The New Communication Applied to the Problem of Suicide in Families

Suzanne Lamarre MD FRCPC DLFAPA

Assistant Professor in McGill Department of Psychiatry

What’s the New Communication

• Stems from Endocrinology, Physiology, Mathematics, Anthropology at the beginning of the 20th century

• It’s about regulatory mechanisms and the change and stability of living systems and organisms

• It has been called Cybernetics, a new transdisciplinary discipline

• New communication is part of the systemic approach and family therapy theories in psychiatry

The double elements of any communication

• Within any communication there is

– a content (digital) (what I say) (telegram)

– an incentive (analogic) (how I say it)

• on the identity of the actors– “It is not what you say that bothers me it is the tone you use

to say it” (You make me feel worthless by the way you talk to me)

• on the attribution of responsibility – “You are asking me about my wish to die”

“It means without saying it is your responsibility now to protect me from doing it and you should respect my rights”

Regulatory mechanisms within a relation between two persons communicating

• Explosive type

– Up-Down (dominant – submissive)

– Rivalry or symmetrical

• Counterbalanced or a mutuality relation

– Always a possibility of a temporary rupture or STOP

The regulatory mechanisms in suicidal crisis

1. Explosive relation between protector and protegeeSuicide is a symptom to be controlled by the HCP who ends up controlling the suicidal person who opposes to the control of the protector in order to save his identity of an autonomous person

2. Mutuality relation between 2 autonomous personsproposed by the HCP when addressing the Ethic of Reciprocity in the family meeting“how would you feel if your loved one in a state of distress would think of suicide as you do?”Let’s agree on this golden rule: “don’t do to others what you don’t want others do to you, killing your loved one”

The reequilibrium is in a mutuality relation and a change in the values and in the ways to address problems

Installing the mutuality relation

• A change in an explosive relation can only be brought up by a third party which usually is the HCP in a suicidal crisis

The catch 22 of the protector role

CommunicationDoing more and more of the same until it

explodes“I am despaired and I don’t want anyone to upset me more”“Leave me alone and don’t hurt me more” “Life cannot continue the way it is going”“Something needs to happen! An explosion”

The HCP needs • to recognize the impossibility to be in this

situation and • to take at first contact the role of the third party

in addressing the explosive relation

New communication and autonomy

• One cannot control someone’s mind– The unpredictability of an autonomous person

• When someone thought of death as the only way out, it means this way out could be used again

• The suicidal crisis is the key moment to address another way to manage problems among people who care about each other

• There should be a place for everyone’s sensitivity as a human being by choosing values and behaviours – where interpersonal violence is excluded and

– the need of interconnectedness is recognized

New values for a life without violence

• Suicide is a violent, explosive, way to change a situation

• New types of values and new ways in managing problems for a life without violence

1st phase

• Safety aspects : context of self protection (no more violence) based on the engagement in the ethics of reciprocity where people adopt a new rule in their communication: RRAV-LR

Rule of Respect of the Autonomy of everyone and Vulnerability(sensibility) – I can talk about my Limits to Reorganize the situation

• Treatment aspects: a choice

• New values to manage problems without interpersonal violence

2nd phaseApplying new Values

• See www. lasantementale.info

On the individual level

Roads of victimization in

a Protectionist context

Roads toward a quality of

life and ethic of

reciprocity

WHAT TO STOP DOING WHAT TO TRY

Withdraw from others when in

despair 1Reach out to others when in despair

and manage problems in a different

way

Assume that depressive ideas and

depressive mood don’t interact with

each other2

Practice mindfulness, stay grounded

in the moment, and choose one’s

thoughts

Ignore brain neuroplasticity,

communication and principles of

relations, action recursivity and final

causes

3Count on brain plasticity: new

patterns can emerge when one

becomes aware of the contexts that

maintain them

Act impulsively or emotionally 4Be aware of one’s emotion and deal

with the frustration after reflection

Roads of victimization in

a Protectionist context

Roads toward a quality of

life and ethic of

reciprocity

WHAT TO STOP DOING WHAT TO TRY

Ignore the entrance pathway towards

victimization and death 5S (STOP ) or STEP

T (take a breath)

O (observe) or E (explore)

P (proceed)

Change nothing and wait for someone to

die 6Put the problem on the table, mourn

losses and let the brain process the info

Ruminate on unfairness and continue with

“I should have” or avoid those thoughts in

engaging in dead ends7

Forgive: decide to choose pleasant

thoughts and moods – Get oriented to

the future “I should” rather than anger

Waste time on “why” – the initial cause of

the problem – rather than identifying the

final cause (the aim)8

Switch quickly from “why” to “how” to

reorganize the situation with others and

foster collaboration to solve problems

Burn out 9Be aware of energy renewal and

feedback loops; get a perspective on

relations to maintain peaceful and

fulfilling contexts

Roads of victimization in

a Protectionist context

Roads toward a quality

of life and ethic of

reciprocity

WHAT TO STOP DOING WHAT TO TRY

Stay cornered in a protectionnist system

(saviour’s role) by overprotecting the

suffering one10

Address oneself to a third party so as to

change from a rule of the game a rule of

collaboration and self-protection and for

the ethics of reciprocity

Avoid or hide problems, or look for guilty

people to exclude or to punish 11A good leader acknowledges the

existence of problems and installs a

context for everyone to participate in

solutions

Maintain oneself in controlling,

manipulative behaviours by being even

more so, imposing solutions, blaming,

and disqualifying others (see the wheel

of victimization)

12Become an expert in identifying

dysfunctional, explosive systems by

focusing on relations rather than on

individuals

Assume the right to bully and humiliate

another for self defence 13Exclude all violence and explosive

means for self protection and do time-

out in love in case of tension.

Blame oneself, blame others or let

others blame us 14Recognize one’s mistakes and discuss

how to repair with neither guilt nor

shame.

Roads of victimization in

a Protectionist context

Roads toward a quality

of life and ethic of

reciprocity

WHAT TO STOP DOING WHAT TO TRY

Fall into wrongdoing that needs to be

hidden, and engage in self denial and

blackmailing15

Expect honesty and discretion and

defuse all time bombs

Force the other to agree so as to be ‘one

of us’ 16Love and collaboration does not mean

having to say “yes” to every request.

Compare oneself to others, be envious,

maintain oneself in shameful and guilty

feelings, continuously excuse oneself 17

Gain self confidence by accepting one’s

own mistakes, without assuming the

identity of the ‘bad boy’ or ‘bad girl’: be

aware there is suffering in all action, but

acting is much more interesting than

waiting for the authorization to act.

Keep trying to prove one’s value 18Learn to risk trusting others, and expect

others to reciprocate

Lessons to take home

• Momentum for change– 1st psychiatric contact– Don’t let the suicidal loved one alone with the HCP– It is a key moment to change your way to care about each other

and to manage problems

• Real change– Relational rule

• From controlling each other, to collaborating with each other• From overcompensation, to partnership in reciprocity

• Who has the lever for bringing such a change?– The Health Care Professional and – When the reciprocity rule is adopted, the family including the

suicidal one