These are some of the books and published work which inform my thinking and reasoning. Please add your own in the comments.
C Fred Alford on whistle blowers: Whistleblowers: Broken Lives and Organizational Power
Annals of the New York Academy of Sciences
Issue: Social Neuroscience: Gene, Environment, Brain, Body
Social isolation John T. Cacioppo, Louise C. Hawkley, Greg J. Norman, and Gary G. Berntson Center for Cognitive and Social Neuroscience, University of Chicago, Chicago, Illinois. Department of Psychology, Ohio State University, Columbus, Ohio
Address for correspondence: John T. Cacioppo, Center for Cognitive and Social Neuroscience, University of Chicago, 5848 S. University Avenue, Chicago, IL 60637. Cacioppo@uchicago.edu
Social species, by deﬁnition, form organizations that extend beyond the individual. These structures evolved hand in hand with behavioral, neural, hormonal, cellular, and genetic mechanisms to support them because the consequent social behaviors helped these organisms survive, reproduce, and care for offspring sufﬁciently long that they too reproduced. Social isolation represents a lens through which to investigate these behavioral, neural, hormonal, cellular, and genetic mechanisms. Evidence from human and nonhuman animal studies indicates that isolation heightens sensitivity to social threats (predator evasion) and motivates the renewal of social connections. The effects of perceived isolation in humans share much in common with the effects of experimental manipulations of isolation in nonhuman social species: increased tonic sympathetic tonus and HPA activation; and decreased inﬂammatory control, immunity, sleep salubrity, and expression of genes regulating glucocorticoid responses. Together, these effects contribute to higher rates of morbidity and mortality in older adults.
Being ignored, excluded, and/or rejected signals a threat for which reflexive detection in the form of pain and distress is adaptive for survival. Brief ostracism episodes result in sadness and anger and threaten fundamental needs. Individuals then act to fortify or replenish their thwarted need or needs. Behavioral consequences appear to be split into two general categories: attempts to fortify relational needs (belonging, self-esteem, shared understanding, and trust), which lead generally to prosocial thoughts and behaviors, or attempts to fortify efficacy/existence needs of control and recognition that may be dealt with most efficiently through antisocial thoughts and behaviors. Available research on chronic exposure to ostracism appears to deplete coping resources, resulting in depression and helplessness.
Baumeister, Roy F and Leary, Mark R. The need to belong: desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin 1995 Vol 117, No 3, 497-526.
Psychol Rev. 2010 April; 117(2): 575–600. doi: 10.1037/a0018697
PMCID: PMC3130348 NIHMSID: NIHMS301351
The Interpersonal Theory of Suicide Kimberly A. Van Orden, Tracy K. Witte, Kelly C. Cukrowicz, Scott Braithwaite, Edward A. Selby, and Thomas E. Joiner, Jr.
The Psychology and Neurobiology of Suicidal Behavior
Annual Review of Psychology
Suicide is a leading cause of death, but it is not well understood or well researched. Our purpose in this review is to summarize extant knowledge on neurobiological and psychological factors involved in suicide, with specific goals of identifying areas particularly in need of future research and of articulating an initial agenda that may guide future research. We conclude that from both neurobiological and psychological perspectives, extant research findings converge on the view that two general categories of risk for suicide can be identified: (a) dysregulated impulse control; and (b) propensity to intense psychological pain (e.g., social isolation, hopelessness), often in the context of mental disorders, especially mood disorders. Each of these categories of risk is underlain at least to some degree by specific genetic and neurobiological factors; these factors in general are not well characterized, though there is emerging consensus that most if not all reside in or affect the serotonergic system. We encourage future theorizing that is conceptually precise, as well as epistemically broad, about the specific preconditions of serious suicidal behavior, explaining the daunting array of suicide-related facts from the molecular to the cultural level.
Interpersonal Processes in Depression
Annual Review of Clinical Psychology
Humans have an intrinsic need for social connection; thus, it is crucial to understand depression in an interpersonal context. Interpersonal theories of depression posit that depressed individuals tend to interact with others in a way that elicits rejection, which increases their risk for future depression. In this review, we summarize the interpersonal characteristics, risk factors, and consequences of depression in the context of the relevant theories that address the role of interpersonal processes in the onset, maintenance, and chronicity of depression. Topics reviewed include social skills, behavioral features, communication behaviors, interpersonal feedback seeking, and interpersonal styles as they relate to depression. Treatment implications are discussed in light of the current research on interpersonal processes in depression, and the following future directions are discussed: developing integrative models of depression, improving measurement of interpersonal constructs, examining the association between interpersonal processes in depression and suicide, and tailoring interventions to target interpersonal processes in depression.
Kolcaba, Kathy on comfort: Comfort Theory and Practice
K.Michel, D. Jobes, A.A. Leenaars, J.T. Maltsberger, P. Dey, L. Valach, R. Young Meeting the Suicidal Person
Working with a client who is suicidal: a tool for adult mental health and addiction services. Produced by the Centre for Applied Research in Mental Health and Addiction (CARMHA), for the Ministry of Health. Cf. Acknowledgements.
Available also on the Internet. ISBN 978-0-7726-5746-6.
Meichenbaum, Donald. 35 years of working with suicidal patients: Lessons Learned (pdf)
LESSON 1. THE WIDESPREAD INCIDENCE OF CLINICAL PRACTICE AND SUICIDE
LESSON 2. IMPLICATIONS OF EPIDEMIOLOGICAL DATA AND SUICIDE
LESSON 3. IMPLICATIONS OF A CONSTRUCTIVE NARRATIVE PERSPECTIVE OF SUICIDE
a) Characteristic Thinking Patterns of Suicidal Individuals:Implications
LESSON 4. ASSESSMENT OF SUICIDAL IDEATION and SUICIDAL BEHAVIOR: NEED FOR COMPREHENSIVE ASSESSMENT STRATEGIES
LESSON 5. CLINICAL INTERVENTIONS
a) Meeting the Challenges of Working with Suicidal Patients
b) Critical Role of Early Interventions: Some Examples
c) Use of Evidence-based Interventions in a Culturally-sensitive Manner
d) Core Psychotherapeutic Tasks When Working with Suicidal Patients
e) How to Implement Core Psychotherapeutic Tasks: Example from Cognitive Behavior Therapy
f) Additional Possible Interventions with Suicidal Patients
g) Putting It All Together: Treatment Checklist for Suicidal Patients
McGuire, Michael T. and Raleigh, Michael J. Behavioral and Physiological
Correlates of Ostracism 1986.
A MODEL OF HUMAN SOCIAL INTERACTION
Two ideas are central to the model: (I) humans are predisposed to socially interact, and (2)
social interactions alter physiological states which, in turn, alter behavior. A representation of
the model is presented in Figure I.
Received September 14-16, 1984; revised March 19, 1986.
Address reprint requests to: Dr. Michael T. McGuire, UCLA Neuropsychiatric Institute, 760
Westwood Plaza, Los Angeles, CA 90024.
Ethology and Sociobiology 7: 187-200 (1986) 39 (187)
@ Elsevier Science Publishing Co., Inc., 1986
52 Vanderbilt Ave., New York, New York 10017
Sherrow, Hogan. The Origins of Bullying. Blog, Scientific American Dec 15, 2011.
According to psychological sources, bullying is a specific type of aggression in which (1) the behavior is intended to harm or disturb, (2) the behavior occurs repeatedly over time, and (3) there is an imbalance of power, with a more powerful person or group attacking a less powerful one. This asymmetry of power may be physical or psychological, and the aggressive behavior may be verbal (eg, name-calling, threats), physical (eg, hitting), or psychological (eg, rumors, shunning/exclusion). The key elements of this definition are that multiple means can be employed by the bully or bullies, intimidation is the goal, and bullying can happen on a one-on-one or group basis (Nansel et al, 2001).
MacDonald, Geoff and Leary, Mark R. Why does social exclusion hurt? The relationship between social and physical pain. Psychological Bulletin 2005 Vol 131, No 2, 202-223.
Cobb, S. Presidential Address-1976. Social support as a moderator of life stress. Psychosomatic Medicine, Vol 38, Issue 5 300-314, Copyright © 1976 by American Psychosomatic Society
Social support is defined as information leading the subject to believe that he is cared for and loved, esteemed, and a member of a network of mutual obligations…. It appears that social support can protect people in crisis from a wide variety of pathological states….
Sperber, Michael. Suicide: Psychache and Alienation. Psychiatric Times Nov 2011.
Although suicidologists Ron Maris and Mort Silverman successfully argued fifteen years ago that “…suicide is, by definition, not a disease, but a death that is caused by a self-inflicted intentional action or behavior”, the new DSM-V diagnosis process would automatically make suicide a mental disorder regardless of the actual motivation involved. While any countries have decriminalized suicide, redefining it as a mental disorder would have far-reaching implications into laws regarding the mandatory reporting of suicide attempts and how they are treated by health professionals.
In somatic medicine, increasingly, physicians and the public are discussing the questions of legalizing terminal sedation, assisted suicide, and euthanasia for suffering related to refractory, incurable illness. As a resident in psychiatry, I struggle to understand the discrepancies in this regard between psychiatry and other medical specialties. After discussion with several advisors and bioethicists, I have come to believe that several questions should be open for discussion: what are the ethical issues we must address in psychiatry when considering how to help patients with unbearable, prolonged treatment-refractory suffering? Why is it that we are more comfortable with the notions of “refractoriness” and “terminality” in physical illness than in mental illness? What would “palliative
psychiatry” look like, and when – if ever – might assisted suicide be a reasonable course of action in mental health care?
AbstractFor patients at risk for suicide, discharge from an emergency room or psychiatric inpatient facility is all too often the beginning of a difficult and unpleasant journey across the landscape of a disarrayed mental health care system seeking fundamental transformation. The present mental health care system is pluralistic with competing, disconnected, and autonomous
subsystems and with various types of singularly focused mental health professionals. Large numbers of these professionals are in independent practice. America’s emergency departments and psychiatric inpatient facilities generally have limited specific assessments, programming, and treatments for people at risk for suicide. Moreover, both can be faulted for doing too little to prevent suicide. Once patients are discharged, the complexity of coordinating and continuing mental health care presents an enormous challenge, confounded by existing fragmentations and gaps in services among service providers.The emergency management of suicide risk is, at present, substandard because so frequently it is removed from evidence-based, clinical practices. Persons at high risk for suicide are seen commonly in America’s emergency departments, but they, time and again, go unrecognized. When recognized, the treatment for suicidality is out-referral; however, as many as half of those referred do not attend the first follow-up care appointment that can be weeks away from the initial visit. Disappointment awaits many that do attend because clinical information just recently provided
may not accompany the first visit and subsequent care may be marginal or downright inadequate. These standard-of-care practices provide a standard of care associated with an unacceptably high rate of suicide attempts and suicide deaths in the days and weeks subsequent to discharge.There is a better way forward. For individual patients, designing, testing, and implementing integrated networks of care that ensure comprehensive assessments, rapid follow-up, continuity of care, and evidence-based treatments for those at high risk for suicide may prove to reduce suicide rates and, thereby, should complement universal interventions aimed at the general public. Relevant to follow-up and continuity of care subsequent to discharge from an emergency department or psychiatric inpatient unit, this report systematically examines the published literature, summarizes the evidence base, and makes recommendations for practice and for new directions in public policy based on current research. Moreover, this report seeks to identify the most crucial gaps in knowledge and to suggest directions for new research to fill those gaps.
The Dynamics of Stigmatization
Sources of Stigma
Assumptions, Beliefs and Practices People Found to be Stigmatizing
“Staff Hold the Keys”: Power Issues
Regimentation and Deindividualization
Separating People from Ordinary Community Life Non-developmental Approach
“Life in a Fishbowl”
Inadequate Access to Information
Lack of Attention to Personal Characteristics Which May be Stigmatizing
Language and Labeling
Cues in Physical Environment from Asylum Era
Responses Initiated by the Stigmatized Person
Responses Originating from Staff and Others
Mullen, A. (2009), Mental health nurses establishing psychosocial interventions within acute inpatient settings. International Journal of Mental Health Nursing, 18: 83–90. doi: 10.1111/j.1447-0349.2008.00578.x
Acute inpatient units provide care for the most acutely unwell people experiencing a mental illness. As a result, the focus for care is on the containment of difficult behaviour and the management of those considered to be ‘at high risk’ of harm. Subsequently, recovery-based philosophies are being eroded, and psychosocial interventions are not being provided. Despite the pivotal role that mental health nurses play in the treatment process in the acute inpatient setting, a review of the literature indicates that mental health nursing practice is too custodial, and essentially operates within an observational framework without actively providing psychosocial interventions. This paper will discuss the problems with mental health nursing practice in acute inpatient units highlighted in the current literature. It will then put forward the argument for routine use of psychosocial interventions as a means of addressing some of these problems.
9) Taking Risks
Resources page -broad and deep resource guide to self-coaching, habit formation and change management
The content, principles and techniques strike me as an optimal therapeutic mode that is generalizable far beyond organizational leaders (my former field). I’ll be searching for this type of help/support – abstract to concrete, partnership-based, non-coercive, goal-directed, mutual respect-based. Hat tip to Dr. Richard Winters.
Carnegie Foundation. Flexner Report Medical Education in the United States and Canada. 1910.
What is at the Heart of Health Care? Advocating for and defining the clinical relationship in patient centered care
Diana Dill & Peter Gumpert. Journal of Participatory Medicine. Vol. 4, 2012, April 25, 2012
Summary: Models of medical care that are patient-centered have demonstrated capability to improve quality of care and reduce costs, while at the same time improve patient satisfaction, adherence, and clinical outcomes. Patient-centered models also improve clinicians’ satisfaction with their work. The human connection between patient and clinician — the clinical relationship — is at the heart of patient-centered care. Without a clinical relationship that supports patient-centered care, the benefits will not be realized. This paper explores the definition of the clinical relationship in the context of patient-centered care. We propose that providers aspire to create relationships with patients that are characterized by three dimensions: (1) emotional connection, (2) partnership, and (3) guided discovery, with a joint commitment to the scientific method. We describe and give examples of these dimensions that demonstrate their importance in clinical practice, and summarize the evidence that, when these dimensions are present, patient outcomes are better and clinicians are more satisfied. Our goal is to clarify the benefits of the patient-centered clinical relationship so that they can be more widely incorporated into practice, training, and accreditation.
Keywords: Patient-centered care, physician-patient relationship, clinical relationship.
Citation: Dill D, Gumpert P. What is the heart of health care? advocating for and defining the clinical relationship in patient-centered care. J Participat Med. 2012 Apr 25; 4:e10.
Jarrett, Christian. When Therapy Causes Harm. British Psychological Society. Vol 21. Part one. 2008. 10-12.
The Harms of Suicide. From the blog, The View From Hell. 2008. moral arguments in favor of autonomy around self imposed death.
Yuhas, Daisy. Three critical elements sustain motivation: autonomy, value and control. Scientific American blog, December 2012.
In 2006 Deci and Ryan, with psychologist Arlen C. Moller, designed several experiments to evaluate the effects of feeling controlled versus self-directed. They found that subjects given the opportunity to select a course of action based on their own opinions (for example, giving a speech for or against teaching psychology in high school) persisted longer in a subsequent puzzle-solving activity than participants who were either given no choice or pressured to select one side over another. Deci and Ryan posit that acting under duress is taxing, whereas pursuing a task you endorse is energizing.
Leenaars, Antoon A. Suicidology Online 2010; 1:5-18. ISSN 2078-5488 5
Review: Edwin S. Shneidman on Suicide
I. The common purpose of suicide is to seek a solution.
II. The common goal of suicide is cessation of consciousness.
III. The common stimulus in suicide is intolerable psychological pain.
IV. The common stressor in suicide is frustrated psychological needs.
V. The common emotion in suicide is hopelessness-helplessness.
VI. The common cognitive state in suicide is ambivalence.
VII. The common perceptual state in suicide is constriction.
VIII. The common action in suicide is egression.
IX. The common interpersonal act in suicide is communication of intention.
X. The common consistency in suicide is with lifelong coping patterns. (Leenaars, 1999, p. 225).
Webb, David. The Many Languages of Suicide. June 2002. Suicide Prevention Australia Conference, Sydney.
My greatest concern is how rarely we hear the original voice of suicidology, the first-hand accounts of suicidality.
There are many reasons – none of them good – why this suicidal voice is so silent, so invisible. Shame and stigma make it difficult, particularly when you are feeling suicidal. We are expected to be silent and when we do speak up we are often not heard, our voice is denied. This is of particular concern when it comes from those we seek help from or from the institutionalised censorship of simplistic diagnostic labels. Another obstacle is the ambivalence of suicidality. We don’t want to believe it ourselves, even when we find ourselves thinking about it all the time for days, weeks, months, maybe years. The pervasive fear of death in our culture, sharpened by suicide where death is deliberately chosen, feeds this silence and deprives us of the language we need to talk about it sensibly. Shame, stigma, denial, self-doubt and fear combine to create a very real and powerful taboo against talking of our suicidality.
We need to hear these voices. Most importantly it is needed to empower those who are contemplating suicide to speak up and hopefully reach out for help. Part of the poison of suicidality is the loneliness. When you hear others who truly know suicidality, whether they’ve recovered or are still struggling, then you are no longer quite so alone in the world. Stories of survival and recovery can sometimes spark a light at the end of the tunnel of hopelessness, another of suicidality’s poisons. I was told to hang in there, that the pain would pass which, although true, was not believable at the time. Hearing this from a survivor can help. We need to hear the voice of others to help us find our own voice. Healing and recovery begins with telling your story.
- Why People Die by Suicide (untreatableonline.com)
- Mental Illness Vs. Bullying as a Cause of Suicide (barnabyd.wordpress.com)
- Does Repeated Suicide Assessment Give Salience to Suicidal Behavior? (incompatiblewithlife.wordpress.com)
- Suicide, Politics and the Vulnerability Regime (ultimo167.wordpress.com)
- Suicide and the New DSM (drvitelli.typepad.com)
- On the measure of the mental health system (hopeworkscommunity.wordpress.com)