by Thérése Gaynor
On the weekend of 12th November 2004 I attended a three-day conference on Suicide in Modern Ireland, organised by the charity The 3T’s (Turning The Tide of Suicide) and hosted and sponsored by Holiday Inn. The conference had a profound effect on me at the time and much of what I heard and experienced has stayed with me and has encouraged me to reflect on a subject that I believe is incredibly painful for us to face head on as a society.
The conference had an impressive line-up of speakers, both national and international from the Science, Arts and Humanities arenas. To say that the conference was full on is quite simply to acknowledge that the wealth of research material presented over the days was quite staggering but more significantly, the depth of much of the material presented brought me into direct contact with the impact of suicide on my own life both personally and professionally and touched me at the emotional, physical and psychological realms. Throughout, I remained mindful and attentive to personal responses and while familiar defence strategies came into play at particular times, I endeavoured to remain open and willing to trust the organicity of what was happening and to engage in an experience that moved through and beyond any one individual experience into the wider domain of the collective experience. Over the days I met individuals who had been bereaved by suicide and individuals who had come through either a single or multiple experience of attempted suicide. There were representatives from education, probation and prison services, health boards, social services, counselling and psychotherapy, medicine, psychology and psychiatry, religious communities, the Garda Siochana and representatives from the sporting community and many others – all coming together for three days to listen, to share, to discuss and to give renewed hope to each other and to the people of Ireland, particularly young people, a recognised at-risk group. The tide was indeed turning as these voices came together to continue breaking down the silence that surrounds suicide.
In her opening remarks. President of Ireland, Mary McAleese wasted little time in setting the scene for what were to be some of the themes of the conference. She highlighted the startling and harsh reality in Ireland of suicide as the most common cause of death in young people between the ages of fifteen and twenty-four and when she spoke of adolescence she reminded us of the fragility of this stage of development and stressed the ’need to promote self-esteem and self-confidence’ in young people as this in itself has proven to be; ‘an important aspect of suicide prevention.’ As I listened to President McAleese I was touched by her heartfelt compassion, understanding and sensitivity to the many issues facing young people in our society today and was deeply moved when she spoke of the; ‘devastating and lasting impact’ on the families and friends of those who have died by suicide.
Unlike so many of our society who have felt silenced for one reason or another, President McAleese has a platform from which her voice can be heard and has an opportunity at both a national and international level to bring focus and attention to an issue that, whilst staggering in its enormity in this country, is not unique to Ireland. In opening this conference on suicide, President McAleese lent her voice to those committed to turning the tide of suicide. She also spoke of another awful kind of silence that exists and is a contributory factor in attempted and successful suicide; the silence that is kept by so many young people of Ireland who are frightened to speak of their pain and suffering and the intolerable circumstance which too often leads them to a decision utterly devastating in its finality – death by suicide. When silence is broken, hope can begin to emerge and I certainly experienced a sense of hope as I listened to President McAleese. I felt she was encouraging all of us to spread the word to young people that they no longer have to suffer in silence and in her inaugural speech on the 11th November 2004, just the day before this conference began, President McAleese voiced her own commitment to; ‘reach out to our wonderful young people’ and chose to identify ‘youth suicide’ as one of the issues that needs keen, committed and ardent attention and consideration in our society.
The conference was an eye opener for me into the incredible depth and breath of research that is being carried out into suicide nationally and internationally but it also highlighted the absolute need for so much more. Did you know that in the past decade, over 400 Irish families a year have been affected by suicide? I didn’t. The outcomes of research into suicide as they were presented went a long way toward dispelling many of the myths that surround suicide. For example, the myth that talking about suicide may introduce or reinforce the idea – not so, in fact the complete opposite would appear to be the case and the fear that dictates our avoidance of such conversations is simply that, our fear. The more vulnerable groups in our society were identified; young men under the age of twenty five, those experiencing mental illness such as a Borderline Personality Disorder or depression, high risk occupational groups and those bereaved by suicide. When Theresa Millea spoke of her experience of losing her 25 year old son by suicide and the impact this had on her life and on the lives of her family, the devastating pain, courage and journey of individual experience could be witnessed. It is to this mother and to those other courageous individuals who joined with Theresa in her campaign that we owe a debt of gratitude for the change in the law in 1993 to decriminalise suicide.
The conference offered plenary sessions with parallel workshops related to suicide. As a perpetual life student having so many choices was deeply disconcerting and challenging! This meant having to forego one thing in order to attend something else and my sensibilities were immediately aroused as I noticed how my wondering about what I was missing distracted me from what it was I was actually attending! However, opportunities were provided over a lengthy lunch and substantial tea and coffee breaks for conversations about all that was taking place over the three days. When so much is being offered and so much new and at times, diverse information is being presented and experts in the area of suicide are offering personal and professional insights and ideas into working with individuals who may exhibit suicidal behaviour it can be difficult to remain completely attentive. But there were speakers who grabbed my attention straight away.
John Lonergan, Governor of Mountjoy Prison was one such speaker and he spoke passionately about the issues that face both men and women who find themselves ‘confined against their will.’ He spoke of isolation, loneliness, depression, stigmatisation, shame and hopelessness experienced by prisoners and invited us to consider that it is the behaviour of individuals that needs to be condemned and not the person. He informed us of the twelve deaths by suicide that have occurred in Mountjoy Prison over the past four years and reminded us that when suicide happens in prison there is; ‘…a trauma for the family in prison’ as well as for the loved ones of the individual who has taken their life by suicide. John Lonergan did not shy away from challenging us to reflect on our own perceptions, bias, judgments and to consider that how we respond reflects a culture. Many of us, as psychotherapists, are working with individuals in prison, working within the limitations of a prison environment and having to consider what level of therapeutic intervention is appropriate within this environment. There was a great wisdom for me in all that John Lonergan spoke about but I found it particularly moving, insightful and powerful to be reminded that; ’…not one of us is but an inch away from being vulnerable’ and ‘…if we claim responsibility for success we need to claim responsibility for failure.’
The most engaging speaker for me over the course of the conference was someone I had only known of by reputation. Dr. Tony Bates is Principal Psychologist in St. James’ Hospital, Dublin. The title of Tony’s input was ’Conversations that Keep Us Alive’ and even as I write this, I experience a feeling of calmness and notice how my breath deepens and my body almost drops down a level as I relax into what I experience as the power and wonder and hope of these words. There is nothing intimidating or mysterious in this title, yet when I consider it professionally as a psychotherapist there is something deeply challenging – after, all as a therapist, l do not engage in conversations with my clients or do I? In describing his conversations with individuals who exhibit suicidal behavior Tony described these individuals as courageous and heroic and described the; ‘quality of conversations with someone in distress’ as ‘a felt experience of something more.’ He referenced a particular model that informs the work with individuals exhibiting suicidal behaviour called; ‘Cry Of Pain’ by Mark Williams (1997) where one finds oneself in the presence of an individual who is experiencing intense psychological pain from where there no sense of escape, of no rescue combined with feelings of failure, defeat, hopelessness and demoralisation and suggested that therapy can be an opportunity to offer new perspectives, to open up a constricted view and to offer a different conversation. Tony also suggested that culturally, we have perhaps; ‘…lost the courage to hang on in these conversations’ and should (his be the case, we should; ‘…not be afraid to be in that space with someone’ and in turning up, we quite simply demonstrate; ‘…a willingness to approach without offering a solution.’
The conference gave me a stronger sense of the need to work more in collaboration with family (where appropriate) and other professionals when working with a client exhibiting extreme suicidal behaviors and the absolute need for support from colleagues and supervision to remain grounded, clear, sensitive, contained and effective within the therapeutic relationship. One of the challenges facing therapists working with suicidal clients is our response. If we are working in an organisation it is likely that there will be guidelines on suicide that offer some level of a secure base but when we are working in private practice we may not have such structures in place and so good supervision is imperative to allow for exploration not only of the deeply emotive aspect of the work but also to consider what may need to be put in writing with a client and how this in itself can impact on the therapeutic relationship. Having found myself in this situation with clients. I have benefited from the support of others within my profession and from supervision and have discovered that while there are no absolutes there are always options that can go a long way to inform best practice.
Speaking with a colleague just days after this conference I was struck by their initial response to my attending a three day conference on suicide; ‘wow that must have been uplifting’ and though said in jest, this offered me an opportunity to observe my immediate response which was to declare that I had indeed found it uplifting. Suicide and the impact of suicide is deeply emotive and utterly devastating for those left behind and I find myself enthusiastic and want to remain open to listening, to hearing, to discussing and to exploring this aspect of our humanity that effects so many vulnerable individuals within our society and has left so many of our young population believing suicide was their only option. Surely as a society we need to embrace this issue and become more active in our response. John Lonergan put it this way in his closing remarks at the conference; ‘…conferences are worth nothing if we don’t then do something.’
Therese Gaynor is a psychotherapist working in private practice and in the prison service with perpetrators of sexual abuse and is Clinical Director of One in Four an organisation working with women and men who have experienced sexual violence in childhood or as adults.