Lived Experiences: Surviving and Thriving After a Suicide Attempt
1. Improving the Care of those who
Lived Experiences:
Engage in Suicidal Behaviour
Surviving and n Improving the care of those who make suicide attempts
will involve clinicians, families/whānau and community
Thriving After A agencies developing and evaluating more effective
methods of treatment, management, aftercare and
Suicide Attempt support.
Chris Bowden n Little is known about the “lived experiences” of those who
attempt suicide, how they view the interventions of others
Lecturer around the attempt and what expertise they have
School of Education Studies developed as recipients of the interventions of others.
Victoria University of
n The perceptions, stories and lived experiences of people
Wellington who have attempted suicide constitute valuable
knowledge for researchers and practitioners within the
2006 SPINZ Symposium: Understanding
Dunedin, 28 Nov 2006
context of suicide intervention initiatives and the
Suicidal Behaviour: Update Your Knowledge promotion of wellbeing.
and Practice
Updating Knowledge and Practice
Bigger Questions
Key Questions ¨ What counts as knowledge?
¨ Who’s knowledge is valued?
n What do we know about the experience of being suicidal? ¨ How is knowledge produced and reproduced?
n What does it mean for a person to “survive” a suicide attempt? ¨ When should knowledge be challenged?
n What do we know about how people who have engaged in nonfatal n Social Constructionist Position: knowledge does not come through
suicidal behaviour perceive the interventions they receive? the objective, scientific study of phenomena such as suicidal behaviour
n What specific aspects of interventions are helpful and unhelpful and but through a democratic process whereby people discuss and debate
why are they perceived as helpful/unhelpful? knowledge, its meaning, importance and that knowledge is socially
and culturally constructed.
n Knowledge is also used to position people and knowledge is also
n What do we know about what is required for a person to stop connected to power. Some forms of knowledge are seen as more valid
engaging in suicidal behaviour? What do they need to survive? and useful than others. Some people who hold knowledge
n What do we know about is required for a person to recover from (gatekeepers) so that they can retain positions of authority, expertise
suicidal behaviour and what protects them from future suicidal and power.
behaviour? n It is through interdisciplinary and integrative studies that we can
generate new research questions, expand and situate knowledge
within a broader context and improve our response to pressing human
problems.
The Scholarship of Integration Integrating Standpoint Theory, Lived
n Boyer (1990) identified four separate but overlapping functions of scholarly
activity:
Experience and Suicide Research
¨ Scholarship of Discovery n Standpoint Theory is extremely influential within the social sciences
¨ Scholarship of Integration (particularly sociology) and is both insightful and controversial.
¨ Scholarship of Application n A standpoint can be conceptualised as a perspective: a place in time and
¨ Scholarship of Teaching
space from which an individual views the world around them. It provides a
lens to see the world and influences how an individual and groups of
¨ Messages from the edge individuals socially construct the world. A standpoint determines what we
focus on as well as what is obscured from us.
n Scholarship means doing original research but also means stepping back n Suicide attempters have standpoints, so do practitioners and researchers
from one investigation, looking for connections, building bridges between (there are not often acknowledged or made explicit).
theory and practice, and communicating one’s knowledge effectively (Boyer, n Standpoint theorists (e.g., Harding, 1991; W ood, 1982) suggest that societal
1990). inequalities generate different accounts of nature, the world and social
n The scholarship of integration means interpreting, drawing together, relationships.
and bringing new insight to bear on original research. It involves fitting n The world looks different depending on where you view it and those who
one’s own research – or the research of others – into a larger context and engage in nonfatal suicidal behaviour will see and understand the world in
perspective. ways that are different to family, friends, professionals and researchers.
n By gaining access to the knowledge and perspectives of suicideattempters
Those engaged in the scholarship of discovery ask, “What is to be we will be in a better position to critique the knowledge around suicide, and
known, what is yet to be found?” whereas those who are engaged in what are effective forms of intervention and prevention.
integration ask, “What do the findings mean? It is it possible to
interpret what’s been discovered in ways that provide a larger, more
comprehensive understanding?” (Boyer, 1990, p.19)
1
2. Lived Experience
n Lived experience is a filter through which experiences and events
are made sense of. Like a standpoint it is influenced by gender, age,
developmental stage, class, culture, prior learning, knowledge and
n Standpoint theory suggests we should access these marginalised experience etc. It involves conscious, subconscious and unconscious
groups’ perspectives and that we should value their knowledge and processes (Brown, 2000).
expertise because they are privileged to certain insights compared to n It is the result of living through the experience, it is constructed and
other groups. is not just a perception of that experience (Gadamer, 1975).
n A person’s way of being in the world (or not wanting to be in the world
in the case of the suicidal person) is reflected in his or her everyday
“Because understanding an individual’s perception of the lived experiences.
world may shed light on why a suicidal decision is made, it n The perceptions, stories and lived experience of people who have
is important in particular to explore the meaning that the engaged in suicidal behaviour constitute a valuable source of
knowledge for researchers and practitioners. Provides “experts” with a
suicidal individual gives to the suicidal act” (Ketelaar & potentially powerful means of developing knowledge about the
Ohara, 1989, p.393). suicidal process and what makes a difference to people in their
recovery and growth.
n Why don’t we ask them? – brings us back to the big questions: what
counts as knowledge? Who’s knowledge counts? Suicidal people are
often seen as irrational.
Quantitative vs. Qualitative
Suicide Research n Identifying the number of suicide attempters who experience
n While some research reviews (e.g., Gould, Greenberg, Velting and decreases in suicidal thinking and behaviour as a result of
Shaffer, 2003) have identified approaches and interventions that may intervention, treatment and care through a survey or measuring the
reduce risk of suicidal behaviour and suicide Beautrais (2006) states reduction of levels of suicidality, depression, and associated states by
that: means of a questionnaire will not bring us in direct contact with the
living in order to capture the experiential quality of the lives of those
“…despite our vastly increased knowledge about the causes of who have engaged in suicide attempts.
suicidal behaviour we know relatively little about what is most n In decontextualizing an individual’s experiences of suicide, treatment
effective in preventing suicide” (p.2). and recovery, we lose sight of the fullness of life and what it means to
n Understanding the lived experiences nearfatal suicide attempters and survive, and therefore, risk losing the meaning we hope to capture.
the factors that contributed to their attempt and survival may help n The complexities of human experience preclude the use of such
prevent not only suicidal behaviour but suicide (O’Carroll et al., 2001). reductionist approaches in answering questions of meaning. A
n Cutliffe (2003) argues for more phenomenological studies of suicide question of meaning calls for a method that truly explores the lives of
attempts and that there is an urgent need to better understand the the suicidal as they are cared for, comforted and helped to recover.
particular life experiences and the meanings of the individual’s n By listening to suicide attempter’s voices and their stories, it becomes
experiences in order to design interventions to help reduce the suicide possible to come closer to life as suicide attempters live it "rather than
rate. as we conceptualize, categorize or theorize about it"; and in this way
n Studying the lived experience of suicidal behaviour may contribute to the possibility of uncovering and capturing a deeper
our knowledge of what causes suicide and protects people from understanding of the nature or meaning of what it means to
suicide but it may contribute to the development of more responsive survive a suicide attempt and thrive (van Manen, l984).
and effective practice by shedding light on what works and why.
What Contributed to Suicidal
Some Selected Studies
n Coggan and Bennett (2002) young Pakeha suicide attempters (NZ),
Behaviour? Themes from the
experience of recovery. n Series of events (relational, instrumental and Research
n Chesley and LoringMcNulty (2003) experiences of attempts, what health problems) but some were impulsive acts
helped them stop and what helped recover. (Gair & Cammilleri, 2003).
n Crockwell and Burfod (1995) young female suicide attempters, n Childhood abuse including sexual abuse (Curtis, “Well the main
2003; Söderberg, 2004). reason I tried to kill
experiences of intervention. myself was because
n Curtis (2003) female suicide attempters (NZ), cessation & recovery. n Overwhelming and multiple losses: traumatic, my girlfriend left me
dysfunctional, alienation (Heckler, 1994). and took my kid away
n Gair and Cammilleri (2003) young suicide attempters and help n Early unaddressed pain (Heckler, 1994). from me…so I got
seeking behaviours. n Mental health problems (Hill, 1995). really depressed. I
n Heckler (1994) adult suicide attempters, focuses on suicidal process n An event that cements the conviction that there is didn’t think I could
and recovery. no hope or recourse other than suicide (Heckler, take it…so I just didn’t
n Hill (1995) young suicide attempters and suicides, focuses on risk 1994). want to live…I just
took…a cocktail of
factors and experiences of treatment and support. n Unrecognised depression and view of limited tablets (Brad, 22
n Söderberg (2004) adult suicide attempters with and without BPD, agency (Bennett, Coggan & Adams, 2003). years old) (Gair &
focuses on treatment experiences, stabilisation & recovery. n Feeling trapped (Tzeng, 2001), unbearable Cammilleri, 2003,
thoughts and/or unbearable situation, loneliness p.87).
n Tzeng (2001) Taiwanese suicide attempters, suicidal experience and (Söderberg, 2004).
needs.
Tend to be smaller sample populations, qualitative, issues of
retrospection but trade off is rich descriptions, explanations and data.
2
3. Intent and Motive Clear Motives & Ambivalence
n Gair and Camilleri (2003) Themes from the
n To escape inescapable pain. Themes from the
found intent was unique n Communicate distress and Research
Research
to individuals but about intolerable situation
(Heckler, 1994).
reflects those reported n Suicide was seen as a solution, a “Up until that point, I just had this
in the research. Gina) To die or to get help. comforting and attractive solution hopelessness, this
when they were experiencing powerlessness and the only
n Some of the participants (Wendy) I thought I really despair, low selfesteem and power I had was knowing that I
described some attempts wanted to die but I powerlessness. was going to take my own life.
wanted help. That was the only thing I could
that were ‘more serious’ n To manage pain (Heckler, 1994). see and the only strength I had.
and when they ‘just didn’t (Darlene) Every time I n Some change their minds after an (Ian)” (Heckler, 1994, p.112).
want to live’ while other wanted to die. attempt but at the time of the
attempt they were serious about “I tried to commit suicide four times.
attempts were described (Darlene) I wanted ending their life (Curtis, 2003). I slashed my hands, wrists and
as ‘just more about getting someone to know how n Hill (1995) found that for some arms. I just felt so much mental
out’ and ‘just didn’t want to frustrated I was. young suicide attempters actions pain inside. When the blood
(Crockwell & Burford, came out it felt like all the pain
be in the world for a intended to be lethal do not coming out. I felt calm. I still
1995, p.6) always have that outcomes, and don’t know whether I was trying
while’. some not intended to be lethal still to kill myself or just hurt myself.”
convey suicidal intent: (Maxine) (Hill, 1995, pp.126).
The Suicidal Process Why Did They Survive?
n Impromptu or sought rescue or Themes from the
“It’s a terrible thing when you intervention. Research
wake up in the morning “I decided right then: I n Unsolicited and unexpected
and you don’t want to be already felt dead. intervention (Heckler, 1994).
alive. I genuinely wanted to Everything I did, I felt n Lethality of means chosen.
die. It’s just something you n Giving up when they became “I told him I was fine, but
more dead. Nothing I’m sure he could hear
can’t get away from. Life felt alive and nothing alarmed by unexpected physical
something in my voice.
seems so pointless. You distress – increased heart rates,
would help. I just felt it uncontrollable muscle spasms, He was over here in
cannot think about the pain would be more shortness of breath and calling help. minutes, dressed in a
you might cause anybody congruent to be dead. tux! I didn’t want to
¨ Intervention of another person open the door, but it
else. That’s not even a Just not to have this (49%, n=33).
consideration, because seemed like providence
you feel so unimportant in body to keep being in” ¨ Changed their minds after had stepped in. I
(Karen) (Heckler, initiating a suicide attempt and thought “Who am I to
yourself you don’t think it 1994, p.67). then sought help (22%, n=15). fuck with the universe?”
will affect anyone else. I ¨ Not taken enough medication (Deborah) (Heckler,
didn’t want to be here. I or nonlethal means (18%, 1994, p.124)
was sure I’d die.” (Hill, n=12) Chesley & Loring
1995, p.129). McNulty, 2003).
How Did They Feel About Surviving?
n Chesley and LoringMcNulty (2003) found that suicide attempters expressed
The Suicidal Trance is Broken
a range of feelings in the time immediately after their suicide attempt.
¨ Sad, depressed, disappointed, empty (31%, n=25)
¨ Angry (17%, n=14) n As Heckler (1994) describes, for some the attempt fails
¨ Embarrassed, ashamed (14%, n=11) and yet the trance and desire to end their lives remains.
¨ Happiness, relief (12%, n=10) n Others experience the beginnings of a change, either
¨ Scared (11%, n=9) during or just after the harrowing episode.
¨ Sense of failure (9%, n=8)
¨ Other (ambivalent, unable to remember) (5%, n=4)
n When the devotion for the suicidal quest wanes, it leaves
¨ 55% (n=30) currently reported feeling ‘glad or grateful’ about having
a vacuum.
survived their suicide attempt. n Heckler (1994) claims that how that vacuum is filled
strongly influences the trajectory of the individual’s
n Highly stressful and emotional time for attempter and family (Coggan & recovery or whether as Curtis (2003) points out there is
Bennett, 2002).
n Physical symptoms and feeling of emptiness Tzeng (2001).
often only a brief moment of cessation.
n Coming to terms with the physical damage caused to the body; a loss of n The quality and nature of support and intervention
privacy; received affects whether or not an individual will
n acknowledging one’s vulnerability; anger, reproach and condescension from stop making suicide attempts and go on to recover.
one’s family, physicians, nurses and other health professionals (Heckler,
1994).
3
4. Themes from the
Cessation vs. Recovery Reasons for Stopping Research
Chesley and LoringMcNulty (2003) found:
n Treatment with a professional (14%, n=13) (contact with primary
n Curtis (2003) makes an important health provider, hospital staff, or a mental health professional)
distinction between cessation and n Sense of selfempowerment (10%, n=10) (developing a stronger
sense of self, improving selfesteem, or increasing personal power)
recovery. n New outlook on life (10%, n=10)
n Personal/professional success (10%, n=10)
n She argues that cessation relates more to n Concern for children (9%, n=9)
a decrease in suicidal behaviour (but the n Medication (8%, n=8)
n Spirituality (7%, n=7)
possibility of still experiencing suicidality), n Relationship with significant other (6%, n=6)
whereas recovery entails an individual n Relationship with family/friends (5%, n=5)
n Improved mood (4%, n=4)
developing coping strategies, problem n Maintaining sobriety (3%, n=3)
solving skills that lead to a reduction in the n Sharing feelings with others(2%, n=2)
suicidality. n Emotional maturity (2%, n=2)
n Other (7%, n=7)
Themes from the
Narratives of Discontent: What Narratives of Discontent Research
Didn’t Help? Themes from the
Research
n Male roles and helpseeking seen as n Maintaining professional
weakness, stigma of having a mental distance and not respecting the “I felt uncomfortable – she said
illness, not having enough time with “When I got out of hospital it individual’s rights (Crockwell & nothing, only listened. I had
mental health professionals (Gair & Burford, 1995; Söderberg, 2004). need of some guidance, not
Camilleri, 2003). was like nothing
happened. Nothing was n Interventions that reinforce just hearing myself talk”
n Having someone else do all the talking, ever said about it again. It feelings of lack of control
people not listening (Hill, 1995). (Curtis, 2003).
was like I’d just come “(The therapist) was cold and
n Unhelpful statements – You’ve got home from school for the
heaps to look forward to (Hill, 1995). n Difficulties with medication distant, seemed like she felt
day. Nobody asked if I (Curtis, 2003). burdened by another
n Inflexible crisis support (Hill, 1995). was all right. I was in bed
n Silencing – Family and friends n Parents and family not depressed middleaged
for a few days and they knowing how to support man. I felt abandoned”
pretending nothing has happened (Hill, treated me like I’d got a
1995). cessation or recovery (Curtis, (Söderberg, 2004, p.68).
sore throat or something. 2003).
n Recrimination and Ridicule – look what Just nothing was said.
you are doing to us (Hill, 1995). n A lack of mutual
Which makes it quite hard
n Minimising and Chastising – you silly when you’re 12” (Debbie) understanding (Söderberg,
pathetic girl’ ‘it’s just cry for help’ (Hill, 2004).
1995) (Hill, 1995, p.176).
Negative Experiences as Motivation Narrative of Contentment: What
for Change Themes from the
Research
Helped Them Stop? Themes from the
Research
n Family members providing
access to information on
depression and making “Before, I thought I couldn’t
“The second suicide attempt contracts around helpseeking manage life – so I didn’t try,
“I did it myself – got a grip ‘saying goodbyes’ (Gair & because I didn’t dare. Then I
on my life, created a new was a turning point, a Camilleri, 2003). found things so destructive, I
shock – I felt I don’t want had reached rock bottom. Then
life situation. I had let n Feeling loved and valued I sat down and thought about
myself be sick before, to go through this again. (friends and family); feeling what I really needed, and
There was no change guilty for making parents angry decided things like that should
had waited for others to or worried; or an absence of never happen again.” (woman,
do it all for me – but until I took a decision of reaction from significant BPD, not abused). (Söderberg,
my own to take a hold of others (nonsuccessful 2004, p.60).
nothing changed, in spite manipulation or communication)
of all the resources that the situation. I think (Curtis, 2003). “I decided to work things through –
were mobilised.” (woman, things could have gotten n Being hospitalised or being top open up, talk to my friends. I
much worse if I had had kept it all locked up before.
BPD, abused). stigmatised helped stop (Curtis, Nowadays I treat situations
(Söderberg, 2004, p.60). waited for a therapist to 2003; Hill, 1995). quite differently when I come to
fix it.” (man, BPD) n Reaching a turning point and a conflict or a crisis I go
having to make a decision straight at it.” (man, NoBPD).
(Söderberg, 2004, p.60). (Söderberg, 2004). (Söderberg, 2004, p.60).
4
5. Narrative of Contentment: What
Mixed Perceptions of
Helped Them Stop? Themes from the
Themes from
Research Interventions the Research
n Thinking positively, and focusing
n Hospitalisation kept them from harming
on positive aspects of the future. themselves (and contributed to cessation) but did “[They should tell
n Not losing sight of the balance “It’s not worth it [attempting not contribute to recovery (Curtis, 2003). me] what I should
between positive and negative suicide] because it just n Some staff from CAT Teams, counsellors, do when I get
experiences in life. does get better. You’re therapists, psychologists, and psychiatrists to be suicidal
n Realising that problems are not going to stay like that helpful. Community based organisations and
counselling were reported more beneficial than tendencies, what I
frequently a temporary through your whole life. should do when I
other organisations (Curtis, 2003).
experience (Coggan & Bennett, And even if it is bad like get the flashbacks,
2002). n Some treatment approaches as helpful
kind of a lot, there’s particularly those that encouraged learning coping how I’m supposed
n Talking about feelings which led always good times and strategies and problemsolving skills that would be to get over the
to being able to identify things you can miss with useful in the longterm. These included Cognitive
problems (Hill, 1995). Behavioural Therapy, Dialectical Behaviour abuse” (Darlene)
your friends” (Emma) (Crockwell &
n Exploring suicidal feelings and Therapy and Narrative Therapy (Curtis, 2003).
(Coggan & Bennett, n Medication can be helpful but when mixed with Burford, 1995, p.7)
assessing danger (Hill, 1995) 2002, p.20) counselling (Curtis, 2003).
n Recognising when they were n Wanting advice and guidance but also greater
experiencing a problem and selfcontrol (Corckwell & Burford, 1995).
seeking help (Hill, 1995).
Negative Perceptions of Key Features of Counselling/Therapy
Themes from the
That Helped
Interventions Research Themes from the
Research
n An empathic counsellor. “He met me like
n Not fitting the model n A sense of control or partnership in the counselling
(Söderberg, 2004). an equal human
“I fit the model, but the model process. being. I felt like I
n Not matching the therapeutic didn’t fit me” (Söderberg, n Feeling listened to.
method to the personal qualities, was being seen
2004, p.69) n Not feeling blamed/invited to feel guilty for their and heard”
expectations and values of actions.
patients (Söderberg, 2004). n Not feeling judged.
n Reliance on therapeutic “They start practicing their ideas “She saw I
about what help I need – n Not feeling like a burden, as compared to trying to talk
method instead of therapeutic to family and friends and having to censor what was needed to make
alliance (Söderberg, 2004). and only after they’ve come changes in my
to a dead end they start said for fear of worrying or hurting them
· Expert language that has asking me what we should n Feeling the counsellor could relate to what they were life, and she
labelled them – symptoms and do” (Söderberg, 2004, pp.69 saying – similar age and/or background and/or supported me in
experiences that have the power experience. the process. I
70).
to control them (Söderberg, n Feeling the counsellor genuinely cared. felt her support
2004). n Feeling the counsellor could be trusted – this was and I felt I was
particularly important issue for women who felt
betrayed by a number of people in their lives including safe with her”
parents and previous counsellors (Curtis, 2003, p.261) (Söderberg,
n Acceptance and listening (Hill, 1995). 2004, p.66).
Narratives of Contentment: What
Other Important Aspects Helped Recovery? Themes from the
Themes from the Research
Research
n Getting to know the person and
acknowledging what the Coggan and Bennett (2002) report that for the young people they
individual has been through The guy just wanted the facts but interviewed reported a number of factors that contributed to them not
(Crockwell & Burford, 1995). she was like I could howl and engaging in further suicidal behaviour. These included:
n Social workers listening to young she would say ‘don’t worry n A change in selfimage, the ability to perceive themselves in a more
people’s unique stories (Gair & about being upset, just cry if positive light.
Camilleri, 2003) you want to. You have every
right to cry, you’ve been n Having responsibilities and commitments.
n Social workers filling a ‘mate’ through hell’ and just validation n Making a connection with the future.
role (Gair & Camilleri, 2003) of your feelings and she got n Decreasing a sense of social isolation and reconnecting with friends.
n Regular contact (Gair & more into ‘where did I come n Personal counselling that enabled them to develop interpersonal
Camilleri, 2003). from’ ‘what kind of things have skills to reconnect with others who could provide them with good
n Honest and forthright answers led up to it?’ but so that was things in times of crisis.
so that false promises (e.g., really nice but then I went to
n A sense of selfresponsibility in seeking effective help.
everything will be OK) are not [social worker]” (Darlene)
(Crockwell & Burford, 1995, n A change of circumstances and living environment that provides
made Crockwell & Burford, 1995).
pp.910). greater personal safety and autonomy.
5
6. What Helped Recovery? What Helped Recovery? Themes from the
Research
Themes from the
n A change in perspective or standpoint on Research
life. Chesley and LoringMcNulty (2003) asked their participants how they
learned to cope with suicidal feelings and this question generated a
n Mental stability through psychiatric care “The last few years wide range of responses:
(particularly for those with serious mental have been quite n Medical treatment (12%, n=18) (with health professional or health
illness) (Söderberg, 2004). OK. What I went care provider)
through gave me
n A change in situation (e.g., leaving a a new perspective n Sharing feelings with others (10%, n=14)
destructive relationship) (Söderberg, 2004, on my life, and my n Involvement in activities/hobbies (10%, n=14)
p.56). priorities n Relationships with friends (7%, n=10)
changed. I’m truly n Improved selfesteem (7%, n=10)
n Regaining control and learning new skills. grateful I’m alive”
(man NoBPD) n Spirituality (5%, n=8)
n Taking control of selfharming behaviour,
emotions (e.g., feelings of hopelessness and (Söderberg, 2004, n Recognising that suicidal thoughts are transient (5%, n=8)
helplessness) and one’s body seemed to p.55). n Involvement in support groups (5%, n=7)
contribute to cessation and also learning n Sense of control over their life (4%, n=6)
positive coping strategies and interpersonal
n Medication (3%, n=5)
problemsolving skills resulted in enhanced
selfesteem, coping skills and increased sense n Journaling (3%, n=5)
of control which seems to have contributed to n Professional success (3%, n=5)
(recovery) a reduction in the likelihood of
repeated suicide attempts (Curtis, 2003).
Heckler (1994) Five Stages of Heckler (1994) Four Attitudinal Shifts
Recovery Essential For Recovery
1. Dissolving the Suicidal Trance person discovers that
it is the suicidal context, not the individual, that has to These shifts include a “Just look at how my life
die. This involves the person suspending doubt, grieving, movement from: has changed so far,
and learning to trust & letting go of dying. n Powerlessness to and this is just the
2. Rebuilding the self focuses on healing the past, taking authorship. first year of my
responsibility for one’s actions, and discovering new promise. I know
n Loss of faith to a working
answers to the question “Who am I?” exploring oneself terrible things could
through creative work, and cultivating an openness to relationship with the
life. spiritual. happen in the future,
n Being or feeling “stuck” to
but in a way, I want
3. Building a new relationship with oneself. Person
reaches out (the opposite to the isolation of the suicidal to see it. I want to
becoming “unstuck”, and
trance) learns to ask for help, being willing to be seen, see all of it now. I’m
n A lack of belonging to a truly looking forward
4. Allowing others in and inviting the intimacy of others. sense of place. to what happens
5. Giving back. The individual having learned to receive
from others in new and healthy ways, now must learn to next” (Ruth) (Heckler,
offer what they have learned back to their community. 1994, p.291).
Experiences Required for People to What Is the Difference That Makes A
Recover? Difference? Challenging
Dominant Ideas
n Mirroring & Practice
n Seeing a bigger picture
n Experiencing the humanness of
“I needed to hear
that there are
Therapeutic Alliance
others, other options
besides killing n Therapeutic contact and a therapeutic alliance that
n Extending to family (Heckler, 1994). myself. allows the person to take a new perspective or
Heckler (1994) writes: (Deborah)” standpoint (Söderberg, 2004).
Some of these experiences will be (Heckler, 1994,
serendipitous and unexpected, while p.252).
others will be consciously sought and · Finding a different perspective in life that has
hardwon. Nevertheless, they constitute modulated their identity selfconcept (Söderberg, 2004,
major turning points in the process of p.71).
rebirth. And while not everyone passes
through various stages in the same linear
progression, people who recover do
experience most of them at some point
during the road back” (p.168).
6
7. Challenging
Therapeutic Alliance Dominant Ideas
& Practice Personal Commitment to Change
Challenging
n The therapeutic alliance is Dominant Ideas
important for alleviating a “I don’t know what n Change is always dependent & Practice
suicidal individual’s happened that night, upon the perception of the
sense of powerlessness but something individual, and cannot be
to change himself or herself clicked. I think I just implemented from without. “The change came
or the environment, and got things into n It follows, that helping an individual when I realized I
facilitate the experience of perspective. It scared identify his or her standpoint and could change
success and mastery in perspective, as well as showing things, I wasn’t
dealing with his/her me that I’d got so
depressed. I thought him/her that there are other helpless.”
situation. standpoints and perspectives might (Söderberg, 2004,
I’ve got to get on and
be a promising starting point for p.73).
n The aim of this alliance sort myself out. If I fail change.
should be to help the finals, I fail. I can
always take them n Making an active decision.
individual find a different · Acknowledging that relief and
perspective on the again” (Karen) (Hill,
situation (Söderberg, 1995, p.161). change need to be achieved and
2004). not merely received (Söderberg,
2004).
Empowerment Challenging Relationships
Challenging Dominant
Ideas & Practice
n Freedom through Dominant Ideas
n Longterm stable personal
& Practice “It’s basically a question of
empowerment so the relationships with someone attachment – relationship is the
individual can make self they can trust, who basis for change” (Söderberg,
“I started to see that every understands them. 2004, p.71).
directed changes in their own problem in the relationship n The support to take a different
life. wasn’t my fault. She gave standpoint and maintain the “No matter if the parasuicide was
me the strength […] to change. related to severe mental problems
n The therapeutic relationship, make a stand” (Söderberg, leading to extensive psychiatric
n Achieving a change in
whether it exists within the 2004, p.67). perspective or standpoint treatment or an act of despair due
context of therapy, treatment, to a crisis situation in life, the core
requires the presence of persons feature for subsequent
care or support calls for a that can become ‘significant stabilisation was described to be
“You start the process, you others” who have an reliable relationships that could
perspective of collaboration instrumental role in helping the further enhance selfesteem and
that enables the individual to get someone’s help – and
person develop a new identity selfworth, or getting rid of
finally it changes, although and reinforce their new approach relationships that withheld such a
define their own needs, use a it always takes time” development. The process has
to the world.
language that makes sense (Söderberg, 2004, p.71) n These relationships carry the
resulted in the integration of a
to them and their significant different understanding of the
potential for a development of possibilities and limitations in life”
other and empowers them to selfesteem and selfworth and (Söderberg, 2004, p.75).
take control of their life. build on an active decision and
personal commitment for change
(Söderberg, 2004).
The Need for More Research and
The Need to Meet the Expert
Translation of Findings into Models
Within Challenging Dominant
Ideas & Practice
n It is only through this mutual understanding can the individual and
n Suicidal people are valuable sources of expertise and knowledge practitioner understand and work towards resolving the issues that
and that if practitioners have well developed communication skills, have led the person to suicide (Crockwell & Burford, 1995).
and are willing to see past the suicidal behaviour to meet the
“expert” within the individual they are more likely to find the answers
to what the person needs to stop their suicidal behaviour and recover n There is also a need to translate findings from research into
and thrive (Crockwell & Burford, 1995). workable models and methods of measuring recovery that take
into account the perspectives and meanings of individuals. For
n There is a need for professionals to build more trusting example, the Stages Of Recovery Instrument (STORI) (Andreson,
relationships with people. Caputi & Oades, 2006) while acknowledging the complex and non
n There is a need to move away from aloof professionalism to linear nature of recovery from metal illness and psychological
developing therapeutic alliances with troubled people defined by a trauma identifies four key processes of recovery and five stages or
bond, where friendship is offered but negotiated in relation to phases of recovery.
providing relevant resources. n This model has implications for promoting recovery and resilience
and training of mental health professionals. It may be that a similar
n The importance of establishing a therapeutic alliance with the suicidal model could be proposed for those who experience cessation and
person is also something recognised within New Zealand guidelines recovery following a suicide attempt.
(NZGG, 2003) as something that can facilitate the disclosure of
information and a sense of hopefulness and connectedness.
7
8. STORI – Stages of Recovery Recovery & Resilience
Instrument
The four component processes of recovery identified from the thematic
analyses of personal accounts of recovery are:
1. finding and maintaining hope;
2. the reestablishment of a positive identity;
3. finding meaning in life; and
4. taking responsibility for one’s life.
The five stages of recovery that were proposed in the model are:
1. Moratorium: A time of withdrawal characterised by a sense of
loss or hopelessness.
2. Awareness: Realisation that all is not lost, and that a fulfilling
life is possible.
3. Preparation: Taking stock of personal strengths and limitations
regarding recovery, and starting to work on learning and
developing recovery skills.
4. Rebuilding: Actively working towards a positive identity, setting
meaningful goals and taking control of one’s life.
5. Growth: Living a full and meaningful life, characterised by self
management of the illness, resilience and a positive sense of Ungar (2004)
self (Andresen et al., 2006, p.973).
The Experience of Resilience A Constructionist Discourse
n Ungar (2004) suggests we take a constructionist approach where we
look at the experience and meaning of resilience for the individual.
n Ungar (2004) claims the ecological approach to
understanding resilience, (one that is informed by n According to the postmodern view of resilience, what is important is:
Systems Theory that emphasises predictable ¨ The language that people use to describe their resilience after
relationships between risk and protective factors, circular suicide
causality and transactions between the individual and ¨ Resilience is the outcome of negotiations between people and
the environment) their environments for the resources to define themselves as
healthy, achieving etc despite conditions that are defined by others
as ‘adverse’.
…is inadequate for explaining the diversity of
n Resilience research should look at the multiple ways that wellbeing
people’s experiences of resilience. and resilience can be defined.
n A constructionist interpretation of resilience explicitly tolerates
diversity in the way resilience is nurtured and maintained. It also
n The relationships between risk and protective factors are asks us to consider the effects of age, class, race, gender and so forth
often chaotic, complex, relative to the individual or group on the ability of youth to maintain healthy functioning.
and contextual.
Availability of Resources Conclusions: Interventions
n The difference that makes the difference between those who are should…
considered resilient (healthy) and those who are labelled vulnerable is
the availability of resources to sustain their own wellbeing and Strive to be multisystemic, addressing individual, family, whanau and
their resulting selfconstructions as healthy (Ungar, 2004). community issues,
n Enhance competencies and protective factors,
n In order to make suicide intervention more effective we need to n Reduce risk factors, and treat disorders.
consider the needs of suicide attempters and the resources and n Take into account diversity of experience and differences in
power they require to reposition themselves and maintain their own access to resources.
sense of wellbeing. n Attempting to provide a quick fix, and fix one thing at a time won’t
work – protective and risk factors are interactive and often
n A constructionist approach to resilience also fits well with growing interdependent.
interest in strengthbased perspectives to treatment, youth work etc
(Ungar, 2004). n Focus on identifying the difference that makes a difference for
n Suicide attempters require a therapeutic alliance, mutual that individual.
understanding and empowerment to be able to find their own n Provide access to and acknowledge the standpoints of the
strengths and develop their own resources that can lead to recovery suicidal.
and resilience. n Take into account the meaning for the individual and his/her
perspective.
8
9. Conclusions References
Andresen, R., Caputi, P. & Oades, L. (2006). Stages of recovery
n The standpoints and perspectives of suicide attempters should instrument : Development of a measure of recovery from serious
be acknowledged and studied. mental illness. Australian and New Zealand Journal of Psychiatry, 40:
n They provide important information about intention, the unique 972980.
aspects of suicide attempts, what impedes helpseeking, what aspects Beautrais, A. (2006). Suicide prevention strategies 2006. Australian e
of treatment and care are effective and why, and they reveal that Journal for the Advancement of Mental Health (AeJAMH), 5 (1): 16.
workers listening to the person’s unique story is important for that
person and for his/her recovery. Bennet, S., Coggan, C., Adams, P. (2003). Problematising depression:
n We need to stop treating suicide attempters as a homogenous young people, mental health and suicidal behaviours. Social Science
group with similar backgrounds and experiences and start treating and Medicine, 57: 289299.
them as individuals with unique experiences and insights into their Boyer, E.L. (1990). Scholarship Revisited: Priorities of the Professoriate.
own behaviour and needs. New Jersey: The Carnegie Foundation for the Advancement of
Teaching.
Identifying the processes that helps the person find “the difference that Brown, J.D. (2000). Adolescents’ sexual media diets. Journal of
makes the difference” should be in focus of future psychiatric research Adolescent Health, 27S (2): 3540.
and at the heart of psychiatric support and treatment after parasuicide,
to enable the patients to find their own strengths and resources and in Coggan, C. & Bennett, S. (2002). Young people’s experience of recovery
this way be able to leave it all behind” (Söderberg, 2004, p.viii) and wellbeing following a suicide attempt. Social Work Now, 23: 15
22.
Crockwell, L. & Burford, G. (1995). What makes the difference?
Adolescent females’ stories about their suicide attempts. Journal of
Child and Youth Care, 10 (1): 114.
References References
Curtis, C. (2003). Female suicidal behaviour: Initiation, cessation and Ketelaar, T., & O’Hara, M.W. (1989). Meaning of the concept “suicide” and risk
prevention. A thesis submitted in partial fulfilment of the requirements for attempted suicide. Journal of Social and Clinical Psychology, 8, (4): 393
for the Degree of Doctor of Philosophy in Psychology at the University 399.
of Waikato. New Zealand Guidelines Group (2003). The assessment and management of
Cutcliffe, J.R. (2003). Research endeavours into suicide: A need to shift people at risk of suicide. Wellington, New Zealand: New Zealand Guidelines
the emphasis. British Journal of Nursing, 12 (2): 9299. Group.
O’Carroll, P.W., Crosby, A., Mercy, J.A., Lee, R.K. and Simon, T.R. (2001).
Gadamer, H.G. (1975). Truth and method. New York: Seabury Press. Interviewing suicide “decedents”: A fourth strategy for risk factor assessment.
Gair, S. & Camilleri, G.P. (2003). Attempting suicide and helpseeking Suicide and LifeThreatening Behaviour, 32 (Supplement): 36.
behaviours: using stories from young people to inform social work Söderberg, S. (2004). To Leave It All Behind: Factors Behind Parasuicide, Roads
practice. Australian Social Work, 56 (2): 8394. to Stability. Umeå University Medical Dissertations (New series No. 925, ISSN
03466612, ISBN 9173057452) Sweden: Umeå University. Accessed
Gould, M.S., Greenberg, T., Velting, D.M, Shaffer, D. (2003). Youth retrieved from http://urn_nbn_se_umu_diva3621__fulltext.pdf
suicide risk and preventive interventions: A review of the past 10
years. Journal American Academy Child Adolescent Psychiatry, 42(4): Tzeng, W. (2001). Being trapped in a circle: Life after a suicide attempt in
386405. Taiwan. Journal of Transcultural Nursing, 12 (4): 302309.
Ungar, M. (2004). A constructionist discourse on resilience: Multiple contexts,
Harding, S. (1991). Whose Science? Whose Knowledge: Thinking multiple realities among atrisk children and youth. Youth & Society, 35 (3):
Women’s Lives. Ithica: Cornell University Press. 341365.
Heckler, R.A. (1994). Waking up alive: the descent, the suicide attempt, van Manen, M. (l984). "Doing" phenomenological research and writing: An
and the return to life. New York: Putnam Books. introduction. Monograph No. 7, University of Alberta.
Hill, K. (1995). The Long Sleep: Young People and Suicide. London, Wood, J. T. (1982). Communication and relational culture: Bases for the study of
Virago Press. human relationships. Communication Quarterly, 30, 7582.
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