Cualidades del sonido

6.5.1.1 Emotional state on regaining consciousness

Participants’ experiences immediately after regaining consciousness following a suicide attempt varied from a momentary sense of calmness to a state of heightened agitation (distress or aggression). One participant described calmness and clarity but it lasted only a very short time:

I woke up with calmness and clarity, but as the minutes go by all the stress comes back.

In contrast, another participant described waking up in a medical ward after some time in intensive care. She was behaving in an uncontrolled, aggressive way that was uncharacteristic of her usual self and attributable to acute brain syndrome:

When I come round I’m always agitated and abusive…

I woke up and my dad was there. I said hello can you get me a cigarette. He said no ___[her name]. I said well bugger it, I’ll go and get myself one. I unhooked myself, I went to walk out the main doors…and these three bouncers were there, the security guys,… I was swearing my head off, uncontrollably, and they said well you have to get past us first. I said well that’s alright I will [laughs]. … I wasn’t sort of thinking oh I didn’t die, I just had this very aggressive, uncontrollable aggressive behaviour. I was swearing and shouting and carrying on, and I was told it was called acute brain syndrome.

Another participant described a state of agitated distress in which she attempted further self-harm.

… so I ended up at __ [major metropolitan] hospital and I was very groggy, I can’t remember the first bit of it, … when I came to I was so

upset that I was still alive that I grabbed anything I could find … and started to cut myself with it

In contrast to the specificity of these accounts, some participants remembered mainly a general sense of waking up sick or dazed or not quite aware of what was happening. While experiences upon regaining consciousness varied, there was much more

agreement about what happened in relation to suicidal thoughts and feelings over the ensuing days, weeks and months.

6.5.1.2 Suicide attempt as an acute event within a suicidal episode

Contrary to ideas about a suicide attempt providing a catharsis (Zilboorg, 1996), participants in this study did not experience a significant diminution in suicidality after their attempt. In most instances the suicide attempt could be understood as a particularly acute manifestation of a suicidal episode which continued for some time. One participant made three suicide attempts within a period of a few weeks. Another told doctors at the hospital where she received medical treatment that she was no longer suicidal, even though she was, so she would be allowed to go home.

While lying in hospital I was still trying to think of a way to kill myself. … Then the Psychiatry Registrar came. I told him I was OK. I was very very sad, but I didn’t tell. I was trying to leave the hospital, and I went home. … I was still suicidal … and I was going to try again.

Some participants continued to feel suicidal but felt they didn’t know how to act on those feelings anymore. One woman, when discussing her medical recovery in hospital after her attempt, was asked whether she was still feeling suicidal afterwards or whether that had receded. She responded:

It hadn’t receded but I didn’t have a clue about how to go about it. I felt like I’d failed and I didn’t know that I wouldn’t fail again. I didn’t have that confidence that I could successfully kill myself, because of the failure for it to work. … [So] not making plans, just feeling suicidal, depressed and lost, without any sort of concrete plans.

For some, with the realisation that the suicide attempt ‘hadn’t worked’ came the thought of having to live. While this can be understood as an effort to turn away from suicide, it was experienced as a kind of forced effort, and as a significant struggle and very vulnerable to setbacks.

…the thing after a suicide attempt is I’ve always come to with this kind of sense of ‘oh it didn’t work’ and I’ve still got to try and live, and it’s this massive effort to try and get your brain into that ‘I’m going to try and live now’ kind of frame of mind.

An exception to the theme of a continuing suicidal struggle in the period after the suicide attempt, was the participant who sustained ongoing language difficulties. This participant said that, within years of struggle with mental illness, this period provided some relief - from nightmares, traumatic memories and distress, ‘the hell I’ve gone through’ – and suicidal feelings were not present. However this remission of suicidality seemed related to cognitive function at the time, including impaired memory for previous trauma, rather than to an experience of catharsis.

AG: Were you feeling suicidal at that stage?

No. The first 3 months there were some cases where someone would think that I, you know, am I in case where I could be attempting to kill myself or not. I told people that I had enough trouble trying to understand what my real world is, that there was no attempt for me to kill myself in those first few months or so. …

Yeah, I couldn’t understand, I couldn’t talk, I couldn’t understand what was around me, for a start, just like a brand new baby, and it was only at the last few weeks at my last hospital that I started going back to having my nightmares, ….. So it was only the last couple of weeks at that second hospital that I started going back to the hell that I’ve gone through.

For most however the period following the suicide attempt was a time of suicidal thoughts, depression and emotional turmoil which lasted at least for weeks and sometimes for many months. Many of the participants were admitted to a psychiatric

unit (at least one on an involuntary basis) because of an ongoing suicidal struggle. Recovery then was not only about recovery from the suicide attempt itself but recovery from the whole suicidal episode. This was complicated however by the fact that reactions to the suicide attempt (the participant’s own and/or the family’s reaction, and indeed the reactions of health professionals) could exacerbate the person’s state of emotional turmoil. These processes are discussed in later sections of this chapter.

6.5.1.3 Significant shifts in suicidality

Although it did not relieve their suicidality, for most participants the suicide attempt did mark a significant shift from how things had been before. This was clearly apparent for those who had sustained an ongoing impairment of function, and for many others there was a shift in life circumstances (as discussed in later sections). But for three participants who discussed their first or only attempt at suicide this shift (at least in part) concerned their experience of suicidality before and after the attempt. This shift in relation to suicidality is the focus of this section.

One participant’s first suicide attempt was followed within weeks by two more attempts, followed in turn by admission to a psychiatric unit because of ongoing suicide risk. This participant had struggled with thoughts of suicide for five years before the first attempt but, consistent with Joiner et. al.’s (2009) theory of acquired capability, it seems that the first suicidal action opened the door to taking further action. In the following quote this participant was talking about experience of mental illness in general, but the image resonates in relation to that initial cluster of suicide attempts.

I can see [signs of] the illness in [others] but they have shut the door. I’ve opened the door and once you’ve opened the door you have to walk right through.

Another participant described how, despite a long history of depression, it was only since her (rather impulsive) suicide attempt, that she had a recurrent and frightening struggle with suicidal thoughts. Prior to her suicide attempt,

I used to get very, very down and probably would think oh God I don’t want to be here anymore, but never with any sort of real thoughts that I might take it beyond that feeling.

After the suicide attempt she indicated ‘it moved into a different realm’. Since then she becomes fearful, terrified when heading toward feeling suicidal because she knows it is possible for her to act on it.

I suppose that’s what I’m struggling with now, knowing that I’ve been in that space and that’s something that is possible. So I think the fear, that terrifies me every time I feel myself heading into that space and that’s not something that I always grappled with. … I get quite terrified since that attempt because I know the potential for where I’m headed.

This participant made an interesting comparison of suicidality with alcoholism,

referring to the idea that once one has been an alcoholic, even if recovered one has the potential to become an alcoholic again.

I think maybe it’s possibly a bit like being an alcoholic, there’s always that sense that you could end up drinking again. So even when things are OK there’s that niggle for me still that this [suicidality] is something that I now live with and, you know, how robust am I? What will tip me over?

This is consistent with Joiner’s (2005) idea that an acquired capability for suicide may lie dormant in the absence of a suicidal emotional/cognitive state, but that a capability for suicide becomes pertinent again when there is also a psychological desire for suicide. In other words the possibility of suicide may return if the person is

sufficiently distressed and distraught. This seems relevant also to another participant’s account of a suicide attempt occurring after a twenty year hiatus from previous

attempts.

For the third participant who described a shift in suicidality after her attempt, the shift was more to do with the nature of her suicidal thoughts. Her suicide attempt followed

a period of thoughts about suicide, but ‘I guess I didn’t think I’d really do it’. Whereas her attempt had been rather impulsive, afterwards her thoughts turned more towards planning. When asked about whether there was a difference in thinking about suicide before the suicide attempt and thinking about suicide since the attempt, she responded

Yes I think I frightened myself a bit, with doing something on impulse. Now I think more about planning, about where I would do it, who would find me and so on. I wouldn’t do it where I live because I wouldn’t want my housemate to find me.

An ongoing or recurrent struggle with suicidal thoughts was part of their life

experience for all participants in this study. The next section aims to characterise the nature of that experience.