Crisis Intervention: The Aftermath of Suicide - Coursework Example

Crisis Intervention: The Aftermath of Suicide Introduction “Schizophrenia is a serious mental illness, and a common public health problem which affects around 1% of the world’s population,”states Andreasen (2000: 106). This disorder which varies in severity, involves intense suffering, unpredictable, and sometimes frightening behavior. Suicide occurs among approximately 10 % of the patients. Most of the affected persons are unable to lead productive lives, and prefer to isolate themselves. They have problems in social functioning, self-care skills, and in distinguishing reality from illusion. Further, schizophrenic patients require public assistance from governmental social security systems, thus costing society billions of dollars. Most importantly, the lives of the family members of a patient may be impacted severely due to emotional stress and financial cost (Mueser & Gingerich, 2006). WHO (1988) defines suicide as “the act of killing oneself, deliberately initiated and performed by the person concerned in the full knowledge or expectation of its fatal outcome”. This paper proposes to discuss the crisis of suicide in the family: committed by a mentally ill, schizophrenic adolescent child. The purpose of the research is to identify the characteristics of this mental disease, the behaviors of the afflicted individual, the various intervention techniques that are used for treatment, the stressors that could cause the crisis, and the recovery process of the family who suffer intensely in the aftermath of the incident. Discussion Characteristics and Symptoms of Schizophrenia: “Schizophrenia is a brain disease that impairs the ability to think creatively and imaginatively, to have close social relationships with other human beings, to use language to express ideas with clarity, or to experience and express a variety of emotions such as love and fear” (Andreasen, 2000: 107). The people suffering from the mental illness have intrusive experiences such as hearing voices, beliefs of being persecuted or injured by those around them or by alien external forces. Schizophrenia cannot be identified by a single sign or symptom, since there is a diversity of symptoms which encompass multiple mental processes. Those symptoms of schizophrenia which represent distortion of normal functions are: hallucinations, delusions, disorganised speech, and abnormal behavioral monitoring and control (Tsuang & Farraone, 1997). Simultaneously, the symptoms which represent a reduction or absence of normal mental functions are: reduced emotional expressiveness, decrease in the fluency of expression through language, in the ability to initiate or pursue goal-directed activity, in seeking out enjoyable activities, and in focusing attention. All the various symptoms may not overlap in the same patient. The most important defining feature of schizophrenia is inability to think in a clear, fluent and logical way due to cognitive fragmentation (Andreasen, 2000). Diagnosis: There are no laboratory tests to diagnose schizophrenia. Specific diagnostic guidelines have been established, to ensure consistency in the criteria used. A diagnosis must be based on a careful interview conducted by a trained professional to determine whether the person has experienced any of the symptoms listed in the guidelines. In additional a physical examination is necessary, to rule out physical problems that could cause similar symptoms, such as a brain tumor or hyperthyroidism. The disease is caused by an imbalance in chemicals in the brain. Situations or Stressors That May Result in Suicide: When feelings of depression, anxiety or anger resulting from stress and negative thinking become overwhelming, most schizophrenics suffering from delusions or hallucinations may react violently, with feelings of hopelessness or helplessness. Serious situations which can lead to a crisis need immediate action. Some of the most critical situations are when some-one’s safety is threatened (Tsuang & Farraone, 1997). Harkavy-Friedman et al (2004) found that although depression is a potential stressor for triggering suicidal behavior in a vulnerable group of individuals with schizophrenia, even without a depressive episode there is considerable risk for suicidal behavior in schizophrenia. It is observed that there are individual variances in perceptions of stress, whether from life events or from ongoing stressors. Life events are experiences which most people find stressful, some stressors being more severe than others. These are “major life occurrences such as having a baby, starting a new job, moving, being ill, experiencing a death in the family, and getting a divorce”. Also, ongoing stressors from “financial conditions to crowded, noisy or poor quality living conditions, health problems, conflict situations and arguments, frequent criticism or intrusions, a long commute or unpleasant household chores” (Mueser & Gingerich, 2006: 179). Heila et al (1999) studied the effects of adverse life events as risk factors in completed suicides. They compared schizophrenia suicide victims and victims without schizophrenia: as part of a psychological autopsy study of all suicides in Finland over a 12-month period. “Suicide among persons with schizophrenia was found to be less associated with recent life events than in nonschizophrenia victims, which may partly be due to the schizophrenia victims’ fewer social contacts, rare employment, and less misuse of alcohol” (p.528). This difference was clearly seen in the case of dependent life events, whereas independent life events, such as death of a close person had equal significance for both groups before suicide. Schizophrenic Behaviors Leading to the Crisis of Suicide: Violent or destructive behavior, suicide attempts, and threats of hurting oneself or others may lead to critical actions on the part of the patient, hence requiring urgent interventions. Most crises in schizophrenia involve a worsening of symptoms that may include psychotic experiences like hallucinations and delusions which are expressed in aggressive and defensive actions, and suicidal behavior or inflicting self-harm. Some crises may be unrelated to symptom relapse, such as loss of inhibition caused by drinking or using drugs. “The general principles of responding to crises are similar, regardless of their origin” state Mueser & Gingerich (2006). Links et al (2005) conducted a research study on severe and persistent mental illness in relation to crisis occurrence. The patients’ crisis experiences were recorded qualitatively to compare with quantitative measures of suicidality. Almost 40% of the subjects experienced crisis events and more than a quarter of these events resulted in hospitalization, caused by increased severity of mental illness. The risk of suicide was stated to be separate from crisis occurrences. “The reduction of impulsivity, agitation, or interventions to counter hopelessness might have more of an impact on the risk of suicide than measures put in place to prevent crises” (p.168). Intervention Techniques: “Since suicide is the taking of one’s own life by one’s own hand, it is often sudden and creates many emotional reactions for the survivors left behind. Survivor responses can be impacted by a range of circumstances, from how the person died to the reactions of people to the survivors” (Hall & Epp, 2001: 74). In death by suicide, family may be stigmatized, thus increasing their sense of loss, grief and isolation. The caring and practical skills of paraprofessionals and lay people who organise self-help groups and peer support, when integrated with professional intervention, can be effective in helping the bereaved family. This is supported by Kaslow and Aronson (2004: 240) who state that a suicide may “accentuate previously problematic family interactions, create new negative interactional patterns, or diminish prior functional family relationships”. The family therapist should assess each member and determine the therapies that would prove most beneficial. Outreach from a therapist to the survivors can protect and benefit the family and their social network, by both serving as the “initial contact for acute psychological care and offering the possibility of a longer term safe haven in which the family can resolve their grief and re-engage in meaningful relationships and experiences”(p.245). On the other hand, Rudestam (1977) observes that family relationships were frequently strengthened, following loss of a child by suicide. When a schizophrenic child commits suicide, the extremely painful loss creates unbearable stress and depression among the parents and the surviving children. They should learn to provide emotional support for each other, and not drift apart because of different coping methods for grieving. An integrative and preventive psychological approach is required for meeting the needs of the family and for helping when social support is withdrawn after the initial condolence is given (Koocher, 1994). Clinical interventions with bereaved families have incorporated the concepts of support for significant others and giving attention to their individual needs, openly expressing grief to each other, and help the siblings of the suicide victim to “realistically confront, understand and accept the death, and to encourage grieving”. The focus of such preventive interventions should be on empowering the family members to move on with their lives, while they support and express grief to each other during the difficult times (Koocher, 1994). The Aftermath of Suicide: Treating the Bereaved Family Roberts (2000: 280) states that “crisis is a period of psychological disequilibrium, experienced as a result of a hazardous situation”. Crisis theory confirms that most crises are limited to a period of four to six weeks. Hence crisis intervention is time-limited, the goal being to help the client acquire enough support, resources and coping skills to adapt to the new circumstances after the traumatic event. When trauma and grief occur together, reactions are more prolonged and distressing. Stroebe & Schut (1999) emphasize the intensity of the grief experienced at the time of the loss, and the changing nature of the grief over a period of time. According to Clark (2001), the bereaved feel weighed down by guilt, rejection and shame, as well as doubts upon one’s own value system. The period of bereavement, according to Humphrey and Zimpfer (1996) comprises of three distinct but overlapping phases: shock, disorganisation and reorganisation. In the shock phase, the family experiences disbelief and numbness; and crying may continue from weeks to months. This phase during the aftermath, helps the family to adapt itself slowly to the reality of the suicide. This is followed by a period of disorganisation, when life needs to be brought back to normal, and then reorganisation towards finding solace and a new purpose for living. The timely delivery of appropriate treatment is considered crucial to avoid long-term psychopathological consequences such as post-traumatic stress disorder. Another viewpoint is that the coping process during which the individual strives to stabilize themselves after a seriously traumatic event, is a necessary basis for growth, state Weiner et al (2003). “Crisis intervention services are now widely recognised as an efficacious treatment modality for the provision of emergency mental health care to individuals and groups” (p. 432). With the help of effective assessments and interventions on bereaved families, they can be guided to carry on with a degree of peace and normalcy. Findings from research conducted by Begley and Quayle (2007) show that suicide bereavement is impacted by the bereaved individual’s life experiences with the deceased and how the survivors are viewed by the other members of the community. Making sense of the suicide may be important for understanding of the nuances in suicide bereavement. Moreover, bereaved families face particular dilemmas such as “what to tell others, whether to hold a public funeral, and intrusion by police and the legal processes involved” (Clarke, 2001: 102). The helping profession continues to develop new frameworks by which to understand this problem. Conclusion This paper highlights the crisis situation of suicide committed by schizophrenic patients within the family setting. Backed by thorough research, the mental health condition has been discussed, along with the situations or stressors that would cause the crisis, the behavior of schizophrenic patients in the prelude to suicide, the intervention techniques used on the bereaved family for their re-adjustment to normal life, and their recovery process after the crisis of suicide. There is scope for further research in this topic: in the area of crisis prevention, and also in providing help to the bereaved for re-integration into the community following the social exclusion they undergo after the occurrence of suicide in the family. ----------------------------------------- References Andreasen, N. C. (2000). Interactive report: Schizophrenia: the fundamental questions. Brain Research Reviews, 31: 106-112. Begley, M. & Qayle, E. (2007). The lived experience of adults bereaved by suicide: a phenomenological study. Crisis, 28(1): 26-34. Clark, S. (2001). Bereavement after suicide: How far have we come and where do we go from here? Crisis, 22(3): 102-108. Hall, B. L., Epp, H. L. (2001). Can professionals and non-professionals work together following a suicide? Crisis, 22(2): 74-78. Harkavy-Friedman, J. M., Nelson, E. A., Venarde, D. F. & Mann, J. J. (2004). Suicidal behavior in schizophrenia and schizoaffective disorder: examining the role of depression. 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