HONESTY, LIES, AND SUICIDE

A. HONESTY What is honesty? Many children understand a definition of honesty to be "don't lie". But a complete definition of honesty also means that an honest person doesn't do things that are morally wrong. If something you do is breaking the law or you have to hide it because you'll get in trouble, you are probably not being honest. Honesty refers to a facet of moral character and connotes positive and virtuous attributes such as integrity, truthfulness, and straightforwardness, including

straightforwardness of conduct, along with the absence of lying, cheating, theft, etc. Furthermore, honesty means being trustworthy, loyal, fair, and sincere. "Honesty is the best policy" is a proverb of Benjamin Franklin. However, the quote "Honesty is the first chapter in the book of wisdom" is attributed to Thomas Jefferson, as used in a letter to Nathaniel Macon. And then more opinions about honesty is honesty is speaking the truth. Lying is not honest (also called dishonest) because you are saying something that isn't true. Examples of this form of honesty include: Honesty means you don't say things about people that aren't true. You are not being honest if you make up rumors about someone. Being honest means you admit to your actions, even if you'll get in trouble. You are not being honest if deny you did something wrong when you really did it. Honesty means you explain how a situation really happened. You are not being honest if you say something happened one way when it really happened another way. What is honesty? Honesty is in how you act.. When you do something you know is morally wrong, or when you have to hide your actions because you know they are wrong, you are not being honest. Being honest means you act in a way that you know is the right thing to do.

This part of the definition of honesty includes not hiding the truth (deceiving), not breaking rules to gain an advantage (cheating), and not taking something that isn't yours (stealing) and any other action that you would hide because it is against what you consider morally right. What is being honest with yourself? A big part of honesty is what you say and how you act toward others. But another part of the definition of honesty is whether you treat yourself the same way. Being honest with yourself means you really know why you are acting in a certain way or whether what you tell yourself is true. This part of the definition of honesty includes: You are not being honest with yourself if you say something mean to a friend and tell yourself it's for their own good, when really you are trying to get even for something they did to you. You are not being honest with yourself if you are trying to convince yourself you didn't really do something wrong, or it wasn't that bad, even though you really did it.

How to Be Honest Honesty is said to be the best policy. Being honest with others and yourself can be challenging. Political correctness, being sensitive of other people's feelings, and facing uncomfortable truths about yourself usually requires much patience, vigilance, and hard work 1. Understand the workings of dishonesty Most learn dishonesty as children upon realizing that different behaviors result in different outcomes. For example, saying certain things (or not saying certain things) garnered desirable approval and praise, or the undesirable disapproval and censure, if not punishment: dishonestly achieving desired results was always temptingly easy. With time the thought processes behind such actions became so unconscious and automatic that ethics and negative consequences are tossed aside. (see Warnings below). Dishonesty often becomes a tool to:

Pretend that there is nothing wrong with us Shift blame to others Avoid embarrassment Distract ourselves

Minimize conflict. Avoid responsibility or work.

2. Fess up Acknowledge past dishonesty whether you took a cookie and then denied it or blatantly lied about whose fault an automobile accident was. Although reviewing your past transgressions can create discomfort and guilt, recognizing past dishonesty can reveal and help you stop patterns of lies.

If you feel guilty for having been dishonest in the past, then apologize those to whom you lied or creatively set things right. For example, if you kept money that you knew wasn't yours and didn't make a good faith effort to return it to its owner, then return an equivalent or greater amount to its rightful owner or, if you cannot locate the owner, donate an equivalent or greater amount to charity. If you've lied to a person who plays an important role in your life (a significant other, relative, or friend) then come clean.

List your potential weaknesses, which may be as simple as a tendency to make up excuses for failures or as complicated as kleptomania. Dishonesty stems from fear: find and face it. List problems and then deal with them to consciously battle these habits. If you find yourself lying because you fear disapproval from someone, for example, then you may need to learn how to stop being a people pleaser and be yourself. Most importantly, so admit your errors that you can forgive yourself and use those experiences to reinforce your determination to improve. You can't fix what you ignore.

3. Think honestly So doing may sound silly, but prejudices and preconceived ideas can blur the truth: neither take things at face value nor assume when you read, see, or hear something. Offer the benefit of the doubt and be skeptical where necessary. When you make a commitment to communicating and understanding the truth, you may humblingly realize that most of what we believe to be knowledge is actually comprised of assumptions. Consider the Jewish proverb: "What you don't see with your eyes, don't witness with your mouth."

4. Practice being honest on the simple things, especially where "coloring" the facts is meaningless The situations range from speaking the truth to avoiding such simple, thoughtless acts as picking up someone's pencil or grabbing an apple off the neighbor's tree to snack on without thinking about it). Abraham Lincoln became famous for going to great lengths to return a few cents that that were not his--hence his nickname, "Honest Abe". Applying honesty to little things builds a general habit of honesty.

5. Exercise tact We all know that being literally honest can hurt feelings and sour friendships. It can also be misinterpreted as criticism or a lack of support. A "white lie" can be very tempting when dealing with sensitive loved ones (especially children), but you can still be honest by being creative in how you express the truth.

Emphasize the positive. Shift the focus away from what, in all honesty, you think is negative. Instead of saying "No, I don't think you look good in those pants" say "They're not as flattering as the black dressthat dress really looks amazing on you. Have you tried it on with those stockings you wore to my cousin's wedding last year?"

You have the right to remain silent. If you're pushed into a corner and don't know how to respond, say "Can we talk about this another time?" or "I really don't feel comfortable talking about this. You should really address this with..." Don't say "I don't know" if you really do knowit can come back to bite you. The person might realize that you know something, and they might get pushy. Repeat yourself and leave the conversation as quickly as possible.

When all else fails, be honestbut gently. Wrap the potentially hurtful truth in appreciation, praise, and, if applicable, affection

6. Find a balance between full disclosure and privacy Being honest doesn't necessitate revealing all your (or anybody else's) business. We leave some information unmentioned because it is not information to which others are entitled; withholding information that you know should be disclosed nevertheless constitutes lying by omission. For instance, not telling a romantic partner

of a child or past marriage is objectionable to most. Deciding what a person should or should not know is a personal decision. Although a person may be better off not knowing something, hiding that information is not necessarily in their best interest. Follow your gut and introject: "If I were in their shoes, would I rightfully feel betrayed if this information wasn't shared with me at an appropriate time?"

7. Honesty makes us vulnerable by revealing to others our selves and mistakes. They may therefore more hurtfully criticize and reject us than if we'd hidden the truth or lied to begin with. The truth sometimes simply hurts, but honesty develops character, credibility, and trust--all of which build self-esteem and improve your relationships. Being honest isn't a goal that you check off a listit's an ongoing process that will both challenge and benefit you throughout your life.

B. LIES What is a lie? A lie is a false statement to a person or group made by another person or group who knows it is not the whole truth, intentionally. The kinds of Lie: a) A barefaced (or bald-faced) lie is one that is obviously a lie to those hearing it. b) A Big Lie is a lie which attempts to trick the victim into believing something major which will likely be contradicted by some information the victim already possesses, or by their common sense. c) To bluff is to pretend to have a capability or intention one does not actually possess. d) Bullshit is often used to make the audience believe that one knows far more about the topic by feigning total certainty or making probable predictions. e) An emergency lie is a strategic lie told when the truth may not be told because, for example, harm to a third party would result. f) An exaggeration (or hyperbole) occurs when the most fundamental aspects of a statement are true, but only to a limited extent. g) A fabrication is a lie told when someone submits a statement as truth without knowing for certain whether or not it actually is true. h) A half-truth is a deceptive statement that includes some element of truth. The statement might be partly true, the statement may be totally true but only part of the

whole truth, or it may employ some deceptive element, such as improper punctuation, or double meaning, especially if the intent is to deceive, evade, blame, or misrepresent the truth. i) An honest lie (or confabulation) is defined by verbal statements or actions that inaccurately describe history, background, and present situations. j) Perjury is the act of lying or making verifiably false statements on a material matter under oath or affirmation in a court of law, or in any of various sworn statements in writing. White lies are minor lies which could be considered to be harmless, or even beneficial, in the long term. k) A lie-to-children is a lie, often a platitude, which may use euphemism(s), which is told to make an adult subject acceptable to children. Common examples include "The stork brought you" (in reference to childbirth) and the existence of Santa Claus, the Tooth Fairy or the Easter Bunny. l) A polite lie is a lie that a politeness standard requires, and which is usually known to be untrue by both parties. Whether such lies are acceptable is heavily dependent on culture. A common polite lie in international etiquette is to decline invitations because of "scheduling difficulties." m) White lies are minor lies which could be considered to be harmless, or even beneficial, in the long term. White lies are also considered to be used for greater good. A common version of a white lie is to tell only part of the truth, therefore not be suspected of lying, yet also conceal something else, to avoid awkward questions. White lies are also often used to shield someone from a hurtful or emotionally damaging truth, especially when not knowing the truth is completely harmless. Consequences Once a lie has been told, there can be two alternative consequences: it may be discovered or remain undiscovered. Under some circumstances, discovery of a lie may discredit other statements by the same speaker and can lead to social or legal sanctions against the speaker, such as ostracizing or conviction for perjury. When a lie is discovered, the state of mind and behavior of the lie teller (liar) is no longer predictable. The discoverer of a lie may also be convinced or coerced to collaborate with the liar, becoming part of a conspiracy. They may actively propagate the lie to other parties, actively

prevent the lie's discovery by other parties, or simply omit publicizing the lie (a secondary lie of omission). In culture Close-up of the bronze statue depicting a walking Pinocchio, named Walking to Bors by Jim Dine

Cultural references

Carlo Collodi's Pinocchio was a wooden puppet often led into trouble by his propensity to lie. His nose grew with every lie; hence, long noses have become a caricature of liars.

A famous anecdote by Parson Weems claims that George Washington once cut a cherry tree over when he was a small child. His father asked him who cut the cherry tree and Washington confessed his crime with the words: "I'm sorry, father, I cannot tell a lie." The anecdote has been proven to be a completely fictional story.

The Boy Who Cried Wolf, a fable attributed to Aesop about a boy who continually lies a wolf is coming. When a wolf does appear nobody believes him anymore.

Fiction

In the film Big Fat Liar, the story producer Marty Wolf (a notorious and proud liar himself) steals from student Jason Shepard, tells of a character whose lies become out of control to the point where each lie he tells causes him to grow in size.

In the film Liar Liar, the lawyer Fletcher Reede (Jim Carrey) cannot lie for 24 hours, due to a wish of his son that magically came true.

In the 1985 Max Headroom, the title character comments that one can always tell when a politician lies because "their lips move." The joke has been widely repeated and rephrased.

Augustine's taxonomy Augustine of Hippo wrote two books about lying: On Lying (De Mendacio) and Against Lying (Contra Mendacio). He describes each book in his later work, Retractions. Based on the location of De Mendacio in Retractions, it appears to have been written about 395 AD. The first work, On Lying, begins: "Magna qustio est de Mendacio" ("There is a great question about Lying"). From his text, it can be derived that St. Augustine divided lies into eight categories, listed in order of descending severity:

Lies in religious teaching Lies that harm others and help no one Lies that harm others and help someone Lies told for the pleasure of lying Lies told to "please others in smooth discourse" Lies that harm no one and that help someone materially Lies that harm no one and that help someone spiritually Lies that harm no one and that protect someone from "bodily defilement"

Augustine wrote that lies told in jest, or by someone who believes or opines the lie to be true are not, in fact, lies. Psychology The capacity to lie is noted early and nearly universally in human development. Social psychology and developmental psychology are concerned with the theory of mind, which people employ to simulate another's reaction to their story and determine if a lie will be believable. The most commonly cited milestone, what is known as Machiavellian intelligence, is at the age of about four and a half years, when children begin to be able to lie convincingly. Before this, they seem simply unable to comprehend why others do not see the same view of events that they doand seem to assume that there is only one point of view, which is their own. Young children learn from experience that stating an untruth can avoid punishment for misdeeds, before they develop the theory of mind necessary to understand why it works. In this stage of development, children will sometimes tell outrageous and unbelievable lies,

because they lack the conceptual framework to judge whether a statement is believable, or even to understand the concept of believability. When children first learn how lying works, they lack the moral understanding of when to refrain from doing it. This takes years of watching people tell lies, and the results of these lies, to develop a proper understanding. Propensity to lie varies greatly between children, some doing so habitually and others being habitually honest. Habits in this regard are likely to change in early adulthood. Religious perspectives It is alleged that some belief systems may find lying to be justified. Leo Tolstoy is cited as describing religious institutions as "the product of deception [and] lies for a good purpose". C. SUICIDE Suicide (Latin suicidium, from sui caedere, "to kill oneself") is the act of intentionally causing one's own death. Suicide is often committed out of despair, the cause of which is frequently attributed to a mental disorder such as depression, bipolar disorder, schizophrenia, borderline personality disorder, alcoholism, or drug abuse. Stress factors such as financial difficulties or troubles with interpersonal relationships often play a role. Efforts to prevent suicide include limiting access to firearms, treating mental illness and drug misuse, and improving economic development. The most commonly used method of suicide varies by country and is partly related to availability. Common methods include: hanging, pesticide poisoning, and firearms. Around 800,000 to a million people die by suicide every year, making it the 10th leading cause of death worldwide. Rates are higher in men than in women, with males three to four times more likely to kill themselves than females. There are an estimated 10 to 20 million non-fatal attempted suicides every year. Attempts are more common in young people and females. Views on suicide have been influenced by broad existential themes such as religion, honor, and the meaning of life. The Abrahamic religions traditionally consider suicide an offense towards God due to the belief in the sanctity of life. During the samurai era in Japan, seppuku was respected as a means of atonement for failure or as a form of protest. Sati, a now

outlawed East Indian practice, expected the widow to immolate herself on her husband's funeral pyre, either willingly or under pressure from the family and society. Definition of Suicide Suicide, also known as completed suicide, is the "act of taking one's own life". Attempted suicide or non-fatal suicidal behavior is self-injury with the desire to end one's life that does not result in death. Assisted suicide is when one individual helps another bring about their own death indirectly via providing either advice or the means to the end. This is in contrast to euthanasia, where another person takes a more active role in bringing about a person's death. Suicidal ideations is thoughts of ending one's life but not taking any active efforts to do so. Signs and symptoms Suicidal ideation has a straightforward definition suicidal thoughts but there are some other related signs and symptoms. Some symptoms or co-morbid conditions may include unintentional weight loss, feeling helpless, feeling alone, excessive fatigue, low selfesteem, presence of consistent mania, excessively talkative, intent on previously dormant goals, feel like one's mind is racing. The onset of symptoms like these with an inability to get rid of or cope with their effects, a possible form of psychological inflexibility, is one possible trait associated with suicidal ideation. They may also cause psychological distress, which is another symptom associated with suicidal ideation. Symptoms like these related with psychological inflexibility, recurring patterns, or psychological distress may in some cases lead to the onset of suicidal ideation. Other possible symptoms and warning signs include:

Hopelessness Anhedonia Insomnia Depression Severe anxiety Impaired concentration Psychomotor agitation Panic attack Severe remorse

Scales

Beck Scale for Suicide Ideation Columbia Suicide Severity Rating Scale The Kessler Psychological Distress Scale (K10)
o

This test does not measure suicidal ideation directly, but there may be value in its administration as an early identifier of suicidal ideation. High scores of psychological distress are in some cases associated with suicidal ideation.

Risk factors There are numerous indicators that one can look for when trying to detect suicidal ideation. There are also situations in which the risk for suicidal ideation may be heightened. The risk factors for suicidal ideation can be divided into 3 categories: psychiatric disorders, life events, and family history. 1. Psychiatric disorders There are several psychiatric disorders that appear to be comorbid with suicidal ideation or considerably increase the risk of suicidal ideation. The following list includes the disorders that have been shown to be the strongest predictors of suicidal ideation. It should be noted, however, that these are not the only disorders that can increase risk of suicidal ideation. The disorders in which risk is increased the greatest include:

Major depressive disorder Dysthymia Bipolar disorder Post-traumatic stress disorder (PTSD) Personality disorders Psychosis (anxiety or detachment from reality) Paranoia Schizophrenia Drug abuse

Prescription drug side effects Some prescription drugs, such as selective serotonin re-uptake inhibitors, can have suicidal ideation as a side effect. Moreover, these drugs' intended effects can themselves have the unintended or undesired consequence of an increased individual risk and collective rate of suicidal behavior: Among the set of persons taking the medication, a subset feel bad enough to want to commit suicide (or to desire the perceived results of suicide) but are inhibited by depression-induced symptoms, such as lack of energy and motivation, from following through with an attempt. Among this subset, a "sub-subset" may find that the medication alleviates their physiological symptoms (such as lack of energy) and secondary psychological symptoms (e.g., lack of motivation) before or at lower doses than it alleviates their primary psychological symptom of depressed mood. Among this group of persons, the desire for suicide and/or its effects persists even as major obstacles to suicidal action are removed, with the effect that the incidences of suicide attempt and of completed suicide increase. 2. Life events Life events are strong predictors of increased risk for suicidal ideation. Furthermore, life events can also lead to or be comorbid with the previous listed psychiatric disorders and predict suicidal ideation through those means. Life events that adults and children face can be dissimilar and for this reason, the list of events that increase risk can vary in adults and children. The life events that have been shown to increase risk the greatest are:

Alcohol abuse
o

Studies have shown that individuals who binge drink, rather than drink socially, tend to have higher rates of suicidal ideation.

Certain studies associate those who experience suicidal ideation with higher alcohol consumption.

Certain studies associate those who experience suicidal ideation with unemployment.

Not only do some studies show that solitary binge drinking can increase suicidal ideation, but there is a positive feedback relationship causing those who have more suicidal ideation to have more drinks per day in a solitary environment.

Loss of family and/or friends

Other studies have found that tobacco use is correlated with depression and suicidal ideation.

Unplanned pregnancy. Bullying, including cyberbullying. Previous suicide attempts.

o

Having previously attempted suicide is one of the strongest indicators of future suicidal ideation or suicide attempts.

Military experience
o

Military personnel who show symptoms of PTSD, major depressive disorder, alcohol use disorder, and generalized anxiety disorder show higher levels of suicidal ideation.

Community violence Undesired changes in body weight

o o

Women: increased BMI increases chance of suicidal ideation Men: severe decrease in BMI increases chance of suicidal ideation

In general, the obese population has increased odds of suicidal ideation in relation to individuals that are of average-weight

Exposure and attention to suicide related images or words.

3. Family history

Parents with a history of depression

o

Valenstein et al. studied 340 adult offspring whose parents had depression in the past. They found that 7% of the offspring had suicidal ideation in the previous month alone

Abuse
o o

Childhood: physical abuse Adolescence: physical and sexual abuse

Family violence Childhood residential instability

o

Certain studies associate those who experience suicidal ideation with family disruption.

Relationships with parents and friends According to a study conducted by Ruth X. Liu of San Diego State University, a significant connection was found between the parentchild relationships of adolescents ranging from early, middle and late adolescence and their likelihood of suicidal ideation. The study consisted of measuring relationships between mothers and daughters, fathers and sons, mothers and sons and fathers and daughters. The relationships between fathers and sons during early and middle adolescence shows an inverse relationship to suicidal ideation. Closeness with the father in late adolescence is "significantly related to suicidal ideation". Liu goes on to explain the relationship found between closeness with the opposite sex parent and the child's risk of suicidal thoughts. It was found that boys are better protected from suicidal ideation if they are close to their mothers through early and late adolescence; whereas girls are better protected by having a close relationship with their father during middle adolescence. An article published in 2010 by Zappulla and Pace found that suicidal ideation in adolescent boys is exacerbated by detachment from the parents when depression is already present in the child. Lifetime prevalence estimates of suicidal ideation among nonclinical populations of adolescents generally range from 60% and in many cases its severity increases the risk of completed suicide. Prevention Early detection and treatment are the best ways to prevent suicidal ideation and suicide attempts. If signs, symptoms, or risk factors are detected early then the individual will hopefully seek treatment and help before attempting to take their own life. In a study of individuals who did commit suicide, 91% of them likely suffered from one or more mental illnesses. However, only 35% of those individuals were treated or being treated for a mental illness. This emphasizes the importance of early detection; if a mental illness is detected, it can be treated and controlled to help prevent suicide attempts. Another study investigated strictly suicidal ideation in adolescents. This study found that depression symptoms in adolescents as early as grade 9 is a predictor of suicidal ideation. Most people with long-term suicidal ideation do not seek professional help.

The previously mentioned studies point out the difficulty that mental health professionals have in motivating individuals to seek and continue treatment. Ways to increase the amount of individuals who seek treatment may include:

Increasing the availability of therapy treatment in early stage Increasing the publics knowledge on when psychiatric help may be beneficial to them
o

Those who have adverse life conditions seem to have just as much risk of suicide as those with mental illness.

A study conducted by researchers in Australia set out to determine a course of early detection for suicidal ideation in teens stating that "risks associated with suicidality require an immediate focus on diminishing self-harming cognitions so as to ensure safety before attending to the underlying etiology of the behavior". A Psychological Distress scale known as the K10 was administered monthly to a random sample of individuals. According to the results among the 9.9% of individuals who reported "psychological distress (all categories)" 5.1% of the same participants reported suicidal ideation. Participants who scored "very high" on the Psychological Distress scale "were 77 times more likely to report suicidal ideation than those in the low category". In a 1-year study conducted in Finland, 41% of the patients who later committed suicide saw a health care professional, most seeing a psychiatrist. Of those, only 22% discussed suicidal intent on their last office visit. In most of the cases, the office visit took place within a week of the suicide, and most of the victims had a diagnosed depressive disorder. There are many centers where one can receive aid in the fight against suicidal ideation and suicide. Hemelrijk et al. (2012) found evidence that assisting people with suicidal ideation via the internet versus more direct forms such as phone conversations has a greater effect. Substance use Most people are under the influence of sedative-hypnotic drugs (such as alcohol or benzodiazepines) when they commit suicide with alcoholism present in between 15% and

61% of cases. Countries that have higher rates of alcohol use and a greater density of bars generally also have higher rates of suicide with this link being primarily related to distilled spirit use rather than total alcohol use. About 2.23.4% of those who have been treated for alcoholism at some point in their life die by suicide. Alcoholics who attempt suicide are usually male, older, and have tried to commit suicide in the past. Between 3 and 35% of deaths among those who use heroin are due to suicide (approximately 14 fold greater than those who do not use). The misuse of cocaine and methamphetamines has a high correlation with suicide. In those who use cocaine the risk is greatest during the withdrawal phase. Those who used inhalants are also at significant risk with around 20% attempting suicide at some point and more than 65% considering it. Smoking cigarettes is associated with the risk of suicide. There is little evidence as to why this association exists; however it has been hypothesized that those who are predisposed to smoking are also predisposed to suicide, that smoking causes health problems which subsequently make people want to end their life, and that smoking affects brain chemistry causing a propensity for suicide. Cannabis however does not appear to independently increase the risk. Problem gambling Problem gambling is associated with increased suicidal ideation and attempts compared to the general population. Between 12 and 24% pathological gamblers attempt suicide. The rate of suicide among their spouses is three times greater than that of the general population. Other factors that increase the risk in problem gamblers include mental illness, alcohol and drug misuse. Medical conditions There is an association between suicidality and physical health problems such aschronic pain, traumatic brain injury, cancer, kidney failure (requiring hemodialysis, HIV, and systemic lupus erythematosus. The diagnosis of cancer approximately doubles the subsequent risk of suicide. The prevalence of increased suicidality persisted after adjusting for depressive illness and alcohol abuse. In people with more than one medical condition the risk was particularly high. In Japan, health problems are listed as the primary justification for suicide.

Sleep disturbances such as insomnia and sleep apnea are risk factors for depression and suicide. In some instances the sleep disturbances may be a risk factor independent of depression. A number of other medical conditions may present with symptoms similar to mood disorders, including hypothyroidism, Alzheimer's, brain tumors, systemic lupus erythematosus, and adverse effects from a number of medications (such as beta blockers and steroids). Psychosocial states A number of psychological states increase the risk of suicide including: hopelessness, loss of pleasure in life, depression and anxiousness. A poor ability to solve problems, the loss of abilities one used to have, and poor impulse control also play a role. In older adults the perception of being a burden to others is important. Recent life stresses such as a loss of a family member or friend, loss of a job, or social isolation (such as living alone) increases the risk. Those who have never married are also at greater risk. Being religious may reduce one's risk of suicide. This has been attributed to the negative stance many religions take against suicide and to the greater connectedness religion may give. Muslims, among religious people, appear to have a lower rate. Methods

Case fatality rate by suicide method in the United States. The leading method of suicide varies between countries. The leading methods in different regions include hanging, pesticide poisoning, and firearms. These differences are believed to be in part due to availability of the different methods. A review of 56 countries

found that hanging was the most common method in most of the countries, accounting for 53% of the male suicides and 39% of the female suicides. Worldwide 30% of suicides are from pesticides. The use of this method however varies markedly from 4% in Europe to more than 50% in the Pacific region. It is also common in Latin America due to easy access within the farming populations. In many countries, drug overdoses account for approximately 60% of suicides among women and 30% among men. Many are unplanned and occur during an acute period of ambivalence. The death rate varies by method: firearms 80-90%, drowning 65-80%, hanging 60-85%, car exhaust 40-60%, jumping 35-60%, charcoal burning 40-50%, pesticides 6-75%, medication overdose 1.5-4%. The most common attempted methods of suicide differ from the most common successful methods with up to 85% of attempts via drug overdose in the developed world. In United States, 57% of suicides involve the use of firearms with this method being somewhat more common in men than women. The next most common cause was hanging in males and self poisoning in females. Together these methods comprised about 40% of U.S. suicides. In Switzerland, where nearly everyone owns a firearm, the greatest number of suicides are by hanging. Jumping to one's death is common in both Hong Kong and Singapore at 50% and 80% respectively. In China the consumption of pesticides is the most common method. In Japan self disembowelment known as seppuku or hara-kiri still occurs however hanging is the most common. Treatment Treatment of suicidal ideation can be puzzling due to the fact that several medications have actually been linked to increasing or causing suicidal ideation in patients. Therefore, several alternative means of treating suicidal ideation are often used. The main treatments include: hospitalization, outpatient treatment, and medication/other modalities. 1. Hospitalization Hospitalization allows the patient to be in a secure, supervised environment to prevent their suicidal ideation from turning into suicide attempts. In most cases, individuals have the freedom to choose which treatment they see fit for themselves. However, there are several circumstances in which individuals can be hospitalized involuntarily. These circumstances are:

a) If an individual poses danger to self or others b) If an individual is unable to care for one's self Hospitalization may also be the best treatment if an individual:

Has access to lethal means Does not have social support or people to supervise them Has a suicide plan Has symptoms of a psychiatric disorder

2. Outpatient treatment Outpatient treatment allows individuals to remain at their place of residence and receive treatment when needed or on a scheduled basis. Before allowing patients the freedom that comes with outpatient treatment, physicians evaluate several factors of the patient. These factors include the patient's level of social support, impulse control and quality of judgment. After the patient passes the evaluation, they are often asked to consent to a "no-harm contract". This is a contract formulated by the physician and the family of the patient. Within the contract, the patient agrees not to harm themselves, to continue their visits with the physician, and to contact the physician in times of need. These patients are then checked on routinely to assure they are maintaining their contract and staying out of troublesome activities. 3. Medication Prescribing medication to treat suicidal ideation can be difficult. One reason for this is because many medications lift patients' energy levels before lifting their mood. This puts them at greater risk of following through with attempting suicide. Additionally, if a patient has a co-morbid psychiatric disorder, it may be difficult to find a medication that addresses both the psychiatric disorder and suicidal ideation. Therefore, the medication prescribed to one suicidal ideation patient may be completely different from the medication prescribed to another patient. However, there are several medications that seem to work fairly well for treating suicidal ideation:

Antidepressants - there are several antidepressants that physicians should refrain from prescribing due to their lethal potential in the case of an overdose. A common antidepressant to avoid is Tricyclic.

o o o o o o

Fluoxetine (Prozac) Sertraline (Zoloft) Paroxetine (Paxil) Fluvoxamine (Luvox) Venlafaxine (Effexor) Nefazodone (Serzone)