Changing method in order to approach human complexity

I shall begin this talk by telling you briefly about what I do at the Universidad Nacional Autónoma de México (UNAM), where I have been a professor and researcher for twenty-five years. The subject I teach at undergraduate level is research methodology. In the beginning, we taught our students to do research within a behaviourist framework. Behavioural theory looks at the human being in a way that turns him into a kind of robot responding to the stimuli of his environment. Little by little, however, we left the positivist models behind in order to understand and explain the human being, and what happens to people, from a new paradigm. This necessarily implies a change of method.

The experimental method has proved extremely effective for research in the field of the physical and natural sciences; it is not, for all that, the most adequate for studying human complexity. The new ways of doing research, grounded in hermeneutics, ethnography, phenomenology and dialectics, necessarily imply a qualitative vision of phenomena. I should like to mark a few differences between these two epistemologies. The quantitative is enumerative (it merely describes and counts phenomena), whereas the qualitative is constructive (it subjectively constructs reality); the quantitative is concerned with verification, the qualitative with the production of knowledge; quantitative knowledge is deductive, the second is inductive; the quantitative presents itself as objective knowledge, whereas the knowledge that comes from the qualitative method knows and accepts itself as coming from a subject who interprets and describes the facts, and which is therefore necessarily subjective.

Working with a qualitative methodology and using its tools is nevertheless not as simple as administering a questionnaire and drawing statistical data from it. Qualitative methods oblige us to reflect throughout the process, they make us understand things by taking into account the context in which they occur and, above all, they involve us more deeply in the research, because we accept from the outset the proposition of the famous cyberneticist Heinz von Foerster, who recalled that “the researcher is always present in what he observes”.

Suicidal ideation in young people

The research I am presenting to you is the first part of a much broader study, which goes from the quantitative to the qualitative, from the simple to the complex, and which includes not only the study of what is happening, but also a proposal for a solution to the problems detected.

We began the first phase last May; the whole project will last about two years. The first part is quantitative and aims to find out whether young students present suicidal ideation, to know the social climate that prevails in their family and to understand how these two factors may be connected. Both the detection of suicidal ideation and the assessment of family social climate will be carried out with the help of two measuring instruments chosen for their high validity and reliability.

We define suicidal ideation as those intrusive and repetitive thoughts bearing on the death one would inflict upon oneself, on the desired forms of death, as well as on the objects, the circumstances and the conditions in which one proposes to die.

We put forward the hypothesis that young people enrolled in the health disciplines — medicine, nursing, psychology, dentistry —, because they work with people and stand closest to human pain, are more inclined to think about death than students of other disciplines. We also retain the family of origin as an important variable: if the family social climate is positive, there will be no suicidal thoughts, or these will occur only very sporadically.

The researchers Medina Mora and González-Forteza, of the Institute of Mental Health, indicate that suicide may be understood as a process that begins with the idea of taking one’s own life, passes through the suicide attempt or attempts, and ends with the death one inflicts upon oneself, that is to say with completed suicide.

We consider that this process could be interrupted if we stop it, in other words if we detect it from its first phase onwards. By identifying the young people who obtain the highest scores, we are in a position to offer them a brief systemic therapy. This last phase is also part of the research: the therapy sessions would be recorded on video so as to be analysed and to yield data allowing us to identify not only the causes, but the situations that led these young people to envisage suicide as an option. At this stage we would use in-depth interviews and life narratives, tools that belong to qualitative research. With this last phase we would thus close the three parts that make up the process: research, teaching and service. Namely:

I should like to share with you a few pieces of data we have found concerning suicidal ideation. At the congress in which I recently took part in the city of Salta, colleagues were telling us that, in certain regions of Argentina, suicides are occurring among ever younger people; I do not know whether you are aware of this. We note, however, that although suicide has been studied by different sciences and from distinct theoretical frameworks, it has not been possible to clarify why people resort to suicide, nor what characteristics are presented by the people who are inclined towards it.

Something is happening in large cities such as Tokyo, New York or Mexico City, where people resort to suicide as a way of escaping difficult situations; this probably has to do with the economic situation, but it also has a social correlate. The family of which the subject is a part may be a trigger or a container of suicidal conduct.

Death by suicide constitutes, after accidents, the second cause of mortality among young people from fourteen to twenty-four years of age. The statistics published by the National Institute of Statistics, Geography and Informatics are data we have to face, even if we do not like to speak about death. Many people hold that one should not speak about it, claiming in this way to keep it at a distance, or even to deny it. Certain psychological theories maintain that verbally expressed suicidal ideation is a form of blackmail; here one must be careful. I would say that we ought to stop and reflect on the validity of such an argument, for error has no place here: from death there is no return. Let us rather ask ourselves whether it is worth turning a deaf ear to these calls for help.

In another study we had carried out in 1995 on suicide, we found that certain people who resorted to it had recently lived through the suicide of someone close — father, brother, cousin — or had learnt that a person emotionally close to them had taken their own life. Everything happens then as though suicide were transmitted by contagion.

Another factor associated with suicidal conduct is low self-esteem, which is linked to depression. Both are correlated with suicidal ideation and with completed suicide. It has also been observed that ease of access to firearms or to other dangerous objects favours the passage from the idea to the act. Other factors come into play: loneliness, economic difficulties, problems with parents, with classmates. Losses in general, whether economic, emotional or affective, may lead to suicidal thinking.

It has been observed that people who have known a childhood marked by violence, or whose history includes physical or sexual abuse, tend to amplify the negative events that occur in adult life. For example, the loss of a loved one will have a far greater impact on them than on a person who has not lived through traumatic experiences in childhood.

Another important element we have identified has to do with family relationships. People who live in a family where communication is of good quality, where it is possible to speak and to be listened to, do not have as much probability of taking their own lives as young people who live in a disarticulated, authoritarian family, where communication does not exist. The family is an important factor for the majority of young people: emotional adjustment is better when these families are cohesive, expressive, and when they favour the independence of their members. Families that are too agglutinated, or excessively authoritarian, which do not favour independence, where the children have more difficulty in detaching themselves and find themselves limited in their possibilities of growth, may also lead to suicide as a form of flight.

So much for everything that belongs to previous research, what it has become customary to call “the state of the art”. We shall now speak about the research we have carried out.

Family social climate and suicidal ideation

The aim of this research was to assess the social climate that prevails in the families of young students and to relate it to suicidal ideation.

Subjects

A hundred young people took part on a voluntary basis, aged from seventeen to twenty-six, all of them undergraduate students of psychology.

Instruments used

Two instruments were administered to these young people: the suicidal ideation scale devised by Roberts and Moos’s assessment of family social climate. The administration of the two instruments lasted between forty-five minutes and an hour. The suicidal ideation scale assesses the presence of feelings and thoughts bearing on death. The family social climate scale, for its part, serves to know the characteristics of the family and assesses three important aspects: relationship or cohesion, development and, lastly, stability. In the “relationships” part, cohesion, expressiveness and conflict are assessed, with all the important factors of the relational register; in the “development” aspect, autonomy, achievement orientation, the intellectual dimension, the social-recreational dimension and morality-religiosity are assessed. And lastly stability, where organisation and control are assessed.

The assessment situation

The instruments were administered in the classroom, with the authorisation of the teachers as well as of the students, who volunteered to answer them.

Results obtained

The results indicate to us that 51% of the psychology students had thought about suicide at least once during the past week, which is an extremely high figure. Let me point out that this assessment was made at the end of the semester; a replication would be needed here in order to verify whether, by administering the same instruments at another moment of the semester, the data vary.

Among the women assessed, 47% presented some of the symptoms of suicidal ideation during the week preceding the assessment, as against 63.6% among the men: men therefore think about suicide more than women. This datum contradicts what is found in the literature, where it is stated that women think more about taking their own lives, make more attempts, but do not take their own lives as much as men do.

In analysing the profile of the sample presenting suicidal ideation, we observe that the symptom most frequently reported was the one that indicates the feeling of not being able to go forward: 22.8% of the men reported having had thoughts bearing on death for one to two days during the week preceding the assessment, as against only 15.4% of the women with the same persistence. On the family climate scale, correlations were obtained between the ten subscales; as I said at the beginning, this scale assesses several factors, and the correlations between them were therefore calculated: a strong correlation is found between the factors that make up the social climate test.

The correlations between the suicidal ideation scale and that of family social climate proved to be negative, which means that, when the scores are high in the domains of family climate, the suicidal ideation scores are low. The three factors that come out highest — in other words those that do not favour suicidal ideation — are:

• family cohesion;
• expressiveness;
• achievement orientation.

According to these results, the people presenting the highest risk of suicidal ideation were the male subjects, which agrees with the results found in a study I myself had carried out in 1995 — even if the comparison cannot be direct, since different measuring instruments were used there.

In another study, also carried out in Mexico by González-Forteza, it was nevertheless found that women present a higher prevalence of suicidal ideas, something usually attributed to cultural reasons, men not speaking about their depressive feelings even when they experience them. Perhaps they do not admit them because they see a weakness in them; men, in Mexico, are “very macho”… and therefore do not allow themselves these feelings, so that it seems preferable to them to deny them or to turn depression into aggression.

Studying suicidal ideation is quite complex, because many people are unaware that they present any, or do not want to reflect on it seriously. There are many behaviours that lead to death at the end of a long process and that are not considered suicidal acts strictly speaking: for example a diabetic person who does not take care of herself; eating disorders such as bulimia or anorexia are forms of suicide, but in the longer term.

A death kept apart from life

Many customs of our ancestral peoples, such as the Aztecs or the Incas, are linked to death. Rituals are celebrated on 2 November; graves are adorned with cempasúchil flowers, those orange-yellow flowers that grow in that season; the dishes the deceased liked are also prepared; an altar of the dead is set up with candles and the photograph of the person who has gone, not to mention a series of traditions showing that our peoples accepted death as a part of life. In the anthropology museum in Mexico City there is a sculpture carved in onyx, half of whose face is a skull and the other half living flesh, which suggests that, for pre-Hispanic cultures, life and death belonged to one and the same unity. That has been lost: we have set death aside, it is separated, split off from life. Today, nobody wants to speak about it, nobody wants to have it present in mind.

One of the difficulties we encountered in the research is that many young people, when we explained to them the aim of the study, said they did not want to be assessed. This suggests that there exists a rejection with regard to death: “don’t make me think that I am going to die, because it makes me feel bad”. The rejection is total; one cannot accept that dying is part of the human condition — and yet it is the only certainty we have.

Here ends the presentation of the research, but I should like to open a dialogue with you on this theme. Would anyone like to ask a question or make a comment?

Dialogue with the audience

I wanted to ask you whether you had found, at one moment or another, a correlation between being the child of people who have taken their own lives and a tendency in these children themselves.

Lourdes Eguiluz: this question was not asked directly in this particular study, because we used instruments that were already constituted; but, in the 1995 study, one of my concerns came somewhat close to what you are pointing out, for I believe that there is a learning process there, and I think it is possible that someone who has lived through this experience may also try to do it. But there also exists the possibility of reflection and change, and of never passing to the act. Suicide is something that is generally hidden in most families, because it is a very painful and distressing situation, and for some even dishonourable. This makes any therapeutic help more difficult, when one does not clearly know what happened; but the strangest thing is that mere suspicion may lead to the same result.

The concealment of suicide is quite ancestral. We know that, in classical Greece, those who had taken their own lives were buried with the hand that had committed the act separated from the rest of the body. Socially it is frowned upon; almost every culture shows a rejection with regard to suicide, not always with regard to death, but it seems to me that with regard to suicide, yes, in general. Except when it takes on a more spiritual, religious character, of self-giving; on the other hand, “traditional” suicide, the one in which a person takes their own life in a more selfish sense, is indeed rejected.

I remember a study on the number of suicides in the United States, in which it appears that the highest rate is found among physicians, and in particular among psychiatrists; it has been associated with the burnout syndrome linked to the clinical work of psychiatrists. Now, given your research, it would seem that psychology students, even before having the slightest clinical experience, already present a high predisposition; so it would appear that the choice of the discipline may be connected with this, and not only wear and tear…

Lourdes Eguiluz: what you say seems very interesting to me. The fact that psychology students have a high ideation even before having had therapeutic experience suggests that health professionals have a greater suicidal risk than other professionals, something that could be conditioned by a pre-existing datum.

Let us now ask the question I usually put to students entering their first year: “Why are you here?”, or “Why did you decide to study psychology?” Most will give you two answers: “Because I want to help others” and “Because I want to help myself”. With this last answer, you will find that it is likely that these young people have a problem of identity, that they have undergone physical violence or very severe assaults, that they have been harmed on the sexual plane; these are young people who already carry a very serious problematic, connected with identity and personality.

The theme is interesting for more thorough research: with what you are saying, I believe it would be worth finding out why these young people want to study psychology and not another discipline.

When an adolescent plays with death, for instance in risky sports, and ends up killing himself, may we consider that it is a suicide or an accident?

Lourdes Eguiluz: I would say that officially it is an accident, but that psychologically it would be a long-term suicide, as in the case of risky sports: things that society allows, but which we know expose the person to great danger. The question that arises would be: why did she decide to become a bullfighter, or a racing driver? That is where one would have to look, for once this has become a profession, it is very difficult for people to acknowledge that they are running a risk — so with the police officer, the firefighter…

Phenomena such as the samurai, the kamikaze, the semantics of human sacrifice, have another meaning…

Lourdes Eguiluz: the evaluation of the suicidal act depends on periods and on cultures: it is very different according to whether suicide is considered an act of courage or a great discredit. It depends therefore on the idea one forms of it, on the meaning one gives it: it will be allowed or not. It is the social connotation that puts the plus sign or the minus sign on suicide; it is not the isolated person, but the person within the social group.

As for the means used for suicide, have you found differences between men and women?

Lourdes Eguiluz: the means that would damage the image are hardly used by women; men look for a more violent death, they resort to the firearm. If a woman were to shoot herself, she would shoot herself in the heart, whereas the man shoots himself in the head: it is very symbolic — in men, “it is the ideas that burst”, in the woman, “it is the feelings that burst”. The man does not care about the state in which his corpse will be left, the woman does; the woman is more theatrical, she resorts for instance to poison, she makes more attempts without carrying them through; the man, for his part, says “I am taking my own life”, full stop, and he does it; the woman tries several times over.