Suicide by hanging
Encyclopedia
Suicide by hanging is the act of intentionally killing oneself by suspension by a ligature. Hanging
Hanging
Hanging is the lethal suspension of a person by a ligature. The Oxford English Dictionary states that hanging in this sense is "specifically to put to death by suspension by the neck", though it formerly also referred to crucifixion and death by impalement in which the body would remain...

 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
Mortality rate
Mortality rate is a measure of the number of deaths in a population, scaled to the size of that population, per unit time...

; Gunnell et al. gives a figure of at least 70 percent. 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
Suicide prevention
Suicide prevention is an umbrella term for the collective efforts of local citizen organizations, mental health practitioners and related professionals to reduce the incidence of suicide....

. In the International Statistical Classification of Diseases and Related Health Problems, suicide
Suicide
Suicide is the act of intentionally causing one's own death. Suicide is often committed out of despair or attributed to some underlying mental disorder, such as depression, bipolar disorder, schizophrenia, alcoholism, or drug abuse...

s by hanging are classified under the code X70: "Intentional self-harm by hanging, strangulation and suffocation".

Hanging is divided into suspension hanging and drop hanging; this method can kill in various ways. Survivors usually suffer injuries. Ron M. Brown writes that hanging has a "fairly imperspicuous and complicated symbolic history". There are commentaries on hanging in antiquity
Ancient history
Ancient history is the study of the written past from the beginning of recorded human history to the Early Middle Ages. The span of recorded history is roughly 5,000 years, with Cuneiform script, the oldest discovered form of coherent writing, from the protoliterate period around the 30th century BC...

, and it has various cultural interpretations. Throughout history, numerous famous people have performed suicide by hanging.

Prevalence

According to Anton J. L. van Hooff, hanging was the most common suicide method in primitive and pre-industrial societies. A 2008 review of 56 countries based on World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

 mortality data found that hanging was the most common method in most of the countries, accounting for 53 percent of the male suicides and 39 percent of the female suicides. 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. 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. In the United States
Suicide in the United States
Suicide in the United States is the 11th leading cause of death in the country. In 2006, the total number of suicide deaths was 33,300. It was the 7th leading cause of death for males, and 16th leading cause of death for females. Suicide was the third leading cause of death for young people ages 15...

 it is the second most common method, behind firearms, and is by far the most common method for those in psychiatric wards and hospitals. Hanging accounts for a greater percentage of suicides among younger Americans than among older ones. Differences exist among ethnic groups; research suggests that hanging is the most common method among Chinese and Japanese Americans. Hanging is also a frequently used method for those in custody, in several countries.

The act

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
Suffocation
Suffocation is the process of Asphyxia.Suffocation may also refer to:* Suffocation , an American death metal band* "Suffocation", a song on Morbid Angel's debut album, Altars of Madness...

 may also be considered together with hanging.

To perform a suspension hanging, a rope
Rope
A rope is a length of fibres, twisted or braided together to improve strength for pulling and connecting. It has tensile strength but is too flexible to provide compressive strength...

 or other ligature is tied into a noose
Noose
A noose is a loop at the end of a rope in which the knot slides to make the loop collapsible. Knots used for making nooses include the running bowline, the tarbuck knot, and the slip knot.-Use in hanging:...

 which goes around the neck, a knot
Knot
A knot is a method of fastening or securing linear material such as rope by tying or interweaving. It may consist of a length of one or several segments of rope, string, webbing, twine, strap, or even chain interwoven such that the line can bind to itself or to some other object—the "load"...

 (often a slip knot
Slip knot
A slip knot is one of two different classes of knot. The most common are knots which attach a line to an object and tighten when tension is applied to the free end of the line...

, 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. Suspension hanging can kill in three ways: compression of the carotid arteries, the jugular veins, and the airway
Airway
The pulmonary airway comprises those parts of the respiratory system through which air flows, conceptually beginning at the nose and mouth, and terminating in the alveoli...

. About 5 kg of pressure
Pressure
Pressure is the force per unit area applied in a direction perpendicular to the surface of an object. Gauge pressure is the pressure relative to the local atmospheric or ambient pressure.- Definition :...

 is required to compress the carotid artery; 2 kg for the jugular veins; and at least 15 kg for the airway. 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. Full suspension is not required; most hanging suicides are done by partial suspension, according to Wyatt et al. 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.

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
Spinal cord
The spinal cord is a long, thin, tubular bundle of nervous tissue and support cells that extends from the brain . The brain and spinal cord together make up the central nervous system...

, causing death. 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. Regarding the practicalities of performing a drop hanging, Stone recommends using a low-stretch rope such as manila
Manila rope
Manila rope is a type of rope made from manila hemp.Manila hemp is a type of fiber obtained from the leaves of the abacá. It is not actually hemp, but named so because hemp was long a major source of fiber, and other fibers were sometimes named after it...

 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. This form of suicide is much rarer than suspension hanging and is likely to be less painful.

Medical effects and treatment



Hanging survivors report seeing flashing lights and hearing ringing sounds.

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. Because of the pressure on the jaw, the tongue is sometimes protruding, causing it to dry. Depending on the circumstances, petechia
Petechia
A petechia is a small red or purple spot on the body, caused by a minor hemorrhage ."Petechiae" refers to one of the three major classes of purpuric skin conditions. Purpuric eruptions are classified by size into three broad categories...

e may be present on the eyes, face, legs, and feet. Cervical spine fractures are rare unless the hanging is a drop hanging, which usually causes an injury known as hangman's fracture
Hangman's fracture
A Hangman's fracture is the colloquial name given to a fracture of both pedicles or pars interarticularis of the axis vertebra .The mechanism of the injury is forcible hyperextension of the head, usually with distraction of the neck. Traditionally this would occur during judicial hanging, when the...

. Suspension hanging usually results in cerebral hypoxia
Cerebral hypoxia
Cerebral hypoxia refers to a reduced supply of oxygen to the brain. Cerebral anoxia refers to a complete lack of oxygen to the brain. There are four separate categories of cerebral hypoxia; in order of severity they are; diffuse cerebral hypoxia , focal cerebral ischemia, cerebral infarction, and...

 and decreased muscle tone
Muscle tone
In physiology, medicine, and anatomy, muscle tone is the continuous and passive partial contraction of the muscles, or the muscle’s resistance to passive stretch during resting state. It helps maintain posture, and it declines during REM sleep.-Purpose:Unconscious nerve impulses maintain the...

 around the neck. According to Aufderheide et al., the most common cause of death of hangings is cerebral hypoxia.

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). 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
Hyperventilation
Hyperventilation or overbreathing is the state of breathing faster or deeper than normal, causing excessive expulsion of circulating carbon dioxide. It can result from a psychological state such as a panic attack, from a physiological condition such as metabolic acidosis, can be brought about by...

 with supplemental oxygen to control intracranial pressure". A study involving 128 near-hanging victims who were treated appropriately at hospital found that 77 percent of them survived.

Related elements

The vast majority of deaths by hanging in the UK and US are suicides, although there are some cases involving erotic asphyxiation
Erotic asphyxiation
Erotic asphyxiation or breath control play is the intentional restriction of oxygen to the brain for sexual arousal. The sexual preference for that behavior is variously called asphyxiophilia, autoerotic asphyxia, hypoxyphilia. Colloquially, a person engaging in the activity is sometimes called a...

. Homicide
Homicide
Homicide refers to the act of a human killing another human. Murder, for example, is a type of homicide. It can also describe a person who has committed such an act, though this use is rare in modern English...

s may be disguised as a hanging suicide. 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.

Cultural aspects

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. 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". A 2010 study by the British Journal of Psychiatry
British Journal of Psychiatry
The British Journal of Psychiatry is a peer-reviewed medical journal published monthly by the Royal College of Psychiatrists containing original research, systematic reviews, commentaries on contentious articles, short reports, a comprehensive book review section, and a correspondence column...

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.

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. Angry and oppressed women would use this method as an act of revenge. 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 suicide ceremonially dressed prior to the ultimate act".

In ancient Rome
Ancient Rome
Ancient Rome was a thriving civilization that grew on the Italian Peninsula as early as the 8th century BC. Located along the Mediterranean Sea and centered on the city of Rome, it expanded to one of the largest empires in the ancient world....

, death by hanging—suicide or otherwise—was regarded as particularly shameful, and those who had died by this method were refused a burial. Virgil
Virgil
Publius Vergilius Maro, usually called Virgil or Vergil in English , was an ancient Roman poet of the Augustan period. He is known for three major works of Latin literature, the Eclogues , the Georgics, and the epic Aeneid...

's Aeneid
Aeneid
The Aeneid is a Latin epic poem, written by Virgil between 29 and 19 BC, that tells the legendary story of Aeneas, a Trojan who travelled to Italy, where he became the ancestor of the Romans. It is composed of roughly 10,000 lines in dactylic hexameter...

, for example, refers to the noose as nodum informis leti ("the coil of unbecoming death"). 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. The Greeks
Ancient Greece
Ancient Greece is a civilization belonging to a period of Greek history that lasted from the Archaic period of the 8th to 6th centuries BC to the end of antiquity. Immediately following this period was the beginning of the Early Middle Ages and the Byzantine era. Included in Ancient Greece is the...

 considered hanging a women's death because many women had died by this method. 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.

Suicide and hanging is particularly common among Indigenous Australians, primarily because of the high suicide rate for young indigenous
Indigenous Australians
Indigenous Australians are the original inhabitants of the Australian continent and nearby islands. The Aboriginal Indigenous Australians migrated from the Indian continent around 75,000 to 100,000 years ago....

 males. Ernest Hunter and Desley Harvey suggest that hanging accounts for two-thirds of indigenous suicides. Hanging has deep symbolic meanings in Indigenous Australian culture, beyond those attached to the act generally. The indigenous person hanging himself is a stereotypical phenomenon. Hanging appears in indigenous art, film, music, and literature. There are reports of voices encouraging people to kill themselves, and of ghostly figures holding a noose, but saying nothing.

Sources

  • Hunter, Enest; Reser, Joseph; Baird, Mercy; et al. (1999). . Department of Health and Aged Care.
  • Murray, Alexander (2000). Suicide in the Middle Ages: The Curse on Self-Murder. Oxford University Press
    Oxford University Press
    Oxford University Press is the largest university press in the world. It is a department of the University of Oxford and is governed by a group of 15 academics appointed by the Vice-Chancellor known as the Delegates of the Press. They are headed by the Secretary to the Delegates, who serves as...

    .
  • 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
    Guilford Press
    Guilford Publications, Inc. is a New York City-based independent publisher founded in 1973 that specializes in publishing books, journals, software, and audiovisual programs in psychology, psychiatry, the behavioral sciences, education, and geography...

    .
  • Brock, Anita; Griffiths, Clare. "Trends in suicide by method in England and Wales, 1979 to 2001". (Office for National Statistics
    Office for National Statistics
    The Office for National Statistics is the executive office of the UK Statistics Authority, a non-ministerial department which reports directly to the Parliament of the United Kingdom.- Overview :...

    ) 20: 7–18. Winter 2003. Archived 30 July 2011.
  • Hill, Timothy (2004). Ambitiosa Mors: Suicide and Self in Roman Thought and Literature'. Routledge
    Routledge
    Routledge is a British publishing house which has operated under a succession of company names and latterly as an academic imprint. Its origins may be traced back to the 19th-century London bookseller George Routledge...

    .
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    Academic Press
    Academic Press is an academic book publisher. Originally independent, it was acquired by Harcourt, Brace & World in 1969. Reed Elsevier bought Harcourt in 2000, and Academic Press is now an imprint of Elsevier....

    .
  • Gunn, Alan (2009). Essential Forensic Biology. John Wiley & Sons
    John Wiley & Sons
    John Wiley & Sons, Inc., also referred to as Wiley, is a global publishing company that specializes in academic publishing and markets its products to professionals and consumers, students and instructors in higher education, and researchers and practitioners in scientific, technical, medical, and...

    .
  • Miletich, John J.; Lindstrom, Tia Laura. (2010). An Introduction to the Work of a Medical Examiner: From Death Scene to Autopsy Suite. ABC-CLIO
    ABC-CLIO
    ABC-CLIO is a publisher of reference works for the study of history and social studies in academic, secondary school, and public library settings.-History:...

    . pp. 75–77.
  • Wyatt, Jonathan P.; Squires, Tim; Norfolk, Guy; et al. (2011). Oxford Handbook of Forensic Medicine. Oxford University Press
    Oxford University Press
    Oxford University Press is the largest university press in the world. It is a department of the University of Oxford and is governed by a group of 15 academics appointed by the Vice-Chancellor known as the Delegates of the Press. They are headed by the Secretary to the Delegates, who serves as...

    .

Further reading



External links

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