To Live or Not To Live

3 P Presents

2

THE

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TODAY

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YOU

3

HUMAN’S LIFE

Existentialist self-responsible meaning

Aristotelian

arete-virtue,excellence

Humanistic

self-creation, actualization

Religious & Spiritiual (transcend)

Hedonistic

pleasure

Stoicism

wisdom

4

Stoicism permits as rational(arete) or deliberate choice

Cosmic&situation

Moral Rupture

Crime,sin

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The Milbank Quarterly, Vol. 67, Suppl. 1, 1989

5

To Be

Not To Be

Passaporn Lorterapong, M.D.

6

Passaporn Lorterapong, M.D.

7

Lenses and Framings of suicide 

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suicide is pathological

“People who kill themselves are mentally ill”

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suicidology is science

“We will understand suicide by studying it objectively, using Western medical science”

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suicide is individual

“Suicidality arises from, and is located within, the ‘interiority’ of a separate, singular, individual subject”

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🡪 social roots : injustice, inequality, exclusion and oppression�

Passaporn Lorterapong, M.D.

8

• September 1999, Crosslake suicide crisis line took 1call every 84 mins.
• schools and churches fail to provide sense of collective self-hood 
• No channel for productive activity
• Sense of self is blocked, rejected
• expressed oneself through self-negation
• Media attention : brought value never achieved during alive
• Group identity forms around the will to die and suffering
• Disengagement of older generation

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Passaporn Lorterapong, M.D.

Thwarted belongingness

�

Communities provide the answers of

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“Who are we?” → “Who am I?”

“Why am I?”

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Passaporn Lorterapong, M.D.

Perceived burdensomeness

Others’ lives would be better without me.

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Passaporn Lorterapong, M.D.

11

Joiner’s Interpersonal theory of suicide

Van Orden 2010

Passaporn Lorterapong, M.D.

Capability for suicide

• Lowered fear from previous attempts
• Elevated physical pain tolerance

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12

Passaporn Lorterapong, M.D.

13

Passaporn Lorterapong, M.D.

14

Suicide coupling

Passaporn Lorterapong, M.D.

15

Passaporn Lorterapong, M.D.

It’s not about pain – Albert Camus

• It’s about meaninglessness.
• More painful than pain itself
• “The Absurd”

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Passaporn Lorterapong, M.D.

Philosophical suicide

• response to the absurdity of life
• Unfair
• no meaning
• no goal

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17

Passaporn Lorterapong, M.D.

It’s not an end

• It is awakening to the way life is
• There’s no answer
• Be lucid

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Passaporn Lorterapong, M.D.

19

Passaporn Lorterapong, M.D.

20

The Absurd Man

Passaporn Lorterapong, M.D.

21

To Be

Not To Be

OR

Passaporn Lorterapong, M.D.

References

• Niezen R. Suicide as a way of belonging: Causes and consequences of cluster suicides in Aboriginal communities. Healing traditions: The mental health of Aboriginal peoples in Canada. 2009:178–95.
• Mishara BL, Weisstub DN. Practical ethics in suicide: Research, policy and clinical decision-making: Cambridge University Press; 2024.
• Van Orden KA, Witte TK, Cukrowicz KC, Braithwaite SR, Selby EA, Joiner Jr TE. The interpersonal theory of suicide. Psychological review. 2010;117(2):575.
• Bharati K, Lobo L, Shah J. Revisiting Suicide: From a Socio-Psychological Lens: Routledge India; 2020.
• Gladwell, M., 2019. Talking to strangers: What we should know about the people we don’t know. Penguin UK.
• Clarke, R.V. and Mayhew, P., 1988. The British gas suicide story and its criminological implications. Crime and justice, 10, pp.79-116.
• Seiden, R.H., 1978. Where are they now? A follow‐up study of suicide attempters from the Golden Gate Bridge. Suicide and Life‐Threatening Behavior, 8(4), pp.203-216.

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Passaporn Lorterapong, M.D.

23

24

Anomic

Fatalistic

Regulation too strong

Regulation too weak

Bond too weak

Altruistic

25

https://www.kcl.ac.uk/policy-institute/assets/social-attitudes-in-the-uk-and-beyond-pub01-116.pdf

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27

Impulsive?

Painless Act?

Tainted soul?

crisis?

Self-euthanasia?

Prior attempt?

Exposed to

suicide?

socially

isolated?

Time left

in life?

Religious 0r

culture?

Landy JF, Shah P. What drives opposition to suicide? Two exploratory studies of normative judgments. Judgment and Decision Making. 2022;17(1):164–88.

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Psychiatric Lens