the meaning of attempted suicide to young parasuicidesa repertory grid study

7/30/2019 The Meaning of Attempted Suicide to Young ParasuicidesA Repertory Grid Study

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B ri t. J . P sy ch ia t. ( 19 81 ), 1 39 , 3 06 3 12

The Meaning of Attempted Suicide to Young Parasuicides:A Repertory Grid Study

ADRIAN PARKERSummary: In an attempt to clarify the intentional aspect of parasuicide, constructs in response to a supposed crisis were elicited from a group of overdosepatients, using the standard method of contrasting elements. In this case theelements were presented as a list of 11 alternative behaviours (including overdose and suicide) possible in such a situation. Using 9 of the most commonconstructs obtained, a repertory grid was administered to a second group ofoverdose patients and by computer analysis consensus group grids wereobtained for patients scoring high and low on the Beck suicidal intent scale.These consensus grids showed that the low intent group perceived an overdose(in comparison to other alternative behaviours) as sim ilar to b ein glo ne a ndcrying' and gettingrunk' and construed it alm ost exclusively as an escape fromtension. In contrast, the high intent group perceived overdose and suicide inquite sim ilar terms. The data indicated that an overdose may have a respitefu nctio n fo r lo w su icidal in ten t p atients.

A lthough it is open to dispute to w hether attem ptedsuicideor parasuicide (K reitm an, 1977) is a psychological problem rather than a psychiatric one, it isclear that a purely psychological approach can contribute m uch to the understanding of the processesinvolved. Indeed there are strong grounds for concluding that a substantial num ber if not the m ajorityof overdose patients have no form al psychiatric illnessand for these a psychological approach would beappropriate. This is supported by the situation inEdinburgh where, whether due to the vagaries ofdiagnosis or a change in clientele, there has been asteady decline in the number of patients diagnosedpsychiatrically ill attending the Regional PoisoningTreatm ent C entre (R PTC ), E dinburgh, (D yer, D uffy,Kre itm an , 1 97 8).A s an alternative to the diagnostic approach, thepsychological study of parasuicide has focused alm oste xclu siv ely o n the p ers on ality traits sp ec ific to su ic id alpatients (M cC ulloch and Philip, 1972) and on the typeof cognitive functioning which characterises thoseindividuals (L evenson, 1974; N euringer, 1976). Fromthe latter work in particular we have learned a greatdeal concerning the dichotom ous inflexible thinking,the narrow range of constructs, and the field dependentperceptual style of suicidal individuals, all of whichculminates in their diminished problem solving andconflict resolving ability. One area that rem ains to be

studied how ever is the actual nature of the constructsthem selves w hich suicidal individuals apply in conflictresolution. W ork by Bancroft and his co-workers(1976) on the intent and motivational aspects ofsuicidal behaviour consisted of using a checklistap proa ch in w hich o ve rd ose p atien ts w ere req uired toidentify one or m ore of various categories of feelingsand motives. Surprisingly a degree of consensus wasachieved in the findings, onelynd unw anted' beingchosen m ost often am ong the feelings and obtainreliefrom theirstateof mind' among the motivesmost comm only chosen. However there were seriouslimitations to the findings. A large percentage ofpatients w ere unable to identify any of the m otivesgiven and the method of presentation may havee vo ke d resp on se s h eav ily lad en w ith in flu enc es o f so cia la cc ep ta bility . A sk ed d ire ctly a s to Why ',o s t overdose patients are likely to give a wish to die as anexplanation, yet alm ost a third in one study (Bancroft et al, 1979) denied suicidal intent. Certainlythereseemst obe a cleardiscrep ancyetweenthetypesof m otives assigned by psychiatrists and those given bythe patients them selves. Psychiatrists tend to chooseth e c ommun ic atio n o f h os tility a nd th e man ip ula tio nof others as key motives yet these are least oftenchosen by patients (Bancroft et al, 1979). It is proposed here that some of the constraints and difficulties inherent in the psychiatric interview m ay be

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30 7D RIA N PA RK ERavoided by the use of the repertory grid as a m eans ofeliciting explanations of behaviour. It has been arguedfor exam ple that the Grid m ay to some extent circumv en t th e d efen sive d enial th at d irect q ue stio nin g an dforced choice responses involve (Ryle,. 1976). Inparticular it may be instructive to understand interms of construct theory how the parasuicidal individual views his choice of behaviour in a crisis ascontrasted w ith other behaviours that w ere possib il it ie s a t t he t ime .In traditional term s of construct theory (K elly,1961) suicidal behaviour is seen as a response to unpredictability, chaos, and sudden loss of understanding of one's w orld. A s such, it can be regardedeither as an attem pt to retain the basic structure ofone' s cons tr uc t sys tem by avoi di ng fur the r i nva li da ti onthrough the choice of death, or as an attem pt to elicitnew behaviour or data'rom the key person relevantto the act. W ith su icid al b eh av io ur th ere is said to b e aco nstriction in co nstruin g, o r n arro wing of co nstruc ts ,so that a sim plified uniform way of thinking results.M uch of this agrees w ith the results of the cognitiveapp ro ach m en tio ned p rev io usly , a nd is sup po rted b ythe less w ell know n w ork of L andfield (1976). U singmea su re s o f in te rre la te dn es s o f c on stru cts L an dfie ldw as able to show that the construct system s used bysuicidal and suicidal gesture groups could be distinguished from those of controls. The high degree ofin te rr ela te dn es s o f th e c on str uc ts o f th e fo rme r g ro up swas taken as indicative of the cognitive disorganiz atio n whic h a cc omp an ie s su ic id al b eh av io ur. E ve nthe suicidal and suicidal gesture groups could bedistinguished from each other in terms of the extremity o f d iso rg an iz atio n o f c on stru ct sy stems. However the possibility does rem ain that this m ay be tosome extent a secondary effect of differing anxietystates.In contrast w ith this a neglected area of study conc ern s th e c on te nt o f th e c on str uc ts , u se d by in div id ua lsw ho differ on suicidal intent, as distinct from theirm ode of application. H ere the supposition is m adeth at th e co nstru in g o f g ro ups o f in div id uals w ith h ig hs uic id al in te nt w ill d iffe r from th os e o f low in te nt w ithregard to the m eaning their action has to them . C learlyit is of central interest to know how patients withrelatively high and low suicidal intents perceive thebehaviour of taking an overdose. In pursuit of thisobjective the w ork of B eck and associates (1974) indeveloping the suicidal intent scale is relevant since thescale enables a differentiation betw een groups of highand low intent to be m ade. A further prelim inaryco nside ratio n is th e v ast heterog en eity o f th e ty pe o fproblems associated w ith parasuicide. Patients presenting on an overdose treatment ward show anenorm ous diversity of precipitating and contributory

life circum stances. In the present study it w as decidedto attempt to reduce some of this heterogeneity bylim iting the subjects to young persons aged 15 to 34w ith i nt erp er so na l p ro blems th at c ou ld b e c on ce iv ed a srelev an t to th e o verd ose. Ind eed in terp erso nal p roblems are reported as among the commonest precipitants of parasuicide and the restriction to a youngerage group may well enable some further homog en eity to b e a ch ie ve d. T hu s P allis (1 97 7) in h is re viewo f th e literature estim ated th at m arital d isha rm on ytogether with relationship conflicts occurred in twoth ird s of su ic ida l pa tien ts. K reitm an (1 97 7) in co mp ar in g 1 5 34 ,3554,and 55 plus age groups reportedthat the youngest group had a lower incidence ofp sy ch ia tric p ro blems a nd p re vio us p sy ch ia tric c are a swell as a lower risk of subsequent suicide. It m ay wellbe that from a psychological viewpoint young parasuicides represent a fairly distinctive group. It is w orthnoting for example that a number of studies haveinterpreted the m eaning of suicidal behaviour am ongadolescents as an effort to re-establish a close dependent relationship w ith a loved one, or as an attem ptto ch an ge that p erso n's be hav io ur (Jaco bziner, 1 96 0;J ac ob s a rid Teic he r, 1 967) .F ollow ing these considerations it w as decided toapply the repertory grid technique to young peopleb etw een th e ag es o f 1 5 t o 3 4 w ith interp erson al pro blems who presented at the regional poisoning treatmen t c en tre o f th e E din bu rg h Roy al In firm ary a fte r a no ve rd os e. T he o nly e xc lu sio n c rite rio n th at o pe ra te dwas the presence of undisputed psychotic or sociopa th ic d iso rde r.

MethodIt i s s till c on sid er ed a n ope n i ss ue wheth er e lic ite d o rp ro vid ed c on stru cts o ffe r th e mo st mea nin gfu l re su lts

with the repertory grid (Adams-Webber, 1970;Nystedt et al, 1976). In the present context where wehave the objective of understanding som ething of thephenom enology of parasuicide, it is clearly im portantto obtain constructs which are specific to parasuicidal individuals and yet at the sam e tim e retainsom e com mon basis for com parison of groups. In ana ttemp t to sa tisfy b oth th ese re qu ireme nts a p re lim inary study w as carried out in order to obtain a series ofc on str uc ts wh ic h mi gh t b e t yp ic al o f p ar as uic id es whenv ie wing th eir b eh av io ur in a c risis.Tw enty patients (m ean age 21 years, including 8males and 12 females) who satisfied the above entrycriteria were interviewed on the ward at the firstopportunity and presented with a short vignettedescribing a standard conflict in which two partnersengage in a serious quarrel. The patients w ere asked tomake the conventional grid triad comparisons from alist o f co nflict reso lu tio n b eh av io urs ( elem en ts'),


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308 THE MEANING OF ATTEMPTEDSU IC IDE TO YOUNG PARASU IC IDESextracting tw o w hich had som e com mon m eaning tothem and w hich they could contrast w ith a third. T helis t o f b eh av io urs o r e leme nts su pp lie d to th e p atie ntsin clu de d: g ettin g a ng ry a nd e xp re ssin g a ng er; m ak in ga threat of leaving the key person; going out andgetting drunk; talking the problem over with the keyperson; choosing a sure means of killing oneself;attacking the key person physically; taking an overdos e; s ee kin g p ro fe ss io na l h elp ; e xp re ss in g f ee lin gs b ybe ing alo ne a nd cry in g; talking the pro blem o ver w itha friend; and doing nothing in the situation. B y thismethod a total of 104 contrasting statementsorconstructsw ere obtained (a m ean of 5 per patient).These w ere then transcribed and presented to 4 judges(3 psychologists and a sociologist) w ith the task ofallocating them to sim ilar groups of constructs. T hefollowing list of nine constructs w as obtained inwhich there was independent agreem ent by two ormore judges:

S om eth in g I fin d or reg ard a sI. useless and likely to fail. . . effective in solving m yproblems.2. sensible and thought out . . . impulsive anddesperate.3. a way of hiding feelings. . . a way of expressingfeelings.4. helpful and positive. . . harm ful and destructive.5. a w ay of blam ing the other person(s). . . blam ingmyself.6. a way of changing my situation. . . results in meg iv in g in .7. m aking m e frustrated and w orked up. . . a llow s m eto e sc ap e fro m ten sion .8. enabling m e to com municate m y needs to others

denying everyth ing .9 . ha rd fo r m e perso nally . . . e asy fo r m e perso nally .A standard repertory grid was thus formed as am atrix of the 11 elem ents and 9 constructs. T his w asthen adm inistered to a further group of 29 patients.Patients w ere seen as soon as possible on the w ard,usually follow ing the psychiatric interview and inap prox im ately h alf th e cases b efo re th ey had co ntactwith the key person relevant to the overdose. Thec on stru cts w ere p re se nte d a s e xtreme s o f a s ev en p oin trating scale and the individual w as asked to indicatehow he saw each possible behaviour (the elements) inhis ow n earlier crisis situation in term s of these constructs, indicating their appropriateness by the rating

given. Finally the Beck suicidal intent scale was administered. This is a 15 item questionnaire com pleted bythe clinician and contains inform ation about thecircum stances relating to the attem pt and the patient'sconception of the seriousness of it. Inter-scorerreliab ility is h ig h (B ec k et al, 19 74 ) a nd th e scale has

been found to correlate significantly w ith lethality(G oldberg, 1979). The data w ere analysed w ith theobjective of revealing how patients view parasuicide inthe co ntex t o f their o wn p erso nal strateg y o f co nflictresolution.

ResultsFifteen grids of low suicidal intent patients and 14g rid s o f mo de ra te to h ig h in te nt su ic id al p atie nts w ereobtained. The mean age of the total group was 20.54with a range of 15 to 34. The sample included 10males and 19 females. Scores on the Beck scaleranged from 0 to 23 with a mean score of 8.48. Sinceth ere a re n o sta nd ard iz ed n orm s a va ila ble fo r th e B ec kscale, it w as d ecid ed to use th e m ean as an in itial b asisfor division into low and m oderate to high intentg ro ups. A fu rth er refin em en t w as later m ad e fo r th osew ith relatively high scores (of 12 or over) as used by

other authors (e.g. Goldberg, 1979). Fifteen patientsr ep ort ed e xc lu siv ely ma ri ta l o r ov e'ro blem s, 8 h admixed parental and partner conflicts, and a further 6h ad in te rp ers on al c on flic ts w ith o th er fig ure s. T he rewere a total of 14 parasuicide repeaters (48.3 per cent)for w hich there w as a record of one or m ore previousattempts, and a further 2 patients reported unrecorded incidents. T he repetition rates w ere nearequal for the low and m oderate to high intent groups.

C onsensus grids w ere obtained representing averageratings for the low and the moderate to high intentgroups and then subjected to INGRID computeranalyses (Slater, 1972). The results of these arepresented as Figs I and 2 which display the first twoprincipal components (accounting for 64 per cent ofthe variance in the low group and 71 per cent in them oderate-high group), the elem ents in constructsp ac e, a nd th e c on stru cts th em se lv es p la ce d ra dia lly .It should be noted that since the display is only tw od imens io na l u sin g th e f ir st two f ac to ria l c ompon en ts ,the positions of constructs and elem ents should beconceived as only approximate. Furthermore the twoprim ary factors that em erge are different in the tw ogroups so that while it is legitimate to look at therelative positions of e.g. suicide and parasuicidew ithin each group, it is not possible to com pare thediagrams di rec tly .T he IN GR ID analysis also gives specific informa tio n a bo ut th e g ra ph ic al d ista nc es a nd re la tio nsh ip sbetween elements, between constructs, and therelationships between constructs and elem ents.Tables I and II present the various cosines betw eenco nstru cts an d elem ents. A cco rding to S later (1 97 7)th ese can b e treate d as m athe matically eq uiv alen t tocorrelation coefficients .

Some clear differences emerged between the twogroups in the construing of the form s of crisis be


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30 9DRIAN PARKER11TENSION.

HARDFOR U SE LE SS &INEFFECTIVE3

PROBLEMdoing nothingI

PLANNEDSENSIBLE

BLAMINGMYSELF

I

@gettingangry

talking to key person9- I- H A RM FU L

s ee ki ng p ro f. h el p.43

HELPFUL

CHANGE

haviour and in particular those of overdose andsu ic ide . T he follow in g m ajo r fea tu re s w ere ap pare nt:( i) The cons tr ui ng o f overdose and sui ci de

T he low su ic id e in te nt g ro up p erc eiv ed a n o ve rd os eas distanced and distinct in construct space from thatof suicide itself. In fact an overdose is perceived inthese terms as much closer to b ein ga lo ne a ndcrying' and gettingrunk' than to killingm yself' tow hich it is relatively unrelated. This group construesan overdose alm ost exclusively as a desperate escapefrom tension while suicide itself is seen as a harmfulact involving denial of the personal problem andsuppression of feelings. The low intent group placedanverdose' as second only to ge tt ingrunk ' i nterms of ratings of perceived easiness of action. Thiscontrasts w ith that of the m oderate-high intent group

#getting drunkIMPULSIVE&DESPERATEFEELINGS

COMMUNICATING taking an overdose

EASYFORMEUSEFUL &EFFECTIVE

FIG I .Representation o f elem ents in co nstruct space for the lo w in tent g roup.

w ho perceived overdose'as the closest elem ent inconstruct space to suicide and not related to thecrying and getting drunk elem ents. F or this group anoverdose is construed in sim ilar (although less significant) terms to suicide, this being seen primarily ascommunic ation of needs,express ionof feelings ,ndescap e fro m ten sio n. A s ex pec ted fro m th e c on tex t o fthe Beck questionnaire used in selecting this group,suicide has also aspects of thought out planned actionw ith c ha ng e resu ltin g. C orrelatio n c oeffic ien ts b etw ee nthe elements of suicide and overdose also suggest abasic dissim ilarity in construing for the low intentgroup (r .33) and their sim ilarity for the m oderatehigh intent group (r = .73). (Differences in correlatio n c oe ffic ie nts h ow eve r fa iled to re ac h sig nific an ceon a Fisher's Z test.) A further refinement was conducted to produce a small group (N = 9) with rela

thteateninto Leav

beinaaton e & cryi ng


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ElementsConstructs 1 2 3 4 5 6 7 8 9 10 Il

31 0 THE M EA NIN G OF A TTEM PTED SU ICID E TO Y OUN G PARA SUICIDES

ME

ESCAPEDESPERATEGIVING INDENY ING PROBLEM

HIDINGBLAMING OTHERS

overdose.@.

gettingattacItng.p being

talking EFFECTIVEseeking prof. he1p

TAB LE I

HARDME

4threatening to leave killingmyself HELPFUL

2 EXPRESSINGFEELINGS

BLAMINGtalking key person COMMUNICATING

.3 CHANGEPLANNED&SENSIBLE

T EN SIO N &FRUSTRATIONFIG 2.Representatio n of elem ents in construct space fo r the m od erate-h ig h intent group .

Low sui ci da l i nt en t g roup : r el at io ns b etween con st ru ct s and e lemen ts e xp re ss ed a s cos in es

.22 .31 .28 .28 .50 11 .19 .03 34 39 772 09 65 .03 75 .60 .62 .60 91 .60 21 .173 68 .66 .42 .64 03 .25 65 .46 35 37 414 .14 .28 40 06 .12 71 .09 02 .23 .04 .225 .23 74 58 86 08 .61 .69 75 .42 .45 .496 .58 15 03 55 02 36 .28 25 .48 .09 .097 55 .33 .45 23 .77 12 .35 35 .64 51 628 .64 75 44 57 .03 64 .75 29 .15 .67 .039 62 .07 .15 32 .48 .51 11 62 .52 56 .33


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Constructs.Elements12345678910111.27.60.38.36.66.49.54.51.13.49.792.35.29.08.1

7848.68.02.423.78.37.66.11.40.17.57.06.4356.114.07.49.10.25.37.66.15.26.17.36.155.40.62.84.52.16.23

10.00.28.55.346.58.38.05.36.32.4179.32.67.15.487.69.66.18.24.88.64.69.65.42.63.398.81.61.45.24.35.33

71.27.65.28.279.66.43.63.36.91.38.49.74.25.84.07

31 1DRIAN PARKERT AB LE 1 1

Moderate-highnte ntroup:relat ionsetwe encon stru ctsnde lementsxpresseds cosines

Key: Cons tr uc ts a bove a re l is te d.Elements : I doingnothingnthesituati on2 ta lk ing the pro ble m o ve r w ith a frien d3 e xp re ss in g f ee li ng s b y b ein g a lo ne a nd c ry in g4 seeking profess iona lhe lp5 takinganverdose6 a tta ck in g t he k ey p ers on p hy sic al ly

7 choosing a certain means of killing oneself8 ta lk ing the pro ble m ov er w ith th e k ey p ers on9 go in g o ut an d g ettin g d ru nk10 makinga threatfleavinghekeypersonI I g et ti ng ang ry and exp re ss in g ang er ( ve rb al ly )tively high scores (l2@ ) on the Beck scale. A similarpattern w as revealed but w ith m ore significant trendsfor both overdose and suicide on the constructs ofcom municating needs, expressing feelings and escapef rom ten si on .( ii) Re la tio ns hip to th e k ey p er so n

The low suicidal intent group is clearly morepositiveabout the resolutionof conflictthroughverbal means with the key person, this being seen as asensible, helpful yet personally difficult solution.Expression of anger to the key person is perceived asharm ful. The moderate-high intent group are morenegatively inclined in their perception of these alternatives and view interaction with the key person asresulting in tension and denial of the real problem .( ii i) P ro fe ss io na l h el pSince the grid administration followed the psychiatric interview it probably reflects to som e extent theeffects of this. A gain the low suicidal intent group tendto construe this possibility of seeking professional help

favourablyas elpful'n d en si bl e'hilstthemoderate-high intent group view it more neutrally.(The selected high intent group tend to see it asre su ltin g in blaminghe other'.) B oth groups ratedd oi ngo th in g' , hr ea te ni ngt o b re ak o ff t he r el at io nship', and alkingo the key person' as hardest forthem. Seeking professional help was rated a moredifficult choice than suicide for the moderate-highintent group and slightly so for the low intent group.Discussion

Parasuicide is an anomalous event in which it islikely that a full understanding of the intent of theindividual concerned can only be gained from acom plete know ledge of his life history. N everthelesssomething can be learned by studying the meaningthat the act has for homogenuous groups. In thisstudyinterestas focusedon differencesn theconstruc.tystemsof relativelyow and high suicidalgroups. Clear differences w ere obtained indicatingthat the two groups do perceive overdose in ratherdistinct ways. Some of these differences may merely


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31 2 THE MEANING OF A1TEMPTED SU IC IDE TO YOUNG PARASU IC IDESreflecttautologousspectto thestudy,namely thatthe application of the B eck scale could itself be conceived as selecting a group who carry out a seriouso ve rd os e a cc omp an ie d b y p la nn in g a nd d elib era tio n.Y et n ot a ll th e d iffe re nc es c ou ld b e re la te d to p la nn in ga nd d elibe ratio n. P erh ap s the m ost strik in g fin din g isth e more o r le ss e xc lu siv e e sc ap e o r e sp ite 'unctionthat an overdose has for the low intent group, andw hich for them places the elem ent overdose in construct space close to gettingrunk' and cryingalone'. lt may be that for this group an overdoseperm its both an expression of feelings and an escapefrom tension and from their situation. S uicide on theother hand is view ed in quite different negativelyloaded term s. This espite' spect has receivedrelativ ely little a tten tio n in the research literaturealthough it is a finding present in the Bancroft et a!(1 97 6) d ata, 5 2 p er cent o f w ho se resp on den ts w an tedrelief from an unpleasant state of m ind. M oreover theywere a ble to id en tify a c lu ste r o f fe elin gs, mo tiv es, a nde ffe cts c on ce rn ed w ith w ith drawa l, fa ilu re , a nd re lie ffrom state of m ind. B ancroft ci a! also found a negativ e a ss oc ia tio n b etw ee n a wisho die' and the needescaperom a n impo ssib le situ atio n', a fin din g whic his c on sis te nt w ith th e u se o f e sc ap e a s a majo r c on stru ctb y th e low in te ntio n g ro up .It m ust be stressed that the present application ofth e g rid te ch niq ue to su ic id al b eh av io ur is e ss en tia llyat an exploratory level, but there w ould seem to beg ro und s fo r co nclud in g th at w ith fu rth er refin em en t,especially in term s of hom ogeneity of groups, thetechnique can be profitably applied to the study ofcrisis and anom alous behaviour. B y definition cons tru cts a re s up po se d to p re dic t b eh av io ur o r imp orta ntchanges in the individual's world. For this reason aswell as form ing homogenous groups (e.g. peerrelationship crisis, fam ily crisis, lover conflict) itwould seem important to also include in futureresearch the temporal aspect. This may involvestu dy in g th e ch an ges in co nstru in g of th e in div id ualand key persons w hich are consequent to the parasuicidal act. In this w ay it should be possible to give afuller account of the intentional aspect of this behaviour.

ReferencesADAMS-WEBER, J. (1970) Elicited versus provided con

structsin repertorygridtechniques:A review.BritishJournal o f Med ica l Psychology , 43 ,34954 .

BANCROFT ,. , SKRIMSH IRE ,. & S IMK IN ,S . ( 1976 ) Thereasons people give for taking overdoses. B ritishJournal o f Psych ia try , 128,538-48 . HAWTON, K., S IMKIN, S., KINGSTON, B ., CUMMING, C.

& WHITWELL ,D . (1979)The reasonspeoplegivefortaking overdoses: A further inquiry. British Journal ofMedical Psychology, 52,353-65.B EC K, A ., S CH UY LE R, D . & H ERMA N, 1 . ( 19 74 ) D ev elo pm en to f su ic ida l i nt en t s ca le s. I n The Pr ed ic ti on o f Su ic ide(eds. A . B eck, H . Resnik and D . Letteri). Bow ie,

M aryland: C harles Press.D YER, J., D UFFY , J. & K .R EITMAN, N. (1978) P ara su icide inEdinburgh. U npublished report. Edinburgh M RCUn it f or Ep id em iolog ic al S tu di es i n P sy ch ia tr y.FAIGF.L, H . (1966) Suicide among young persons: A reviewof its incide nce a nd cau ses, an d m eth od s o f its prevent ion . Cl in ica l Paed ia tr ic s , 5 , 18790 .GOLDBERG, R. (1979) Attempted Suicide: Correlates ofL eth ali ty . MD The si s Uni ve rs ity o f A de la id e 1 97 9.JACOBZINER, H. (1960) Attempted suicides in children.Journal of Pediatrics, 56,519-25.JA CO BS, J. & T EIC HER, J. (1967) Broken hom es and@socialiso latio n in a ttem pte d su ic id e o f a doles ce nts. Inte rna tiona l Journal o f Socia l Psych ia try , 13 ,139-49.KELLY, G. (1961) Suicide: The personal construct point ofview . In N . Farberow and E . Schneidm an T he C ryf or He lp .New Yo rk : McGraw Hil l.KRn iP4M@I , . ( r. o. )( 1977 )P ar as ui ci de . London : Wi le y.LANDFIF.LD, A. (1976) A personal construct approach tosuicidal behaviour. In P. Slater Explorations ofi nt rape rsonal Space , Vo l. 1 . London : Wi le y.LEVENSO N, M . (1974) Cogn itive correlates of su icide risk.In P sy ch olo gic al A sse ssmen t o f S uic id al R is k (e d.C. Neuringer) . Springfield:C harles Thomas.M CCU LLOCH , J. & PH ILIP, A . (1972) Suicidal Behaviour.

O xf ord : P er ga mo n.NEU RING ER, C . (1976) Current developm ents in the stud y ofsuicidal thinking. In Suicidology: C ontem poraryDevelopments (ed. E. Schneidman). New York:Grune & St ra tton.N vsrriv r, L ., E KE HA M ME R,. & K UU SIN EN ,. (1976)S tru ctu ra l re pre se nta tio ns o f p ers on p erc ep tio n:a co mp ariso n b etw ee n o wn an d p ro vid ed c on stru cts.Scand inavian Journal o f Psychology , 17 ,22333 .PALUS ,D . ( 1977 ) Th e P sy ch ia tr ic As se ssmen t o f A t tempt edSuicides: Personality, intent, and suicide risk. M DThesis. Aberdeen Universi ty.R YL E, A . (1976) Som e clinical applications of grid technique.In Explorat ionsnIntrapersonalpac e.Vol .1( ed . P . S la te r) .London : Wi ley& Sons .SLATER, P. (1972) Notes on INGRID 72. Manuscript.D ep artm en t of P sy ch iatry , S t G eorg e's H osp ital,London. (1977 ) Exp loratio ns o f In tra persona l Space . Vo l. 2 .London: Wi ley .

Adri an Pa rke r, MA. .Ph .D. .Dip.CIi n.Psychol ..RC Unit f or Ep idemio log ic al S tud ie s i n Psych ia tr y, Ed inburgh Un ive rsity D epartm ent of Psychiatry, Royal Edinburgh H ospital, M orningside Park, E dinburgh E HIO 5H FPresentaddress: Barn-och Ungdomspsykiatr iska Klinikern, Box 7284,S@-4025 Gothenburg, Sweden.(Rece ived 16 February 1981)

the meaning of attempted suicide to young parasuicidesa repertory grid study

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