I recently attended an international conference on suicide. It was an instructive experience, and not just because of the content. As we listened to lectures, browsed posters, and conversed over coffee, a colleague and I reflected on a sense of there being something missing from the overall experience.
We realized it was a lack of affect, or emotion.
Amongst the studies, statistics, and symposia, there was little sense of the feelings that surround suicide. How could this be, given the undeniably intense emotion that taking one's life entails? Surely, to paraphrase the psychiatrist RD Laing, in order to understand suicide, you must first understand despair?
Clearly, such thoughts and feelings are painful, dangerous and usually unwelcome. They are real, however, and likely to be stirred by the content of the conference. This is especially the case when such dark material has surfaced in one’s life in the past.
During several conversations, attendees told me that they had either experienced suicidal thoughts or suffered the trauma of a loved one taking his or her life. I suspect that many of the people present shared similar backgrounds, and the harnessing, or sublimation, of this pain provided the motivation and energy for their work in the area of suicide.
My colleague and I wondered what happened to those memories during the conference, and whether the mechanisms keeping them at bay were helpful and healthy.
Before we decided on the details of the presentation we gave, a group psychoanalyst colleague had suggested that we should not present any material, but rather allow our workshop to become a safe space for people to try to get in touch with their suicidal feelings. The presupposition is that everyone has a suicidal part of their psyche, and that it would be a valuable learning experience to acknowledge this. The idea was a fascinating one, but we did not feel confident enough to implement it.
One reason we lacked confidence was that we were resistant to having to face our own suicidal parts. We may have been protecting ourselves from them, using psychological defence mechanisms.
Looking back at the conference, such defences seem to have been in action in the minds of the delegates. Two examples are projection and splitting. Unpleasant suicidal feelings, stirred from the depths of the psyche by the content of talks, were transferred, or projected, into the ‘suicidal’ group - the subjects of the scientific studies. A split occurred, separating the ‘normal’ professionals and the suicidal patients. The latter became ‘the other’: objects to be studied, numbers in a table, percentages in a graph.
In short, they became dehumanized.
A striking example of this occurred during a talk about high suicide rates in an isolated Asian tribe. When asked whether there were plans for intervention, the speaker said that the team would like to examine the tribe’s genes first. The room laughed.
Freud said that there is ‘no such thing as a joke’, meaning that rather than being a humourous aside, a joke reveals repressed content of the mind. In this case, suicidal people have been reduced to subjects carrying interesting DNA. Their sadness and hopelessness goes unacknowledged, indeed, unrecognized, and so need not trouble us.
This self-protection is of course, normal behavior. We have to do it if we are to function as we do. But without allowing ourselves to know and feel these shadowy parts of ourselves, can we really empathise with our patients?
It is particularly important for mental health professionals to allow themselves to feel their patients’ despair at times. Without this empathy, we run the risk of producing too great a distance between professional and patient. Without a therapeutic relationship, we are unlikely to bring about meaningful, long term positive change.
It was instructive to speak to a number of delegates who, whilst attending the conference in a professional capacity, had previously been treated within mental health services for a range of problems including suicidal thoughts. They all told me that they felt excluded and alienated at the conference. They felt that the content discussed was too abstract, with not enough humanity. One person had been so struck by a speaker’s obsession with neurotransmitters that she had nicknamed him ‘Serotonin Man’.
There is a great value in quality academic work carried out with integrity. However, especially in psychiatry, we must remember what, and who, we are working for. Understanding psychic pain requires more than measuring brain chemicals and gene associations. In order to help those who are driven to end their existence, we may need to question ours.