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Death & Dying Ch 12

"The Last Dance - Encountering Death and Dying" Chapter 12

QuestionAnswer
Define altruistic suicide. The giving of one's life for others or for a greater good.
Historically and across cultures suicide has been recognized as a way to express what? Ultimate commitment to a moral or philosophical principle.
Questions about what are central in understanding suicide and other self-destructive behaviors? Intention and choice
Each definition of suicide emphasizes certain aspects of what? Suicidal intention and behavior
What is the Webster's New Collegiate Dictionary definition of suicide? The act or an instance of taking one's own life voluntarily and intentionally, especially by a person of years of discretion and of sound mind.
What is Ronald W. Maris' definition of suicide? Self-killing deriving from one's inability or refusal to accept the terms of the human condition.
What is Jean Baechler's definition of suicide? All behavior that seeks and finds the solution to an existential problem by making an attempt on the life of the subject.
What is Edwin Shneidman's definition of suicide? The human act of self-inflicted, self-intentioned cessation.
What 3 types of self-destruction does suicide include? Completed suicide Attempted suicide Suicidal gestures
What are thoughts and plans about suicide referred to as? Suicidal ideation
About how many people die by suicide every year in the U.S.? 33,000
As a whole, where does suicide rank in the U.S. among all causes of death? 11th
Among persons 15 to 24 years old, where does suicide rank in the U.S. among all causes of death? 3rd
In what group is the rate of suicide highest? Men 75 years old and older
What is the ratio of suicide of males and females? 4/1 (males/females)
For every male who attempts suicide, how many women attempt suicide? 3
According to a recent study, how many Americans seriously consider suicide each year? 8 million
It is estimated that each suicide affects at least how many other people? 6
How often does a suicide occur in the U.S. on average? One for every eighteen minutes
By how much is it estimated that official counts underestimate the number of suicides each year? 1/2
Why might a coroner or medical examiner not classify a suicide as such? Absence of: deceased's history of suicidal tendencies or acts of self-injury, or suicide note, or circumstances of death clearly pointing to suicide.
What is the 51% rule of suicide? A suicide classification is neither a matter of elimination nor a default option. Rather it is a manner of death that must be positively demonstrated.
Some authorities believe that if autocides were added to known statistics, suicide would be ranked as what number in deaths of young people? 1
What is autocide? Automobile accidents that are really a suicide in disguise.
When there are questions about whether a death was an accident or suicide, how is the case likely to be classified? Accident
Victim-precipitated homicide may be what? A masked suicidal intent
What is "suicide by cop?" Individuals engage in life-threatening and criminal actions that force police to shoot and kill them.
What is the murder-suicide syndrome? When individuals murder others and seek the death penalty.
According to Shneidman, what are some of the reasons the extent to which suicide pervades modern society is diminished and distorted? Religious and bureaucratic prejudices, family sensitivity, differences int eh proceedings of coroner's hearings and postmortem exams & the shadowy distinctions between suicides & accidents.
Who was the psychological autopsy developed by? Norman Farberow, Edwin Shneidman & Robert Litman
What is a psychological autopsy? An impartial investigation by behavioral scientists to look for the motivational or intentional aspects of cases of ambiguous death.
What are the modes of death? Natural, accident, suicide or homicide
What are 4 purposes of the psychological autopsy? Clarify the mode of death. Determine why a death occurred at a particular time. Gain data that may prove useful in predicting suicide & assessing the lethality of the suicidal person. Obtain info that can be therapeutic to survivors.
Where does the judiciary stand on admission of psychological autopsies as evidence? They are undecided. Some allow them and others do not.
What are 5 of the limitations to reconstructive psychological procedures such as death analysis and psychological autopsies? Lack of standardized procedures. Retrospective nature. Distorted info. Lack of availability. Too few studies.
What are the 2 lines of theoretical investigation for the study of suicide? The sociological model with a foundation in the work of 19th century Emil Durkheim. The psychological model based on the work of Sigmund Freud.
Durkheim theorized that social forces are manifested how? In the degree of integration and regulation present in a given society.
What is low integration in terms of social integration? Situations in which individuals feel alienated form the institutions and traditions of his/her society.
What are egoistic suicides? Without an adequate sense of social connectedness, a person becomes overly dependent upon his/her own resources, and social sanctions against suicide are ineffective because of the extent to which his/her mental energies are concentrated on him/herself.
What does egoistic suicide spring from? Excessive individualism
What type of people might be victims to egoistic suicide? The disenfranchised and those at the fringes of society.
In Durkheim's view, when a person is detached from society, what happens regarding personality? Individual personality takes precedence over collective personality.
What is altruistic or institutional suicide? Self-destruction demanded by a society as a price for being a member of that society. When a person identifies with the values or causes of society to the extent that his/her own personal identity is diminished.
What is an example of institutional suicide in Japan? When samurai warriors sacrificed their lives to maintain the honor or reputation of their lords.
What is hara-kiri or seppuku? Ritual disembowelment accomplished with prescribed etiquette.
When might one commit hara-kiri? When a warrior experienced disgrace in battle, as a way to regain honor. Public statement of disagreement with a corrupt superior.
In what case did Buddhist monks commit altruistic suicide? In the Vietnam War, via self-immolation, to protest their country's governmental policies.
What kind of society naturally encourages altruistic or fatalistic suicide according to Durkheim? A highly integrated society.
Historically in India, certain castes expected what form of suicide? Faithful wives to be cremated upon her husband's cremation pyre.
What is heroic suicide according to Durkheim? Deaths in combat where one voluntarily sacrifices one's life to save the lives of others.
Define mass suicide. The simultaneous suicide of the members of a social group.
What are the 2 types of mass suicide? Hetero-induced Self-induced
Where/when does hetero-induced suicide typically occur? In defeated and colonized populations.
In what case does self-induced mass suicide occur? When the motivation is related to a distorted evaluation of reality.
Name 3 examples of self-induced suicide. 19978: Jonestown, Guyana - 900+ people died at Revered Jim Jones' instructions to drink cyanide-laced fruit punch. 1993: Waco, TX - David Koresh's Branch Davidians set fire to camp. 1997: San Diego - Heaven's Gate
In Durkheim's model, what creates the conditions for anomic suicides? Insufficient social regulation
In the typical example, what happens in the relationship between an individual and society to cause anomic suicide? It is suddenly shattered or disrupted.
What is a classic example of social estrangement? When societies undergo rapid social change and people lose their moorings to traditional values and lifeways.
Suicide worldwide is partly attributed to what? Individualism and autonomy loosening bonds between individuals and society.
What are examples of anomic events? Sudden trauma or catastrophe, such as loss of a job, amputation of a limb, death of a close friend or family member.
What produces fatalistic suicide? Societies characterized by excessive social constraints generating a feeling that there is nowhere to turn and nothing good can be achieved.
Suicide in jail is due in part to what? Rigid regulations in such environments.
From a social perspective, what heightens the potential for suicide? An imbalance in the degree of social regulation and/or social integration.
What are the 3 key insights from psychological studies of suicide? The acute suicidal crisis is of relatively brief duration - though it may recur. The suicidal person is likely to be ambivalent about ending his/her life Most suicidal events are dyadic events, involving the suicidal person and a significant other.
In the psychological view, suicide involves strong what? Unconscious hostility
What happens to the defense mechanisms of the ego in the psychological view of suicide? Conditions of enormous stress impel a person toward self-destruction to the point that they overwhelm the ego.
What does the primitive ego state involve? Powerful forces of aggression.
Suicide may be viewed as murder in the what? 180th degree
What psychological process comes in to play as self-preservation works against the self-s acquiescence in its own death? Ambivalence
Most people who commit acts of self-damage with more or less conscious self-destructive intent do not want either to live or die, but to do what? To do both at the same time.
What may tip the scales of the opposing polarities of ambivalence in the case of suicide? An otherwise minor incident
Suicidal acts are often examples of what? Risk-taking behavior or gambles.
What 5 words did Edwin Shneidman distill his lifetime of learning into? Suicide is caused by psychache.
What does psychache refer to? The unbearable mental pain that is caused by the frustration of a person's most important needs, which are unique to each individual.
What are the 4 clusters Shneidman believes most suicide cases tend to exhibit themselves in? Thwarted love, acceptance or belonging. Fractured control, helplessness & frustration. Assaulted self-image & avoidance of shame, defeat, humiliation & disgrace. Ruptured key relationships & attendant grief & bereftness.
Suicide is the outcome of a person's what? Desire to reduce intolerable pain.
What is a common theme among the various paths to suicide? It is seen as the ultimate form of gaining control over insurmountable difficulties in life.
What does the sequence leading to suicide often begin with? Interactions between biochemical imbalances in the brain, personality factors and life stress.
Most suicides are the outcome of a disease in the brain, an illness such as what? Depression, anxiety, schizophrenia, bipolar disorder, or some other mood disorder.
What is a major factor in suicide? Clinical depression
A key aspect of depression is the person's sense of what? Hopelessness
What personality disorders are associated with a higher risk of suicide? Borderline or antisocial personality.
What is a contributing cause in many suicides? Alcohol or substance abuse.
What kind of risk factor is mental illness for suicide? Ongoing
What neurotransmitter appears to be lower in suicide attempters and postmortem studies of suicide victims? Serotonin
Recognizing the strong connection between diseases of the brain and suicide challenges the conventional notion that suicide is what? Chosen by a person of his/her free and rational choice.
Suicide as a means of escape from a severely debilitating or terminal illness is sometimes referred to as what? Rational suicide
Physician-assisted suicide can be considered what type of suicide? Rational (Suicide as Escape)
When an individual's self-concept or sense of identity is confused, and when this confusion is coupled with problems in relating to others, it can result in the person's self-perception as a failure. In this case suicide may be termed what? Referred
In what country has suicide become the leading cause of death among young adults? China
How many suicides and attempted suicides by young adults are there each year in China? .25 million suicides, 3 million suicide attempts
Not performing up to expectations or role definitions can provoke a what? Crisis of self-concept
What is meant by "accumulating successes one after another may seem a Sisyphean effort"? A continual struggle for achievement without a corresponding sense of accomplishment.
Name some of the cultural meanings of suicide. Sinful Criminal Weakness/madness The Great Death Rational alternative
Name some of the individual meanings of suicide. Reunion with a lost loved one. Rest and refuge. Getting back. Penalty for failure. A mistake.
Suicide as a cry for help aims to what? Force a change
What actions reveal the cry for help in youthful suicide? Cutting ones wrist or taking a drug overdose.
Some experts express the view that self-harm, such as "cutting," can be considered an act of what? Self-preservation or self-assertion.
What are the 2 distinct populations of individuals who engage in suicidal behavior? Attempters Completers
Some suicidologists believe that attempted suicide should be seen as the norm, while complete suicide should be seen as what? A failed behavior in which a person inappropriately died.
When low-lethality suicidal behavior is met with defensive hostility or attempts to minimize its seriousness, what may happen? The risk of suicide may increase, along with the possibility that a future attempt will be lethal.
In responding to the cry for help, it is crucial to do what? Recognize that a problem exists and take steps toward expanding communication and proposing remedies.
What is the standard estimate for how many suicide attempts there are to every death by suicide? 25 attempts for every 1 death.
What may explain the difference in rates at which women attempt suicide versus the completed suicides of men? The methods chosen - males tend to use more lethal methods, such as guns, whereas females tend to take pills or slash wrists.
Alcohol abuse, a risk factor for suicide, is more common among males or females? Males
What is the suicidal success syndrome? A failed attempt may be considered cowardly or unmasculine.
What gender role comes in to play in reporting suicidal thoughts or seeking help? Males are less likely to do so and more likely to try to hide their feelings of depression or hopelessness.
People who survive a suicide attempt may view their continued existence as what? A second chance or a bonus life.
As defined by Edwin Shneidman, what is subintentional death? One in which the person plays some partial, covert, subliminal, or unconscious role in hastening his own demise.
Besides subintentional death, Shneidman delineates what 2 other patterns of death-related behaviors? Intentioned Unintentioned
What does chronic suicide, a term coined by Karl Menninger, refer to? Individuals who destroy themselves by means of drugs, alcohol, smoking, reckless living.
Name 4 of the types of intentioned death. Death seeker Death initiator Death ignorer Death darer
Name 5 of the types of subintentional death. Death chancer Death hastener Death facilitator Death capitulator Death experimenter
Name 6 of the types of unintentional death. Death welcomer Death accepter Death postponer Death disdainer Death fearer Death feigner
What are some of the risk factors that play a part in suicide among Native Americans? Cultural disruption and stress.
Name a way that cultural messages about suicide acceptability can lead a group to believe suicide is acceptable. Suicide to end physical suffering from terminal disease may be acceptable by some cultures.
Name a group in which social intolerance and oppression have resulted in elevated rates of suicide. Gays and lesbians.
How does suicide among African Americans compare to that among white Americans? African Americans tend to view suicide as a weak, cowardly way out of their problems, and the rate of suicide is lower among African Americans than among white Americans.
What plays an important role in buffering social forces among African Americans that might otherwise promote suicide? Religion and family
Easy access to guns is an important factor in suicide among what age groups? Children and young adults.
The apparent acceptance of violence in our lives can change what into what? Posturing into deadly deeds.
What book from 1774 was thought to have stimulated an epidemic of suicide among young people? "The Sorrows of Young Werther" by Johann Wolfgang von Goethe
The influence of suggestion on suicide has been termed what? The Werther effect
Name 4 pro-life forces. Belief that problems can promote growth. Perceived ability to solve life problems. Willingness to struggle and suffer if necessary. Healthy fear of death and its aftermath.
Name 4 pro-death forces. Belief that problems are intolerable. Perception that life problems are intractable or unyielding. Sense of entitlement to a rewarding life. Philosophical stance that sees suicide as a mans of obtaining relief.
In Barry's view, what 2 fundamental assumptions about life has modern society accepted that no previous generation has embraced so thoroughly? Belief that we deserve significant fulfillment in our jobs, marriages, and overall lives. Belief that, rather than accepting unalterable circumstances, we must live and die on our own terms.
Suicide bombings reflect what? An understanding that the cultural collective - religion, sect, nation - is more important than the individual.
Name some of the personality factors that contribute to suicidal thoughts and behaviors. Low self-esteem, difficulties with intimate relationships, hopelessness, lack of coping skills, feelings of stagnation, loneliness and despair.
Following the example of Thomas Chatterton who killed himself in 1770 at the age of 17, the Romantics thought of death as what? The great inspirer and the great consoler - in other words, death is a lover to be courted.
The intersection of what creates the unique life situation experienced by a particular person? Culture & personality
What is the usual example of crisis suicide? An adolescent who experiences traumatic change in his/her life, such as loss of a loved one or threatened loss of status in school.
How does the suicide rate in the American military compare to the general population? It is higher.
What are some of the contributing causes to a rising suicide rate in the American military? Working long, solitary hours; errors in mental health screening; missing signs of distress; outdated assessment questionnaires; high-energy drinks taken in combination with drugs for combat stress.
On average, the U.S. loses the equivalent of what in physician suicides? An entire medical school class - as many as 400 physicians.
What are some of the risk factors in physician suicide? Depression, knowledge of and access to lethal means of suicide.
Among physicians, how do suicide rates of women compare to those of men? Equal.
How do suicide rates of female physicians compare to that of the general population? Far exceed it.
A study of suicide among young Micronesian males found what? An epidemic-like increase during a 20 year period.
In the study of Micronesian male suicide, what phenomena pointed to the existence of a suicide subculture? Suicides occurring among a small circle of friends over several months; Self-destructive behavior in reaction to the suicide of a friend or relative; Suicide pacts between 2 or more people.
Labeling a death as suicide may be problematic with young children because of what? Questions about whether a child possesses a mature concept of death and thus is fully aware of the consequences of his/her actions.
There is evidence that children who attempt suicide tend to be in what stage? A transitional stage between concrete operational thought and formal operational thought.
List the first 3 social disruption risk factors in youthful suicide as you can. 1. Early separation from one's parents. 2. Family dissolution, economic hardship & increased mobility. 3. Highly conflicted family or one that is unresponsive to the young person's needs, or who are anomic, depressed or alcoholic.
List the next 2 sets of social disruption risk factors in youthful suicide. 4. Increased social isolation as compared to the support previously provided by the extended family, church & community. 5. Rapidly changing sex roles. 6. Increase in relative proportion of young people in the total population (increased competition).
List the next 4 sets of social disruption risk factors in youthful suicide. 7. Pressure for achievement and success. 8. Impact of suicides by peers and role models. 9. Media attention given to suicide, influence of self-destructive themes in pop culture. 10. Sense of lack of control over one's life.
List the last 4 sets of social disruption risk factors in youthful suicide. 11. Low self-esteem & poor self-image. 12. Devaluing of emotional expression. 13. Lack of effective relationships with peers. 14. Easy access to drugs & alcohol.
What age group does adolescent suicide begin to appear in? 10 to 14 year olds
What fact suggests that developmental changes, such as cognitive development and conceptualization of death, play a role in adolescent suicide? A significant increase in adolescent suicide among older adolescents and young adults.
What are the most notable external stressors linked to suicidal adolescents, and to what are they related? Legal/disciplinary problems, related to impulsive violence.
Active substance abuse combined with which two things is potentially lethal in adolescents? Depression and the availability of a handgun.
What three behaviors are linked on a continuum of escape behaviors in which young people engage to avoid feelings of depression and hopelessness? Substance abuse, delinquency & suicide.
Define cluster suicides. One person's suicide triggers another - typically within the same locale, closely related in time, and involve the same method.
Copycat suicide is cluster suicide that occurs in connection with what? Depiction of suicide in the media.
In suicide pacts, two or more people determine to what? Kill themselves at the same time and usually in the same place.
What are analogous to a death pact between two persons in which the second person's death occurs as a reaction to the first person, without the knowledge of the first. Graveside suicides
In London, how can the police tell the difference, between suicide drownings of unhappy love affairs versus debtors, in the Thames? Lacerated fingertips from attempts to save themselves by clinging to the piers of the bridges in lovers, but debtors go down like slabs of concrete without struggle or afterthought.
What is net suicide? Suicide pacts arranged between strangers who meet on the internet.
Where does net suicide average 60 people a year? Japan
For young adults, what do the major issues tend to involve in regards to suicide? Academic achievement, courtship, family formation, career.
What characteristic is notable about the men ages 20 to 34 who had an exceptionally high rate of suicide? They had been recently widowed.
What are the present 2 most promising approaches for reducing suicide among young people? Providing treatment for disorders that increase the risk of suicide. Targeting prevention efforts at high-risk groups.
What are the treatment options for suicide prevention? Hospitalization for psychological evaluation, subsequent close outpatient follow-up, removal of firearms and securing of lethal meds from home, therapy for any associated psychiatric disorder.
What ages does middle age span? 35 or 40 to 65
What has middle age been called? The terra incognita of the human life span.
Middle age is a time of shifting from valuing physical to what? Valuing wisdom
Middle age has been characterized as what in suggestion that middle age may be as turbulent as adolescence? Middlescense
What is generativity? Giving back to society some of the gifts of nurture and sustenance received during earlier periods of life.
Middle age is a time for coping with what? The loss of dreams and ambitions, coming to terms with the realization that one may not reach the goals one had for oneself earlier in life.
What may be some of the motives for suicide in middle age years? Difficulties in one's career or marriage.
What are the major factors influencing suicide among the middle aged? Accumulation of negative life events, affective disorders - especially major depression - and alcoholism.
TRUE or FALSE: Older people are more likely than young people to have expressed suicidal ideation or to have made a previous suicide attempt. FALSE
Researchers seem to agree that elderly people who attempt suicide genuinely want what? To die, as opposed to a cry for help.
Double suicide occurs with greatest frequency among which age group? The elderly
What does a typical double suicide involve? One or both partners physically ill; heavy alcohol use by one or both; dependency on each other & isolation from external support; "special chemistry" with the more suicidal partner dominant & the more ambivalent partner passive.
Name the first 5 risk factors of suicide in late adulthood listed in our book. 1. Social isolation & loneliness. 2. Boredom, depression, sense of uselessness. 3. Loss of purpose & meaning in life. 4. Financial hardship. 5. Multiple losses of loved ones.
Name the last 3 risk factors of suicide in late adulthood listed in our book. 6. Chronic illness, pain, incapacitation. 7. Alcohol abuse & drug dependence. 8. Desire to avoid being a burden or to end one's life with dignity.
What might be the first stage when one is considering suicide? Formulating the means of killing oneself.
What might be the second stage when one is considering suicide? Acquiring the means to kill oneself.
What is the final stage when one is considering suicide? Using the means that have been acquired to proceed with the suicidal act.
Why might one choose a particular method of suicide? Because of the image it represents to the suicidal individual.
A study of suicide notes found what about people using horrific methods of suicide? Rejection was a critical factor - wanting survivors to pay for all the grief they caused the suicidal person.
The method of suicide tends to reflect a person's what? Experience and state of mind.
Among methods used for the suicidal act, there is what? An order of lethality regarding hope of changing one's mind after the lethal act is initiated.
Suicide notes have been called what? Cryptic maps of ill-advised journeys.
What ratio of people leave suicide notes? 1 in 6 people
Name some of the expressions suicide notes may include. Love, hate, shame, disgrace, fear of insanity, self-abnegation; feelings of rejection; explanations for the suicide, defense of suicide; disavowal of a survivor's responsibility for the suicide; instructions for distributing property and possessions.
Who has been hailed as "suicidology's most powerful practitioner" and "the patron saint of the suicide prevention volunteer?" Chad Varah
What and when did Chad Varah do toward suicide prevention? In 1953 he developed a telephone service, called The Samaritans, in London staffed mainly with volunteers whose goal was to befriend the suicidal and despairing.
What was a comparable milestone to The Samaritans in the U.S., who founded it, and when? Los Angeles Suicide Prevention Center in 1958 by Norman Farberow and Edwin Shneidman.
What was the most important change brought about by the work begun in the Los Angeles Suicide Prevention Center? A shift away from seeing suicide as an act committed by an insane person to one by a person who felt overwhelming ambivalence toward life.
Describe a typical suicide prevention center. A telephone-answering center with 24x7 availability to serve as a short-term resource for people contemplating suicide. Anonymity is respected. Need for help accepted unquestioningly. Some pros, some volunteers with training - use intervention strategies.
What are the lessons to be learned in suicide prevention education? Acknowledge the truth that life is complex and everyone will have disappointment, failure & loss. Learn to deal with this via coping techniques, including critical thinking.
A corollary of coping skills involves the cultivation of what? A sense of humor.
Positive self-esteem is what? A preventative against suicide.
What physical strategy is involved in suicide prevention? Setting up physical barriers in places where suicides are likely to occur.
In Washington D.D., what has historically been the number one jump site? The Duke Ellington Bridge.
Intervention during a suicidal crisis can do what? Reduce its lethality and give the would-be suicide an opportunity to reassess a painful situation and perhaps find a more constructive, healthier solution.
Suicide intervention emphasizes what? Short-term care and treatment of persons who are actively experiencing a suicidal crisis.
What avenues of exploration can be helpful in suicide intervention? 1. Imminence - how soon? 2. Provocation - What happened to make suicide feasible now? 3. Plan - Is there a suicide plan? 4. Means - Are the means available?
What is the cardinal rule in suicide intervention? Do something.
What are the basic questions in suicide intervention? Where does it hurt? & How may I help you?
Suicide intervention involves what 6 things? 1. Take threats seriously. 2. Watch for clues to suicidal intentions & behaviors. 3. Answer cries for help by offering support, understanding & compassion. 4. Confront the problem - ask questions. 5. Get pros to help. 6. Offer constructive alternatives.
What does suicide postvention refer to? The assistance given to all survivors of suicide - those who attempt it as well as the families, friends and associates of those why die by it.
What 4 main ways do Evans and Raberow point out that suicidal intent may be expressed? 1. Verbal direct. 2. Verbal indirect. 3. Behavioral direct. 4. Behavioral indirect.
Name some of the warning signs that fall under the behavioral indirect category of expressing suicidal intent. Giving away prized possessions, making a will, attending to final arrangements Sudden & extreme changes in eating habits/sleep patterns Withdrawal/major behavioral changes w/depression Changes in school/job performance Personality changes Drugs/alcoh
What has been called the "grand old myth of suicide?" People who talk about suicide don't kill themselves.
What are some potentially fatal responses to suicide talk? Failure to respond, encouraging suicide, brushing it aside, provocation, moral superiority, litany of good reasons why the person should not die by suicide.
What is helpful in responding to suicide talk? Listen carefully to exactly what the person is communicating. Know the patterns of suicidal behavior. Be acquainted with crisis intervention resources. Recognize that no one can take ultimate responsibility for another human's decision to commit suicide.
In suicide intervention, it is important to sustain or stimulate what? The person's desire to live.
One way to help people in suicide crisis is to help them discover what? What about themselves can matter, however small or insignificant it may seem.
Asking the suicidal person what s/he needs to feel __________________ may be a matter of survival. Worthwhile
Suicidal thoughts and behaviors indicate a critical loss of a person's belief that what? S/he is a person who matters.
Suicide is a permanent solution to what? What is most likely a temporary problem.
Created by: silvrwood