We live in a contentious and divisive world. Political extremism is de rigueur, and the notion of compromise is seen as a sign of weakness or even defeat. But in suicide prevention we can neither afford divisiveness nor extremism. No one has a corner on truth; there are many paths to truth that we must follow if we intend to reduce suicidal suffering and stem the tide of ever-increasing rates of suicide.
There was a recent exchange on a suicide prevention listserv wherein academia was broadly portrayed as “a classist, white supremacist system” and that 50 years of empirical research has done little to reduce the suicide rate, summarily dismissing this work as “not impressive.”
As someone who has spent decades sacrificing certain career opportunities, income, and time with my family, I have spent countless hours writing grant proposal after grant proposal only to have them roundly rejected. In fact, I spent ten years in the feckless pursuit of getting funded before I finally succeeded. Then once funded, the pressure and responsibilities of being a Principal Investigator or Co-Investigator of clinical trials with suicidal participants was—and is—incredibly taxing and stressful. While there have been successes to be sure, there have been many disappointments which occur whenever one conducts clinical research because outcomes are not guaranteed. And there have been suicides, which are particularly painful for my students and me because we watch recordings of sessions for adherence and fidelity purposes. We grow attached to the patients in our trials and when they do not make it, it hurts. Given the risks, challenges, and sacrifices I have endured as an academic the words in this dismissive listserv post stung.
The post was written by a colleague that I respect, who is a leader speaking from the perspective of “lived experience”—those people who have been previously suicidal, made suicide attempts, and invariably struggled within contemporary mental health care. Simply stated, the lived experience perspective has help transform the field of suicide prevention in many positive ways. And for my part, I have always believed that each individual experiencing suicidal thoughts and behaviors is unique and their perspective is special. Accordingly, I have concluded that there will never be one perfect solution within suicide prevention that will fit every suicidal person’s respective needs. In other words—as I have spoken and written about—regarding suicide assessment, intervention, and treatment: one size does not fit all. There has got to be room for everyone’s contribution in the field of suicide prevention. In truth, there is a desperate need for everyone’s contribution. There is no merit or need to dismiss any perspective for the greater good—we need them all.
While I may be an academic, my work has always been informed by the voices of people with lived experience, namely my suicidal patients and research participants. Over thirty years, I have had the privilege of listening to hundreds of suicidal people describe their suicidal pain and suffering. In turn, these voices have directly informed and shaped my clinical practice and my research and has fundamentally inspired the creation of CAMS.
Like every graduate student in clinical psychology in the 1980s, I was trained that suicidal ideation and behaviors were symptoms of a major mental disorder (e.g., depression, manic-depression, or schizophrenia). Despite research to the contrary, this assumption is still pervasive today. Once when I was a young clinician, I saw an extremely suicidal patient who had been dumped by his girlfriend of two years. Apparently, she had been cheating on him with his best friend for months. After reviewing his previous few weeks of abject misery and a perilous aborted suicide attempt, I earnestly observed to the patient that he was clinically depressed, and to save his life we would need to effectively treat his depression. He looked up at me with exasperation and said, “You really don’t get it do you? I am not going to kill myself because I am depressed! Don’t you see? I am depressed because the love of my life cheated on me with my best friend and then dumped me! I am going to kill myself because I can’t live without her!”
Lesson learned. From this patient’s lived experience—along with the input of countless other patients and research participants—the seed to treating suicide directly and collaboratively was planted, and that seed has grown into a central construct within the CAMS, and has been proven effective in multiple clinical trials.
The field of suicide prevention is remarkably complex and contentious. People who pursue work in this field are invariably passionate. But in our passion, we really need to better listen to each other and not contend that we know the truth. In this sense, neither lived experience nor empirical research provide singular paths to truth. To dismiss either perspective is to miss the opportunity for creating a greater synergy of respective truths to create an even greater truth that just may help reduce suicidal suffering and save lives from suicide.