Hi Neil,

Hope you are well. I don't have any research to hand, but I can contribute some general anecdotal observations from my own life experience and clinical experience...

Suicide is very rarely about aggression, whether directed towards self or others.

It most often seems to occur because the person is suffering from unresolved past traumas and/or from current life circumstances that they find intolerable, and because they cannot envisage any way of dealing with their circumstances or improving or escaping them, other than by ending it all.

Murder-suicides are most frequently committed by suicidal men, and the murder

victim(s) is/are most typically a woman known to that man and/or her children.

A vanishingly small percentage of murder-suicides are situations such as a mass murderer (or murderers) shooting workmates, classmates, or random strangers and then turning the gun on themselves. And despite the plethora of Hollywood "stalker" scenarios, an equally small or even smaller percentage represent people becoming infatuated with another and murdering them when their affections go unnoticed, ignored or rebuffed.

Some murder-suicides appear to be prompted by hatred or resentment (aggression) towards the murder victim, or to exact revenge or out of jealousy. Men may kill an estranged partner and then kill themselves, ("If I can't have her, no-one will..."), and disturbed men who have lost custody rights will sometimes kill their own children by an estranged or separated spouse in an act of spite before killing themselves.

However we must also acknowledge that a minority of murder-suicides are consensual. Both people (typically sexual partners) want to die and carefully plan the event. These tend to be deaths by less dramatic or violent means, (drug overdose etc).

A very large percentage of murder-suicides are committed by men. A significant proportion involve a man deciding to suicide, and then killing significant others (typically a sexual partner and/or their children, although suicidal young men may kill their parents and/or siblings before attempting to take their own life).

I have personally met three male perpetrators of these sorts of acts who survived their own suicide attempts. Each attempted to justify the murder of their own partner and/or children by saying that they were deeply concerned about their loved ones, and didn't want them to outlive them and suffer- "I didn't want them to grow up knowing their dad did..."

It seems to me that in this last scenario it may be an exaggerated form of male pride that forces these men to kill the only people they care about before ending their own lives. They don't want anyone who's judgement they care about to survive their own self-destructive act.

However it's important to acknowledge that people behave in ways that are not rational and may rationalise that behaviour after the fact. And it could also be the case that the suicide is not planned- the person loses control and kills someone close to them and then kills them self in the emotional aftermath of that loss of control.

I have just jotted these lines down extemporously - I do hope these notes are useful and that they don't give the impression that I am trivialising what is a very serious issue.

Paul.

Hello Neil and Paul,

is murder-suicide a term which includes extended suicide? Or does it more stand for a situation in which someone kills another person, feels kind of sorry or trapped and suicides... Does it (statistical seen) make a difference?

I do not think that extended suicide has to do something with pride, Paul. I would rather say it is some kind of distorted form of responsibility which for sure goes hand in hand with (extremly positive or neutral) ideas about afterlife (in any way). It is for sure not about judgement but either about preventing someone else from sorrow. Because they are unable to imagine how the other one can go on left alone... Arrogance... maybe... because they feel as if they are the center of someone elses life. But then again... what if they really are...? Children are in a way highly dependent from parents... It is for sure calculation. Some kind of really strange "euthanasia".

>>"I didn't want them to grow up knowing their dad did blah blah blah".

Can you imagine that this was just "poorly represented"? Maybe this guy was not able to directly speak about emotions but rather pointed to thoughts... Not everyone is thinking in emotions, you know... But that doesn't mean they directly speak about their concerns about how beeing seen. However I can understand why you think it has to do something with pride when you interpret it as self-concern.

Thanks Carmen.

I'm sure that the motivations for these sorts of acts are just as individual as the people who carry them out. The only three people I have had the opportunity to speak with (mentioned above) seemed more concerned with what others would think of them after they were gone, rather than what impact their suicide would have on others, and that is why I used the words "form of male pride". My daughters depend on me, but it would be pure selfishness on my part to not wish them to survive my death.

However my statements are based on talks with only three men, and three is a very small sample. Moreover, none of those three men were particularly comfortable or articulate at expressing their emotions (which is perhaps a factor that contributed to their behaviour?). I personally suspect that many people who have reached such a point of desperation and then survived may not be able to accurately recall or describe their mental state weeks or months after the fact.

Thanks for pointing out the category I hadn't really mentioned- the person who kills another in an emotional outburst (an "act of passion") and then suicides out of guilt or remorse, or to escape the consequences. Most suicides are planned to some degree. Most homicides are not planned. Some "murder-suicides" are indeed initiated by an unplanned act of homicide.

Regards,

Paul.

Yesterday I have seen a really interesting philosophical show on TV. Someone (forget his name... but he had a doctor-degree. And for this I hope he didn't tell people crap) mentioned that sense or how sensible humans do experience situations has to do a lot with joy or how delightful someone expects a situation to be. Those moments are "out of questions" and are in fact experienced as highly sensible. I really think that those "out of question" moments which someone experiences as sensible can be a huge motivator when it comes to problem solving (and how a person acts). I am wondering: How come that people think that death or afterlife can end every question and that they identify those situations or heading to those situations as delightful and for this sensible? Maybe cultural troubles?? To be honest how we nowadays see death has changed a lot. There are meanwhile far less consequences passed on than in former centuries (f.e. if you suicide you go all the way right up to hell). So people expect there are no or less consequences for them. It would be really interesting what people who suicide do believe in when it comes to death.

>>I personally suspect that many people who have reached such a point of desperation and then survived may not be able to accurately recall or describe their mental state weeks or months after the fact.

I knew a girl from my hometown. Her older brother was killed by cops in a robbery when we were like 10 years old (her brother was 17 or 18... stealing a car radio and was shot down while he tried running away..... as far as I know). Then we moved away and I didn't see her for years. Years later (we both were like 25 years old I guess) I went back to my home town and met her on the street. I asked her how she is and especially how she has been all the years... and she didn't answer the question like "I am fine... all good" but rather showed me her mobile phone pointing to question she had about the phone. To be honest I was a bit shocked because she was totally without emotions (no smile or any gesture of kindness you would expect from someone you didn't see for years). Like a zombie. Later on I also met someone (suffering from depression) who clearly said to me: "Do not ask me how I am. People anyway do not really want to know how someone feels.". Avoiding emotions seems to be quite normal for people who experienced specific situations. It really can change the way they speak, what kind of words they use, how they "feel" about others and so on. But there is also always this kind of coping style... not to touch any emotion. Especially not the subtile ones. Really sad in a way...

To tell the truth: I myself am not very good in handling those situations when someone is like emotioneless. It always gives me this kind of "What the hell"-feeling. And I don't believe (by now) that any training can help to overcome it. I bet I would be really worse as a therapist for people who suffer from such problems. "How do you feel?" "DONT ASK ME!" "Ok... time is over... bye... and please don't come back again."... *urghs*

The link between suicide and homicide is very interesting but far from being explained.

First, let's keep in mind that true homicide-suicides are very publicized but rare, around 0.2 per 100,000 in the USA i.e. 50 times lower than suicide. See Panczak, R, et al. (2013), ‘Homicide-suicides compared to homicides and suicides: Systematic review and meta-analysis.’, Forensic Sci Int, 233 (1-3), 28-36.

Second, it is now well established that suicide completers have a high rate of impulsive-agressive traits. This is notably the case in young completers. So, some traits may predispose to both violent acts and to self-directed acts. See, McGirr, A., et al. (2008), ‘Impulsive-aggressive behaviours and completed suicide across the life cycle: a predisposition for younger age of suicide’, Psychol Med, 38 (3), 407-17.

Third, an interesting situation is prison, where suicide is very high among a population in which many individuals are violent. Interestingly, suicide seems to be more frequent among individuals who have committed violent crimes including homicide, rape... See Fazel, S., et al. (2008), ‘Suicide in prisoners: a systematic review of risk factors’, J Clin Psychiatry, 69 (11), 1721-31.

As both suicide and homicide are partly related to neurocognitive traits of vulnerability, we examined their link in schizophrenia. Unfortunately, literature is scares and no study directly compared suicide attempters and homicidal patients. See http://www.ncbi.nlm.nih.gov/pubmed/24444320

My hunch is that some traits may predispose to both suicide and homicide but a mix of empathetic abilities combined with situational factors may orientate toward suicide or homicide. For instance, prison may push toward suicide more than homicide. Outside prison, empathy may to some extent prevent you from killing someone even if he is a problem for you. Etc...

Hope it will help.

Fabrice

Impulsive-aggressive...

http://books.google.de/books?id=CN4rQsW_Ri0C&printsec=frontcover&hl=de#v=onepage&q&f=false

Scroll to page 63.

This evidence suggests that, among those who do report persistent homicide behavior, there is a small group committed suicide which is associated with significant other problems e.g. mental health

Interesting question.

You might consider the nature of the metaphorical 'suicide note'... as being a message. Yes, there's the "if I can't have her" message. And the "I can't leave my children" message. There's the 'Romeo & Juliet' pacts.

But there's also something about the silent, loneliness of suicide which renders the act almost invisible, insubstantial, trivial and pointless (which is a reflection, perhaps of the experience of life by some of those engaging in the act).

Or suicide by police officer (a more public form of suicide).

Then there's the inevitability of death brought forward, a self-euthenasia.

But there's this less benign, multiple death, violent scenario you are asking about. A death deliberately spread across some wider canvas - on which the blood of many is painted - is the antithesis of an intoverted, isolated act. It's a way of writing suicide large across the world media, as if the death of the protagonist is somehow larger, more noticeable, and therefore visible, leaving a (sick) legacy, and generating some post-suicide awareness amongst others.

I wonder about PD characteristics at play here. This form of murder-suicide is emerging from an increasingly expressive social media dis-connect... the society in which people are 'friends' with thousands, yet also alienated and marginalised. Might this metaphoric message be a form of their final blog: a final, bloody tweet to the world? A bloodied graffitti in a shopping mall or school ground?

>>the society in which people are 'friends' with thousands

I got a friend... his name is Bobo. We use to have a lot of fun together on the internet. And like every good friend he has a great impact on my behaviour... The stupid thing about Bobo is that he has a multiple personality. Yesterday he maked himself up as a drug addicted rapper with a lot of $$$ and a car and a big house and a lot of beautiful girls. And I just tought: Man... I can't afford all that make up... neither do I have a talent for painting. But I go outside to buy some drugs and a pistole. Just because maybe it is going to transform me...

http://www.youtube.com/watch?v=pQjuQ1Rj2LI

Homicidal and suicidal behaviour is listed as possible 'side effects' of many mental health medicines so for me the question to ask is what is the timing of this behaviour in relation to treatment? Articles can be found on a site called Mad in America and by one of their authors Maria Bradshaw which shows a huge correlation. Her research show that most murder/suicides occur within a month of starting medication. Over prescribing in rife and I know several people who were offered antidepressants for such things as sore backs and mild concussion yet they made no mention of feeling down at all.

Mis-prescribing is a problem. However any association between individuals commencing treatment and committing this type of crime is probably not causal.

The time when someone first accesses treatment, or is persuaded or coerced to do so, is almost always when they are unwell and experiencing or causing the most concern or distress.

Still no reason not to look at the correlation after all many people could be having an ab-reaction and your argument could hide this. Almost all the famous school shootings and other mass murder/suicides involve mental health drugs in huge doses, with recent changes or given to young people for whom they have not been proven to be safe.

Hi Heather,

Hope you are well.

It is not actually true that "almost all the famous school shootings" involve prescribed psychotropic medications. This piece of misinformation from the Scientology front Citizens Commission On Human Rights International has been widely disseminated by popular news sites and blogs.

Intuitively pleasing as the drugs = murder hypothesis may be, it simply is not supported by the evidence.

re Antidepressants, see this study, based on over 9,000 patients using two different antidepressants (fluoxetine (Prozac) and venlafaxine (effexor).

Conclusion? SSRIs reduce suicidal ideation and reduce suicidal behaviour.

http://archpsyc.jamanetwork.com/article.aspx?articleid=1151018

.

re Young people and SSRIs, ee also;

http://www.docguide.com/reassessing-youth-suicide-and-ssri-antidepressant-use-presented-cpa?tsid=5

.

re Antipsychotics, see this study which found that the rate of homicides committed during a first episode psychotic break before treatment was 1.59 homicides per 1,000 patients, but that the annual rate of homicide after treatment for psychosis was 0.11 homicides per 1,000 patients."

Conclusion? ,>

http://www.ncbi.nlm.nih.gov/pubmed/18990713

.

Most homicides are not committed by people suffering mental illness. People suffering a mental illness are far more likely to commit such offences when they are not in treatment, and in fact they are most likely to do so during their first episode of psychosis. >>

http://www.treatmentadvocacycenter.org/storage/documents/violent-behavior-backgrounder.pdf

.

It is understandable that people confronted by these sorts of events look for simple explanations of why they have occurred. However events like the Columbine shootings are not the result of Big Pharma's ruthless marketing practices, they are the result of communities in which individuals feel powerless, excluded and alienated and also have access to high-capacity-magazine semi-automatic firearms.

Regards,

Paul.

People who suffer psychotic disorders ARE more likely to be violent (on average) however this is due to a small sub-set of those people who are diagnosed with some form of schizophrenia;

http://bjp.rcpsych.org/content/180/6/490.full

.

Generally speaking, it is when someone prone to delusions of persecution or paranoia is experiencing an acute episode that they may act out violently. In these cases the violence is almost always directed at a family member, partner or neighbour. The incident typically takes place in the home.

People suffering serious mental illness are actually MUCH more likely to harm themselves than someone else;

http://www.nimh.nih.gov/health/publications/schizophrenia/are-people-with-schizophrenia-violent.shtml

.

The vast majority of random mass shootings are committed by people with no previous diagnosis of mental illness. While most homicides are not committed by people with a mental illness, people with untreated psychotic disorders are far more likely to commit a violent crime than those who are in treatment;

>

http://journalistsresource.org/studies/government/criminal-justice/rates-homicide-first-episode-psychosis-meta-analysis

.

Alcohol and other drug use makes violent offences more likely, whether the perpetrator has a mental illness or not;

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000120

.

There are identifiable risk factors for violent offending in schizophrenia;

http://www.nimh.nih.gov/science-news/2006/new-factors-identified-for-predicting-violence-in-schizophrenia.shtml

.

However the chance of detecting potential mass murderers before the event is slim;

>

http://www.salon.com/2011/01/12/jared_loughner_mass_murderers_diagnose/singleton/

.

So, mental health services can't stop someone from looping out and going postal.

But gun control legislation can try and limit the amount of damage a lone "would-be commando" can inflict.

http://journalistsresource.org/studies/government/criminal-justice/effectiveness-policies-programs-reduce-firearm-violence-meta-analysis

.

There is an excellent discussion of these issues here;

http://journalistsresource.org/studies/government/criminal-justice/mass-murder-shooting-sprees-and-rampage-violence-research-roundup

.

Finally, the vast majority of homicides in the US are not mass shootings, and are committed by people who do not suffer any serious mental illness. They are committed by people who have a handgun.

>

http://www.ncbi.nlm.nih.gov/pubmed/20571454

.

Paul.

If I have found the right study, then here is a bit of analysis on it. I could not follow Paul's link, so my numbers are from here, and I hope they cite the same Richardson and Hemenway, 2011, study that Paul linked to.

"The total population for the United States for 2003 was 290.8 million while the combined population for the other 22 countries was 563.5 million. There were 29,771 firearm deaths in the US and 7,653 firearm deaths in the 22 other countries. Of all the firearm deaths in these 23 high-income countries in 2003, 80% occurred in the US."

First off, the US had about half the population as the other countries combined. And the US has about as many gun as it has people. This article says nothing about homicide rates, only "gun deaths." In a country without guns, murderers use other weapons.

Second, of the 29,771 firearm deaths in the US, 16,007 were suicides.

"For the US the overall suicide rate was 10.8 per 100,000, and slightly over half of these deaths were firearm suicide (5.8 per 100,000). "

The CDC claims 31,484 suicides in the US in 2003, with 16,907 by firearm (http://webappa.cdc.gov/sasweb/ncipc/mortrate10_us.html)

That leaves about 14,577 firearm deaths in the US that are accidents or homicides, compared to 7,653 total firearm deaths in a set of countries with twice the population as the US.

So, about the same, leaving out US suicides.

But what about suicides in those other 22 countries, you ask?

" In the other high income countries 2003 the overall suicide rate was 14.9 per 100,000 with a overall firearm suicide rate of 1.0 per 100,000."

Remember from before: "For the US the overall suicide rate was 10.8 per 100,000, "

More people per 100,000 committed suicide in the other 22 countries. 14.9 per 100,000 works out to a total of 84,000 suicides. 1.0 per 100,000 works out to 1,000 as the total firearm suicides in these 22 countries.

So, in conclusion:

6,653 non-suicide deaths by firearms in these other 22 countries, with a combined population of 563.5 million. 1.18 per 100,000.

14,577 non-suicide firearm deaths in the US, with a population of 290.8 million. 5.01 per 100,000.

That doesn't account for accidents, though. CDC claims only 730 deaths by accidents with firearms that year.

The US seems to have firearm homicide rate 5 times higher than these other countries. Without knowing the other country's overall homicide rates, that doesn't say much, but do keep in mind the US has enough firearms for every man, woman, and child to have at least 1.

I don't see how this Richardson and Hemenway study possibly found "The US homicide rates were 6.9 times higher than rates in the other high-income countries, driven by firearm homicide rates that were 19.5 times higher. "

Can someone who has access to the study explain it to me? Or tell me where I made mistakes with my math?

While not focused on the link between homicide and suicide, there is an article recently published that looks explores the potential the suicide terrorists are actually suicidal.  It can be viewed at the following link.

http://innovationscns.com/are-suicide-terrorists-suicidal-a-critical-assessment-of-the-evidence/