Suicidal States and Restrictions in the Eligibility to Negotiate Personal Characteristics

Ned L. Kirsch (Ph.D., 1978)

Thesis directed by Associate Professor John R. Forward

A comprehensive reconceptualization of suicide attempts is offered concentrating upon the interpersonal significance of the suicidal act. Specifically, it is suggested that I. Suicide attemptors find themselves in a relationship or set of relationships that are problematic for them; II. within such problematic relationships suicide attemptors find that the range of behaviors available to them has been significantly restricted; III. most saliently, this restriction includes the ineligibility of suicide attemptors to negotiate their personal characteristics within that relationship and that IV. the suicidal act is a behavior which has the significance of a negotiation move within the problematic relationship and which represents the efforts of attemptors to either (a) prevent a degradation of their position within the relationship or (b) reinstate themselves to a position from which they have already been degraded (i.e., the suicidal act is one of self-affirmation). Finally, since the suicidal act reflects problematic relationships of a certain kind, the magnitude of suicidal intent will, in turn, correspond to the range of relationships in which suicidal people find that their eligibility to negotiate has been restricted.

A study was designed to test the following predictions: (1) in situations which call for the negotiation of personal characteristics, suicidal individuals will offer significantly fewer negotiation moves than non-suicidal individuals and (2) as the magnitude of an attemptor's intent increases, the reasons offered for the attempt will shift in the direction of diffuse rather than focal relationship reasons.

Four groups of subjects (N = 60) were tested including (1) high magnitude of intent attemptors; (2) low magnitude of intent attemptors; (3) suicidal ideators; (4) a non-suicidal comparison group. All subjects were non-psychotic admissions to a state hospital. Comparison group subjects had no prior history of attempts and all subjects were interviewed within 24 hours of admission. Instruments included: (1) a 20 item Negotiation Inventory consisting of scenarios in which accusations of wrongdoing are made. Subjects' responses to these items are coded into one of five categories: (a) non-negotiation; (b) apologies; (c) accounts; (d) challenges; (e) contingency statements; (2) the Beck Depression Inventory; (3) the Beck Suicide Intent Scale; (4) subjects' reported reasons for the attempt; and (5) 28 clinical historical variables.

As predicted, suicide attemptors offered significantly more non- negotiation responses than non-suicidal subjects (F[3,56] = 3.23, p<.03) and high magnitude of intent attemptors offered significantly more non- relationship reasons for their attempt than low magnitude of intent attemptors (t[29] = 2.81, p<.005). A more extensive examination of differences between the two attemptor groups also revealed that while depression distinguished between attemptors and non-attemptors, attemptors themselves were best distinguished by a regression equation consisting of depth of depression scores, reason for attempt scores and negotiation scores which accounted for 40% of the suicide intent score variance (F[6,23] = 2.63, p<.05).

The findings are discussed as demonstrating the utility of the conceptual model of suicide attempts as negotiation moves. It is also suggested that (1) the conceptualization offers a solution to the paradoxical component of suicidal attempts (i.e., doing something which will only benefit a person who does not succeed) by stressing the importance of self-affirmation as a sufficient reason for an attempt in relationships of the kind described above; (2) the discriminating power of depression may indicate that depressive phenomena can also be profitably described in interpersonal terms and (3) future research should examine the etiology of suicide eliciting relationships. [134 pp.]