Archive for March, 2012

Understanding and Preventing Suicide

March 9, 2012

Fernando Martí, “Quetzal”

 “Suicide is never born out of exaltation or joy; it is a child of the negative emotions.” — Edwin Shneidman, The Suicidal Mind

With her Understanding and Preventing Suicide (2009), psychologist Kristine Bertini seeks to explain some of the factors that can contribute to the development and completion of suicide; in her own words, the book is written as a “map of how the suicidal mind can develop.” Like many other investigators of the human mind, Bertini seeks generally to inform her audience about the issue of suicide toward the end of identifying risk factors for this phenomenon in an attempt to do away with these. Bertini herself admittedly exhibits “a great joy for living” and “a ferocious life instinct”; this may inform her view of suicide as psychopathology, as is reflected in her claims that “[l]ife… seeks to replenish itself and survive,” that “[t]he desire to live is instinctual.”

On Bertini’s account, a great deal of vulnerability to suicide in life is related to one’s early life experiences, in addition to genetics; like Freud, Bertini focuses much of her attention on early childhood. Predisposition to suicide can thus develop out of biological and personality formation or in response to particular life moments of hopelessness. For her, the emergence of suicidal proclivities can be inhibited by one’s experiencing expressions of love and warmth in infancy and childhood, for these allow the self to develop a sense of security as well as an unconscious knowledge that one will be cared for. These life-conditions generally permit for the subsequent development of independence and self-esteem. Conversely, childhood neglect and challenging social environments such as those plagued by racism and material impoverishment can increase one’s susceptibility to depression and other neuroses. In this sense, children of more socio-economically privileged parents are at an unfair advantage in terms of the potential for suicide (not to mention much else), though Bertini importantly notes that adverse social conditions can be largely overcome if one is afforded a loving and supportive family environment, which can help establish a foundation in which the developing self can flourish, despite negating surroundings. Some children are more vulnerable to depression and suicide simply because of genetics, as they can inherit predispositions to these conditions from their parents; if to this propensity to mental-health issues is added a lack of understanding or supportive parents—ones who are absent or unavailable—the child’s emotional vulnerability and subsequent development are considerably exacerbated. Moreover, one’s own medical vulnerability or the experience of that of a close loved one can contribute to depression and suicide ideation, especially among children. In general terms, Bertini argues that a child’s disconnection from her parents can lead to the development of a “bleak, impoverished inner world” that can contribute to depression and suicide ideation. If a child is rejected by her parents, she may come to think of herself as unlovable and hence experience low self-worth, depression, and anxiety. Children who are victims of sexual abuse are particularly susceptible to depression and suicide. As Bertini notes, these individuals may wish for death to escape the fear, pain, and confusion to which they are subjected by their oppressors, hence the turn to suicide; if interpersonal trust is violated at an early age, the victim of abuse is more likely to isolate oneself and use avoidance patterns in her dealings with others. As regards the struggle against childhood and adolescent depression and suicide, the author stresses that it is critical that adults “be aware that each developing soul needs to be considered special and cherished.”

Continuing her investigation, Bertini highlights three specific factors that contribute to adult suicide: internalized despondency, learned helplessness, and distorted belief systems. Internalized despondency, or despair, she ties to several causes: biology (genetics), traumatic life experiences, and depression; she notes that this hopelessness may well have served as a coping mechanism for difficulties in childhood that has been carried on later into life. The worry here is that a prolonged period of living this way tends to convince one that there is no chance for an alternative to hopelessness; in this sense, suicide can be seen by the potential victim as a means of control and a measure to put an end to pain (suicide can thus be considered an “oasis of peace and calm, beckoning like water in the desert”). Learned helplessness Bertini situates as being a response to the environment; she stresses that this is a common reality for members of marginalized social groups, who are alienated from the mainstream-dominant culture either because of culture or psycho-physical status (people with disabilities and those who “look different” are especially vulnerable to this, Bertini says, as are the impoverished). Many experiencing learned helplessness choose interpersonal relationships that reinforce alienation, thus contributing to the view that there can be no escape; as a result, suicide is again seen as a possible exit or as punishment of those who administer systems of exclusion. Those exhibiting a distorted belief system have developed a “strong negative belief system”; they feel that there is no option but suicide, that they are powerlessness to change destructive and hopeless patterns, and that their helpless and despondent state will always be. They often hold, based on past life experiences, that they that will never be loved, and hence that the future is bleak. Suicide ideation and completion in this regard holds out the prospect that the victim be remembered after she is gone by those who grieve her death; perhaps ironically then, self-death can lead others to express their love for the subject, the very absence of which is driving one to suicide. In this section Bertini links depression strongly with suicide, noting the former potentially to be a “silent killer,” as it can easily go unrecognized.

Systematizing risk factors for suicide, Bertini identifies those with mood disorders, low self-worth, a history of abuse, family history of suicide or mental-health issues, serious medical problems, a lack of an “important other,” loss, exposure to racism, and low socioeconomic status to be of high risk. In terms of U.S. populations, she emphasizes adolescents, the homeless, the elderly, white men, LGBTQ individuals, Native Americans/Native Alaskans, and Pacific Islanders as being especially vulnerable to suicide attempts and completion.

Against these trends, the reconstructive point for Bertini is for those contemplating suicide to replace negative thought-patterns with positive self-talk and hopeful messages. Drawing on her own clinical experience and research, she states that individuals can be made to recognize the internal resources they have for changing own destiny, in addition to externally derived ones: some examples are basic coping skills (walks on the beach, hot baths, music, exercise, good food), surrounding oneself with loving others, engaging in therapy, and taking medication if necessary. She recommends that those who are suicidal must “reach out for help,” perhaps following their instincts for self-preservation, if they are to successfully avoid completion; she suggests that observers or friends of suicidal persons engage with that person toward the end of referring her to professional help.

Bertini closes her work by examining human resiliency, the a “dynamic process of healthy adaptation in the face of severe adversity.” She observes that this may be the result of “unknown genetic determinants”; one’s temperament at birth is seminal in this sense, though the basis for the nature of this temperament is at a certain point seemingly random. Reviewing psychological findings, she stresses that one of the principal factors guarding against suicide is having a supportive environment. Under such conditions, one’s own mental-health problems and possible struggles with suicide can be dealt with and resolved in a loving and caring manner, making the emergence of these less likely. In general, then, social support serves as a buffer against the difficulties of life. For children, there is often an “important other” different than one’s parents who can “help the child feel a sense of being loved and esteemed by someone in the world,” especially if such love and esteem are lacking in the domestic setting: “little kindnesses that others can provide in the early years foster hope and resilience and improve the individual’s ability to combat despair and suicidal tendencies throughout the life span.” Similarly, love as expressed by one’s friends and companions helps to create hope in that person, thus helping her to flourish. Beyond this, having an adaptable personality has been seen to aid individuals in navigating life’s many challenges. Additionally, cultural identification and religious/spiritual affiliations can help to promote sense of belonging, reducing isolation and depressiveness. Interestingly, a child’s escape into fantasy may allow her greater resiliency in the sense that this engagement with fantasy can foster the belief that life can be different; the recall of pleasant memories can serve similar functions. As Bertini concludes, “[t]he ability to hope that a positive outcome will be eventual is essential to ensure emotional well-being.” Self-efficacy and optimism—the belief that one has the ability to change one’s circumstances—lead to action, reducing despair. Hope fosters the desire to survive!