From time to time, we’ll be posting on research related to suicide attempts. There is so much about suicidal thinking that the learned experts don’t yet understand, and one purpose of this blog is to bring together their voices with the voices of the lived-experience experts _ those of us who’ve been through it. This is where your thoughts and contributions are needed. Our “Contact us” page now lists several topics that are meant to nudge you into writing.
Stephen O’Connor is a founding contributor of this blog and a faculty member in the Department of Psychiatry and Behavioral Sciences at the University of Washington. In a field where many researchers might feel more comfortable keeping their subjects at a distance, and where many clinicians refuse to treat suicidal patients because of concerns about lawsuits and other issues, Stephen has kindly agreed to write a half-dozen posts on research this year.
As he writes here, he wants to hear from attempt survivors on where research findings “may seem accurate or somehow miss the mark.”
To the readers of this site, thank you for the opportunity to write about my perceptions on the topic of suicide prevention, with emphasis on people who have survived a suicide attempt. Honestly, it feels a bit intimidating to enter into this conversation as a person who carries no history of self-directed violence, and therefore limited insight, into the realities of making a suicide attempt. What I can share is the perspective of someone who conducts research with people at increased risk of suicide, which often includes those with an attempt history.
I work in a level 1 trauma center in the Pacific Northwest, where I hold an academic appointment in a department of psychiatry and behavioral sciences. People are often taken to a level 1 trauma center when their injuries are severe and they are in danger of dying. Our hospital also serves as a safety net setting for a wide range of at-risk individuals in the community, including those who are incarcerated, victims of domestic violence and/or sexual assault and non-English-speaking poor. I was initially drawn to work in a medical setting because of the opportunity to collaborate on an interdisciplinary care team for patients in acute crisis, which might include disciplines such as psychiatry, psychology, nursing, speech pathology, trauma surgery and internal medicine.
Over the past few years, I have become aware of the role that trauma centers serve for patients who have survived a suicide attempt.
Patients treated following a suicide attempt can be seen in three different settings within our hospital: the emergency department, medical/surgical floors (including the intensive care unit) and inpatient psychiatry units. Sometimes patients progress through all three settings over the course of their stay, depending on the severity of their physical injuries and psychological distress.
Interacting with individuals who have survived a suicide attempt is often a mixed experience. On one hand, patients, families and care providers are relieved that a death did not occur. At the same time, lives are often changed forever. There can be crushing debt related to medical expenses, irreparable physical damage (e.g., paralysis) and post-traumatic stress and guilt in family members who search for answers. Joy can be found in discovering that a patient is finally being connected to adequate outpatient services, but that can be countered by the worry that patients may begin to associate receiving helpful services with making a suicide attempt. The main concern being that a person may turn back to attempting suicide when they are in a dark moment, thus increasing the likelihood of a dire outcome.
Therefore, I have been working to discover the best ways to interact with and care for patients treated in hospitals following a suicide attempt. With such a complex event, in which multiple systems are affected (e.g., patients, family, community, health service providers), we must develop a keen understanding of what motivates a person to attempt suicide and then to possibly transcend the experience and continue to grow as a dynamic human being upon their return to the community.
My colleagues and I recently examined responses from 200 patients interviewed at our trauma center while being treated for a self-injury (75 percent were suicide attempts) in order to understand the motivations behind their behavior. Certain aspects of the interview tried to uncover the specific factors underlying the suicide attempt, in essence, “How did the suicide attempt function for you?” Counselors in the community often use the same approach to understand seemingly ineffective behaviors, which communicates to a patient why their behavior makes perfect sense given everything they were experiencing at that time. It also helps both patients and counselors identify alternative problem-solving strategies to address the real problems that were underlying the suicide attempt, as the ultimate goal is to prevent suicide attempts from happening again.
We asked patients to check off a list of 30 reasons why they might have made a suicide attempt. A few examples of the motivations for suicidal behavior include “to escape from emotional suffering,” “to get into the hospital” and “to relieve the burden of my family and friends.” Using statistical methods, we managed to whittle down these responses into three main categories, which we called 1) emotion regulation, 2) communication and 3) perceived better alternative. Our results suggested that 99 percent of patients we interviewed reported emotion regulation as a motivation of their suicide attempt. These types of response included “to escape from emotional pain” and “to feel something, anything.” This was a universal truth among the patients, who had a wide variety of diagnoses including major depression, borderline personality disorder and
substance dependence. A majority of patients also reported that their suicide attempt served as a function of communication, such as “to let someone know how angry I was” or “to get help.”
Fewer patients reported seeing their suicide attempt as a better alternative to living.
Put another way, most people were not driven to make suicide attempts because they were intent on dying.
We found that most patients appreciated the opportunity to speak openly in a non-shaming
interview with a researcher while they were still receiving medical care. Of note, our research team did have the luxury of time needed to conduct such a thorough interview, which might not always be the case in a busy hospital setting. I know that some patients do feel pre-judged by hospital care providers, who of course are human and may have their own preconceived notions about individuals who make suicide attempts. That is the dialectic of being treated in an acute medical setting: Their care providers are trained to keep your body alive, and they know very little about your unique suffering.
So, how do we use this information to improve a person’s physical and emotional recovery
following a suicide attempt? How can we help patients identify that the goal of their
attempt wasn’t necessarily to stop living, but more likely was to ease emotional suffering
and communicate an unspoken message? Would pursuing this approach during the acute
hospitalization period shortly after a suicide attempt help prevent further attempts?
These are questions that my colleagues and I are working to answer. As with all research, the general findings we come up with probably won’t apply to each and every person who survives a suicide attempt. That’s a big reason why I want to contribute to this blog – to share current efforts in suicide prevention research and to hear back from attempt survivors where research findings may seem accurate or somehow miss the mark.