Benson Outi, Gibson Susanne, Boden Zoë V R, Owen Gareth
SANE, St. Mark's Studios, 14 Chillingworth Road, Islington, London N7 8QJ, UK; University of Exeter Medical School, College House, St Lukes Campus, Exeter EX1 2LU, UK.
SANE, St. Mark's Studios, 14 Chillingworth Road, Islington, London N7 8QJ, UK; The McPin Foundation, 32-36 Loman Street, London SE1 0EH, UK.
Soc Sci Med. 2016 Aug;163:126-34. doi: 10.1016/j.socscimed.2016.06.045. Epub 2016 Jun 25.
Suicides are related to diverse demographic, socio-economical, medical and behavioural 'risk factors'. Theoretical work in suicidology attempts to construct models that explicate the mechanisms underlying these suicides; however, models taking first person perspectives as their primary evidential bases are scarce. Drawing on interviews carried out by researchers at a UK mental health charity during 2010-2012 with people bereaved by suicide (n = 25), suicidal individuals (n = 14) and their 'significant others' (n = 15), we present an explanatory model of the process of suicide derived from a Grounded Theory study.
Suicide/attempt can be understood as the result of a complex interaction of three elements of experience: 'lack of trust', 'lack of inherent worth' and 'suicidal exhaustion'. The first two may be seen as conditions from which the third emerges, but so that all the elements are related to each other reciprocally and the exhaustion and the suicidal thoughts, feelings and behaviours it gives rise to feed back into the initial conditions. Trust, understood as an aspect of experience that allows a person to accommodate uncertainty in relationships and in thinking about the future, is lacking in suicidal people, as is a self-determined sense of worth that is independent of external factors. Substituting inherent worth with self-worth gained from extrinsic factors, and trustful experiencing with strategies of self-reliance and withdrawal, a person begins to consume mental resources at a high rate. 'Suicidal exhaustion' is distinguished from other types of chronic mental exhaustion in that it is experienced as non-contingent (arises from living itself) and hopeless in that the exhausted person is unable to envisage a future in which demands on his/her mental resources are fewer, and their replenishment available.
The model has potential applications for public participation in suicide prevention, which should be mapped and assessed in further research.
自杀与多种人口统计学、社会经济、医学及行为方面的“风险因素”相关。自杀学的理论研究试图构建模型来阐释这些自杀行为背后的机制；然而，以第一人称视角作为主要证据基础的模型却很匮乏。基于英国一家心理健康慈善机构的研究人员在2010年至2012年期间对自杀丧亲者（n = 25）、有自杀倾向者（n = 14）及其“重要他人”（n = 15）进行的访谈，我们提出了一个基于扎根理论研究得出的自杀过程解释模型。
自杀/自杀未遂可被理解为三种体验要素复杂相互作用的结果：“缺乏信任”、“缺乏内在价值”和“自杀性疲惫”。前两者可被视为第三种要素出现的条件，但所有要素相互之间是相互关联的，疲惫以及由此产生的自杀想法、感受和行为又会反馈到初始条件中。自杀者缺乏信任，而信任被视为一种能让人在人际关系和思考未来时接纳不确定性的体验方面；他们也缺乏一种独立于外部因素的自我决定的价值感。用从外部因素获得的自我价值取代内在价值，用自我依赖和退缩策略取代信任体验，一个人开始高速消耗心理资源。“自杀性疲惫”有别于其他类型的慢性心理疲惫，因为它被体验为非偶然的（源于生活本身）且绝望的，疲惫的人无法设想一个对其心理资源需求更少且能得到补充的未来。
该模型在公众参与自杀预防方面有潜在应用价值，应在进一步研究中进行规划和评估。
