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The Psychology Of Suicide: Do The Means Predict The Motive?

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In the Netflix series 13 Reasons Why, the main character Hannah Baker violently completes suicide after experiencing bullying and sexual assault. She leaves seven cassette tapes of the 13 reasons why she completes suicide. The Netflix series received significant backlash from the mental health community for its graphic and sensationalized treatment of suicide. The controversy that followed the airing of the film made me think about various motives that cause people to take such dramatic action. A common belief of the clinical community links more violent suicides with motives of revenge and feelings of anger. In this paper, I will be investigating the empirical evidence of whether the means of suicide provide an indication of the motives responsible for the act. Can we infer motives from the selection of means? I will also be addressing to what degree suicide notes offer insight into motives.

There are 12 common methods for completing suicide. These 12 methods include self-poisoning by psychotropic drugs, self-poisoning by other drugs, self-poisoning by other means, hanging/suffocation, electrocution, strangling, car crash, drowning/submersion, firearms, being overrun, stabbing by sharp instruments, and jumping from high places.

Recently, the internet has been used to provide options for those experiencing suicidal ideation. These individuals search methods to complete suicide. “Correlations were conducted between Google search frequencies and the number of suicides for all suicide methods and gassing suicides stratified by gender and age” (Paul, 2017, p. 3). Female suicides in Germany increased between 2007 and 2015. These females were between the ages of 25 and 44. In 2007 from 2015 there was also an increase in self-poisoning due to gases. Google searches of self-poising were found to be correlated with gassing methods. These methods included helium, argon, and nitrate. Gassing methods were statistically significant in young males and older women. Males on average, were 25 years of age or older, and females were 65 years of age or younger. Recent years have shown a sudden rise in gassing methods used to complete suicide in European countries (Paul, 2017).

Statistically, men write more suicide notes than women. Men are also more likely to use more lethal methods than women. One perspective suggests women should own firearms for protection. Therefore, women may consider more lethal methods when completing suicide. Callanan notes, studies have shown that suicide risk is linked with a higher number of firearms in an individuals home. Typically, more men own firearms. Men are most likely to use firearms to complete suicide; whereas women are more likely to attempt suicide, and they typically use methods that involve poisoning. Usually, there is a greater chance of rescuing those who attempt suicide by poison. A common belief about those who use less lethal methods is that it is a cry for help. However, “a psychological autopsy of 141 male and female suicide victims found no gender differences in intent to die” (Callanan, 2012, p. 858). Thus, a third explanation suggests women are more likely to use poisoning methods so they do not disfigure their faces. It is hard to test this claim directly, but it would follow societal influences on female appearance.

There were 621 confirmed suicides in this study. Race was examined in this study, as “More than 90% of suicide victims in [the] sample were white” (Callanan, 2012 p. 861). Significantly, more men died by suicide. Only 141 women completed suicide. The most common method used in this study was firearms. In the article “Content differences,” Lester found that those who used guns as a method to kill themselves expressed less sadness in suicide notes. On the contrary, those who used gases as well as those who used solid and liquid methods expressed more sadness written in their notes. The word “down” was used more frequently when notes written by those who completed suicide using self-poisoning methods. Notes written by women were more about positive emotions and significant others. These notes were also more “present-oriented.” Notes written by women were more likely to use “we” pronouns (Lester, 2010).

More often Women are diagnosed with depression and mood disorders. Depression is diagnosed more frequently in first-world countries. Suicide is declining in other first-world countries; however, suicide rates are rising in the United States. Strong individualism is suggested to play a role in suicidal behavior. The United States has less social and economic support. This fact may suggest why it has a high suicide rate. United States citizens participate in riskier behaviors such as overeating and gun violence. “[Social Media and pop culture] can exacerbate bullying, romanticize suicide, and provide harmful content about suicide methods, says Deborah Stone of the US Centers for Disease Control” (Caghlan, 2018). For instance, 13 Reasons why received significant backlash for romanticizing suicide. This graphic content leaves viewers at risk for suicidal contagion and “downplays the cognitive distortions of depression [and other risk factors for suicide]” (Jacobson, 2017). This series gives the message that suicide is an acceptable and logical decision in cases of revenge, a fact which leads me to my initial question of whether the means predict the motive. In the series 13 reasons why, Hannah Baker’s suicide would be categorized as both bloody and messy. Based on her cassette tapes, it seems as if her motives and reason for suicide completion are rooted in feelings of anger and revenge. Suicide notes (and in Hannah Baker’s case, “cassette tapes”) display the genuine feelings of those who are suicidal (Caghlan, 2018).

Suicide notes gives families and researchers the chance to interpret the motives. Notes are reflective of how those individuals feel before completing suicide. Thirteen studies were reviewed, and there were no significant differences between suicide note-writers and non-writers. There have been inconsistent findings. For example, some studies found that older people were more likely to leave a note whereas other studies found that “younger people were more likely to do so” (Cheung 2015). However, Cheung’s study has found that people who complete suicide are more likely to live alone. In the research report “Late-Life suicide”, 94% of those who completed suicide, left a note behind. The individuals who left notes were more likely to be white and female. They were also more likely to use less violent methods. Non-violent methods include, poisoning, overdoses, and carbon monoxide inhalation (Cheung 2015).

Sixteen of these people addressed their notes to their family and friends. Notes were grouped into three categories. These three categories include apologies, appreciation or final goodbyes and anger. Anger was usually expressed towards a significant other. In this research report, suicides were completed due to illness, poor quality of life, and the inability to function independently. This study may not generalize to the population because it only assesses those who complete suicide later in life.

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According to Osman, anger is a major risk factor for suicidal behavior. Four studies were conducted to develop and cross-validate scores. In these studies, The Suicide Anger Expression Inventory-28 (SAEI-28) was used to evaluate suicide rumination, maladaptive expression, reactive distress and adaptive expression. There was a moderate to significant correlation between suicidal behavior and rumination. Maladaptive expression, or negative behavior patterns were linked with higher levels of aggressive and impulsive behavior. Adaptive expression is associated negatively with suicidal ideation. The more an individual expresses his or her thoughts and feelings the less suicidal behavior they exhibit. Suicidal behavior is moderately correlated with reactive distress. Reactive distress is “negative beliefs about circumstances or consequences” (Osman 2010). Reactive distress can also be referred to as internalized anger. Reactive distress, or internalized anger, is also associated with a lack of social support and self-esteem. Clinically referred youths who have attempted suicide are more likely to express higher levels of aggression and hostility. Depression, impulsivity, hopelessness, and management of negative feelings are psychological constructs that were correlated with suicidal behavior (Osman 2010).

International data shows that those under 25 die by suicide. Suicide is a leading cause of death for adolescents and young adults. Suicide is ten times higher among those who self-harm. Samples were drawn from two psychiatric hospitals. Subjects were only eligible if they had attempted suicide between the ages of 15 and 25. Subjects were interviewed about their experience and emotions before and after their suicide attempt. There were five common themes by those who attempted suicide. The first theme was negative emotions towards themselves. The second theme was a lack of control over their lives. The third theme was “perceived impasse in family and peer relationships” (Orri 2014). The fourth theme was communication, and the fifth theme was revenge.

In the first theme “negative emotions towards the self”, participants stated that they devalued themselves. Shame and guilt were feelings most frequently reported. Typical symptoms of depression were “loneliness and loss of meaning in their lives”(Orri 2014). Suicide was seen as a choice of salvation to free themselves of feeling trapped in their negative emotions.

The second theme was a need to have control over their lives. In the first theme, participants mentioned feeling entrapped in their lives. Nearly half of the adolescent participants cut themselves. Cutting was used as a mechanism to exert a false sense of control over their lives. The participants who felt a lack of control in their lives described experiencing feelings of anger. Participants who self-harm may provide insight for future research on anger and self-harm, as well as, anger and suicide.

The third theme is “perceived impasse in interpersonal relationships”. Participants felt a lack of acceptance by their families and “described rigid and overwhelming family dynamics” (Orri 2014). The fourth theme is labeled as “communication.” These participants did not have healthy interpersonal communication.

The fifth theme is “revenge”. Orri notes “Several adolescents explained the aggressiveness of their act as a way to make other people feel guilty” (2014). Essentially, revenge is the plot of 13 reasons why. Hannah Baker violently completes suicide, and she blames other people for her decision in the seven cassette tapes she leaves behind. This study concludes that “revenge assumes a particular role that appears to have been neglected by both clinicians and researchers until now, and further research should address this issue” (Orri 2014). Unfortunately, this study does not mention the methods participants used to attempt suicide. However, Orri does provide evidence that motives can be driven by feelings of anger and revenge.

Violent suicide attempts include hanging, firearms, car crashes and electrocution. Violent suicides are three to four times more prominent in men. Ludwig’s notes that in the study Personality organization in borderline patients they “found that patients with a history of suicide attempts had higher aggression scores. The study also assessed “anger, aggressions and temperament via several interview inventories they tried to associate these traits with violent/non-violent suicide attempts, but no significant correlation was found” (Ludwig). In the study Baus chose 71 patients from an outpatient unit. These participants were between the ages of 18-60. There were 68 patients diagnosed with borderline personality disorder. According to Baus, aggression is a primary personality trait in those with borderline personality disorder. Violent behavior and suicide were significantly associated as well as violent behavior and self-harm. However, the person’s emotional state is not associated with how violent the suicide was (Baus 2014).

In conclusion, the reasons people complete suicide are not indicative of how violently they carry out the act. However, there is little research on the link between violent suicides and feelings of anger and revenge. Future research may contradict current research. For now, it is safe to conclude that motives do not determine means. Unlike what is portrayed in the media, evidence contradicts the common belief that violent suicides are linked to feelings of anger and revenge. Violence and blood mess do not signify any specific emotion or reveal state of mind.

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