
Applbaum, A. I. (2012). All foundings are forced. HKS Faculty Research Working Paper Series 12(42).
Retrieved
February
3,
2014
from
http://dash.harvard.edu/bitstream/handle/1/9804489/RWP12042_Applbaum.pdf?sequence=1
Auernheimer, G. (2008). Lehrer-Schüler-Interaktion im Einwanderungsland. In M. K. Schweer
(Ed.), Lehrer-Schüler-Interaktion: Inhaltsfelder, Forschungsperspektiven und methodische Zugänge
(Vol. 2, pp. 455-478). Wiesbaden: VS Verlag für Sozialwissenschaften.
Baechler, J. (1979). Suicides. New York: Basic Books.
Barraclough, B., & Hughes, J. (1987). Suicide: clinical and epidemiological studies. London: Croom
Helm.
Baudelot, C., & Establet, R. (2008). Suicide. The hidden side of modernity. Cambridge: Polity.
Baumann, U. (2001). Vom Recht auf den eigenen Tod. Die Geschichte des Suizids vom 18. bis zum 20.
Jahrhundert. Weimar: Böhlau.
Bayatrizi, Z. (2008). Life sentences. The modern ordering of mortality. Toronto: University of Toronto
Press.
Bayatrizi, Z. (2010). John Weaver, A Sadly Troubled History: The Meanings of Suicide in the
Modern Age. Canadian Journal of Sociology, 35, 169-172.
Bourdieu, P. (1998). Practical reason: On the theory of action. Cambridge: Polity Press.
Bourdieu, P. (2000). Pascalian meditations. Stanford, CA: Stanford University Press.
Brock, D. W. (1992). Voluntary active euthanasia. Hastings Center Report, 22(2), 10-22.
Bronisch, T. (2007). Der Suizid (5th ed.). München: Beck.
Broom, A., & Cavenagh, J. (2011). On the meanings and experiences of living and dying in an
Australian hospice. Health, 15(1), 96-111.
Buiting, H. M., Deeg, D. J., Knol, D. L., Ziegelmann, J. P., Pasman, H. R., Widdershoven, G. A.,
et al. (2012). Older peoples' attitudes towards euthanasia and an end-of-life pill in The
Netherlands: 2001–2009. Journal of Medical Ethics, 38(5), 267-273.
Cavanagh, J. T., Carson, A. J, Sharpe, M., & Lawrie, S. M. (2003). Psychological autopsy studies
of suicide: a systematic review. Psychological Medicine, 33(3), 395-405.
Chu, J. P., Goldblum, P., Floyd, R., & Bongar, B. (2010). The cultural theory and model of
suicide. Applied and Preventive Psychology, 14, 25-40.
Clavandier, G. (2009). Sociologie de la mort. Paris: Armand Colin.
Conwell, Y., Van Orden, K., & Caine, E. D. (2011). Suicide in older adults. Psychiatr Clin North
Am, 34(2), 451-468.
Cording, C., & Saß, H. (2009). Begutachtung der „freien Willensbestimmung“ bei Suizid in der
Lebensversicherung. Der Nervenarzt, 80(9), 1070-1077.
Dawson, M. (2012). Reviewing the critique of individualization: The disembedded and embedded
theses. Acta Sociologica, 55(4), 305-319.
Donne, J. (1982). Biathanatos. New York.
12
Douglas, J. . (1976). The social meanings of suicide. Princeton: Princeton University Press.
Ehrenberg, A. (1998). La Fatigue d’être soi – dépression et société. Paris: Odile Jacob.
Fairbairn, G. (1998). Suicide, language, and clinical practice. Philosophy, Psychiatry, & Psychology 5(2),
157-169.
Feldmann, K. (1998). Suizid und die Soziologie von Sterben und Tod. Österreichische Zeitschrift für
Soziologie, 23(4), 7-21.
Feldmann, K. (2010). Tod und Gesellschaft. Sozialwissenschaftliche Thanatologie im Überblick. Wiesbaden:
VS-Verlag.
Fenner, D. (2008). Suizid - Krankheitssymptom oder Signatur der Freiheit? Eine medizinethische
Untersuchung. Freiburg: Karl Alber.
Fincham, B., Langer, S., Scourfield, J., & Shiner, M. (2011). Understanding suicide: A sociological
autopsy. Basingstoke: Palgrave Macmillan.
Hadders, H. (2011). Negotiating leave-taking events in the palliative medicine unit. Qualitative
Health Research, 21(2), 223-232.
Hanafin, P. (2009). Rights of passage: law and the biopolitics of dying.
eprints.bbk.ac.uk/820/1/Phanafin820.pdf
Retrieved from
Hjelmeland, H. (2010). Cultural research in suicidology: Challenges and
opportunities. Suicidology Online 1, 34-52.
Hjelmeland, H. (2013). Suicide research and prevention: the importance of culture in "biological
times". In E. Colucci & D. Lester (Eds.) with H. Hjelmeland & B.C.B. Park, Suicide and
culture. Understanding the context (pp. 3-23). Cambridge, MA: Hogrefe.
Hjelmeland, H., Dieserud, G., Dyregrov, K., Knizek, B. L., & Leenaars, A. A. (2012).
Psychological autopsy studies as diagnostic tools: Are they methodologically flawed?
Death Studies, 36(7), 605-626.
Howarth, G. (2007). Death and dying. A sociological introduction. Cambridge: Polity Press.
Jamison, K. R. (1999). Night falls fast: understanding suicide. New York: Vintage Books.
Jordan, J. R. (2001). Is suicide bereavement different? A reassessment of the literature. Suicide and
Life-Threatening Behavior, 31(1), 91-102.
Jox, R. J. (2011). Sterben lassen. Über Entscheidungen am Ende des Lebens. Hamburg: edition KörberStiftung.
Kahneman, D. (2011). Thinking, fast and slow. New York: Farrar, Straus & Giroux.
Kitanaka, J. (2009). Questioning the suicide of resolve: medico-legal disputes regarding
‚overwork-suicides’ in twentieth-century Japan. In J. Weaver & D. Wright (Eds.), Histories
of suicide. International perspectives on self-destruction in the modern world (pp. 257-280). Toronto:
University of Toronto Press.
Kogan, N., Tucker, J., & Porter, M. (2011). Extending the human life span: An exploratory study
of pro- and anti-longevity attitudes. The International Journal of Aging and Human Development,
73(1), 1-25.
Lester, D. (2003). Fixin' to die. A compassionate guide to committing suicide or staying alive. Amityville,
New NY: Baywood.
Lester, D. (2006). Can suicide be a good death? Death Studies, 30, 511-528.
Luper, S. (2009). The philosophy of death. Cambridge: Cambridge University Press.
13
Marsh, I. (2010). Suicide. Foucault, history and truth. Cambridge: Cambridge University Press.
Minagawa, Y. (2013). The social consequences of postcommunist structural change: An analysis
of suicide trends in Eastern Europe. Social Forces, 91(3), 1035-1056.
Mitchell, E. A. (2009). Phenomenological psychological autopsies: a survivor driven model for understanding
suicide. Master’s thesis. The University of Texas at Arlington.
Owens, C., & Lambert, H. (2012). Mad, bad or heroic? Gender, identity and accountability in lay
portrayals of suicide in late twentieth-century England. Culture, Medicine, and Psychiatry, 36,
348-371.
Ozawa-De Silva, Ch. (2010). Shared death: Self, sociality and internet group suicide in Japan.
Transcultural Psychiatry, 47(3), 392-418.
Petersen, A. (2011). Authentic self-realization and depression. International Sociology, 26(1), 5-24.
Phillips, M. R. (2010). Rethinking the role of mental illness in suicide. The American Journal of
Psychiatry, 167(7), 731-733.
Pilgrim, D., & Bentall, R. (1999). The medicalisation of misery: A critical realist analysis of the
concept of depression. Journal of Mental Health, 8(3), 261-274.
Pompili, M. (2010). Suicidology: a new discipline for preventing suicide. In M. Pompili (Ed.).
Suicide in the word of suicidologists. (pp. 1-8). New York: Nova Science.
Pompili, M. (2011). Evidence-based practice in suicidology: what we need and what we need to
know. In M. Pompili & R. Tatarelli (Eds.), Evidence-based practice in suicidology: a source book
(pp. 3-26). Cambridge, MA: Hogrefe.
Rogers, J.R., & Lester, D. (2010). Understanding suicide. Why we don’t and how we might. Cambridge,
MA: Hogrefe.
Rose, N. (2007). The politics of life itself. Biomedicine, power, and subjectivity in the twenty-first century.
Princeton: Princeton University Press.
Rosenquist, J. N, Fowler, J. H., & Christakis, N. A. (2011). Social network determinants of
depression. Molecular Psychiatry, 16, 273–281.
Rubin, E. (2010). Assisted suicide, morality, and law: Why prohibiting assisted suicide violates the
establishment clause. Vanderbilt Law Review, 63, 763-811.
Schlimme, J. E. (2013). Sense of self-determination and the suicidal experience. A
phenomenological approach. Med Health Care and Philos, 16, 211-223.
Scourfield, J., Fincham, B., Langer, S., & Shiner, M. (2012). Sociological autopsy: An integrated
approach to the study of suicide in men. Social Science & Medicine, 74, 466-473.
Sher, L. (2012). What should we tell medical students and residents about euthanasia and assisted
suicide? Aust N Z J Psychiatry, 46(2), 87-91.
Silverman, M. M. (2011). Challenges to classifying suicidal ideations, communications, and
behaviours. In R. O’Connor, S. Platt & J. Gordon (Eds.), International handbook of suicide
prevention (pp. 9-25). New York: Wiley.
Sudak, H., Maxim, K., & Carpenter, M. (2008). Suicide and stigma: A review of the literature and
personal reflections. Academic Psychiatry, 32, 136-143.
Swarte, N. B., Van der Lee, M. L., Van der Bom, J. G., Van den Bout, J., & Heintz, P. M. (2003).
Effects of euthanasia on the bereaved family and friends: a cross sectional study. Brit Med
Journal, 327, 189-193.
Szasz, T. (1999). Fatal freedom. The ethics and politics of suicide. Westport: Praeger.
14
Tännsjö, T. (2006). Zur Ethik des Tötens. Münster: LIT.
Tomasini, F. (2012). A stoic defence of rational suicide. Medicine Health Care and Philosophy.
Valentine, C. (2008). Bereavement narratives. Continuing bonds in the twenty-first century. London:
Routledge.
Vamos, M. J. (2012). Physician-assisted suicide: Saying what we mean and meaning what we say.
Australian and New Zealand Journal of Psychiatry 46, 284-286.
Van Hooff, A. J. L. (1990). From autothanasia to suicide. Self-killing in classical antiquity. London:
Routledge.
Vollmann, J. (2008). Patientenselbstbestimmung und Selbstbestimmungsfahigkeit: Beitrage zur klinischen
Ethik. Stuttgart: Kohlhammer.
Wächtler, C., Erlemeier, N., & Teising, M. (2008). Alte Menschen und Suizidalität –
Entstehungsbedingungen, therapeutische Strategien, Prävention. In M. Wolfersdorf, T.
Bronisch & H. Wedler (Eds.), Suizidalität. Verstehen – Vorbeugen – Behandeln (pp. 129-143).
Regensburg: Roderer.
Weaver, J. C. (2009). A sadly troubled history. The meanings of suicide in the modern age. Montreal:
McGill-Queen's University Press.
Wedler, H. (2008). Ethische Aspekte der Suizidprävention In M. Wolfersdorf, T. Bronisch & H.
Wedler (Eds.), Suizidalität. Verstehen – Vorbeugen – Behandeln (pp. 311-337). Regensburg:
Roderer.
Westerlund, M. (2012). The production of pro-suicide content on the internet: A counterdiscourse activity. New Media & Society, 14(5), 764-780.
Whitaker, A. (2010). The body as existential midpoint—The aging and dying body of nursing
home residents. Journal of Aging Studies, 42(2), 96-104.
Wittwer, H. (2003). Selbsttötung als philosophisches Problem: Über die Rationalität und Moralität des
Suizids. Paderborn: Mentis.
Wolfersdorf, M. (2007). Suizid aus klinischer psychiatrisch-psychotherapeutischer Sicht. In J. E.
Schlimme (Ed.), Unentschiedenheit und Selbsttötung (pp. 17-28). Göttingen: Vandenhoeck &
Ruprecht.
Yur’yev, A., Värnik, P., Sisask, M., Leppik, L., Lumiste, K., & Värnik, A. (2013). Some aspects of
social exclusion: Do they influence suicide mortality? International Journal of Social Psychiatry,
59(3), 232-238.
Klaus Feldmann, retired Professor of Sociology, University of Hanover, Germany.
Kontakt: k.feldmann@ish.uni-hannover.de
15