Jennifer White is one of the founders of the Critical Suicidology Network, a growing international network of scholars interested in exploring alternatives to biomedical approaches to suicide prevention. Critical suicidology brings together persons with lived experience, mental health professionals, researchers, and activists “to rethink what it means to study suicide and enact practices of suicide prevention in more diverse and creative, less psycho-centric and less depoliticized, ways.”

She is a Professor in the School of Child and Youth Care at the University of Victoria in British Columbia, Canada. She has practiced as a counselor, educator, researcher, and advocate. White served for seven years as the Director of the Suicide Prevention Center in the Department of Psychiatry at the University of British Columbia.

She has written numerous articles and book chapters on suicide and self-harm and has co-authored two books: Child and youth care: Critical perspectives on pedagogy, practice and policy (2011), and Critical suicidology: Transforming suicide research and prevention for the 21st century (2016). Her current research focus centers itself around the contemporary discourse of youth suicide prevention, seeking alternatives to one-size-fits-all approaches.

She is currently leading a Wise Practices for Life Promotion project funded by the First Nations and Inuit Health Branch (FNIHB) of Health Canada. This project seeks to curate a series of wise practices for promoting life based on what is already working and/or showing promise in First Nations communities across the country. She is also conducting a study with family counselors to learn more about the challenges and opportunities they face with youth suicide prevention and the organizational conditions that support them to be most effective in their work. 

Samantha Lilly: Young people with lived experience of suicidality are often disregarded or treated as if their thoughts are silly or unfit for their situation. Can you tell me about youth suicide studies as it exists within mainstream understandings of youth suicidology?

Jennifer White: I think we have inherited an adult kind of framework for thinking about suicide in general, that we apply to young people. That is often predicated, as you say, on the idea that young people are fragile and cannot make decisions on their own behalf. Oftentimes, our interventions can feel quite paternalistic. There is a connection between this dynamic and the tendency to apply a more colonial framework when thinking about indigenous suicide.

I’ve certainly been involved in youth suicide prevention efforts like this. At the very beginning of my career—probably 30 years ago—we’d go into classrooms and deliver a very standard package: here are the warning signs, here are the risk factors, etc. You memorize these things.

There was a very scripted sense of what was permissible to say, what was not allowed to be uttered, and the kinds of questions that were allowed. There was a very clear narrative: “If you’re suicidal, you don’t really want to die. You need to get help from a trusted adult, and this trusted adult will link you up with a professional or an expert who will then intervene.”

In some cases, that’s probably life-saving for some young people. I’ve never been one to say that those things don’t work for anyone. But what I’ve had a problem with is the suggestion that those are the only ways to offer help. We know lots of young people do not avail themselves of formal mental health services. Even if they do show up and get help, they don’t stick around for very long. So I think it’s important that we have a whole range of things to offer that map onto the young person’s needs at the time and their own sense of what’s going to be useful, without us predetermining it.

 

Lilly: What harms arise when a one size fits all model is applied to youth?

White: Mainstream suicide prevention is very much rooted in a risk paradigm. Everybody gets read through this register of risk and pathology. We see it in how we talk about risk factors and “low, medium and high risks,” and there are certain protocols to follow when people fall into these risk categories. But, of course, people are so much more than risk factors.

In some ways, these approaches can dehumanize people and create distance from the very people who can be most helpful. Because of all the fear and anxiety attached to the topic of suicide, well-meaning adults often feel afraid when it comes up in the conversation. Then we get this kind of message: “If you are ever worried about someone, call 911. Or go to the hospital.”

So, I think some of the limits of it are that these scripts—young people as bundles of risk factors that need to be acted upon by another. They become objects to be acted upon or intervened upon.

I think it risks the very possibility of creating a relational connection where you can have an honest, open conversation about what’s leading someone to feel like they don’t want to live anymore.

What’s going on? Let’s try to understand that. But we put that category on someone, and then we’re off to crisis management mode, and sometimes those strategies can be quite coercive. People don’t want to be in a hospital. People don’t want to have their freedoms taken away in some cases.

 

Lilly: It sounds like is this one size fits all approach to youth suicide funnels young people through a system, and the funnel may not fit them. We could be pushing people—pushing a round peg into a square hole. As one of the leaders in Critical Suicide Studies, can you talk a little bit about how this critical thinking about suicide and suicidality might alter that funnel or make it fit more people?

White: I think your metaphor of the funnel is a good one.

I think that is what happens because there is so much anxiety about the topic and how people are professionally trained to deal with it that there’s this illusion of control that we know what to do. We feel like, “OK, someone’s suicidal…I know what to do. I know that I assess them as high-risk, and then we send them off to another expert or a more intensive kind of treatment context.”

In critical suicide studies, we are trying to disrupt thinking about people in terms of their risk to see them as more than their risk factors. That is a part of what is going on.

It is also about situating their distress in a context. What mainstream suicidology often embraces is the context of the experience of distress and suffering. It zeroes in on their interiority—their feelings, their histories, and their intentions.

We, in the general population, get very careful about asking, “are you thinking about suicide? How long have you been thinking about it? How are you going to kill yourself?” We have all of these techniques we’ve learned to assess risk, which ignore a whole bunch of a person’s humanity and experience. Sometimes that can lead people to feel unheard and misunderstood.

Then again, I don’t ever want to suggest that these things can’t be useful. But for some people, for some young people, it feels like it’s a closing down of possibilities—of ways to be human. Because, in some ways, it signals that people don’t want to talk about suicide. Killing yourself isn’t an option, and there aren’t things that we can’t even explore together about that option. We have to constantly be redirecting you to life, to living.

Many people are writing about this. There’s this exhortation to live and this requirement to live that we often also don’t question in suicide prevention. We think, yes, everybody must live. I think it’s good to interrupt that and ask, “do we want to start from there, or do we want to start somewhere else? Is suicide a part of living?”

Other things external to the person might be contributing to the distress. Sometimes when you reframe or rethink what’s causing the pressure or the distress, people can feel like there are things that they’re up against that are not of their own making. That can sometimes be quite helpful. It can give you a little bit of space to think: “Oh, it’s not me, necessarily, that’s the problem. I’m only a part of this problem.”

There is a whole context here! It makes room for practices of solidarity, for involving other communities, for seeing it as a site of resistance against injustice.

There are a lot of ways we can think about suicide other than as a form of pathology. It can be a question. It can be a refusal. “I refuse to live under these circumstances.” There are lots of ways we could think about suicide that does characterize it as a psychopathological condition.

 

Lilly: A lot of folks at home might think, for good reason: “We don’t want to give our young people the wrong idea, that suicide is an act of protest.” Perhaps one of the key questions of critical suicidology is: What if they were “mentally ill”? What if they were just depressed? Can’t they be saved? How do you answer these types of questions?

White: I’m glad you asked because I think it helps to reinforce that I don’t want to get into a situation where it’s either this or that. Suicide is multiple. It is co-constituted with our contacts, our relationships with other people, and our histories.

I don’t want to get into a pattern where we say: “Well, mainstream suicidology thinks about it this way, and we’ve got the answer.” Or, “If only we were just thinking of it this way, we’d solve the problem.”

I think what we’re attempting to do is to create more possibilities and more room for creative ways to understand suicidality so that there are a whole plethora of ways that we might think about it.

Young people experiencing symptoms of depression are encouraged to get help at a mental health clinic. They do get help either through CBT or DBT, which are often thought up as evidence-based practices, and they benefit. I don’t have any problem with that. I think that’s great! It’s great that people are getting help, and that is matching what they need. But I think there are lots of folks for whom those practices don’t work, and they don’t feel like that feels like a good fit.

I’ll give you an example of someone I was speaking with recently who was in a group, and she kept saying, “I want more to life than just being safe.” There was a constant focus on her “safety plan.” She was constantly being asked to create a safety plan to assure people that she was “safe.” And, she said, “there’s more to life than a safe life.” This is an example where some of our tools and instruments that we think are helping people to stay alive felt, for her, like they were diminishing the idea of what is possible for the life she wanted to lead.

To answer your question, we can keep thinking about possibilities that expand our notions of what counts as a livable life. We can continue to engage young people in meaningful conversations about that.

I think we can also say that what we have been doing so far is clearly not working. I mean, suicide rates are going up in many places, including in the states where they were previously stable. We do not see dramatic declines despite all of the efforts where we’ve put into prevention. I think that it also opens up possibilities for thinking about suicide differently.

 

Lilly: I am grateful for you mentioning this kind of reimagining or expansion of how suicide prevention can look and how our thinking about suicidality can change. Regarding the Critical Suicide Studies Network, can you give us a brief overview of some of the work you and your colleagues are doing across the world?

White: There are scholars worldwide that are disenchanted with the mainstream approach to suicide prevention, and they’re looking for alternatives. I think one of the things we haven’t talked about too much, but it’s important to mention is the inclusion of people with lived experience.

That is something that Critical Suicide Studies is committed to, and we also want to be careful about thinking about people in terms of these identity categories. We can get into this trap of thinking, “well, they’re a professional, and they’re a researcher, and they’re a counselor, etc.” People can have multiple identities.

We also came out with an ethics statement that we wanted to circulate for input at a conference we were supposed to have here in Vancouver in June (it was canceled due to the COVID-19 pandemic). It asked, what does ethics in critical suicide studies mean? How do we want to work?

We take a lot of account of people’s political context, forms of oppression, and intersectional identities. We explicitly recognize that some people, despite others’ wishes for them to be alive, will continue to choose death. We write that right into the ethics statement, which I think is important.

As for my colleagues, there are many examples of people doing amazing work in this area, whether it’s around queer youth suicide, austerity suicides, or critiquing psycho-centric views of suicide.

In my own work, right now, I’m doing a study where I’m interviewing counselors who are working with young people who access mental health services because of suicidality. I’m trying to elicit the counselors’ narratives about the standard approach that their organization and institution expect of them.  Then, asking, what other methods are they also doing at the same time?

They each have this way of speaking about their practice: “Well, here’s the standard, which I’m supposed to do, and then there’s this other thing I’m doing.” These additional steps are less formal, less public, and had a kind of a critical quality to them. They were working with young people in ways that were challenging some of these norms around what counts as a worthwhile life, for example.

They were adhering to the standards and doing what is required—meeting the standards of care in a good and ethical way—but there is another layer of practice where they’re working, I think, in a way that’s getting at some of these critical conversations with young people. They ask different kinds of questions that do not position young people as fragile, discredited knowers but capable people. And the counselors find that there are sites of solidarity that they can connect with them over. It is a way of artfully re-crafting the conversations, inviting young people into a conversation instead of acting upon them.

 

Lilly: What are some examples of these questions that invite the autonomy of the young person that these clinicians and counselors ask?

White: Because young people are coming for counseling, they’re able to see that there is a part of them that is wanting to get help. Sometimes it is that they want their parents off their back, so they are willing to come. The counselors work very hard to understand what the goals are for the young person and understand what kind of life they would like to be living.

Some of this comes out of a lot of narrative therapy where you can ask questions like, “With your suicide attempt, what are you taking a stand against?” Here, you’re asking a value related question. It can reveal that they care about something in this world that they’re living in right now that is not forthcoming. It opens up the possibility for a different kind of conversation when you ask that question versus, “When did you last try to kill yourself?” or “How did you last try to kill yourself?”

Again, I am not saying these kinds of questions are not useful. But they can become quite predictable for young people. They’re a little bit stale because they’ve been asked those many times if they’ve seen counselors. It is the standard line of questioning.

Many young people will say, “do we have to go through those questions again?” Can we just get on with them?” Some of those conversations need to be fresh and offer a different way of thinking about themselves and the world.

 

Lilly: How would you advise parents to talk to their child about suicidality if their own child is suicidal, or if they are asking about suicide and what it means? If there was a suicide in their friend group or at school, how would you advise a parent to address suicidality in a way that does encourage an understanding of context and reduces the “stale” nature of the conversation?

White: I am always interested in these kinds of conversations that are driven by curiosity and honest questioning about what is going on for someone without letting anxiety take over. I think that’s the hardest thing for parents and for people who care about young people because their fear and anxiety get the better of them.

Sometimes the fear closes down the possibility for curiosity and a collaboratively generated conversation. When young people feel, “this is someone I can actually have this open conversation with,” it is when someone can acknowledge that suicide is a possibility and that it is part of our human existence to have thoughts of death and suicide.

Many suicidal people will say that through talking it over and thinking it through with another person, they sometimes come to the desire to live again. It’s not a technique. It’s just that sometimes when you’re given permission to honestly express what you’re feeling, you can come to some different understandings for yourself.

 

Lilly: Can you share your current thinking on the debates about whether suicide is a problem.

White: I think my own thinking has evolved so much over the course of my career. I’ve been working on suicide prevention for over 30 years. I started out in a very traditional way, doing things by the book, producing evidence-based documents, and transmitting knowledge from this “expert place.” I’ve done that.

My own questioning emerged through my work with young people, seeing that this wasn’t always what felt useful. It didn’t always feel like a useful conversation. In some ways, it positioned them in a way that I didn’t feel good about —I was the expert, and I was telling them what they should and shouldn’t do.

So, I accepted the idea that, yes, all suicides should be prevented. I accepted that suicide was a problem that should be stopped, and I’m not sure that I’ve stopped thinking that it’s a concern.

I think that the suffering that I’m concerned about is tied in with suicidality. I wonder if there is a different response that we can give to this suffering that may be different from prevention. Prevention has this quality of stopping, disallowing, intervening, and there are maybe other ways of framing it.

If we think about responding to suicidality as an invitation, as an opening to possibility, then, when people make a suicide attempt, we’re called to respond with curiosity, to engage in some kind of joint meaning-making about what it means. I cannot assume that I know what it means, and I’m not going to put it in a predetermined category.

This gestures toward the kind of world that I want to be a part of where we recognize each other’s humanity, and we see each other. We’re not putting people into categories, assuming I know who you are without even having a conversation with you. It is also about changing the structures and the context and the forms of colonial violence and racism and transmisogyny—all things that we know lead many people to feel distressed and suffering.  We have got to work at all those angles.

 

Lilly: What does Critical Suicide Studies have to offer about the current cultural moment as it relates to suicidality?

White: I do think it is important to say that Critical Suicide Studies must turn the critical gaze on ourselves. We have to constantly be reflexive about what we’re doing and the effects of our work.

I wrote something recently about the need to include people from the Global South and more racialized Black and Indigenous folks in these conversations. It is an important move we need to make so that we do not continue to replicate a Euro-Western-centrism in this work —a lot of the theoretical resources drawn on by Critical Suicide Studies scholars are from Western scholars.

I think we have work to do. I think we need to constantly be problematizing where we need to go and how we need to be accountable. It’s definitely not a perfect arrangement, and I think we need to constantly be on the move and thinking about what we need to do to be accountable.

 

***

MIA Reports are supported, in part, by a grant from the Open Society Foundations





Source link

LEAVE A REPLY

Please enter your comment!
Please enter your name here