The Prevention of Suicide

Two items of recent news struck me as needing to be corrected.  The first concerned the benefits of stable relationships.  Professor Hugh McKenna, Dean of the faculty of Life and Health Science spoke at the University of Ulster’s Mental Health Week about how ‘poor and unstable interpersonal relationships can lead to mental health problems, just as the development of stable interpersonal relationships can bring people back to mental health.’  He went on to say ‘what patients need most in the midst of the healthcare maze are sensitive and caring healthcare professionals willing to enter into interpersonal relationships that foster hope and prevent hopelessness.’  Whilst I would take issue with the term ‘mental health’ and referring to people as ‘patients’, I thoroughly agree that therapeutic recovery is completely dependent on the nature of the relationship between the person who is offering help and the person who is seeking it.  Clearly, the relationships that the person who is distressed has with others and they with him or her are crucial considerations.  What Professor McKenna did not point out is that the quality of interpersonal relationships is dependent on the quality of the relationship a person has with self.  What is inside always comes out.  Furthermore, it is not the case that most people in the healthcare professions get the opportunities pre or post training on how to establish effective interpersonal relationships and, certainly, no attention is paid to their level of personal maturity.  It is the case that personal effectiveness is the bedrock of professional effectiveness, but that reality has not yet been grasped in the training of most health-care professionals.

My issue with the term ‘mental health’ is that ‘mental health’ suggests that the problem lies totally within the person and takes no account of the interpersonal sources of inner conflict, thus narrowing the focus of therapeutic endeavours.  Similarly, the word ‘patient’ puts the total focus on the distressed individual and also depersonalises him or her.  People in turmoil need to be seen for their unique presence and their unique interpersonal circumstances.

The second news story that caught my attention was the reporting of the survey on public attitudes to suicide.  Whilst it was heartening to read that the stigma relating to suicide has changed in the past decade, there are still twenty-five per cent of people who would feel ashamed if a family member committed suicide.  What is alarming is that sixty-two per cent of people North and South believe that suicide is symptomatic of ‘mental illness.’  The medicalisation of suicide has, for years, prevented a realistic understanding of what leads to individuals choosing to end their precious lives.  My belief and clinical experience is that suicide is more about ending pain, rather than dying.  The critical question is what pain are we talking about.  This question brings us back to Professor McKenna’s statement that poor and unstable relationships lead to emotional turmoil, which often goe undetected by both family members and health-care professionals.  To suggest that suicide is due to mental illness only further alienates the person who is suicidal from self and from others.  The recent survey among university students on the prevalence of depression found that one in thirteen experienced chronic depression and that two-thirds of this number did not talk to anyone about it, and one-third felt that nobody would understand anyway!  These findings point clearly to unstable interpersonal relationships and the medicalising of depression and suicide only reinforces these sad circumstances.  Given such medicalising, it is not surprising that many men and women believe that  nothing can prevent a suicide once it is decided upon!  Such hopelessness provides no place of understanding for a person in suicidal turmoil.  The fact is that attempted suicide and suicide are psycho-social problems with both intrapersonal and interpersonal determinants.  The survey has shown that suicide has touched up to seventy-five per cent of families North and South and the understanding of it and its prevention is everybody’s responsibility.  However, it is only through the creation of stable interpersonal relationships in all the key social systems – family, school, church, community, work-place – that the safety and understanding can be found to examine honestly the nature of the pain that the person who takes their life wants to end.  The word pre-vention means ‘before the coming of’ and, in my view, and, clearly in Professor McKenna’s opinion, loving relationships are required across the full spectrum of human interactions, lay and professional.

Dr. Tony Humphreys is a clinical psychologist and author of Leaving The Nest.