507
CRITIQUE AND NOTES
MEAD, MARGARET. Social change and cultural surrogates. In C. Kluckhohn & H. A. Murray (Eds.),
Personality in nature, society, and culture. (2nd
ed.) New York: Knopf, 1955. Pp. 651-662.
PIERCE, B. F. Acculturation of Samoans in the
Mormon village of Laie, Territory of Hawaii.
Unpublished master's thesis, University of Hawaii,
1956.
PIERS, G., & SINGER, M. B. Shame and guilt. Springfield, 111.: Charles C Thomas, 1953.
REBELSKY, FREDA G. Sex differences in children's use
of confession. Paper read at Society for Research
in Child Development, Pennsylvania State University, March 1961.
WHITING, J. W. M. Sorcery, sin, and the superego:
A cross-cultural study of some mechanisms of
social control. In M. R. Jones (Ed.), Nebraska
symposium on motivation: 1959. Lincoln: Univer.
Nebraska Press, 1959. Pp. 174-197.
WHITING, J. W. M., & CHILD, I. L. Child training
and personality: A cross-cultural study. New
Haven: Yale Univer. Press, 1953.
(Received April 9, 1962)
Journal o/ Abnormal and Social Psychology
1963, Vol. 66, No. 5, 507-511
ROLE OF DREAD IN SUICIDAL BEHAVIOR
DONALD E. SPIEGEL
Veterans Administration Neuropsychiatric Hospital, Los Angeles
CHARLES NEURINGER
Suicide Prevention Center, Los Angeles
The proposition that inhibition of the experience of dread ordinarily evoked
by suicidal intention is a necessary condition for suicidal action was evaluated
by comparison of genuine and faked suicide notes. 3 judges, unaware that
some notes were simulated, independently rated 33 matched pairs of genuine
and faked notes in terms of 5 variables. On the basis of a combined x2 analysis,
confirmation was achieved for 4 of 5 hypotheses (p < .004) derived from a
theory of suicide. Genuine notes were less explicit in expressing suicidal
intention, contained less suicide synonyms, had more instructions to the
reader, and were more disorganized than faked notes. The findings suggest
that just prior to suicidal action, an individual's attention may be diverted
from the imminent self-destructive act or its potentially dread-inducing
negative ramifications.
Research interest in suicidal behavior has
increased markedly in the past few years. For
the most part, research effort has concentrated
on psychological test findings and presuicidal
behavior clues in terms of their correlations
with future suicidal activity. Only a few investigations such as those reported by Shneidman and Farberow (19S7a, 19S7b, 1959) reveal
much concern with the affective states of individuals prior to suicide, and these have been
mostly descriptive accounts.
The present investigation derived from a
theory of suicide by the senior author which
may be briefly summarized as follows. An
individual does not necessarily commit suicide
when the urge to die becomes stronger than the
urge to live, for everyone who has an overriding urge to die is able to take his own life.
Most individuals find themselves overcome by
dread as they approach suicidal action and are
unable to carry out their wish to die. This
intense experience of dread which arises in association with imminent personal destruction
serves as a natural brake against impulsive
suicidal action. In order for suicidal action to
become possible, some process must occur in
the individual which reduces this experience of
dread. This diminution of dread may be, in part,
a function of psychological defenses which
prevent the individual from a full realization of
the negative ramifications of the suicidal act, and
in part, a function of the natural decay of
intense emotional experience.
In this study an attempt was made to determine whether prior to genuine suicidal action
some process occurs in an individual which results in a reduction in the intensity of the
experience of dread associated with the imminent suicidal action or its anticipated ramifications, to explore and assess the nature of such
CRITIQUE AND NOTES
508
a process, and to discuss the feasibility of
employing therapeutic procedures to counteract
such a process as a suicide prevention measure.
It was anticipated that analysis of suicide
notes might reveal the operation of various
defenses which would tend to minimize the
experience of dread. In general, the notes were
expected to reflect a process of self-deception
with regard to the imminent suicidal event or a
decathexis of the intended suicidal action. It
was expected that this might be manifested in
a tendency to avoid discussing or alluding to
the suicidal intention or act, in a tendency for
the writer to concentrate attention upon events
other than suicide, or in a relatively bland or
unemotional suicidal communication. An extremely disorganized note might reflect a psychotic process which serves to protect the individual from realizing the full implications of
his imminent action, thus rendering dread unnecessary.
From these theoretical considerations, a set
of testable hypotheses were developed concerning differences in the content of genuine suicide
notes and notes written by matched individuals
asked to simulate suicidal intention. As compared to the simulated notes, the genuine notes
would (a) be less explicit in stating suicide as
an intention, (6) contain fewer words or terms
synonymous with suicide, (c) contain more instructions with regard to such things as disposal of property or the assuming of responsibilities by others, (d) have a less dramatic
impact upon the reader, and (e) contain more
instances of extreme disorganization.
METHOD
A series of 33 matched pairs of genuine and
faked suicide notes had been developed by Shneidman and Farberow (1957b). The real notes were
collected from the files of the Los Angeles County
Coroner's office, whereas the faked notes were
gathered from normal individuals who were asked
to write the suicide note that they would write if
they were going to commit suicide. The notes
were matched for age and occupation of the note
writer. All the note writers were male, Caucasian,
Protestant, married, native-born, and between the
ages of 25 and 59. In addition, the normal subjects
had been rigidly screened for the presence of psychopathology.
The three independent judges * used in the main
experiment were first instructed to rate each of
10 practice "suicide notes" in terms of five variables.
1
The authors wish to thank Charles W. Acker,
Linda C. Miller, and Luann Campeau for contributing their time as judges for this study.
A five-point rating scale was used for Variable 1
(relative explicitness of expressed suicidal intention),
Variable 4 (dramatic quality of the note), and
Variable 5 (disorganization of thought processes).
Dichotomous judgments were required for Variable 2
(presence of the word "suicide" or suicide synonyms), for Variable 3 (presence of instructions to
the reader with respect to the disposal of property
or the assuming of responsibilities). Rating criteria
were explicitly stated for each variable and scale
points defined for variables using the five-point
scale.
After satisfactory completion of the training
session, which involved discussions between experimenters and raters regarding the practice ratings, the
experimental set of 66 randomly ordered coded
notes were given to the judges independently along
with a set of written instructions and a rating
sheet. Judges were requested to rate each of the
66 "suicide notes" in terms of the same five variables.
They were unaware that half the notes were
simulated.
After the ratings were completed, the results
were tabulated and evaluated by the chi square
method for Hypotheses b and c. The Mann-Whitney
V method was used to evaluate Hypotheses a, d,
and e, since the data were in ordinal form. The
combined probabilities from, the three judges were
then evaluated by the chi square method suggested
by Gordon, Loveland, and Cureton (1952). This
is a method by which n independent rating samples
can be evaluated to determine the presence of a
statistical trend.
RESULTS
The results of this study confirmed four of the
five derived hypotheses in a statistically significant manner. Less explicitness, fewer mentions of
suicide or its synonyms, greater number of
instructions to the reader, and greater disorganization were found for the genuine notes. No
difference was observed in the dramatic quality of
the genuine and faked notes.
An examination of the 330 ratings by the three
judges revealed that Judge 1 agreed with Judges
2 and 3, 79% and 78% of the time, respectively,
and Judge 2 agreed with Judge 3, 71% of the
time.
A summary of the tabulations of the ratings
made by the three judges on the 33 matched pairs
of genuine and simulated suicide notes for the
five test variables is found in Table 1. The results
for all judges were similar in terms of the direction of the ratings and were in the predicted
direction except for Variable 4 (mean amount of
drama in the notes). The genuine notes were
judged to be less explicit in terms of intention
to die than the faked notes. Suicide or its synonyms were mentioned more often in the faked
notes than in the genuine notes. Instructions to
509
CRITIQUE AND NOTES
TABLE 1
MEAN RATINGS FOR THE FIVE VARIABLES MADE BY THE THREE JUDGES ON THE 33 MATCHED
PAIRS OF GENUINE AND SIMULATED SUICIDE NOTES
Judge 1
Judge 2
Variable
Judge 3
Genuine
notes
Simulated
notes
Genuine
notes
Simulated
notes
Genuine
notes
Simulated
notes
2.27
3.12
2.03
3.42
1.45
3.00
1. Mean amount of explidtness of expressed
suicidal intent
2. Number of notes in which suicide or a synonym is mentioned
3. Number of notes mentioning instructions
to the reader
4. Mean amount of drama in the notes
S. Mean amount of disorganization in the notes
4
16
6
13
8
15
21
11
21
11
15
11
2.90
3.27
2.69
2.75
2.84
2.54
2.51
1.78
3.18
2.96
2.93
2.57
Note.—Figures for Variables 1, 4, and 5 are mean ratings along a five-point scale ranging from small to large amounts of the
variable.
TABLE 2
RESULTS OP THE STATISTICAL ANALYSES or THE RATINGS FOR THE FIVE VARIABLES MADE BY THE THREE JUDGES
ON THE 33 MATCHED PAIRS OF GENUINE AND SIMULATED SUICIDE NOTES
Judge l
Variable
Statistical
value
1. Explicitness of expressed
suicidal intention
2. Frequency of suicide synonyms
3. Frequency of instructions
4. Dramatic quality
5. Disorganization
Judge 3
Statistical
value
t
Statistical
value
P
Mann-Whitney U test
332.5
.0024
294.5
.0005
263.5
.0001
Chi square test
Chi square test
Mann-Whitney U test
Mann-Whitney U test
8.680
4.913
485.5
399.0
.0016
.0136
.2177
.0262
7.922
4.913
525.5
373.5
.0025
.0136
.4013
.0013
2.402
.571
465.5
441.5
.0618
.2266
.1469
.0853
the reader were found more often in the genuine
notes than in the faked notes. The judges rated
the genuine notes as being more disorganized and
dramatic than the faked notes.
These results were then evaluated by the chi
square and Mann-Whitney U methods in order
TABLE 3
CHI SQUARES AND COMBINED PROBABILITIES ASSOCIATED WITH THE RATINGS MADE BY THE THREE
JUDGES ON THE 33 PAIRS OF MATCHED GENUINE
AND SIMULATED NOTES FOR THE FIVE VARIABLES
Variable
X2
1. Explicitness of expressed
suicidal intention
2. Suicide synonyms
3. Frequency of instructions
4. Dramatic quality
5. Disorganization
40.0602***
31.8385***
20.3456**
8.7316*
26.0450***
Note.—df = 6.
*# =.192.
** p < .004.
***p <.001.
Judge 2
Statistical method
to test the statistical significance of the differences between genuine and simulated notes shown
in Table 1. The results of the analyses are to
be found in Table 2. The derived hypotheses were
confirmed by Judges 1 and 2 for four of the
five test variables at p < .03. For Judge 3,
Variable 1 was significant at p < .0001, Variables
2 and 5 at p < .10; however, the distribution
for Variable 3 might easily have occurred by
chance. No statistically significant differences
were found by any of the judges for Variable 4
(dramatic quality).
A summary of the overall probabilities associated with the ratings made by the three judges
is presented in Table 3.2
It would appear that when the ratings made
by the three judges were combined statistically,
three of the previously confirmed hypotheses
2
With this statistical method (Gordon, Loveland,
& Cureton, 19S2), the chi square test is used to
determine the probability that the p levels achieved
by all three independent judges for each variable
might have occurred by chance.
510
CRITIQUE AND NOTES
(Variables 1, 2, and 5) were further substantiated at p < .001, and a fourth hypothesis (Variable 3) at p < .004. Only the hypothesis concerning the dramatic quality of the notes (Variable 4)
failed to achieve confirmation.
DISCUSSION
Although the theoretical propositions advanced
appear to have received general support from the
results of this study, it is recognized that the
rating of genuine and simulated suicide notes
can hardly be considered crucial in establishing
or rejecting the validity of any theory of suicide.
It should be understood that since only a small
proportion of the individuals who commit suicide
leave notes (Shneidman & Farberow, 19S7b),
it would be inappropriate to generalize interpretations of the present findings to the thought processes or feeling states of suicidal individuals who
do not leave notes.
Insofar as the present study is concerned, it
would seem that the most convincing argument in
behalf of the notion that some process inhibiting
the experience of dread occurs in the individual
prior to suicide comes from the confirmation of
Hypotheses a and b. With regard to the "suicide
synonyms" variable, some discussion of the
results of Judge 3 are in order. An actual count
of the number of times "suicide" is mentioned
reveals that this word does not appear at all
in the genuine notes. Even explicit allusions
to suicide, such as "electrocuting myself," "take
my life," "end my life," "end my suffering foreever," or "end it all," appear only in the simulated notes. The failure of Judge 3 to achieve
significance appears to have resulted from a
different interpretation of the instructions concerning suicide synonyms than used by Judges 1
and 2. Nevertheless, a p level of .06, combined
with p levels of .01 for the other judges, yields
a significant combined probability of < .001.
Even though no support was found for the
hypothesis that a difference in dramatic impact
would occur between genuine and simulated
notes, it should be mentioned here that the
majority of both the genuine and simulated
notes were judged to be no more than moderately
dramatic by all judges.
The proposed rationale for the more frequent
concrete instructions to the reader and for the
greater disorganization present in the notes
seems reasonable. It is interesting that Osgood
and Walker (1959), using different measures of
disorganization, found no significant differences
for this variable in comparing the two sets
of genuine and simulated notes used in this
study, nor in comparing genuine suicide notes
with ordinary letters to friends and relatives,
although they had anticipated that greater disorganization would occur in suicide notes as
a manifestation of the disruptive effect of
heightened drive level. The difference between
results obtained in the present study and in
the study by Osgood and Walker might easily
be a function of the differences in the criteria
used to assess disorganization. Their criteria
involved a frequency ratio of errors in the structure of the composition as well as length of
independent clauses, whereas a global rating of
disorganization on a five-point scale was used in
the present study.
It has been proposed that suicide becomes
possible when dread fails to arise because it has
somehow been rendered unnecessary through
self-deceptive maneuvers which may take the
form of an individual conceiving of himself as
intending something other than suicide or avoiding the confrontation of negative ramifications
of a recognized suicidal intention. For example,
his thoughts may focus upon going away, upon
the end state of release from torment, or upon
freedom from pain or responsibility. If selfdeception becomes completely successful one
might conjecture that the individual might even
appear relaxed and content and readily considered by others to be out of danger of
suicide. Under such circumstances it would not be
surprising that many patients have been released from hospitals as improved and shortly
found dead to the amazement of their relatives
and hospital personnel (Shneidman & Farberow,
19S7a).
If one is to take seriously the possibility that
the successful suicide must somehow have
managed to prevent dread from arising in
sufficient strength to block suicidal action, two
questions are immediately cogent concerning
therapy for individuals who have threatened or
attempted suicide.
Is it possible, for example, that certain "therapeutic procedures" actually enhance the likelihood of eventual suicide? It would seem that
if an individual brings about the inhibition of
dread through some self-deceptive maneuver, as
has been suggested, this process may be reinforced by relatives, therapists, or hospital ward
personnel who may feel that it is best to avoid
discussing the suicide issue with the patient,
fearing that discussion might serve to perpetuate
disturbing and obsessive thoughts of suicide,
and who, instead, concentrate their efforts only
upon helping the patient to find renewed in-
511
CRITIQUE AND NOTES
terest in possibilities for living. Without discouraging the effort to stimulate new interests,
might it not be more therapeutic to be persistent
in helping the patient confront in detail the
more dreadful personal ramifications of suicide
with the assumption that a healthy amount of
dread may be revived (or conditioned) in association with thoughts of suicidal action which
might then later be aroused by suicidal impulses
in sufficient strength to block suicidal action?
Is it possible that the administration of
tranquilizers to suicidal patients not only relieves certain depressive symptoms, but simultaneously reduces the very anxiety or dread in
relation to suicidal notions which may stand
as the principal barrier to suicidal action when
all life interests have faded? It seems a little
surprising that although it has been generally
publicized that a high positive correlation exists
between suicide rate and the use of tranquilizers
such as reserpine or phenothiazine derivatives,
investigators have failed to pay more attention to this possible drug effect. Beisser and
Blanchette (1961), for example, while calling
attention to this correlative phenomenon, comment that "the reasons for this correlation of
high suicide rate and the use of tranquilizers
are not evident" (p. 369).
REFERENCES
BEISSER, A. R., & BLANCHETTE, J. E. A study of
suicide in a mental hospital. Dis. nerv. Sys., 1961,
22, 36S-369.
GORDON, M. H., LOVELAND, E. H., & CURETON, E. E.
An extended table of chi-square for two degrees
of freedom, for use in combining probabilities
from independent samples. Psychometrika, 1952,
17, 311-316.
OSGOOD, C. E., & WALKER, E. G. Motivation and
language behavior: A content analysis of suicide
notes. /. abnorm. soc, Psychol., 1959, 59, 58-67.
SHNEIDMAN, E. S., & FARBEROW, N. L. (Eds.)
Clues to suicide. New York: McGraw-Hill,
1957. (a)
SHNEIBMAN, E. S., & FARBEROW, N. L. Comparison
between genuine and simulated suicide notes by
means of Mowrer's DRQ. /. gen. Psychol., 1957,
56, 251-256. (b)
SHNEIDMAN, E. S., & FARBEROW, N. L. A sociopsychological investigation of suicide. In H. P.
David & J. C. Brengelmann (Eds.), Perspectives
in personality research. New York: Springer,
1959. Pp. 270-293.
(Received March 19, 1962)