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 the Need for a Sense of Control

Throughout one's life, every individual develops internal and external mechanisms to manage distress. The internal ability to soothe oneself results from early experiences from comforting caregivers that have been integrated into one's schema. Every individual develops this innate ability to a different extent, depending on the quality of his or her early caregivers and subsequent life experiences. External sources of support in the form of family, friends, clinicians, and pleasurable activities, to name a few, complement this internal ability. Many older adults find themselves without these long–term external supports. It is possible that suicidal fantasies create a mental image of "a way out," providing a sense of control and comfort.[16,24]

Mr. A verbalized his suicidal wish without a clear timeline and vehemently denied the intent to act on his thoughts at the time of the above–mentioned evaluation. An understanding of the purpose that the suicidal thought serves Mr. A is important. An obvious consideration is that the suicidal thought is a step toward an actual self–injurious attempt, which must be taken seriously, but clinicians must also be aware of the possibility that entertaining a death wish might be offering him a superficial sense of mastery during a period of overwhelming uncertainty.[16]