Subintentional Death

Within the death and dying literature, subintentional is defined as indirectly or unconsciously causing one's own death. Many experts such as Normal Farberow, cofounder of the Los Angeles Suicide Prevention Center, believe that subintentional death and suicide exist along a continuum. At one end of the continuum is direct, overtly [Page 899]suicidal behavior. The individual communicates unhappiness and intentionally causes self-death. The actions are unequivocal, and often substantiated by a written note or a verbal declaration. At the other end of the continuum are indirect selfdestructive behaviors that may shorten life whether or not conscious suicidal intent is present. These individuals may have no intention to die and may not consider themselves to be suicidal. The actions are equivocal, and include risk taking in driving and sports; poor physical care including medical noncompliance, disregard of preventive advice, and neglect; nonlethal physical destruction, such as self-punishment and self-mutilation; unprotected sex; pathological gambling; and abusing alcohol or drugs. It is important to examine theoretical understandings of subintentional death, research on this important topic, and society's attitudes toward subintentional death.

Theories

Theoretical understandings of subintentional death began about the early 1900s, when sociologist Émile Durkheim classified indirect self-destructive behaviors as embryonic forms of suicide. The psychiatrist Sigmund Freud considered ordinary mistakes, errors, minor accidents, bungled actions, slips of speech, and other cases of forgetting to indicate unconscious suicidal wishes. Robert Firestone posited that self-limiting, self-destructive behaviors are based on powerful self-hatred and negative self-attitudes incorporated by the child during formative years.

Edwin Shneidman in 1968 coined the term subintentional death and developed four subtypes. Death chancers leave the outcome to chance, such as fundamentalist snake handlers and those who practice autoerotic asphyxia. Death hasteners bring about their own deaths through lifestyle choices and treatment noncompliance; they disregard medical recommendations, such as eating excessive sweets although they are diabetic. Death experimenters pursue altered consciousness, such as chronically abusing alcohol or drugs. Death capitulators give up, such as individuals who die after a voodoo curse.

Developmental theorists, such as Diana Baumrind, note that risk taking is part of normal adolescence. Developmentally constructive risk that promotes growth includes adaptive experimentation, which builds confidence, enhances competence, develops initiative, promotes autonomy and mastery, and hones skills essential for the transition to adulthood. In contrast, pathogenic, deviant, life-threatening risk taking potentially jeopardizes health and life.

Biological theories attribute risk taking to hormonal influences and genetic predispositions. In support of this understanding is that testosterone levels rise during adolescence; at the same time, risk taking increases. In addition, alcoholism runs in families, and risk taking appears to do so as well.

Psychological and cognitive theories note that optimistic expectations influence how people perceive risk and feel invulnerable. People with high tendencies toward sensation seeking take physical and social risks simply for the sake of the experience. For example, they might enjoy bungee jumping. Further, compared to others, they expect more positive outcomes, process novel or intense stimulation differently, have higher thresholds for pain, are more susceptible to boredom, and have unusually low levels of arousability.

Research Findings

Some research exists on subintentional death. A longitudinal analysis by Jan Neeleman in 1998 of a general-population birth cohort born in 1946 indicated that conduct disorders and aggression, and to a lesser extent emotional instability, raised the risk not only for suicide but also for premature death from accidents as well. This finding is consistent with the hypothesis of a continuum between subintentional and intentional self-destructive behavior.

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