Theories Explaining Suicidal Behaviors
Carolina Hausmann-Stabile, Ph.D., Bryn Mawr College
While you read these lines, children and adolescents in the United States and around the world are thinking about, attempting, and dying by suicide. For decades, people who study suicide–called suicidologists– have tried to understand why some people want to die but never try, why some people actually act on their suicidal thoughts, and why most people don’t think about or try to kill themselves.
Emile Durkheim inaugurated the modern study of suicidology with his 1897 book “Suicide.” He started by writing that “there are two sorts of extra-social causes in which one may, a priori, attribute the influence on the suicide-rate; they are organic-psychic dispositions and the nature of the physical environment.” Even though many suicidologists may not be familiar with Durkheim’s work, current scholarship remains very much structured around his seminal insights. Specifically, suicidologists investigate the causes of suicidal behavior by exploring the interaction between social (e.g., cultural norms) and extra-social (individual psychology and the characteristics of the physical environment) dimensions. We call these explanations “theories.” Theories inform research by suggesting what approaches, variables, and explanations should be tested in a study. At the same time, research findings help us evaluate theories.
Depending on their focus, explanations in suicidology can be organized along three lines: theories of suicide risk, theories of the suicidal mind (e.g., the Interpersonal Theory of Suicide or the Integrated Motivational-Volitional Model), and theories of suicidal contexts (such as the Eco-developmental Model of Suicide Attempts and the Cultural Theory and Model of Suicide).
Theories of risk dominate suicide research. Initially, risk researchers focused on qualitatively linking mental illness and suicidal behaviors. For example, John F. Oliven’s 1951 article “The Suicidal Risk: Its Diagnosis and Evaluation” in The New England Journal of Medicine, stated that “suicide is a reaction common to the mentally disordered of many types.” Starting in the 1970s, however, and parallel to the increased availability of quantitative epidemiological and behavioral data, the focus of theories of suicide risk expanded, and their methods changed. What had started as qualitatively linking risk for suicidal behavior to psychopathology, morphed into quantifying the harmful or protective effects of individual characteristics, experiences, and contextual factors.
Although we have gained significant insights from theories of suicide risk, much still needs to be addressed. The most significant problem with risk models is that they rely almost entirely on statistical methods describing prevalence and association, which tell us what may be related to suicidal behavior, but not what causes it. Therefore, they do not advance causal explanations.
Another big concern with risk models for suicidologists interested in minority youth is that most studies do not address measurement error and sampling issues. This is very problematic in suicide research, because disclosure, assessment, and identification in this field are complicated by developmental, cultural, and technical issues, just to list some. Studies that do not include enough minorities in their samples, and that are not sensitive to what issues matter to those minorities, limit what we can understand about how to predict and prevent suicidal behaviors. Additionally, the majority of risk models do not address how the complexities of minority youth experiences may result in accumulated risk.
Compounded with these issues, in the past 23 years, risk researchers supported by Federal funds have not been able to examine the role of firearms in suicidality. This is because in 1996, the U.S. Congress passed the Dickey amendment, which forbade the CDC from using taxpayer dollars to “advocate or promote gun control.” It is impossible to fully assess how this policy has undermined suicide research, especially given that the most common method of suicide in the United States is firearms. Furthermore, by not exploring gun-related variables in risk and protective models, researchers have—perhaps––either played up or played down the role of other factors, potentially biasing research findings.
Overall, theories of suicide risk have alerted us to which groups of people are vulnerable to suicidal behavior, but they have not helped us accurately predict which specific individuals will think about, attempt, or die by suicide.
Theories of the suicidal mind offer an alternative model to explain suicidal behaviors. Like the shift described in suicide risk research, theories about the suicidal mind evolved from exclusively linking suicide to psychopathology, to more recently trying to understand the role played by universal emotions and experiences in people’s suicidal behavior. Today, the dominant theory of the suicidal mind is Joiner’s Interpersonal Theory of Suicide (IPTS). In this model, suicidal behavior emerges at the intersection of a person’s wish to die by suicide and the ability to carry out that wish. The desire to die emerges from two psychological states: “perceived burdensomeness” (to others) and “thwarted belongingness” (from others). In order to act on the desire for suicide, IPTS suggests that individuals must also acquire the capability for suicide. This capacity is learned through repeated exposure to experiences (e.g., violence) that desensitize people to pain and that reduce their fear of death.
IPTS bridges the literature on trauma and violence (“painful and provocative life experiences”), referred to in this model as “acquired capability,” and suicidal behavior. There are several issues, however, with IPTS, most notably its logical gaps. For example, IPTS fails to explain how individuals can simultaneously experience themselves as a burden to others while feeling disconnected from others. Furthermore, given that exposure to trauma and violence are so prevalent, we need more specificity about when and in what doses exposure to trauma and violence leads to suicidality.
As with risk models, theories of the suicidal mind such as IPTS fail to effectively predict how, when, and why suicidal people move from wanting to die to attempting and/or dying by suicide. Overall, these theories describe a set of preconditions––in the case of IPTS, desire to die and exposure to trauma and violence––that could be found among many individuals, most of whom will never die by suicide.
The theories of suicidal context conceptualize the emergence of suicidal behaviors within ecological models. Ecological models propose a framework for understanding dynamic interrelations among various individual and environmental factors and suicidal behaviors. In general, contextual models grapple with issues of change and diversity within specific contexts (for example, societal change, cultural diversity) while staying away from explanations rooted in psychopathology.
One of the most well-known theories of suicidal contexts is Zayas’ Eco-developmental Model of Latina Suicide Attempts. (Disclaimer: I have been involved in research advancing this approach.) This model suggests that the suicidal behaviors of Latina adolescents emerge at the intersection of socio-cultural (e.g., female rearing norms), familial (e.g., conflict), and developmental (e.g., adolescent autonomy) dynamics.
Ecological models bring much-needed attention to contextual factors shaping suicidal behaviors. However, these models lack conceptual specificity to predict which individuals will think about, attempt, or die by suicide. Because of that, contextual theories cannot answer why certain individuals growing up in similar contexts (for example, undergoing rapid cultural change) think about, attempt, or die by suicide, while others do not.
Taken together, the scholarship on suicidal behaviors has grown since Durkheim’s seminal publication in 1897. We know that suicidal behaviors emerge from complex interactions between people’s characteristics, their life experiences, and the broader sociocultural context within which they live. After 122 years of research, however, we lack theories that can accurately predict who will die by suicide and who will live free of suicidal behaviors.
