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Destya Nora 030.06.061 Trisakti University

Jakarta, Juni 2010

Preface First of all, I would like to thank to God for blessing me so I can finish this paper properly. This paper is made as an assignment of English 3 at this semester. This paper is discussing about suicidal behavior in low income and uneducated society with all the risk factors. In this opportunity, I would like to say thanks to DR dr. Rudy Hartanto, M.Fil for being so patient and spent his time mentoring us along the process of making this paper. And also bunch of love and thanks to my family and friends for giving their advice and supports me in finishing this paper. This paper is made as an assignment of English 3 at this semester. I try to search the data from internet, journal and text book, but I realize that I still need your critics and constructive suggestions to make this paper better. At last, I hope this paper could enrich our knowledge and useful for us.

Jakarta, June 2010

Destya Nora


Preface .... 1 Content .... 2 Abstract..... 3 Introduction ..3 Definition ........4 Types of suicidal behavior ......................................................................................4 The psychopathology of suicide..............................................................................7 Risk factor of suicide...8 Discussion ......9 Suicidal behavior from socioeconomic views10 Suicidal behavior from mental views..11 Complication ..........................................................................................................12 Prevention .....13 Conclusion ....14

World Health Organization has declared that September 10th would be a worlds suicidal prevention, it starts on 2005. From the data of suicide prevention program WHO 2009, almost 1 million people ended their lives per year, or 16 lives per 100.000 people or 1 person per 40 seconds. In the last 45 years, suicidal attempts increases 60 % than before. Last month, on December 2009, at least there was 5 suicidal attempts and ended with fatal complication, death. They end their lives with the same way, jump from height in a public place. I choose this topic to be written here because my own curiosity about suicide in some people committed suicide and have suicidal thought. This suicidal phenomenon is increasing in the developing country and happened mostly to the person with low income and uneducated background. As far as I know, suicide is also rarely researched or deeply discussed, Sosimply question emerged on my mind. Why they took that short thought decision?

Introduction (1,2)
Suicide is not the major cause of death in Indonesia, even less than suicidal cases in United States. Suicide is the 11th leading cause of death for all Americans (National Center for Injury Prevention and Control, 2002), also was the 3rd most common cause of death among adolescents and young adults between the ages of 15 and 34 years (National Vital Statistics Reports, 2005) and 80% of suicide deaths are among men. Honestly, I find difficulty to get many data about suicide in Indonesia, maybe because studies related to suicide in Indonesia are seldom. However, from one of national papers, there is a raising number of suicide cases since 2002 (19 people) until 2006 (becomes 114 people) with the age range 20-50 years. I think, it wont stop there because there will more

and more cases in the next years considering amount of Indonesia unemployment in 2006 is 8.3 percents recently. For the last five years, based from FKUI/RSCM data, there are 771 men and 348 women had attempted suicide. 41 percents choose hanging over method, 23 percents choose insecticides and the rest of them use narcotics, then overdosed. In 2005, WHO get the data that, Indonesian attempts suicidal 50.000 per year. In Jakarta, there are 1,2 percent per 100.000, dan and the highest number of suicide is at Gunung Kidul, Yogyakarta, it reach 9 cases per 100.000 citizens.

Definition (3,4)
Suicide (Latin : suicidium, from sui caedere, to kill oneself) is the intentional killing of one's self. The most common cause is an underlying psychiatric disorders which include depression, bipolar disorder, schizophrenia, alcoholism and drug abuse. Financial difficulties or other undesirable situations play a significant role. Suicide is the act of taking your own life. Suicide and suicidal thoughts and behavior are tragic reactions to distressing life situations. Suicide often occurs as an impulsive act in the midst of a crisis, sometimes fueled by intoxication. But simply talking to someone about what you're going through may give you new perspective that shows you that suicide isn't a solution.

Types of suicidal behavior (5)

Suicide is actually a complex set of behaviors that exists on a continuum, from ideas to actions, including:

Suicidal ideation. Having thoughts of harming or killing yourself. Suicidal behavior. Engaging in acts intended to cause your death, or acts that while unlikely to cause your death indicate that you're self-destructive or suicidal. These may include overdosing, reckless driving or excessive drinking.

Suicide attempt. This is a nonfatal, self-inflicted destructive act that was intended to cause your own death.

Parasuicide. This is an act that may resemble suicidal behavior but that isn't intended to cause your death. Such acts may include deliberately injuring yourself, such as cutting. Some people find these acts emotionally soothing. These acts may result in accidental death.

Completed suicide. This is taking your own life. Durkheim stated that there are four types of suicide. These four types of suicide are

based on the degrees of imbalance of two social forces: social integration and moral regulation. Durkheim noted the effects of various crises on social aggregates war, for example, leading to an increase in altruism, economic boom or disaster contributing to anomie.

Egoistic suicides are the result of a weakening of the bonds that normally integrate individuals into the collectivity: in other words a breakdown or decrease of social integration. Durkheim refers to this type of suicide as the result of "excessive individuation". Those individuals who were not sufficiently bound to social groups (and therefore well-defined values, traditions, norms, and goals) were left with little social support or guidance, and therefore tended to commit suicide on an increased basis.

Altruistic suicides occur in societies with high integration, where individual needs are seen as less important than the society's needs as a whole. This is known as the opposite of egoistic suicide. As individual interest would not be considered important, Durkheim stated that in an altruistic society there would be little reason for people to commit suicide. He stated one exception, namely when the individual is expected to kill themselves on behalf of society a primary example being the soldier in military service.

Anomic suicides are the product of moral deregulation and a lack of definition of legitimate aspirations through a restraining social ethic. This is symptomatic of a failure of economic development and division of labour to produce Durkheim's organic solidarity. People do not know where they fit in within their societies. Durkheim explains that this is a state of moral disorder where man's desires are limitless and, thus, his disappointments are infinite.

Fatalistic suicides occur in overly oppressive societies, causing people to prefer to die than to carry on living within their society. This is an extremely rare reason for people to take their own lives, but a good example would be within a prison; people prefer to die than live in a prison with constant abuse and excessive regulation that prohibits them from pursuing their desires.

It's important to understand the types of suicidal thoughts, behaviors and intent in order to get the appropriate type of treatment.

The psychopathology of suicide .(5)

We have detected from some research about suicide above that mental disorder such as mood disorder and personality disorder as the risk factors or suicide. Feel rejected by others (paranoia), this rejection impulse the feeling rejection affection (true feeling), then he feel wronged and hurt, because he thinks of himself as being good and perfect (theomania), he will not adjust himself to reality, he expects reality to adjust itself to him. He also cannot stand frustration, he wants everything to be the way he thinks it should be (fantasy). This is the reason why all suicidal individuals become deeply depressed, because they reject this consciousness. The turning away from reality, from affection, is the true root of suicide.

Pathways to suicide

Risk Factors (6)


There are no authoritative answers to explain why adolescents attempt and complete suicide. There is however, a consensus that youth who take their own lives feel hopeless about their situation and believe it will never change. Suicide emerges as a reaction to seemingly unbearable pain. A complex set of factors interacts with the biological, emotional, intellectual, and social stages of adolescent development. The factors identified below

contribute to suicidal acts, such as Socio-Environmental, families, perinatal hazard, sexual orientation, neurochemical abnormalities, imitative suicide evidences, suicide clusters appear to depend on imitation . High-risk factors for suicide have remained fairly constant over the years previous

suicide attempts, age 16 or over, associated mood disorders, and associated substance abuse. Whereas, survey of United Nation Office On Drugs and Crime (UNODC), 2007 noted that there are 3.2 million people in Indonesia (1.5% of population) abuses substance . Research of Badan Narkotika Nasional cooperated with University of Indonesia. also results that 5.8% substance abuser are 15-25 years old, which is something that should be concerned about. (6) Diagnosis in Completed Suicides

Psychiatric diagnoses are present in about 90% of suicides. Alcohol and cocaine abuse are present in approximately 2/3 of 18 to 19 year-old males, but is not common in the younger male (< age 14) or female suicides.

Depression with or without aggressive behavior and/or substance abuse or anxiety is found in over half of all suicides.

Aggressive/impulsive behavior is common in both sexes.


Only a small number of suicides occur in schizophrenic or manic-depressive teenagers.

Approximately 1/3 of teenage suicide victims have made a previous suicide attempt. About half of the teenagers who commit suicide have had previous contact with a mental health professional.

Suicide is due to a complex interaction of social, environmental, biological and cultural factors operating in an individuals life. Cultural beliefs, social standards, gender bias, educational problems, income levels, living status, growing aspirations, pressures of modern life, the need to excel and compete in the modern world, employment issues, marriage-related factors, interpersonal conflict due to disturbed family relations, breakdown of family values and systems, terminal or serious illness, social isolation and death of a loved one, are all capable of initiating suicidal thoughts. These factors could be as varied as gender discrimination at the birth of a girl child in India, to the problem of being inflicted with HIV/AIDS in Thailand, economic upheavals in Indonesia, and poverty in Bangladesh. The village of Gunung Kidul in Indonesia has very high suicide rate. The spiritual leaders in the area predict the arrival of pulung gangtung (fire ball), which can only be seen by them. The occurrence of suicide after this is considered to be a call from a supernatural power. In reality, the increased rate of suicide in this village is mostly related to the presence of severe illness among the elderly. (9)


Suicide from the socioeconomic views (7)

The economic and political unrest in Indonesia in 1997 and 1998 left many without jobs and income. Failure to rehabilitate people in such situations by the concerned authorities may have led to many acts of suicide. Certain suicidal deaths related to dowry issues or inability to accept decreased academic performance or failures among students. The "empty nest syndrome" of the elderly are also major causes of concern in the Region. The various factors, whether initiating, motivating, triggering or precipitating in nature, operate in combination with one another in driving a person to a stage of suicide or parasuicide. Frequently, these factors (e.g. financial losses, family conflicts and failures in life) are cumulative, repetitive, progressive and may act as building blocks in a continuum of the process. The increasing economic turmoil, political unrest, social upheaval, communal disharmony and widening gap between the haves and have not have added another dimension to the problem of suicides. In these situations, serious losses or threats of loss of property, loved ones, job, pride, honor, status, independence and support systems operate in a major way to push an individual to a state of despair and dejection. These question the fundamental survival of human beings in their respective societies based on existence, ideologies and strategies. The emerging "empty nest syndrome" in all countries (children moving away from parents), "latch-key children syndrome" (parents leaving children alone due to their working status) has also been identified as a major factor for suicide. With the aged, terminally ill, or isolated individuals having no one to take care of them and offer emotional support, the situation has become more difficult. At the other extreme, the economic need for both parents


to work coupled with educational pressures has contributed to the increasing social and health problems among children and adolescents.


A recent study revealed that the majority of suicides were related to mental health problems, disruption within the family, alcohol and drug abuse in the lower socioeconomic groups, disrespectful attitude towards religion and poor social integration. An intersectoral approach

Suicide from the mental views (8)


From some researches concerning suicide, it can be concluded that the main risk factors for suicide death are mood disorders or depression were most frequent, followed by substancerelated disorders. American Journal of Orthopsychiatry found that among young men, suicide is linked to the following mental disorders: major depression, borderline personality disorder, and substance abuse. For detail, Ive attached about Mental Disorders in Cases of Suicide in Young in this table (8)

Although mental illness is generally linked to premature deaths, certain mental illnesses carry with them a remarkably high lifetime instances of suicide. In fact, 95% of people who commit suicide have a mental illness. Hospitalization for a psychiatric disorder is quite prevalent in the suicidal population. This includes people with any depressive disorder, manic-depressive illness (bipolar illness), schizophrenia, PTSD, phobias, substance abuse, delirium, and dementia, as well as certain genetic factors. In a general sense, mental illness all too often is an isolating experience, and that isolation correlates with suicide.

Complications (9)
Suicide and suicidal thoughts have many potential complications. The most obvious and tragic, of course, is death. Many suicide attempts are impulsive acts during a moment of


crisis, they can leave you with permanent serious or debilitating injuries, such as organ failure or brain damage. For those left behind after a suicide people known as survivors of suicide grief, anger, depression and guilt are common.

Prevention (10)
Approaches to prevention of suicides

If you see many warning signs in the person, you have to help them. It won't be easy, but remember CLUES:

Connect - Make contact with the person. Actively show that you hear what is being said and understand that his or her pain is real.

Listen - Listen very carefully. You don't have to have all the answers - just be there and let him or her know that you care.


Understand - Don't tell him or her how s/he should feel or what s/he should do. Just express your desire to support and help understand what s/he is feeling. Reflect what is said back to the person

Express concerns - Let the person know that you are worried and want to help.

Seek help - The person's safety is the number one priority, and you might not be able to handle it on your own. Talk with the person about seeking help, either through a doctor (preferred, if you discover they have a plan, the means and the intention of carrying it out) or clergy. Suicidal thoughts cannot be kept a secret.
Each person contemplating suicide needs a supporting hand, a comforting shoulder and a patient hearing.

People commit suicide for many reasons, including depression, shame or guilt, desperation, pain, financial problems, relationship problems and often other undesirable problems. The predominant view of modern medicine is that suicide is a mental health concern, associated with psychological factors such as the difficulty of coping with depression, inescapable suffering or fear, or other mental disorders and pressures. Life happens. Sometimes though


life seems to overwhelm us because of our emotions. Suicide however is not the answer! There are alternatives.

1. Investment in Research Save Lives and Money #21: Facts about Suicide. Available at : http://www.researchamerica.org/resource_library/. Accessed January 5, 2010 2. Kasus bunuh diri di Indonesia . Available at : http://nasional.vivanews.com/news/read/110420-kasus_bunuh_diri_di_indonesia. Accessed : 5 January, 2010.
3. Definition of suicide. Available at : http://en.wikipedia.org/wiki/Suicide. Accessed :

January 2, 2010
4. Types of suicidal behavior. Available at : http://www.mayoclinic.com/health/suicide/.

Accessed : January2, 2010 5. The psychopathology of suicide . Available at : vinnacaturinata.wordpress.com/2009/06/08/suicide/. Accessed : January 5, 2010 6. The risk factors of suicide. Available at : http://emedicine.medscape.com/article/288598-overview.Accessed : January 7, 2010


7. Suicide prevention : emerging from the darkness. Available at :http://www.searo.who.int/en/Section1174/Section1199/Section1567/Section1824_80 81.html. Accessed : January 17, 2010 8. Suicide from the mental views .Available at : vinnacaturinata.wordpress.com/2009/06/08/suicide. Accessed : January 5, 2010
9. Suicide and suicidal thoughts. Available at :

www.cnn.com/HEALTH/library/suicide/DS010. Accessed :January 10, 2010

10.Suicidal prevention. Available at : http://www.wikihow.com/Prevent-a-Suicide.

Accessed : January 11, 2010