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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