The Aeschi Working Group

MEETING THE SUICIDAL PERSON

The therapeutic approach to the suicidal patient

Patients' dissatisfaction

"I got very angry when they kept asking me if I would do it again. They were not interested in my feelings. Life is not such a matter-of-fact thing and, if I was honest, I could not say if I would do it again or not. What was clear to me was that I could not trust any of these doctors enough to really talk openly about myself".

Quote from a 36-year old man seriously handicapped by rheumatism, who had taken an overdose of antidepressants after his discharge from the medical ward.

Suicide attempters on emergency wards are special cases. They are not admitted because of an illness or an accident, but because of an act, or an action. Health professionals by their training are ill equipped to understand emotional states that lead to an act of self-harm. The traditional biomedical illness model is a linear and causal model, i.e. it assumes some form of pathology, for which the cause must be identified and treated. Consistent with a causal illness model, health professionals search for the fault in the system, and they have been trained to be the experts in this search.

Not surprisingly, patients sometimes report that nurses and social workers have been more helpful than physicians and that they would rather opt for a follow-up appointment with a nurse than with a doctor (Treolar et al. 1993). Treolar et al. found a significant relationship between the staff's listening behaviour and sympathy shown on one hand, and the patients' perception of the amount of help received on the other hand.

References

Treolar, A.J., Pinfold, T.J. (1993) Deliberate self-harm: An assessment of patients' attitudes to the care they receive. Crisis, 14: 83-89.

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