Talking About Suicide

Because it's not a taboo

Talking with Celine Redfern

Celine Redfern is a good example of the rising generation of mental health professionals who choose to speak openly about their own experiences. As a trainee clinical psychologist, she has chosen to break away from the usual “disease model” view of suicidal thinking and explore the other, sometimes more meaningful, ways that people frame it.

“Society doesn’t know quite what to do,” she says. “Humans strive to live and function, and when faced with someone who says, ‘I don’t want to live anymore,’ people say, ‘How could you not?’ I don’t think people can manage all of that, too complex, so we reduce it to labels because it makes more sense.”

She believes that change will come through conversations like the ones that have begun with the suicide attempt survivor movement, and she’d like to see more talk about the larger, trickier, existential issues of why we’re here.

Who are you? Please introduce yourself.

So, Celine Redfern. I’m a trainee clinical psychologist in the UK. We have a three-year doctoral program; we have to do a thesis in research but also are doing placements at the same time. We do adults, adolescents, older adults, but we’re also being trained as researchers. Thinking critically is a real important part of my doctoral program, part of Christchurch University. It’s my last year,  and I suppose the doctorate takes up a big chunk of life. It’s also something I feel really passionate about doing. At the end of this, I will be a trained clinical psychologist working in the NHS, which I’m also quite passionate about.

How did you get to be doing the project you’re working on now?

The project is part of my thesis. The idea is that there have been quite a lot of quantitative statistics predicting suicidal behavior and minimizing risks. There’s been a little bit of talking to people who attempted suicide, but not really so much. There were the kind of supervisors who were interested in doing a project on suicide. I proposed this, and they said it would be really interesting. I’ve got two great supervisors including Ian Marsh; he did a doctoral project looking at different discourses in the world on suicide. There are a lot of stories understanding suicide as pathological, irrational, linked to the disease model of mental health, and actually, that kind of approach might not be allowing a lot of the other voices, experiences to happen, to come out. My research is talking to people about their experiences, understanding what their stories are, what narratives they use to explain what was happening to them, their recovery as well.

My kind of influence in doing this comes from my own experiences with suicidality about 15 years ago and feeling it wasn’t … my experience doesn’t fit with it being a kind of biological mental illness I had, or an irrational thing. I experienced it in a different way. I was interested in how people understand it, how to give them a voice, especially when suicide is so stigmatized. I would like to think about how that fits into wider society as well.

What are the logistics of your project? How did you find people, how many did you speak with, and so on?

I went through a rigorous process of ethics, ethics committees. It’s an interesting idea because I was aware that some ethics committees tend to be jumpy when talking to people who are suicidal. I had to think very carefully how I would be able to approach people. You are limited in some ways what is possible. I was thinking, in some ways it was kind of felt that people who were acutely suicidal at this time would be harder to get through the ethics committee; it would take longer. So that shaped who to open it up to. I really wanted to tap into a broad section of experience, even people who haven’t ever gone to their GP to talk about it or have never been to a mental health center. I wanted to hear their stories as well. After thinking through it, it came down to printing out posters and putting them in cafes all around, and also the wonderful world of the internet, really. And knowing you and a few others. Like, untold possibilities of connecting. I did a website and went out on Twitter. I connected mental health organizations and said, “Can you help me tweet a few things?” Everyone was really positive. I got a lot of positive comments, helpful responses, people sharing things. People responded very quickly. It was really inspiring to have that kind of response. At one point, I was kind of deluged with participants and I had to say “Maybe not” to some people. I’ve interviewed 12 or 13 people, so to go into the necessary depth of transcripts, to get a real feel for people’s stories … So, small scale. But interviews, that kind of research is small scale anyway.

What were some of the surprises about people and their stories?

I’ve met people face to face, or Skype interviews when people are further out. The thing I’m continually surprised about is how amazing it is to have a chance to sit there and soak up people’s stories. Things people share are really quite personal and touching. Every single time, within about two minutes I’ve forgotten about what’s going on and been really engrossed in what they’re telling me. Sometimes they’re not able to tell anyone else. More than anything, it felt like such an honor and privilege to just be there and be able to listen. So that was one of the big surprises. I wondered sometimes if I would start thinking, “OK, another story,” but every one was great, with a wide range of feelings and experiences.

And I think the other thing is, hearing stories, meeting face to face has helped me shape my own story about my experiences. And it’s been … I didn’t quite expect in that way. I’ve had to tap in every now and then to be respectful and true to their stories and not be putting mine in there. I really wanted to do these people justice in some way. I’ve been talking to friends and colleagues on the course and making sure that is done. It has had an impact on how I see my experiences.

In what ways?

I attempted suicide probably a good 15, 16 years ago, and in some way although I chose to do this project because I was interested in that, those experiences helped me shape why I wanted to do this, to talk to the people who attempted suicide themselves. I was aware that this could impact on me beforehand. You never quite know until you go through them sometimes. And, I suppose, one thing I became aware of was I never had really told my story. I’ve told my story in my head, I have had this monologue of what happened. I realized in these interviews that so many other things come up, and people would say, “I didn’t expect it to go that way, you made me think in different ways.” And I got my friends to ask about my experience, and the same thing kind of happened, some of the monologues I had shifted slightly just because of the questions I was being asked. It’s made me feel braver to tell my story. Even as a therapist, a psychologist, to say, “Yeah, I attempted suicide,” and actually I feel like that has added to my practice, and it’s probably made me a better psychologist than I would have been if I had not had those experiences. So it’s been quite powerful, actually.

Did your colleagues know?

I laugh because no, and now it’s changed so much. And even though my kind of best friends had known but had never really spoken. There kind of was something in me like, “I don’t want to go back there.” It was at some point last year, actually, I kind of thought, “I probably actually want to be telling my supervisors. It’s important to have this discussed, how it’s shaping the research.” And those first conversations are really the trickiest because you don’t know how someone will react. You have the feeling that because they are mental health professionals themselves, they wouldn’t bat an eyelid: “OK, I’ll go to bat for you.” But because there’s still that stigma, the way society sometimes does respond, and when society responded to me when I was feeling suicidal, that does influence your thinking. It feels like a huge risk, even if you know it’s probably safe.

After my supervisors, I was like, “Oh, maybe this is something I need to be talking more about.” What felt quite brave for some of these participants to be meeting essentially with a stranger, I was like, “Wow, I want to be brave in some way.” I understand some people don’t want to talk about it, you don’t have to, but for me I thought, “Actually, now is the time. I want to be a part of this movement which is trying to lessen the stigma, reducing suicidality.” The pathologizing model wasn’t how I saw it, which made me feel alone.

How do you see your experience?

I suppose I kind of see it as someone who’s in an extraordinary amount of … Well, at the time, I look back and see someone dealing with a lot of emotions and no idea how to cope with them, no idea how to manage them. I didn’t feel people would listen if I did talk to someone. I didn’t feel people could have dealt with what I was doing, thinking, feeling, so I felt like I had to deal with it myself, but I couldn’t. So it came out in a lot of ways, one of them suicidality, thoughts and behaviors. And I kind of see that as anyone else in that situation probably would have kind of responded in the same way.

I see suicide as kind of quite a normal expression in some way of just not coping, and pain. And I don’t see it as something kind of mentally ill or those kind of narratives. I know they work for some people, and I do respect that, but for me personally they didn’t quite fit. And I think I felt kind of blamed for my responses, kind of, “Why on earth did you put us through that, doing that?” Or “Oh, you’re just doing it for attention.” How is that helpful in any way, shape or form? I think those responses come from people being really scared, not knowing themselves how to manage or understand on a bigger level. Society doesn’t know quite what to do. Humans strive to live and function, and when faced with someone who says, “I don’t want to live anymore,” people say, “How could you not?” I don’t think people can manage all of that, too complex, so we reduce it to labels because it makes more sense. So the narrative I would use would be, someone who is emotionally in pain and distressed and lonely and couldn’t communicate that. It didn’t help the way other people reacted. So it probably tipped me over a bit more.

Is there something that needs to change in the suicide prevention field, which seems largely led by people who didn’t prevent someone’s suicide? They likely are traumatized by that, and many of them might be alarmed at using the word “normal” around suicidal thinking.

A lot of the field is risk prevention and risk minimization. Which I suppose, I think it comes from a position of “We want to save people, and we don’t want people to die. We are a health service.” So I think that probably it does come from wanting to help people, but in some way there’s, there’s a fear of saying that suicide might be an understandable response. I think there’s a fear that “OK, in that case, we’re not going to help anyone who’s suicidal.” It’s a huge topic, a huge existential topic, life and death, why we’re here, all these big scary questions that bring up all these complex feelings, and a lot of the time people don’t necessarily want to be thinking them through. And maybe we don’t have the time to think it through as policy makers, doctors in the system, especially in the current climate of doing more with less money. You’ve got less thinking time. And within that, you get reactive, and then it gets black and white. Either you’re allowing everyone to kill themselves or you have to save everyone, and no one can try it. It seems polarized, and I don’t want to be on either end myself.

It’s not giving it enough time to have those discussions. I can really understand if you’ve lost someone by suicide, of course you’re not going to want anyone else to experience that. I also talked to attempt survivors who said they were really close and “I’m glad I didn’t die,” but after their attempt said, “Don’t be ridiculous, there’s nothing to live for.” It’s complicated, so complicated, and we need to be giving space for these really difficult issues. And not ignore people from those experiences, not to ignore people bereaved by suicide, attempt survivors, professionals, saying we come from different perspectives. We give suicide a topic, a time and voice, to allow disagreement, to get into the gray, away from quite polarized positions. Because it’s really scary stuff to talk about.

How did you get better, and do you still have suicidal thoughts?

I still wonder myself how on earth did I get through that! In some ways, I’m not sure, but time kind of helped to shift a few things. As I was getting older, I came to find other ways of managing difficult emotions. I found different friendship groups. The natural freedoms of moving away from the home I was in. Generally, life evolving in its own way kind of helped me not to act on any suicidal thoughts I was having, then suicidal thoughts were just not really present, actually. And it kind of faded away in some way. And I don’t think I’ve really had them more recently.

Of course, in these last few years I’ve been through a lot more than when I was having suicidal thoughts, but it feels like something has changed within me to be able to manage that in a very different way. Having more people around me … I really believe in the power of people being supportive. Work has had so many supportive people there, supervisors, managers, colleagues, friends, fellow trainees. On the wider scale, I have all my friends. Having those connections has helped me more for suicidal thoughts not to even enter my mind anymore. Yeah, it feels slightly mysterious as to what happened, but there’s been a shift. And I did kind of seek therapy myself, and that helped. I hadn’t had a suicidal thought for a long time, but I did go, and being a psychologist myself, that experience is, like, intense but really amazing.

Have you been able to disclose during your interviews, and would you want to in your work and in the future?

I put on my website a little about me and why I might be interested in this area: When I was younger, I had thoughts of wanting to end my life. So people will know. Largely, I suppose, I wouldn’t have had a problem if someone had asked. If people talked to me as though I were another attempt survivor, which I am, I responded in that way, but that time and research is for them to share their experiences. I really wanted to honor that and not put in my own experiences and take over. So yeah, I’ve really been trying to be led by the interviewees themselves. And occasionally, people will ask me, “What drove you to do this research?” And at that point I’ve been open about that, my attempts in the past.

I’ve kind of had to think through a bit, and it’s been great to have that space to think through with others. When it comes to qualified psychologists, there are a few who talk about having gone through their own experiences, whether psychosis, hearing voices, self-harm. There are some professionals out there who have been a part of that movement of trying to say, “Hang on, professionals have experienced these issues. It’s not this kind of ‘us and them’ position. You can be both.” And it can be really helpful. Actually, your experiences can help you to be more in tune sometimes, sometimes not. But when it comes to being a trainee, I don’t know of anyone who has talked about that. I’m sure there’s lots of reasons. I’m sure there’s a fear _ as a trainee, you have less power _ or fear of what future employers may or may not say. I’ve had to think through that as well. I kind of would hope that a conversation might be able to be had about that, why that is. I kind of had that discussion with a few people and thought that for me, I’m kind of ready to disclose in the wider sense. If it’s meaningful to stand up for something a bit different. So for example, the suicide attempt survivor movement, I think it can be useful to have someone professional or a trainee saying “I’ve had these experiences.” It gives a new perspective, shifts things slightly, to just bring different ideas maybe that might impact how to deliver services. I think I can be useful in that arena.

When it comes to doing therapy … If I had a feeling it would be useful to share any part of my experience with a client, then I’d likely take that to a supervisor and ask what is motivating me to do that. Maybe it can be offered to the client and they can make of it what they want, yeah, I would probably disclose. But if it’s not going to be helpful, if it’s not what they want as well, then I probably would hold back. Some careful thought of who’s this really for. If for me, no. But if they might be able to get some, if it helps them make sense of things, yeah, I’d think it through, talk with a supervisor about how to share them.

How difficult is it to get the help you need over there? Is therapy a luxury?

With the NHS, the idea would be it’s available to everybody, regardless of income. You wouldn’t pay for psychological services and treatment. The difficulty is, and it’s such a huge topic, it kind of ends up that it can be part of a lottery; some areas might just have more of a waiting list than others. There’s certainly going to be a waiting list just about everywhere. And inpatient units, whether there are beds or not. You can sometimes be taken off to the other side of country if there’s a bed. And with mental health funding being quite poor to start with and being stripped own even further, it ends up unfortunately sometimes that you get a strict number of sessions you have to give and you have to abide by those. Having said that, there are so many people in the profession, and they get into this to support and help others. I think psychological support in this country is generally exceptionally good. I think we’re striving to give the best quality we can.

Wasn’t there some kind of Mind manifesto to the government about mental health, making it a priority?

I may have missed that. It’s whether the government will do anything about it or how to choose to pick up on it. Again, mental health is still quite scary for the general public. A lot of people would rather not talk about it. And my cynical mind kind of goes, well, prioritizing mental health when a lot of society doesn’t want to talk about it, well, a lot of the politicians don’t necessarily want to talk about it and if they do, it’s not necessarily popular. It’s a tricky position. Money is being cut left, right and center and they’re having to choose where it goes. The manifestos from Mind, those things are really important to bring the awareness of how important it is. There’s been some real great awareness campaigns, but sometimes that’s maybe a bit more about anxiety and depression. They can be talked about.

What would be the ideal way to really address talking openly about this, and about treatment?

I think the conversations are a good starting point. I’m thinking about, for example, the Hearing Voices network. So they’ve done a lot of work showing that a lot of different people can hear voices in different ways, making it not so scary. I wonder if something around suicide and suicidality would be useful. Making it more approachable, making people more aware that suicidality isn’t something to be feared. And having kind of a few more community projects, user-led projects. I think something along those lines for suicide would be useful. Ideally, having lots of spaces where people can just retreat to if they need to get away from the world, safe and containing spaces. And a lot more research, more qualitative research, interviewing professionals about their experiences working with suicide, with attempt survivors, about whether they feel recovered or in the middle of suicidal experiences. Almost fill in the gaps of what quantitative statistics doesn’t do. I really advocate for people of lots of different perspectives being able to discuss these kind of issues and being able to say, “If you’re bereaved by suicide, I understand it will be difficult for you sometimes to talk with an attempt survivor, but can we allow those difficult situations to happen? Can we allow everyone who’s been touched by this to come together?” And just think through this. I think more thinking space is needed, and less reactivity. And then there are some people who are still quite scared of it.

Is there any approach that might be best for those people?

(Laughs) I haven’t found a way yet. I can only talk about this point in personal circles. I know some people who, every time I talk about my thesis, look as though it’s really uncomfortable talking about it. And what I try to do with them is, I haven’t let that silence me. I would still kind of talk about it. I would kind of notice that discomfort and say, “I know you don’t like it when I talk about this,” and it gives them the opportunity to say, “Yeah, I really don’t like it.” And if I’m able to go there, we have a conversation about why, and respectfully for them, understanding that for them it’s hard to even say the word “suicide” without grimacing in some way. It’s still frightening to them. But at least it’s been a bit more open than them grimacing and me thinking I can never talk about it again. And I use a bit of humor as well. So the last time, I just made a joke out of it: “I know you don’t like it, I can do the grimace, too.” I made her laugh. Helping people see humor in it, so it’s not so scary. So just starting off very small. I’m hoping that bit by bit, talking to lots of different people, I’m hoping if everyone can talk to a few people, start slowly opening up, eventually it snowballs into something where you can really change things.

How will you build on your research? What’s next?

I would love to be able to build on it. First thing, let’s get it marked first by my colleagues. Then I’m looking to publish it, do some conferences, things like that. From that, I suppose we can see where that kind of takes me. I’ve been given a lot with these people’s narratives, and I wonder if there will be lots of publications that can come from that. The stories are so rich, in my mind, I don’t now how to get it into just one paper. And what maybe are the barriers to more qualitative research? At the level of ethics committees? Can I interview people on ethics committees about their thoughts on suicide, asking people about their suicidality? So that’s one project that came up from doing this. It would be very interesting to know.

Is there anything I haven’t asked that you’d really like to address?

I suppose there’s one thing I was thinking about: other people’s responses when you’re feeling suicidal and how damaging that can be. You know, those responses like “You’re just seeking attention,” “You really didn’t mean to,” probably come from not understanding, But how damaging they can be, how much it can make you become silent. And how a restful silence can be nice, but it can make kind of a really, almost a violent silence, where inside everything is kind of screaming and you’re having to hold it back because you can’t talk. I was talking to one of my friends about this. Some of the comments people make are quite insulting. It was kind of this idea of literally adding insult to injury. And how much more it adds to the pain.

And yeah, I don’t know if I’ve been a bit overly negative about people’s responses, but there are really great people out there who respond in personal ways. And there are some great professionals, and I know from working with them, some incredible family therapists. I quite like that approach, family therapy. It’s useful as not stigmatizing the individual.

How can we change that rudeness? You think it would be common sense, something already taught in training.

There probably are some rude people out there, but most professionals are not in a job to be rude. That rudeness might be coming from not understanding why someone would hurt themselves. In that sense, getting to talk to people about their experiences, to kind of show what it might feel like, why people might contemplate doing that. And something else, why people would be rude in my mind, the pressures of doing that job, to kind of be everywhere, saving lives, lots of different people coming in, being demanded to do so much. Maybe you’re being asked to do too much in little time and might be in a position of forgetting how to be not rude and how to be constantly empathic. We’ve all had moments in our lives when there was too much going on and it was hard to be empathic. Maybe putting across that that’s one thing needed above anything else at that point in that person’s life. So also, maybe, the structures of the places they work in, to allow professionals to have more space and time to continue with that empathy. You want someone to be able to empathize and be kind and be there for you.

What does your family think about all of this?

It’s a tricky question, because I think mostly it hasn’t been brought up with them. I haven’t really had that conversation so much with them. I’m just kind of thinking it through … I think mostly they’re a little confused about what happened. But I think they would also be proud of me, maybe, kind of feeling a bit more able to stick up for people who have been feeling suicidal, saying, “Hang on a second, attempt survivors need a voice.” So I suppose there’s a mixture of what they think about it. I have to ask them.

Who else are you?

(Laughs) Um, sometimes when you do the doctorate, it’s hard to find another part of you! Of course there is. I’m a friend, an aunt, a sister, a daughter, a girlfriend, a best friend. Yeah. There are so many facets of a person. And sometimes that can be, you kind of foreground parts of your identity at different points depending on the nature or context of a conversation. I’ve been foregrounding my attempts and work. But yeah, there’s a lot more. I like that question. I’m a very social, generous, friendly person. I hope my friends would agree, too.

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