Rational Suicide in Elderly Adults: A Clinician's Perspective

Meera Balasubramaniam, MD, MPH


J Am Geriatr Soc. 2018;66(5):998-1001. 

In This Article

Aging and Bodily Changes

Orbach has discussed the relationship between body love, self–preservation, and suicide. He wrote that the tendency to view one's physical body favorably stems from early positive body care experiences from one's self and from caregivers. When the body is perceived as a source of contentment and pleasure, it offers a sense of self–preservation that protects against self–harm. Similarly, individuals with elements of body hate and rejection of their physical selves have been reported to have higher pain thresholds and an overall sense of emotional distancing. Such individuals feel less resistance toward destroying their bodies, a process that is necessary for suicide.[14] Adults with insulin–dependent diabetes have been reported to have ambivalent feelings toward their physical selves as a result of injecting themselves with insulin from early childhood, a process that, although therapeutic, is also superficially painful and destructive.[15]

Older adults experience functional and aesthetic changes in their bodies. Mr. A had recently undergone invasive surgery and used a walker. Illnesses such as cerebrovascular accidents, Parkinson's disease, and osteoarthritis, whose prevalence increases with age, bring about changes in the body to varying extents and at different rates. Older adults are left to redefine notions of their physical selves, and each individual's ability to integrate changes depends on long–held ideas of what their bodies meant to them. Mr. A's death wish must be understood in the context of his lifelong attitudes toward his body, his recent medical illness, and the physical changes resulting from it.[16] One must examine whether he has been able to integrate the effect of the recent surgery and the need to use a walker into this schema. Muskin described how medical illnesses evoke emotional and psychosocial stress and sometimes result in a sense of internal division between one's sick and healthy selves.[17] The "sick" self can be perceived intrapsychically as alien, with the "healthy" self harboring the wish to destroy it. The clinician must be attuned to the possibility of a split in the perception of a person's healthy and sick parts of themselves, especially in the event of acute illnesses.[16,17]