Interpersonal Theory of Suicide Overreach

Saxby Pridmore¹ and William Pridmore²

¹ University of Tasmania, Hobart, Tasmania, Australia. ² Australian National University, Canberra, ACT, Australia.

Corresponding author: Prof S Pridmore, Email: s.pridmore@utas.edu.au

Key words: Suicide, suicide prevention, culture, literature

Received: 15/5/2019; Accepted: 25/5/2019

Abstract

The Interpersonal Theory of Suicide states that burdensomeness, thwarted belongingness and capability are sufficient to explain all suicide. It has been recently challenged by Hjelmeland & Loa Knizek (2019). Burdensomeness is difficult to identify in reports of suicide. A great challenge for this theory is to explain the discrepancy in the suicide rate of many indigenous and dominant cultures co-located around the world.

Hjelmeland & Loa Knizek (2019) are to be congratulated on their careful examination of the Interpersonal Theory of Suicide (IPTS) (Joiner, 2005). This theory states that universally, three factors explain/are required for suicide: perceived burdensomeness, thwarted belongingness and capability to suicide. The theory states that all three must be present for suicide to occur.

But, is perceived burdensomeness (the notion that one is a burden to others) always present?

The Bible tells us that Saul was critically wounded in battle and so that he would not fall into the hands of and be abused by the enemy he fell on his sword (died 1012 BCE; I Samuel 31:3-5). His assistant did the same. Samson was captured by his enemies, blinded, whipped, humiliated and revengeful and killed himself and many of his tormentors (died 1078 BCE: Judges 16:30). Abimelech was seriously wounded in battle by a woman, and so that he would not suffer the disgrace of having been killed by a woman, he had his assistant run him through (died 1854; Judges 9:50-55). Ahitophel betrayed King David and hanged himself (died circa 1000 BCE; 2 Samuel 17:23) and Judas betrayed Jesus, “was seized with remorse” and killed himself (died 30-33CE; Matthew 27:3-4).

In Athens, Aegeus incorrectly believed his son Theseus had been killed by the Minotaur in Crete – overcome with grief he threw himself into the (Aegean) sea (died before 1200BCE).

In Finnish folklore, Aino was promised to an old man in marriage, and chose instead to drown herself (no date available). In China in 1919, Miss Zhao was similarly promised to an old man whom she did not wish to marry and on the way to the ceremony, cut her throat.

In England, Dr Harold Shipman murdered hundreds of his patients. He was convicted and given a life-time custodial sentence. He made public statements that he would not live in goal and when the appeal process was exhausted, he hanged himself (2006).

There is nothing to support that these people felt they were a burden to others. There are, of course, examples where this perception may have been a factor – Hercules was suffering intractable pain and burned himself to death (died circa 1200 BCE) – Ajax had, in disappointment, killed the livestock of his neighbours and then fell on his sword (died circa 1184) – Lady Mi in China was wounded in fighting and slowing the escape of others and threw herself down a well (died 208 CE).

However, in most of the historical suicides listed above, there is no evidence the deceased experienced a sense of burdensomeness. And, it is difficult to imagine Joseph Goebbels, Heinrich Himmler and Adolf Hitler feeling themselves a burden to others.

The IPTS also states that mental illness plays a role in all or almost all suicide (Joiner 2005; Joiner, Hom, Hagan, & Silva, 2016). This is a surprizing and difficult position given that the World Health Organization (2014) have described the notion that all or almost all suicide is a result of suicide is a ‘myth’, and that the Centers for Disease Control and Prevention (2018) report that more than half of the people who died by suicide did not have a known mental disorder.

On planet Earth, annually, about one person per 1000 kills themselves – it is uncommon, but it is universal, being known throughout history and in every country. It is generally agreed that people who complete suicide are suffering distress/psychache (Shneidman, 1993) and that social “integration” or support can help to prevent suicide (Durkheim, 1987/1951). Perhaps the greatest challenge for the IPTS is to explain the very high suicide rates around the world of many indigenous populations exposed to dominant cultures (Pridmore & Fujiyama, 2009; Hamdullahpur, Jacobs & Gill, 2017).

Disclosure statement

No potential conflict of interest was reported by the authors.

References

Centers for Disease Control and Prevention. (2018). Suicide rising across the U.S. https://www.cdc.gov/vitalsigns/suicide/index.html

Durkheim, E. (1897/1951). Suicide. New York: The Free Press.

Hamdullahpur, K., Jacobs, K., & Gill, K. (2017). A comparison of socioeconomic status and mentla health among inner-city Aboriginal and non-Aboriginal women. International Journal of Circumpolar Health, 76(1), 1340693. doi: 10.1080/22423982.2017.1340693.

Hjelmeland, H., & Loa Knizek, B. (2019). The emperor’s new clothes? A critical look at the interpersonal theory of suicide. Death Studies. https://doi.org/10.1080/07481187.2018.1527796

Joiner, T. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press.

Joiner, T. E., Hom, M. A., Hagan, C. R., & Silva, C. (2016). Suicide as a derangement of the self-sacrificial aspect of eusociality. Psychological Review, 123 (3), 235–254. doi: 10.1037/rev0000020

Pridmore, S., & Fujiyama, H. (2009). Suicide in the Northern Territory, 2001-2006. Australian and New Zealand Journal of Psychiatry, 43(12), 1126-1130.  doi: 10.3109/00048670903279861

Shneidman, E. (1993). Suicide as psychache. Journal of Nervous and Mental Disease, 181(3), 145-147.

World Health Organization. Preventing Suicide: A Global Imperative. Geneva: World Health Organization, http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/ (2014, accessed 10 February 2019).