Final Report for Print

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MANILA, Philippines — The suicide rate among Filipinos has gone up in the last 21 years with the majority of cases involving young people aged 24 years old and below, according to studies. They also showed that in most instances, the person who committed suicide did so during summer or in the morning when all family members had gone off to work or school, leaving the house empty. Based on records culled from the National Statistics Office, the suicide rate from 1984 to 2005 went up from 0.46 to seven out of every 200,000 men. On the other hand, it jumped from 0.24 to two for every 200,000 women. While the figures might seem insignificant compared with those from neighboring countries that recorded the highest suicide rates, the numbers have gone up from 1984 to 2005, especially among the Filipino youth, said Dr. Dinah Nadera, a psychiatrist and an associate professor of the University of the Philippines’ Open University who has been working on a suicide prevention strategy. “This simply means that there is an increasing trend of suicide [especially] among the youth, particularly in the age group 5 to 14 and 15 to 24,” Nadera said at last week’s media consultation on suicide prevention conducted by the World Health Organization (WHO) in Manila. Meanwhile, a study of around 300 cases collected from the records of hospitals and the police in 2008 and 2009 also revealed that the majority of suicides were carried out at home during summer, particularly during the Lenten season when Catholics observe fasting, prayer and penitence. “Of course, this is based on findings from selected cases. We are not saying that this is the general trend for both [suicide and attempted suicide cases],” Nadera said. Most of the suicides that were studied occurred in the morning—between 8:01 a.m. and noon— and on weekdays. “This is the time when people usually leave the house and go to work and this person who wants to die goes back when no one is home and carries out the suicide when there is no one there,” she explained. In contrast, the least number of cases were reported between 12:01 a.m. and 4 a.m., Nadera noted. The study also showed that the “leading methods” chosen by those who decided to end their lives was hanging, strangulation and suffocation. For those who tried to kill themselves but ended up just sustaining injuries, the preferred means ranged from self-poisoning (mainly ingestion of silver cleaner) to exposure to other unspecified chemicals and noxious substances. Nadera also noted that not all cases were due to depression. She stressed that while it might be a contributory factor, other factors could lead to a person’s decision to end one’s life such as low income and unemployment, medical conditions such as heart diseases and cancer; and marital status.

A rising number of cases has also been observed among married women compared to single women, she noted. Dr. Wang Xiangdong, WHO regional adviser in mental health and injury prevention, sounded the alarm over the growing number of people resorting to taking their lives among the young, stressing that suicide must be considered a public health issue rather than a mere event to be treated as a police case. In the Western Pacific Region, which consists of 37 countries and areas, including the Philippines, suicide is the leading cause of death in the age group of 15 to 39, according to Wang. “There are big gaps to effective suicide interventions and these are gaps in knowledge, gaps in translations of existing knowledge into interventions, and gaps in mental health and crisis support system,” Wang told the media recently. In the Philippines, many non-government organizations are running help centers for people with suicidal tendencies. Suicide prevention is given a low priority in many Western Pacific countries due to competing health problems, stigma and poor understanding of its incidence and aetiology. Little is known about the epidemiology of suicide and suicidal behaviour in the Philippines and although its incidence is reported to be low, there is likely to be under-reporting because of its nonacceptance by the Catholic Church and the associated stigma to the family. Depression is defined as mental illness in which a person experiences deep, unshakable sadness and diminished interest in nearly all activities. People also use the term depression to describe the temporary sadness, loneliness, or blues that everyone feels from time to time. In contrast to normal sadness, severe depression, also called major depression, can dramatically impair a person’s ability to function in social situations and at work. People with major depression often have feelings of despair, hopelessness, and worthlessness, as well as thoughts of committing suicide. Depression occurs in all parts of the world, although the pattern of symptoms can vary. Furthermore, younger generations are experiencing depression at an earlier age than did previous generations. Social scientists have proposed many explanations, including changes in family structure, urbanization, and reduced cultural and religious influences. Although it may appear anytime from childhood to old age, depression usually begins during a person’s 20s or 30s. The illness may come on slowly, then deepen gradually over months or years. On the other hand, it may erupt suddenly in a few weeks or days. A person who develops severe depression may appear so confused, frightened, and unbalanced that observers speak of a “nervous breakdown.” However it begins, depression causes serious changes in a person’s feelings and outlook. A person with major depression feels sad nearly every day and may cry often. People, work, and activities that used to bring them pleasure no longer do. Symptoms of depression can vary by age. In younger children, depression may include physical complaints, such as stomachaches and headaches, as well as irritability, “moping around,” social withdrawal, and changes in eating habits. They may feel unenthusiastic about school and other activities. In adolescents, common symptoms include sad mood, sleep disturbances, and

lack of energy. Elderly people with depression usually complain of physical rather than emotional problems, which sometimes leads doctors to misdiagnose the illness. Symptoms of depression can also vary by culture. In some cultures, depressed people may not experience sadness or guilt but may complain of physical problems. In Mediterranean cultures, for example, depressed people may complain of headaches or nerves. In Asian cultures they may complain of weakness, fatigue, or imbalance. If left untreated, an episode of major depression typically lasts eight or nine months. About 85 percent of people who experience one bout of depression will experience future episodes. A Appetite and Sleep Changes

Depression usually alters a person’s appetite, sometimes increasing it, but usually reducing it. Sleep habits often change as well. People with depression may oversleep or, more commonly, sleep for fewer hours. A depressed person might go to sleep at midnight, sleep restlessly, then wake up at 5 AM feeling tired and blue. For many depressed people, early morning is the saddest time of the day. B Changes in Energy Level

Depression also changes one’s energy level. Some depressed people may be restless and agitated, engaging in fidgety movements and pacing. Others may feel sluggish and inactive, experiencing great fatigue, lack of energy, and a feeling of being worn out or carrying a heavy burden. Depressed people may also have difficulty thinking, poor concentration, and problems with memory. C Poor Self-Esteem

People with depression often experience feelings of worthlessness, helplessness, guilt, and selfblame. They may interpret a minor failing on their part as a sign of incompetence or interpret minor criticism as condemnation. Some depressed people complain of being spiritually or morally dead. The mirror seems to reflect someone ugly and repulsive. Even a competent and decent person may feel deficient, cruel, stupid, phony, or guilty of having deceived others. People with major depression may experience such extreme emotional pain that they consider or attempt suicide. At least 15 percent of seriously depressed people commit suicide, and many more attempt it. D Psychotic Symptoms

In some cases, people with depression may experience psychotic symptoms, such as delusions (false beliefs) and hallucinations (false sensory perceptions). Psychotic symptoms indicate an especially severe illness. Compared to other depressed people, those with psychotic symptoms have longer hospital stays, and after leaving, they are more likely to be moody and unhappy. They are also more likely to commit suicide. Some depressions seem to come out of the blue, even when things are going well. Others seem to have an obvious cause: a marital conflict, financial difficulty, or some personal failure. Yet many people with these problems do not become deeply depressed. Most psychologists believe depression results from an interaction between stressful life events and a person’s biological and psychological vulnerabilities.

A

Biological Factors

Depression runs in families. By studying twins, researchers have found evidence of a strong genetic influence in depression. Genetically identical twins raised in the same environment are three times more likely to have depression in common than fraternal twins, who have only about half of their genes in common. In addition, identical twins are five times more likely to have bipolar disorder in common. These findings suggest that vulnerability to depression and bipolar disorder can be inherited. Adoption studies have provided more evidence of a genetic role in depression. These studies show that children of depressed people are vulnerable to depression even when raised by adoptive parents. Genes may influence depression by causing abnormal activity in the brain. Studies have shown that certain brain chemicals called neurotransmitters play an important role in regulating moods and emotions. Neurotransmitters involved in depression include norepinephrine, dopamine, and serotonin. Research in the 1960s suggested that depression results from lower than normal levels of these neurotransmitters in parts of the brain. Support for this theory came from the effects of antidepressant drugs, which work by increasing the levels of neurotransmitters involved in depression. However, later studies have discredited this simple explanation and have suggested a more complex relationship between neurotransmitter levels and depression. An imbalance of hormones may also play a role in depression. Many depressed people have higher than normal levels of hydrocortisone (cortisol), a hormone secreted by the adrenal gland in response to stress. In addition, an under active or overactive thyroid gland can lead to depression. A variety of medical conditions can cause depression. These include dietary deficiencies in vitamin B6, vitamin B12, and folic acid (see Vitamin); degenerative neurological disorders, such as Alzheimer’s disease and Huntington’s disease (see Chorea); strokes in the frontal part of the brain; and certain viral infections, such as hepatitis and mononucleosis. Certain medications, such as steroids, may also cause depression. B Psychological Factors

Psychological theories of depression focus on the way people think and behave. In a 1917 essay, Austrian psychoanalyst Sigmund Freud explained melancholia, or major depression, as a response to loss—either real loss, such as the death of a spouse, or symbolic loss, such as the failure to achieve an important goal. Freud believed that a person’s unconscious anger over loss weakens the ego, resulting in self-hate and self-destructive behavior. Cognitive theories of depression emphasize the role of irrational thought processes. American psychiatrist Aaron Beck proposed that depressed people tend to view themselves, their environment, and the future in a negative light because of errors in thinking. These errors include focusing on the negative aspects of any situation, misinterpreting facts in negative ways, and blaming them for any misfortune. In Beck’s view, people learn these self-defeating ways of looking at the world during early childhood. This negative thinking makes situations seem much worse than they really are and increases the risk of depression, especially in stressful situations. In support of this cognitive view, people with “depressive” personality traits appear to be more vulnerable than others to actual depression. Examples of depressive personality traits include

gloominess, pessimism, introversion, self-criticism, excessive skepticism and criticism of others, deep feelings of inadequacy, and excessive brooding and worrying. In addition, people who regularly behave in dependent, hostile, and impulsive ways appear at greater risk for depression. American psychologist Martin Seligman proposed that depression stems from “learned helplessness,” an acquired belief that one cannot control the outcome of events. In this view, prolonged exposure to uncontrollable and inescapable events leads to apathy, pessimism, and loss of motivation. An adaptation of this theory by American psychologist Lynn Abramson and her colleagues argues that depression results not only from helplessness, but also from hopelessness. The hopelessness theory attributes depression to a pattern of negative thinking in which people blame themselves for negative life events, view the causes of those events as permanent, and over generalize specific weaknesses as applying to many areas of their life. C Stressful Events

Psychologists agree that stressful experiences can trigger depression in people who are predisposed to the illness. For example, the death of a loved one may trigger depression. Psychologists usually distinguish true depression from grief, a normal process of mourning a loved one who has died. Other stressful experiences may include divorce, pregnancy, the loss of a job, and even childbirth. About 20 percent of women experience an episode of depression, known as postpartum depression, after having a baby. In addition, people with serious physical illnesses or disabilities often develop depression. People who experience child abuse appear more vulnerable to depression than others. So, too, do people living under chronically stressful conditions, such as single mothers with many children and little or no support from friends or relatives. V TREATMENT

Depression typically cannot be shaken or willed away. An episode must therefore run its course until it weakens either on its own or with treatment. Depression can be treated effectively with antidepressant drugs, psychotherapy, or a combination of both. Despite the availability of effective treatment, most depressive disorders go untreated and undiagnosed. Studies indicate that general physicians fail to recognize depression in their patients at least half of the time. In addition, many doctors and patients view depression in elderly people as a normal part of aging, even though treatment for depression in older people is usually very effective. A Antidepressant Drugs

Up to 70 percent of people with depression respond to antidepressant drugs. These medications appear to work by altering the levels of serotonin, norepinephrine, and other neurotransmitters in the brain. They generally take at least two to three weeks to become effective. Doctors cannot predict which type of antidepressant drug will work best for any particular person, so depressed people may need to try several types. Antidepressant drugs are not addictive, but they may produce unwanted side effects. To avoid relapse, people usually must continue taking the medication for several months after their symptoms improve.

Commonly used antidepressant drugs fall into three major classes: tricyclics, monoamine oxidase inhibitors (MAO inhibitors), and selective serotonin reuptake inhibitors (SSRIs). Tricyclics, named for their three-ring chemical structure, include amitriptyline (Elavil), imipramine (Tofanil), desipramine (Norpramin), doxepin (Sinequan), and nortriptyline (Pamelor). Side effects of tricyclics may include drowsiness, dizziness upon standing, blurred vision, nausea, insomnia, constipation, and dry mouth. MAO inhibitors include isocarboxazid (Marplan), phenelzine (Nardil), and tranylcypromine (Parmate). People who take MAO inhibitors must follow a diet that excludes tyramine—a substance found in wine, beer, some cheeses, and many fermented foods—to avoid a dangerous rise in blood pressure. In addition, MAO inhibitors have many of the same side effects as tricyclics. Selective serotonin reuptake inhibitors include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil). These drugs generally produce fewer and milder side effects than do other types of antidepressants, although SSRIs may cause anxiety, insomnia, drowsiness, headaches, and sexual dysfunction. Some patients have alleged that Prozac causes violent or suicidal behavior in a small number of cases, but the U.S. Food and Drug Administration has failed to substantiate this claim. Prozac became the most widely used antidepressant in the world soon after its introduction in the late 1980s by drug manufacturer Eli Lilly and Company. Many people find Prozac extremely effective in lifting depression. In addition, some people have reported that Prozac actually tranforms their personality by increasing their self-confidence, optimism, and energy level. However, mental health professionals have expressed serious ethical concerns over Prozac’s use as a “personality enhancer,” especially among people without clinical depression. Doctors often prescribe lithium carbonate, a natural mineral salt, to treat people with bipolar disorder (see Lithium). People often take lithium during periods of relatively normal mood to delay or even prevent subsequent mood swings. Side effects of lithium include nausea, stomach upset, vertigo, and frequent urination. B Psychotherapy

Studies have shown that short-term psychotherapy can relieve mild to moderate depression as effectively as antidepressant drugs. Unlike medication, psychotherapy produces no physiological side effects. In addition, depressed people treated with psychotherapy appear less likely to experience a relapse than those treated only with antidepressant medication. However, psychotherapy usually takes longer to produce benefits. There are many kinds of psychotherapy. Cognitive-behavioral therapy assumes that depression stems from negative, often irrational thinking about oneself and one’s future. In this type of therapy, a person learns to understand and eventually eliminate those habits of negative thinking. In interpersonal therapy, the therapist helps a person resolve problems in relationships with others that may have caused the depression. The subsequent improvement in social relationships and support helps alleviate the depression. Psychodynamic therapy views depression as the result of internal, unconscious conflicts. Psychodynamic therapists focus on a person’s past experiences and the resolution of childhood conflicts. Psychoanalysis is an example of this type of therapy. Critics of long-term psychodynamic therapy argue that its effectiveness is scientifically unproven.

C

Other Treatments

Electroconvulsive therapy (ECT) can often relieve severe depression in people who fail to respond to antidepressant medication and psychotherapy. In this type of therapy, a low-voltage electric current is passed through the brain for one to two seconds to produce a controlled seizure. Patients usually receive six to ten ECT treatments over several weeks. ECT remains controversial because it can cause disorientation and memory loss. Nevertheless, research has found it highly effective in alleviating severe depression. For milder cases of depression, regular aerobic exercise may improve mood as effectively as psychotherapy or medication. In addition, some research indicates that dietary modifications can influence one’s mood by changing the level of serotonin in the brain. Suicide, intentional, self-inflicted death. A uniquely human act, suicide occurs in all cultures. People who attempt or complete suicide usually suffer from extreme emotional pain and distress and feel unable to cope with their problems. They are likely to suffer from mental illness, particularly severe depression, and to feel hopeless about the future. Data for suicide deaths occurring between 1974 and 2005 were obtained from Philippine Health Statistics. Age- and sex-specific trends were examined graphically. Underreporting was investigated by comparing trends in suicides, accidents and deaths of undetermined intent. To provide a fuller picture of suicide in the Philippines, a comprehensive search for published papers, theses and reports on the epidemiology of suicide in the Philippines was undertaken The incidence of suicide in males increased from 0.23 to 3.59 per 100,000 between 1984 and 2005. Similarly, rates rose from 0.12 to 1.09 per 100,000 in females. Amongst females, suicide rates were highest in 15-24 year olds, whilst in males rates were similar in all age groups throughout the study period. The most commonly used methods of suicide were hanging, shooting and organophosphate ingestion. In non-fatal attempts, the most common methods used were ingestion of drugs, specifically isoniazid and paracetamol, or organophosphate ingestion. Family and relationship problems were the most common precipitants. While rates were lower compared to other countries, there is suggestive evidence of underreporting and misclassification to undetermined injury. Recent increases may reflect either true increase or better reporting of suicides.

IV CAUSES Suicidal behavior has numerous and complex causes. The biology of the brain, genetics, psychological traits, and social forces all can contribute to suicide. Although people commonly attribute suicide to external circumstances—such as divorce, loss of a job, or failure in school—most experts believe these events are triggers rather than causes in themselves. The majority of people who kill themselves suffer from depression that is often undiagnosed and untreated. Because depression so often underlies suicide, studying the causes of depression can help scientists understand the causes of suicide (see Depression: Causes). Other mental illnesses, such as bipolar disorder, schizophrenia, and anxiety disorders may also contribute to suicidal behavior.

A Biological Perspectives Research indicates that suicidal behavior runs in families, suggesting that genetic and biological factors play a role in one’s suicide risk. Among one community of Amish people in Pennsylvania, almost three quarters of all suicides that occurred over a 100-year period were in just four families. Studies of twins reared apart provide some support for a genetic influence in suicide. People may inherit a genetic predisposition to certain psychiatric disorders, such as schizophrenia and alcoholism, that increase the risk of suicide. In addition, an inability to control impulsive and violent behavior may have biological roots. Research has found lower than normal levels of a substance associated with the brain chemical serotonin in people with impulsive aggressiveness. B Psychological Theories In the early 1900s Austrian psychoanalyst Sigmund Freud developed some of the first psychological theories of suicide. He emphasized the role of hostility turned against the self. American psychiatrist Karl Menninger elaborated on Freud’s ideas. He suggested that all suicides have three interrelated and unconscious dimensions: revenge/hate (a wish to kill), depression/hopelessness (a wish to die), and guilt (a wish to be killed). An American psychologist considered to be a pioneer in the modern study of suicide, Edwin Schneidman, has described several common characteristics of suicides. These include a sense of unbearable psychological pain, a sense of isolation from others, and the perception that death is the only solution to problems about which one feels hopeless and helpless. Cognitive theorists, who study how people process information, emphasize the role of inflexible thinking or tunnel vision (“life is awful, death is the only alternative”) and an inability to generate solutions to problems. According to psychologists, many suicide attempts are a symbolic cry for help, an effort to reach out and receive attention. C Sociological Theories Most social scientists believe that a society’s structure and values can influence suicide rates. French sociologist Émile Durkheim argued that suicide rates are related to social integration—that is, the degree to which an individual feels part of a larger group. Durkheim found suicide was more likely when a person lacked social bonds or had relationships disrupted through a sudden change in status, such as unemployment. As one example of the significance of social bonds, suicide rates among adults are lower for married people than for divorced, widowed, or single people. Studies consistently show that although suicidal people do not appear to have greater life stress than others, they lack effective strategies to cope with stress. In addition, they are more likely than others to have had family loss and turmoil, such as the death of a family member, separation or divorce of their parents, or child abuse or neglect. The parents of those who attempt suicide have a greater frequency of

mental illness and substance abuse than other parents. However, suicide occurs in all types of families, including those with little apparent turmoil. Fluctuations in social and economic conditions frequently result in changes in the suicide rate. In the United States, for example, suicide rates declined during World War I (1914-1918) and World War II (1939-1945), when unemployment was low, but increased during the Great Depression of the 1930s, when unemployment was high. Occasionally, people commit suicide as a form of protest against the policies of a particular government. Mass suicides, in which large numbers of people kill themselves at the same time, are extremely rare. The most famous mass suicides occurred in AD 73 at Masada in what is now southern Israel, when 960 Jews killed themselves rather than face enslavement by Roman captors; and in 1978 in Jonestown, Guyana, when more than 900 cult members committed suicide on the orders of their leader, Jim Jones. V PREVENTION Because depression precedes most suicides, early recognition of depression and treatment through medication and psychotherapy are important ways of preventing suicide (see Depression: Treatment). In general, suicide prevention efforts aim to identify people with the highest risk of suicide and to intervene before these individuals become suicidal. A Risk Factors Certain aspects of a person’s life increase the likelihood that the person will attempt or complete suicide. Studies have shown that one of the best predictors of suicidal intent is hopelessness. People with a sense of hopelessness may come to perceive suicide as the only alternative to a pained existence. People with mental illnesses, substance-abuse disorders such as alcoholism or drug dependence, and behavioral disorders also have a higher risk of suicide. In fact, people suffering from diagnosable mental illnesses complete about 90 percent of all suicides. Physical illness also increases a person’s risk of suicide, especially when the illness is accompanied by depression. About one-third of adult suicide victims suffered from a physical illness at the time of their death. Other risk factors include previous suicide attempts, a history of suicide among family members, and social isolation. People who live alone or lack close friends may not receive emotional support that would otherwise protect them from despair and irrational thinking during difficult periods of life. B Signs of Suicidal Intent About 80 percent of people who complete suicide give warning signs, although the warnings may not be overt or obvious. These usually take the form of talking about suicide or a wish to die; statements about hopelessness, helplessness, or worthlessness; preoccupation with death; and references to suicide in drawings, school essays, poems, or notes. Other danger signs include sudden, dramatic, and unexplained changes in behavior and what are called “termination behaviors.” These behaviors include an interest in

putting personal affairs in order and giving away prized possessions, often accompanied by statements of sadness or despair. A person who observes these signs should ask the person in question whether he or she is thinking of suicide. If so, the observer should refer the person to a trained mental health professional to reduce the immediate risk of suicide and to treat the problems that led the person to consider suicide. Most suicides can be prevented because the suicidal state of mind is usually temporary. C Suicide Prevention Programs In the United States, mental health professionals established the first major suicide-prevention telephone hotlines in the 1950s. Counselors or trained volunteers usually staff the hotlines around the clock. The staff members provide a listening ear to those in despair and tell callers where they can go to receive professional help. Although hotlines provide a valuable service to people in crisis, research has shown that hotlines help only those that call. Young women call more frequently than do men, who have a greater risk of suicide. An increasing number of schools have suicide-prevention programs that train students, teachers, and school staff to recognize warning signs and tell them where to refer students at risk of suicide. These relatively new programs have not yet demonstrated their effectiveness at preventing youth suicide. Another prevention method involves restricting access to means of killing oneself. Barriers that prevent people from jumping off bridges, for example, and restrictions on access to firearms have shown some effectiveness in reducing suicides. Such methods introduce a delay during which suicidal feelings and decisions may change or rescuers can physically intervene. VI IMPACT ON OTHERS Suicide has a devastating emotional impact on surviving family members and friends. The intentional, sudden, and violent nature of the person’s death often makes others feel abandoned, helpless, and rejected. A family member or friend may have the added burden of discovering the body of the suicide victim. Parents often suffer exaggerated feelings of shame and guilt. Because of the social stigma, or shame, surrounding suicide, survivors may avoid talking to others about the person who died, and others may avoid the survivors. Despite these extra problems, research has shown that suicide survivors go through the same grieving process as other bereaved people and eventually recover from grief. Support groups may be particularly helpful for grieving suicide survivors. Some evidence suggests that highly publicized suicides—those of celebrities, for example—may cause vulnerable individuals, especially teens, to kill themselves. However, these findings are controversial and other studies have found no such imitative effect. VII ATTITUDES TOWARD SUICIDE

Many people feel uneasy talking about suicide, in part because of a social taboo on talking or learning about suicide. One popular myth is that suicide should not be mentioned around depressed people because it would plant the idea in their minds. But most mental health professionals agree that people who have suicidal wishes can benefit by talking about their feelings. Attitudes toward suicide have varied widely throughout history. In ancient Egypt people considered suicide a humane way to escape intolerable conditions. For centuries in Japan people respected instances of harakiri (ritual suicide with a dagger) as a way for a shamed individual to make amends for failure or desertion of duty. During World War II Japanese kamikaze pilots considered it an honor to perform suicidal missions by crashing their airplanes into an enemy target. In India women were once expected to burn themselves on a funeral pyre after their husband died, a custom known as suttee. In many other societies, however, suicide has been strongly condemned or made illegal. The Greek philosopher Plato strongly disapproved of suicide. In general, ancient Roman governments opposed suicide when the state stood to lose assets, such as soldiers and slaves. Suicide was clearly prohibited by Judaism unless one faced capture by an enemy, as in the mass suicides at Masada. Christianity has generally condemned suicide as a failure to uphold the sanctity of human life. In the 4th century AD, Saint Augustine decreed suicide a sin. By the Middle Ages, the Roman Catholic Church forbade the burial of suicide victims in consecrated ground. English law considered suicide to be a crime punishable by the forfeiture of goods and property to the government unless the suicide was the result of madness or illness. This criminal view of suicide immigrated to colonial America and was adopted by individual states. Today, with more modern views of mental illness and concern for the rights of survivors, most major religions offer compassion and traditional funeral rites in cases of suicide. No U.S. state now considers suicide a crime. Helping someone complete suicide, however, is criminally punishable in several states.

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