David Aldridge is co-director at the Nordoff-Robbins Zentrum in Witten, Germany, where he specializes in research methods for various therapeutic initiatives, including music therapy. He is the author of a wide range of JKP books on topics ranging from music therapy and dementia to non-violent resistence in families and spirituality in health care.
Sergio Andres Pérez Barrero is a doctor of medicine and a professor of psychiatry specializing in suicidal behaviour, particularly from a family and community perspective. He has been temporary advisor of the Panamerican Health Organization and World Health Organization for the suicide prevention in The Americas Region, and is the author of many books about the theme of suicide.
In this interview, they discuss their collaboration on the new book, Understanding Suicide: A Guide for Families and Professionals, and their interdisciplinary approach to suicide prevention.
Please tell us about your professional backgrounds – how did you become interested in this area?
David: What started me off studying suicide was when I worked for a voluntary organization, the Samaritans. Although I had spoken with suicidal people through the night, there were still others who were in hospital the next day. We seemed to be missing something. I wanted to know what this was. Then I met a professor of psychiatry who told me that suicide was an act that just came “out of the blue” and could not be prevented. From my limited experience at that time, I knew it just could not be true. As a social worker and youth worker, I knew people who had become suicidal over time and could see the process of their worsening plight.
I began my research career with a doctoral study of suicidal behaviour where I developed a model of escalating distress in family situations. I was one of the early doctoral students with the Open University and they encouraged my study because of the relevance and applicability that it has for the community.
Sergio: I was the author of the first book on the subject written in Cuba during the revolutionary period, which was called Suicide: Behavior and Prevention and published in 1995. In the same year, I founded the Suicidology Section of the Cuban Society of Psychiatry, and was Chairman of the Organizing Committee of the country’s first and only congress on the Prevention of Self-destructive Behavior in November 2003, which was attended by delegates from Cuba, Norway, Puerto Rico, Mexico and Argentina.
I continue to give lectures on community projects and concentrate on psychiatric care in primary health care.
What led you to collaborate on this book?
David: We are both interested in a systemic perspective on suicidal behaviour and have emphasized an interdisciplinary approach in our writings. In our working lives we are committed to the relief of personal distress. However, we know that this distress has relational, cultural and social origins.
In addition, we are both concerned about the world-wide problems that suicide causes, particularly in developing countries, and we believe that an inter-disciplinary approach to prevention is necessary.
Both of us are also committed to the idea that scientists from all over the world should be able to share their knowledge freely, without embargoes of any kind. Suicide is an international problem that requires our combined efforts including free access to research findings and clinical expertise.
Can you give us an overview of the book – what is it about?
David: Suicide is about a process of distress that worsens. Finding the causes of that distress and offering an alternative means of distress management will help prevent suicide.
Many professionals come into contact with people who are in distress. Teachers come across bullying all too often. They also meet children who are having family difficulties where parents have mental health problems, problems with substance abuse, are having difficulties coping with a chronic illness or are in financial difficulties. Some children face despair when their family lives fall apart. Social workers and probation officers, too, meet these problems in their daily working lives. Health professionals are often faced with emergency crises which they know are only the tip of an iceberg of distress. This book shows some of the warning signs and encourages them to see the bigger picture and intervene earlier.
Sergio: The book aims to bring awareness to those concerned with suicide prevention, whether students, professionals or those interested in preventable death more generally. It was written in a accessible, digestible way for the average reader, starting from the principle that suicide prevention is the responsibility of whomever is closest to the suicidal person and knows how to help.
Our aim in the book is to simplify how we approach suicidal behaviour. Because there is so much research from varying perspectives, and the problem is multi-faceted, it is possible to make things very complicated. If, however, we look at the chain of events where distress in the family becomes suicidal behaviour that needs a psychiatrist, then we can bring some clarity. Differing perspectives on the problem are important. What we are emphasizing is the process of events for the person and his or her family so that they are clear to see.
What are some obstacles that professionals encounter when working with suicidal individuals and their families?
David: One of the main obstacles that we encounter is the shame and stigma surrounding mental health, and feeling suicidal in particular – both from the sufferer’s point of view and from the health professional’s viewpoint.
The second obstacle is that many general health care practitioners do not recognize depression often, or early, enough.
The third problem is the lack of cooperation between health care practitioners, social workers and care agencies.
The fourth problem is that of economic decline. At the moment we are writing this book, Greece has been facing a major economic challenge. The suicide rate has risen in this time by 40%.
What we offer is a model to show how problems escalate and how these problems are connected to relational contexts. We are encouraging people, particularly professionals, to communicate with each other and to look at the bigger picture. This is not a problem that can be tackled alone – but it can be tackled. To do so, we have to talk to each other. As professionals, we also need to collaborate more on combating mental health problems. This is an educational process, heightening awareness of how depression manifests itself but also removing the stigma of mental health.
Sergio: In my view, the biggest issue is that the suicidal do not come forward to receive specialist attention. When they do seek help, though, the obstacles are recognized by an expert on the subject, among which are the following:
- Difficulties on the part of the family to interpret suicidal signals;
- The persistence of myths around suicide that we must try to eliminate;
- Failure of family members to take the necessary measures to keep their loved one alive – for example, allowing access to suicide methods and leaving them alone.
Why was it important to include a chapter on the internet?
Sergio: Bullying, in all its manifestations, is a major health problem in school settings. Cyberbullying is more common in developed countries in which adolescents and youth have access to the internet, email and other technologies, while face-to-face harassment was much more common in our day.
David: The internet is an important means of gaining information in modern times. It also provides the platform for various social networking sites, which can also be anti-social in that they are sometimes used for cyberbullying. Bullying is a primary cause for distress in young people.
It is important first to raise awareness about cyberbullying and about the fact that this can bring young people to a state of despair. Second, parents need to understand that while their children do indeed have private lives, that privacy can also mask a social threat to their well-being and mental health. What may be an innocuous social network can become the source of a malevolent attack from which a child has seemingly few avenues of escape. The social can circumvent closed doors into the very heart of privacy, beyond the caregiver’s knowledge.
What are some of the most important messages that you hope the reader will take away from this book?
- The need to implement national and regional strategies for suicide prevention using a multi-layered approach involving voluntary, educational, social and health care resources.
- The need to resolve distress early using a family approach.
- The need to be active in preventing bullying.
Copyright © Jessica Kingsley Publishers 2012.