Facioli Adriano Machado, Amorim Fábio Ferreira, De Almeida Karlo Jozefo Quadros, Trindade Eliana Mendonça Vilar
Psychologist and Professor of Medicine in the Department of Research and Scientific Communication at Escola Superior de Ciências da Saúde in Brasília, Distrito Federal, Brazil.
Professor of Medicine in the Department of Research and Scientific Communication at Escola Superior de Ciências da Saúde in Brasília, Distrito Federal, Brazil.
Perm J. 2015 Summer;19(3):90-4. doi: 10.7812/TPP/14-201.
This case study is an example of applying narrative medicine as a useful tool for health professionals to manage an existential and complex scenario such as the suicide of a sibling. Some suicides are like baobab trees—these large and resilient trees grow deep roots for many years, only spreading their limbs above ground once they are firmly established. Like the baobab, when suicide or a suicide attempt occurs, suicidal ideations are well cultivated and have often already been repeatedly planted. Consequently, suicide is often difficult to prevent: once the death seed is planted, it is difficult to recreate life. Every year, more than 800,000 people die by suicide worldwide (1.4% of all deaths), which is approximately 1 person every 40 seconds. These unexpected deaths, predominantly occuring among young and middle-aged adults, have a continuing ripple effect and result in a huge economic, social, and psychological burden for individuals, families, communities, and countries. The complexity of suffering and pain experienced by suicidal individuals and their families, regardless of the success or failure of the suicidal act, is intensified by strong stigmas attached to traditional concepts of sin and eternal damnation. This unfortunate reality emerges in the narrative as a tragic family drama, which is permeated by deep feelings of helplessness. But suicide is preventable. Prevention requires 3 important factors: knowledge, public support, and creation of strategies to enact social change. Now is the time to act and make suicide prevention an imperative goal.
本案例研究是将叙事医学作为一种有用工具的示例,供卫生专业人员应对诸如兄弟姐妹自杀这样的生存性复杂情况。有些自杀行为就像猴面包树——这些高大且坚韧的树扎根多年,只有在根基稳固后才在地面上伸展树枝。与猴面包树一样,当自杀或自杀未遂发生时,自杀念头早已根深蒂固,且往往已经反复出现。因此,自杀往往难以预防:一旦死亡的种子种下,就很难重获生机。全球每年有超过80万人死于自杀(占所有死亡人数的1.4%),大约每40秒就有1人自杀。这些意外死亡主要发生在中青年人群中,会产生持续的连锁反应,给个人、家庭、社区和国家带来巨大的经济、社会和心理负担。无论自杀行为成功与否,自杀者及其家人所经历的痛苦和煎熬的复杂性,因传统的罪恶和永恒诅咒观念所带来的强烈污名而加剧。这一不幸的现实在叙事中呈现为一出悲剧性的家庭剧,弥漫着深深的无助感。但自杀是可以预防的。预防需要三个重要因素:知识、公众支持以及制定实现社会变革的策略。现在是采取行动并将预防自杀作为当务之急目标的时候了。