Living Ideation: A New Approach to Suicide Prevention and Intervention

By Steven W Nicholas

Living Ideation and the philosophical shift about suicide intervention are not just for clinically trained people. All of us feel the complexities of joy, despair, fear, and love. Therefore, it doesn't take a mental health professional to engage in the balancing act of mental health. We are all relatives, loved ones, friends, and

• Language: English
• Publisher: EmbGro
• Release date: Mar 1, 2021
• ISBN: 9781736488911

Book preview

PREFACE

When I was 17 years old, like many young bucks, I knew just about everything. I remember having a spirited conversation with my dad, and I thought that my philosophies and experiences were akin to Guru status. My pop narrowed his gaze and quietly said, Alright, mister. What is the meaning of life? I recognized the postured chess match and I paused before I replied. Pop, the meaning of life is to live… with meaning. Good grief was I an arrogant young man! My humility has germinated and grown in the last 30 years, and I admit that I haven’t figured out the meaning of life yet; however, I have zeroed in on several factors that give life meaning.

The endeavor of creating a suicide prevention model began many years ago when my brother, David, ended his life. Suicide bereavement was simultaneously agonizing and confusing. The perplexities of my grief awoke a strange motivation to understand my experiences, and I found that I was unable to live a banal life any longer. I was searching for an exit within the dark room of my pain. Surely, there was more to grief than just regret and loss.

I began researching the existing literature about suicide loss, and I was dissatisfied with my options. It seemed that all of the prevailing screenings and assessments targeted depression and anxiety. While these approaches are logical and parallel to medical models (reduce symptoms of disease), clinicians and professionals were only urged to identify concerns and potential dangers. Everything was an illness reduction model.

What if a different philosophy could drive suicide assessment?

Perhaps clinicians could assess for variables of strength and wellness prior to interviewing for directions of death and despair. Living ideation, rather than suicidal ideation, would potentially outcompete symptoms of depression and hopelessness.

My current philosophy and approach of Living Ideation is an accumulation of three dissertation projects (two rejected) and multiple research endeavors. The first two dissertations attempted to reduce and prevent suicide. I remember a committee member from another department sitting across the table from me saying, Steve, it's like you're trying to cure suicide. I said, Well, of course I am! And then I heard myself. What a fool I was; there is no cure for suicide. Yet, if you are holding this book, you and I are joined in the herculean efforts of trying to better ourselves while assisting people in knowing their own vitality. We are trying to cure, or at least minimize, death by suicide.

My third dissertation project shaped the rest of my career, and my life’s work has turned toward helping people who are swamped in depression, bereavement, and an unyielding sense of overwhelm. My research examined surviving families who had lost a member to suicide. I interviewed those family members individually and collectively and developed qualitative descriptions and themes of their bereavement. You can imagine the stories and the information that they would provide. Profound. I had well over a thousand pages of data compressed into the themes on how families transform in the wake of their losses. In short, family dynamics shimmy and shake when a prominent member is gone.

Suicide is a funny bugger in that the person who has been lost is simultaneously the one who is assigned responsibility for the loss. Some surviving families became tragically disconnected and they became unrecognizable in their isolation and distance. My research revealed that those family members maintained environmental and relational distance. They would cut people out of their lives. They would disagree about the rationale for suicide. They would hold each other in contempt. The family would dissolve.

Conversely, people who actually moved toward greater connectedness in their bereavement did very basic things. They literally stayed near each other. There was one family that I studied who created a family bed that the three members slept in for weeks. They cried together and expressed their emotions and opinions together. They kept open minds about the unwritten future. They allowed newness into their lives and therefore created a new chapter to their history. This family and those like it illustrated that living directions of autonomy and wonderment could ultimately overpower death directions of atrophy and despair.

Everything changes when you lose somebody in a family, for any reason, but, especially with suicide. The families that I worked with travelled a blend of two grief-stricken roads. Several survivors demonstrated traits of depression and hostility while others found newfound flavor in their opportunities. The differing grief reactions were curious to me because I discovered that suicide loss and family dynamics could enhance meaningfulness and connectedness.

Our world has witnessed death by suicide statistics rise consistently for many years. As much as I honor the work of those who have immersed themselves in suicide prevention and treatment, I believe that it is time to consider a new philosophical approach to working with suicidal distress. Living Ideation examines the pain and despair of a distressed person and then invites a paradigm shift toward meaning and potential existence.

Chapter One

WHAT’S THE PROBLEM?

After my brother David died, I simply could not stop trying to engage with those experiencing despair. I was trying to help others in ways I could not offer to my deceased brother. I couldn’t save him; perhaps I could help others save themselves. I originally thought that I was going to work in sports psychology. However, after his death, I was steered toward being a therapist who specialized in suicide intervention and prevention with a focus on couples and families. The past 15 years of my journey - through private practice, a university setting, and regional and national agencies - has overlapped with those lost within their own shadows. My work has continually bumped into the stale approaches of the suicide prevention models that try to measure warning signs and levels of lethality. Something has always been missing in the field, and I have been trying to discover the enigma my whole career.

In 2018, I was asked to work with a wonderful organization named the Children’s Cabinet in Reno, Nevada. They had a grant that was focused on addressing the suicide epidemic with non-dominant culture adolescents. Specifically, we were tasked with understanding why suicide rates were higher with Hispanic youth than Caucasian youth. This was a tall task as there are many cultural and emotional barriers to talking about suicide and self-harm.

Before we could attend to the diversity of the community, we needed to understand how the current suicide assessment and treatment models were being received by people. We turned our attention to the two existing assessment models that were delivered to the kids in our community and schools - the Signs of Suicide (SOS) and the Columbia-Suicide Severity Rating Scale (C-SSRS). Frankly, these instruments are the most accepted and utilized questionnaires currently in use, and they can be credited with saving countless lives. Nonetheless, they were not capturing the truths of many young people.

We developed an interview that asked about comfort levels with the SOS and C-SSRS, and we administered the interview to a group of Hispanic teens and their caregivers. Not surprising, we found that the kids and the adults in their lives were very uncomfortable answering questions about self-harm and suicide. The respondents were apprehensive to be truthful when asked the direct questions in the existing models. We concluded that the SOS and the C-SSRS are too ethnocentric and written for middle and upper-class white kids who probably have more environmental supports for mental health.

When you take into consideration a predominantly masculine culture, where talking about emotional pain is considered a weakness, the respondents are inclined to deny depression and suicidality. Latino cultural narratives tend to have an emphasis on masculinity where having emotional distress equates to weakness. Additionally, in a traditionally Catholic culture, suicide is an act of sin. Therefore, young people cannot admit to depression, pain, or dark thoughts. The existing models were essentially asking kids if they have thought about being weak and sinful. Furthermore, should a young person try to talk with trusted adults with their shared cultural norms about thoughts of depression or suicide, they encounter an inherent response of minimization, avoidance, and, sometimes, ridicule.

Our research with local Hispanic families confirmed these hesitations, and respectfully, the SOS and C-SSRS were ineffective at discovering suicidality among Hispanic youth. The intersection of my graduate research, current research, and the high suicide rates in my community led to the creation of a different approach. Living Ideation is that new direction. Living Ideation is an approach that acknowledges the stigmas associated with conversations about suicide. Living Ideation also accepts that the general truths of a suicidal mindset are limitations of healthful and enduring perspectives.

Symptom reduction and the medical model

My previously summarized research utilized the Signs of Suicide (SOS) and Columbia - Suicide Severity Rating Scale (C-SSRS). I also have studied the applications of a very common tool from the American Association of Suicidology, titled with the acronym IS PATH WARM. These instruments and the mnemonic aid have encouraged clinicians to recognize the warning signs of a suicidal person. These approaches seem logical: find the problems and fix the problems. This implies a broken nature of people who express their painful experiences. Throughout the years, the treatment and consideration of a suicidal mindset has been reflexive and paralleled with an illness (medical) model. In fact, the most common treatment for a person experiencing suicidal distress is to steer them to the hospital emergency department. In the darkest moments of a person’s life, suicide is treated as a medical emergency rather than a psychological emergency.

Illness reduction models can trigger discomfort and non-participation, and while suicide questionnaires target concepts that are taboo and uncomfortable for many respondents, they are still essential for appropriate mental health care. The increasing rates of suicide attempts and completions have unveiled the opportunity for a new assessment strategy. The symptom reduction models