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Articles    H3'ed 9/13/15

Suicide Prevention -- Does it Work?

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My wife, Barbara, and I attended Ron and Karen's Recovery Camp, in Mabie (near Dumfries), Scotland, this past June. Over 80 people who had been multiply diagnosed camped together in a forest and considered how to recover. Some were still on medications. Some were not. As this was a camp for mountain bikers, piles of firewood were scattered freely about the area -- an ample supply for each site. At the side of each pile, was a hatchet or an axe so that people could chop kindling for starting their fire. A former patient, now psychiatric nurse practitioner from Australia, made a point of photographing all these hatchets and wrote a blog about the unused axes among "the mental patients". We would never allow this in our professional settings. Yet, nothing happened, though there were a few emotional crises during the week. No effort was made to prevent people who had received psychiatric diagnoses from access to hatchets, and nothing happened! I think this would be the message of the Recovery Movement -- people do what you expect them to do. If you expect them to be responsible, they will be. If you expect them to be irresponsible and to take the first opportunity to chop themselves or others, then they will do that. People drop into the story we provide them, and perform it as expected. If we provide positive stories, we get positive results. If we provide negative stories, we get negative results.

I have also done dialectical behavior therapy groups for chronically suicidal people. This approach, pioneered by Marsha Linehan of the University of Washington, is recognized even in many mainstream circles as the best therapy for people who are chronically suicidal. DBT has a distinctly Buddhist flavor. The message is that life is unfair and unjust; embrace it and rise above it. Make the best of unfair and unjust situations through using coping skills and making the best choice available, even if it isn't the best choice. Within DBT, it is not uncommon for group members to respond to the "see you next week", statement with the answer, "I'll probably be dead before next week," to which we are trained to say, "I expect to see you here at group next week, whether you are dead or alive." Of course, DBT does not minimize the gravity of people's suffering. Rather, it teaches that to live is to suffer. We all suffer. What matters is how we manage that suffering. The unjust part is that many of us were made to suffer deeply as children through no choice of our own. Many of us were deeply traumatized before we even had language to describe what had happened. Nevertheless, we have to work together to shore up each other, and to assist each other in coping better, in surviving our pasts, and thereby heroically prevailing. This is the role of the hero's story in psychotherapy -- to teach the idea that we are all heroes of our lives just because we keep going. The more we incorporate the hero's story, the less likely we are to kill ourselves.

How many times have I sat with patients in medical settings who dared me to keep them from killing themselves? As anyone who works in emergency psychiatry can attest, more than I'd care to remember. What if I could say to them, "Well, that's one of your choices? You could do that? What else could you do? For that approach to succeed, I think they would need a decent place to live and a community; somewhere to go following their emergency department visit. The Clubhouse model is one viable option in which people live together and take care of each other. Ron and Karen's concept of Recovery Houses is another model. People in crisis can go to the Recovery House without being medicalized. They do not need a DSM-5 diagnosis. They do not have to take medication, though they may if that works for them. Trained peers are there to assist them. We hope to hear more about how this works in other countries this coming October 10th and 11th, in Onoro, Maine, when Ron and Karen visit us. The puzzle for the United States, which is so heavily directed by the medical model of mind, is to wonder who would pay for a Recovery House. Ron tells me he has a theory for how to make it work financially in the U.S. Won't that be interesting to hear?

Ron Coleman and Karen Taylor will join us (Coyote Institute) in Orono at the Community House, 19 Bennoch St., downtown Orono, 10am to 6pm each day, October 10th and 11th, 2015. For more information , visit or check out Ron and Karen's website at We plan to have an internet connection available for some or all of the day. Contact us at info|AT|coyoteinstitute.usEmail address for further details. Lewis Mehl-Madrona and Barbara Mainguy will also be in Yellow Springs, Ohio on October 3rd and 4th.

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Lewis Mehl-Madrona graduated from Stanford University School of Medicine and completed residencies in family medicine and in psychiatry at the University of Vermont. He is the author of Coyote Medicine, Coyote Healing, Coyote Wisdom, and (more...)
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