|
Article Excerpt
Note: A shorter version of this article was presented at the Conference of the European Society for Suicide Prevention, Copenhagen, 2004.
Previous analyses of the narratives of 40 persons hospitalized in a general hospital after suicide attempt found that they described their suicide attempts as goal-directed processes, sometimes planned in advance, sometimes executed spontaneously. They also described short-term actions, mid-term projects, and long-term careers reflecting goal-directed processes related to maintaining and developing their lives. In this qualitative study that reports on a re-analysis of these data, the research participants' narratives were examined for links between life-related and suicide-related goal-directed processes. The analysis followed a distinction between a goal-directed view of suicide processes and a dynamic systems view. The findings indicated that some links were goal-directed and consistent with the reasoning of life-maintaining projects. These "top-down" links between life-related and the suicide-related goal-directed processes reflected the goal-directed view of suicide processes. Other links indicated a substantially limited capacity for goal-directedness, reflecting the "bottom-up" dynamic systems view. Finally, it third group of links reflected a mix of "top-down" and "bottom-up" processes. Implications are offered for mental health counselors working with suicidal clients.
**********
Suicide acts, despite their high rates and repeated occurrence, are extraordinary events. Some authors (e.g., Maltsberger, 2004) indicate that suicide involves a complete break down of any order in the person's life. Others (e.g., Maris, 1981) suggest that suicide is part of long-term, orderly processes. We need to unpack this apparent dichotomy in terms of both breakdown and orderly processes as they are experienced in clients who have attempted suicide.
The present study uses an action theoretical view of suicide acts and the processes that precede suicide. This view is premised on an understanding of suicide as goal-directed action (Michel & Valach, 1997). Like other everyday human actions, suicide attempts and other self-destructive behaviors involve the intentional and goal-directed actions of the person both in the short-term, self-destructive act itself, and in longer-term projects and careers of which the self-destructive acts are a part. Michel and Valach (2001) showed that self-destructive and suicidal processes could be seen in terms of joint goal-directed action. The "processes" we refer to in this article include actions, projects, and careers and their associated verbal and non-verbal behaviors, cognitions, feelings, and social interactions. This term applies equally to processes that are life-affirming or life-destroying. In as much as these processes are related to each other, we can also refer to them as a goal-directed system.
In the reports of research participants after a non-lethal suicidal act, we were able to identify short-term suicide actions, mid-term suicide projects, and a long-term suicide career, all of which the participants constructed as goal-directed processes (Valach, Michel, Young, & Dey, 2002). These narratives referred to both suicide-related and life-related processes (that is actions, projects, and careers related to life instead of to suicide).
The specific question addressed in this article is how persons, after a suicide attempt, link suicide-related and life-related processes, that is, how they switch between their life goal-directed system and their suicide goal-directed system. The linking of these processes is a segment in the stream of actions that allows a quick switch from being engaged in one system to pursuing another. This phenomenon has not been investigated extensively. Specifically, in terms of the narrative of a suicide attempt, we identify this link in the case when an action of an everyday project is suddenly followed by an action related to an existing suicide project.
It is hypothesized that the links between suicide-related and life-related processes may occur in one of two ways. First, the link may be organized as "top-down" steering and control in which both sets of processes are linked within the explicit goal-directed system (see Figure 1). Here, the person may have decided at some previous time to attempt suicide. The link is clear to the person at the time of the attempt and seemingly rational. This type of link is anchored conceptually in the goal-directed perspective described above.
[FIGURE 1 OMITTED]
Second, suicidal processes can also reflect bottom-up steering or control of a suicide action by the person who is attempting suicide. In this case, the suicide action is described as starting with smaller component parts and gradually building up to the larger units and is contrasted to top-down processes that begin with larger units and then proceed to smaller units. In bottom-up processes, the links are suggested to occur in processes of a lower order in goal-directed action, that is, words, phrases, movements, images, perception of environmental features, or sudden feelings rather than goals or long-term plans. This perspective captures the unconscious processes or responds to a momentary pull or impulse that is critical in the suicide attempt. However, this bottom-up process still occurs in the context of life-maintaining processes, which are expected to contextualize the person's narrative. Thus, the term "bottom-up" steering indicates a process in which the specific behavioral elements appear first and the higher order processes such as goals are developed later. Bottom-up steering is reflected in the terms "affective," "emotional" or "impulsive" suicide (Simon, Swarm, Powell, Potter, Kresnow, & O'Carroll, 2001; Williams, Davidson, & Montgomery, 1980) as distinct from the term "rational" suicide that is often used in everyday language and in law for a suicide action that was not planned in advance and was executed under strong emotion in a specific stressful situation. This perspective is captured in dynamic systems theory (Vallacher & Nowak, 1997).
The purpose of this research is to unpack the link between life processes and suicide processes using the notions of "top-down" and "bottom-up" steering we have described. The bottom-up launching of a suicide-related process may be one particular way of getting involved in a suicidal attempt, but not the general rule. Even more, we suggest that suicide- and life-related processes are both goal-directed processes. The link between suicide- and life-related processes reflects either the goal-directed system or the dynamic system, described above. If suicide-related and life related processes co-exist, it would represent a substantial challenge to the conception of suicide as disengagement (e.g., Carver & Scheier, 1998). These explications will be illustrated with the patients' narratives following a non-fatal suicide act.
METHOD
In this study we were interested in eliciting a narrative of the suicide attempt and related actions in the context of a psychotherapeutic interview. This narrative gave us access to the construction of the suicide act and related projects and careers and to their associated goal-directed processes.
Participants
A consecutive sample of 40 persons, hospitalized because of the health consequences of their suicide attempts comprised the participants in this study. As they were hospitalized in a general hospital in a Swiss city, they represented a non-random sample of the general population of suicide attempters in the area. Their education spanned from compulsory schooling to university degree, and their occupations from university student, home keeper to unemployed labourer. Citizens of foreign countries were underrepresented (instead of the expected value N=8 (20% inhabitants in Switzerland are of foreign nationality), there were only 4 foreigners in the sample). A few days after their attempt, a psychotherapist invited them to participate in this study. Their participation was explained as consisting of talking to a psychotherapist about their suicide attempt. The participation rate for the study was reasonable (40 recruited clients out of 162 treated in...
|
