Images of God used by self-injurious burn patients 1 D.H. Grossoehme a, *, L.S. Springer b a Cliord A. Boeckman Regional Burn Center, Children's Hospital Medical Center of Akron, Akron, Ohio, USA b Miami Valley Hospital, Dayton, Ohio, USA Accepted 25 January 1999 Abstract Suicide by burning and other forms of self-injurious behaviors which involve burning are sometimes considered to have religious overtones. The ritual death of widows upon their husband's funeral pyre is closely associated with Hindu beliefs. Buddhists have used self-immolation as a form of protest. The Judaeo-Christian traditions have imagery of ®re as cleansing and purifying; there is also secular imagery associating ®re with images of condemnation and evil. Previous studies have described religiosity as a common theme among survivors. The present study describes the ways in which persons who in¯icted self- injurious behaviors through burning, including attempted suicide, imagine the Divinity and use religious language to give meaning to their experience. # 1999 Elsevier Science Ltd and ISBI. All rights reserved. Keywords: Burns; Self-in¯icted injury; Religion 1. Introduction Suicide and other forms of self-injurious behavior involving burning are sometimes considered to have religious overtones. The use and symbolism of ®re for religious purposes has been extensively described pre- viously [1±3]. In order to dierentiate among motives for this behavior, Topp described three classi®cations of persons who select ®re as their method of suicide. These are burning by `intelligent and calculating per- sons for idealistic purposes ... '; `by individuals prone to acute emotional reactions ... as an outlet for aggressive tensions ... '; and by those with an `abnor- mal personality.' This ®nal category can be broken down into (a) persons with a ®re fetish; and (b) who are `mentally unstable.' [1] Political protests fall into Topp's ®rst category, that is, for `idealistic purposes.' All of the patients in this study fall into one of the lat- ter two classi®cations. A newer way to classify suicide attempts by burning has been proposed by Geller [4]. As with Topp's sche- mata, this is based upon the motivation of the person. The scheme proposed by Geller also has a future orientation which may be useful for developing a care plan for the surviving patient. Geller has applied this scheme only to self-immolaters attempting suicide and not those involved in self-injurious behaviors. This classi®cation is presented in Table 1. Patients attempt- ing suicide in the present study have also been classi- ®ed according to this scheme. 2. Method This study was conducted jointly by the chaplains at their respective institutions. Included in the study were persons who attempted suicide or other self-injurious behavior. Self-injurious behavior was broadly de®ned to include non-accidental, non-work-related events. Examples would include playing with ®re, free-basing (the inhalation of vapors produced by heating cocaine Burns 25 (1999) 443±448 0305-4179/99/$20.00+0.00z # 1999 Elsevier Science Ltd and ISBI. All rights reserved. PII: S0305-4179(99)00016-9 1 An oral summary of this work was presented at the 25th Annual Eastern Great Lakes Burn Study Group, MetroHealth Medical Center, Cleveland, Ohio, USA, 16 September 1997. * Corresponding author. Tel.: +1-330-397-8457; fax: +1-330-379- 5152. E-mail address: dgrossoehme@chmca.org (D.H. Grossoehme)