"I'm at My Rope's End": Suicide in New Orleans, 1920-1940.

For over a century, researchers have argued that suicide in the United States fluctuates with business cycles, rising during downturns, when "deaths of despair" skyrocket, and falling during flush periods. Using case-level data from autopsy reports and suicide notes, this essay analyzes suicide trends in New Orleans between 1920 and 1940, an era that included immense prosperity and the Great Depression. Thus, the essay draws from quantitative and qualitative evidence to revisit the leading explanation for suicide patterns. It concludes that only a small segment of the population experienced surges and contractions in response to economic forces. For other New Orleanians, different stressors, relating to class-, race-, and gender-based expectations, shaped suicidal behavior. Firearm availability and public health conditions also influenced suicide patterns. Counterintuitively, suicide rates soared in good times and plummeted in bad times.

Collective Optimism and Selection Against Male Twins in Utero.

Scholarly literature claims that health declines in populations when optimism about investing in the future wanes. This claim leads us to describe collective optimism as a predictor of selection in utero. Based on the literature, we argue that the incidence of suicide gauges collective optimism in a population and therefore willingness to invest in the future. Using monthly data from Sweden for the years 1973-2016, we test the hypothesis that the incidence of suicide among women of child-bearing age correlates inversely with male twin births, an indicator of biological investment in high-risk gestations. We find that, as predicted by our theory, the incidence of suicide at month t varies inversely with the ratio of twin to singleton male births at month t + 3. Our results illustrate the likely sensitivity of selection in utero to change in the social environment and so the potential for viewing collective optimism as a component of public health infrastructure.

You shall bury him: burial, suicide and the development of Catholic law and theology.

Whether physician-assisted dying should be legalised is a major debate in medical ethics and much has been written on it from both secular and religious perspectives. Less, however, has been written on one of the potential consequences of legalised physician-assisted death: whether those who undergo this procedure will be given funerals by religious groups who oppose the practice. This article investigates the Catholic Church's attitude to the burial of suicides, and how Catholic canon law has approached the question of ecclesiastic funerals for suicides throughout its history. From the sixth through the late 20th century, the Church technically did not bury anyone who willfully committed suicide. Broad shifts in the cultural attitude towards suicide, due in large part to new understandings of mental illness as disease, had a powerful effect on Catholic thought and practice in modernity, and the Church eventually dropped the ban on funerals for suicides from its law code altogether in the 1980s. The legalisation of physician-assisted death, however, raises again the possibility of a prohibition on funerals. The Church was able to drop its restrictions on funerals since suicide was seen as an act beyond the control of the deceased and thus worthy of mercy and compassion. In cases of physician-assisted dying, the patient must have consciously and willingly agreed to the procedure, undermining this understanding of suicide. The history of canon law on suicide funerals reveals the complexity of the Catholic attitude towards suicide and provides an important context to the current debate around physician-assisted death, and conflicts between medicine and religion more broadly.

The Press and Suicides in the 19th Century: Investigating Possible Imitative Effects in Five Territories of the Austro-Hungarian Empire.

During the 19th century, suicide rates increased in many countries. The press may have contributed to this increase, even though empirical evidence is lacking in this regard. We assessed suicide statistics within five territories of the Austro-Hungarian Empire between 1871 and 1910 and combined these data with a content analysis of suicide reporting in five newspapers, each appearing in one of the five territories. The analysis revealed a covariation between the quantity of reporting and the number of suicides within all five regions. Furthermore, the quantity of reporting significantly predicted the following year's suicides. Although the causal order of suicides and the quantity of reporting should be assessed with caution, evidence is consistent with the idea that the press may have contributed to the establishment of suicide as a mass phenomenon. The findings also support contemporary guidelines for journalists, especially the notion of avoiding undue repetition of suicide stories.

[The oeuvre, life history and illness of Sylvia Plath].

The roots of confessionalism reach back to the early Middle Ages and to the Confessions of Rousseau. Confessional literature gained a theoretical foundation in the age of Romanticism, then in the 20th century the genre underwent a revival and late modernisation in the works of the "confessional poets" (Lowell, Sexton, Plath etc.). The literary studies and psychobiographical examination of these authors threw light on the psychiatric aspects of confessionalism; most of them suffered from psychiatric or addictive disorders and committed suicide. Confessional poetry takes repetition of the (fragmented) psychological process of the individual life history as its almost sole theme. The poet builds up, demolishes, then again builds up his or her own life history, blurring the boundaries of reality and fiction. Interrupted personality development and the failure to work through traumatic experiences can be observed in the psychological background, to which Vladimir Nabokov also referred in his personal notes. In this collection of Psychiatria Hungarica about Sylvia Plath, titled The Broken-necked Deer the studies in three parts under the headings oeuvre, life history, illness are imbued with considerations of literary psychology and literary psychiatry that expand and enrich both literary studies and the psychiatric field of vision.

[Failure in the construction of the ego in confessional poetry - Sylvia Plath and Attila Jozsef].

The two poets, an American Sylvia Plath and a Hungarian, Attila József were separated by a quarter of century of time, they lived and worked in different spaces, cultures, but both created in their poetry a radically new style of self-expression, called confessional poetry. The "Belated Lament" of Attila József was written in 1936, and in the following year its author - after repeated earlier attempts - committed suicide. The "Daddy" of Sylvia Plath was written in 1962. She, again, after several attempts, killed herself the following year. They both talk about the powerful effect of the disruptive effect of unresolved Oedipal memories, both are deeply concerned with mourning of the Oedipal other a father and a mother (who died several decades before), and they also construct the death of their own. They both present themselves as an unsuccessful Oedipus and articulate a disturbing and disruptive arrival to Kolonos.

[From the experience to anger: The elaboration of the feelings against the parents in the art of Sylvia Plath].

AIM: The purpose of this present paper is to demonstrate the biographical antecedents and the adverse childhood experiences, which might have possibly contributed to those ambivalent feelings which can be observed in Sylvia Plath's confessional art in relation to her parents. METHOD: Biographical-, document- and artistic analyzes. The analyzed artistic pieces are the following: Johnny Panic and the Bible of Dreams, The Bell Jar, Collected poems (from The Colossus and Ariel books) and the Journals by Sylvia Plath. The reconstruction of the biography was conducted based on international textbooks. RESULTS: Sylvia Plath at the age of 30, on the 12th of October, 1962 wrote her famous poem, Daddy, which starts with these lines: "You do not do, you do not do /Any more, black shoe/In which I have lived like a foot For thirty years, poor and white,/Barely daring to breathe or Achoo. Daddy, I have had to kill you./You died before I had time/Marble-heavy, a bag full of God/Ghastly statue with one gray toe/Big as a Frisco seal/And a head in the freakish Atlantic /Where it pours bean green over blue/In the waters off beautiful Nauset./I used to pray to recover you. /Ach, du Dreck." A couple of months later, on the 11th of February 1963. Sylvia Plath committed suicide. Her journal entries and her works all testified that the emotional relationship with her parents significantly contributed to her genuine art and at the same time to the onset of her psychiatric illness. According to her journals, Sylvia Plath reported hate and ambivalent feelings several times to her psychiatrists. It is very likely, that the illness and death of Otto Plath and the emotional crises afterwards might have been that primary experience that might have exercised an adverse effect on Sylvia's life, and what have been composed very vividly in the poem called Daddy. CONCLUSIONS: Based on the analyzes of the biography, the journals and the poems, it can be stated, that the adverse childhood experiences, Sylvia had to experience during her father's illness, after his death, and during the restructuring of the family system are vital in the understanding of Sylvia Plath's art and her psychopathology.

[On Sylvia Plath's Personality].

In this early study, written in 1985, I examined six of the most important personality traits of Sylvia Plath, the poet and writer (1). Sylvia oscillated between positions of dependency and independence; she was characterised by sexual inhibition and promiscuity, writer's block and an explosion of writing, achievement con- straint and liberation from the constraint, emotional dependence and independence. Paradoxically, she committed suicide when far more things (children, productive creative period, publication of her novel) tied her to life than was the case before her first suicide attempt (2). Her life was spent in the perspective of death; death was her main point of reference, and at the same time was a constantly present alternative solution (3). Her neurasthenic, sometimes bipolar mode of existence determined her everyday behaviour: fatigue, irritability, a low ability to tolerate failure, a tendency to somatisation, anxious attitude, low self-esteem (4). She lived between extremes: insensitivity and over-sensitivity, bad and good moods, ego systole and ego diastole, ambivalence towards close family members (father, mother, Ted), relationship fluctuating between adoration and hate (5). Her poetry persona was characterised by object phobia: in her poems objects become hooks, loops, traps (6). She was ambivalent towards both women and men: she hated women, while her effective therapist was a woman; she was jealous of men, she was not capable of a symmetrical partner relationship, she was either subordinate or superior. In Plath's poetry the incompatible dichotomy of soft worm and hard mask refers to the irreconcilable contradiction between the male and female world.

[Psychiatric disorder of Sylvia Plath].

Sylvia Plath was one of the most famous American poets in the twentieth century. Plath was diagnosed with depression after her first suicide attempt when she was 20 years old. Her major depression (without psychotic symptoms) recurred several times. Plath never had a manic episode, but there were probable hypomanic periods in her life. She died by violent suicide when she was 30. Sylvia Plath took a bottle of sleeping pills and stuck her head in a gas oven. Several factors may have contributed to Plath's psychiatric disorder and suicide. The author reviews the etiological factors and course of psychiatric disorder based on the Unabridged Journals of Sylvia Plath and the literature. Her family history was positive and her premorbid personality was vulnerable to depression. There were histrionic, narcissistic and borderline features in her personality. The probable diagnoses of Plath were bipolar II. affective disorder and mixed personality disorder.

["The grasses unload their griefs on my feet" - the therapy of Sylvia Plath].

The study deals with the psychiatric treatment of the writer with a tragic fate, Sylvia Plath. Sylvia's treatment began with electroconvulsive therapy for suicidal thoughts at the age of 20 and soon afterended up in hospital for an attempted suicide with sleeping pills to McLean Hospital.Her treatment was trusted on Doctor Ruth Beuscher with whom she's been remaining in touch directlyor indirectly (phone, mail) all her life. At the age of 30 she passed away committing suicide at her flatin London after having been treated with antidepressant for her assumably psychotic depression.In the article we provide an insight to the main therapeutic events of Sylvia's treatment and invitethe colleagues for an imaginary experiment based on modern knowledge and family system approach with a trauma focus (on theory of structural dissociation)- hoping it provides us with a conclusionto use in the treatment of suicidal patients.

[The risk of imagination, or orgy of anger. Trying to reconstruct and understand the Sylvia Plath-phenomenon].

To clarify the relationship between literature and psychiatry we can call on the help of the American-English writer Sylvia Plath, who was given electroconvulsive therapy and psychotherapy on a number of occasions for psychiatric illness and later took her own life. This study seeks an answer to five questions. Did Sylvia Plath suffer from psychiatric illness? Did she show signs of the bipolar triad (bipolar affective disorder, trait aggression, substance or behavioural dependence)? Did her activity as a writer have a therapeutic effect? What was the nature of her "confessionalism"? To what extent does her oeuvre reflect her life? Sylvia Plath very probably suffered from a psychiatric illness, namely bipolar 2 affective disorder. The unsuitable treatment of her illness and the interruption of intensive psychotherapy could have contributed to her early death. Together with the bipolar affective disorder, she was also characterised by serious dispositional aggression and emotional dependence. For her, writing was both a source of stress, because her dysthymia intensified her inhibitions, and at the same time self-healing and a self-fulfilling prophecy. The roots of her confessionalism can be found in her personality development suspended in the stage of becoming an adult, and the failure to work through her traumas. Unlike Goethe and Salinger who killed their heroes, having them commit suicide in The Sorrows of Young Werther and A Perfect Day for Bananafish, while both writers recovered from their crisis, Sylvia Plath described a positive development in The Bell Jar and in Ariel, her verse cycle, then put her head in the gas oven. Would she have stayed alive if she had followed the patterns of Goethe and Salinger?

[Devil and God - The double role of Ted Hughes in Sylvia Plath's life and death].

The relationship of two, equally talented poets, as it can have whether a beneficient or inhibitory effect on both person's creative processes, is informative in a 'literature psychological' way. The present study aims to analyse the marriage of the poets Sylvia Plath and Ted Hughes. Sylvia Plath's life was directed by several dualities; her polarized perspective, being likely the result of her psychiatric illness, has taken control over every area of her life. Although, its most important duality is in connexion with the laureate British poet, Ted Hughes: she idealized and hated the man - being both her love and spouse - at the same time. Their marriage, fecundating the poetry of both, has led to a tempestuous ending. Soon after, the young Sylvia took her own life, and the public - more or less implicitly stating - blames it on Ted Hughes. In the present study we tend to give a literature psychological analysis of their relationship, based on their autobiographical works and, focused on the stages leading to the crisis, to question whether the personality of Plath could have an effect on the ending of their marriage? Could these phenomena have contributed to the early death of Sylvia Plath - and, especially, what was Ted Hughes's role in this process?

[The "price" of creativity? Predictive and protective factors in the suicide of Sylvia Plath].

An increasing number of studies deal with the potential correspondence between suicidal behaviour and creativity nowadays. Psychobiographical analysis of the life of well known artists may help the better understanding of this phenomenon. In the present study predictive and protective factors of suicide are presented through the case of the well known suicidal poet and writer, Sylvia Plath. The most important predictive factors of suicide in her case are: affective disorder, comorbid anxiety disorder, prior attempt of suicide, and also her seriously affected personality, that mainly appears in her affective dependence. Her life events, both causes and effects of these, are also predisposing suicide. The early loss of her father, ambivalent relation with her mother and her marriage foredoomed to failure are the most significant of them. Although she used to write since her early childhood, the constant fluctuation of her psychological state had serious effect on her ability to write and also her motivation, both being an additional source of stress, due to her performance pressure. The fear of the acceptance of her works could also lay to increased amount of stress and anxiety on her sensitive personality. Her tragical life events, her psychiatric illness and her relentless templets towards herself could cause such a pressing stress, that neither creation, nor motherhood (the most important protective factor for women) could predominate. Neither moving to England, nor her last confessional book, "The Bell Jar" could cure her many kind of wounds, and these factors together lead to the suicide.

Suicide in early China and the current West.

OBJECTIVES:: To characterize suicide in early China, as a means of extending knowledge of this behaviour. METHODS:: We examined Romance of the Three Kingdoms, and collated and considered relevant details. RESULTS:: In early China, loss of authority/status, loved ones and fortune were triggers for suicide. The expression of the intention to suicide, either by word or action, was observed and elicited a placating response. Less frequent, but nevertheless clearly recorded, were accounts of suicide completed to satisfy the wishes of others. CONCLUSIONS:: The suicide and related behaviour of early China shares many features with late Western societies, but one form (to satisfy the wishes of others) is currently undetected.

Suicide of Australians during the Vietnam War.

OBJECTIVES: National suicide rates fall during times of war. This fits with the notion of the population coming together against a common foe. But, what happens in the case of a war which is not fully supported, which draws the population and families apart? We consider this question by examining the Australian suicide rates during the divisive Vietnam War. METHODS: We graphed and examined the Australian suicide figures for 1921-2010. RESULTS: We found clear evidence of a decrease in the suicide rate for World War II (consistent with other studies), but a marked elevation of suicide during the Vietnam War. CONCLUSIONS: The elevation of the Australian suicide rate during the Vietnam War is consistent with Durkheim's social integration model - when social integration is lessened, either by individual characteristics or societal characteristics, the risk of suicide rises.

The views of Wilhelm Griesinger (1817-68) on suicidality or 'self-murder'.

To date, little attention has been paid to the fact that a whole section in Wilhelm Griesinger's textbook is devoted to suicidality. Griesinger perceived suicide as a distinct entity. In his opinion, only one-third of all suicides were committed by people suffering from mental disorders; heredity and brain anomalies could also be involved. Therapeutically, Griesinger recommended removing all potential means for suicide and admitting people at risk to a psychiatric hospital. Since his textbook was a standard work, his views reveal what young doctors could have learned about suicidality in German psychiatry of the second half of the nineteenth century.

Age, period and cohort effects on suicide mortality in Russia, 1956-2005.

BACKGROUND: Russian suicide mortality rates changed rapidly over the second half of the twentieth century. This study attempts to differentiate between underlying period and cohort effects in relation to the changes in suicide mortality in Russia between 1956 and 2005. METHODS: Sex- and age-specific suicide mortality data were analyzed using an age-period-cohort (APC) approach. Descriptive analyses and APC modeling with log-linear Poisson regression were performed. RESULTS: Strong period effects were observed for the years during and after Gorbachev's political reforms (including the anti-alcohol campaign) and for those following the break-up of the Soviet Union. After mutual adjustment, the cohort- and period-specific relative risk estimates for suicide revealed differing underlying processes. While the estimated period effects had an overall positive trend, cohort-specific developments indicated a positive trend for the male cohorts born between 1891 and 1931 and for the female cohorts born between 1891 and 1911, but a negative trend for subsequent cohorts. CONCLUSIONS: Our results indicate that the specific life experiences of cohorts may be important for variations in suicide mortality across time, in addition to more immediate effects of changes in the social environment.

Lessons Learned from 50 Years of Violence Prevention Activities in the African American Community.

PURPOSE: This article covers violence prevention (homicide and suicide) activities in the African American community for nearly 50 years. METHOD: Drawing on lived experience the works of early and recent efforts by African American physicians, the author illustrates we know a great deal about violence prevention in the African American community. RESULTS: There remains challenges of implementation and political will. Further, most physicians, like the public, are confused about the realities of homicide and suicide because of the two different presentations both are given in the media and scientific literature. CONCLUSIONS: Responses to homicide and suicides should be based on science not distorted media reports. There are violence prevention principles that, if widely implemented, could stem the tide of violence.