Psychological Profile of Suicide Survivors: Retrospection on Decisions of Suicide

A Dissertation Submitted in Partial Fulfilment of the Requirements for the Award of the Degree of

Master of Philosophy in Psychology

by Sabina Susan Samuel (Reg. No. 1234209)

Under the Guidance of Baiju Gopal Assistant Professor

Department of Psychology

CHRIST UNIVERSITY BANGALORE, INDIA March 2014

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Approval of Dissertation

Dissertation entitled ‘Psychological Profile of Suicide Survivors: Retrospection on decisions of Suicide’ by Sabina Susan Samuel, 1234209 is approved for the award of the degree of Master of Philosophy in Psychology

Examiners:

1. ______

2. ______

3. ______

Supervisor(s):

______

Chairman:

______

Date: April 4, 2014

Place: Bangalore

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DECLARATION

I, Sabina Susan Samuel hereby declare that the dissertation, titled ‘Psychological Profile of Suicide Survivors: Retrospection on decisions of Suicide’, is a record of original research work undertaken by me for the award of the degree of Master of Philosophy in Psychology. I have completed this study under the supervision of Dr. Baiju Gopal, Assistant Professor, Department of Psychology. I also declare that this dissertation has not been submitted for the award of any degree, diploma, associate ship, fellowship or other title. It has not been sent for any publication or presentation purpose. I hereby confirm the originality of the work and that there is no plagiarism in any part of the dissertation.

Place: Bangalore Date: April 4, 2014

Signature of candidate Sabina Susan Samuel Register No 1234209 Department of Psychology Christ University, Bangalore

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CERTIFICATE

This is to certify that the dissertation submitted by Sabina Susan Samuel, 1234209 titled ‘Psychological Profile of Suicide Survivors: Retrospection on decisions of Suicide’ is a record of research work done by her during the academic year 2012-2014 under my supervision in partial fulfillment for the award of Master of Philosophy in Psychology. This dissertation has not been submitted for the award of any degree, diploma, associate ship, fellowship or other title. It has not been sent for any publication or presentation purpose. I hereby confirm the originality of the work and that there is no plagiarism in any part of the dissertation.

Place: Bangalore Date: April 4, 2014

Signature of the Guide Dr Baiju Gopal Assistant Professor Department of Psychology Christ University, Bangalore

Signature of the Head of the Department Dr. Tony Sam George Department of Psychology Christ University, Bangalore

Property of Christ University. Use it for fair purpose.Give credit to the authoriv by citing properly, if you are using it. Acknowledgement

First and foremost, I would like to thank my guide, Assistant Professor Dr Baiju Gopal, for his unconditional support, patience, guidance and encouragement over the past two years. His constant enthusiasm, care and support, especially when dealing with such a sensitive topic, proved to be my source of strength. I would also like to thank my Head of Department, Dr Tony Sam George and the team of panelists for their valuable insights throughout the process of coursework and presentations. I am also indebted to members of the Mental Health community - Dr Lata Jacob (Clinical Manager, Medico Pastoral Association and Sahai Helpline) Dr Ajit Bhide (Head of Department of Psychiatry and Family Medicine, St. Marthas Hospital) Dr Jane Henry (Clinical Psychologist, Mercy Clinic, branch of St Marthas Hoapital) Dr Chandrashekhar (Professor and Head of Department of Psychiatry, Victoria Hospital) Dr Gururaj (Professor and Head of Department of Epidemiology, National Institute of Mental Health and Neurosciences) Dr Preethi Patil (Psychiatrist, Narayana Hrudayalaya) Dr Minoo Pothen (Asst Professor of Psychiatry, Melaka Manipal Medical College, Malaysia), Dr Jhonson (Psychiatrist, St Johns’ Hospital) for providing me with their time, to discuss various doubts. Thank you so much for your feedback, it proved to be the foundation of my research. My participants, my angels, without you I would not have been able to complete my research. Through your courage, strength and support, you helped all of us understand an event which most of us shudder even to reflect upon. Thank you for allowing me, into your world. I feel privileged to have met you. I dedicate this work to you’ll and my friends who have passed on to another world. I would also like to thank my family and friends (especially Swetha Rao, Titus Thomas, Babushka Chauhan, and Kiran Kumar) for encouraging, helping, supporting and tolerating the roller-coaster progress of my research and its associated moods over the past two years. Your patience and support has been integral to completing my research. I would also like to thank God for blessing me with the ability to bounce back from the personnel demons I came across during this journey, for blessing me with his strength, patience and tolerance. .

. . .

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The event of Suicide is one that has been studied and documented in several studies abroad and in India. But, to approach the event of Suicide from the perspective of the ‘attempted’ or ‘survivor’ is rare. The purpose of this research is to understand the meaning the act of suicide holds, emotions and thoughts, of the attempter, leading up to the suicidal decision and to trail them till the decision manifests into action. It would provide an in depth perspective of the experience of this event. The research attempts to find not only the meaning behind these events but to also put together a psychological profile by observing the common thoughts, emotions and meaning attributed to the attempt. The research will make use of the method of narratives, over a period of sessions, which would provide the life stories of the individual, as well as the event, in itself. The research is conducted on ten women participants in age range of 18 – 35 years. The participants are selected based on the criteria, specified. The research is qualitative in nature. Interpretative Phenomenological Analysis (IPA) will be used to analyze and interpret the data collected. Data analysis shows that the psychological profile, of a suicide survivor consists of cognitions that are predominantly, restrictive and negative in nature, experience of negative emotions especially that are related to the traumatic event and suicide as a meaning fulfilling action. The research would attempt to provide a profile which would not only help in understanding the meaning and life events of such an individual but would also help in training of mental health professionals.

Keywords: Suicide, psychological profile, meaning of suicide, suicide decision, cognitions and suicide, emotions and suicide, understanding suicide, causative factors of suicide.

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Table of Contents

Approval of Certificate ……………………………………………………………….ii

Declaration …………………………………………………………………………...iii

Certificate ………………………………………………………………………….....iv

Acknowledgements ………………………………………………………………...... v

Abstract ……………………………………………………………………………....vi

List of tables …………………………………………………………………………..x

List of figures ………………………………………………………………………...xi

Introduction

Indian Scenario…………………………………………………………………...... 3

Comparison of Suicidal Behavior between Asian and their Western Counterparts...... 4

Cognitive perspective ...... ………………………………………………………………...... 5

Social learning and Theory of Differential Activation ………………………………...... 7

Stress and Suicide …………………………………………………………………………….9

Cultural factors and Suicide ………………………………………………………………..9

Culturally relevant meaning of suicide …………………………………………………...... 12

Significance of Study …………………………………………………………………....15

Research Objectives ……………………………………………………………………..16

Review of Literature

Cognitive factors ……………………………………………………………….....18

Problem solving or Coping Skills ………………………………………………….19

Interpersonal factors ………………………………………………………...... 21

Traits of Aggression and Impulsivity ………………………………………...... 25

Traumatic stress and early experiences ……………………………………………26

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Research Methodology

Qualitative study …………………………………………………………………..28

Paradigm ………………………………………………………………………….28

Participants …………………………………………………………………….. …29

Criteria …………………………………………………………………………...30

Operational definition ………………………………………………………...... 31

Method of data collection …………………………………………………………31

Procedure ………………………………………………………………………...32

Data Analysis ……………………………………………………………………32

Validity …………………………………………………………………………..33

Ethical Guidelines ………………………………………………………………..34

Results and Discussion

Summaries of participants’ Interviews ……………………………………...... 37

Participant one. …………………………………………………………...... 37

Participant two...……………………………………………………………...... 40

Participant three.……………………………………………………………...... 42

Participant four.…………………………………………………………………43

Participant five.……………………………………………………………...... 45

Participant six.…………………………………………………………………..47

Participant seven.…………………………………………………………….....49

Participant eight.………………………………………………………………..51

Participant nine.……………………………………………………...……...... 53

Participant ten.……………………………………………………………….....55

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Discussion……………………………………………………………………………59

Superordinate themes emerging during cross case analysis, according to first specific objective…………………………………………………………….60

Superordinate themes emerging during cross case analysis, according to second specific objective…………………………………………………….62

Superordinate themes emerging during cross case analysis, according to second specific objective…………………………………………………….72

Summary and Conclusion

Findings of research …………………………………………………………….....81

Limitations of research ………………………………………………………….....84

Implications of research ………………………………………………………...... 84

References

List of references …………………………………………………………………..85

Appendix

List of Appendices

Appendix A – General demographic sheet ………………………………………92

Appendix B – Informed consent …………………………………………………93

Appendix C – Interview guide …………………………………………………...96

Appendix D – Field notes …………………………………………………...... 98

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List of Tables

Table 1: Showing the themes and superordinate themes of participant VIJ………...39

Table 2: Showing the themes and superordinate themes of participant SS…………41

Table 3: Showing the themes and superordinate themes of participant GK...………43

Table 4: Showing the themes and superordinate themes of participant JS..………...45

Table 5: Showing the themes and superordinate themes of participant SB…………47

Table 6: Showing the themes and superordinate themes of participant SGK…….....49

Table 7: Showing the themes and superordinate themes of participant TC…...…….51

Table 8: Showing the themes and superordinate themes of participant PK.….……..53

Table 9: Showing the themes and superordinate themes of participant SN…………55

Table 10: Showing the themes and superordinate themes of participant BT…….….58

Table 11: Reflects the cross cluster themes of participants according to the first objective of research……………………………………………………………...….59

Table 12: Reflects the cross cluster themes of participants according to the second objective of research………………………………………………………….……...66

Table 13: Reflects the cross cluster themes of participants according to the third objective of research…………………………………………………………………71

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Table of Figures

Figure 1: Shows the conceptual map where varied experiences influence the cognition, emotions and meaning making process (psychological profile) in an individual, which ultimately leads to their decision of suicide……...……………… 17

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Running head: PSYCHOLOGICAL PROFILE OF SUICIDE SURVIVOR

Chapter 1: Introduction

Nobody could understand what I was going through and nobody bothered to understand what I was going through – nobody cared that much! I did not want to change and live like a zombie, if I had a life, I would only live the way I wanted otherwise it was not worth it. (VIJ, personal communications, July 26, 2013)

The words death by suicide conjures to one’s mind, a range of emotions. Death is a concept we are all aware of but we also spontaneously try to avoid discussing, due to its innate moroseness. Hence, the dual nature of the concept that exists in all our minds, would lead us to make the assumption that death is not something we want for ourselves. It is not something that any of us look forward to. Why then, would certain individuals want to commit suicide? What is it that is going on in their lives that would lead them to make such a decision? Did they not see any other alternative before them or had they exhausted those options as well? How do they persuade or convince themselves to take away their own lives? Various articles and research suggest a range of reasons such as impulsivity, frustration, disease, exhaustion, poverty, unemployment, despair, and pressure as certain factors. The tale of suicide is unique to those individual. The term ‘suicide’ conjures to the societal mind a horrific, unjustifiable end. The news of suicide sends waves of shock, disbelief and guilt in the lives of those significant people left behind. The closest of family and friends insist that they are not aware of the reason behind such drastic action. It is this grey area, which is open to exploration, particularly for this research project. In order to understand the world of suicide, it would be best to be guided by one who has journeyed along its paths (Clemons, 2001).

The two case studies, given below, reflect in different ways, the path to suicide, that the individuals pursued. The former recounting a more emotional experience while the latter describing a psychological profile and the reasons for suicide. Both accounts reflect a sense of intense emotional pain, an inability to change situations and a sense of loneliness. Suicide, is often, seen as a solution to end the unbearable pain of living, a solution for all of life’s problems. Person P, 27, had lost his job and two months down the line, he and his wife separated, as they felt the this break, would help their marriage. These separate loses had impacted his life in a large manner, he started having suicidal thoughts but initially Property of Christ University. Use it for triedfair purpose.Giveto ignore it. Being credit a person to of the faith, author he attended by citing church properly, and was a partif you of the are Bible using it. PSYCHOLOGICAL PROFILE OF SUICIDE SURVIVOR 2

group study. In an attempt to find help, he talked about the problems in his life and that he was thinking of committing suicide but nobody from church or study group seemed to have called or even enquired regarding him. He felt dejected by two institutions of marriage and religion, in which he used to have great faith in. Within a few months, the person finalized his separation from his partner. Although, the logical decision to make, he felt like his world had been turned upside down, he felt like somebody close to him had passed away. He stated that he felt like this for months, even his friends seemed to moving on with their lives. He felt that the only stable friend he could count on was his loneliness. He felt he had become numb to the situations and experiences of the world. Only thoughts about suicide elicited emotions in him, he started to write poems about suicide. One day, when crossing a busy, traffic laden street, his mind swimming in its own thoughts, he suddenly felt the urge to step out, in front of an oncoming truck, this very thought seemed to seduce him, simultaneously he experienced fear. But the thought of ending it all was more powerful. (Clemons, 2001) while another Indian study on Psychological profiling showed that person L, 28, a pre – university drop out, married to a tailor. The individual’s parents had separated when she was young and hence earlier on she felt an absence of sorts. Once married, she had three children, a boy and two twin girls. She had quit her earlier job, as a factory worker, when she had children, as she found it difficult to balance the duties of work and home but as years passed, finances around the household got tighter. Hence, she decided to take up a job, as a tutor. The designation itself was not recognized and it paid her a meager salary. She found it difficult to adjust to work ambience and her colleagues, who would look down upon her and sometimes even mistreat her. She did not share the situation at work with any of her family members fearing that they will stop her from going and as she perceived it, this was not an option that could be entertained, as the finances were needed. The problems at work became bad to such an extent that she started to isolate herself from her family members. One day, a senior staff had reprimanded her in front of her colleagues. She felt that this was too much for her to bear. She took the rest of the day off and came back home. When questioned by her family members, she just stated that she was not keeping well. In the evening she mixed, pesticide along with her tea and consumed it. Her mother found her throwing up and when questioned, the individual confessed to taking the pesticide. She was immediately rushed to the hospital, where she passed away the next day (Gururaj, Isaac., 2001)

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The term suicide seems to capture the attention of any individual. It is viewed as an illogical act which also connotes negativity, uncertainty, hopelessness and fear whenever it is used. Suicide, simply put, is a deliberate act of self harm or self destruction. The individual is aware of the inevitable destructive consequences of their actions and despite its harmful nature proceed with their actions. Hence, it simply does not refer to a certain pattern of thinking but also includes self destructive behavior that is focused on taking away their own lives. This can be a distinguishing point with that of suicidal gestures (which can include suicidal ideation and suicide attempt) as these although intentional have low lethality and no aim to cease to exist or in other words, self injurious behavior without the intent to die is called self harming behavior while self injurious behavior with the intent to die is called suicide attempt (Stepp, Morse, Yaggi, Reynolds, Reed & Pilkonis, 2008) A definition of suicide by the World Health Organizations (1998) stated that suicide was an act that was behaved upon, fully conscious of the outcome of the action. Another definition, in the same article, put forth by Shneidman (1985) stated that Suicide is action directed towards killing oneself, it is perceived by the individual as the beast solution to the problem. (Burgis, Bertolote, Kerkhof, and Billeb-Brahe, 2006) As cited by Grewal and Porter in 2007, O’Carroll and colleagues in 1996, defined suicide as death of an individual as a consequence of evidenced, self inflicted harm or injury, where the decedent (deceased person) harbored the intent of killing himself or herself.

Indian Scenario The earliest cases of suicide in India can be observed during the Gupta period (320 – 550 A.D) where suicide by drowning was as an acceptable practice. It was later on observed in the Mughal period (1526 – 1857) where the women, on learning the death of their husbands would jump into the funeral pyre of the husband or set oneself ablaze, in the hopes that to join the husband in the afterlife and to protect oneself from being taken away by the enemy and being made slaves. Also, such practices, give us a glance into the complex social forces that were at play during this time that dictated that a woman had no place in the world after the death of their partner, which also forced the individual into the act (Ghelot, Nathwat, 1983)

In the last few years, it is stated that 5,00,000 individuals committed suicide, on an annual basis and 61% of the suicides in the world, was accounted to happen in Asia Property of Christ University. (Vijaykumar, 2005) According to the reports in National Crime Records Bureau 2010, the Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

PSYCHOLOGICAL PROFILE OF SUICIDE SURVIVOR 4

rate of suicide has seen an increase from the year 2000 – 2010, the figures being ranging from 1,08,593 in the year 2000 to 1,34,599 in the year 2009, showing a 23.9% increase in suicidal deaths. Among the cities, Tamil Nadu recorded the highest number of suicides, 16,561 that is, 12.3% of total suicides. The second place was occupied by West Bengal 16,037, that is, 11.9%, the third place tie between Maharashtra 15,916 and Andhra Pradesh 15,901, both contributing 11.8% to the total suicides. Karnataka, attained the fourth position, accounting for 12,651 suicidal death, that is, 9.4% of the total suicides in the country. The causes of suicide has also been statistically represented by the National crime records bureau with family and interpersonal issues, accounting for 23.7% , chronic illness responsible for 21.1% , romantic relationships responsible for3.1%, substance abuse responsible for 2.5%, issues related to dowry responsible for 2.3%, poverty responsible for 2.3% and financial issues such as bankruptcy responsible for 2.0% . According to the reports of National crime records bureau, 2010, in summarization, the suicide rate decreases with educational qualification, with only 3.3% of graduates and post graduated accounting for suicide. The rates of suicide for males were found to be slightly higher than females. The rate of suicides was observed too be highest in the age group of 15 - 29 years. It was also observed that suicide rates were higher for married individuals, as compared to separated, divorced or widowed. The method of suicide preferred were hanging, poisoning and self immolation, in that order.

Comparison of Suicidal Behavior between Asian and their Western Counterparts The western world reflected higher rates of suicide among adolescents, in the elderly, the urban population and the widowed or separated. Commonly used methods of suicide, included, using firearms, car exhaust (carbon monoxide inhalation) and poisoning. While, the Asian world reflected a higher rate of suicide among the young, that is, below the age of 30, among married women and among the rural populations. Commonly used methods consisted of pesticide poisoning, hanging and self immolation or suicide by fire. (Vijaykumar, 2005) There can be various reasons for an individual to take away his own life – loss of a significant relationship, substance abuse, depression, schizophrenia, personality disorder, lack of family support and inadequate help received. Various researches have shown strong links between mental illness and suicide. In the studies done by Vijayakumar and Rajkumar in 1999 showed that, 8% of the Indian population suffered from Schizophrenia, 25% from mood disorder, 60% of individuals suffered from mild to Property of Christ University. moderate depression, 34% of individuals from alcohol abuse and dependence. In another Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

PSYCHOLOGICAL PROFILE OF SUICIDE SURVIVOR 5

study, done by the same researchers found 12% of the population in India to have personality disorder and specifically Cluster B personality type. Certain personality traits such as reduced skills to solve problems, blaming situational or environmental factors (a sense of external loci of control) and impulsivity were associated with suicide. A history of suicide in the family, past or earlier attempts and a diagnosis of a mental disorder increased the risk of suicidal behavior. Even though, the clinical causes that lead to suicide can be studied, it is difficult to categorize the motivations and emotions that lead to such acts. Mental health professional emphasize that it is not a single but a inter-connected web of situations, emotions and perception that lead to the act of attempting suicide.

Many researchers from various fields have made an attempt to understand and explain the act of suicide. It should be kept in mind that not any one theory can completely contribute to its understanding; rather, each theory gives an insight into that specific area of function, which when put together gives us a glimpse into the complex concept of suicide and suicidal behavior. There are many theories that explain suicidal behavior such as Psychoanalytic theory, Cognitive theory, Sociological & Cultural theory, Biological theory, early experience & traumatic events perspective and Evolutionary theory but keeping in mind the objectives of research - Cognitive theory, Sociological & Cultural models, early experience & traumatic events and stress and suicide will be focused upon.

Cognitive Model of Suicide Cognitive theorists would attribute suicide to the faulty cognitions (cognitive distortions such as all or nothing thinking, discounting positive experiences, overgeneralisation, minimisation, maximisation, and labelling) and schemas (thought patterns and beliefs) which would contribute to the way the world is perceived and processed or understood. It would also influence what is being observed and how it is interpreted. Beck et al., 1999 stated that knowledge about the state of mind of suicidal individuals is limited, but particular thoughts that occur during the suicidal phase would help predict suicidal behaviour, to an extent. Mann et al., 1999 has stated that various researches have documented the impaired cognitive functioning in individuals with mental health issues that increases their risk of suicide.

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PSYCHOLOGICAL PROFILE OF SUICIDE SURVIVOR 6

vision of the self, a negative or depressed view of the self in relevance to the community or the world, at large. The third feature being a negative or pessimistic view of oneself in relevance to the future. This was referred to as Becks cognitive triad. He stated that the persistent and all encompassing negativity was a consequence of the triad, negative automatic thoughts, cognitive distortions or schemas and maladaptive mind-set. (Grewal & Porter, 2007)

The arrested flight (‘cry of pain’) model, states that there are three features that distinguish depressed people who are suicidal with depressed people who are not. The first feature being sensitivity to particular stimuli or cues, this makes the person sensitive to specific stimuli that aid in recalling the memories of humiliation or defeat. Individuals associate that particular stimuli to that of the humiliating or shameful event, as a result, when they are in a particular state of mind, they will end up interpreting even neutral events as representing humiliation or defeat. Becker et al., 1999 also explained the role of attention and selective perception in the development and maintenance of suicidal ideations, but this did not necessarily lead to suicidal behaviour. The second component is the perception of escape and problem solving. Escape or avoiding such a situation becomes impossible. A link has also been drawn between the functioning of the autobiographical (specific) memory and problem solving. Various studies show that the autobiographical memory is not able to bring to mind, specific events especially if it is related to the traumatic events the individual have undergone. They are able to recall the general details of an event. This function is a defence mechanism that serves to protect the individual but valuable information is not attained which in other individuals is attained through reflection and hence develops better problem solving skills. But for a suicidal individual, since this information cannot be attained, hence they understand suicide as their only solution to the problem. In a study conducted by Pollock-Williams in 2001, the relationship between autobiographical memory and performance in problem solving was studied, on a group of individuals who had recently attempted suicide. They found a highly significant relationship autobiographical memory and problem solving deficits. The third component is rescue and prospective or future cognition. Studies indicated that individuals in a suicidal state of mind, saw their problems as everlasting, as in there was no end to the problem/s. They could not see a positive future for themselves and it was accompanied by the core characteristic of suicidal behaviour – hopelessness. As cited by Grewal and Porter 2007, Property of Christ University. Beck defined hopelessness as negative or depressing or pessimistic thoughts about the Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

PSYCHOLOGICAL PROFILE OF SUICIDE SURVIVOR 7

future. Hence this inability to see a positive future with increased negative feelings or anticipation increased the suicidal tendencies, according to Williams and Pollock. Hopelessness and absence of positive mood have been characterised as traits that is associated with long term vulnerability. Rumination is another key cognitive element of depression as well as Suicide. It is the tendency to ponder about the ‘why’ of situations and events. It is activated by a negative or low mood state, which then further is enhanced through this kind of thinking. Generally, individuals rationalise that by thinking this way, it would offer them a solution – they could get to the core of the problem and resolve it but in reality, this kind of thinking maintains the cycle of negative thoughts mood state, a sort of an unbreakable cycle.

Another theory, as cited by Lester and Gunn, 2012, proposed that Joiner (2005) stated there were three elements that could be associated with suicide. It was referred to as Joiners’ Interpersonal theory of suicide. The first element being the perceived sense of burdensomeness, where one thinks that he or she is a burden to others. It could also mean a financial or emotional burden. In reality, in may be an irrational thought that the individual carries with him or her. The second element is thwarted or frustrated sense of belonging, where the individual would be like to be a part of a significant group but is unable to be a part of it due to certain factors such as an inability to relate to the group, loss of some sort and various others factors. While, the third element refers to an acquired ability or skill for harming oneself, as any individual does not possess the natural or innate ability to hurt oneself. It is something that is acquired through learning and practice such as previous suicide attempts. Hence these various cognitive models gives a view into the functioning of the mind and the important schemas and beliefs that play an essential role in leading to a decision on suicide.

Social Learning and Theory of Differential Activation Individuals can be exposed to or even taught beliefs that either support or denounce suicidal practices. They can be exposed to this through their religious denominations, region, education received, age and sex. (Robert Agnew, 1998) Pavlov would attribute conditioning or learning leading to Suicidal Behaviour, that is, a child may learn negative coping patterns from within the family and significant others and later manifest them, as an adult. Clinical experienceProperty reveals thatof Christsuicidal University.behaviour is more common in individuals Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

PSYCHOLOGICAL PROFILE OF SUICIDE SURVIVOR 8

who have been raised in families where the members made frequent suicidal threats (Ghelot, Nathawat, 1983)

Another theory, as cited by Bretherton 1992, that aims to explain the influence of significant relationships is the attachment theory which was initially put across by Bowlby (1969). The model tries to explain, the sense of security developed in self and other relationships, due to experiences with the primary caregiver, mainly through the caregiver response, availability and care given to a child. Basically, through the child’s interaction with the primary caregiver or caregivers, the child develops an internal framework of how the world works which also becomes the blueprint to the experience of future relationships. The same study, showed that individuals with unresponsive and uncaring caregivers, developed a negative sense of self, where one was considered as worthless, alone and unloved – these children also did not interact much with the world. But, children who are responsive caregivers, developed a positive sense of self, forming healthy and secure emotional attachments. The extension of this work, by West and Keller, 1993 showed that children, who underwent traumatic experiences such as child sexual abuse or child physical abuse, developed a negative sense of self. They also had issues with trust, a disability in forming long lasting relationships, anxiety of others believing in them.

Another model that emphasis on conditioning is the theory of differential activation or context dependant memory which was initially put forth by Godden and Baddeley in 1975. It stated that certain events, thoughts, memories are easier to recall in the respective emotional contexts they occurred at. Hence returning to the particular mood grants better accessibility to the thought patterns and memories, that have occurred at that state in the past, initially when it occurs there is only a loose connection between these elements but with time certain associations are established between moods, thinking and body responses. Thus this could apply to a depressed individual, where the low mood activated the negative thinking pattern which in turn provokes feelings of ‘escape’ which may lead to suicidal behaviour. Studies by Goldstein and Weiner (2002) showed that feelings of entrapment and failure could be produced through mood induction that is by producing a negative mood or simply stated, when in a low or negative mood, one would recall negative incidents and memories, thereby enhancing or maintaining the low or negative mood. Property of Christ University.

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Stress and Suicide Attention is generally paid to events such as loss, separation, death, conflicts and family problems and their relation to suicide not much attention is given to traumatic stress as such. Generally, this refers to events that would elicit distress in anyone who faces them. It would consist of situations like sudden death of a significant person, exposure to assaultive violence such as rape, physical or sexual abuse, witnessing someone being killed or seriously injured and other injuries and accidents. Any event experienced by the individual with intense fear, feeling of helplessness and a lack of personal coping strategies and lack of available support, are now the criteria considered for traumatic stress. Studies conducted by Adams and Lehnert 1997, show that certain types of stress are related to increase risk of suicide. Type I stress is when the individual has had to face intense traumatic events with a short duration. Issues such as substance abuse, increased interpersonal conflict and an increased risk of suicide have been observed. Type II stress is seen in individuals that have undergone stress for a long time, they would adapt to cope with the situation but the situation would not have changed, the support received during this situation would be minimal. These individual develop personality disorders, behavioural problems and dissociation in extreme cases. This type of stress is also related to self destructive behaviour varying from self mutilation to completing acts of suicide. Studies on war zone trauma and childhood assault experiences were also studied by Goldney et al., 2000 to find a positive association with these experiences and suicidal ideation. Research reflects that individuals who had to undergo childhood events of physical and sexual abuse were at a higher risk level of developing or being diagnosed with vulnerability post-traumatic stress disorder, depression, borderline personality disorder and impulsive suicidal behaviour. (Chatard, Selimbegovic, Kinan,2008) The same study also showed that young adults that had been through childhood physical and sexual abuse showed an increased relatedness with anxiety disorder, conduct disorder, substance abuse and suicidal ideation and attempt at the ages of 16 – 25 years. PTSD (Post traumatic stress disorder) highly linked with war zone trauma and combat; studies linked depression, suicidal ideation and completed suicide to PTDS.

Cultural Factors and Suicide The French sociologist, Emile Durkheim in the year 1897, put forth the social theories of suicide. He stated the suicide was associated with the varying degrees of social integration Property of Christ University. and social regulation. This he said formed the foundation of social organization in the Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

PSYCHOLOGICAL PROFILE OF SUICIDE SURVIVOR 10

society. The unsatisfactory functioning of these two concepts, led to individual expressions such as suicide, which reflected the disturbance in the functioning of the society. Social integration referred to closeness or cohesiveness among the members of a family or community while social regulation referred to the behaviour of the individuals that are being guided by societal norms and rules. He later categorized social integration as three types, where in egoistic there is a lack of integration between the members which led to liability or being susceptible to attack by outside forces. It was observed that individuals who had week attachments with their community and family, more easily resorted to suicide, as they would also lack any kind of negative instruction or support from anyone, hence the would perceive it as having less reason to live. (Agnew, 1998) Altruistic, referred to individuals or families whose identity and purpose was based on the social group they belonged to while anomic, referred to social instability, the normal functioning of a community is disrupted due to various factors (such as, for example, economic or industrial causes) that ultimately leads to its collapse. This could be brought on by any social event. Sociologists are of the opinion that suicide due to too much social integration is rare although suicide due to low social integration and regulation can be observed. These theories were used to explain suicide explain suicide among the indigenous people, specifically the Native Americans (Lester, 2008).

Another theory focused on cultural conflict. The concept of acculturation was put forth by Barry in 1990, as cited by Lester in 2008. It refers to the changes that happen when two communities, a prevailing and a non prevailing community meet each together. Pressure from the dominant community lead to various changes in the non dominant community, changes such as becoming more urbanized, change in type of food consumed, changes in method of education, values, attitude, motives etc At this point the non prevailing community has four options, they being - incorporation into the prevailing community but maintaining a strong cultural identity (incorporation), not being absorbed with the prevailing community but maintaining a separate cultural identity (assimilation),not interacting or communicating with the prevailing community but maintain a cultural identity (separation), not being incorporated by the prevailing community and not being able to maintain a cultural identity (marginalization). This theory has been successful in explaining suicide, to an extent, among indigenous as well as individuals who have migrated. Other studies focus on violence in the community, especially against women. Property of Christ University. Studies on the populations of India, Pakistan and Sri Lanka, reflected that women were Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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more prone to attempting suicide had a higher incidence of pointing to causative factors of interpersonal relationships (disputes within the family, either between the couple or wit the in-laws) and acts of domestic violence (Bhugra, Desai., 2002) The same study also showed that migration could become a causative factor due to decreased sense of belonging and acceptance, which in turn influenced their identity and self esteem. But, it was also observed that in society or culture centred communities, there was an excessive amount of pressure for the individuals to conform, hence any individual who felt differently in such a situation was found to go through inner conflict, which would at times result in suicide. The study also listed other community based factors such as expectations and roles related to sexual category or gender, domestic violence perpetrated mainly by male members of the family, alcohol use by male members of the family, when there was a clash of liberal and traditional values, psychological distress that arose out the individuals’ rejection of the cultural values and low self esteem. Domestic violence refers to various behaviours such as verbal, sexual and physical abuse, intimidation, threats, harassment, and cruelty.

Researchers identified a few factors that increased the risk for violence against women. Factors such as traditional gender roles and norms, use of approved of violence to settle disputes, cultural approval or no strong rules against such treatment of women, disproportionate distribution of resources. The law enforcement agencies would not interfere in issues such as this, as they would be classifies as a domestic dispute, which is left to the family to settle. Traditional male roles require men to be dominant, powerful and financial power and decisions are taken by them while traditional female roles require them to put the needs of the family before themselves, be submissive and passive, obey the husband without question – such ideals may make the women also feel that abuse is their fate, which may hinder them from seeking help. Also, seeking help from sources that are external to the family is not encouraged as this is seen as protecting the reputation and honour of the family. (Colucci, Montesinos., 2013) Usually, due to fears like being ostracized by the society, financial limitation of solely supporting the family, issues children with one parent has to grow up with - women tend to internalize the stress, pain and their inability to make decisions in relevance to these situations which also increases their chances for depression (Niaz, Hassan.,2006)

Another perspective that linked human behaviour to that of suicide was the perceived sense of help received, Propertyduring significant of Christ events University. (Baumeister, 1995). It explained Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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loneliness as a concept, arising out of the inability to express themselves, alienating oneself, extent of help seeking behaviour, when the situation arises.

Culturally Relevant Meaning of Suicide The assumption that suicide means the same thing, to anyone who chooses it, is by its innateness impossible, due to the unique nature of individuals. Heindein (as cited by Robert Merton, 2009) had stated that it was significant to understand the perspective of the individual on the topics of death and the afterlife, in order to understand what would motivate him or her to undertake such an act. Suicide was not always considered a shameful act. History of various cultures would reflect the attitude held in relevance to suicide at different points of time. As cited by Jamison 2001. Self murder/suicide were considered a matter of honor among the Greeks and Gladiators, they would rather die by their own hands than be treated as slaves in the hands of the victor. Socrates, who refused to renounce his teachings, drank hemlock, in rebellion. While, Aristotle and Pythagoras, thought of suicide as an act of cowardice and also passed a law prohibiting suicide and considered it as against the State itself. The Catholic Church from its earliest days condemned suicide. It is believed that it is in direct violation of the sixth commandment which prohibited killing. It was an act against the church and ultimately God. Life was considered a gift and to discard it was sacrilegious (The State rules and Religious rules could not be separated during this time; they shared a very intimate relationship). Hence an act against the church was also as punishable act against the State. Many theologians believe that suicide is an unforgiveable sin; Martin Luther had stated that suicide was the work of the Devil. In Jewish tradition, the one who committed suicide is not honored; only given a burial but his/her families are consoled. Sometimes, in some cultures the families were ostracized as well. The term ‘commit’ suicide has its origin during this period. Its equivalent is compared to committing a crime – a sin. The term ‘commit suicide’ is still used till today (Clemons, 2001). In India, one of the stories, in the epic mythology of Mahabharatha, states that when Yuddhisthra learnt about the death of all his brothers, he lost the will to live and he contemplated suicide. He was persuaded from doing this on religious and ethical basis. The Rig Veda, a sacred text of the Hindus, states that an individual does not have the right to take away his own life as life and his body does not belong to him, it belongs to the creator as well as to the parents. They are considered the life giving and nourishing sources and hence the greatest duty an individual has to fulfill is Property of Christ University. the one of serving his parents. Thakur in 1963 stated that in the Dharmashastras (a Hindu Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

PSYCHOLOGICAL PROFILE OF SUICIDE SURVIVOR 13

book which consists of principals that guides people in their lives) overtly and clearly condemns the act of suicide. The body of such a person must be defiled/dishonored and a fine be paid by the family members. If the person who attempted suicide survived, he too was to pay a heavy fine (Ghelot, Nathwat, 1983)

Heindein in 1964, conducted studies on suicide in Scandinavian countries. In his study, he found that Danish mothers used guilt as a behavior controlling method, usually to control aggression in children; this led to the development of dependant traits in their children. Later on as adults, these traits led to depression and suicidality, especially after a separation or loss, hence fantasies of coming together or reuniting with the lost or separated loved one, was a common cause for attempting suicide. While in Sweden, emphasis was laid upon performance and success which led to work becoming the vital activity around which their lives revolved; hence suicide was related to failure and damage to self esteem. While in another study in Papua New Guinea, it was used by women to incite revenge and shame on the family, as it is the family that was held responsible if this was method of death chosen.

As cited by Robert Merton, 2009, Jean Baechler (1979), a French social philosopher categorised the meaning and motivation of suicide into eleven broad concepts. His works are original in French, but it was later translated. The model stems from the belief system that suicide is not abnormal; it is a decision or a choice that is made, that is based on the rationalisation, that, that choice is the solution. He believed that suicide was an existing solution, to an integral problem that is being faced by the person. The behaviour of the person was so designed that it would help them in fulfilling their basic needs. The basic needs included both, psychological (belonging, acknowledgement or recognition, autonomy, freedom of choice and the need for excitement through learning, adventure) and physiological (survival) needs. These needs did not necessarily form a hierarchy; in fact it could even be in conflict with one another. The conflict could be between the psychological needs themselves or between psychological and physiological needs. An example of conflict between psychological needs is the following, it is seen that although celebrities enjoy being in the limelight (need for recognition), it often comes at the price of their personal space and freedom (need for autonomy). Another example of conflict between psychological and physiological needs is substance abuse, where the abuse is Property of Christ University. resorted to gain relief from the psychological needs; here the choice is made over Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

PSYCHOLOGICAL PROFILE OF SUICIDE SURVIVOR 14

physiological needs. Hence from this perspective, suicide is ultimately seen as a choice that they are making to fulfil their basic needs. The eleven categories that he proposed were the following. The first form being, escapist suicide where the individual attempts suicide, to flee from unbearable emotional pain (the need to be free from pain) that is being caused by an individual/s or a particular situation. The individual is not able to bear this pain any longer and chooses suicide as the alternative. A second form of escapist suicide, which is an expression of grief (the need to be free from grief or pain) where the individual has lost, an integral part of his or her life which he or she considers essential to what he or she considers as the normal way to live. The third form of escapist suicide refers to way of punishing the self and expressing remorse, for the inability to fulfil the aspirations of others (the need for recognition and acknowledgement) that has been set by the family, significant others or the society. The fourth type is aggressive suicide where, the individual commits suicide engaging others (voluntarily or involuntarily) in this action or situation. Here, the need for power, control – recognition is observed. The fifth form is aggressive vengeance suicide, where the act is used to provoke feelings of shame, guilt and repentance in another (the need to control others emotions, hence need for recognition is observed) It is used as a way to punish the other. The sixth form is an extension of the later, as in, it is directed at the other, and this type of aggressive suicide involves blackmail. Again, the fulfilment of need of recognition is seen. The seventh form of suicide refers to, appeal suicide, where the intention of the individual is to let others know that he or she is in trouble, this form of suicide, is meant to be a signal for help. Hence, it is classified as satisfying the need to belong as well externally control others through ones actions, hence even the need for recognition is fulfilled. The eighth form of suicide, sacrificial suicides, refers to an act that is done with the belief that their life is being given up for a worthy cause. Here, the need for belonging is being fulfilled. This can be seen in military acts. The ninth form, oblative (here it refers to voluntarily sacrificing one’s life) suicide with the aim of transfiguration. This refers to suicide that is undertaken with the notion of the afterlife in mind, it could be of a reunion with a partner or loved one – here the person feels that the afterlife would be better than the present condition. The need for belonging is being fulfilled. The tenth type ludic suicides, where the goal is to prove oneself, towards others or himself. The need for belonging as well as excitement is fulfilled. Finally, the eleventh form, ludic game suicides is an extension of the previous type, where games are involved. Here, there is fulfilment of the need for excitement. Beachlers’ theory was heavily criticised for its vagueness and lack Property of Christ University. of intricate distinction. Researchers were of the opinion that suicide arose from the basic Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

PSYCHOLOGICAL PROFILE OF SUICIDE SURVIVOR 15

needs being frustrated and hence suicide could be a result of that and not be explained in terms of suicide being an action in order to fulfil basic needs. Additionally, the attempt at making meaning and motivation for suicidal behaviour although helpful, could not differentiate between suicidal gestures and suicidal completion, more work in this area is required.

Significance of Study The focus of the research is on the psychological profile of the individual who attempted and survived the attempt. A psychological profile refers to the personality or the behavior makeup of the individual, by observing their actions, emotions, thoughts and in this project, one also takes into consideration the individual experiences and the meaning attributed to it. This would give us and in depth understanding into the dark, misunderstood world of suicide. The feature that distinguishes this project from that of the others, is its perspective on the experience of suicide by the attempter. Most of the studies done in India are in reference to suicidal notes and psychological autopsies, which does provide a psychological profile from the point of view of the other or the outsider. Although, suicidal notes do come in fairly close to helping us understand from the perspective of the attempter. So, this project goes a step further in understanding them. This research is done with the aim, to convey the experience, in its most true and subjective sense to novice practitioners in this area.

The uniqueness of the particular study is its focus on the experience of individuals who have attempted suicide. There are various studies and researches and articles that focus on the reasons behind suicide - the genetic predispositions, clinical diagnosis, personality traits, family and interpersonal relationships and socio-economic reasons but not many researchers have focused on the experience of suicide and its attempt from the perspective of the attempter. The various events, emotions and thoughts associated with the life and the episode of attempt of such an individual. Various psychological autopsies are constructed based on the reflection and accounts by the families of the individuals who have completed suicide. This often helps the families not only understand the reasons behind the act but attain a certain sense of closure. The study on suicidal notes also helped understand the more personal and intra-psychic reasons behind the act. But, there is a need for this kind of study to be done at a more micro level. This research focuses on the idiographic Property of Christ University. experiences of individual; importance is given to the uniqueness as well as the similarities, Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

PSYCHOLOGICAL PROFILE OF SUICIDE SURVIVOR 16

with the experience of every individual. In the review of literature, there are numerous articles focusing on the clinical perspective of suicide, this article explores the feelings and emotion of this experience thereby providing a more holistic perspective. The research would be able to provide a psychological profile of sorts and identify the key emotions, thoughts and life experiences that led to the suicidal decision, which would help in spotting or being alert to individuals or clients on a similar path. It would also facilitate effective training of novice mental health practitioners to be better prepared for such situations.

Research Objectives The objectives of the study, is as follows - 1.1 Major objective refers to study the psychological profile of the individual who survived the attempt of suicide 1.2 Specific objective refers to a) To study the thoughts that lead to suicidal decisions b) To explore the emotional experience/s of the individual, before the suicidal decision (in terms of significant life events) c) To explore the meaning assigned to their actions that lead to their attempt of suicide

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Friends Rejection Aggression Family Sexual abuse Cultural beliefs

Romantic partners Impulsivity Physical abuse Societal values Other significant

Loss / Abandonment relationships

Experience Experience Personality Societal of traumatic of traits factors events interpersona l relationships

Cognitions Meaning making Psychological Profile

Emotions

Making decision of suicide

Figure 1 Shows the conceptual map where varied experiences influence the cognition, emotions and meaning making process (psychological profile) in an individual, which ultimately leads to their decision of suicide.

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Chapter 2: Review of literature

There are numerous articles, journals and researches on Suicide worldwide. As theorists and Mental health practitioners have already stated there is no sole reason leading to suicide, it is rather a web of intricate reasons and their unique interactions that lead to suicidal behaviour or decisions on suicide. Traditionally, suicide is studied from three perspectives - epidemiological model (demographic risk factors), an individual model (where personality traits are taken into consideration) and environmental model (where external factors such as family structure and support, stressful events are taken into consideration). Keeping in mind, the objectives of research, the individual and environmental will be focussed upon, with the intent of studying qualitative factors that influence individuals making a suicidal decision. The review of literature is thematically presented. It covers cognitive factors, problem solving and coping skills, interpersonal factors, traits of aggression and impulsivity and early experiences and traumatic events.

Cognitive Factors Research took into account the relationship between various cognitions (thinking patterns) and suicidal behaviour. Cognitions studied included dichotomous thinking (thinking or classifying themselves or other as good or bad, right or wrong, etc., also referred to as black and white thinking) cognitive rigidity (inflexible way of thinking or solving problems) and attributional style (beliefs that fuel the perception about themselves and the world)

In a study by Neuringer (1968), it was found that among adults, psychiatric and non psychiatric hospital patients, dichotomous thinking was largely observed in suicidal patients as compared to that of non suicidal patients. In another study by Garza & Petit (2010) on studying perceived burdensomeness, cognitive patterns and suicidal ideation, among Mexican women, found that perceived burdomesomness and minimisation (cognitive pattern of thinking) were highly related not only suicidal ideation but completion of suicide.

Cognitive rigidity reflects an inability to formulate multiple or alternative solutions to Property of Christ University. situations that are labelled as difficult. This style of thinking can influence the inability or Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

PSYCHOLOGICAL PROFILE OF SUICIDE SURVIVOR 19

ability to perceive the problem as solvable or not. Neuringer (1964) was of the opinion that cognitive inflexibility or rigidity is a feature observed in suicidal individuals who have a deficiency or lack of adaptive or problem solving skills. This later on fuelled their perception of hopelessness. Studies have reflected the positive correlation that is shared between increasing feelings of hopelessness and increased risk of suicide (Kumar & Steer., 1996) He had also hypothesized that cognitive rigidity would increase at the time of stress and it would play a contributory, mediating role between stress and suicide.

Attributional style determined their perception of themselves and the world they live in. It is closely linked with locus of control, that is, the degree of control, individuals possess to change themselves or their situations. Research reflects that the inclination to ascribe negative situations and events of life to oneself and to keep doing this increased cognitive rigidity. Bader (1996) also drew a link between the attributional style of cynicism and suicidal behaviour. He stated that cynicism is the adaptation to situations or settings of danger or an attempt to avoid or minimise the feeling of vulnerability especially when the individual views the other as motivated by selfishness. (Bader, 1996) This led to mistrust of people and social isolation. In fact, cynical individuals did not enjoy the protective factor of social comfort and support (Lepore, 1995)

In various studies in India, the link between cognitive distortions and suicidal behaviour have been drawn but there are no studies that states that a particular distortion or distortions has been observed that is relevant to the Indian culture and further there are any cognitive thought patterns can be linked to gender. The research can attempt to fill these gaps and also observes the atrributuional style of cynicism, although more in-depth study would be required in this area.

Problem Solving and Coping Skills The Diathesis-Stress Problem Solving model states that a sense of hopelessness and suicidal behaviour is caused when there is a combination of high stress levels (which can be measured through negative life events) and an inability to solve the problem. This model has been forward by Clum and his associates (Schotte, Clum, 1982). Research has discovered that the elements of high levels of stress and problem solving deficits can also be individually related to the act of Suicide. For example, suicidal individuals were found Property of Christ University. to account for negative life events six months earlier to their attempt at suicide. This model Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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has been criticized, on the grounds that not all negative events can be measured in a standardized manner as what is perceived as stressful may vary from one person to another. It has also not included the cognitive factors such as effect. The model although useful seems to need more comprehensive work, as it is also not able to make intricate distinction between suicidal ideation and suicide attempt and hence is unable to conclude how life stress and problem solving deficit would interact differently across different groups. Neuringer (1964) had stated that cognitive rigidity reflected a lack of ability or skills to solve problems. Resolving problems or issues refers to the active use of behavioural and cognitive processes directed towards the self, in an effort to identify, create or discover efficient or adaptive ways of managing and dealing with the problematic situations that one comes across everyday or daily life (D’Zurilla, Chang, 1995) Problem solving consists of problem orientation and the specific skills of problem identification and formulation, generation of alternative answers, making a decision and solution execution and verification. There is also a distinction made between problem solving and execution of a solution, while problem solving refers to finding alternative solutions to issues, solution implementation or execution of a solution refers to transferring the plan into an action of resolving the problem. Researchers have recognized two vital systems of processing information that influences problem solving. First, is an experiential or automatic system that is based on recall of previous memories and operates at a preconscious level, the second, a non automatic, or rational system that is based on logic and analyses, which operated on the use of alternative problem solving techniques. When the automatic memory could not produce an appropriate response to the problem situation the rational memory would come into play. (D’Zurilla & Goldfried, 1971) The contribution of information processing model towards ineffective problem solving would be helpful to further understand the concept of problem solving.

The researchers also suggest a reciprocal relationship between depression and ineffective problem solving – the presence of one leads to the presence of other and this can be enhanced during the time of stressful events. Studies on the role of autobiographical memory and resolving problems have been conducted. This has illuminated its role, which is seen in depressed patients who were able to recall only general details regarding emotionally loaded, autobiographical memories. While these individuals were medicated for their Depression, an improvement in Depression did not show any improvement in the Property of Christ University. memory. Individuals could only recall generic memories, which gave only few cues as to Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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how to cope with a problem situation. (Pollock & Williams, 1998) A distinction has been made between active and passive problem solving. Simply put, active problem solving refers to the individual taking steps to remedy the crisis situation while passive problem solving refers to the individual depending on others to solve the crisis situation or for the crisis situation to solve itself. Pollock & Williams (1998) stated that the methodology employed does not show sensitivity to this distinction and hence it becomes a limitation to the paper. But various other researchers that employed a different methodology have observed this significant difference. In a study done by Orbach, Bar-Joseph and Dror (1990), it was observed that suicidal patients followed passive method of problem solving when contrasted against the non suicidal control group.

In another observation or study, problem solving was compared between the depressives and anxious individuals, it was found that depressed people had difficulty in earlier stages of problem solving while anxious people had difficulty with the latter, it was interpreted that anxious individuals knew what to do but could not implement it due to inhibitions which may be emotional, negative self statements or lack behavioural skills. The influence of emotional mood state on problem solving is not yet fully understood, although research does show that emotional states does influence cognitive processes, but which of the aspects of problem solving stays stable or is changed by mood is yet to be understood. Longitudinal studies, in relevance to this aspect would be helpful. The current research would help in observing the perception women have on their problems and common ways of problem solving that they would employ in dealing with the situation.

Interpersonal Factors The interpersonal psychological theory states that suicide can be perceived in the framework of three features – thwarted or frustrated sense of belongingness, perceived individual incompetency or ineffectiveness and a sense of burdensomeness on salient individuals and an acquired capability of suicide. (Joiner, 2005) Joiner stated that this theory explained as to what pushed certain individuals to commit suicide, even though there were many people who experienced psychological risk factors such as hopelessness, emotional pain. Personal ineffectiveness and burdensomeness played important roles with eliciting the emotions of shame and guilt (Smith & Cukrowicz, 2010) The need to belong Property of Christ University. to a significant group or relationship is a basic, powerful and universal requirement. When Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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this does not happen, undesirable effects on health, wellbeing and adjustments have been documented. (Baumeister & Leary, 1995) This need when satisfied can act as a protective factor from going ahead with the act of suicide. Social isolation led to increased suicidal tendencies also the frequency of developing psychiatric disorders was much higher among prisoners who were kept in solitary confinement. (Anderson et al., 2000) It was also observed that parenthood functioned as a protective factor (Baumeister & Leary, 1995)

Studies were also conducted on the sense of perceived burdensomeness by Joiner (2002) by comparing the content of suicide notes from individuals who completed the act of suicide and from individuals who attempted it (Lester &Gunn, 2012) It was found that a perceived sense of burdensomeness was more frequent in the notes of the individuals who completed the act of suicide. Further detailed study of the notes found the following insights - the individual felt that they were a burden to the people who they cared for them and who they concerned about, individuals felt that people around them would be better off without them, if the individuals felt, they were some kind of emotional or financial burden and if individuals felt that the people who they loved, stood to gain something through their death. While, the frustrated sense of belonging brought about the feeling of being disconnected from significants and feeling isolated or expressing feelings of loneliness. Another study, tried to associate, perceived sense of burdensomeness with lethality of method used for suicide. Although, a positive association was seen for some participants, it could not be stated that perceived burdensomeness can independently be related to suicide. Although, it is an essential variable when associated or put together in combination with other variables such as anger, pain and hopelessness. A combined experience of all three factors is necessary to lead to the act of suicide. But, compared to the other two, not acquiring the capability of suicide was insufficient to lead to the act of suicide. The act of suicide went against evolutionary programming of self-preservation, hence this point emphasised on that capability which consisted of developing processes that could counter or deal with heightened degree of pain and fear involved with the act. Hence the experience of physically painful and psychologically challenging life stressors and events were significant in acquiring this capability. As, such exposure or repeated exposure to such events would decrease the alarming reactions or even physiological reflexes that one possess in reaction to such threatening stimuli. Multiple experiences of this kind of exposure would lead to habituation of fear of suicide and habituation to the pain involved Property of Christ University. in suicide. Hence, effective and efficient route to suicide can be acquired by practice Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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(Joiner, 2005) Life experiences therefore can be categorised into events that are directly or indirectly related to acquiring this capability. It is found that individuals who developed a higher tolerance of fear and pain of suicide, chose more lethal methods of suicide. This was influenced further by gender, men are socialized to express less fear as compared to women and hence this influenced the choice of the method used. (Joiner, 2005) It was also stated that individuals who were uncertain or wanted to be rescued from the attempt, were a result of residual fear and pain. (Smith & Cukrowicz, 2010) Studies on attachment style found that individuals with a childhood history of neglect or avoidant attachment, were likely to engage in acts of self harm and suicide attempt, as adults. As cited by, Stepp et al. (2008) secure attachment styles gave rise to fewer indications of psychopathology as compared to individuals raised with an insecure attachment style (Ward, Lee & Polan, 2006) These attachment styles have also been related to various form of psychopathology, which show issues with interpersonal relationships. The anxious-ambivalent attachment is related to signs of dependant, histrionic and borderline personality disorders. Avoidant attachment is related to indications of avoidant, narcissistic, antisocial and schizoid personality disorders (Stepp et al., 2008) Another study which was conducted only on women, emphasized on the influence of various attachment patterns on the development of depression. It was seen that children with low felt security, perceived unavailability of attachment figures were seen as related to developing depression as adults (Cawnthorpe, West & Wilkes, 2004)

In India, the report by the Bureau of Police Research and Development of Union Home Ministry in 1976 recorded 41, 415 suicides that year. 19.5% of the individuals killed themselves due to a life threatening illness, 9.1% of individuals did this over quarrels with parents in law,6.7% did it over quarrels with spouse, 5.4% did it over disappointment or rejection in romantic relationships, 3.8% did it over property disputes, 3.7% did it due to poverty (Ghelot, Nathawat, 1983) Another Indian Study, tries to collect data on the motives and social factors in an Indian society. Marital and interpersonal problems were noted as key causative factors that are related to the act of suicide. Marriage, in an Indian setting is not a protective factor while education is considered a protective (Vijayalakshmi, 2010)

A study was conducted on the suicide notes from Delhi (Leenaars, 2010) The New Delhi notes showed that interpersonal factors, family problems and illness were central Property of Christ University. causes but certain intra-psychic forces also present. The culture of India focuses on Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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collectivism, hence the societal or interpersonal world is of utmost significance as it will affect the perspective of the people. Intra-psychic factors such as insufferable psychological pain, confusion or ambivalence of thoughts, indirect expressions of anger. Although cross culturally some of these themes were common, there were differences (cognitive inflexibility) and indirect expression were observed in the Indian notes, which showed that the individual was also influenced by their own culture. Indian culture does not encourage expression of aggression towards another hence these impulses will be ‘masked’ or expressed in another manner towards another or the rage expressed towards one-self. The study reveals that indirect expressions and veiled aggressive impulses play an important role in leading to suicidal behaviour in India. Psychological autopsy determined the commonalities, to cover a general theory as to why people would resort to killing themselves. The study revealed interpersonal factors such as frustration and an inability to adjust, disturbed interpersonal relations, rejection, and aggression (Vjayakumar & Rajkumar, 1999) Studies indicated individuals who have suicidal ideation or thoughts have experienced a deep sense of rejection and deprivation of affection, extramarital affairs was included as a factor. The experience of hopelessness was also reported among individuals who were suicidal, the presence of hopelessness was also a strong predictor of suicidal behaviour as compared to depression. (Beck, 1985) Hopelessness signified negative expectations or decreased feelings of being successful in the future. Childhood gender non conformity is a construct that connotes the preference or non-preference of characteristics that are normally marked by gender. Studies on this, has been conducted in reference homosexuality and bisexuality. According to research, these are observable characteristics that are seen to develop in childhood and are seen throughout adolescence and adulthood. It was also observed that it was related to psychological distress, parental and peer rejection as well as increased risk f suicide (Eskin, 2012)

The Indian studies do cover various interpersonal factors but an area that also requires attention, is one of childhood gender non conformity and sexual orientation. Although various international articles stated that same sex orientation and bisexuality, does become risk factors for suicide attempt among young adults due to issues in identity formation, inability to maintain intimate relationships and engagement in negative coping habits. (Silenzio. Pena, Duberstein, & Knox, 2007) there is a gap in Indian literature to state the same. Property of Christ University.

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Traits of Aggression and Impulsivity Studies report traits such as perfectionism, low levels of optimism, low self esteem, excessive amount of control either ascribed to oneself or the environmental factors (internal or external loci of control) have been associated with suicide. (Palmer, Rysiew, & Koob., 2004) Certain personality disorders such as borderline and narcissistic personality disorder have also been associated with suicide. These traits are triggered when the person goes through developmental challenges and are more manifest as adults.

Many studies show a strong link between aggression and suicide. One study compared suicidal patients to non-suicidal, healthy control group. Trait aggression was found to be considerably elevated among the suicidal patients. (Conner, 2009) They observed that the utilization of violent methods or acts of suicide is a behavioural feature signifying an increased level of a lifetime of impulsive-aggressive personality or behaviours which is more often notices, as being made use of by males who complete the act of suicide, affected by psychosis as compared to their counterparts. Gender has been found to be an essential factor in the role of lethality of suicide attempt. Different studies reflect, that fatal or actual or completed acts of suicide is more widespread among men, whereas nonfatal suicidal behaviour are more common among women (Linehan, 1981). But, amid individuals with histories of violent behaviour, gender does not seem to play an impactful or influencing role. Becker (2007) considered the result of gender on the prediction or forecast of suicidal behaviour and violent behaviour. Gender was seen to directly contribute to both, independently. It was observed that females had a higher incidence for suicidal behaviour or risk while males had a higher incidence or risk for violent behaviour. The study of personality also led to consideration of another factor – impulsivity. It covers a extensive array of behaviours that reveal impaired self-regulation or control. Behaviours such as inability to plan, early reaction or response without a thought to consequence, thrill seeking behaviour which contains an element of risk taking, incapacity to hold back responses or reactions and preference for instant gratification over delayed gratification. Generally, suicides are considered to be acts of impulsiveness and now studies do support the same. Studies show it to be a direct factor in the act of suicide (Becker, 2007) Researchers have taken a step further to understand if there is a significant relationship between impulsivity and lethality. Some assign it to be a feature of nonlethal suicide Property of Christ University. attempts (falling in the category of suicide gestures) while others accredit it to be vital Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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feature in the completion of suicidal act (Liao, 2009) One of the explanations that can be allotted to the confusion in the findings can be due to the widespread differences in the understanding of the state and trait features of the impulsivity. First and foremost it is important to differentiate between a suicidal act that results from impulsivity and a person who is impulsive. Recent findings show, even though individuals tend to act impulsively when attempting suicide, the actual act of completed suicide is not related to or acted upon mere impulsivity (Selby, 2007) He discovered that fewer than 50 percent of the individuals who attempted suicide, really expressed the intent to die hence referred to their acts as poorly planned impulsive acts. The role of impulsivity influencing lethality had not been conclusively drawn.

The role of aggression, impulsivity and suicidal behaviour has been researched and is found to play a strong role in influencing the suicidal act. But, it has been observed that this relationship is much more stronger in younger individuals and it reduces in strength of its relationship, as their progress in their age (Anestis, 2007) Vijayakumar & Rajkumar in 1999 showed certain personality traits such as poor problem solving skills, external locus of control and impulsivity were associated with suicide. Self esteem refers to a likeable opinion of oneself, an assessment of sorts, of the feeling of worthiness as a human being. It can function as a protective factor against suicide as it directly contributes to self confidence and worthiness. Studies show the connection between self esteem and suicide, satisfaction with the body also does become one of the constructs of self esteem. Low sense of self worth is related to depression, eating disorders as well as suicide attempt (Eskin, 2012)

The literature is somewhat confusing probably since the operational definitions of impulsivity and aggression are unclear. Most studies tend to study the two together, so if it independently relates to suicidal behaviour is a question, not as a part of the psychiatric diagnosis.

Early Experiences and Traumatic Stress Attention is generally paid to events such as loss, separation, death, conflicts and family problems and their relation to suicide not much attention is given to traumatic stress as such. Generally, this refers to events that would elicit distress in anyone who faces them. It Property of Christ University. would consist of situations like sudden death of a significant person, exposure to assaultive Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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violence such as rape, physical or sexual abuse, witnessing someone being killed or seriously injured and other injuries and accidents. Any event experienced by the individual with intense fear, feeling of helplessness and a lack of personal coping strategies and lack of available support, are now the criteria considered for traumatic stress (Brent, 1994) Studies conducted, show that certain types of stress are related to increase risk of suicide. Type I stress is when the individual has had to face intense traumatic events with a short duration. Issues such as substance abuse, increased interpersonal conflict where an increased risk of suicide have been observed. Type II stress is seen in individuals that have undergone stress for a long time, they would adapt to cope with the situation but the situation would not have changed, the support received during this situation would be minimal. These individual develop personality disorders, behavioural problems and dissociation in extreme cases. This type of stress is also related to self-destructive behaviour varying from self-mutilation to completing acts of suicide. Studies on war zone trauma and childhood assault experiences were also studied by Brent, 1994 to find a positive association with these experiences and suicidal ideation. Although studies show that these individuals, who have undergone assault, do develop self harming behaviour and suicidal ideations as adolescents but even in a few cases attempting suicide not only as adolescent but also as adults. PTSD (Post traumatic stress Disorder) highly linked with war zone trauma and combat. Studies linked depression, suicidal ideation and completed suicide to PTSD.

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Chapter 3: Research Methodology

The chapter on research methodology covers the reasons for qualitative research, paradigm, participants, sample, criteria for selection of participants, method of data collection, procedure and validity.

Qualitative Study The research is qualitative in nature. It aims to study and understand the experience of a fellow human being, rather generate demonstrable data. Holstein and Gubrium, in1997, stated that human experience of an event is unique to each and every one and by taking into account these varied experiences; one could try and understand human behavior. It is not taken for granted that the experience is already understood on the basis of assumption or presumptions.

Although numerous studies have been conducted on Suicide and general factors and causes of suicide, the individual experience of suicide is different or unique for each person. It is this uniqueness that the research wants to study as this information is invaluable in helping us. Many researches on Suicide have been done in India, but they contribute tremendously to the statistical representation of the causes. There are studies that have explored the event of suicide to a greater depth and the current research looks at contribution towards that in-depth understanding.

Paradigm Phenomenology, is a method or stance that connotes an association with the examination of experience emerging from the outlook of the individual. It arises from personal knowledge and subjectivity. It emphasizes on the importance of understanding the object or reality from a personal perspective and its interpretation. Phenomenological approach studies human experiences. It is a method that was contributed by Husserl and improved upon by others such as Heidegger, Merleau-Ponty and Sartre. Husserl was interested in examining experience, he stated that this could be done only when people who looked inwards and were able to explain their experience to another, this would enable recognition of the core features of that experience which would facilitate understanding in another. This required a Property of Christ University. phenomenological attitude which means that as individuals we had to bracket off or curb Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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our assumptions and our own interpretations of the phenomena or event. (Smith, 2009) Heidegger, was concerned with making this method more practical and concrete. It is the perception of events and activities in ones world that gave meaning to it, hence meaning is what that connected one to the experience of situations and people. Merleau-Ponty emphasized that the way we described ourselves in relation to the world, in terms of our stance and differences, colored our perception of it, thereby giving it subjective meanings. This meaning hence is highly subjective but is fully accessible at all time to the individual, sharing fully, these experiences are limited as the other may view them from their stance. While, Sartre, took into account the concepts of ‘becoming’ and ‘nothing’, that is, human knowledge and experiences are in the process of making, it is not all already existent on our minds for discovery. The absence of things, situations and people also contributed to meaning making (Smith, 2009)

Phenomenological data collection methods would consist of a collection of dialogue, narratives, discussion, action research, study of personal texts and focus meetings. The spotlight is on getting as much information as possible, consciously and cautiously avoiding the influence of the researcher. In this study, as what is under focus is the psychological profile of suicidal survivor, a retrospection on the decision of suicide, this method would aid research by, expanding our knowledge on emotions, thoughts, motivation and decisions. It would give us a comprehensive explanation and understanding of their experience.

Participants The sample size is 10 women which include young adults of age range 18 – 35 years. A sample of only women have been selected so as to intimately study their experience and to be able to themeatise them to a particular gender. Both genders are not be taken into consideration also due to time restrictions and difficulty in acquiring men as participants for the study, as men who attempt suicide have higher incidence of completing it. As this is a qualitative study, researchers are of the opinion that the appropriate sample size would be between 10 – 15 participants while various other researchers argue that there should not be a fixed number, interviews should go on, until the interviewer reaches the saturation point in the themes presented by the participants (Smith, 2003) While, still more researchers, are of the opinion that even one case study would qualify for idiographic research. (Smith, Property of Christ University. Flowers, Larkind, 2009) Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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The method of sampling is purposive. Purposive sampling is a technique where individuals with certain characteristics or set criteria (by researcher in relation to the research objectives) are selected. The particular criteria are set, so as to recruit individuals who can provide the relevant information, which is being focussed upon. These individuals are considered most appropriate sources of information.

Criteria for selection of participants The population under study are individuals from the age group 18 – 35 years (young adults). In this age range, preference will be given to those aged 25 years and above, as the criteria mentioned is the maximum time from experiencing the event as three - five years to elicit better recall. The recall of events below the age of 18 years would classify as experiences of an adolescent, thereby deviating from the aim of the project. Hence, this could be considered as precautionary step to avoid such a pitfall. This particular group has been selected, as this is the age that is mentioned, in various statistical representations, to have a higher occurrence of suicide, as contrasted against middle adulthood and old age. The age group is considered the peak, of ones life, hence the kind of situations, life events, emotions, thoughts and meaning that lead to the suicidal decision would be of interest for exploration.

Other criteria includes - The study includes participants who have attempted suicide, at least once in their life time. The time period between the event and now, should be a minimum of three - five years to enable better recall of the event The participants should be able and willing to recall the event Participants who are a resident of India can take part, the study is not bound place If participant is undergoing therapy, consent from their therapist or counselor or psychiatrist will be obtained The study also excludes those who are substance-dependent The participant should not be diagnosed with any form or type mental illness. They will be screened out during the interview process. It excludes individuals who are severely ‘mentally ill’ and who are presently undergoing intense therapy and heavy medication. Property of Christ University.

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Operational definition The operational definition of psychological profile extends to not only include the behavioral characteristics such as emotions and thoughts of an individual but in this project, one also takes into consideration the meaning attributed to their decision. It emphasizes on the standpoint of individuals who have attempted and survived the act of suicide.

Cognitions refers to the thoughts, beliefs and perceptions of the individual while emotion refers to intense experiences, that the individual went through. Experience of suicide refers to studying the meaning that has been given to it by the individual. As cited by Grewal & Porter, 2007 it is to be noted that, hopelessness will be considered as a cognitive variable (Hughes & Neimeye, 1993) hence will be categorized under cognitions.

Method of Data Collection The sample will recruited by personally approaching individuals, organizations and making use of personal contacts. Data is collected through in-depth, semi structured interviews. This method of interviewing has been selected so as to enable the participant to express themselves fully and not to be faced with restrictions on exploration of their own life events and its communication to another. The research interview is invaluable in gathering information on perspectives, attitude, opinions, situation and events experienced by people and observe commonalities between them (Smith, 2003)

Relevance to the research objectives is maintained, by following an interview schedule. It is a guide or a framework for the interview process. It consists of the list of questions or areas to be covered during the interview. It follows certain lines of enquiry that focuses on childhood experiences of events that they consider significant, relationship with significant individuals, initial occurrence of suicidal thoughts & coping, thoughts, emotions, motives, events at the time of suicide.

It is structured so as to elicit detailed accounts of life events from an individual. It also helps one prepare for certain unpredictable events. It helps to maintain a certain sense of flexibility which also encourages a greater sense of equality between the interviewer and Property of Christ University. interviewee, during the interview. The control or power factor is not or never always equal, Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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it does shift throughout the interview but this flexibility helps equalise the power or control. There is a kind of power sharing, between the interviewer and interviewee, which enable the unobtrusive flow or account of the experience (Riessman, 2008) Smith and his colleagues (2009) also talk about the concept of rhythm or the transients of interpersonal exchange. The variations in the interview process as it goes on, that is, when the participant initially gives general answers and slowly moves on to specific, descriptive, emotional accounts of events and experiences, and this can keep changing, hence the interviewer has to alert to the emotional states of the participant. The participants will dispense information in the form of narratives. The reason for using narratives is so that rich, detailed information regarding the participant can be obtained, it is in contrast to other methods that require specific answer. The goal of the researcher is to find the voice of the participant at a particular place in time. It presents a portrayal of the stories and experiences built upon their reminiscences and an account of their own feelings and viewpoint.

Procedure The current questionnaire has been designed, based upon the questionnaires used by other researchers for the purpose of their research. It has been validated by two Clinical Psychologists, one Psychiatrist and one rehabilitative counsellor. Also, a pilot interview was initially conducted in order to bring about modifications, if any. Collecting of data is to be done in four sessions. Session one, would focus on rapport building. Demographic data is collected from the population and participants are selected purposively according to the inclusion criteria of the study. Then these young adults are to be interviewed intensively through semi structured interview method. The interview guide will be used. Session two, would focus on their life experiences and events that lead to suicidal decision. Session three, focussed on the period between the suicidal decision and the suicidal act. The thoughts, emotions and experiences during this period. Session four, serves to debrief and close the interview process

Data Analysis The collected information is analysed using IPA (Interpretative Phenomenological Analysis) IPA is influenced by Phenomenology, which tries to understand the meaning of human experience and Hermeneutics, which refers to the interpretative activity involved Property of Christ University. when doing research with other people. It is idiographic in nature, meaning that it considers Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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the experiential account of a small number of people or cases and attention is given to each case, so as to understand their individual experiences. The essence of this method, states reality is available to us, but out point of access of that reality, is our experience and perception of it (Smith, 2009) It also gives importance to the perception of the event, at a particular place and time.

The researcher gets familiar with the transcripts by reading them again and again. In this way, the researcher comes across the descriptive summaries (includes issues, events, emotions and feelings talked about by the participant and the initial interpretations of those summaries. It is usually advised to make a note of the descriptive summaries on the left hand side of margin, while the initial themes and interpretations can be written on the right hand side of the margin. The raw qualitative data is further analysed and reduced into meaningful chunks, these chunks are put under various themes. This is also referred to as clustering of themes. This is followed by establishing the final or superordinate themes. This method is followed with each of the participants and the general themes and unique themes are made a note of.

Validity The term validity immediately connotes the use of measurements or producing verifiable data. The standards that come to mind are the criteria for quantitative validity, but the criteria followed for qualitative validity is different. Every good research requires a certain degree of reliability and validity, some kind of qualifying check or measure for their research. Hence, Lincoln and Guba, 1985 stated that, reliability could be established, if validity is evidenced in the research. In this research, extended fieldwork will be made us of by the researcher. Here, information is collected over an extended period of time. Member check, will also be made use of, where the interpretation of the researcher is verified by asking participants to give their feedback on it, is made use of. Reflexivity can also be used in this area, which would account the personal reflections of the researcher throughout the research process, this can be done in the form of diary keeping or process or filed notes, this would help the researcher reflect on ones own bias and assumptions. By being aware of them, effort can be made to minimise its influence on research work. Debriefing, this refers to a process where the individual recounts his or her emotions, thoughts andProperty experiences of during Christ interaction University. with the participant. This ensures Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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the researcher in keeping a clear head, maintaining objectivity and not carrying the baggage of emotions from one participant to another. Generalisability in qualitative research connotes transferability. There are two types of generalisability, abstract or external generalisability, where patterns and concepts can be applied in similar situations and specific or internal generalisability, where those unique characteristics can be identified and used only for a particular situation. Yin, 1989 is of the opinion that generalisability of the data generally increases if the research report is systematically presents, the methods (not necessarily results) should be reproducible by another researcher (Smith, 2009) Peer reviews can be made use of, where ‘outside’ peer questions the researcher on the process and methods involved in evaluating the data. The researcher will have to produce evidence, in the form of statements from the data collected, to support his claims.

To check the validity of the conclusion drawn from this study a communicative validity can be carried by openly discussing it with experts in the this field, like professionals who work with families whose member has committed suicide and researchers and learned people (regarding the topic) who have studied the same phenomenon. In addition to this, Lucy Yardley (2009) stated three elements to determine the validity of a qualitative research work. They being, sensitivity to context by being aware of the existing literature on the topic, the philosophical underpinnings and how well these arguments or positions taken up, are defended. The second element refers to the commitment, rigour, transparency and coherence. Commitment and rigour is practiced by the researcher throughout the research process, on various grounds such as data collection, processing and its analysis, while transparency and coherence are seen in the data collection and data analysis stages. The third element being, the impact and importance of the work, the kind of changes it brings about in the discipline or the through the knowledge it offers to add to the existing framework.

Ethical Guidelines Research ethics, simply put, refers to an appropriate way of conducting research, by following a certain set of ethical standards. As cited by Smith, 2009 state that research ethics implies a careful consideration of moral behaviour and responsibility on part of the researcher, throughout the research process (Edwards and Mauthner in 2002) Property of Christ University.

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The following are the ethical concerns followed in the particular research. Time is taken to go through and explain the informed consent, the nature, purpose and process of the study is explained to them. The informed consent is also given to the authorising agency or person. Permission from family will be obtained, if required. Participants are assured that any personal information shared with the researcher will not be made public or disclosed without the participant’s consent. They are also made aware that the date will be audio recorded for academic and analytic purposes. Anonymity of the participant will be maintained even later when presenting the data. Their consent is taken in writing. Confidentiality is broken, only if the participant seems to pose an immediate threat to oneself or others. Permission will also have to be sought for ‘off the record’ data, that is, information revealed during the break or after the interview process is over, when the recording instrument is switched off. Participants can decide whether this information should be used in the research or not. The participant would be free to back out from the study if he/she feels it evokes too much anxiety and is incapable of coping with it. But, this will be decided by the participant itself. A break could also be requested in such a situation. The interview could be resumed after the break, according to the request of the participant. As the topic studied is by nature difficult, the participant is allowed to take a five minute break during a one hour session. If the participant breaks down during the interview time will be allotted to the participant to recompose himself or herself. Or if necessary it will be scheduled to another convenient time. To avoid emotional exhaustion a time limit would be assigned to each part of the process, and the interactions of the sessions would be noted down. The nature of the topic is such that, it has potential for psychological harm hence the participant is made aware of the topic and that it would consist of emotional reflections and intense memories. Hence this would help the participant not only prepare better but be able to anticipate the flow of the research process. The interview will be conducted at a mutually convenient time and location, that ensures participant and researcher safety. The participant will be debriefed at the end of the interviewing process, once again explaining how the information will be used. The researcher contact details are given (if appropriate) for further enquiry. The researcher will only play the specific role of a researcher, although a trained Psychologist. The skills of both roles may overlap but not as to cause confusion in the participant. If situation arises, the researcher will hand over the participant to his or her Psychiatrist, Psychologist or Counsellor, who will be present at the interview process, if the participant so request for it. Property of Christ University.

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Chapter 4: Results and Discussion

The major research aim of the study is to investigate the psychological profile of the suicide survivor. While, the specific objectives were to explore the thought process and emotional experiences (in terms of significant life events), leading towards the decision of suicide. While the third specific objective was to explore the meaning of their act. The participants were selected through purposive sampling. The sample consists of ten women, who were recruited from Bangalore and Hyderabad, according to the criteria specified. Some of the sample characteristics were: participants were in the age range of 26 – 33 years, who had attempted suicide, on an average, 3 – 4 years ago. The time taken for the sessions, on an average, ranged from one hour to two hours. Majority were not married, while two participants were married and the two were separated. Majority participants came from a middle income background, while four participants were from high income; they were all hospitalized on account of their attempt and had attempted suicide only once. Neither they nor their family were clinically diagnosed with any kind of issue. Not all participants have been registered as a suicide attempt and in some cases the families themselves are still not aware of they went through as an attempt of suicide. In some of the cases, it has been perceived as accidents.

The method used for data analysis is IPA (Interpretative Phenomenological Analysis.) This method is chosen so as to understand the lived experience of the participant and the meaning the participant assigns to what is experienced. Hence, here the analyst tries to understand experience from the point of view of the participant. The stages of analysis as put forward by Smith, Flowers and Larkin (2009) are put forth below – 1. Understand the transcription and immersing oneself in the data by reading and re-reading the transcripts 2. Making the initial notes through explorative commenting and paraphrasing from three key points of observation – descriptive, linguistic and conceptual data. 3. Developing the basic themes/subthemes 4. Finding connections across the different emerging themes 5. The themes that can be grouped into super ordinate themes. Super ordinate themes could be arrived at through Abstraction (putting the like with like), Subsumption (when emergent Property of Christ University. themes acquires super ordinate status) Polarisation (oppositional relationships between Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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emerging themes) and Numeration (the frequency with which a particular theme occurs in the data)

The procedure is followed separately for all cases. The themes for each individual are noted down. Care is also maintained to minimize bias of data or its interpretation through deconstruction and sticking to the data available (discussed about). The interpretations will be validated at a later stage by professionals in the particular field. In order to understand the background and analyses of each participant, a summary of their interview has been provided. The sub – themes and superordinate themes have been represented in the form of tables.

Summaries of Participants’ Interviews

Participant one. Participant one, a 29 year old from a Christian (but prefers to be called agnostic), high economic background who attempted suicide at the age of 25. The participant comes from a strict disciplinarian milieu, where authority could not be questioned. The participant begins her narrative by recalling her childhood experiences. She draws a clear distinction in the way she was asked to behave when she was at home and when she was with the extended family in ( on her yearly trips to another State). She states that she had to a ‘different person’ all together - where she had to dress differently (wear pavada - skirt) and top), wear gold ornaments and help her mother and aunts in the kitchen, especially after a certain age. She also states that boys seemed to have more fun and girls had been asked to be or act or do things to show their maturity. This, she states, in an outburst with her mother was ‘unfair’. She was taught that proper clothing indicated the respect for the people and the place while she was also taught prayers which she states became a part of routine as she did not understand the language or meaning behind it. As she grew up, she states that she felt a ‘difference’ within her, she tries to explain this difference through clothes worn, hair style of choice and not being able to feel attracted to another guy. She states that she was a person who did everything by the book, did things which girls her age did, even if sometimes she did not agree but she did not want to stand out. She states that she trained herself in ‘spotting’ the attractive males so as to conform to her group. But is unable to keep up with the same mechanism in college, when her friends start dating guys who they like for their individual, subjective reason and since she is Property of Christ University. unable to draw patterns in the behavior she is left being lonely and confused. Thoughts on Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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sexuality begin and she is confused weather she is bisexual or homosexual, a friend who later on becomes her first partner, aids her in figuring out who she is and also encourages her to come-out to her family. After a period of time, her partner returns to her family stating that she is unable to be who she is as her father threatened suicide if she does not conform to the ‘normal’ way of living. The participant is devastated by the news and once her partner leaves, becomes sad and lonely. It is at this time, that she is also attacked by three men, who are masked, at her home. She is hospitalized. She feels vulnerable and open to attack at any time. She requests her mother to come to her city. On arriving and knowing about the situation, mother states that God is punishing her for the lifestyle she has chosen, this becomes the last blow that pushes her over the edge to attempt suicide. The themes reflected by the participant reflects her experience of the parents and family, the society, the need for belonging and acceptance, the experience of traumatic events and her fear of loneliness and her act of suicide as an act of rebellion and rejection.

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Table 1 Showing the themes and superordinate themes of the participant VIJ Super ordinate Theme Theme 1.The need for belonging and acceptance 1.1Disciplined by parents to follow certain behaviour without question. 1.2Following set ways of dressing, behaving, praying and playing (gender roles) especially when with the extended family 1.3Having two identities – ‘home identity’ and ‘societal identity’ 1.4Feeling of being fake and lonely 1.5 Constant negative thoughts of loneliness and non-acceptance running in her head

2.1Rejection by family due to sexual orientation 2.Experience of traumatic events 2.2Feeling of lonliness, when her partner left 2.3Sudden attack and physical abuse, calling her a ‘papi’

3.1 Belief on life being ‘pointless’ without a 3. Fear of being alone partner 3.2 Trying to keep herself busy and disliking coming to an empty house, after partner left 3.3 Fear of never falling in love again or finding a partner

4.Suicide as an act of rebellion and rejection 4.1 Fear of life becoming like partners’ (zombie- like existence) – forcible change 4.2 Objection of being ‘moulded’ into an acceptable form

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Participant two. Participant two, is a 26 year old, from a Hindu, high economic background. She separated from her husband and is currently living with her parents. She attempted suicide at the age of 23.The participant begins by recalling that her childhood consists of a ‘mix of memories’. She recalls travelling and staying in different places and settling down in the city. She recounts her experience of sexual abuse at the age of ten with her older cousin brother. She expresses that most times this happened she felt disoriented and not in a state to protect herself. The abuse ends at the end of three years, as the cousin moves away to college. She is unable to tell her parents regarding the abuse as the cousin brother is intelligent, athletic, the top of his class and the captain of his school, so she feels that nobody would believe her. She states that she looked at her body as a ‘source of pain’ and hated it. She also started to eat a lot. She had become very silent. When doing her eleventh and twelfth, she tries to become like the popular group of girls – learning to be bulimic and doing weed. By doing this, she was able to hang out with the ‘coolest and hottest people’ and that is something she wanted. She also mentions that, her weight during this period fluctuated as fast as her mood, due to which she develops stretch marks o her body, which she refers to as ‘icing on the cake’ as she already considered herself ugly. An older guy from another college, who she meets at her campus, develops an interest in her and they spend a lot of time together. She discovers the strong bond he shares with his friend and she is happy to be a part of their group. One night, they pick her up on the context of holding a party at their apartment and take her there. She observes that there is no one around but they cover it up saying that people will arrive shortly, in the mean time, they get ‘high’ and due to the intensity of it she passes out. She wakes up later to discover that she had been sexually molested by both friends. In confusion and disgust she returns home. She states that she feels ‘used, dirty and stupid’. She is unable to express this experience with anyone and it takes her three to four months disclose it to her closest friend. After this, she engages in a series of relationships without any emotional connection, until she comes across the individual, who accepts her with her ‘gory’ past and she falls in love with him and marries him. But during the period of her marriage, she discovers that he unable to meet her expectations and wants to call the marriage off but is unable to as she fears of bringing shame on the family and believes that suicide is the honourable way out. The suicide attempt becomes a warning to live her life according to her wants. The themes of the participant reflects that the traumatic events have influenced Property of Christ University. her personality and beliefs, the breaking of trust, beliefs about herself, suicide as a way of Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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‘saving face’ from her family and society, she also expresses remorse in the suicide note that is left behind.

Table 2 Showing the themes and superordinate themes of participant SS Super Ordinate Themes Themes

1.Experience of traumatic events 1.1Experience of child sexual abuse 1.2Experience of sexual abuse by a significant relationship and his friend 1.3Experience of sexual abuse in marriage (marital rape)

2.1 Self blame for all instances of abuse 2.2 Conviction that parents would not 2.Beleifs contributing to the sense of self believe her 2.3 Internal conflict for acceptance and need to be self (developing bulimia and smoking) –need to belong 2.4 Reliving memories, which promoted sense of worthlessness 2.5 Believing her body to be a ‘source for pain’

3.1 An act to avoid ‘shame’ of divorce at young age 3. Suicide a way to ‘save face’ from own 3.2 Suicide note, expressing her remorse for family and failing their expectations not being able to fulfil expectations.

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Participant three.Participant three, a 27 year old female from a middle class, Hindu (Punjabi) background attempted suicide at the age of 24years. The participant begins by describing the structure of her family and explains that she is the daughter from her mothers’ second marriage. Her brother although being her step brother, the two, shared a close relationship. The first husband had passed away due to certain medical complications, after four years of the marriage and according to custom; the mother had to get married to the younger brother (he was seven years younger than the lady) in the same family, to ensure the survival of the family name, especially since the child begotten was a boy. The participant looked at her parents as the ‘victims of society’s senseless rituals’. Her mother had also made statements of wanting to put an end to the relationship and moving out but not being able to as she was the ‘girl’. That meant that she did not have the freedom of choice for her own life. Growing in such a background influences her to develop a personality that could make decisions independently and for the self. An incident with a close friend at school makes her determined to shut off the sharing of her issues which would make her seem different and abnormal and hence vulnerable to ridicule. There is huge want to become an adult as she perceives it as more ‘fun and powerful’ as compared to that of a child. The passage of time brings with it a serious change, where her father is on a roller coaster ride with his mental and physical health, her brother gets into a near fatal accident and the finances of the family become unstable, her mother who was originally a home maker has to now do various jobs to make ends meet, her brother also after his recovery pursues a job abroad and with time gets married to a foreigner. The work life of the participant, heralds a ‘magical’ chapter where she becomes intimate with a colleague from a different cultural and religious background. She believes they are married in order to be intimate with him, she also makes various personality and lifestyles changes to help manage his insecurities; however the relationship does not last, as her partner cheats on her. This becomes the point where participant starts entertaining thoughts of suicide. The sudden passing away of her father deepens her already sorrowed state. Her partner during this time of sorrow is non-existent; in fact he gets engaged to another girl. She blames herself constantly and believes that she is cursed to be unhappy as all her other friends have not had to go through as much as her. As situations and thoughts worsen, she finds an acceptable (to herself, family and society) way to commit suicide and attempts it. The themes reflect the influence of beliefs in self, experience in a series of traumatic Property of Christ University. events, influence of society and her suicide as an act for herself. Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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Table 3 Reflects the themes and superordinate themes of Participant GK Super Ordinate Themes Themes

1.Beliefs leading to the origin and 1.1 Coming from a family that is not normal development of negative sense of self and that this is a vulnerability 1.2 Strict beliefs o relationship and intimacy 1.3 Self blame when relationship does not work 1.4 Belief in being a curse – ‘Medusas’ touch 1.5 Belief in a powerful, dominant society 1.6 Belief that she does not deserve the ‘bad life’

2. Experience in a series of traumatic events 2.1Change in father ( deterioration, unpredictability of health and psychological changes) 2.2 Accident of brother (hospital becoming second home) 2.3 Financial hardships (Mother working – tailor and later parlour. Brother stopping studies, going abroad) 2.4 Cheating of partner – absence of support 2.5 Father passing away

3.1 Internal struggle with thoughts of 3. Suicide as something for herself suicide – a cowardly act 3.2 Suicide, as something for herself.

Participant four. Participant four, is a 27 year old from a Tamil Christian, middle income family. She attempted suicide at the age of 23. The participant recalls her childhood as ‘wonderful’ where she was the lovable, naughty girl – the only child of her Property of Christ University. Use it for parents.fair purpose.Give She was an average credit student, to the athletic author and by was citing an outgoing properly, person, if youshe never are hungusing it.

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out in the same groups as she found it boring, she likes to be with everyone and have a lot of friends. She refers to his as the ‘best phase’ in her life where there was fun, learning and no responsibilities. The participant immediately juxtaposes this phase with the worst phase of her life, which begins in her third year of her degree college. This was a period where she got to know a guy at her friends’ party. She is immediately attracted to him and within no time, start dating each other. The participant is unable to attend her degree final exams as he becomes pregnant with his baby, but since he is unable to take on the responsibility of a family immediately due to career commitments, they decide to go in for an abortion. He does support her by being there for her financially, but she feels alone when the decision is carried out. The awareness that she was killing her own child, when she was a person who loved kids, she states was ‘indigestible’ to her but it had to be done for the benefit of all. Sometime after the event, during the time they are together, he wants to be intimate with her and when she refuses as she feels she is not emotionally ready for the act, he becomes forceful with her and she gives in, knowing she cannot defend herself against a person who is bigger and stronger. Her partner also starts to physically torture her - twisting her hand, slapping her, pinching her but she ignores it all, calling his actions ‘childish’. With time her family and relatives, get to know about the relationship and there is pressure for marriage. Although she has her doubts, she goes ahead with the marriage. She convinces herself that it is a ‘very Indian marriage’- where physical abuse is an unsaid part of the relationship and this was in some way an extension of the partners love. She isolates herself from the rest of her world, viewing people who say negative things about her relationship as threats to the continuing of the relationship. Except for the honeymoon, the marriage becomes difficult for her; she reaches out for counselling as support. It is at this time she also discovers that she is pregnant, in a moment of anger during a fight, she tells her husband regarding the counselling and he attacks her, she loses her baby in an ‘accidental abortion’. In the hospital, she blames herself for this loss and for bad decision she has made in making the present event happen, not being able to forgive herself for her ‘dumb’ decisions she attempts suicide by jumping from the building. The event becomes a point where she decides to live for herself. The themes of the participant reflect the traumatic experiences of the individual, her beliefs about self and her act of suicide as a punishment.

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. Table 4 Reflects the themes and superordinate themes of Participant JS Super ordinate themes Themes 1.Experience of traumatic event 1.1 Forced sexual relations (before and after marriage) 1.2 Publicly embarrassing her 1.3 Verbally abusive 1.4 Physically abusive (cigarette bud incident) – threat to kill her if she screamed again 1.5Accidental abortion

2.1 Blaming self for not making better 2.Beleifs about self choices – marriage and supporting him 2.2 Belief in being physically (diagnosed with anaemia) and emotionally week (not standing up for herself

3. Act of suicide as an act of punishment of 3.1 To stop pain and torture of accusatory self voices of self blame

Participant five. Participant five, who is of 28 years of age, comes from a Hindu (Brahmin), high economic background. She attempted suicide at the age of 25. The participant begins by stating that she feels like her childhood was another life and she was another person back then. Her childhood, she recalls was a period of ‘grand lifestyle’ where there was good food, clothes, a lot of travelling and everybody (family) was always together. There was never a second of the feeling of loneliness. Her grandfather played a crucial role in keeping the family together. It is after his death that ‘all hell broke loose’ – they sold the family house and the brothers (her uncle’s) with their respective families moved to smaller independent houses. The participant has difficulty in adjusting to their Property of Christ University. Use it for newfair independencepurpose.Give and creditfinds it lonelyto the but author tries to by adjust citing to it. properly, It is during ifthe you time are of herusing it.

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college that she discovers her mothers’ illness (uterus cancer) and takes on the responsibility of looking after her as well as the house and her sister. Her father stays in the same house but is unable to take on responsibilities as he is perceived to be not stable, dependable or consistent in actions and role. He also develops a problem with his drinking. The participant on various occasions has to cover up for her nonexistent father and play various roles and take on responsibilities at a younger age. She feels older when compared to her friends. She does become cynical about her life and ponders if this is what her life is going to be like. At a party, she meets a guy who she becomes good friends with, with time, it blooms into a relationship. She perceives him to be the answer to her prayers and the relationship proceeds into an engagement. He becomes the ‘son’ before the wedding itself, in her family. He is loved by all and becomes a strong support for her, with him by her side, she observes that even bad events that still happen do not have such a negative effect on her, she feels it’s all bearable. A few months before the wedding, she starts out on a religious trip to give to offer her gratitude to the Gods – it is at this time that her fiancé passes away in a fire accident at work. Devastated and confused by the news, she attempts to commit suicide as a technique that would either wake her up from the nightmare or reunite her with her love in the afterlife. It is during recovery, that she actually understands what had happened and tries to accept it. The event of suicide does not hold any particular meaning for her, but she has now accepted that she has to live this life, suicide is not an option. She believes that her partner who passed away had now become her protector, looking out for her and keeping her safe. The themes reflected show that the impact of traumatic events, perception of being alone and her act of suicide to join her loved one

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Table 5 Shows the themes and superordinate themes of participant SB Super ordinate themes Themes

1.Experience of traumatic event 1.1Division of joint family 1.2Diagnosis of illness of mother 1.3Absence of extended family and father, as support systems 1.4Sudden death of fiancé

2. Perception of being and managing 2.1 Responsibilities of home and college everything by self 2.2 Trying to ‘fill in’ the role of her absent father (alive but not there, financially provides but no emotional support, doctor asking if father was still alive) 2.3 Feeling her life was ‘stolen’ from her, questions ‘why’ this is happening to her. Feeling older when compared to them 2.4 Internalisation of negativity, becoming ‘cynical’

3.Act of Suicide done as an act to join loved 3.1 Disbelief and confusion caused sudden one death 3.2 Want to deny reality and join loved one

Participant six. Participant six, who is 32 years old, comes from a Christian, Middle class milieu. She attempted suicide at the age of 28 years. The participant recalls her childhood as memorable. She categories herself as an ‘overachiever’ I various activities – be it sports, studies, choir or the school band. She shares a close relationship with her parents. After college, she travelled to another city to pursue her higher studies. During her time at college, she begins a relationship with a boy in the same college, they live-in Property of Christ University. Use it for togetherfair purpose.Give at a rented apartment. credit Duringto the thisauthor time, bythey citing become properly, one of those if youcouples are that using are it.

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‘inseparable and are able to complete each other sentences’. After their term at college, both find work in their hometown and hence travel back. They decide to get married and hence break the news to their families. They are aware this will be particularly difficult as they are from two different religious backgrounds. The participant breaks the news to her family members and although not too happy with the turn of events, they request to see the boy. Once they meet, the participants’ mother is won over by him. Her father and brother decide to go along with it for her sake. At the participant’s partners’ house, the family members do not take the news well at all; they even warn him that she maybe after his money, as they come from a wealthy background. They decide on certain conditions on which the marriage could take place. When these conditions are told to the participant she feels some of them are unfair as it will effect the prosperity of their children. They try to reach a consensus regarding the issues. During this time, things between the participant and her partner start to change. Insecurity is observed in events such as checking her phone and in the outburst that happens at the participants’ home when he tried to check her phone, in front of her parents. Feeling insulted she questions his actions, which he is not able to tolerate and lashes out at her through the use of verbal slanders. She is left feeling embarrassed, confused and wondering what to do next. The same situation repeats itself and this time she slaps him for insulting her and he escalates by choking her, the fight is broken up by her father who asks him to leave the house. She wants to call off the wedding but is not able to as she does wants to publicly embarrass her parents. On the day of the official engagement, her partner calls off the wedding saying that he did not want to be taken for a ‘fool’ and not marry a ‘used product’. She as well as the friend, who has been implicated, tries to clear the misunderstanding but the partner seems to be set in his beliefs. This further leads her to feel like she had brought shame and terribly hurt her family which leads to her attempting suicide. The event helps in forgiving herself, finding a new life for herself as well as being forgiven. The themes reflect that the relationship the impact of her traumatic event, perception of letting down and hurting her parents and suicide becoming a remorseful act.

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Table 6 Shows the themes and superordinate themes of participant SGK Super ordinate themes Themes

1.Experience of traumatic events 1.1Verbally abusive (‘whore’, ‘used product’) 1.2The fight where both got physically abusive 1.3Calling off wedding on engagement day

2.1 Feeling of bringing shame on the family, 2. Perception of letting down and socially letting down parents (feeling like she killed embarrassing her parents some part of her parents, especially father) and not being able to forgive herself 2.3 Concern for the way parents will be perceived to the society (‘laughing stock of society’)

3 Suicide as an act of repentance 3.1 Suicide an act to make things better 3.2 Suicide as an act to attain forgiveness from family

. Participant seven. Participant seven, who is a 28 year old individual coming from a middle income, Christian (Protestant) background, attempted suicide at the age of 26 years. The participant recalls spending time with her family. It seems those memories are like a 'distant dream'. She shared a very close relationship with both her parents. It was during her sixth birthday that she realized, that something was going wrong with her parents’ relationship. This happened as both of them forgot to buy her a cake. It's only when she reminded them that they even remembered that it was her birthday. She noticed her father was staying out of the house more often and her mother seemed sad and she used to sleep a lot. When the participant asked her father about why he was staying away from home, he replied saying that he had a lot of work to do and that his work required travel. By her seventh birthday, her father had moved out of the house permanently. It was on her tenth birthday that she understood that her parents had undergone a divorce. She thought she had somehow caused her parents’Property divorce. of Christ She remembers University. spending many sleepless nights Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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trying to figure out where she had gone wrong and how she can make it right - she did everything what she heard other parents wanted of their children - good grades, being good at extra-curricular activities, she even became the house captain. She cannot understand how he could marry somebody else and have a family with them. She constantly compares herself with the 'other' child of her father. She feels that nobody appreciates her or her talents, while her father seems like a 'changed man', somebody she does not know and cannot relate to. During her degree college, she feels like not trying to impress anyone anymore. She states that everyone started to see her as a 'rebel' and that she found freedom in this, the freedom to discover who she is and create who she can be. She even started dating. She goes through a series of relationships, each begins with the hope of it lasting and fulfilling her needs. But, she finds that none of the relationships are unconditional and that people just want to use her for their needs. A few times she even tries to threaten her significant other that she will end her life, if the relationship comes to stop. It does work for a short time, but does not seem to resolve any issues. She states that there is probably something innate that makes everyone hate her and want to leave her. The events in her life make her feel that she is not worthy of love. She grows disillusioned at the 'weary, conditional, world that plays by their rules of convenience' and attempts suicide as a way of showing her rejection of this world. The event does transform her by changing her perspective on her life and making her believe in a higher power. The themes reflected show that the role of her family – the impact of her parents, beliefs about self that led to suicide as an act of rejecting the society and the world.

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Table 7 Shows the themes and superordinate themes of participant TC Super ordinate themes Themes 1.Role of family 1.1Feeling of abandonment and rejection after divorce, especially by father 1.2Constant comparison between ‘my’ and ‘that’ family 1.3Absence of mother

2.1 Blames the word for her situation 2. Belief of Self 2.2 Feeling of incompetence (as daughter, student and girlfriend) and inability to fulfil expectations 2.3 Belief in love being conditional – a commodity to buy or exchange for another 2.4 Tired of being lonely

3. Suicide as an act of rejection of the world 3.1 Did not want to be in a world that did not want her 3.2 Feelings of loneliness

Participant eight. Participant eight, is a 33 years old individual, coming from a Kannada Christian, middle income background. She attempted suicide at the age of 30 years. The participant recalls her childhood as the only phase of her life that she felt ‘normal’ which meant that she was surrounded by the people who she loved and she had all that she wanted as compared to now, where she felt there was a scarcity of the many things. She comes from a simple, village life where her father was a farmer; she was educated in Kannada medium school. She has fond memories of her father being a loved man and especially adored by the children of the village as he used to play various games with them. After her tenth, the participant comes to the city to do a course in English as well as begin training as a secretary. After her course, she is placed as a secretary in a Hospital. Here, she meets a young doctor who takes an interest in her and starts to have casual conversations Property of Christ University. Use it for withfair herpurpose.Give. They become creditgood friends to the over author a period by of citing two years. properly, He also iftravels you toare another using it.

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city for his practice. Around this time, he proposes marriage to her, although surprised she states that this will have to be discussed with her father. The added issue was that they were not only from different religions but from different parts of the country. They boy comes down to meet her and her family and the father approves of the relationship. It is observed that the boy is not particularly close to his family and hence states that he has no problem with conversion, although his family members are against it. They are married and begin life together in another State, where they settle due to his practice. They discover various characteristics about each other. At this time, the participant goes back home as she hears her father is not keeping well. She also discovers that she is pregnant, she returns to her husband. Her father does well for himself with his new business but he falls ill again and is admitted in the hospital, where a clot is discovered in his brain and surgery is not possible due to his age. The doctor announces that he has a few more months to live. The participant struggles to cope with the news. Her father requests to see the son-in-law, but by the time he arrives, the father goes into a coma. The participant feels angry and let down by the husband, she becomes cold and distant towards him. Her father passes away and she also gives birth to her baby daughter, but is unable to return to her responsibilities. She pines away for her father or wanting to return to her husband or baby. She begins to spend time sleeping as talking to her farther in her dreams, is the only thing she wants to do. Unable to cope with her father’s absences as well as not being able to fulfill her responsibilities, she attempt suicide. The participant believes that the attempt was God’s plan as it became a step towards a better life. The themes reflect the close bond she shared with her father, the inability to fulfil her responsibilities, growing feelings of not being understood leading to suicide as an act to be with her father.

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Table 8 Shows the themes and superordinate themes of participant PK Super ordinate themes Themes 1.Role of family 1.1Feeling of abandonment and rejection after divorce, especially by father 1.2Constant comparison between ‘my’ and ‘that’ family 1.3Absence of mother

2.1 Blames the word for her situation 2. Belief of Self 2.2 Feeling of incompetence (as daughter, student and girlfriend) and inability to fulfil expectations 2.3 Belief in love being conditional – a commodity to buy or exchange for another 2.4 Tired of being lonely

3. Suicide as an act of rejection of the world 3.1 Did not want to be in a world that did not want her 3.2 Feelings of loneliness

Participant nine. Participant nine, who is of 26 years of age, comes from a Islamic, high income background. She attempted suicide at the age of 23 years. The participant recalls her childhood as a period where she comprehends what it means to be a ‘girl’. She reports of having observed various instances where her mother was treated like a ‘maid’ and a ‘criminal’ which leads to her mother attempting suicide by slitting her wrists, although she does not see the event she is aware of it. Her mother survives but the participant perceives her mother as helpless person, who cannot stand up for herself or her children. This is brought to limelight over and over again, with the various instances they face. She compares herself to other children and states that when other children were taught to dream of so many possibilities, she was made aware of her limitations and rules. She years for her ‘own space’, to develop her own identity but that is something that is not allowed. She grows up in a joint family, where the elders make decisions regarding Property of Christ University. Use it for everythingfair purpose.Give about her life. credit She feels to the ‘chocked’ author by by family citing from properly, all sides. Althoughif you are using it.

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surrounded by family, she feels lonely, as there is no one to talk to. She compares herself to water or clay that takes shape depending on the external molder. Women are treated in a particular way, there is no distinction in relevance to age, she stated that women have to work like dogs and that their age does not matter. She refers to women as ‘beautiful slaves’. She wishes that she was never born. The participant also remark that they live in a society that makes no sense and refers to them as ‘educated idiots’ School, tuitions, friends and college become her distractions, she refers to them as her places of escape where she does not have to face her family members or the drama created by them. The sudden death of her uncle (road accident) leaves her shattered, he is the only source of any kind of support she had in the family. She remarks that he is fortunate that he does not have to face the responsibilities of the world anymore and that she should probably follow his path. During her college years, she falls in love with Hindu boy and her life revolves around him, they plan on eloping. She prepares for this day but it never happens as the partner starts taking her for granted, starts to get involved with his previous girlfriend and does not respond much to her, gradually the relationship comes to an end. She feels like her ‘fantasy world’ and her escape from home collapses. Knowing she cannot lead a suppressed life or turn out like her mother, she plans for her suicide, which does make her cheerful as she feels that for the first time she is in charge of her life. She executes her plan of suicide. She perceives this event as part of her past, which should be left there and believes that going through the event has strengthened her to face anything. The themes show the perception of the participant about her mother as a ‘helpless’ figure,, beliefs about family and society, beliefs about being a girl, the various ways which she tried to cope with her situation. The act of suicide as a way of expressing that she had control over her life.

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Table 9

Shows the themes and superordinate themes of participant SN

Super ordinate themes Themes 1.Experience of traumatic events 1.1Seeing mother as a ‘helpless victim’ throughout her life 1.2Being punished for not doing their homework (incident of being hit with a construction pipe) 1.3Mother attempts suicide by slitting her wrists but survives 1.4The falling apart of her relationship as an adult

2.1 Aware that she is a girl at a young age, 2..Beliefs about being a girl awareness of limitations, when compared to other children who have dreams and fantasies 2.2Use of the term ‘I’ and ‘She’ – a sense of separation. Functional – property, ‘beautiful slaves’, make babies, women work like ‘dogs’, no matter the age 2.3 No concept of ‘my space’, ‘my freedom’ – comparison to clay and water. 2.4 Negation of her position as ‘first daughter’ – her father’s want for a son – negation of her ability and existence 2.5 Anger towards her community for such beliefs

3.Different methods of coping – her ‘escape 3.1 School and friends (first home) cry on routes’ days of holiday. 3.2 Avoiding or ignorance of family Property of Christ University.members (on phone all the time) Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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3.3 Studies and tuitions 3.4 Relationship with guy – staying away from home as much as possible – wanting to run away from home

4.Act of Suicide as a way of expressing the 4.1 Fear of own life ending up like mother ability to control her own life 4.2 Feelings of being a ‘zombie’, multiplication of feelings of childhood, after breakup 4.3 Planned suicide (method, day, giving away things) 4.4 Change in emotion (happy, excited, smiling)

Participant ten. Participant ten, who is of 29 years of age, comes from a middle class, Catholic family. She attempted suicide at the age of 25 years. The participant associates her childhood with her experience sexual abuse by her older cousin brother for a period of two years. She states that it was an experience that was physically excruciating and emotionally ‘tore her apart’, she can still recall the way his touch felt and even now she tends to react strongly to any kind of intimate physical touch, as she is constantly reminded of it. The experience influences her to such an extent that she prefers to be left alone most of the time, she does not make friends or trust anyone easily and avoids the company of boys as she is unable to communicate to them as other girls do, she feels uncomfortable around them. She states she was never able to talk about it, as they were an extremely devout catholic family, where thoughts or questions about the topic of sex were not encouraged. She felt that they would blame her itself, for even bringing it up. There was a another instance when another cousin brother tries to take advantage of her, in her own house but since she reacts strongly to this, nothing happens to her but after this she does not feel safe even at her own home. She states that she does not feel close to anyone in her family, it is way of living. The participant tries to cope with the situation by studying, reading, listening to music and dreaming about getting away from home. She shared her past, with a close Property of Christ University. Use it for friendfair purpose.Give who immediately credit blames to the the way author she dresses by citingfor the abuse;properly, this strengthens if you are her using it.

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view of the world. She becomes close with another girl who she meets through a friend. They become good friends. With time she feels that they should become more than ‘just friends’. They are sexually attracted to each other and do become intimate on a few occasions. The partner states that the relationship is only to fulfill certain needs. This puts the participant in confusion as she wants to have a ‘proper’ relationship with her but simultaneously her conscience and thoughts about homosexuality keep pricking at her. The former friend figures out the secret relationship and treats her like an outcast for it. Her partner leaves her as she wants more out of the relationship as well as during this time her pet, who is her only confidant passes away and she is blamed for its death. She feels like she is treated like a doormat at her work and not appreciated for the efforts she puts in for her work. Her mind keeps swirling with thoughts around these events, which makes her conclude that everybody would be better off without her. Hoping that she will be remembered and appreciated, she implements her attempt of suicide. The event changes aids her in understanding the power of the self and the kind of changes that can be employed, once the mind is set.The themes reflect the influences of the traumatic event, beliefs about self and going ahead with suicide as a way of not wanting to face pain anymore.

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Table 10 Shows the themes and superordinate themes of participant BT Super ordinate themes Themes 1.Influence of traumatic event 1.1Sexual abuse by cousin brother (age 7) 1.2Another cousin trying to advantage of her 1.3Blamed for the death of her pet, who occupied a significant place in her life 1.4Being exploited at workplace (no acknowledgement, no fulfilment expected remunerations)

2. Beliefs about self 2.1 Blaming self for not being able to stand up for herself (a sense of anger and helplessness) 2.2 Belief that everybody would blame her for the experience and not believe her 2.3 Belief that she is ‘bad’ and ‘disgusting’ for experiment with homosexual relationship, rejected by her close friend for this act 2.5 Belief that she is a ‘doormat’

3. Suicide as a way of putting an end to the 3.1 Earlier try (standing on terrace) pain experience 3.2 ‘cut self away from the pain’

Discussion The IPA model not only acknowledges the unique characteristics of the individual but also looks at similarities across the participants. Both, the uniqueness and similarities are made a note of in individuals as well as across participants. The themes that emerged across the cases are discussed according to the objectives of the Property of Christ University. Use it for research.fair purpose.Give credit to the author by citing properly, if you are using it.

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Major objective To study the psychological profile of the individual who survived the attempt of suicide Specific objectives To study the frequent thoughts that lead to suicidal decisions To explore the emotional experience/s of the individual, before the suicidal decision (in terms of significant life events) To explore the meaning assigned to their actions

The experience of suicide and the meaning individuals attach to their experience is an intimate and unique, it is difficult to categorise them under a particular theme. The one difference is that the superordinate themes of the individual level are retitled as the subthemes for cross case analysis. The master themes or superordinate cross case themes, are derived by following the same process, as was followed for developing the superordinate themes. Processes of abstraction (putting similar themes together), polarisation (putting opposing themes together) and numeration (frequency of themes)

Table 11 Reflects similar cross cluster themes across participants, that lead to decisions of suicide Master Themes Superordinate themes Themes 1.1.1.The need for belonging and acceptance (constant negative thought of being alone and non acceptance) 1.1Reliving past painful 1.1.2.Beliefs contributing to the sense of memories self (thoughts on self-blame, not being believed, reliving past painful memories) 1.2Dichotonomous 1.1.3.Beliefs leading to the origin and 1.Emergence and thinking and self blame development of negative sense of self maintenance of (thoughts on self blame, constantly the restrictive, 1.3 Belief in ever-lasting questioning the ‘why’ of situations, negative thoughts nature of problem believes in being a curse, strict pattern of Property of Christ University.thinking, hopelessness) Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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1.4Overwhelming sense 1.1.4.Beliefs about self (thoughts on self of hopelessness blame – strict pattern of thinking) 1.1.5.Perception of being and managing everything by self (thought on questioning ‘why’, becoming cynical) 1.1.6.Sense of hopelessness 1.1.7.Belief of Self (blames the world) 1.1.8.Sense of Hopelessness 1.1.9.Sense of hopelessness 1.1.10.Beliefs about Self (past memories, self blame, strict ideas of ‘good’ and ‘bad’)

Superordinate themes emerging during cross case analysis, according to the first specific objective. The first specific objective refers to cognitions, thoughts, beliefs that influences the way the person interprets the world around him or her.

Reliving past trauma.One does hear individuals talk about the bombardment of negative memories or negative events, when one is feeling low. Here, many of the participants talked about having to relive the pain provoking events just by recalling them. The narratives of participants SS and BT reflect that experiencing of past trauma. Participant SS states “I felt like my life was spiralling out of control. All what I been through kept coming back to me” (SS, personnel communications, June 4, 2013) During the conflicted process of taking a decision regarding her marriage, these traumatic events of sexual abuse at various stages of her life, seemed to haunt her. She talks about these memories have frightening, dominant and prevailing qualities. While, participant BT states, “Each time I felt low, these horrible memories would come rushing back to me” (BT, personnel communication, July 24, 2013) reflecting that each time a negative situation happened, these memories would come back to her, in a flash. It is interesting to note, that the participant mentioned ‘each time’ that she felt low she would recall the memories, in contrast to it being recalled only when intense negative situation or events took place (present). Participants SS and BT talked about overwhelming memories that kept reminding them of what they had been through the past. Both participants had been Property of Christ University. Use it for throughfair purpose.Give child sexual abuse credit as well to theas sexual author abuse by in citing the adolescent properly, phas ife youof their are lives. using it.

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These memories were provoked by present negative mood states. In the studies conducted by Godden and Baddeley (1975), showed that certain memories could be triggered by the mood state they were in, which means that if they were in a negative mood state they would recall negative events that had occurred while being in that mood state in the past, which according to Neuringer (1964) this would fuel cognitive rigidity or a fixed way of perceiving the world. It’s like a pathway, initially the association between the connectivity points (thoughts and emotions) are loose but the more the pathway is used the stronger the connection becomes. Hence, this could also be one of the reasons that directly influence the quick or immediate negative automatic thoughts which is observed in participant BT narrative. Ruminations or repetitive thoughts also formed a key characteristic, which would make the individual think that they are attempting to solve an issue, but all the while, having these thoughts only maintained the cycle of negativity. This can be seen, in what is stated by participants GK and SB. Participant GK states, “Why did this happen to me? All of this, all of a sudden, what did I do?” (GK, personnel communication, January 28, 2013) In the background of a series of traumatic events, she is seen as looking or rather searching for an answer that justifies what she is going through the same dynamic can be seen to be at work with participant SB who states, “What did we do to deserve this?”(SB, personnel communication, May 12, 2013) where she too is searching for an answer. The participants ask themselves these questions aiming at delving at the issue and trying to resolve it but end up sustaining the negative mood state. Ruminations play the role of illusive solutions.

Dichotonomous thinking and self blame. The way one thinks directly influences behaviour and emotions, which is one of the salient features of any cognitive therapy. But, a depressive mood is caused due to faulty schema or beliefs. There are many types of cognitive distortions. But, one that can be seen to be in play here is dichotonomous thinking or simply put, black and white thinking. It refers to very strict way of processing information where, the information is categorized into strict sections of ‘good’ and ‘bad’, according to the persons’ beliefs, ethics and value systems. The narratives of the participants reflect that they thinking in this particular manner limited the ability to generate alternative solutions.

I was broken, I could not sleep or eat – I just could not forgive myself. Knowing that my life could be better. Knowing I could have made better Property of Christ University. choices and that i had made bad decisions, was too much for me. I felt Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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like I was too dumb to live life and because I took these dumb decisions my life had become miserable. I could not forgive myself for my dumbness!(JS, personnel communications, June 7, 2013)

Participant JS talks about making a series of wrong decisions that has led to her pitiable condition. Her awareness, that various situations could have be avoided if she had taken different decisions proves to be causing her to feel regret. She holds herself responsible for her actions. She calls herself, in the light of her awareness, proclaiming that a person as dumb as her should not be allowed to live, she is unable to forgive herself, at the realisation that the pain she is now going through is the consequence of her own actions. While, participant SGK is unable to forgive herself as she considers herself to be the cause of her beloved parents’ public humiliation. Her fiancé calls the wedding off and insults her as well as her family on the occasion of their engagement. Although, her relationship falls her part, she cannot stand the thought of her parents being ridiculed for their open mindedness and support of her, through every decision that she made. She came from a larger restrictive community where inter-religious marriages were not allowed; hence her parents supporting her had meant a lot. But, now due to the way the events had turned out, she was concerned about her parents and how they would take it. She is unable to forgive herself for bringing shame on her family. She states, “My parents did not deserve a wretched daughter like me. I did not deserve to live.” (SGK, personnel communication, June 10, 2013) As she has brought shame to her family, she transforms from the good to bad daughter.

Participant BT states, “I knew what I was doing was wrong, it would not be accepted by anyone!”(BT, personal communication, July 24, 2013) She talks about her sexual orientation and stated that she knew it was wrong to be attracted to another female. She even generalises this feeling of non acceptance towards everyone. Here, she too classifies herself as bad due to her orientation. Participant SGK and BT see themselves as ‘bad’ individuals causing pain to themselves as well as to the people around them. Studies by Neuringer 1968 had observed dichotonomous thinking which were linked to suicidal ideation and completion. This also added to cognitive inflexibility or the inability to think of various other solutions since the person cannot see beyond this cycle of negative beliefs. It is also observed that, during the dichotnomous thinking, most participants tend to blame Property of Christ University. themselves for the situation, even in instances of sexual and physical abuse, participants Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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BT, SS and JS blame themselves for not being able to take a more active role in protecting or defending themselves or even being able to make better decision, the sense of helplessness coupled with the inability to cope with the situation has been found to be common especially in individuals who have faced abuse (Brent, 1994) Studies have also linked excessive amounts in external or internal locus of control associated with suicidal behavior (Palmer, Rysiew, & Koob., 2004) Participant TC, reflects a unique observation, she is the only participant in the sample that has ‘blamed the world’ (external locus of control) for her situation while other participants have internalized the blame for the situations they face. Internalization of blame is found to be common among women, especially in South Asia (Niaz, Hassan 2006)

Belief in ever-lasting nature of problem. Participants talked about thinking that their situations would never come to an end. Participant SB states, “I kept getting a lot of negative thoughts like this life was not worth living, this is what my life was going to be, my life would never improve. I was supposed to go through all the negativity. I just put it to the back of mind – but when it’s there for a long time, you start to listen to it, you start to believe it is true and you start to see life from that perspective” (SB, personnel communications, May 12, 2013) The narratives of participants SB shows that the events that she had to go through made her believe that she had to go through all the negativity and that she had to live like this her entire life. While participant TC states, “you don’t believe anything anyone says, theres’ no way of avoiding these situations, you have to go through it, it effects you, they become a part of you.” (TC, personal communications, May 28, 2013) Participant TC states that these negative thoughts one gets after going through a negative event or events is not just a passing phase, but its effects are so powerful that they last an entire lifetime. The negativity of an external event becomes the inner negativity. It is observed that both participants do not feel that this was a temporary phase of their lives. As a result, they started viewing themselves and the world around them negatively. This is in conformation with Becks theory on the cognitive triad, which stated that the an individual with depression or suicidal ideation is found to have a unenthusiastic view of himself, of the world around him and as well as the future (Grewal & Poter, 2007) The narratives of participant GK show that they felt that they were going through various events that were not considered as part of the normal routine, “One after another, bad things just kept happening – i could not understand it” (GK, personnel communications, January 28, 2013) Property of Christ University. They felt that they had being trying to cope with various traumatic events for a long time. Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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Traumatic stress could be brought about by any event that distressed or upset the person undergoing it. Enduring high levels of stress, for long periods of time was associated with suicidal ideation (Brent, 1994) Also experiencing elevated levels of stress along with the inability to manage or unravel the situation was also associated with suicidal behaviour (Schotte, Clum, 1982) Problem solving and solution implementation, is an essential part of feeling competent, thereby also influencing self esteem or the way one would evaluate oneself. (D’Zurilla, Chang, 1995) This kind of negativity also gave rise to the attitude of cynicism. Bader in 1996, explained what cynicism meant, he stated that it was when other individuals were looked at as people who are motivated to protect their vested interests. But here, participants SB and TC use the term ‘cynic’ with the meaning that is similar to sceptic, where the person is always have a questioning attitude about everything and in their understanding of it, it is their continuous thoughts on negativity that even makes them question the occurrence of a positive situation. So even if something positive occurred, they would view it with negativity. Bader (1996) drew a link between cynicism and suicidal tendencies. Individuals tended to focus on themselves as the creators and sustainers of negativity (internal locus of control) this also signified the amount of control they had to change themselves or the kind of situations they were in. Participant GK, states. “It was like i had Medusas’ touch – everything and everyone i came in contact with became unhappy” (GK, personnel communications, January 28, 2013) Here, her thoughts about negativity are so strong that she ascribes the origin of that negativity to herself and refers to herself as a ‘curse’. The narrative also reflects that they viewed the situation they were going through as long lasting and permanent, which means that they could not fathom a positive future. This supplemented feelings of hopelessness (William Pollock, 2001).

Overwhelming sense of hopelessness.Hopelessness was considered as a cognitive element. Most participants talk about feeling a sense of hopelessness. “I started to feel like there was nothing else I could do – I started to feel trapped, like there was no hope left – I felt like screaming but I could not. I could not do anything”. (GK, personnel communications, January 28, 2013) Participant GK, describes hopelsessness as a feeling of being trapped, while participant SN states that it feels like her fantasy world had been destroyed

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we had so many different opinions and fights on everything, I felt so broken! I kept trying really hard to make the relationship work but it just did not feel the same, I felt like my escape route from my family was fading. I felt like there was no more hope left. (SN, personnel communications, March 5, 2013)

While participant SGK gave up trying to do anything more, she admitted a sense of defeat, “This was such a hopeless situation. There was nothing left to be said.” (SGK, personnel communications, June 10, 2013) Participant GK, SN and SGK felt that they had no other alternative before them. There is a sense of not being able to do anything about the situations’ they were going through. They felt like they did everything they can but they were nothing more they could do, this feeling of not being able to do anything else is what they refer to as feeling trapped. Participant GK had been through a series of loss and sudden changes, it made her feel as though she could not change her situation. Participant SN also felt that her ‘escape route’ had disappeared, all that she had worked towards had come to an end and she could not do anything about it. Participant SGK also expresses despair and a sense of ‘giving up’ at trying bringing about any kind of change. The element and degree of the cognitive construct of hopelessness is detrimental to the act of suicide. Studies have shown a positive relationship with hopelessness and suicide. (Kumar, Steer, 1996)

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Table 12 Reflects similar cross cluster themes across participants, according to the second specific objective of research. Master themes Superordinate themes Themes

2.1Feelings of anger and 2.1.1.Experience of traumatic events (thrown impulsiveness (feeling out of home for sexual orientation, attacked of regret) by strangers, left by partner) 2.Experience of 2.2.Experience of traumatic events negative 2.2 Fear and experience (childhood sexual abuse, abuse as emotions of loneliness, not being adolescent, marital rape) towards self, understood or fear of 2.2.3.Experience in a series of traumatic emerging from being judged events(change and passing away of father, the traumatic accident and moving away of brother, events 2.3Fear and feeling of financial issues, partner cheating on her) rejection and 2.2.4.Experience of traumatic event worthlessness (violence) 2.2.5.Experience of traumatic event (split in 2.4Feeling of being a joint family, illness of mother, sudden death burden of fiancé) 2.2.6.Experience of traumatic events (physical fight, calling off engagement) 2.2.7.Impact of family (divorce of parents) 2.2.8.Traumatic event (dad passing away) 2.2.9.Experience of traumatic events (mother, ‘girl’, falling apart of relationship) 2.2.10.Influence of traumatic event (sexual abuse)

Superordinate themes emerging during cross case analysis, according to the second specific objective.The second specific objective of research is to explore the emotions involved, in terms of the negative life events experienced by the participants, Property of Christ University. Use it for whichfair purpose.Give they attribute to playingcredit toa role the in author influencing by theirciting decision properly, of suicide. if you It isare worthy using of it.

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noting that participants report feelings at two levels, feelings experienced due to the event and feelings experienced about themselves in the light of the event. For example, a participant talks about her abuse as making her feel angry that it had happened but she also states that it was shameful to talk about it to others. The second level of interpretation of feeling shows the perception of self and identity, in relevance to a community, society or culture coming into play.

Feeling of anger and impulsiveness. Literature reflects that the traits of anger and impulsiveness, independently and inter-dependently can be seen as leading to suicidal behaviour. The data of the participants shows that although the feeling can be narrowed down to anger and impulsiveness, it can be generalised and stated that they felt a sense of regret for the type of decision that were made and the present situations that they were going through because of those decisions. . Aggression was found to be noticeably raised amid the suicidal patients. (Conner, 2009) Participant JS, states, “I was so so angry with him. He had ruined me, he had ruined my life! I was so angry with myself, why was I so dumb not to do anything to get away. Why was I so dumb?” (JS, personal communication, June 7, 2013) The narrative of participant JS, reflects the anger she initially felt for her partner and then she felt for herself for not being able to make a better decision. She classifies herself as being ‘dumb’ for not being able to make an informed choice. She goes on to state,” I could not wait anymore I had not great plans of killing myself, I just wanted to die, I wanted to die soon. I did not want to feel anymore, to not hear voices in my head accusing me, I did not want to hurt anymore, I had enough. I just wanted to die soon.” (JS, personal communication, June 7, 2013) The narratives show that the participant also feels s a sense of urgency to put a stop to the kind of situation she is facing. She states that she has had enough and is unable to take it anymore. Participant SGK states, “I looked at them, they looked so sad, I could not stand that, all because of me, this had happened! I had to do this.. I took the knife and ran to my room” (SGK, personal communications, June 10, 2013) while participant VIJ states, “I got angry at her and then she told me that all of this my own doing – God was punishing me for my decisions and actions – this pushed me over the edge.” (VIJ, personal communication, July 16, 2013) Here, both the participants felt anger towards themselves, leading to the feeling of impulsiveness. The role of anger, impulsivity and suicidal behaviour is found to play a strong part in influencing the suicidal act. (Anestis, 2007) All three participants mentioned here, show that the feeling of anger Property of Christ University. against themselves was experienced for a longer amount of time while the feeling of Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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impulsiveness was experienced in the final moments leading to the act. Although impulsivity has been noted in suicidal act, its link to lethality is yet conclusive (Selby, 2007)

Feelings of loneliness, not being understood or fear of judgement. The loneliness that participants felt were directly associated with their perception of their own helplessness and the support received from near and dear ones. Participants have expressed their feelings of loneliness as a result of not being able to communicate to another, their fear of how they would be perceived, fear of being judged or not at all being supported by the other. Various researchers have confined the feeling of loneliness as a powerful feeling that can independently be linked to suicidal ideation. A participant states,

I felt like my life did not matter anymore, I had no one to share it with - what was a life without having someone to share it with, you might as well be dead, it will be like you never existed anyway. Nobody would remember sweet or annoying things about you, nobody was there to celebrate you birthday and other joys, there was no one to share your fear, worries and sadness with it – life seemed pointless. (VIJ, personnel communication, July 16, 2013)

Participant VIJ expresses her viewpoint of life being futile, without having anyone to share it with. The participant had tried, for a major part of her life to be a part of groups she considered significant. Especially here, she refers to having a partner to share her life, hopes, sorrow and dreams with. Not having a partner is equivalent to not existing. While participant TC states, “I was just tired of being alone’ (TC, personnel communications, May 28, 2013) Participant TC plainly states that she was weary from being lonely. Being alone and lonely, were looked upon as the former being a choice, while the latter was situation to cope with. Participant GK states, “From being frank, I had to start wearing a mask all the time” (GK, personnel communications, January 28, 2013) where she feels that after the experience of these situations she was unable to trust or communicate with anyone, what she was going through, also there is a fear of judgement as well. Numerous studies have been established associating loneliness and suicidal ideation, at different phases of life. Loneliness was experienced as a result of inability to communicate what one was going through, isolation of oneself, perception of support received and degree of help Property of Christ University. seeking behaviour when needed (Baumeister, 1995) On the same note, it is interesting to Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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bring to one’s attention that participant JS who talked about others perceiving her as a failure, was something that she feared and she could not stand the thought of others seeing her that way. She states,

I knew about this behaviour of his even before marriage but it was not this bad then and I always thought it was a childish way of behaving and that he would grow – up out of it. But that never happened – if I told somebody, I would have to tell them all of this and they would ask me why I went into this relationship then, and I did this thinking it would work and that I did not want my relationship to fail at any cost (JS, personal communication, June 7, 2013)

This becomes a strong reason that hinders or stops her from reaching out for any kind of help, because she feels the moment that she does this, she will be judged for her problems and seen as a person who could not work on her relationship and make it work. There can be a lot of factors such as inability to trust, fear of judgement and fear of rejection, social stigmatisation, protecting the prestige and honour of the family colouring her decision to not reach out and ask for support (Colucci, Montesinos 2013)

Belief in being a burden. Studies reflect that individuals feel like they are a burden to people who care for them and love them. Engaging in the act of suicide is especially observed if an individual feels that their loved ones stand to gain from it or if their absence would benefit them in some way. “ I felt like nobody appreciated me or the things i do. I had felt like no one liked me or wanted me around so i thought i would do everyone a favour and do away with myself’ (BT, personnel communications, July 24, 2013) Participant PK states that she felt unacknowledged and invisible to people around her. She expresses a sense of disconnect or not being able to relate to others as well as others as not being able to relate to her. This ignorance and isolation from people makes her feel that she is a person whose company is not enjoyed and hence seen as doing a ‘favour’ for others by not making others putting up with her presence. While, participant PK states, “I did not want to do anything, I could not, I was not at all useful to anyone, to my mother, my husband and to my baby also” (PK, personnel communications, January 25, 2013) Participant PK could not perform the duties of a wife, mother and daughter as she was grieving for her father. She was unable to get herself out of the grief she felt over this, Property of Christ University. which led to her not being able to attend to her duties and responsibilities, which made her Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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feel that she was useless in relevance to others. Studies done by Garza & Petit (2010) showed that perceived burdensomeness was related to suicidal ideation.

Fear or experience of rejection and worthlessness. Participants expresses that some of them had been through these experiences before and hence feared it from happening again while others felt a sense of rejection and worthlessness due to the past or present similar situations which they had to face. Participant GK, while talking about her relationship or partner who cheated on her states, “I cannot believe he used me like that, i had considered him in the place of my husband, how could he just throw me away like that?” (GK, personnel communications, January 28, 2013) Participant GK felt a deep sense of rejection as she had considered him not to be just a boyfriend but a partner for her life. Not treating her with the same values and respect also made her feel worthless. Participant VIJ states, “They asked me to get out of the house, i was dead to them, they could not accept me” – (VIJ, personnel communications, July 26, 2013) The narratives talks about her immediate family, asking her to leave home as they could not accept her as a ‘homosexual’, she had struggled hard to be a part of the family and society but after a point she felt she had to be herself. The fear of rejection and the need for acceptance was a prolonged inner conflict and to finally undergo rejection by her immediate family was a huge setback to her perspective about herself and her life. The participants talk about the inner conflict of accepting her values and the values imposed on her by the family and society, the inability to make the decision. The psychological stress arising out of the conflict between traditional and liberal values, is also linked to have led to the decision of suicide (Bhugra, Desai 2002)

There were so many instances that I came across in my life that I was pointed out that I was a girl! It made me feel it was equivalent to being dumb. Even my father used to keep saying that he wished he had an older son then it would have been if help in so many ways (SN, personnel communications, March 5, 2013)

The narrative of SN also reflects that being a girl and that being pointed out to her as a impediment at various instances in her life, made her associate the being a girl with that of worthlessness. In this case, she is the oldest sibling in the house but her father wishes the oldest was a son, this notion also makes him treat the younger son with more importance, which leads to the unequalProperty treatment of ofChrist the children. University. Studies show that the type attachment Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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children share with the parents also contributes to the feelings of worthlessness. Here, there is no sense of attachment between father and daughter. (West, Keller., 1996) Other studies also showed that individuals rejections of own cultural values also contributed to the decreased sense of self esteem, belongingness and worthlessness. (Bhugra, Desai 2002) Participant SS, states, “I felt so small, so dirty, like some use and throw material. I hated having to give in every time” – SS (Sandy, personnel communications. June 4, 2013) Sexual and physical abuse had an impact on the individual at various levels. Participant SS, talks about her feeling that she was reduced to a ‘use and throw’ item after her various experiences with sexual abuse at various instances in her life. Studies by Brent, 1994 showed that childhood traumatic experiences were directly associated with that of attempt of suicide, as an adolescent and as adult. Other studies also showed the development of intense fear to certain stimuli as well, the feelings of powerlessness and incompetency to manage the situation. These feelings are seen in the narratives of SS and BT who faced childhood sexual abuse. There are also associated feelings of fear, inability to trust easily and anxiety of significant others believing them (West, Keller, 1993)

Table 13 Reflects similar cross cluster themes across participants, according to the third specific objective of research. Master themes Categorisation of Superordinate themes at individual level Superordinate themes 3.1.1Suicide as an act of rebellion and rejection 3.1An act of standing up 3.1.2Suicide a way to ‘save face’ from own family 3.Suicide as an for oneself and failing their expectations action that fulfil 3.2An act of repentance or 3.1.3Suicide as an act of correcting a wrong the meaning held remorse 3.1.4Act of suicide as an act of punishment of by individual 3.3An act to reunite with self loved on 3.1.5Act of Suicide done as an act to join loved one 3.4An act to put an end to 3.1.6Suicide as an act of repentance pain experienced 3.1.7Suicide as an act of rejection of the world 3.1.8Suicide as an act of going to father 3.1.9 Suicide as an act of controlling one life 3.1.10Suicide as a way of putting an end to the Property of Christ University.pain experienced Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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Superordinate themes emerging during cross case analysis, according to the third specific objective.The third specific objective is to explore the unique meaning of suicide that has been assigned to their actions by the participants. It is this meaning that becomes the motivation for participants to persuade themselves into action; it is the meaning that transforms their suicidal ideations or plans into reality.

Suicide as an act of standing up for oneself (rebellion, ultimate control over oneself and rejection of family and society). The narratives of participants VIJ and TC reflect their decision of not wanting to be a part of their family and community anymore. Studies reflect that family care and support is a protective factor against suicide but here, in the light of non acceptance from parents as well as other significant relationships, it become a factor that pushes them further to make the decision of suicide. Participant TC, perceived herself to be rejected by both her family and her string of relationships (boyfriends) while participant,

I felt so weary about this conditional world that plays by their rules of convenience. Nobody ever loved me; I don’t think anyone ever really did. Nothing was ever enough! I did not want to be a part of a place that did not want me (TC, personnel communications, May 28, 2013)

VIJ spent her entire life trying to ‘fit –in’ first as a girl in a patriarchal society and secondly as a homosexual.

I did not want to change and live like a zombie, if I had a life, I would only live the way I wanted otherwise I did not think of it as worth it. I felt that the world was filled with zombies, people who kept making senseless sacrifices to live in a senseless society. I could not deal with this anymore – I did not want to live a life that was forced onto me (VIJ, personnel communications, July 26, 2013)

She felt that she always being asked to change to conform to the norms of the society. She was always aware of her differences but while growing up, she tried to be like everyone else. Later on, her partner also is forced to be ‘normal’ and marry into a family Property of Christ University. that her parents have decided for her. Participant VIJ is utterly disillusioned, with this inner Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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conflict that is tearing her apart. She decides to live her life her way and that is the statement she wants to make with her act of suicide. Studies show that, usually in society or culture centered communities, when they was immense pressure from a family or community on an individual to conform the individual would go through tremendous inner conflict which may ultimately lead to the choice of suicide (Bhugra, Desai 2002) The inner conflict would lead the person into taking decision that usually seemed extreme, either in terms of cutting off from the family or taking away their own lives. The same article also listed out factors such as gender related roles and expectations, domestic violence and alcohol abuse carried out by male family members, conflict between liberal and traditional values and distress caused by the persons’ rejection of his or her cultural values, all, led to suicidal behaviour. Participant SN states,

I started to feel happy, i smiled even, like for the first time I had a plan and I was doing it, everything for once was under my control. I did not want to live my life in the way others dictated (SN, personnel communications, March 5, 2013)

The narrative expresses the participants want to be in charge of her life, while normally a person would fear death, the participant states that she feels happy, as she possess the power to make the most important choice, the choice of life and death. Earlier in her verbatim, she had stated that death was always the option she could resort to, if circumstances came up for it, the thought always seemed to comfort her. One of the main reasons for her feeling this way that she had felt powerless her entire life, in her narratives she also recalls a time when she was in the eight standard and her family wanted to marry her off and she was so furious that her family had the power to do what they wanted with her life, when they wanted. She was brought up in a traditional, patriarchal family, which meant traditional gender roles were followed. Traditionally speaking, a man would the powerful, decisive, leader who would also have financial authority while traditionally a woman’s’ role would put them in a more docile, obedient, submissive position, where her husbands’ and family needs had to be put before her needs. Traditionally, women would internalise the pain and frustration that rose from these events. They would consider it their fate (Colucci, Montesinos 2013) She being from an Islamic background, suicide is considered a sin, she persuades herself that religion and the ways of life are for the people of this world who are alive and are interested in living, it is not meant for the people who Property of Christ University. are already dead inside and who look alive on the outside. An analogy is made of her Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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present existence as that of a zombie, feeling that she is floating in vacuum. Hence, when finally the participant is no longer able to live life, the way she has been, she makes the ultimate decision, expressing her desire and her ability to be the master of her life.The need that the participant was trying to fulfil was need for autonomy, independence or freedom. The ability to make her decisions and run her own life (Merton, 2009) The act of suicide is highly individualistic and personnel but its impact is felt on the larger society as well. On philosophical perspective, suicide as stated by Henry Fedden, as cited by Georgia Noon, 1978, was considered to be an act of contempt towards humanity, insulting the way of life, values, beliefs and norms that are being followed by the larger society. This forced them to look at and question their society and themselves more critically, the way of life that seemed so dear to them and made their life worth living. Normally, there is resistance towards any kind of societal change; hence society condemns such individual acts. Philosophers such as Montaigne, also stated that there was only one entry door to life while there were many exits. It was the lack of action or cowardice or fear that prolonged the suffering of an individual. Living would then become an act of slavery especially when there were feelings of wanting to die. While another philosopher, D’Holbach stated that life of an individual was based on the contract of mutual benefit received from the society. If the society could not provided the stated benefit, the individual had the right to remove himself from that society. (Noon, 19778)

Suicide as a method of expressing remorse. Suicide was also seen as a method of expressing regret, remorse or repentance. Participant SS states, “I wrote a letter saying that my suicide was not anybody fault and that i could not take it anymore that i am sorry I had failed everyone” (SS, personnel communications, June 4, 2013) The participant had gone through various instances of sexual abuse in her life, which had contributed to her internal conflicts on issues such as acceptance from others, self worth, ability to trust and her relationship with her body. These conflicts are heightened all the more, when she gets married to an individual whom she loves but he also, starts to sexually abuse her. She desperately wants to get out of the marriage, get a divorce but her mind is filled with thoughts about what the society would think of a girl who is getting divorced at such a young age. The fear that people may talk about her negatively as well as she may have to face some kind or form of negativity from them, weigh heavily on her mind and she is unable to take a decision. Hence her decision of suicide is dual functional that is, it helps Property of Christ University. her in getting out of her present situation and she does not have to face the consequences of Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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her action. She also expresses her sorrow for not being able to live up to her family and society expectations of her. While participant SGK states, “It killed me to think mine did support me and now they were the laughing stock of the community. More than anything else I cannot forgive myself for doing that to them” (SGK, personnel communications, June 10, 2013) Her narratives reflect that although she came from a traditional background, her parents had given her the opportunity and encouraged and supported her in various decisions that her larger community would interpret as improper, modern and not befitting their culture. But, when the one of her decisions, her decision regarding her life partner, goes wrong and brings about shame on herself and her family, she is unable to bear that she is the reason for her parents being talked about negatively or ridiculed by the larger community. Unable to manage those feelings, she decides that suicide is a way out, added to that it is through this action that she will express repentance for making her parents feel this way. Participant JS, states, “I was so angry with my myself, a person as dumb as me does not deserve this life” (JS, personnel, communications, June 7, 2013) She states that she had made the worse decision in her life, although was aware of certain situations from the beginning, she thought it would change but with time the situations grew worse and she kept making bad decision. She blames herself, for losing two babies (one by abortion and the loss of the other life due to accidental abortion that took place due to physical abuse by her husband) She, by nature used to love taking care of children and being in their presence, so when this happens she gets enraged at her partner and then at herself, for letting this happen. She verbally abuses herself by stating that she is dumb to have a life and her decision of suicide expresses repentance at this feeling, its her way of expressing remorse for having to take away her unborn children precious lives. It is interesting to note, community dynamics at play here, the prevailing role of collectivism over individualism is observed. Earlier studies on suicidal notes also reflected thwarted anger as an intra-psychic factor for the cause of suicide. As being a collectivist community where acceptance by the other was laid emphasis upon, anger is thought of as a negative emotion that cannot be expressed directly, hence it is expressed towards the self (Leenars., et al, 2010) Beauchler, as cited by Robert Merton, 2010 who explained suicide as an option and action undertaken in order to satisfy a need, would classify this as escapist suicide due to remorse where the individual is reprimanding the self and expressing remorse, for the incapability to meet the terms and wants of others (the need for acknowledgment is seen to be in operation here)

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Act of suicide to reunite with loved one. Literature shows that the act of suicide is sometimes pursued with a clear plan, while some others follow impulsiveness. Participant SB, states,

My mind could not process it. My first thoughts were that this could not be happening, this has got to be some bad dream – I could not even cry – I was so confused. I just sat on the floor and started rocking myself, this was not true – this was a bad dream. He was not dead. I wanted to get up from this dream, I did not want to be in the nightmare anymore – I looked at the window – thought I would jump – I would get up from the nightmare and if the news was true I could join him – it was a quick thought and that was what I was going to do – it felt normal and right. (SB, personnel communications, May 12, 2013)

In the case of participant SB, the confusion ad impulsiveness of decision can be seen. It is a decision that she takes in a matter of a short span of time after hearing the news of the sudden death of her fiancé. There is a significant connection between impulsivity and suicide attempt (Becker 2007) But, the meaning that is held for their attempt is significant. Both participants, view suicide as a method that will get them back together with the person they cherish the most. Participant PK states, “I did not want to live this life anymore – I wanted to go be with dad – when he used to be alive I used to feel so brave, so strong like I could do anything” (PK, personnel communications, January 25, 2013) For participant PK, she views it as a way a reuniting with her father and resuming the role of a carefree child. She is not able to resume her role and responsibilities with that passing away of her father. She feels that she has lost an integral part of herself, without which she is not able to function normally. Reunion suicides are referred to as oblative suicides (Merton, 2007)

Suicide as an act of wanting to put an end to pain experienced.Participant BT states, “I just kept feeling used by everyone, blamed by everyone. I wanted not to feel anymore I wanted to cut myself away from all of this” (BT, personnel communication, July 24, 2013) The participant here, talks about the pain she experienced which led from her perception of the world around her and from this perception all she could understand is that she was alone. She did have any support of any kind from family or friends, added with the Property of Christ University. fact that was going through situations which were not considered as normal She was Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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abused as a child and then abused as an adolescent, coupled with this, she was confused about her sexual orientation, but she craved for some sort of support. The pain of not being able to find a partner or anyone to be with her was too much for her. The realisation that she was alone, disliked and shunned by people who she cared for, was a painful experience for her. Studies do show that suicide is generally the result of unbearable emotional pain, which likened to that of torture (it is referred to as ‘psyche-ache’ by Shneidman (1985) in his earlier articles) - the thought, emotions and experiences of the individual have the common aim of eliciting pain in the individual. Suicide becomes the option where that pain can be completely stopped. This is referred to as escapist suicide. (Merton, 2009) The pain of the person is something that is being elicited consistently and the individual is overwhelmed by it. The individual is unable to manage the pain and suicide becomes the only option to stop it the pain.

Unique findings.The interpretation of meaning of suicide does not simply stop at the participant’s perception and explanation of it but it can also be observed in the action they execute, as in the mode of the method they chose to commit suicide. The data displays data which are not only in support of various studies but also represents findings that were unique. Those findings have been mentioned below. Participant SN states,

I had to choose a method, I somehow did not like the idea of hanging or slitting my wrist. But the thought of water, it had something soothing, relaxing about it, I did not know how to swim. But, I felt that I should probably end my life in something that I loved so much considering I lived my life with things I did not like. (SN, personal communications, March 5, 2013).

The participants choice of death also coveys that she not only stood up for herself but chose something that she felt secure and happy in, to surround herself with, in order to complete this transition from living to beyond. Her statement clearly resonates the want to do something for herself, the manner that she likes. Even the behaviour of participant SS, at the final moments had changed from restlessness to calmness, reflecting a certain sense of certainty in every step that she took. There is no sense of haste or confusion at any step. She states, Property of Christ University.

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I went and had a long hot relaxing shower, with my favourite music playing in the background. I just listened to the music, then I dressed myself in my house clothes and ate something and then I took the sleeping pills and swallowed them one by one. I washed it down with a half a glass of whiskey. Then I went ahead and put on the TV, I chose to watch a comedy show. I wanted to laugh, I wanted to die laughing. I sat there watching the show, feeling sleepy, my head got heavier, I kept falling asleep and waking up, I felt like throwing up as well. I felt like there were so many thoughts in my head but I could not respond to anything. I felt distant. (SS, personal communications, June 4, 2013)

The narratives reflect that the participant chose a method that she felt would be appropriate and calming for her, the way she conducts herself seems to have a sense of order to what she is doing. While, consuming the tablets she watches something funny on the television, in her attempt to make her final moments of this life, funny. Something she felt that had been denied to her, the ability to laugh. Her statement that says that he wanted to die laughing encumbers her entire act. She is able to go ahead with the act of suicide which is heavily negatively connoted topic, surrounded by positivity and things that made her happy. It can be interpreted as her final acts being that of persuading herself that the act she is about to make happen is something that would make her happy. While participant GK states, the method chosen for suicide had to be well thought about and as an individual she did not believe in suicide, she did believe a choice like that would be made by someone who was weak and who was unable to manage life but at the same time it is something that she wanted for herself. An idea strikes her that she would complete the act of suicide by making it look like a road accident. This idea doe make her happy as she states that she could now peacefully commit suicide and not worry how her act is going to affect her family members. She refers to it as the ‘biggest gift’ that can be given to them as well as to herself. She regards it as a ‘freeing’ choice which had the ability to provide peace to her as well as would shield her family from the shame, inquisitive questions and blame from the larger society.

Suddenly the idea struck me! This was my solution; this was the method I should use. I could commit suicide but make it look like an accident. I don’t know, I felt Property of Christ University. mad for thinking like this but I felt this sense of accomplishment in coming up with Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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such an idea where they would not be able to determine if it was an accident or suicide. I felt a sense of peace that my family would not be tortured with thoughts or questions of what had happened to me and to not worry about them felt great – it felt freeing for once – in death i could be at peace and it is the biggest gift i can give to them as well, in terms of peace from answering to themselves and the society. (GK, personal communications, January 28, 2013)

For all three participants, the method becomes salient as they give it meaning as well. They all have a functional meaning or purpose. The act of suicide was frowned upon as it diminished the value of a human life, the extended significant others of the deceased, due to their association, are also stigmatises and encumbered in an atmosphere of shame. Sometimes the prohibited topic of suicide runs so strong, it is not only avoided in speech but the cause of the suicides’ death is also misrepresented on the certificate of death (Noon, 1978) Plato, the Greeks and Roman stoics supported the act or choice of suicide. They were of the opinion that if life became unbearable, then suicide offered to him an honourable door, which they could choose when faced with situations that were unendurable. The idea that they promoted was that man is free to end his worries or his life, whenever he decided to do so. They also emphasised on the manner in which an individual died, which was supposed to convey decency, rationality and dignity and this was widely accepted by the masses (Noon, 1978) The ideology changed with the advent of Christianity and Christian beliefs, which looked as life as the gift of god and hence suicide being an irrepentable act. The narratives of participant GK also sates,

My life should have been better, it should have been another life, i do not know why but I wondered if God had made a mistake in giving me this life. Did he confuse it with someone else’s’ it was possible, there were so many people in this world! I know he is God and powerful and he knows what he is doing, but couldn’t it be possible that he actually made a tiny mistake by giving me somebody else’s life and that somebody else was enjoying mine. I know it sounds crazy, but the more I thought about it the more sense it made to me (GK, personal communications, January 28, 2013)

The narratives express another interesting feature, the thought of death as a sort of Property of Christ University. continuance. There is no non-existence or sudden stop of life but rather a transistional or Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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transformational changes, in the perceived worlds where life is looked upon as something that is continued on another plain. Even the narratives of participant PK expresses this, as she states that she wants to commit suicide in order to be with her father.

The main objective of research is to understand the psychological profile of the suicide survivor. The elements of a psychological profile are the cognition, emotions and meaning attached to such an event. The specific objectives, help in explaining the major objective of research. Hence the psychological profile of a suicide survivor, shows that cognitions consist of the emergence and maintenance of the restrictive, negative thoughts experience of negative emotions towards self, emerging from the traumatic events and suicide as a action that is directed towards achieving meaning.

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Chapter 5: Summary and Conclusion

The study was taken up to provide insight into the phenomenon of suicide. Although, innumerable studies have been done on suicide, nationally and internationally, majority of these studies focused on understanding the statistical significance and its suicide and its precipitating risk factors. This aided in the partial understanding of suicide but the risk factors (such as clinical diagnosis, genetic predispositions, personality traits, interpersonal relationships, socioeconomic factors) could not always become the causative factors, it lacked ‘humanness’ in the data. The experience of suicide, whereby, the focus was on thought, emotions and meaning attributed to the event, was not common. Psychological autopsies, helped in understanding the event from the perspective of the ‘other’, where close and significant family were allowed to recount the story, this also helped them ventilate and attain some sense of closure. Studies on suicide notes, gave one fascinating insight into the private and intra-psychic causes to pursue the act. The literature review does focus on the cognitive factors, problem solving and coping skills, interpersonal factors, personality traits like aggression, impulsiveness, early traumatic experiences and coping. The major objective of the study was to understand the psychological profile of the individual who survived the attempt of suicide, while the specific objectives were to understand the thoughts, emotions, experiences and meaning attributed to suicide. In order to attain these objectives, a qualitative outline with a phenomenological paradigm was undertaken. The account of experience of suicide from the perspective of the survivor was followed. As the foundation for phenomenology is its lived experience, a phenomenological paradigm was made use of. The study was conducted on ten, female participants in the age ranging from 18 to 35 years were selected. Purposive sampling was used to form the target group. Semi structured, in-depth interviewing was used to collect data, which was recorded and transcribed. Interpretative Phenomenological Analysis (IPA) was used to analyse and make sense of the data.

Findings of the Study The major objective is explained through the specific objectives. The psychological profile consists of the following. The master theme of cognitions emerged that were maintained through restrictive, negative thoughts. The superordinate themes that supported this were Property of Christ University. a)Reliving past memories; b)Dichotonomous thinking and self blame; c)Belief in Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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everlasting nature of problem; d)Overwhelming sense of hopelessness. These common superordinate themes were found to among the women participants the study was conducted on. Participants had stated that once they went through a traumatic situation, it was recalled each time either something similar happened, or their mood was low and sometimes they even became sensitive to neutral stimuli around them, causing them to act disproportionately to the person, situation or event. Another similarity seen was that the participants showed dichotnomous thinking or black and white thinking, which meant either things were labelled as either good or bad, right or wrong. This kind of thinking also led them to ignore the shades of grey or reflect on the responsibility of the other in the situation, they viewed themselves as the source of the problem with relentless vehemence. They held themselves as responsible and hence having the connotation of doing or performing an action that would convey the way they felt about a certain situation. Most participants, assigned the blame to themselves, while one participant did not, she blamed the world and significant other in her life for lack of support, encouragement, warmth and love. The participants having to face the issue for a long duration of time or facing a considerably high intensity of it, for a short duration, would change the individual’s perception of the problem as something that is endless. They are unable to think about positive future outcomes of the situation. Research shows that this thought process also led to the development of the personality traits of the cynic. Basically, various thoughts processes and schemas led to negative thinking which led to cognitive inflexibility, which also helped in maintaining the thought process. All participants did talk about an overpowering sense of hopelessness, where they would have tried known ways to get themselves out of the problem or situation but then would have failed. Hence, they could not find any other alternative other than suicide, to help them cope or manage the situation.

The master theme experiencing negative emotions directed at self, which arose from negative events, was common. The superordinate themes at the cross cluster level that could be observed were the following, a)Feelings of anger and impulsiveness (feeling of regret); b)Fear and experience of loneliness, not being understood or fear of being judged; c)Fear and feeling of rejection and worthlessness; d)Feeling of being a burden. The participants felt a sense of anger and impulsiveness, they had felt anger about the event for a longer duration of time, culminating in an act of impulsiveness. Also, one participant had mentioned that the feeling of anger was also directed towards herself. Studies show that Property of Christ University. such behaviour is also common to a collective community, where individualism and the Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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expression of negative emotions like anger is frowned upon, hence suicide becomes an act of thwarted negativity. Fear of loneliness that was also a common emotion that the participants felt. It sometimes could also be loneliness that arose out of labelling oneself as not understandable or fear of being judged for the or bringing shame upon the family due to the nature of certain events and the way it was perceived through the eyes of a community. Loneliness was also experienced as a result of not being able to be a part of the significant groups due to the differences perceived by others as well. Feelings of rejection and worthlessness were also seen. The perceived differences by the community led to the rejection of the individual which made them feel like they were unimportant, which also inevitably led to them perceiving themselves as a burden. Studies support that the feeling of being a burden to another, especially ones family led to the person interpreting suicide as a favour towards them. Hence, the meaning held by suicide changed along with the understanding of the individual.

Suicide became an action that was pursued in order to achieve a certain meaning. The superordinate themes of meaning that seemed arise from the data were the following a)An act of standing up for oneself; b)An act of repentance or remorse; c)An act to reunite with loved on; d)An act to put an end to pain experienced. Participants felt that suicide was a powerful act that made a statement for themselves and to others around them. It could be seen as an act of individual rejecting their community, rebellion towards a societal attitude or expressing that they had the ultimate power and control to make the decision of taking away their own lives. While, in some other cases, it was an act that expressed remorse or repentance for not being able to measure up to the standards set by their own families and to an extent their larger families or the extended community. The act also meant of reuniting with a lost, loved one as they felt that their lives no longer had meaning in this world. While, some others looked at it as the only way to stop the emotional torture and pain that they felt every minute of their lives. It is interesting to note that suicide was not always seen as an end itself but rather an action that led to the continuance of life maybe in another form at another level. Unique meaning was also seen to be shown in data. One participant looked at suicide as a way of correcting wrong that was made by God in confusing her life with another persons’, as she believed she did not deserve such a life. While, the meaning of suicide can also be extended to the type of method used by them to incur suicide. Two participants, preferred to pursue the act in method that revealed a sense Property of Christ University. of happiness and security, when undergoing such an act. Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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Limitations of Study Firstly, time consumed in finding the appropriate sample was lengthy, as talking about such a sensitive topic was still ‘taboo’. Secondly, the dropout rate was significant; hence being able to continue with an interview with same person might always not be possible. Thirdly, the study was conducted only on women, the findings need not be applicable to men further research is required in this area. Fourthly, the study was conducted only on ten women; it is a possibility to discover more meanings to suicide, if size of sample is significantly increased. Fifthly, it is always not easy to define, separate and categorise what cognition is and what a feeling is, as it is interpreted as the same thin by people, For example, the belief or perception of being a burden can also be said to be a person who is feeling that he or she is a burden. Hence, there is always scope for overlap.

Implications and future research The study can be expanded along the following areas. Firstly, the study gives insight into the experience and meaning of suicide. But, it is also an area where further studies can be conducted in order to understand the meaning making process, especially in a culturally rich nations like India where values, traditions, principles and norms of each community influence an individuals’ behaviour as well as their meaning making process. It would also be interesting to find a predominant theme in all three areas, in relevance to a community. Secondly, the study is limited to the experience of young adults; hence further research can be conducted on various age groups for a comparative study on the experience of suicide. Thirdly, studies can also be conducted on the relation between sexual orientation and suicide, as is seen to be coming up in the data. Not much existing Indian data can be found on such a topic. Such studies are of immense help to novice mental health care professionals, as they can provide an understanding into the person and their world. It would also help to some extent relate to their world, in order to provide better and more effective care and intervention.

The research has become a step towards understanding the meaning behind the suicidal act. Further research, both qualitative and quantitative studies, can serve to enhance the knowledge in this field, especially in the area of meaning and motivation behind suicide. Phenomenology was essential in understanding the complex phenomenon of suicide and its Property of Christ University. various features. Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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Appendix -A

General Data Sheet (Demographical Data) Age:

Gender:

Religion:

Socioeconomic status:

Not married/married/separated/widowed/other (specify):

Presently, living with family (family married into /family with ones parents) or living by oneself:

Family type: (Nuclear/ Joint Family/Other) Specify:

Attempted suicide: (Yes/No)

Have you been hospitalised after the attempt (Yes/No)

Are you under counselling/ therapy/ medication?

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Appendix – B

Informed Consent Form Christ University

Research Topic: Psychological profile of suicidal survivor: A retrospection of suicidal decisions Faculty Supervisor: Dr Baiju Gopal Researcher: Ms Sabina S Samuel The study has been taken up, as a part of the fulfilment of the criteria for completing the Master of Philosophy (MPhil) course from the Department of Psychology, at Christ University

Kindly read this document before participation.

Explanation of the study: The study would focus on the experience of individuals who have attempted suicide at least once in their life. The objective is to understand the meaning attached and significance of the important events in their lives, events which lead to them making their decision and what happens to them from the time the decision is made to the day they go through with the act. The meaning of various events, emotions and thought process that the individual experienced during the particular phase of their lives is looked into.

Purpose of the Study: The study would give us an in depth perspective on the life of the individual, it would bring to light the significant events in their life that lead them to making the decision and the meaning, emotions and thoughts they undergo after making their decision. There are numerous articles on Suicide in India and abroad, focusing on the clinical perspective. But there are not many articles in India that look at Suicide from the individual perspective. Hence, this study would not only help me but any mental health practitioners who are interested in this topic. It would be helpful in understanding the common themes, meanings and events, as well as the unique differences of the individual with regard to this context. It would be helpful in creatingProperty a psychological of Christ profile, University. which would be helpful not only in Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

PSYCHOLOGICAL PROFILE OF SUICIDE SURVIVOR 94

understanding but to a limited extent predicting this kind of behaviour, which would be of immense help to a mental health practitioners.

Criteria considered for inclusion and exclusion:  Participant must between the ages of 18 - 35 years of age to participate in this research.  The study includes participants who have attempted suicide, at least once in their life time.The time period between the event and now, should be a minimum of three - five years to enable better recall of the event  The participants should be able and willing to recall the event  Participants who are a resident of India can take part, the study is not bound by place  If participant is undergoing therapy, consent from their therapist or counselor or psychiatrist will be obtained  The study also excludes those who are substance-dependent  The participant should not be diagnosed with a mental illness (such as Depression, Bipolar disorder, Schizophrenia etc) – they will be screened out during the interview process.  It excludes individuals who are severely ‘mentally ill’ and who are presently undergoing intense therapy and heavy medication.

Procedure followed for the participant: The interview process will be held in 4 sessions. In the first session, the rapport will be built. During the second session the part of their life leading up to the decision is focused on. Events in their life that they often think about are focused on. In the third session, what happens to the individual after making the decision is focused on, the changes (if any) of thoughts, emotion and meaning is focussed upon. In the fourth session, focus is on closure. At a much later time, which will be specified later, the participant is requested to take part in a check where the researcher verifies if the content of the information reflects the perspectives of the participant.

Rights of the participant and confidentiality:  Identifying information of the individual will be changed. All information collected from the individual (even in the form of audio recording) will be kept confidential. Anonymity is maintained, of the individual and organisation, during presentation or publishing of the academic work. Property of Christ University. Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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 The interview will be conducted at a mutually convenient time and location, that ensures participant and researcher safety.  Participants are made aware of the nature of topic, the procedure and the risks and benefits associated with the research  Participants can request for a copy of the consent form and the research work, when it is completed  Participant can clarify doubts and address various concerns, when needed.

Potential Risks: a) The nature of the topic is difficult hence the participant may be put into a negative emotional state. Recalling of such an experience may also lead to the emotional breakdown in an individual. b) Participant will have to provide confidential information about them self

Potential Benefits: a) The sessions can be used by the participant to explore this ‘forgotten or undealt with’ area. The session could also be used as a cathartic process. b) When the story is being told, the participant may get a new perspective on the situation. c) The participant is given an opportunity to share their own unique story and also contribute to Research in Psychology.

The researcher could be reached at – 9632604859 ([email protected]) and the research guide can be reached at 9886355956 ([email protected]) Your signature below indicates that you voluntarily agree to participate in this study. Date:

______Signature of Participant

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Appendix - C

Interview Guide

Session 1 The focus of this session is to build a rapport with the individual. To make the participant know about the research, its process, rights of the participant and any other area of concern is addressed. The consent form and demographic details are collected during this session.

- Informed consent form is given, relevant questions and doubts are addressed - Demographic Information is collected - How do you feel regarding the interview? Address any anxiety, if any.

Session 2 Questions that would help individual recollect and narrate experiences of significant events that lead to the decision of Suicide. The focus is on the earlier part of life, significant events in the areas of childhood experiences, school, family, parents, friends, significant others, perception of self, are made a note of.

- Could you recollect or tell me about important events that took place in your life? (Prompt: areas such as childhood experiences, school, friends, parents etc.) -What happened? Could you tell me how you felt then? - Is there any event that stands out in your memory, could you tell me about it? - Who are the most important people in your life? Was there any role (positive or negative) that they played? - Could you tell me about events that lead to you making the decision of Suicide? - How did you view suicide at that time?

Session 3 The focus of this session is to focus on events, emotions and thoughts at the time of the decision.

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- You were going through for some time, could help me understand what suddenly upset you? -What event or events made you think about it initially? What did you do about it? - How did these events make you feel? - What are the emotions you recall with these events? - What kind of thoughts went on through your mind? - How do you think other people saw you? - How did you see yourself? - What did Suicide mean to you? - How did this decision effect the quality of your life? Your emotions? Your relationships? - What happened to you after your decision was made? Could you recount to me the events and experiences that you went through till the time of the act of Suicide?

Session 4 The focus of this session is to ask questions that would help the participant focus on more positive experiences and positive aspects of himself. It would also help the participant to get back to daily events and normal life.

- How did you recover from the event? - What do you feel are your strengths you discovered about yourself through this ordeal? - What are the situations or events that you are looking forward to – immediate future. - How did you feel over the last few days? - What are you plans for today? -Is there anything else on your mind, you would like to address?

Thank you for sharing your invaluable time and powerful experiences with me. It has given me insight into understanding human behaviour better. The information given by you forms an important part of my research and it would help so many others, to understand.

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Appendix – D

Field Notes

Rationale for study The researcher took up the study of experience of suicide as, even with all the existent information and statistics, there was no in-depth study that explored the feelings, emotions and thoughts of a person who wanted to commit the act of suicide. The researcher was of the opinion that if the experience was truly understood, it would aid a great deal in providing better and more insightful care and attention to the people undergoing this condition. Additionally, it would also serve the mental health professionals to explore the unique, subjective experiences of the individual. Personally, for the researcher it was a difficult topic to take up, as the act of suicide provoked a sense of fear, confusion and wonder. The personal goal of the researcher through this project was to understand the experience of suicide more holistically which would help manage feelings associated with the act.

Background of researcher The researcher completed her course in Masters in Psychological Counseling and is currently pursuing her degree for Masters of Philosophy. The researcher had been working as a Corporate Counselor as well as a School Counselor, prior to taking up the research project. The researcher has worked in the crisis management team and has handled suicidal clients.

Framing of the inclusion and exclusion criteria As this is a sensitive topic, it was of utmost significance to frame ethically and morally acceptable criteria that would not harm the client in any manner. Entire panels of specialists were made use of, during this phase. The internal guides (Research guide and panelists) and external experts were consulted during this process. The critiquing, contribution and support of the entire team, made this project a possibility. Continual changes were made in the criteria, according to the valuable insight received during discussions with them. Property of Christ University.

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The process of data collection During the process of data collection, it was extremely difficult to discover the target group needed for the study. It took over a period of six months to find the target group. Hospitals (government and private), NGO’s, institutions that dealt with suicide and religious organizations were approached. Although they sympathized with the cause of research they could not allow the interviewing of clients due to ethical and confidentiality issues. As a final resort, the researcher turned to friends and others who she was personally acquainted with, who would be helpful to the project.

The participants were recruited from Bangalore and Secunderabad. Initially, a trial interviewing process and its critiquing was conducted for one participant. It was important to conduct the interview in places that they felt safe, secure and comfortable. Interviews were conducted mainly at their residences and offices, arranged at a time they would be available. During the interviewing, the stories of certain clients were overwhelming. It had been recommended earlier by the panel of experts, that the researcher make use of personal sessions during the interviewing process and this helped a great deal in maintaining the objectivity, dealing with the emotions that were brought out during that time and maintaining the focus of research. Although, the participants were briefed about the research, some still did expect it to be ‘magical’ few sessions that would help them, while others thought of it as an opportunity to talk about the incident they never dared to talk about and some others wanted to reach out to individuals just like themselves and offer hope. Majority of participants requested that they not be contacted again for the discussion of this specific topic, as they considered it as a ‘dealt with’ chapter that, only had place in their past. Participants did get emotional at various points during the interviewing process; they were allowed to process those emotions and were always given a choice of either taking a break and continuing at a later scheduled date or continuing with the interview at present. Participants felt at ease towards the ending phase of the interview, they felt relieved in sharing an event they considered as extremely private and being at their most vulnerable, majority of participants did not talk about it with their families or the significant people in their lives as they feared being judged for their actions. Sometimes the inner conflict of such a decision could also be observed during the rapport building and ending sessions – most participants categorize their suicidal decision as being taken by somebody else, a part of themselves that they cannot connect with or do not want to Property of Christ University. connect with anymore. The researcher believes that during the interviews one could Use it for fair purpose.Give credit to the author by citing properly, if you are using it.

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observe the love-hate relationship that human beings share with themselves and with those around. This is highlighted even more when they refer to it as a ‘necessary evil’. Most participants looked at their suicide event as a ‘necessary evil’ that helped them adopt a different perspective towards life as well as realize their own strengths.

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