Pain and Unmet Needs by Action on Male Suicide

actiononmalesuicide.org

OURAPPROACHISSIMPLE:

OUR APPROACH IS SIMPLE:

1. RESEARCH 2. INSIGHT 3. ACTION

WHY DO MEN DIE BY SUICIDE?

“male gender is almost universally the biggest single risk factor for suicide since records began, it logically follows that suicide research if nothing else would be dominated by studies of male psychology and behaviour. In fact, the opposite is the case.” Seager, M. (2019). From Stereotypes to Archetypes: An Evolutionary Perspective on Male Help-Seeking and Suicide. In J. A.Barry, R. Kingerlee, M. Seager, & L. Sullivan (Eds.), The Palgrave handbook of male psychologyand mental health. Cham, Switzerland : Springer International Publishing. http://dx.doi.org/10.1007/978-3-030-04384-1_27

MEN

SUICIDE RESEARCH

VERVIEW

OVERVIEW 1. “The Pain of Unmet Needs” model of suicide 2. Applying the model to male risk 3. Applying the model to childhood challenges

Gamma bias (Seager & Barry, 2019), is the hypothesis that our empathy is partly conditioned by cultural norms.

COMMON SOCIETAL VIEW OF MEN > Men as causing harm > Men as privileged

RARER SOCIETAL VIEW OF MEN > Men as harmed > Men as disadvantaged

KEY CAVEATS BEFORE WE BEGIN

SUICIDE IS INCREDIBLY COMPLICATED

MANY FACTORS CAN CONTRIBUTE TO THOUGHTS AND FEELINGS OF SUICIDE INCLUDING:

MANY FACTORS CAN CONTRIBUTE TO THOUGHTS AND FEELINGS OF SUICIDE INCLUDING: Biological Psychological

Upbringing Relationships & social support

Cultural attitudes Social and political factors

Clinical

Life stressors

Economic conditions

All these elements and more interact and contribute to the distress a man may feel.

Substance misuse

Unemployment

Substance misuse

Relationship breakdown

BECAUSE OF THIS COMPLEXITY SINGLE RISK FACTORS DON’T TELL US MUCH

EVERY SUICIDE IS AN INDIVIDUAL SYMPHONY OF SORROW

RE VERYDIVERSE

MEN ARE VERY DIVERSE

DIVERSITY OF MALE BEHAVIOUR

DIVERSITY OF MALE BEHAVIOUR “aggressive and macho”

“community’s moral support”

Want help but can’t afford

Getting help is “weak”

Visibly excluded

Lots of people but feels alone

“out of the blue”

“known challenges”

Impulsive attempt

Years of planning

Child as protective

Unfair to stay alive for others

SUICIDECANAFFECT MEN FROMALLWALKSOFLIFE

SUICIDE CAN AFFECT MEN FROM ALL WALKS OF LIFE Student

Retired

Homeless CEO

Black

White

Childless Father

Gay

Married Single

There are no “one size fits all” answers....

Straight

Individual complexity of suicidal pain

General principles for understanding suicidal pain

THE PAIN OF UNMET NEEDS MODEL OF SUICIDE

HOR

“THE AUTHOR OF SUICIDE IS PAIN” Edwin Shneidman, Clinical Psychologist and Suicidologist, Further Reflections on Suicide and Psychache, 1998.

A British man, who has attempted suicide: “I think my son thinks it’s a choice, that I choose to devastate my children, when I keep saying to him, it’s not about you, it’s about the pain I experience getting so bad, the only option I have is to end my life.”

A UK woman, bereaved by her brother’s suicide: “I believe people take their own lives because they can’t cope with the pain. That’s my belief.

“Looking at all the people I know who have killed themselves, it’s because of emotional pain (...) “People are just trying to self medicate the pain, they don’t necessarily want to end their lives they just want the pain to go away. They just want to block the pain out.”

PSYCHOLOGICAL PAIN IS AN UMBRELLA TERM FOR DIFFERENT UNPLEASANT EMOTIONS...

PSYCHOLOGICAL PAIN

Loneliness Embarrassment Sadness Anxiety Despair Humiliation Longing Depressed Distress

Grief Guilt Fear Anger Regret Jealousy Rejected Shame Emptiness

response to psychological stress

response to actual/potential tissue damage

A UK woman, bereaved by her father and son’s suicide:

“What do we do when life absolutely collapses? When we collapse? “I’m not ill, but I am if you know what I mean. I’m bordering on the side of madness. “But, I lost my child, of course I am. This is not something that can be fixed, this is about how do you manage, how do you get through?”

PAINISA

PAIN IS A “HOMEOSTACTIC EMOTION” BUD CRAIG, NEUROSCIENTIST

HOMEOSTASIS= BALANCE

HOMEOSTASIS = BALANCE BODILY PROCESSES - OFTEN OUTSIDE OF CONCIOUS AWARENESS - TO KEEP INTERNAL CONDITIONS IN FUNCTIONAL LIMITS (i..e, blood suger, breathing, blood pressure)

HOMEOSTATIC

HOMEOSTATIC EMOTIONS ARE AN ALARM BELL THEY SIGNAL A SYSTEM IS OUT OF BALANCE AND REQUIRES CORRECTIVE ACTION

HOMEOSTATIC EMOTIONS HAVE TWO KEY PROPERTIES:

1. SENSATION 2. MOTIVATION

REGULATORY BALANCE

No food

Too much food

No water

Too much water

Too cold

Too hot

No pain

Too much pain

Death

REGULATORY BALANCE

HOMEOSTATIC EMOTIONS HELP US KEEP REGULATORY PROCESSES WITHIN TOLERABLE LIMITS

HOMEOSTATIC EMOTIONS HELP US KEEP REGULATORY PROCESSES WITHIN TOLERABLE LIMITS H. EMOTION

Too much food

Thirst

No water

Too much water

Too cold

Too hot

No pain

Too much pain

Temp. Pain

Death

No food

Death

Hunger

HOMEOSTATIC RANGE OF WELLBEING

HOMEOSTATIC EDGE HOMEOSTATIC DYSREGULATION

Systems in harmony

Can promote growth & flourishing

DAMASIO, 2021

Dangerous instability

KEY IDEA

PAIN IS NECESSARY FOR SURVIVAL...

UTITHASTO KEPTWITHIN REGULATORYLIMITS

No pain

Too much pain

danger

BUT IT HAS TO BE KEPT WITHIN REGULATORY LIMITS

DANGROUS INSTABILITY

HOMEOSTACTIC PAIN DYSREGULATION MORE PAIN THAN YOU CAN REGULATE IMPACTS OTHER REGULATORY PROCESSES

PANIC / ANXIETY EXHAUSTION INSOMNIA

HOMEOSTATIC DYSREGULATION

PANIC / ANXIETY EXHAUSTION INSOMNIA POOR ATTENTION APPETITE IMPACTED DYSREGULATED THINKING POOR DECISION-MAKING LACK OF SELF-CONTROL SHUT DOWN WITHDRAWAL NO COPING RESOURCES

A British man, who has attempted suicide: “In my head just constantly horrible thoughts. No hope. No belief that things will ever get any better. You’re just consumed by it.

“It was like normal emotions had been cut out of me and then you think they’re not coming back. “Every day became a massive struggle. I went from feeling flat and not myself, to it being a struggle to get through every hour really. You can’t think straight.”

ENTRAPMENT

PSYCHOLOGICAL PAIN SUICIDE RISK

PSYCHOLOGICAL PAIN & SUICIDE RISK Imagine we each carry a tank of psychological pain inside.

1. Exposure to Pain

3. Pain Dysregulation & Distress Entrapment PSYCHOLOGICAL PAIN TANK

2. Regulation of Pain

UNDERSTANDING DISTAL & PROXIMAL SUICIDE RISK

Exposure to Pain

DISTAL RISK Background risk

Exposure to Pain

PSYCHOLOGICAL PAIN TANK

DISTAL RISK Background risk

DISTAL RISK Background risk PSYCHOLOGICAL PAIN TANK

Regulation of Pain Good / Bad

PROXIMAL RISK Immediate Triggers

PSYCHOLOGICAL PAIN TANK

Threshold for Pain Tolerance Sudden / Accumulative

SUICIDALCRISIS ARETIMELIMITED

SUICIDAL CRISIS ARE TIME LIMITED Pain Dysregulation & Distress Entrapment PSYCHOLOGICAL PAIN TANK

WHAT DRIVES SUICIDAL PAIN?

UNMET NEEDS “in most cases, suicide stems from psychological pain, and the psychache itself arises from frustrated psychological needs.” Edwin Shneidman, Clinical Psychologist and Suicidologist, Further Reflections on Suicide and Psychache, 1998.

HATISA NEED?

WHAT IS A NEED?

WHEN A PSYCHOLOGICAL NEED IS UNMET, IT CAN LEAD TO PSYCHOLOGICAL DISTRESS AND SIGNIFICANT IMPACT ON WELL-BEING.

Suicide = High psychological distress

Suicide = Critical Unmet Needs

WHAT ARE THESE NEEDS? trapped lonely

1. SOCIAL NEEDS

SELF NEEDS

EMOTIONAL NEEDS

UNMET NEEDS POSE DUAL SUICIDE RISK

INCREASE PAIN EXPOSURE

PSYCHOLOGICAL PAIN TANK

2. REDUCE EFFECTIVE PAIN REGULATION

1. SOCIAL NEEDS

Belonging

SOCIALNEEDS: BELONGING

SOCIAL NEEDS: BELONGING Reciprocal bonds of love

Attachment security

Meaningful, intimate connection with others

UNMET SOCIAL NEEDS

“thwarted belongingness” Painful thoughts about relationships

For example: "No one likes me” "I can't trust anyone" "I don't make people happy"

RELATIONSHIP BREAKDOWN SEPERATION POOR QUALITY RELATIONSHIPS THWARTED BELONGINGNESS LONELINESS

HOMEOSTATIC DYSREGULATION

RELATIONSHIP BREAKDOWN SEPERATION POOR QUALITY RELATIONSHIPS THWARTED BELONGINGNESS LONELINESS ISOLATION NOT BEING MARRIED BULLYING INTIMATE PARTNER VIOLENCE BEREAVEMENT

THREATS TO OUR SOCIAL NEEDS MAY INCREASE OUR EXPOSURE TO PAIN

AND REDUCE ACCESS TO SOCIAL RESOURCES FOR REGULATING PAIN

SOCIAL ALLOSTATIS - THE SHARING OF REGULATORY WORK WITH OTHERS REDUCES INDIVIDUAL LOAD IT IS METABILOCALLY MORE COSTLY TO SELF-REGULATE - CONSERVE RESOURCES WHEN UNDER STRESS.

1. Increased exposure to pain

1. Increased exposure to pain Unmet social needs

PSYCHOLOGICAL PAIN TANK

Unmet social needs

2. Reduced regulation of pain

2. SELF NEEDS

Tolerable thoughts of self

HUMANS ARE A SPECIES HIGHLY SENSITIVE TO SOCIAL FEEDBACK

FUTURE

PAST

PRESENT

FUTURE

GOOD

BAD

PAST

GOOD

PRESENT

FUTURE

LFNEEDS: OLERABLESELF-ESTEEM

SELF NEEDS: TOLERABLE SELFESTEEM • Autonomy • Competency • Positive contribution to groups that matter

• Tolerable self-view • Tolerable social feedback

UNMET SELF NEEDS

“aversive self-esteem” Painful thoughts about self

For example: “I am worthless” “I am a failure” “I am not good enough”

FEELING LIKE A FAILURE LOW SELF-ESTEEM SHAME FEELING LIKE A BURDEN FEELING DEFEATED FEELING TRAPPED

HOMEOSTATIC DYSREGULATION

FEELING LIKE A FAILURE LOW SELF-ESTEEM SHAME FEELING LIKE A BURDEN FEELING DEFEATED FEELING TRAPPED

THREATS TO OUR SELF NEEDS MAY INCREASE OUR EXPOSURE TO PAIN

AND REDUCE SELF RESOURCES FOR US TO REGULATE PAIN WITH

1. Increased exposure to pain

1. Increased exposure to pain Unmet self needs

PSYCHOLOGICAL PAIN TANK

Unmet self needs

2. Reduced regulation of pain

3. EMOTIONAL NEEDS

Effective emotional regulation

WE ARE ALWAYS FEELING

EFFECTIVE EMOTIONAL REGULATION IS CRITICAL TO US MEETING OUR SOCIAL NEEDS

EFFECTIVE EMOTIONAL REGULATION IS CRITICAL TO US MEETING OUR SELF NEEDS

EFFECTIVE EMOTIONAL REGULATION IS CRITICAL TO US REGULATING OUR PAIN

NMET EMOTIONAL NEEDS

UNMET EMOTIONAL NEEDS

“emotional dysregulation” Painful thoughts about emotions

For example: “I feel trapped” “I feel hopeless” “I feel empty” “I feel overwhelmed with pain”

EMOTIONAL DYSREGULATION ALEXITHYMIA EMOTIONAL SUPPRESSION EMOTIONAL AVOIDANCE

HOMEOSTATIC DYSREGULATION

EMOTIONAL DYSREGULATION ALEXITHYMIA EMOTIONAL SUPPRESSION EMOTIONAL AVOIDANCE

EMOTIONAL REGULATION IS EFFORTFUL

EMOTIONAL REGULATION IS EFFORTFUL As pain increases our energy to regulate it can deplete

Unmet emotional needs

1. Increased exposure to pain

Unmet self needs Unmet emotional needs Unmet social needs

PSYCHOLOGICAL PAIN TANK

Unmet self needs

Unmet social needs

2. Reduced regulation of pain

RECAP

PSYCHOLOGICAL PAIN IS A HOMEOSTATIC EMOTION WITH REGULATORY LIMITS

OVER HUMAN EVOLUTION CERTAIN NEEDS MAY HAVE INTEGRATED WITH OUR PAIN SYSTEM

UNMET NEEDS MAY INCREASE EXPOSURE TO PAIN & REDUCE TOOLS TO REGULATE IT

DISTAL RISK REPEATED CYCLES OF UNMET NEEDS, EXPOSURE TO PAIN, REDUCED REGULATION, AND BUILDING PAIN.

Unmet needs & exposure to pain

PSYCHOLOGICAL PAIN TANK

Reduced tools for regulation

ALRISK

PROXIMAL RISK A TIME-LIMITED STATE WHERE PAIN ACCUMULATES BEYOND WHAT A PERSON CAN COPE WITH PSYCHOLOGICAL PAIN TANK

Pain Dysregulation & Distress Entrapment

Substance misuse

Unemployment

Substance misuse

Relationship breakdown

SINGLE RISK FACTORS MAY REPRESENT DEEPER UNMET NEEDS

EVERY SUICIDE IS AN INDIVIDUAL SYMPHONY OF SORROW

UNIVERSAL CHORD OF SUICIDAL PAIN FROM UNMET NEEDS:

UNMET SELF NEEDS UNMET SOCIAL NEEDS

UNMET EMOTIONAL NEEDS

FRAMEWORK OF CORE PSYCHOLOGICAL NEEDS FROM WHICH A HOMEOSTATIC STATE OF DYSREGULATED PAIN MAY EMERGE.

A MILLION DIFFERENT SYMPHONIES MAY EMERGE. STRUCTURAL FACTORS ARE STILL CRITICAL BUT UNDERSTANDING THEM THROUGH A PSYCHOLOGICAL LENSE.

WHY MIGHT MEN BE MORE AT RISK?

CULTURE

BIOLOGY

CULTURE

RICTIVE CULTURALNORMS UNMETNEEDS

RESTRICTIVE CULTURAL NORMS

UNMET NEEDS & EXPOSURE TO PAIN

Restrictive normsofmasculinity suiciderisk

Restrictive norms of masculinity & suicide risk 1. Reduce ability to meet social, self, and emotional needs 2. Increase pain exposure 3. Reduce social, self, and emotional resources for effective pain regulation

Cultural norms of masculinity are like an unwritten rule book about what it means to be a man.

For example: > What makes a man valuable to others? > What emotions can men express? > What jobs should men do and be ambitious for? > What makes a man attractive?

EWING TWENTY

REVIEWING TWENTY YEARS OF RESEARCH 20

YEARS OF RESEARCH

STUDIES

Looking for common patterns

RISK Distant Immediate

RECOVERY

Norms of emotional suppression and male suicide risk (92%)

Norms of male success, feelings of failure, and male suicide risk (76%)

Norms that deny and diminish men’s relationships needs and male suicide risk (82%)

Unmet self needs

Unmet social needs

Unmet emotional needs

Self Needs Social Needs

Emotional Needs

Denial

Unmet needs & exposure to pain

Disconnection

Dysregulation PSYCHOLOGICAL PAIN TANK

Reduced tools for regulation

Unmet emotional needs

2. Self

Needs

3. Social Needs

Emotional Needs

Distant risk 1. Emotional suppression and dysregulation 2. Childhood challenges impact emotional development

Denial Disconnection Dysregulation

3. Getting help is seen as weak 4. Negative experiences accessing help 5. Short-term coping strategies make pain worse

Immediate risk 6. Suicide as a release from pain.

Australian man, 36, who has attempted suicide:

“With my closest friends it was, “I don’t want you to know how I feel.” I’m a dad of three kids and a husband. I’ve got a good job. I don’t want you to know that I’m so sad that I cry at red lights.”

2. Self

Needs

3. Social Needs

Emotional Needs

Denial Disconnection Dysregulation

Distant risk 1. Emotional suppression and dysregulation 2. Childhood challenges impact emotional development 3. Getting help is seen as weak 4. Negative experiences accessing help 5. Short-term coping strategies make pain worse

Immediate risk 6. Suicide as a release from pain.

71-year-old man from Canada, in relation to experiencing abuse as a child:

71-year-old man from Canada, in relation to experiencing abuse as a child: “I would wish very much that I was dead, even at an age when I am not sure a kid understands what death is”

Norms of male emotional suppression

Painful events in childhood

Norms of male emotional suppression

2. Self

Needs

3. Social Needs

Emotional Needs

Denial

Disconnection Dysregulation

Immediate risk 6. Suicide as a release from pain.

A UK man bereaved by his son’s suicide: “He was a tough man, a hard man, because of the people he was hanging around with, but really he was a softie underneath. He was too kind. He wanted people to think he was the tough man but he wasn’t at all.”

2. Self

Needs

3. Social Needs

Emotional Needs

Denial Disconnection

Dysregulation

Immediate risk 6. Suicide as a release from pain.

UK woman bereaved by her brothers suicide:

UK woman bereaved by her brothers suicide: “They discharged him because he looked okay, he was intelligent and he didn’t make a fuss, and the next day he did it.”

2. Self

Needs

3. Social Needs

Emotional Needs

Denial Disconnection Dysregulation

Immediate risk 6. Suicide as a release from pain.

Short-term coping strategies make pain worse

1. Growing psychological pain

2. Pain relief behaviours

3. Pain increases

UK man who has attempted suicide:

“Although I’m trying to lift myself with this short-term miracle [drinking], long term it was doing me more damage because it was pushing me lower and lower”

2. Self

Needs

3. Social Needs

Emotional Needs

Denial

Disconnection Dysregulation

Immediate risk 6. Suicide as a release from pain.

A UK man, who has attempted suicide:

A UK man, who has attempted suicide: “When my pain is so painful and I don’t know what to do with my feelings I think okay I will take my life now.”

Unmet Self Needs

2. Self

Needs

Emotional Needs

Social Needs

Denial Disconnection

Dysregulation

Distant risk 1. Feeling like a failure 2. Pretending to be fine 3. Low self-esteem from childhood

Immediate risk 4. Suicide as the killing of a failed self 5. Suicide as regaining control

Canadian man who is suicidal, aged between 50 and 59: “Expectations I’ve had on myself in terms of what I consider to be successes in life - a good father, a good husband, a good provider, um, those are probably at the top of the list, and it’s my belief I failed at - at all of those three responsibilities.”

2. Self

Needs

Emotional Needs

Social Needs

Denial Disconnection

Dysregulation

Distant risk 1. Feeling like a failure 2. Pretending to be fine 3. Low self-esteem from childhood

Immediate risk 4. Suicide as the killing of a failed self 5. Suicide as regaining control

A young man from Ireland who has attempted suicide: “I hate myself for trying to be somebody else... I got so pissed off putting on a front - always putting a happy face on and always being a laugh, a joke”

2. Self

Needs

Emotional Needs

Social Needs

Denial Disconnection

Dysregulation

Distant risk 1. Feeling like a failure 2. Pretending to be fine 3. Low self-esteem from childhood

Immediate risk 4. Suicide as the killing of a failed self 5. Suicide as regaining control

A Norwegian man with substance abuse and suicidal behaviours: “Since I was quite small I was told (by his father) that ‘you won’t amount to anything’. Even now, when I encounter new situations, his words come back to me. …”

2. Self

Needs

Emotional Needs

Social Needs

Denial Disconnection

Dysregulation

Distant risk 1. Feeling like a failure 2. Pretending to be fine 3. Low self-esteem from childhood

Immediate risk 4. Suicide as the killing of a failed self 5. Suicide as regaining control

A Brazilian man described his suicide attempt as such: “I tried to set up a business for myself and my family and it didn’t work. I lost money and there was no other alternative except killing myself.”

2. Self

Needs

Emotional Needs

Social Needs

Denial Disconnection

Dysregulation

Distant risk 1. Feeling like a failure 2. Pretending to be fine 3. Low self-esteem from childhood

Immediate risk 4. Suicide as the killing of a failed self 5. Suicide as regaining control

Bereaved mother, UK: “Later reading his thoughts in his diary, it almost seemed that planning to die by suicide actually gave him a ‘purpose’ in life. In a life that had spiraled out of control, a life that was too painful to live any more, a lonely life where he could not ‘love’, or (in his opinion) be loved. He could not communicate, he felt ‘grotesque’ and ashamed, so I think that planning his death became the only ‘positive’ thought in his mind. It gave him back some kind of ‘control’.”

In a Norwegian study, a young man wrote in his suicide note:

In a Norwegian study, a young man wrote in his suicide note: “When in heaven, I’ll watch over you and look after you. It will be my job.”

Unmet Social Needs

A Canadian man, aged 40–49 years: “I’m not adding to anybody else’s life. I can go for months and years without talking to family members, so you know, if I’m here or if I’m not here, what difference does it make …”

A woman bereaved by an elderly man’s suicide, Norway:

A woman bereaved by an elderly man’s suicide, Norway: “He never opened himself to us, never showed his feelings”

A girlfriend bereaved by suicide, Norway: “He was afraid to let people get too close to him. … I believe that was a survival mechanism … he has had so many tough experiences through his life … he learned very early to just shut off, sharply. …”

A man bereaved by suicide, UK:

“The day he died he actually messaged me and said, “Love you. Look after <xxx>”. He’d actually never said “love you” to me. That’s just not the way we are. So actually that day, expressing emotion towards me and his son, is when we clicked something was up, because it was so out of character.”

INTERACTING HARMS 65% Emotions

Our emotions, thoughts and feelings about ourselves, and our relationships, are all connected and impact Relationships one another.

of studies

Self

1. Feeling like a failure

Feelings of failure were associated with men intensifying their emotional suppression, socially withdrawing and isolating themselves. Emotional suppression

Social withdrawal and isolation

2. Emotional suppression

Feelings of failure were associated with men intensifying their emotional suppression, socially withdrawing and isolating themselves. Isolation from self Isolation from others

WHY MIGHT MEN BE MORE AT RISK?

UNIVERSAL CHORD OF SUICIDAL PAIN FROM UNMET NEEDS RESTRICTIVE MASCULINE NORMS CONSTRAIN SOME MEN’S ABILITY TO MEET THESE NEEDS

UNIVERSAL CHORD OF SUICIDAL PAIN FROM UNMET NEEDS > RESTRICTIVE MASCULINE NORMS CONSTRAIN SOME MEN’S ABILITY TO MEET THESE NEEDS > INCREASED EXPOSURE TO PAIN + REDUCED TOOLS FOR REGULATION

UNMET SOCIAL NEEDS

UNMET SELF NEEDS

UNMET EMOTIONAL NEEDS

DISTAL RISK REPEATED CYCLES OF UNMET NEEDS, EXPOSURE TO PAIN, REDUCED REGULATION, AND BUILDING PAIN.

Unmet needs & exposure to pain

PSYCHOLOGICAL PAIN TANK

Reduced tools for regulation

AL RISK

PROXIMAL RISK REPEATED CYCLES OF UNMET NEEDS, EXPOSURE TO PAIN, REDUCED REGULATION, AND BUILDING PAIN.

PSYCHOLOGICAL PAIN TANK

Pain Dysregulation & Distress Entrapment

DEPENDENT ON ENERGETICALLY MORE COSTLY SELF-REGULATING STRATEGIES

CHILDHOOD: UNMET NEEDS & EXPOSURE TO PAIN

HOODDIVERSITY

CHILDHOOD DIVERSITY

American man, 38, attempted suicide:

American man, 31, thoughts of suicide in the last week:

“I would like to out-live my abusive parents. I plan to desecrate their graves, if possible.”

“My mother has sacrificed too much to drag me this far in life. I don’t want to cause her that pain, because she has done nothing to deserve it.”

A UK/Indian man, 39, thoughts of suicide in the last week:

“(...) I was partially raised in a all male boarding school, which was posh and thus I felt inadequate”

A UK man, 50, who has attempted suicide and had thoughts of suicide in the last week: “Growing up in Liverpool in the 70’s & 80’s during horrible economic & social hardship & deprivation, in an impoverished & uneducated working class family. Whoever said poverty is violence has possibly never said anything truer.”

HILDHOODPAINHAS MULTIPLESOURCES

CHILDHOOD PAIN HAS MULTIPLE SOURCES

CHILDHOOD EVENTS CAN HAVE A LASTING LEGACY ON OUR LIVES

A UK woman bereaved by her brother’s suicide: “Living and being brought up by alcoholics, the physical abuse to my mother - not to us - we just got the mental abuse of watching it, and it really affected him. (...) I always knew, as a young girl, that that childhood was going to affect him. I really, really, really believe that he never got over it (...) The childhood ate away at his brain. He never moved on from it and it followed him into adulthood. (...) I think it was the root of all of his troubles.”

EARLY-LIFE ADVERSITY:

EARLY-LIFE ADVERSITY: Any challenge faced by a child/adolescent that necessitates undergoing significant adaptations to cope, and where these adaptations deviate from what is considered healthy for development. (Duffy et al., 2019)

British man, 50, who has attempted suicide: “Dad leaving when I was 7. The day he left I remember feeling like I crumbled mentally/emotionally. And a feeling of massive depression descending that I’ve never escaped.”

SOCIAL NEEDS

SELF NEEDS

EMOTIONAL NEEDS

SOCIAL NEEDS

SELF NEEDS

EMOTIONAL NEEDS

UMBRELLA REVIEW OF 68 SYSTEMATIC REVIEWS

HIGHER ODDS OF LIFETIME SUICIDE RISK

2,660 / 80

2,660 / 80 1.

THOUGHTS OF SUICIDE v NO SUICIDAL HISTORY

SUICIDE ATTEMPT v NO SUICIDAL HISTORY

SUICIDE ATTEMPT v THOUGHTS OF SUICIDE

Emotional Abuse

Physical Neglect

Emotional Abuse

Emotional Neglect

Sexual Abuse

Bullying

Female caregiver over-control

Female caregiver abuse

Female caregiver indifference

Male caregiver over-control

Male caregiver abuse

Male caregiver indifference

Physical Abuse

PSYCHOLOGICAL PAIN SUICIDE RISK

PSYCHOLOGICAL PAIN & SUICIDE RISK • Physical abuse • Physical neglect • Emotional abuse • Emotional neglect • Sexual abuse • Bullying • Female caregiver overcontrol • Female caregiver overabuse • Female caregiver overindifference • Male caregiver overcontrol • Male caregiver over-abuse • Male caregiver overindifference

1. Exposure to Pain

3. Pain Dysregulation & Distress Entrapment PSYCHOLOGICAL PAIN TANK

2. Regulation of Pain

PSYCHOLOGICAL PAIN UNMET NEEDS

PSYCHOLOGICAL PAIN & UNMET NEEDS • Physical abuse • Physical neglect • Emotional abuse • Emotional neglect • Sexual abuse • Bullying • Female caregiver over-control • Female caregiver over-abuse • Female caregiver over-indifference • Male caregiver overcontrol • Male caregiver overabuse • Male caregiver overindifference

SOCIAL NEEDS

SELF NEEDS

EMOTIONAL NEEDS

Emotional Abuse

Physical Neglect

Emotional Abuse

Emotional Neglect

Sexual Abuse

Bullying

Female caregiver over-control

Female caregiver abuse

Female caregiver indifference

Male caregiver over-control

Male caregiver abuse

Male caregiver indifference

Physical Abuse

Emotional Neglect

Physical Neglect

Emotional Abuse

Emotional Neglect

Sexual Abuse

Bullying

Female caregiver over-control

Female caregiver abuse

Female caregiver indifference

Male caregiver over-control

Male caregiver abuse

Male caregiver indifference

BULLYING

BULLYING UNMET SOCIAL NEEDS

UNMET SELF NEEDS

UNMET EMOTIONAL NEEDS

Increased exposure to psychological pain & reduced tools to regulate it

• • •

People in my family said hurtful or insulting things I felt that someone in my family hated me. I believe that I was emotionally abused

EMOTIONAL ABUSE UNMET SOCIAL NEEDS

UNMET SELF NEEDS

UNMET EMOTIONAL NEEDS

Increased exposure to psychological pain & reduced tools to regulate it

Emotional abuse/ neglect at home

Emotional abuse/ neglect by society

714 MEN

“Are there other painful experiences from your childhood not referenced here that have had a negative impact on your adult life?”

60% IDEATION

40% ATTEMPT

Looking for common patterns

A 44-year-old UK man who has thoughts of suicide every day, and first started thinking about suicide before he was a teenager:

“Biological father walked out (...) I felt worthless. No good male role models. Very difficult to find/understand myself as a man. Chronic school bullying (...) Mums 3rd husband was, frankly, a bastard. Financially, emotionally, mentally and physically abusive, pretty much every day.

“This meant that, home or outside, I had no ‘safe space’.”

A 44-year-old UK man who has thoughts of suicide every day, and first started thinking about suicide before he was a teenager:

“This meant that, home or outside, I had no ‘safe space’.”

INTERNAL UNSAFETY AN UNSAFE SELF

EXTERNAL UNSAFETY DYSREGULATED OTHERS

INTERNAL UNSAFETY AN UNSAFE SELF

INTERNAL UNSAFETY -

INTERNAL UNSAFETY AN UNSAFE SELF

1. Stigmatised Self (body, image, health, culture, isolation)

Polish man, 18, suicide attempt in the past year: “Not having any close friends; feeling scared of everything; feeling unloved, undesirable, unwanted; no one to talk to”

Scottish man, 22, who has attempted suicide in the past year:

“(…) there is no help for young boys in school I was told from day one that I was a rapist, misogynist, evil because I was a boy and told to feel that I should be ashamed of myself because of my gender so I started to hate myself because of it (…)”

INTERNAL UNSAFETY -

INTERNAL UNSAFETY AN UNSAFE SELF

1. Dysregulated Self (Mental health, maladaptive coping strategies, suppressed emotions, and/ or painful thoughts of self)

Irish man, 37, who has attempted suicide: “I turned to drugs and alcohol at an early age for escape and solace, which massively inhibited my development and my ability to complete qualifications.”

American man, 32, thoughts of suicide in the past year:

“To this day I feel that anyone close to me will one day realize I’m not worth their time and useless. I expect them to hurt me, to think I’m useless, fat, stupid, and hated, and one day they will walk away. My self worth is not a concrete feature of my personality and its something I fight against everyday to shore up.”

EXTERNAL UNSAFETY DYSREGULATED OTHERS

EXTERNAL UNSAFETY -

EXTERNAL UNSAFETY DYSREGULATED OTHERS

Dysregulated Caregivers and Unsafe Homes (abuse / neglect / caregiver conflict / addition / illness

German man, 23, thoughts of suicide in the past year: “To be called a parasite (paraphrased from my native language) because your real father isn’t paying. To have your own mother wish that a truck runs over on your way to school. To tell you she wished she aborted you.”

Latvian man, 26, who has attempted suicide: “After my parents separation when i was 7, my mother fell into deep depression and was suicidal (…) I would get bouts of anxiety and check on her in her room every 30 minutes or so.”

British man, 57, thoughts of suicide in the past year:

British man, 57, thoughts of suicide in the past year: “Never actually being told someone loved me. I can’t remember ever being hugged.”

EXTERNAL UNSAFETY -

EXTERNAL UNSAFETY DYSREGULATED OTHERS

Violent Social Worlds (relational / sexual / structural)

Iranian man, 27, who has attempted suicide:

“Being sexually abused by adult females that my family trusted and not being able to talk to anyone about it, or worse noone saw them as sexual abuse because they were females and I am a male ...”

Nigerian man living in the UK, 27, suicide attempt in the past year: “I was an illegal immigrant for most of my teenage years (...) my experiences were so harrowing and it has severely impacted my views on childbirth and on having children in the future”

Some of the sources of childhood pain for men who are suicidal:

Some of the sources of childhood pain for men who are suicidal: drink loneliness & isolation

emotional dyregulation

homophobia

drugs

family breakdown

abusive homes

suicidal behaviours

body issues

poverty racism

bereavement

porn addiction

anti-male attitudes

community violence

lack of male role models

romantic challenges

sibling abuse

parental alienation

health issues

mental sexual health violence challenges

bullying

absent caregivers

emotional controlling neglect care

binge eating

physical violence

addiction being neurodiverse

EDOES THATPAINGO?

WHERE DOES THAT PAIN GO?

IDEATION PSYCHOLOGICAL PAIN TANK

ATTEMPT PSYCHOLOGICAL PAIN TANK

HMENTSUICIDERISK

ATTACHMENT & SUICIDE RISK

EVOLUTION OF ATTACHMENT

EVOLUTION OF ATTACHMENT Humans are born helpless with significant survival needs they cannot meet themselves.

RESPOND

From birth we are primed to experience unmet needs as distressing, and: 1. to express that distress 2. others primed to respond to these signals

EXPRESS

ATTACHMENT IS CENTRAL TO HOW WE FIRST LEARN TO REGULATE THE HOMEOSTATIC PAIN OF UNMET NEEDS

ATTACHMENT FIGURES

ATTACHMENT FIGURES CAREGIVERS SIBLINGS

PEERS

INSTITUTIONS

ROMANTIC PARTNERS

SYMBOLIC FIGURES

ATTACHMENT PATTERNS

SECURE ATTACHMENT

SECURE ATTACHMENT Secure attachments form when an attachment figure is responsive and available to help a child regulate their distress and restore an emotional equilibrium

SOCIAL NEEDS

SELF NEEDS

EMOTIONAL NEEDS

ATTACHMENT SYSTEM ACTIVATED

ATTACHMENT COMFORT

CO-REGULATE

SELF-SOOTHE

A PERSON LEARNS THAT DISTRESS CAN BE RESOLVED. THE NERVOUS SYSTEM IS TRAINED THAT DISTRESS SIGNALS LEAD TO RELIEF VIA ATTACHMENT PROCESSES.

INSECURE ATTACHMENT Insecure attachments deviate from what is typically considered healthy for a child. They develop when attachment figures do not effectively attend to distress, signalling that care cannot be relied upon for safety

INSECURE ATTACHMENT

Insecure attachments deviate from what is typically considered healthy for a child. They develop when attachment figures do not effectively attend to distress, signalling that care cannot be relied upon for safety

SOCIAL NEEDS

SELF NEEDS

EMOTIONAL NEEDS

ATTACHMENT SYSTEM ACTIVATED

ATTACHMENT FAILURE

DISTRESS ENTRAPMENT

A PERSON LEARNS THAT DISTRESS IS NOT RESOLVED. THE NERVOUS SYSTEM IS TRAINED THAT DISTRESS SIGNALS DO NOT LEAD TO RELIEF VIA ATTACHMENT PROCESSES. (bullying, abuse - shame to share / loving caregiver absent)

RATHER THAN GUIDED TO RELIEF YOU ARE TRAPPED IN DISTRESS

DISTRESS ENTRAPMENT DOUBLE JEOPARDY

MALRISK

PROXIMAL RISK FOR PEOPLE WITH INSECURE ATTACHMENTS: ATTACHMENT ACTIVATION MAY COMPOUNDED PAIN PAIN OF INCITING INCIDENT + PAIN OF ATTACHMENT FAILURE (Pain of craving comfort and not getting it)

ATTACHMENT ACTIVATION MAY ACT AS AN ACCELERANT OF SUICIDE RISK RATHER THAN A PROTECTIVE RESOURCE

DEATH

PSYCHOLOGICAL PAIN TANK

ATTACHMENT & DISTRESS REGULATION: ACROSS ALL HUMAN CULTURES STUDIED EVIDENCE OF ADULTS RESPONDING TO INFANT DISTRESS HAS BEEN FOUND.

REBASE

SECURE BASE PROVISION Caregiver actions that help a child to feel safe and comforted when distressed.

MORE PREDICTIVE OF SECURE ATTACHMENTS THAN BROADER MEASURES OF CAREGIVER SENSTIVITY

Early-lifeadversity,insecure attachmentssuiciderisk

Early-life adversity, insecure attachments & suicide risk 1. Reduce ability to meet social, self, and emotional needs 2. Increase pain exposure

3. Reduce social, self, and emotional resources for effective pain regulation 4. Fail to train the body that distress can be effectively resolved

UNIVERSAL CHORD OF SUICIDAL PAIN FROM UNMET NEEDS

UNIVERSAL CHORD OF SUICIDAL PAIN FROM UNMET NEEDS > RESTRICTIVE MASCULINE NORMS & INSECURE ATTACHMENTS REDUCE SOME MEN’S ABILITY TO MEET THESE NEEDS > INCREASED EXPOSURE TO PAIN + REDUCED TOOLS FOR REGULATION

+ UNMET SOCIAL NEEDS

+ UNMET SELF NEEDS

UNMET EMOTIONAL NEEDS

RECAP

PSYCHOLOGICAL PAIN IS A HOMEOSTATIC EMOTION WITH REGULATORY LIMITS

OVER HUMAN EVOLUTION CERTAIN NEEDS MAY HAVE INTEGRATED WITH OUR PAIN SYSTEM

UNMET NEEDS MAY INCREASE EXPOSURE TO PAIN & REDUCE TOOLS TO REGULATE IT

DISTAL RISK REPEATED CYCLES OF UNMET NEEDS, EXPOSURE TO PAIN, REDUCED REGULATION, AND BUILDING PAIN.

Unmet needs & exposure to pain

PSYCHOLOGICAL PAIN TANK

Reduced tools for regulation

DISTAL RISK

Unmet needs & exposure to pain

PSYCHOLOGICAL PAIN TANK

Reduced tools for regulation

DISTAL RISK

Unmet needs & exposure to pain

PSYCHOLOGICAL PAIN TANK

Reduced tools for regulation

ALRISK

PROXIMAL RISK A TIME-LIMITED STATE WHERE PAIN ACCUMULATES BEYOND WHAT A PERSON CAN COPE WITH PSYCHOLOGICAL PAIN TANK

Pain Dysregulation & Distress Entrapment

PROXIMAL RISK PSYCHOLOGICAL PAIN TANK

Pain Dysregulation & Distress Entrapment

PROXIMAL RISK PSYCHOLOGICAL PAIN TANK

Pain Dysregulation & Distress Entrapment

SUICIDE IS A CATASTROPHIC FAILURE OF HOMEOSTATIC PAIN REGULATION

COMPOUNDED BY ATTACHMENT FAILURE & RESTRICTIVE MASCULINE NORMS

actiononmalesuicide.org