Suicide by hanging

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Suicide by hanging is the act of intentionally killing oneself via suspension from an anchor-point (e.g. overhead beam) by a ligature. Hanging is a very simple yet highly effective suicide method. It is one of the most commonly used suicide methods and has a high mortality rate; Gunnell et al. gives a figure of at least 70 percent.^[2] The materials required are easily available, and a wide range of ligatures can be used. Because of this, it is considered a difficult method to prevent.^[2] In the International Statistical Classification of Diseases and Related Health Problems, suicides by hanging are classified under the code X70: "Intentional self-harm by hanging, strangulation, and suffocation."^[3][4]

Hanging is divided into suspension hanging and drop hanging; this method can kill in various ways. Survivors usually suffer serious injuries, including brain damage. Ron M. Brown writes that hanging has a "fairly imperspicuous and complicated symbolic history".^[5] There are commentaries on hanging in antiquity, and it has various cultural interpretations. Throughout history, numerous famous people have committed suicide by hanging.

Prevalence

According to Anton J. L. van Hooff, hanging was the most common suicide method in primitive and pre-industrial societies.^[6] A 2008 review of 56 countries based on World Health Organization mortality data found that hanging was the most common method in most of the countries,^[7] accounting for 53 percent of the male suicides and 39 percent of the female suicides.^[8] In England and Wales, hanging is the most commonly used method, and is particularly prevalent in the group of males aged 15–44, comprising almost half of the suicides in the group. It is the second most common method among women, behind poisoning. In 1981 hanging accounted for 23.5 percent of male suicides, and by 2001 the figure had risen to 44.2 percent.^[3] The proportion of hangings as suicides in 2005 among women aged 15–34 was 47.2 percent, having risen from 5.7 percent in 1968.^[9] In the United States it is the second most common method, behind firearms,^[10] and is by far the most common method for those in psychiatric wards and hospitals.^[11] Hanging accounts for a greater percentage of suicides among younger Americans than among older ones.^[12] Differences exist among ethnic groups; research suggests that hanging is the most common method among Chinese and Japanese Americans.^[13] Hanging is also a frequently used method for those in custody, in several countries.^[2]

The act

The running bowline, a type of slip knot

In general, there are two ways of performing suicide by hanging: suspension hanging (the suspension of the body at the neck) and drop hanging (a calculated drop designed to break the neck). Manual strangulation and suffocation may also be considered together with hanging.^[14]

To perform a suspension hanging, a rope or other ligature is tied into a noose which goes around the neck, a knot (often a slip knot, which tightens easily) is formed, and the other end of the rope is tied to a ligature point; the body is then suspended, which tightens the ligature around the neck.

In addition to rope, other materials can easily be fashioned into an improvised noose e.g. a bed-sheet, ripped T-shirt, shoelaces or telephone extension cable. Regardless of the material used to form the noose, suspension hanging will kill its victims in three ways: compression of the carotid arteries, the jugular veins, or the airway.^[15][16] About 5 kg of pressure is required to compress the carotid artery; 2 kg for the jugular veins;^[15] and at least 15 kg for the airway.^[17] The amount of time it takes to lose consciousness and die is difficult to predict accurately and depends on several factors. Some believe unconsciousness occurs in five seconds, though Alan Gunn writes that it generally takes longer. It took a man who filmed his hanging 13 seconds to become unconscious, 1 minute and 38 seconds to lose muscle tone, and 4 minutes and 10 seconds for muscle movement to cease.^[18][19] Full suspension is not required; most hanging suicides are done by partial suspension, according to Wyatt et al.^[20] Geo Stone, author of Suicide and Attempted Suicide: Methods and Consequences, suggests that death by obstruction of the airway is more painful than by the other ways.^[14]

The aim of drop hanging, which is also frequently used in executions, is to break the neck. Participants fall vertically with a rope attached to their neck, which when taut applies a force sufficient to break the spinal cord, causing death.^[14][21] The length of the drop, usually between five and nine feet long, is calculated such that it is long enough to allow a less painful death, but short enough to avoid a decapitation.^[22] Regarding the practicalities of performing a drop hanging, Stone recommends using a low-stretch rope such as manila or hemp, that the rope be more than an inch thick, and that the knot be close to the chin and situated such that it will move towards the chin when the rope is pulled.^[14] This form of suicide is much rarer than suspension hanging^[17] and is likely to be less painful.^[23]

Medical effects and treatment

Hanging survivors report seeing flashing lights and hearing ringing sounds.^[24]

The necks of hanging participants are usually marked with furrows where the ligature had constricted the neck. An inverted V mark is also often seen.^[25] Because of the pressure on the jaw, the tongue is sometimes protruding, causing it to dry.^[15] Depending on the circumstances, petechiae may be present on the eyes, face, legs, and feet.^[15][26] Cervical spine fractures are rare unless the hanging is a drop hanging,^[27] which usually causes an injury known as hangman's fracture.^[28] Suspension hanging usually results in cerebral hypoxia and decreased muscle tone around the neck.^[29] According to Aufderheide et al., the most common cause of death of hangings is cerebral hypoxia.^[30]

Most hanging participants die before they are found; the term "near hanging" refers to those who survive (at least for a while—for example, until they reach hospital).^[17][31] Howell and Guly write that the initial treatment of hanging survivors follows the "usual priorities of airway, breathing, and circulation (ABC)". They say treatment should be "directed at airway control with endotracheal intubation, ventilation using positive end expiratory pressure (PEEP), and hyperventilation with supplemental oxygen to control intracranial pressure".^[32] A study involving 128 near-hanging victims who were treated appropriately at hospital found that 77 percent of them survived.^[17]

Related elements

The vast majority of deaths by hanging in the UK and US are suicides, although there are some cases involving erotic asphyxiation.^[32] Homicides may be disguised as a hanging suicide.^[33] Features that suggest that the death is a homicide include the ligature marks being under the larynx, scratch marks on the ligature, and the presence of significant injury on the skin of the neck.^[15]

Cultural aspects

Painting by Giotto depicting a person committing the sin of desperatio, the rejection of God's mercy, because while choked they are unable to ask for repentance. Note the demonic figure above the body.^[1]

Historically, countries that have had a recent history of using hanging as a method of capital punishment tend to have a low rate of hanging suicides, which may be because such suicides were regarded as shameful, according to Farmer and Rodhe.^[34][35] Hanging, with its connection to justice and injustice, is what the Department of Health and Aged Care of Australia calls a "particularly confronting display of resistance, defiance, individual control and accusatory blame"; it is "a rebuke and statement of uncaring relations, unmet needs, personal anguish, and emotional payback".^[36] A 2010 study by the British Journal of Psychiatry that investigated the motivations of people who had made a near-fatal suicide attempt found that those who had attempted a hanging considered it a painless, quick, simple, and clean method, while those who had opted for a different method held an opposing view.^[37]

There is a popular belief in Chinese culture that the spirits of those who have died by suicide by hanging will haunt and torment the survivors, because they had died in rage and with feelings of hostility.^[38] Angry and oppressed women would use this method as an act of revenge.^[39] Sing Lee and Arthur Kleinman write that hanging, the most common method in traditional Chinese society, was the "final, but unequivocal, way of standing still against and above oppressive authorities, often with the suicidée ceremonially dressed prior to the ultimate act".^[40]

In ancient Rome, death by hanging—suicide or otherwise—was regarded as particularly shameful, and those who had died by this method were refused a burial.^[41] Virgil's Aeneid, for example, refers to the noose as nodum informis leti ("the coil of unbecoming death").^[42] Timothy Hill writes that there is no conclusive explanation of why the stigma existed; it has been suggested that hanging was a method of the poor.^[43] The Greeks considered hanging a women's death because many women had died by this method.^[44] A study found that, in literary sources, 1.5–10 percent and 30 percent of suicides in the Roman and Greek civilisations, respectively, were by hanging.^[45]

Suicide and hanging is particularly common among Indigenous Australians, primarily because of the high suicide rate for young indigenous males.^[46][47] Ernest Hunter and Desley Harvey suggest that hanging accounts for two-thirds of indigenous suicides.^[46] Hanging has deep symbolic meanings in Indigenous Australian culture, beyond those attached to the act generally.^[21][48] The indigenous person hanging himself is a stereotypical phenomenon.^[49] Hanging appears in indigenous art, film, music, and literature.^[50] There are reports of voices encouraging people to kill themselves, and of ghostly figures holding a noose, but saying nothing.^[51]

See also

• List of people who committed suicide by hanging
• Asphyxia

References

Sources

• Hunter, Enest; Reser, Joseph; Baird, Mercy; et al. (1999). "An Analysis of Suicide in Indigenous Communities of North Queensland: The Historical, Cultural and Symbolic Landscape" PDF (3.1 MB). Department of Health and Aged Care.
• Murray, Alexander (2000). Suicide in the Middle Ages: The Curse on Self-Murder. Oxford University Press.
• Stone, Geo (2001). "Hanging and Strangulation" [online version]. Suicide and Attempted Suicide: Methods and Consequences. Carroll & Graf. Archived 30 July 2011.
• Maris, Ronald W.; Berman, Alan L.; Silverman, Morton M. (eds) (2000). Comprehensive Textbook of Suicidology. Guilford Press.
• Brock, Anita; Griffiths, Clare. "Trends in suicide by method in England and Wales, 1979 to 2001". Health Statistics Quarterly PDF (851 KB) (Office for National Statistics) 20: 7–18. Winter 2003. Archived 30 July 2011.
• Hill, Timothy (2004). Ambitiosa Mors: Suicide and Self in Roman Thought and Literature'. Routledge.
• Dolinak, David; Matshes, Evan W.; Lew, Emma O. (2005). Forensic Pathology: Principles and Practice. Academic Press.
• Gunn, Alan (2009). Essential Forensic Biology. John Wiley & Sons.
• Miletich, John J.; Lindstrom, Tia Laura. (2010). An Introduction to the Work of a Medical Examiner: From Death Scene to Autopsy Suite. ABC-CLIO. pp. 75–77.
• Wyatt, Jonathan P.; Squires, Tim; Norfolk, Guy; et al. (2011). Oxford Handbook of Forensic Medicine. Oxford University Press.

Further reading