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Fragmented Self and Psychache

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Suicide Vulnerability and Risk: Fragmented Sense of Self and Psychache Margaret A. Prysak, BHSc (Hon) School of Psychology Submitted in partial fulfilment of the requirement for the combined degree of Master of Psychology (Clinical)/Doctor of Philosophy April 2018 i FRAGMENTED SELF AND PSYCHACHE Blank page FRAGMENTED SELF AND PSYCHACHE Declaration I certify that this work contains no material which has been accepted for the award of any other degree or diploma in my name in any university or other tertiary institution and, to the best of my knowledge and belief, contains no material previously published or written by another person, except where due reference has been made in the text. In addition, I certify that no part of this work will, in the future, be used in a submission in my name for any other degree or diploma in any university or other tertiary institution without the prior approval of the University of Adelaide and where applicable, any partner institution responsible for the joint award of this degree. I give consent to this copy of my thesis, when deposited in the University Library, being made available for loan and photocopying, subject to the provisions of the Copyright Act 1968. I also give permission for the digital version of my thesis to be made available on the web, via the University's digital research repository, the Library Search and also through web search engines, unless permission has been granted by the University to restrict access for a period of time. I acknowledge the support I have received for my research through the provision of the Australian Postgraduate Award (APA) Scholarship. Margaret Prysak Signed: April 2018 i FRAGMENTED SELF AND PSYCHACHE Blank page ii FRAGMENTED SELF AND PSYCHACHE Dedication in Memory This thesis commemorates the work and humanity of Peter Chamberlain, and is dedicated to those who, under constraints of an unfavourable circumstance, renounced the connection to their own pure, benevolent, unconditioned self iii FRAGMENTED SELF AND PSYCHACHE Blank page iv FRAGMENTED SELF AND PSYCHACHE Abstract Suicidality research has largely focused on psycho-social or demographic suicide risk factors, with less emphasis generally being directed towards understanding individual vulnerability factors. Moreover, although previous research has indicated that suicidality is underscored by the inner workings of personhood, suitable phenomenological approaches appear to have been infrequently applied. Accordingly, this thesis aimed to explore suicidal tendencies as predicted by low sense of self-cohesion, low self-esteem, psychological pain, distress, and emotions that underlie those psychological states. The selection of theoretically derived psychological factors was guided by the theories of Edwin S. Shneidman (psychache), and Heinz Kohut (self and self-cohesion). The cross-sectional nonexperimental design involved a survey of university students and staff, and volunteers from the South Australian community (N = 359, 72% females, 28% males, aged 18-67 years [M = 28.72; SD = 12.29]). Participants completed a battery of psychometric instruments, assessing self-cohesion, psychache, self-esteem, and psychological distress: 1) The Psychological Pain Assessment Scale (PPAS); 2) The Orbach and Mikulincer Mental Pain scale (OMMP); 3) The Psychache Scale (PS); 4) The Adelaide Self-Cohesion Scale (ASCS); 5) The Depression Anxiety Stress Scales 21 (DASS 21); 6) The Beck Self-Esteem scale (BSE); and 7) recent suicidality (from The Psychiatric Symptom Frequency Scale), lifetime attempts, and current suicidality indices. v FRAGMENTED SELF AND PSYCHACHE The thesis involved five studies, with results from each informing subsequent studies. Study 1 examined the psychometric properties of ASCS. Its three-factorial structure was replicated, confirming its validity for assessing a sense of self-cohesion. Study 2 tested relationships between self-cohesion, self-esteem, psychache, depression, anxiety, and stress. Exploratory factor analysis, followed by a Schmid-Leiman solution, found near-equivalence between the psychache measures OMMP and PS. Self- cohesion, self-esteem, psychache, depression, anxiety, and stress emerged as distinct but inter-related constructs, all strongly loading on a general factor of psychological frailty. Studies 3 and 4 explored relationships between these psychological factors and recent suicidal ideation/action, and history of suicide attempts. The utility of ASCS for assessing suicidality was also examined. The strongest contributor to recent suicidal ideation/action was depression, followed by self-esteem (part of self-cohesion) and psychache. The strongest contributor to lifelong suicide attempts was anxiety, followed by unmet childhood needs (part of self-cohesion). Study 5 clarified the nature of psychache in relation to three suicidality indices (recent suicidal ideation/action, lifetime attempts, and current suicidality). Two negative emotions underscored intense psychache across the three suicidality measures: self-hate and worthlessness. Additionally, “lure of death” was associated with lifetime suicide attempts only. Sadness, betrayal, and anger had negative associations with suicidality indices; hopelessness was associated with recent/current ideation, but not suicidal actions. vi FRAGMENTED SELF AND PSYCHACHE It was concluded that suicide vulnerability is characterised by anxiety and a diminished sense of self, originating in early developmental frustrations resultant from unmet psychological needs. Further, tendencies for suicidal ideation/behaviours may partially be attributed to heightened levels of depression and psychache, and lowered self-esteem. As a clinical implication of the findings, it was proposed that a personal capacity for self-empathy may counter limitations of the self, help mollify deleterious effects of psychache and depression, reducing potential for suicide. vii FRAGMENTED SELF AND PSYCHACHE Acknowledgments I express my deep gratitude to all those who supported my efforts throughout the process of compilation of this thesis. Notably, a sincere thank you to Emeritus Professor Ted Nettelbeck, for his unfailing availability, guidance, generous sharing of expertise, relentless encouragement, and consistently methodical approach to each and single task involved in this research journey. My thank you extends to Professor Paul Delfabbro for committing his time and serving with invaluable feedback and advice, remarkably offering his assistance at a critical time of the passing of my clinical supervisor, Dr Peter Chamberlain. With sadness, I say a heart-warm thank you to Dr Peter Chamberlain; I appreciated, and now miss, his ‘contagious’ optimism, enthusiasm for life, and persevering zeal to keep moving forward. A number of other associates have also assisted me at various stages of this project and I thank them all. I am especially grateful for tuition in statistical procedures, kindly provided by then my peer, and now, Dr Christopher Powell. Also, Thank you to Dr Dennis Liu and his research team at the Lyell Mc Ewin Hospital, who offered potential assistance in proceeding studies. Further, thank you to Dr Quentin Black for his insights in respect to the topics covered in this thesis. Importantly, many thanks are due to a number of the University and community members, who made this project possible with their generous participation and expressed interest. viii FRAGMENTED SELF AND PSYCHACHE I thank my family and friends, for being there for me all throughout the process, ensuring that my healthy lifestyle balance is maintained, and replenishing my energy levels with spontaneous relaxation and fun opportunities. And, importantly, a very special thank you to my matchless partner Claudio, for his infinite and unconditional faith in me, and my potential, to accomplish the set forth ambition to complete this, and any future, projects. ix FRAGMENTED SELF AND PSYCHACHE Blank page x FRAGMENTED SELF AND PSYCHACHE Table of Contents Declaration..................................................................................................................... i Dedication in Memory .................................................................................................. iii Abstract ........................................................................................................................ v Acknowledgments ...................................................................................................... viii Table of Contents ......................................................................................................... xi List of Appendices ...................................................................................................... xviii Preface .......................................................................................................................... xix SECTION A: BACKGROUND INFORMATION AND LITERATURE REVIEW .............................. 1 Chapter 1: Introduction: Suicide and Suicidology Overview ........................................... 1 1.1 Suicide: Nomenclature, Definition, Historical Sketch, Aetiology, and Prevalence ............. 2 1.1.1 Nomenclature and definition. ........................................................................................ 2 1.1.2 Historical sketch. ............................................................................................................ 5 1.1.3 Suicidology history sketch. ............................................................................................
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