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 Relational Changes

Edwin Schneidman described suicide as a dyadic event, such that the "suicidal drama" in the mind always involves interplay with another individual.[18] Many older adults find themselves outliving spouses, siblings, and friends; becoming empty–nesters; and losing work colleagues. Mr. A's deceased wife, his adult children, his friends, and peers at the Senior Center are possible partners in the dyad. The quality of his relationship with his wife, the manner of her death, his reactions to it, his identity as a widower, and the presence of survival guilt must be explored.[16] It is important to not exclude deceased loved ones in these conversations, because individuals have been reported to harbor unconscious fantasies of reunion with dead individuals by way of suicide.[19,20] Feelings of jealousy and rage toward younger, healthier family members have been reported.[21] Therefore, clinicians must attempt to understand Mr. A's relationships with his adult children, his perceived sense of support from them, and his notions of his own well–being in comparison to peers.

It is also important to note that Mr. A shared his death wish in a manner that was casual and unsolicited. It nonetheless evoked significant discomfort among the members of his treatment team. First, it is important to explore whether the death wish that Mr. A reported, although unsolicited, was an appeal for reassurance, one in which he is requesting that his clinicians affirm to him that his life is worth living.[16] The second consideration is one of unconscious motives on his part to trigger fear and discomfort in his care providers.[17] This could also be an effort on the part of Mr. A to establish himself as unique in a hospital environment in which one's unique identity is often lost under the labels of diagnoses.[22] Alternatively, his act could reflect changing attitudes toward the right to death and physician–assisted dying.