Parasuicidal Behaviour: Screw Off, Dr. Know

Here, in a nutshell, is a portion of my most recent session with Dr. Know. He's apparently irritated at my sudden love of the scotch bottle, and correction of it's effects with codeine. Well, that and the other meds I take. I did try to explain that I wasn't taking the same amount of meds that I normally take, to which he scathingly replied, (and I do mean SCATHINGLY) "They are in your SYSTEM". So here's my attempt to educate, since I have nothing else to give these days and song lyrics can only be done once before readers get bored and pissy.

The term parasuicide was first suggested by Kreitman, et al, (1969) when he and others grappled with the observation that the term attempted suicide was being used to refer to patients who injured themselves, but, in fact, were not attempting suicide. Kreitman thought of the term parasuicide as referring to self-injurious behavior that simulates or mimics attempted suicide, but is not suicidal in intent. His hope seemed to be that a variety of behaviors, sometimes referred to as suicidal gestures, manipulative suicide attempts, and/or self-mutilation, could be categorized as parasuicidal events and that this classification would help us to distinguish those behaviors that were more truly suicidal. The concept parasuicide, however, was never more clearly defined, and it became used by different investigators with different meanings and inclusive of different behaviors. Just as an example, Linehan (1993) used it to refer to actual suicide attempts as well as to self-injuries such as self-mutilation, while Diekstra and Garnefski (1995) excluded habitual self-injury (i.e., self-mutilation) from their definition.

Given these difficulties in attempting to know and understand suicidal and self-injurious behaviors, the Suicidal and Parasuicidal Aggregate Review Committee at VA Boston decided to forego an “a priori” category system and to launch a quality improvement-type investigation of the range of self-injurious behaviors that we see in our healthcare system. We have taken self-injurious behavior to mean any intentional, self-inflicted, physical harm to the individual. The behaviors that are included as self-injurious can range from the individual who inflicts a superficial scratch to relieve tension to the individual who takes a lethal amount of medication and is accidentally found unconscious. We also track any completed suicides in the system. Since instances of self-harm or self-injury are recorded in the morning reports and in medical center incident reports, it is possible to conduct a post self-injury debriefing interview within a few days of the particular event. We have developed a semi-structured debriefing interview that is based on the available evidence in the literature on characterizing and assessing the seriousness of suicidal and self-injurious behavior. Fundamental to the interview is that self-injurious behaviors are discriminated from each other by the intent of the individual. Thus, there is an effort in the interview to obtain a measure of intent to die and a measure of the perceived lethality of the act.

Ok, the long and the short of it is, they did this study and then asked each patient after an injurious act if they were suicidal, and if they were, to rate it on a scale of 0 - 6, 0 being not at all. Then they'd ask other questions about what was done, whether they were under the influence of drugs and alcohol at the time of the injury, and whether or not it was a "cluster" injury (more than one injury at a time).

SO, I portend that my shrink was WRONG.

My getting drunk was NOT an episode of parasuicidal behaviour, but rather an exercise in self-destructive behaviour, which I believe to be quite different. I had no intention of offing myself. I didn't "self-injure" during the past week, but have hit the bottle. Why? Because my head's going to explode, and scotch seems to help. So sue me.

However, I DO believe I'm going to print out this study by the Boston Healthcare System and take it with me next week and show it to him.

Can there be anything more satisfying than showing a pompous, arrogant mental healthcare professional that he was wrong?

Oh, and yes, I recognize my head is screwed on backwards.