Suicides and the third age
Article Outline
- Abstract
- 1. Introduction
- 2. Elderly and the suicide
- 3. Neuroendocrine alterations
- 4. Some conclusive remarks
- References
- Copyright
Abstract
The phenomenon of suicide represents a complex problem, the specific aspects of which should be examined by a multifactorial analysis, particularly in the elderly subjects. Although the research on risk factors continues to grow, only a limited knowledge is available on the biological changes increasing the risk for suicide. Similarly, limited information is at our disposal about the contributing psychosocial processes extending beyond the demographic factors. Although the best explored population is the elderly using primary care services, no proven interventions are known for the time being, although some efforts to test certain approaches reaching these older adults are under way. Apparently even more, continued efforts are needed to change the attitudes toward the mental illnesses and their treatments in general, in order to reach the older adults who are still outside of the health care services.
Keywords: Suicides in the elderly, Multifactorial analyses, Auto-aggressivity, Suicide behavior, Depressive crisis
1. Introduction
Suicides represent nowadays an important social phenomenon. Studies of this phenomenon apply two paradigms. The first is a personalistic one deriving from the psychoanalytical and antropophenomenic approaches, based on the idea that the suicidal concept means an unhealthy action. This approach contributed seriously to the revelation of the dynamics and the significance of these ideas. The second one is the sociological paradigm, which has always considered the human manifestations, among others the suicide action as a part of a more extensive cultural and socio-economical system (Waern et al., 2002).
There is no doubt that suicide represents a paradoxic phenomenon appearing as one of the ‘most personal’ actions realizable by an individual. Some scientists dealing with the suicide behavior consider this phenomenon not only fluctuating within the life cycle of an individual (psychological, social and cultural conditions), but also in correlation with the vital cycle of the society (Diekstra, 1990). It has also been emphasized that the ‘cultures’ at their zenith of their power and development, display more permissive attitudes toward the suicide, accompanied really an increased frequency of this type of behavior (Teasdale and Engberg, 2001).
The studies of Diekstra (1990) seem to indicate that the societies, the communities and social groups, being on the way of an increasing economic instability, of unemployment and the disruption of the primary traditional structure, or of the familiar grouping, the interpersonal violence in terms of the increased criminal behavior, should be considered as a high risk for an increase of suicides, not only in the younger ages, but also in the elderly. It is evident from these data that the evaluation of the suicide problematics necessitates a multidimensional and multifactorial analysis.
One can list various factors, as follows:
2. Elderly and the suicide
The present study is intended to analyze the observations on the psycho-pathological dynamics of suicides in the elderly population.
In spite of any progress resulting in an improvement of the conditions of the environment and survival, the old age remained the poorest phase of the life, where the traumatic events of psychological nature are increased exponentially by the incapacities and losses of the psycho-physical reserves. The last years of life are characterized by long periods of invalidity, by a continuous dependence on cures which maintain the vegetative functions, but often do not allow the patient to regain the auto-sufficiency (Antonini and Magnolfi, 1990). The extension of life is often not associated with an improvement of the quality of life, i.e. one can see a paradoxic phenomenon characterized by an increased recognition of the own disorders, but this knowledge is often not helpful in prevention of the diseases, but it may even be basis for a feeling of insecurity or depression (Gladstone et al., 2001).
In addition, there is another paradoxic phenomenon: in spite that today a major attention is dedicated to the old age, as compared with the past, it could not lose the aspects of weakness and dependence which had always been characteristic for it. One can record in an increasingly palpable manner an increase of the loneliness of the elderly, an increasing rootlessness in the society, and being devoid of a precise role in which the elderly could gain a recognition. One of the most striking examples confirming which was said above, is given by the so-called ‘social ambivalences’, or the ambivalences of the technological progress. An evident macroscopic example of this is offered by the television. While on the one hand, the television proved to be precious companion for the elderly, a tool activating their socialization, on the other hand, it has also increased macroscopically their passivity, and had redimensioned ‘their functions as holders of a knowledge derived from their direct experience dictated by the facts of life’ (Antonini and Magnolfi, 1990). Therefore, one has to consider the depressive conditions in the elderly as a ‘bio-psychosocial’ disturbance, favored or anyway heavily influenced by the aging process which is correlated to the stress bound to negative vital factors, such as first of all the loss of the closest family members, the financial independence and the personal autonomy. Senescence involves inevitably the periods of separations and affective losses, which do not become compensated by any affective counter-investments. It means that one has to be based more and more on itself, or on the loved objects of the past.
The presence of a continuous depreciation of both the psychical and physical planes, and the critical revision of the own lived past, often induces a feeling of failure, the frustration of the narcistic aspirations, evidenced by the decrease of the level of self-estimation, which derives from the recognition of the gaps between the real and ideal world, all represent an invasion into the ideas, where one can localize the depressive conditions of the elderly (Addonizio and Alexopoulos, 1993). All this means that we observe rather a narcistic catastrophe in the depressive crisis of the elderly, than a complicated mourning induced by an objective loss (Gladstone et al., 2001).
The elderly person feels to be a victim of an external aggression, therefore, the depressive crisis in reality is due to a loss of some objects which is strongly filled by narcistic valencies. In the depressive experience of the elderly one can sometimes recognize the personalistic and existential signs which had distinguished formerly his/her life, and which may assume now a more rigid, clear expression. The aggressivity toward the loved object manifests itself either as an impossibility to tolerate it, or as a wish to deteriorate it (Gilberti, 1985).
From a phenomenological point of view, depression and temporality are in close correlation with each other. During aging, the experienced temporality tends to be oriented toward the past, and the projections in the future are reduced. This situation determines a present in which the psychological contents are rather shifted toward the re-evocations than the future projects.
3. Neuroendocrine alterations
As it has already been evidenced, the geriatric conditions are associated with nosologic, phenomenologic, diagnostic and therapeutic problems. About 80% of the individuals above the age of 70 years suffer from one general and important disease, and more than 50% of them are in clinical conditions interfering with a complete functional autonomy (Rubenowitz et al., 2001). Physical diseases may derive from a depressive episode, or may be maintained by a previous state of dysthymia. As a matter of fact, complex neurosensorial and neuroendocrine alterations are well known in depressive disorders (Loosen, 1987). Numerous evidences show a decreased secretion of dopamine, noradrenaline and serotonine in elderly subjects. There exists a drop of acetylcholine and an increase of vasopressin, somatostatine and galanine (Pearson, 2002).
Advancing age is accompanied by an exponential deterioration of the dopamine receptors RD1 and RD2, as well as by a reduced activity of choline-acetyl-transferase; in addition, both oxidized and reduced levels of glutathione decrease with age (McCracken and Rubin, 1988). Depressed elderly subjects display a reduced gonadotropine production, which is further complicating the already existing physiological deficits (Rinne et al., 1990). Although elderly subjects maintain a circadian rhythm of the prolactine secretion, the daily amplitudes of variations decrease with age (Arnetz et al., 1986).
The age itself does not seem to alter considerably the hypothalamus–hypophysis–thyroide gland axis (Holsboer, 1988). This axis appears to be protected up to extreme conditions correlated with age, like dysthymic conditions and degenerative brain diseases. In spite of the maintenance of integrity of the hypothalamus–hypophysis–surrenal gland axis (Holsboer, 1988), in depression we can see a hyperfunction of this axis (Bernardini et al., 1988).
Alterations of the secretion and circadian rhythm of melatonin production have been observed in elderly subjects, in correlation with nutritional and neurotransmitter deficiencies (Youngsteadt et al., 2000).
As a matter of fact, the complex bio-psychological interrelationships have been so numerous, that the clinical approach and the psychogeriatric experience became of primary and irreplaceable importance, which may result in a synthesis of the multifactorial genesis and the origin of particular operative strategies (Waern et al., 2002).
4. Some conclusive remarks
The elderly of 75 years of age and above has the highest rate of suicides among all age groups, while the suicide attempts are fewer (Miller et al., 2001). As against the younger age groups, the elderly live more dramatically and more frequently in a social isolation. In suicide, the human body becomes the main locus of polarized and externalized conflicts and fears. The body of the elderly subjects becomes emarginated, devoid of importance in social and affective involvements, then it becomes pathologic, i.e. suffering from unsupportable vital conditions. Due to these properties, it is necessary to examine more deeply the problems of euthanasia and assisted suicide (Blank et al., 2001). In this context, suicide becomes a paradoxic behavior. ‘Perhaps, suicide is aimed at gaining a social recognition: this is the ambivalency of an apparently morbid praxis which is perhaps an intense expression of a will to live’ (Baudry, 1985).
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