​Suicide ideation and suicide
 
From a biomedical model to a communicative and relational perspective

 
IN THE MEETING OF SUICIDE AND PREVENTIVE WORK, the biomedical disease model dominates. The strong link between mental illness/disorders and suicide - the famous 90 percent truth - has unfortunate and unintended consequences for preventive work.
 
The biomedical disease model is a reductionist perspective that leads to a biologization and medicalization of the complexity of human life, which in a clinical context is actualized in the form of standardized risk factor-based assessments, as stated in National guidelines for suicide prevention in mental health care.
 
COUNTERPRODUCTIVE. With descriptions as underlying individual pathology of suicide, the understanding of persons as agents in a normative space of reasons disappears - than as pure biochemical organisms and processes in a causal space of cause and effect that must be "fixed" and "treated" by a specialized treatment regime. The spotlight and attention are directed in this way towards the individual. When suicidality becomes a mental illness that lies in the suicidal individual, the importance of contextual and relational factors in the face of suicide prevention is thus underestimated. Neglecting and rejecting these dimensions is counterproductive in suicide prevention work.
 
SOCIAL ILLS. It constitutes an essential difference to look at people based on biomedical understanding - and to look at people as people with life-problems in the face of the ontological facts and givens of existence. This opens up a significant structural and contextual dimension, where this is largely a question of the political conditions, of how society recognizes and serves the fundamental conditions of our existence.
 
The absence of this perspective calls for a psychologisation of unhealthy structural (power) conditions, understood as social ills. Social ills involve seeing individuals in the context of social, economic, cultural and political contexts. In this way, professionals and therapists can adjust their gaze to sources of life-pain and suffering that lie outside the suicidal individual, but still in his/her specific context, in order to develop and offer adequate support.
 
COMMUNICATIVE ACTS. Suicide researcher and professor Heidi Hjelmeland at the Department of Mental Health at NTNU, Norway, is the author of the book "Suicide prevention - To be able to prevent suicide, we must understand what suicidality is about" (2022). She writes that suicide ideation and suicide should be understood as 'communicative acts'.
 
Central to this teleological/intentional and existential perspective is making an effort to understand what suicidal people are trying to communicate with the outside world through suicide and suicide attempts. And if the communicative and existential dimensions of suicidality is to be understood, it should be understood from an intra-subjective and first-person perspective: that is, how suicidal individuals understand and interpret themselves and their world.
 
A FELLOW-TRAVELER? However, it should be recognized that no one can fully grasp and feel how the suicidal person thinks and feels. This realization stimulates an existential humility and openness, but also a courage to meet people where they are. In Soren Kierkegaard's words: "That, when one is to truly succeed in leading a person to a certain place, one must first and foremost take care to find him where he is and begin there."
 
The question professionals and therapists in mental health care should ask themselves is: Have they, in meeting with the suicidal person, found them where they are, and started there? This courage has more to do with one's "being-qualities" than one's "doing-qualities". One's being-qualities do not imply a focus on diagnosis, pathology or paternalism, but rather to be a fellow traveler, one who takes the time to grope with the suicidal when the black fog rises its ugly heads. To be able to step into the dark tunnel they are in, to sit down, and be a mirror and a relational home, even when everything seems without hope, direction and meaning.
 
TRUST IN LIFE? Through a being-with-ness and care in the form of "empathic presence", the suicidal person can feel that they are not alone with their life-pain, that one can be "alone together" in those hours and the time when we feel that the burden of life can no longer be borne: To create a healing space for the brutal. The raw. The confusing. And the meaningless. To create spaces in which the pain of life, as inevitable as a stream of tides, can be tenderly held and cared for. And in that way be a relation,  an existential fellow-traveler-in-the-same-darkness that furnishes conditions for the possibilities of healing power, of re-creating a trust in life, to help them want to live. Again.
 
In this way, healthcare professionals and individuals may be better able to uncover the subjective attributions associated with suicide attempts and thus be better equipped to provide qualified help and support in dealing with suicidal individuals. 
 
The time is long overdue to pay more attention to the complexity behind suicide and suicide attempts. The biomedical model is an inadequate framework which should be supplemented with relational and existential determinants if we as a society want to understand - and effectively prevent - the omnipresent possibility of suicide.
 
 
Farhan Shah, philosopher and researcher