******* Note:

- Bài viết được viết toàn bộ bằng tiếng anh và mình cũng lười dịch vậy nên bạn nào thấy thích thì cứ dịch nhưng mình nghĩ nó không quá khó để đọc, trừ một số thuật ngữ, học thuyết chuyên ngành. Nhưng, nhìn hcung, có giải thích ngắn gọn nên các bạn cũng đừng lo phải tra google nhiều .

- Cảm phiền các bạn đừng bưng assignment hay research paper của mình đi đâu vì nhiều vấn đề khác nhau.

- Chuyện bên lề : Cuối cùng Jay, Christian và Justin là gì thì chắc chắc bạn cũng sẽ giật mình. Thật ra Jay chính là cách mình hay gọi Jeihorse, Christian cho Christian Chim Chim và đoạn cuối có mention nhẹ Justin- Justin Seagul aka Jungkook sshi ~

CASE STUDY:

Jay is a gay senior at a local college in Pensylvania. His father left when he was young and his mother committed suicide a day after Jay received the scholarship in a reputable high school. He was extremely shocked to see his mother garrote herself. After that, he lived with his aunt in New York for 2 years and then moved back to his house before he enrolled in a local college.

Jay had known that he was a gay even before his mother's death. Fortunately, during years that he was living in New York, Jay was carefully educated about the LGBTQ's community and was clarified that gay is not a sickness. He also made friends with other people in a close LGBTQ community in New York. It seems that after his mother's death, Jay led a happy life and he was not trying to deny his sexual orientation. Among his friends, Jay has a close relationship with Christian, who was a bisexual. Although Jay participated in some speed dating and blind date before, which was arranged by the community, he rarely shows his interest in a specific relationship. Christian is different. Christian sympathized with him and he had a sense of humor. He was well acquainted with Jay since high school and the two usually confided in each other. Christian often encouraged Jay when he was in bad mood and was a listener to every Jay's confession.

Consequently, Jay and Christian decided to be in an official relationship after some Jay's unsuccessful relationship. Jay felt that Christian was his "lost pieces" and he totally outweighed previous guys. Jay maintained his thought that Christian was not his first but he would be his last serious relationship; it became his whole life.

On the three-year anniversary of their dating, Christian confessed to Jay that he no longer loved Jay and was leaving for someone else. Jay later figured out that Christian had a girlfriend because Christian claimed himself at first a bisexual person, meaning that there is no confirmation on whether he only likes men. Thus, Christian was truly shocked and devastated. He felt as if his world and the sky was falling down at the moment he found out the truth.

As the week went by, Jay sank deeply into mixed feelings, including depression and anger. He called and texted Christian several times, begging him to come back and pleading for another chance. However, Christian ignored his call, blocked his number and told his friends that they had already been over for months. Thus, he asked Jay not to interrupt him and to stop disturbing his life. At the same time, he hated Christian for putting him in such misery. In such a long time, he felt as if he lost everything and the sunlight, warm atmosphere already went away, thinking that his door to the light would soon be closed. In other words, he really considered that his life would end soon. At first, his friends in the community sympathize, try to eliminate the idea of "ending" out of his head and cheerfully told him that the sadness and would soon lift. However, they became extremely worried about Jay when they later saw Jay acted strangely. He did not seem to be depressed and angry towards Christian anymore (his friend happily thought depression and anger ended) but then he started drinking and going back to his dorm late at night. He also used drugs but he told his friends that these drugs were sleeping spill because Jay usually felt headache. Hence, he would want to sleep.

One night, Jay went into his bathroom, reached for a bottle of sleeping spills and swallowed a handful of them. He wanted to make his pain go away and he strongly wanted Christian to feel her pain, to know just how much hurt he had caused him. She continued swallowing pill after pill, crying and swearing as she gulped them down. When Jay began to feel drowsy, he called his best friend, Justin. He was not sure the reason to call, perhaps to say good-bye, to make sure that Christian would be announced; or perhaps, to be talked out of it. Justin tried to procrastinate his intention to die by encouraging him. He also called his other friend in the dorm to rescue Jay but he already locked his door. When they reach him, he was already in coma. Five hours later, he died in the hospital.

Analysis of the case study of Jay:

Edwin Shneidman (2005, 1993,1963) defined suicide as a self-inflicted death in which the person acts intentionally, directly and consciously. According to his explanation of four kinds of people, who intentionally end their lives, Jay's case is classified as "death darers". Jay experienced an ambivalence in his action when he tried to die by overdosing. Though Jay was extremely desperate, he was not sure that he really wanted to end his life at this point. As previously reported, Jay even called his best friend to announce him that he would die soon and listened to his Justin's encouraging's words. To some degree, he performed a risk-taking behavior, wishing to end his life. However, Edwin Shneidman indicates that those "thrilling" actions do not ensure death. His case could also be shifted slightly to the "death initiators". Jay predicted that sooner or later, his life would come to an end because he lost his "light". He did not find the meaningful message from life so he simply wanted to hasten the process of death.

According to the predictors of suicide, Jay did not have a severe depressive disorder but he developed depression. He also became anger, irritable and suffered from stress, stressful events. He later used alcohol and sleeping pill (no one know how much of dosage he used), which could probably lead to substance abuse. He tended to have an increase in hopelessness and helplessness. Furthermore, he had a history of family suicidal problem and his mood shifts dramatically, from extremely optimistic, happy to extremely shocked and sorrowful, or perhaps devastated.

Jay's death is a result of a combination of stressful and bad events, which finally triggers his death.

1) Stressful events and Situation:

According to researchers, combat stress is consistently related to the stressor that leads to suicide. For instance, veterans survived in the North Korea war attempted to suicide because they experienced the enormous and tremendous stressor of combat in the war. However, common forms of immediate stress, which for example seen in Jay's case can sufficiently cause him to suicide. The loss of beloved relatives, or rejection (Roskar et al., 2011) might be considered stressors that lead to his suicidal attempt. We might also realize that a suicide attempt is less likely or more difficult to occur if there is only a single event and the event does not have a long impact on the person. In Jay's case, it is obvious that he was surrounded by a combination of stressful events. It already rooted from his high school year, when he evidenced his mother's death to his later depression and sorrow due to personal unsuccessful love-story. It is noticeable that these events lasted in long-term and had a serious influence on his thoughts, leading to his behavior.

We can see that in Jay's case, he committed suicide perhaps, because of social isolation. In the report, Jay considered Christian to be his everything and he already thought that Christian is his "last boyfriend", meaning that Jay gained a huge amount of mental and physical contact with Christian. He completely depended on Christian so when he left for someone else, Jay though that he lost his supportive social system and he became vulnerable to suicidal thinking.

2) Mood and thought changed:

Change in mood partly contributes to the suicidal attempt. The increase in sadness, tension anger in Jay's case shows a substantial shift from his past mood. Shneidman (2005,2001) claimed that "psychache" is the main reason to suicide. The term relates to an intolerability of the person due to psychological pain. The psychological pain exceeds a people's limit, and they cannot withstand any more. Thus they end their lives. In Jay's case, he did not state that he could not bear the situation any longer. However, his harmful thinking and the increase in worry of his friends because of his inclination to worsen the situation, imply that Jay was pushed to the limit. It is quite inevitable that he would do something stupid and end up his life by suiciding because he was intolerable before a chain of bad events that happened to his poor life.

Shift in patterns of thinking also participates in Jay' suicide attempt. Jay probably felt hopeless and he lost his clear perspective of what is right and wrong. Personally, I think that we can explain Jay's hopelessness in terms of operant conditioning. As Jay tried to beg for Christian's comeback and for new chance to start again, Christian resolutely denied him and required her to stop disturbing his life. Thus, as positive punishment indicates, Jay would probably stop contacting with Christian because each time he did, Christian ignored his actions and seemed to slightly embarrassed her by telling her friend their personal love-story, decreasing he desired behaviors. As a result, Jay saw that he was not "rewarded", thus, gaining a pessimistic belief that his circumstances was now "unchangeable".

3) Alcohol and other drug use

Perhaps, drinking releases two natural neurotransmitter: GABA and dopamine. GABA is responsible for calming the brain down, and dopamine is responsible for pleasure, a part of the brain's reward system. Thus, when Jay drank alcohol, he felt as if his anxiety was relived. Moreover, alcohol caused a temporary amnesia so it is persuasive if he kept drinking. In his situation, he really wanted to forget everything but there seems to be no other ways except for drinking.

4) Family members and friends

Recent studies show that suicides by family members or friends increase the possibility that a person do the same thing (Ali et al., 2011). In the beginning, we know that Jay's mother also committed suicide and he witnessed her death. Of course, he was extremely shocked and I believe that the last image of her mother tied to his memory, acting as a trauma and or a sense of loss. Her loss absolutely stressed a severe impact on his life later. Combined with bad events happened to him recently, he was more likely to find suicide an easy way to solve his troubles because his mother also ended her life in the same way too.

Underlying causes of Suicide

1) Durkheim's social culture view

According to Emile Durkehim's theory of suicide, the likelihood of a person to suicide is determined by the proximity of that person to social groups, such as friends and families. Although in Jay's case, social groups did not completely trigger his suicide, his mother loss the failure to encourage Jay of his friends added up to his bad situation. At this point, Jay seems to have poor relationship with his society because deemed that no one could help him, even his friends. Moreover, he does not have a parent, who acts as "moral support" for Jay. Thus, Jay is at greater risk of killing himself. We can also consider Durkehim's theory in suicide, called "anomic suicides". The theory points out that if the society fail to provide stable structures, support and give meaning to life, the person develops a loss of belonging. Jay considered Christian as his reason to live so it is convincing that Jay was let down when the "society", including Christian left him alone. Furthermore, his friends cannot do anything to help him or to save his worse situation so he increased a pessimistic view of the society, thinking that the whole society disappointed him.

2) The biological view

Some recent studies (Popili et al., 2010; Man & Currier, 2007) present that the possibility of suicidal behaviors and suicide attempt could be linked to the activity of serotonin. It seems that low level of serotonin is mostly found in people who commit suicide. These studies also suggest that depression might also cause a person to attempt to suicide. As the case reported, Jay had symptoms of anger and depression, which is noticeable because low level of serotonin relates to depression itself.

Treatment:

In Jay's case, if he were luck to survive, counselors and therapist would ask him to attend the suicide prevention program or persuade him to take part in the treatment after suicide. However, I think as a therapist, I would ask him to attend my treatment after suicide program.

First of all, after the trauma caused by attempt to suicide, Jay needs a medical care. The reason is that he overdosed sleeping pills, which might damage some parts of his brain when he is conscious again. Cognitive therapy follows after the medical care in order to provide Jay with helps, to keep him alive and to reduce his psychological pain. This approach concentrates on supporting Jay to release his anxiety, his sense of hopelessness and at the same time, on encouraging Jay accept his ending with Christian, which is considered his psychological pain. Therapists should also ask him to attend programs that enhance his weak problem-solving skills and his coping strategy. They should introduce him to others LGBTQ community, in which, if possible, there are people having survived from the suicide attempt. The similarity in situation helps Jay recover quickly and that therapists are easy to analyze to him the reason why killing himself is a maladaptive thinking.

If I were Jay's therapist, I would apply mindful-based cognitive therapy to him. I tried not to tell him that he was stupid, having risked his life for someone unworthy of his love. The focus of this therapy is to help Jay gradually accept the pain, the situation instead of hiding and eliminating it. In fact, it is really hard to persuade him to forget the pain so it would be better if Jay knows how to admit the reality. Furthermore, I can combine the current therapy with Beck's cognitive therapy. By following Beck's cognitive therapy, Jay and I can start having a conversation to assess his case in detail. After the analysis, I will try to convince him to change his negative attitudes and illogical thinking process. Finally, I will need his friend's help because they can arrange for Jay's a positive schedule. The schedule helps Jay to integrate again into the society, to help him realize that the society has not failed to provide him with happiness and optimistic view.