Suicidality as a Crisis of the Self

We must at all times remember, that the decision to take your own life is as vast and complex and mysterious as life itself. Al Alvarez, The Savage God

the keys to understanding suicide are made of plain language … the proper language of suicidology is lingua franca – the ordinary everyday words that are found in the verbatim reports of beleaguered suicidal minds Ed Shneidman, The Suicidal Mind

Suicidality as a Crisis of the Self Popular myth: “depression is the major cause of suicide” Suicidality is best understood as a crisis of the self: • ‘sui’ in suicide, both victim and perpetrator • closer to the lived experience • encompasses whole person – physical, mental, relational and spiritual • immediately raises important questions that suicidology largely ignores, especially … • who or what is this ‘self’ that is in crisis?

Individual Collective Integral Model - 4 Quadrants Exterior Interior Subjective I It Objective Behavioural (observable) Intentional (felt experience) Phenomenology Psychology/Psychiatry • Validity: aesthetic • personal meaning/values • integrity, sincerity • Validity: empirical • observable, measurable • testable, repeatable Its We Inter-Objective Inter-Subjective Social Cultural Sociology/Ecology Anthropology • Validity: ‘functional fit’ • cohesion, efficiency • ecological, economic • Validity: moral • shared meaning/values • ethics, justness

Singular Plural 4 Quadrants of Mental Health Third-Person (visible) First-Person (invisible) • Lived/felt experience • personal, private • full of meaning • stories, self-talk • ‘consumer’ perspective • Observable behaviour • value neutral • medical, pharmaceutical • behaviour modification • therapies (e.g. CBT) • Mutually shared experience • shared meaning-making • collective story-telling • peer support • consumer delivered • services • Social infrastructure • hospitals, services etc • community development • public policies • laws (Mental Health Act)

Spirit Soul Mind Life Matter --------Physics Biology Psychology Theology Mysticism The Full Spectrum (Levels) of Consciousness Sources: Plotinus Aurobindo St. Teresa Grof Steiner Baldwin Habermas Maslow Buddhism Yoga Kabbalah Vedanta Theosophy Sufism Non-Dual Spirit

Singular Plural AQAL – All Levels, All Quadrants Third-Person First-Person IT - behavioural I - intentional WE - cultural ITS - social

Singular Plural ‘Evidence-Based’ Science Third-Person First-Person IT - behavioural I - intentional WE - cultural ITS - social

Flatland “the great nightmare of scientific materialism was upon us (Whitehead), the nightmare of one-dimensional man (Marcuse), the disqualified universe (Mumford), the colonisation of art and morals by science (Habermas), the disenchantment of the world (Weber) – a nightmare I have also called flatland” Ken Wilber, Integral Psychology “The much touted ‘evidence-based’ research, policy and practice in mental health in Australia today is an ideological flatland nightmare” (Webb, 2006)

David Chalmers (Consciousness Studies): first-person data are “data about subjective experiences that are directly available only to the subject having those experiences” “The distinctive task of a science of consciousness is to systematically integrate two key classes of data into a scientific framework: third-person data about behaviour and brain processes, and first-person data about subjective experience” “our methods for gathering first-person data are quite primitive, compared to our methods for gathering third-person data … the former have not received nearly as much attention”

“a major research problem even for the neuroscientist – they found themselves having to attend to this question of subjective experience whether they wanted to or not” (Chalmers) Francisco Varela (neuroscientist): “to deprive our scientific examination of this phenomenal realm amounts to either amputating life of its most intimate domains, or else denying scientific explanatory access to it. In both cases the move is unsatisfactory” Varela & Shear, The View From Within

Chalmers and Varela on Spirituality The Buddhist traditions and other contemplative traditions have a lot to offer … these guys have been studying subjective experience for many years from the inside, they’ve been gathering what we might call the first person data about the mind David Chalmers it would be a great mistake of western chauvinism to deny such observations as data and their potential validity Varela & Shear

Some References 'Self, Soul and Spirit: Suicidology's blind spots?' New Paradigm September 2003 online at www.vicserv.org.au/publications/new_para ‘Bridging the Spirituality Gap’ Australian e-Journal for the Advancement of Mental Health (AeJAMH) Vol 4(1) 2005 Integral Psychology: Consciousness, spirit, psychology, therapy, Ken Wilber, Shambhala, Boston 2000 Or contact me: davidwebbo@gmail.com

Batty is Beautiful Mad Pride Hi, I’m Batty from insane australia (where batty is beautiful) Nothing About Us Without Us

World Network of Users and Survivors of Psychiatry 1991 –World Federation of Psychiatric Users (WFPU) 1997 – renamed to WNUSP (www.wnusp.org) 2001 – 1st General Assembly (Vancouver) 2004 – 2nd General Assembly (Denmark) • joint congress with European network (www.enusp.org) • 200+ delegates from 50+ countries 2005/6 – formation of Pan-African PANUSP 2008 – 3rd General Assembly (Africa/India?) Four regions, two elected Board members from each: Europe, Americas, Africa and Middle-East, and Asia-Pacific Asia-Pacific: Chris Hansen (NZ), Mari Yamamoto (Japan) [Deputies: Bhargavi Davar (India), David Webb (Australia)]

WNUSP - Major projects/activities: UN Convention on the Rights of Disabled People • WNUSP is UN accredited NGO at the Convention negotiations • delegation led by Tina Minkowitz, a US psych survivor, human rights lawyer, and one of three Co-Chairs of WNUSP • Tina has played a leading role in shaping Convention World Health Organisation (WHO) • WNUSP representative/advisor to WHO Disability and Rehabilitation (DAR) project to produce a World Report on Disability and Rehabilitation by 2009 • a ‘tense’ relationship with Mental Health division of WHO International Disability Alliance (IDA) … etc etc

UN Convention on the Rights of Persons with Disabilities • final text of Convention completed in August 2006 • expected to be adopted by UN General Assembly in December – becomes international law when … • 20 countries ratify (sign on) to Convention • legally binding undertaking to implement the Convention in domestic law A‘paradigm shift’ in how we think about disability: • prohibits any discrimination on the basis of disability (there goes our Mental Health Act) • a person’s ‘competence’ to be based on their legalcapacity (i.e. not mental capacity)

Social Model of Disability • as opposed to medical model of illness • disability defined as functional limitations • something you experience, not something you have • that arises through interaction with environment • environmental factors: physical, social, attitudinal • human rights a core issue • especially self-determination • psychiatric/psychosocial disability is a recognised member of the disability community … • despite Victorian legislation to the contrary!

Social Model of Disability Person (with health condition) Disability (functioning) Activities Participation (limitations) (restrictions) Environmental Factors (facilitators or obstacles) Physical Social Attitudinal

Medicalised (i.e. WHO’s) Social Model of Disability Person (with health condition) Disability (functioning) Activities Participation (limitations) (restrictions) Environmental Factors (facilitators or obstacles) Physical Social Attitudinal

Medicalised (i.e. WHO’s) Social Model of Disability Health Condition (i.e. diagnosis) Disability (functioning) Activities Participation (limitations) (restrictions) Environmental Factors (facilitators or obstacles) Physical Social Attitudinal

The Medicalisaton of Madness • medical labelling of madness one of the most disabling obstacles to wellbeing and recovery • based on flimsy pseudo-science of psychiatry “too much specious accuracy built on a false epistemology” (Ed Shneidman) • Shneidman proposes ‘psychache’ to counter the myth of depression as the cause of suicide: “psychological pain that stems from thwarted or distorted psychological needs”

The Medicalisaton of Madness No branch of knowledge can be more precise than its intrinsic subject matter will allow. I believe that we should eschew specious accuracy. I know that the current fetish is to have the appearance of precision – and the kudos and vast monies that often go with it – but that is not my style. Nowadays, the gambit used to make a field appear scientific is to redefine what is being discussed. The most flagrant current example is to convert the study of suicide, almost by sleight of hand, into a discussion of depression – two very different things. Ed Shneidman

‘Evidence based’ as Ideological Dogma • current ‘evidence based’ criteria are almost exclusively third-person (esp in medicine) • systematic and deliberate exclusion of first-person evidence is neither rational nor scientific • whenever you hear ‘evidence based’, please ask: • whose evidence? • what criteria are used for validity of evidence? • what gets excluded by these criteria? Research and policy challenge: How do we bring the (anecdotal) first-person evidence into research policy and practice in a robust way?

Special Mention on the Politics of Psychiatry • psychiatric disorders do not meet even medicine’s narrow definition for valid scientific evidence • at best, scientific status of ‘depression’ as a medical illness is as an hypothesis Psychiatry’s impossible conflict of interest/duty: • as doctors, first duty is to the wellbeing of patients • as police, to protect society from mad people Inevitable consequence: • widespread and common human rights violations

Where to from here? • challenge ideology of ‘evidence based’ dogma • restore validity of first-person knowledge • do not locate pathology entirely within the individual • communities/societies can be suicidal too! • attend to the whole person – physical, mental, emotional, relational, spiritual • recognise discrimination and human rights are core issues for all disabilities – UN Convention • likewise for building ‘healthy’ communities, the key to suicide prevention

Victorian Charter of Human Rights and Responsibilities • not a Bill of Rights • takes effect Jan 1 2007, full effect Jan 1 2008 • 2007: all Victorian legislation to be reviewed • recognition of international human rights laws • emphasis on civil and political rights (rather than social, economic and cultural rights) • such as those denied us under Mental Health Act Victorian government should include UN Convention in its human rights review of all disability legislation

Singular Plural Third-Person First-Person IT - behavioural I - intentional Suicide Prevention WE - cultural ITS - social

“It is the words that suicidal people say – about their psychological pain and their frustrated psychological needs – that make up the essential vocabulary of suicide. Suicide prevention can be everyone’s business” Edwin S Shneidman, The Suicidal Mind

To The World - Adam Kemp Alone I am as I sit at the lake’s edge throwing pebbles. The colour of my soul is so black, my heart so heavy, That even the pleasant sound of robins drifting from a nearby glade Cannot soothe my feelings of bitterness and emptiness. The warmth of the sun does not reach me as I hide behind a face of questionable character. Who is this person who is always gay and nonchalant? A second self perhaps … a creature born out of search for sanctuary Simply a lifeless carcass to hide within during times of display. Trust, faithfulness, compassion … words which no longer hold meaning for me, Have been replaced with betrayal, isolation and worthlessness. All blended together to create this dark and sour being which is my true self.

To The World I long for the day when I can feel love, happiness and a sense of purpose again Surely there will come a time when the seed of life Which has been planted and buried deep inside of me Can blossom into something wonderful, something special, something joyous to behold, Please nourish me … Let me grow … I yearn to live … Adam Kemp, October 1995 In January 1996, Adam took his life, age 19. (From Leaving Early by Bronwyn Donaghy)

We must at all times remember, That the decision to take your own life Is as vast and complex and mysterious As life itself. Al Alvarez, The Savage God May your psychache be minimal – Ed Shneidman

Suicidality as a Crisis of the Self