Lewis Mehl-Madrona1,2,3,4,5, Barbara Mainguy3,4. 1. Family Medicine Residency, Northern Light Health, Bangor, ME. 2. Associate Professor of Family Medicine, University of New England College of Osteopathic Medicine, Biddeford, ME. 3. Coyote Institute, Orono, ME. 4. Wabanaki Health and Wellness, Bangor, ME. 5. Graduate School, University of Maine at Orono.
Abstract
INTRODUCTION: Suicide is a major problem within North America's indigenous communities. There is debate about the best way to approach indigenous people who have attempted suicide. Conventional methods of cognitive behavior therapy have been criticized for not being indigenous friendly. METHODS: Case files from an academically affiliated, rural psychiatric practice focused primarily on indigenous patients were reviewed for 54 indigenous patients who attempted suicide. Grounded theory methods were used to identify common strategies for approaching those patients who were able to stop attempting suicide. A comparison population had a greater than 90% incidence of a second attempt. RESULTS: Nine major strategies within a narrative approach that appeared to be successful with this population were identified. Introducing novel contradictory ideas to the beliefs people held about suicide appeared helpful. Using stories to introduce the idea that the desired effects of suicide might not be forthcoming seemed beneficial, including the use of story to find means other than attempting suicide to reach the same ends. Creating stories of a positive future appeared helpful. Finding ways to bring humor into the discussion and to refer to and involve traditional culture in which suicide was rare aided in changing perspective. Of 29 patients engaged in this narrative approach, 26 had no further suicide attempt. Retention in counseling was high, and patients reported enjoying the process. CONCLUSION: A narrative approach to indigenous people who attempt suicide is compatible with indigenous culture and appears to be successful.
INTRODUCTION: Suicide is a major problem within North America's indigenous communities. There is debate about the best way to approach indigenous people who have attempted suicide. Conventional methods of cognitive behavior therapy have been criticized for not being indigenous friendly. METHODS: Case files from an academically affiliated, rural psychiatric practice focused primarily on indigenous patients were reviewed for 54 indigenous patients who attempted suicide. Grounded theory methods were used to identify common strategies for approaching those patients who were able to stop attempting suicide. A comparison population had a greater than 90% incidence of a second attempt. RESULTS: Nine major strategies within a narrative approach that appeared to be successful with this population were identified. Introducing novel contradictory ideas to the beliefs people held about suicide appeared helpful. Using stories to introduce the idea that the desired effects of suicide might not be forthcoming seemed beneficial, including the use of story to find means other than attempting suicide to reach the same ends. Creating stories of a positive future appeared helpful. Finding ways to bring humor into the discussion and to refer to and involve traditional culture in which suicide was rare aided in changing perspective. Of 29 patients engaged in this narrative approach, 26 had no further suicide attempt. Retention in counseling was high, and patients reported enjoying the process. CONCLUSION: A narrative approach to indigenous people who attempt suicide is compatible with indigenous culture and appears to be successful.
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