Does Availability of Mental Health Resources Prevent Recurrent Suicidal Behavior? An Ecological Analysis

This study examines whether availability of mental health resources in the county of residence is associated with subsequent suicidal behavior after a previous suicide attempt. Among 10,922 individuals who attempted suicide in Colorado between 1998 and 2002, residence in a county that offered a minimum safety-net of mental health services significantly reduced the risk of suicidal behavior for at least 1 year after the index attempt. Safety-net services included mental health treatment, crisis treatment, and case management. These results suggest one strategy for prevention of suicidal behavior that could inform state-level health policy development and resource allocation.     

Self-harm as a sign of hope

The author describes psychotherapeutic treatment with a woman who uses severe forms of self-harm to express her hope that she can find real understanding and an environment that can respond to her. She discusses the significance of the earliest experiences of maternal care and the particular importance of the skin; she describes how traumatic breakdowns in early care are unconsciously re-created in later assaults on the body, which serve to communicate distress, anger, protest and the hope that a real attempt will be made to relate to the person who self-harms. Self-harm is viewed not as a suicidal gesture, but rather, as an attempt to preserve life, and to represent and contain unbearable states of minds. The author outlines ways in which self-harm can create a narrative and embody unbearable feelings and unspoken thoughts. It is seen as a form of self-expression and communication, both conscious and unconscious, which is not wholly destructive but has important hopeful and self-preservative aims.     

Brooding and reflective rumination among suicide attempters: Cognitive vulnerability to suicidal ideation

Previous research suggests that the brooding subtype of rumination is associated with increased suicidal ideation, but findings are inconsistent with respect to reflection, considered to be the more adaptive form of rumination. This study investigated the circumstances under which reflective rumination might be associated with increased suicidal ideation by examining whether a suicide attempt history moderated the relationship between the ruminative subtypes and current suicidal ideation. Thirty-seven young adults who reported a past suicide attempt and fifty-nine young adults without a suicide attempt history completed measures of rumination and depression symptoms in an initial study session. They then completed a measure of suicidal ideation and hopelessness during a second study session. Overall, brooding was associated with higher self-reported suicidal ideation, whereas reflection was not significantly associated with ideation. However, reflection - but not brooding - interacted with suicide attempt history to statistically predict suicidal ideation, even after adjusting for symptoms of depression and hopelessness, whereas brooding no longer predicted ideation after adjusting for these symptoms. These findings qualify earlier suggestions that reflection is a more adaptive form of rumination by indicating that among vulnerable individuals - in particular those with a history of a suicide attempt - a higher degree of reflective rumination is associated with increased suicidal ideation.     

Embodying analysis: the body and the therapeutic process

This paper considers the transfer of somatic effects from patient to analyst, which gives rise to embodied countertransference, functioning as an organ of primitive communication. By means of processes of projective identification, the analyst experiences somatic disturbances within himself or herself that are connected to the split‐off complexes of the analysand. The analysty’s own attempt at mind‐body integration ushers the patient towards a progressive understanding and acceptance of his or her inner suffering. Such experiences of psychic contagion between patient and analyst are related to Jung’s ‘psychology of the transference’ and the idea of the ‘subtle body’ as an unconscious shared area. The re‐attribution of meaning to pre‐verbal psychic experiences within the ‘embodied reverie’ of the analyst enables the analytic dyad to reach the archetypal energies and structuring power of the collective unconscious. A detailed case example is presented of how the emergence of the vitalizing connection between the psyche and the soma, severed through traumatic early relations with parents or carers, allows the instinctual impulse of the Self to manifest, thereby reactivating the process of individuation.     

Dissociation,Physical Pain,and Suicide: A Hypothesis

The hypothesis of this paper states that at least some suicidal individuals are characterized by a disposition toward dissociation manifested in relative insensitivity to physical pain and indifference to their bodies. Three main topics are discussed: dissociation and suicide, psychological aspects of pain, and pain and suicide. Various theoretical and experimental studies suggest that certain stress conditions lead to the development of dissociative tendencies, and that once these tendencies are established, they become an integral part of suicidal behavior. Psychological variables that affect pain tolerance are presented and they include perception, motivation, emotions, and behavioral and cognitive strategies of pain control. These can increase tolerance of pain in suicidal individuals, making the suicidal act possible. The specific relationships of pain and suicide are then introduced through an examination of pain analgesia in the phenomenon of self-harm. The integration of the material suggests that early and continuous stress lead to the simultaneous development of dissociative tendencies (including indifference to the body and pain) and heightened vulnerability to stress. These dispositions may facilitate suicidal behavior in the face of mounting intolerable stress, helplessness, and hopelessness. Preliminary empirical support for the present hypothesis is cited. This hypothesis shifts the focus of attention from the question of what causes suicide to what facilitates suicide, and in so doing suggests new directions for research and therapy.     

Body attitudes and body experiences in suicidal adolescents

The relationships between cognitive and affective attitudes toward the body, body experiences (dissociation, insensitivity, and lack of control), and suicidal tendencies were examined as a derivative of the hypothesis that bodily attitudes and experiences may facilitate suicidal acting out. Three groups of adolescents (aged 14-18), including suicidal (made a suicide attempt) and nonsuicidal inpatients and controls, were compared with regard to suicidal tendencies, various body aspects, and depression and anxiety. A series of MANOVAs, discriminant analysis, Pearson correlations, and regressions were employed. The results show that the suicidal group differed from the two nonsuicidal groups in feelings toward the body, body protection, and body dissociation. Some aspects of bodily measures discriminated between suicidal and nonsuicidal subjects. In addition, various bodily measures were associated with and statistically predicted suicidal tendencies. The discussion focuses on the web of associations between body attitudes and experiences and their role in suicidal behavior.     

Some thoughts between body and mind in the light of Wilma Bucci's multiple code theory

The author proposes the usefulness of Wilma Bucci's Multiple Code Theory in clarifying some controversial issues in psychoanalytically inspired psychosomatics. Definition of a dialectic among different entities may appear difficult in an unitarian view of the organism, where body and mind are seen as having no kind of intrinsic existence, which may be differentiated from the organism as a whole, but as two categories having to do with the perspective of the observer. This aporia may find a solution in a redefinition of the body-mind relationship as that between symbolic systems and the subsymbolic system, both of which may be viewed as mind or as body depending on the point of observation. Similarly, somatic pathology, if we accept an unitary paradigm, need no longer be viewed as due to an influence of 'mind' on 'body': a definition of pathology as linked to a disconnection between different systems, as found in Bucci's theory, is proposed as a possible solution. Emergence of somatic symptoms, however, besides being witness to disconnection, may be seen as the subsymbolic first expression of an item of content, an attempt at reconnection, as already proposed, in a way, by Winnicott in 1949. This attempt has much better opportunities to succeed when it finds an adequate container, as in analysis. A clinical situation of this kind is presented.     

Using lifeworld philosophy in education to intertwine caring and learning: an illustration of ways of learning how to care

Our general purpose is to show how a philosophically oriented theoretical foundation, drawn from a lifeworld perspective can serve as a coherent direction for caring practices in education. We argue that both caring and learning share the same ontological foundation and point to this intertwining from a philosophical perspective. We proceed by illustrating shared epistemological ground through some novel educational practices in the professional preparation of carers. Beginning in a phenomenologically oriented philosophical foundation, we will first unfold what this means in the practice of caring, and secondly what it means for education and learning to care in humanly sensitive ways. We then share some ways that may be valuable in supporting learning and health that provides a basis for an existential understanding. We argue that existential understanding may offer a way to bridge the categorisations in contemporary health care that flow from problematic dualisms such as mind and body, illness and well-being, theory and practice, caring and learning. Ways of overcoming such dualistic splits and new existential understandings are needed to pave the way for a care that is up to the task of responding to both human possibilities and vulnerabilities, within the complexity of existence. As such, we argue that caring and learning are to be understood as an intertwined phenomenon of pivotal importance in education of both sensible and sensitive carers. Lifeworld led didactics and reflection, which are seen as the core of learning, constitute an important educational strategy here.     

Challenging Design: How Best to Account for the World as It Really Is

Evolutionary psychology and intelligent‐design theory both need to be able to account for the empirical world, or the world as it is. This essay is an attempt to clarify the challenges these theories need to meet, if the relevant empirical findings are replicable. There is evidence of change in the biological world and of modularity of mind, and there is a growing body of work that finds evolutionary theory a convincing and fruitful account of the “design” of the mind. Three major empirical findings within evolutionary psychology are presented and discussed. The author claims that Cartesian dualism, as it is usually meant within psychology—a split between body and mind—is false, but that Descartes' original division between body and soul has not been challenged and is not challenged by the evidence that the mind is also a biological entity. The article concludes that the convergence of theology and science is to be found in the onus to discover the truth about the world as it really is, and this calls for an ability on both parts to account for the empirical world.     

A response to Maggie Turp's paper from a body psychotherapy perspective

Whilst appreciating the quality of containment in Turp's work as a learning point for the Body Psychotherapy tradition, the author argues that Turp does not represent a psychotherapeutic way of ‘working with the body’. This would require a deconstruction of the body/mind dualism inherent in much psychotherapeutic (and psychodynamic) theory, so that the complexity of the spontaneous and reflective body/mind processes, especially in their polar extremes (body/mind dissociation – body/mind integration / ‘psyche/soma unity’), can be contained. An holistic body/mind formulation of countertransference is approached by which – rather than being used as a gratifying or cathartic therapeutic shortcut which avoids the intensity of the transference – the body can be seen to constitute an avenue into the full experience of the transference/countertransference process and its relational sources in early development.     

The trauma of attempted suicide

Suicide is a traumatic event, one which may acutely recreate a previously-experienced traumatic situation. The person's capacity to think after a failed suicide attempt is affected by the use of defence mechanisms against persecutory anxieties and depressive pain, and there is a wish to turn a blind eye to the seriousness of the suicidal act. This includes the damaging effects on the person's relationships with others, and damage to his own psychic integrity.

The need to turn a blind eye to the consequences of a failed suicide attempt may also be mirrored by the therapist who assesses and treats the patient in the early hours after such an event. Suicide is associated not only with the pain of despair but also with a ruthless abandonment of life. It is a complex and difficult task for a therapist in the immediate aftermath of a suicide attempt to be able to keep in mind a concept of suicide that includes both the patient's role as the perpetrator of great violence against himself, in which death is the intended outcome of his actions, and at the same time recognise the patient's identification with an abandoned and cruelly treated object.

In this paper, we describe some of the psychodynamic factors that affect and influence the assessment and treatment of patients in the immediate period following a failed suicide attempt. We emphasise the importance of supervision in helping prevent destructive acting-out by the therapist when treating disturbed patients under such painful circumstances.     

How Many Times and How Many Ways: The Impact of Number of Nonsuicidal Self‐Injury Methods on the Relationship Between Nonsuicidal Self‐Injury Frequency and Suicidal Behavior

Several variables have been proposed as heavily influencing or explaining the association between nonsuicidal self‐injury (NSSI) and suicidal behavior. We propose that increased comfort with bodily harm may serve as an incrementally valuable variable to consider. We sought to indirectly test this possibility by examining the moderating role of number of NSSI methods utilized on the relationship between NSSI frequency and lifetime number of suicide attempts, positing that increased variability in methods would be indicative with a greater general comfort with inflicting harm upon one's own body. In both a large sample of emerging adults (n = 1,317) and a subsample with at least one prior suicide attempt (n = 143), results were consistent with our hypothesis. In both samples, the interaction term was significant, with the relationship between NSSI frequency and suicidal behavior increasing in magnitude from low to mean to high levels of NSSI methods. Although frequency of NSSI is robustly associated with suicidal behavior, the magnitude of that relationship increases as an individual engages in a wider variety of NSSI methods. We propose that this may be due to an increased comfort with the general concept of damaging one's own body resulting from a broader selection of methods for self‐harm.     

The Embodiment of Birth

This paper rejects dualism between mind and body toview the self as an embodied biological entity. Rather thanseeing the body operating by passive mechanisms as Descartesargues, it holds it actively moves in and even defines its world. Carrying this perspective to medicine presents an attempt toincorporate or work with internal processes of the body; it issensitive to how patients identify with their bodies. Thecurrent discussion over the extent to which women should try tohave natural childbirths provides a concrete example of thedifferences between mechanistic and embodied approaches tomedicine.     

Neural correlates of consciousness reconsidered

It is widely accepted among philosophers that neuroscientists are conducting a search for the neural correlates of consciousness, or NCC. Chalmers (2000) conceptualized this research program as the attempt to correlate the contents of conscious experience with the contents of representations in specific neural populations. A notable claim on behalf of this interpretation is that the neutral language of "correlates" frees us from philosophical disputes over the mind/body relation, allowing the science to move independently. But the experimental paradigms and explanatory canons of neuroscience are not neutral about the mechanical relation between consciousness and the brain. I argue that NCC research is best characterized as an attempt to locate a causally relevant neural mechanism and not as an effort to identify a discrete neural representation, the content of which correlates with some actual experience. It might be said that the first C in "NCC" should stand for "causes" rather than "correlates."     

Some Controversies in Suicidology: Toward a Mentalistic Discipline

The main assertion in this paper is that psychache (mental pain) has a life of its own and is separate from the study of the brain, the organ that cradles the processes of the mind. No amount of biologicizing or medicalizing suicide can gainsay the fact that the human impulse of self-destruction is a decision of mind to put an end to the flow of its own unbearable conscious contents, to stop the psychache. The explanations for suicidal actions lie in the Oxford English Dictionary, not in the Diagnostic and Statistical Manual of Mental Disorders. Unless suicidology asserts and maintains the position that suicide is essentially psychachical, that the main focus of suicidal action is in the mind (as opposed to the mind's somatic abode, the brain), it will lose its identity and its usefulness. This is not just a quarrel over professional territory, money, or power; it is a philosophic war, a fight for the very soul of suicidology–and of the mind.     

Correction to gonzalez (2012)

Reports an error in "Association of solitary binge drinking and suicidal behavior among emerging adult college students" by Vivian M. Gonzalez (Psychology of Addictive Behaviors, Advanced Online Publication, Jan 30, 2012, np). In the article, there is an error in the introductory paragraph. The number of students who had seriously considered attempting suicide in the Barrios, Everett, Simon, & Brener (2000) study should have been reported as 11.4%, not 1.4%. Additionally, in the Participants section, data for the study were collected from March 2009 to September 2010, not March 2009 to January 2010 as reported. (The following abstract of the original article appeared in record 2012-02608-001.) Emerging adult college students who binge drink in solitary contexts (i.e., while alone) experience greater depression and suicidal ideation than do students who only binge drink in social contexts, suggesting that they may be at greater risk for suicidal behavior. This study examined the association of a previous suicide attempt, one of the best predictors of future suicide attempts and suicide, and severity of recent suicidal ideation with drinking in solitary and social contexts. Participants were binge drinking, emerging adult (18- to 25-year-old) college students (N = 182) drawn from two studies of college drinkers. A logistic regression analysis revealed that both suicide attempt history and severity of suicidal ideation were significantly associated with a greater likelihood of being a solitary binge drinker as opposed to only a social binge drinker. Students with a previous suicide attempt were nearly four times more likely to be solitary binge drinkers. Multiple regression analyses revealed that suicide attempt history was significantly associated with greater frequency and quantity of drinking in solitary, but not social contexts. Suicidal ideation was significantly associated with drinks per solitary drinking day, but not frequency of solitary drinking once suicide attempt history was accounted for. Given the associations found between solitary binge drinking and a history of suicide attempts, as well as greater severity of recent suicidal ideation, it appears that these students are in need of suicide prevention efforts, including treatment efforts aimed at reducing binge drinking. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

The embodied mind

Abstract :  This paper considers Fonagy et al's concept of mentalization and contrasts aspects of this with aspects of Bion's model of the mind. The author argues that although mentalization adds to our understanding of mind it has limitations; that it may tend to over-emphasize certain types of external interaction between infant and carer and under-emphasize internal psychobiological processes. What is at issue here is the way in which an infant's carers facilitate the development of meaning out of experience. Bion's concept supposes a relatively 'interior' model in which, in important ways, the carer enables the infant to derive the meaning of his or her experience, whilst on the other hand Fonagy et al tend to talk more in terms of the ways in which the carer endows the infant's experience with meaning. Reference is made to Fordham's concept of states of 'Identity'. Fordham has pointed out that Freud's model is one in which mind is conceived of as evolving out of an infant's complex identifications with his or her carer(s); Jung's model envisages developmentally early states of identity as the means by which inherent capacities are realized.     

Female self-injury and suicide attempts: Culturally reinforced techniques in human relations

There is a consistent and significant higher ratio of females who engage in self-injury or who attempt suicide as compared to males, or as compared to suicidal commits by both sexes. This paper focuses on the problem of female excess in self-injury and suicide attempts. Biological/psychological variables which have been linked to these female self-destructive behaviors are enumerated and an alternative sociocultural explanation is suggested. Sex-role expectations are shown to be essential in explaining female self-injury and suicide attempts. The notion that these female self-destructive behaviors offer self-preservation is criticized, as is the failure in the literature to investigate what female self-injury and suicidal attempts actually do accomplish. Direction for solutions is mentioned in terms of research findings on self-actualization and on androgynous persons.     

MMPI characteristics of drug abusers with and without histories of suicide attempts

Compared to drug addicts without histories of suicidal attempt (n = 50), drug addicts who have attempted suicide (n = 50) were characterized by higher levels of maladjustment--particularly in the areas of depression, feelings of alienation, and use of projection and externalization--and were more emotionally withdrawn. Certain Minnesota Multiphasic Personality Inventory (MMPI) codetypes appeared in the attempt group that were not present in the no history group. Drug addicts with suicidal ideation but no history of attempt (n = 13) were not significantly different from the other two groups, and their inclusion as a comparison group masked the real differences between the other two groups. The MMPI results suggest it may be possible to identify a suicide attempt group in substance abusers but not when contrasted with a suicidal ideation group. Treatment implications are considered.     

On matters of mind and body: regarding Descartes

In this paper the author considers Descartes’ place in current thinking about the mind‐body dilemma. The premise here is that in the history of ideas, the questions posed can be as significant as the answers acquired. Descartes’ paramount question was ‘How do we determine certainty?’ and his pursuit of an answer led to cogito ergo sum. His discovery simultaneously raised the question whether mind is separate from or unified with the body. Some who currently hold that brain and subjectivity are unified contend that the philosopher ‘split’ mind from body and refer to ‘Descartes’ error’. This paper puts forward that Descartes’ detractors fail to recognise Descartes’ contribution to Western thought, which was to introduce the Enlightenment and to give a place to human subjectivity. Added to this, evidence from Descartes’ correspondence with Princess Elisabeth of Bohemia supports the conclusion that Descartes did in fact believe in the unity of mind and body although he could not reconcile this rationally with the certainty from personal experience that they were separate substances. In this Descartes was engaged in just the same dilemma as that of current thinkers and researchers, a conflict which still is yet to be resolved.