Understanding Self-Destructive Impulses in Daily Life
by Katie Lewis, PhD, Research Psychologist and Recipient of the Robert S. Wallerstein Psychoanalytic Research Fellowship
According to a recent report by the CDC, suicide rates have consistently increased over the last 15 years in the United States. Sources of risk for suicide attempts, which include both factors that are malleable (such as hopelessness) and those that are not (such as family history of suicide), have contributed to the development of multiple screening measures for suicide; however, the evaluation of risk factors alone has been shown to have limited efficacy in predicting individual suicide attempts. The fact remains that it is extraordinarily difficult to understand, let alone predict, the situations and influences that bring a person to try to take his or her life.
The story behind each individual suicide attempt is unique and personal, each containing its own narrative arc of terrible pain and struggle. Nonetheless, empirical research and clinical wisdom often overlap in describing features that are commonly seen in individuals who are at heightened risk. The shadow of suicidal behavior, for example, almost invariably extends deeply into the past – sometimes as far back as early childhood, when trauma or loss can have a powerful impact on developing a sense of self and the ability to maintain trust in others. Over time, other troubling experiences, such as interpersonal difficulties or ongoing struggles with mental health issues, can wear away at resilience and increase a sense of desperation. As suicide enters the mind as a possible solution to otherwise unbearable pain, daily experiences that otherwise may have little influence begin to carry more weight, either by providing respite (such as a kind word from a stranger) or increasing a sense of anguish and pain (such as feeling slighted or rejected by loved ones).
Building on the work of suicide researchers and scholars, my research at Austen Riggs, which is part of a broader Suicide Research and Education Strategic Initiative, examines specifically how daily interpersonal interactions influence the frequency and intensity of suicidal thoughts and urges. Assuming that different kinds of experiences trigger suicidal impulses for different people, my work takes as its focus the specific experiential features of self and other (i.e., experiencing the self as helpless, or the other person as dominating or controlling) that may uniquely mark an interaction’s salience as a trigger for self-destructive thoughts and behaviors. In my current study (conducted in collaboration with Dr. Jane Tillman), research participants provide information about their interpersonal experiences and self-harm urges multiple times per day using their smartphones, employing state-of-the-art methods that allow us to better understand how these daily experiences relate to changes in suicidality over time. Through the analysis and integration of personal historical details, information on general psychological functioning, and details of daily interactions and momentary changes in mood, I hope to be able to identify the distant and nearby pathways that lead an individual to be at heightened risk for suicide.
In support of this project, I was recently chosen as the recipient of the Robert S. Wallerstein Psychoanalytic Research Fellowship, which will provide five years of grant funding through the San Francisco Center for Psychoanalysis. Dr. Wallerstein, an accomplished psychoanalyst and researcher, was a proponent of empirical research that thoughtfully utilizes an array of methods to address complex psychological issues. With the support of the Wallerstein Fellowship, I am hopeful that findings from this study will shed new light on how interpersonal relationships and interactions influence suicidal thoughts over time, and how treatment may be used to address these issues.