Experiencias con maestras

For some participants the suicide attempt and/or ideation was associated with a sense of lack of control or lack of agency. The issue of control related to both the internal and external worlds, with internal struggles for control over one’s state of mind mirrored by struggles over control in relationships with health professionals.

One participant made a suicide attempt in the midst of a long period of struggle about control over her treatment. She had managed her depression over the years largely without medication which in her previous experience had made her feel worse. She had then been persuaded to try new (‘better’) medications but was unhappy with her treatment, concerned she was spending far more time in hospital than she ever had before, felt ‘patronised’ by treating staff when she tried to express her views, but found herself unable to extricate herself from her treatment regime and relationships. After some months of what she termed this ‘horrendous cycle’ she made a suicide attempt, the sense of loss of control being a key precipitant.

I didn’t have a sense of me, I wasn’t in control, and I was getting

distressed. …it’s all a blur; I was in and out of hospital, and people were sort of giving me the stuff around

…

I felt like I wasn’t in control anymore, because what the medication did was take away any…, it just flattened me. It didn’t help the depression but it stopped me feeling OK, and it just flattened me so much, and then I just completely lost hope and lost, you know, a sense of being in control and there was no… I felt like I was dead inside.

As the above quote suggests, a sense of not being in control involves loss of a sense of agency and is connected with loss of hope and loss of sense of self, culminating in this instance in a feeling of being dead inside. Loss of a sense of control or agency is closely associated with feelings of helplessness and hopelessness, long recognised as hallmarks of depression.

In a way this woman’s suicide attempt could be seen as an attempt to escape or break the deadlock (an appropriate term given she felt caught in a struggle to the death). The immediate effect however was that treating staff became, in her experience, more prescriptive and controlling.

I think it made it more stuck, because then the doctors sort of said well now you’ve got no choice. I’m trying to tell them that this

[medication/treatment] was making me worse and they wouldn’t believe me and now they definitely didn’t believe me. ….. the people looking after me, said because of that now you’ve got no choice and this has changed and you know you’re going to be on medication for the rest of your life.

Eventually fear, desperation and survival instinct lead her to break the deadlock and walk out of the treatment relationship. She felt she had to make the break in order to survive (i.e. that the situation she was in was suicidogenic).

I think at the end of that [period of] months, I got so frightened. I just got so terrified that I thought I can’t do this anymore. If I don’t change and do

things, if I don’t sort of take control and get off the medication, I won’t be here…next year, let alone in 10 years. And I remember sitting in the doctor’s office … but I remember walking out in the middle, and I just said half way through the session I can’t do this anymore.

While issues of control were particularly prominent in this woman’s account, similar themes, including the idea that starting to take control is a step toward recovery, appeared in several interviews.

…. in the nuthouse no-one is there for you, so you have to take control. You may not take control in a socially acceptable way but [too bad].

When I was discharged from ___ [Hospital] I was starting to realise what was happening and I was trying to take charge of my own treatment. After a certain period of depression, after a while my brain just checks back into gear; it’s not immediately OK. At some point I start to think more clearly and start taking charge – it’s a big thing to take control of me. When I see the possibility of starting to be in control, then I can start to get better.

As suggested by the phrase ‘take control of me’ in the above quote, the issue of control is not only about control of one’s own treatment or control over external circumstances, it is also about internal control.

A sense of loss of control over inner life may reflect a sense of inner turmoil. One participant spoke at some length about feeling overtaken by disturbing memories and thoughts of a damaging childhood experienced as full of loss, violence and

strangeness, thoughts and memories which fuelled her suicidality. This woman seemed to be describing an unanchored, uncontained inner life swirling with

disturbing thoughts & memories which co-existed with, but also disrupted, a practical life of activity and engagement with the external world.

Well each time I remember something more, I go into a deeper sort of depression, really really deep depression where I think ‘nobody cares, nobody loves me, I’ve got no-one’ and then I get so so deeply depressed

that I just can’t cope with the world, can’t cope with anything and then I just suicide.

…

I just write [in a journal] woooo straight through and I just don’t stop and then the stuff that falls out is just unbelievable, it’s just … To me

sometimes I think, did I make that up or did it really happen and then my sister or my older brother would say yeah it really happened.

She described life as like a waterslide and finds she has little control over her descent down the waterslide into a state of acute disturbance

But I think life is like a, I call it a waterslide, and you climb up the steps, right up to the top, and you get to the top and you just go hnnnnnnn, you know how it goes, around in circles right, right down to the bottom, and you go so quick, and that’s how quick it is to lose it. Yeah that’s my little saying, you get on the waterslide, you climb all the way up, and then … and it can happen like in a few minutes, you know somebody might say something to you and I’m just gone, I’m just gone.

In contrast to this somewhat uncontained sense of losing control, there can also be an experience more like something unidentifiable exercising an insidious control from within. The following extracts from one interview suggest a sense of there being an ‘it’ which takes over control internally.

I get to a point where I lose control in a sense. I’m fine to a point and I can pick myself up but there gets to a point of no return, and so you just spiral…

... you know it [suicidality] sort of gets a momentum of its own

Because it still, it scares me, terrifies me still, but it’s there, but ... I don’t understand why it’s there.

I’m not quite sure what it is but it’s ... almost like something else has taken over, it’s like it’s got this sort of track of its own and it’s OK. It’s a space of being quite at peace with, and relief, intense relief that right this is now in place and the decisions have been made and the plans are made and I’m in control, ... and the pain will go away and I won’t have to think about this anymore.

The passages suggest a sense of an active controlling other, a thing which terrifies her, and threatens to take control and take her down the path to suicide. While the

experience can be terrifying, it can also lead to a place of peace and relief, where decisions have been made. While she says at this point she is in control, I wonder whether this may represent unconsciously a surrender to, or a joining with, the controlling other. The process is reminiscent of Maltsberger and Buie’s (1980) concept of an internal killer and this extrapolation about the unconscious would be consistent with their conceptualisation.

The findings about loss of control are broadly consistent with the findings of Crocker et al. (2006), Tzeng (2001) and Biong et al. (2008) who also identified loss a sense of control as a core experience in their participants’ suicide attempts. In the (Crocker et al., 2006) study, as in the current study, regaining control in the period after the suicide attempt was associated with recovery from suicidality while a continuing sense of loss of control meant ongoing struggle. However the experiences or

circumstances underpinning the loss of control varied between studies. In the Crocker et al. (2006) study, loss of control was linked to age-related changes in physical states and/or functioning. In the current study experiences of loss of control arose, as in Biong et al. (2008) and Tzeng (2001), from internal psychological processes and/or from experiences of feeling trapped in a situation of being controlled by others.