Suicidologists Should Stop Studying Non-Lethal
Suicidal Behavior
David Lester
An alternative title could be: The
Method of Substitute Subjects Has No Value for Understanding Suicide. The
method of substitute subjects as a term was coined for suicidologists by
Neuringer (1962). Because suicides are deceased and, so cannot be given the
standardized tests and interviews developed by psychologists, Neuringer
suggested turning to the study of those who have suicidal ideation or who have
attempted suicide – substitute subjects The majority of studies on suicide, therefore,
use suicide ideators and attempters as the subjects for research.
I would argue that this is great
for getting publications, academic success and grants, but almost totally
useless for understanding suicide.
You might argue that we are
interested in suicide ideators and attempters themselves, and this is, of
course, true, but they are not as interesting as suicides and will not help us
to understand suicides. Let me give an example.
Joiner’s (2005) Interpersonal Theory
of Suicide proposes that thwarted belongingness and perceived burdensomeness
are behind every suicide. Almost all of the research of this theory uses living
subjects and, indeed, often scores on scales to measure these two constructs
are associated positively with a measure of suicidality. This has been found in
samples of psychiatric patients (Teismann, et al., 2016) and undergraduate
students (Lockman & Servaty-Seib,
2016).
But studies of suicide notes and
suicides find that there is little evidence that perceived burdensomeness plays
a role in more than15% of the suicides (Gunn, et al., 2012; Lester & Gunn,
2021). How is this possible?
Giving undergraduate students Joiner’s
test of perceived burdensomeness (which provides scores in the range of x-x)
does not mean that their scores will be high. Almost all of the students may
obtain low scores. Thus, the researcher is basically comparing students with very
low scores to students with somewhat low scores. If a Likert-type scale is used
(with scores ranging from -3 to +3), nearly all the students might have
negative scores. The correlation, therefore, between perceived burdensomeness
and suicidal ideation is difficult to interpret. If you strongly disagree that
you are a burden to others, you are less suicidal than if you somewhat disagree
that you are a burden. This does not help us understand those who die by
suicide.
This is not relevant only to Joiner’s
IPTS theory of suicide. It applies to the defeat-entrapment theory of suicide,
the cognitive distortion theory, and all theories. I used Joiner’s theory only
because myself and John Gunn have studied suicides from the point of view of
Joiner’s theory and found that perceived burdensomeness is rare in suicides.
These is perhaps a way out of this
problem. In two paper (Lester, et al., 1975, 1979), I argued that researchers
could use attempted suicides to learn about if suicide, if and only if
they categorized the attempters into groups by their level of lethality or
their level of suicide intent. They could then extrapolate to those who died by
suicide, and I illustrated this technique with demographic variables (e.g.,
sex) and hopelessness scores. It is rare that this procedure is used.
Grants are awarded and academics are
tenured and promoted on the basis of their research on living suicidal and
non-suicidal individuals, but suicide remains a puzzle, difficult to predict
and difficult to understand.
References
Gunn, J. F., Lester, D.,
Haines, J., & Williams, C. L. (2012). Thwarted belongingness and perceived
burdensomeness in suicide notes. Crisis, 33, 178-181.
Joiner, T. E. (2005). Why people die by suicide.
Cambridge, MA: Harvard University Press.
Lester, D., Beck, A. T. & Mitchell, B. (1979). Extrapolation
from attempted suicides to completed suicides: a test. Journal of Abnormal
Psychology, 88, 78-80
Lester, D., Beck, A. T. & Trexler, L. (1975). Extrapolation
from attempted suicides to completed suicides. Journal of Abnormal
Psychology, 84, 563-566.
Lester, D., & Gunn,
J. F. (2021). Is perceived burdensomeness present in the lives of famous
suicides? Death Studies, in press.
Lockman, J. D., & Servaty-Seib,
H. (2016). College student suicidal ideation. Death Studies, 40,
154-164.
Neuringer, C. (1962). Methodological problems in
suicide research. Journal of Consulting Psychology, 26, 273-278
Teismann, T., Forkmann, T., Rath, D., Glaesmer, H.,
& Margraf, J. (2016). Perceived
burdensomeness and suicide ideation in adult outpatients receiving exposure
therapy for anxiety disorders. Behaviour Research & Therapy, 85, 1-5.
