Strategies to Stay Alive: Adaptive Toolboxes for Living Well with Suicidal Behavior
Abstract
:1. Introduction
2. Materials and Methods
2.1. Ethics Approval
2.2. Interviewees
2.3. Procedure and Data Collection
2.4. Data Analysis
3. Results
3.1. Theme 1: The Dynamic Relationship with Suicidal Behavior: Living with, and Through
3.1.1. Fighting for Life
In every case when I would reach out, and when I would be honest I always got help. Sometimes it is just the act of being honest and it is not really the help, for me, a lot of the time it is just not hiding out, not keeping secrets.(Lucas)
It turns in on myself and I see things as a way to kill myself, like things that don’t normally look like ways to kill myself become ways to kill myself… it is a constant thought.… [M]y clues to me that I need to go to the hospital are when I start planning out how to get rid of my stuff …one of my primary reasons for living is I want to live with my cats, and I don’t want my cats to go to other houses because I know they would be split up. By the time I don’t care about my cats, and I don’t care about whether or not killing myself would hurt my best friend’s family, and the most important thing is when I can no longer keep myself safe, and that is when I can’t drive, I can’t walk by buses, I can’t look at scissors … I become consumed with thoughts about how to die. I become consumed with thoughts about how to prepare my things for when I am gone, and that is when I go to the hospital….(Candace)
I remember it was strongest when I was in high school—maybe there were times before that—but I think maybe earlier…having periods where I thought, “I want to kill myself. I want to die. What can I do to prevent that?”(Willow)
3.1.2. Ambivalence
I remember laying there just wishing, like just thinking, “Wouldn’t it be nice to just …and put your head down on this pillow and just let it go? Just resign to that?”…It is really tempting. It is almost romantic, like it sort of calls to you like wouldn’t that be the sweetest thing?(Alice)
I don’t know why I did it; I think I did it mostly for fun…I don’t know how serious those (suicide attempts) were really—I really can’t tell you. I wouldn’t’ have objected to however it turned out, I don’t think, but it was kind of a game at that point … in trying to sort of snatch victory from the jaws of defeat things worked out quite well…I don’t believe anybody who has ever tried to commit suicide is safe. I don’t. The only thing that has happened to me in that regard is … I am increasingly less frightened of death. I am not real enthusiastic about dying, especially if it is long and painful but I am not afraid of death at all.(Lucas)
In any case, something was available, I was curious and I never quite dealt with my grief very well and my mind sort of went, “Well what was he thinking?” and so I just sort of repeated it. It wasn’t that I was unhappy, it wasn’t that I wanted to … it was just, “What do you think when you do it?” Stupid! [laughs].(Pippa)
3.1.3. Acceptance
The reality is, in my life…it is likely that I am going to have another bad time. … I am not going to be happy about it, but I have to understand, just like I can’t walk and no matter how much I want to walk it is not going to happen, and so there is a similar—and not in as completely an obvious sense—in which I just have to be ready for it (suicidal behavior) to be a problem…(Ludo)
Here and now is more my concern, and the concern is the more here and the more now the better. That is a big AA teaching…It (suicidal ideation) is not overwhelming, it is just always present… I think that suicide is a sin in a sort of conventional sense because you are taking control out of the hands … like a spiritual authority, from your body, whatever, you are taking it away … So I am in sort of this peculiar spot right now. I think it is a good spot, actually, where I am not really … I am not sort of as goal-directed and I think that is good. I am glad about that.(Lucas)
3.1.4. Finding and Holding Hope
I think being close to people in general…To me, yes, I do think that the thing that is keeping us sort of here, keeping us hopeful about the world in general is meaningful relationships with people.(Hayden)
It is something that with a little bit of work you could get through, yeah, the pain is bad but it hasn’t always been like that. There were good times and there can be good times, you know? It is to try and focus on how to get them back, rather than how to make the pain end, is how to make joy possible again—because it is, you just don’t see it at the moment.(Alan)
3.2. Theme 2: The Toolbox
3.2.1. The Self-Directed/Discovered Toolbox
Some of it (suicidal ideation) was…empowering … because I was so unhappy and I couldn’t do anything about it, and no one would help me. It was like, “Okay, I know I can always do this. I have this option, so if it hurts too much …” you ultimately have the last word and there always is something you can do if it gets too bad, and that is comforting.(Alice)
I’m lucky because I have a little dog and I have to take him for walks and that usually helps, but I still have my bad days and bad nights, but I think I am at a good point where I am not going to kill myself.(Janine)
I had a chance to spend a few years spending a lot of time by myself in nature, time alone in nature, physical exercise… I realized something had changed in me because the old pathways that would go to this place where I was just like, [having] an uncontrollable self-destructive urge constantly alighting on my brain every day was gone. I didn’t go there, and I was really unhappy, but I didn’t go there…But for me, you know, that has to do with quiet. Meditation was also something…I started studying Buddhism, and I would meditate …Yes, meditation outside, walking outside, running outside.(Jeff)
I think…what saved me from taking any steps, was also the karmic thought in my mind saying, “Oh, this all seems really familiar. I bet I have done this before in other lifetimes,” and it kind of feels like I did it before and then realize that that was not the right thing to do, and if I do it again I am just going to be repeating the cycle. Okay, maybe I need to hang on and figure out a way to get out of it.(Willow)
I don’t think being an atheist would be very helpful to me … For me what faith or whatever that I have is a function that I just live better that way. When I lose faith then I become more dangerous to myself.(Lucas)
Telling your story is clearly a therapeutic kind of thing. Hearing other people with similar kinds of symptoms, and how it works out for them, and their stories is very powerful.(Martin)
For a long time I was like, “I will just keep this to myself,” but being a certified peer specialist you have to become comfortable talking about your own experience, and so for two weeks that is all we did—talk about our experiences. I remember there was one man and he was like, “I have these random depressions. They show up every five years, I want to kill myself and then I am fine,” and then he is like, “And five years later it shows up again,” and I was like, “Me too!” He was like, “I have never met someone with that type of experience,” and I was like, “Neither have I!”(Jane)
I think it was helpful that I had a few very dear friends who, like, beg is not the right word, but would talk me out of it… when I look back at it I am shocked that I am still alive because…I didn’t trust a lot of people around me. I would say in a very big way I owe my life to this one friend and my cousin who sort of talked me through a lot of things… I think that I am exceptionally lucky in that I had a few friends who looked out for me very much, and I have an extended family that still likes me, despite the fact that we disagree on a few things.(Angela)
But of course I couldn’t think about really killing myself at that point because I couldn’t do that to my kids…So that stopped me from going that far in the fantasies, like, “Well they need me and I would traumatize them if they came in the room and I was dead, so I can’t do that…. So I needed to make sure that I didn’t commit suicide.(Willow)
3.2.2. The Conventional/Medical Toolbox
So, I was over there (psychiatric unit) for an entire month … and the psychiatrist that worked with me…I got along with him real well and so that was really beneficial. We had some nice discussions…I finally got out after a month and there was a transfer of my medication out to…and I started seeing a therapist out there as well.(Eric)
Because one of the things I learned most from DBT is I need to think of me, not as a victim but a survivor.(Sally)
If I am in some sort of peer support setting, whether it is individual or in a group, or whatever it is, I know that person gets it and it is so much less scary to tell those people… that you really do connect with when you go to a hospital… you connect to other people in the program and those are the biggest influences on you. If you are in a group with a good set of people who are active and participating, and like encouraging in the group you are going to get a lot more out of it, and it doesn’t matter who is standing at the front of that room, it is about the group you are surrounded by.(Jane)
I started seeing a counsellor when I was thirteen, I think—in those early teen years. And then it has been an ongoing sort of come and go… And then just a couple of months ago… it got to a breaking point and I started taking medication. I feel better. I started taking… and it is really good.(Alice)
I don’t take the antidepressants now, I don’t like the side effects. But I still carry (anti-anxiety medication) with me. It helps to know I have it.(Meredith)
3.2.3. The Life Circumstances Toolbox
For a long time, I was like, “When I am an adult I can travel and work in theatre and do all these things,” and that was really helpful to me.(Angela)
To me they (bridge barriers) sent the message of…we care enough now to say, “Don’t jump off the bridges. We don’t want you to kill yourself.” It is the opposite of what having no fences said: “Oh, we don’t care, if you jump off, you jump off and we will just weed you out.” Weed out the weak.(Duane)
The bridges (barriers) are about “the community cares”. That is what the message is.(Pippa)
It will be thirty years (together) this year. Yeah, we got legally married as soon as it was legal…Anyway it is quite an amazing … I specifically call him my ‘husband’ now, and I used to call him my ‘partner’ or my, you know, my ‘boyfriend’. But now I specifically call him my husband because there is something about having … of course depression and, you know, the sense of alienation has to do with how much you feel a part of the center of the defining aspects of society.… it is this slight difference between like how the world feels okay and then it doesn’t. And it is not this very complicated change. Being married is sort of like that, it is not that it changed things radically, but there is this little piece of…You are a part of something, you know?(Ludo)
3.2.4. The Hybrid Toolbox
You should have something that is meaningful, you should exercise, so I try to do all those things because no one thing will (help)… It is not that I will come to understand all my underlying crap, and I will, you know, let go of that stuff, or I will put it in a different place, which is usually how I think about that stuff because I don’t want to just get rid of it, because I don’t think you can get rid of your history … so I think for me, I just have to be really committed to doing all these different things at once.(Ludo)
It (suicidal behavior) has been with me my entire life and it was the only thing I took comfort in for a long time, for years and years… it was my only comforting thought. I know it will be again … one thing I have been practicing in my good times is every day, like I said, meditation… and just sitting down and remembering all the things that are good in my life, and it is very important to stay grateful, like, I have an apartment, it is great, and I can afford it, thanks to my disability. You know, my neighbors are some of my best friends in the world and any time I need them I can go down, and any time they need me they can go up. I love my job. I have never been able to say that before and I have had a lot of jobs. I love my job.(Alan)
4. Discussion
5. Limitations
6. Conclusions
As a society, we see preventing suicide as analogous to snatching a person out of the way of a speeding vehicle. We don’t see it as walking along the road with a person who is completely lost and uncertain about his or her destination, when we don’t know the destination either. It may be a long way away. The person may never get there. But the walk is the process; it’s how we stay alive.
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Participant Characteristics | Number (n) |
---|---|
Age (years) | |
18–24 | 5 |
25–44 | 7 |
45–64 | 4 |
65+ | 1 |
Sex/Gender | |
Male | 6 |
Female | 9 |
Gender Diverse | 2 |
Ethnicity | |
White | 16 |
Middle Eastern | 1 |
Suicidal Behavior | |
Attempted Suicide | 11 |
Suicidal Ideation with Suicide Plan | 5 |
Suicidal Ideation over a long period of time without Suicide Plan | 1 |
LGBTQIA+ | 3 |
Religious/Spiritual Beliefs | 15 |
Childhood Trauma/Abuse | 14 |
Formal Peer Support Worker | 4 |
Theme | Subtheme |
---|---|
1. Dynamic relationship with suicidal behavior: Living with, and through | Fighting for life Ambivalence Acceptance Finding and holding hope |
2. The toolbox | The self-directed/discovered toolbox The conventional/medical toolbox The life circumstances toolbox The hybrid toolbox |
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Share and Cite
Scarth, B.; Bering, J.M.; Marsh, I.; Santiago-Irizarry, V.; Andriessen, K. Strategies to Stay Alive: Adaptive Toolboxes for Living Well with Suicidal Behavior. Int. J. Environ. Res. Public Health 2021, 18, 8013. https://doi.org/10.3390/ijerph18158013
Scarth B, Bering JM, Marsh I, Santiago-Irizarry V, Andriessen K. Strategies to Stay Alive: Adaptive Toolboxes for Living Well with Suicidal Behavior. International Journal of Environmental Research and Public Health. 2021; 18(15):8013. https://doi.org/10.3390/ijerph18158013
Chicago/Turabian StyleScarth, Bonnie, Jesse M. Bering, Ian Marsh, Vilma Santiago-Irizarry, and Karl Andriessen. 2021. "Strategies to Stay Alive: Adaptive Toolboxes for Living Well with Suicidal Behavior" International Journal of Environmental Research and Public Health 18, no. 15: 8013. https://doi.org/10.3390/ijerph18158013
APA StyleScarth, B., Bering, J. M., Marsh, I., Santiago-Irizarry, V., & Andriessen, K. (2021). Strategies to Stay Alive: Adaptive Toolboxes for Living Well with Suicidal Behavior. International Journal of Environmental Research and Public Health, 18(15), 8013. https://doi.org/10.3390/ijerph18158013