Exhausted without trust and inherent worth:A model of the suicide process based on experiential accounts

Rationale and Methods Suicides are related to diverse demographic, socio-economical, medical and behavioural ‘risk factors’. Theoretical work in suicidology attempts to construct models that explicate the mechanisms underlying these suicides; however, models taking first person perspectives as their primary evidential bases are scarce. Drawing on interviews carried out by researchers at a UK mental health charity during 2010–2012 with people bereaved by suicide (n = 25), suicidal individuals (n = 14) and their ‘significant others’ (n = 15), we present an explanatory model of the process of suicide derived from a Grounded Theory study. Results Suicide/attempt can be understood as the result of a complex interaction of three elements of experience: ‘lack of trust’, ‘lack of inherent worth’ and ‘suicidal exhaustion’. The first two may be seen as conditions from which the third emerges, but so that all the elements are related to each other reciprocally and the exhaustion and the suicidal thoughts, feelings and behaviours it gives rise to feed back into the initial conditions. Trust, understood as an aspect of experience that allows a person to accommodate uncertainty in relationships and in thinking about the future, is lacking in suicidal people, as is a self-determined sense of worth that is independent of external factors. Substituting inherent worth with self-worth gained from extrinsic factors, and trustful experiencing with strategies of self-reliance and withdrawal, a person begins to consume mental resources at a high rate. ‘Suicidal exhaustion’ is distinguished from other types of chronic mental exhaustion in that it is experienced as non-contingent (arises from living itself) and hopeless in that the exhausted person is unable to envisage a future in which demands on his/her mental resources are fewer, and their replenishment available. Conclusion The model has potential applications for public participation in suicide prevention, which should be mapped and assessed in further research

Talking about suicide

While it is acknowledged that there is a need for more qualitative research on suicide, it is also clear that the ethics of undertaking such research need to be addressed. This article uses the case study of the authors’ experience of gaining ethics approval for a research project that asks people what it is like to feel suicidal to (a) analyse the limits of confidentiality and anonymity and (b) consider the ways in which the process of ethics review can shape and constrain suicide research. This leads to a discussion of the ways in which ethics committees assess and monitor qualitative research more generally and some preliminary suggestions for how this might be improved

Varieties of disgust in self-harm

This chapter explores how self-disgust may manifest as part of the experience of self-harm. In its primary form, disgust implies a set of behavioural and physiological rejection responses against contamination or incorporation of contaminant material. It involves a sudden arousal of feelings, physiological changes, and action impulses that aim to prevent the threatening object from crossing the body boundary or from spreading within it. People who self-harm are, prior to the act, either in a state of high arousal, in which overwhelming anger, anxiety, or a mixture of unidentifiable emotions is typically experienced, or they are depersonalised. Feeling out of control involves an experience of a lack of autonomy and agency over one’s internal states. The self-harm act “catches” emotions that were previously felt to be “untameable” and amorphous; the wound, scar, and/or blood become a representation of the experience that can be attended to, contemplated, and something that the individual can act upon

The impact of participating in suicide research online

The impact of participation in online mixed-methods suicide research was investigated. Participants, who described feeling suicidal, completed an 18- item questionnaire before and after taking part (n = 103), and answered open- ended questions about participation (n = 97). Overall, participation reduced negative experiences and had no effect on positive experiences. Feelings of calm increased, but participants felt less supported. Some participants did expe rience distress, but some also reported this distress to be manageable. Anonymously sharing experiences of suicidality was viewed as important, had therapeutic ben- efits, and engendered hopes for recovery. The findings suggest a need to ensure vulnerab le participants in online studies are well supported while protecting their anonymit