Suicide Among Aboriginal People in Canada - Institut universitaire ...

Chapter 1due to preoccupation or distraction. In cases involving repeated acts of self-harm like substance abuse,some observers are tempted to interpret the behaviour as a form of “slow suicide.” This assumes a selfdestructiveintention that often cannot be confirmed. Individuals may become caught in many differentsorts of self-destructive patterns of behaviour without intending to end their lives. Moreover, mostsuicidal behaviour involves a degree of ambivalence in which the afflicted person may both want to dieand still hope for rescue and relief (Williams, 2001).In some instances, individuals may make a suicide attempt in a way that clearly serves to communicatetheir distress. For example, someone may threaten to take an overdose in front of a person and wait forhim or her to react. Such actions are sometimes referred to as suicide “gestures,” emphasizing the fact thatthey serve as dramatic communications aimed at provoking a response from others (Linehan, 2000).Finally, some individuals engage in repeated acts of self-injury with no lethal intent. For example, theymay cut themselves repeatedly. These are not suicide attempts but may constitute a method of controllingintense feelings of emotional tension and anxiety. Though they may be very distressed, the individualhas no intent to die, may hide the cutting or self-injury from others, and usually feels some relief afterinjuring themselves. This pattern of behaviour may be chronic, being repeated many times over a periodof years. The term deliberate self-harm is sometimes used as a synonym for parasuicide or suicide attemptsand sometimes more inclusively to include this behaviour of repetitive self-injury.Despite these ambiguities, the research literature on suicide continues to make distinctions amongsuicide, attempted suicide and parasuicide (Hawton, 1986; Maris, 1992). Each term covers a differentset of behaviours and, when used to select a group of people for a research study, each definition identifiesa somewhat different, though partially overlapping, group. While studies indicate some differences inthe factors contributing to each of these forms of self-harm, they are certainly closely related (Williams,2001). The stories of some people who died by suicide show a clear progression from suicidal ideation(having thoughts about suicide) to attempted suicide to the lethal act ( Jeanneret, 1992). Accordingly,suicidal behaviour may be viewed on a continuum of severity and links can be sought between levels oflife-threatening behaviour.This report will focus on both suicide attempts and death by suicide. Where it exists, important contrastsin the groups of people identified by each definition will be highlighted. Statistics are generally morereadily available and less ambiguous for death by suicide, while studies of psychological correlates aremuch easier to conduct with people who have attempted suicide and who can respond to detailedinterviews and questionnaires. Some forms of risk-taking behaviour and attempted suicide, along withsuicidal ideation, will be considered as precursors or risk factors for suicide.There has been recent concern that the language used to describe suicide may have negative connotations.The terms “successful suicide” and “completed suicide” may inadvertently convey a sense of achievementor accomplishment. Current recommendations from the Canadian Association for Suicide Prevention(2004) suggest using the phrase “death by suicide.” This report adopts this terminology except whendirectly quoting other authors.