In suicide research, lessons from survivors – people who, despite the urge to die, find ways to cope and reasons to live – are seldom heard.
Cornell researchers and their colleagues have written one of the first studies to change that.
“Strategies to Stay Alive: Adaptive Toolboxes for Living Well with Suicidal Behavior,” published July 29 in the International Journal of Environmental Research and Public Health. In the study, the authors present a series of interviews with suicidal individuals that opens new avenues of research into suicide prevention and offers a rare window into the minds of those who have considered or attempted suicide.
“I find it ironic that suicide, a most personal decision and the ultimate existential trajectory, should be generalized,” said Vilma Santiago-Irizarry, a co-author on the study and associate professor of anthropology and Latina/o studies in the College of Arts and Sciences (A&S). “A goal of research in this field should be to capture the voices of those who are enmeshed in difficult situations and to determine what they themselves have to tell us.”
“We wanted to know what strategies have helped people live, and live well, through chronic suicidal behavior,” said lead author Bonnie Scarth, a former Fulbright scholar in Cornell’s Department of Anthropology (A&S). “I believe this question is central to successful suicide prevention.”
For the study, Scarth conducted open-ended interviews with 17 people in the Ithaca area. Each interviewee described a similar journey: fighting the temptation to end their lives, contending with periods of ambivalence (not caring whether they lived or died) and accepting suicidal ideation as part of their lives. Hope figured largely into their decisions to set aside thoughts of suicide.
When asked to describe their coping strategies, participants surprised the researchers by offering a number of methods that are deemphasized or altogether absent from conventional studies.
For example, having pets was key for many participants, which isn’t discussed in the literature, Scarth said. Other unconventional strategies included meditation, spiritual practices and engaging with the arts. On the policy level, one participant said bridge barriers helped by reminding her that the community cares. Another said that the legal recognition of same-sex marriage had given him reason to live.
“Until then, I had been thinking of suicide prevention in a somewhat individualized sense,” said Scarth, now a suicide prevention coordinator with WellSouth Primary Health Network, New Zealand. “These responses struck me about the profound, far-reaching impact of laws and policies that may have nothing specific to do with suicide prevention per se, but can make a positive difference.”
A recurring theme throughout the interviews was the importance of peer support and storytelling.
“Hearing other people with similar kinds of symptoms, and how it works out for them, and their stories, is very powerful,” one participant said. Another recalled the catharsis of discussing her chronic depression with a kindred spirit while training to become a peer specialist.
Peer support is still considered outside the bounds of mainstream suicide prevention, as are many of the coping mechanisms recommended by participants in the study.
Scarth hopes her work will inspire follow-up studies that explore and improve upon methods that, like peer support, have garnered scant attention from researchers but remain useful to suicide survivors.
When it comes to preventing suicide – a leading cause of death that, despite decades of prevention research, still claims 700,000 lives each year, worldwide – novel approaches cannot come soon enough.
“The current resurgence of suicide, especially among younger age groups, begs for ethnography’s fine-grained approach for us to understand it,” Santiago-Irizarry said.
Other co-authors of the study are Jesse M. Bering, University of Otago, New Zealand; Ian Marsh, Canterbury Christ Church University, New Zealand; and Karl Andriessen, the University of Melbourne, Australia.