A couple of years ago, I was in a coffee shop with some people, describing how, as I’ve gotten older, I don’t seem to heal as quickly as I used to. I’m very physically active, involved in martial arts and so on, and I noticed that I was straining my back and other areas much more often than I used to, and that it was taking longer (and more rest) to get back to normal. I passed this off as a side effect of aging and figured I would just have to start being more careful. This worked a bit, but inconsistently. Then, not too long ago, I started incorporating a little more strength training into my exercise routine. I had read about how strength training is an important part of any fitness routine, particularly as we age, and that it has lots of benefits. I got back into it slowly, as didn’t want to get hurt and be out of commission for a while. After some time, I noticed something interesting: I was still doing the stuff that occasionally threw my back out or led to sore knees, shoulders, or hips, but I was no longer having these symptoms. I’ll probably never know this for sure, but I think I was vulnerable to all of those pains and strains because I had not been maintaining strength in my supporting muscles, etc. It wasn’t necessarily some kind of age-related slow and steady march to the grave, but rather, the essence of the problem was that certain areas needed to be strengthened. This made me think of other areas where it’s crucial to figure out the essence of the problem before we try to solve it. I was listening, for example, to an interesting program on CBC Radio 1 on how the “me, too” movement has raised awareness of sexual assault. One of the interviewee’s key points was that the essence of the problem contributing to sexual assault is often the misuse of power. Without knowing the essence of the problem, whether the issue is sexual assault, pains and strains or other issues, it is incredibly hard to solve it.
In DBT, we try to help clients get to the essence of the problems that contribute to misery. One way we do this is by asking a lot of questions. When clients struggle with depression, we ask a lot about the things in life that are creating or maintaining misery, how they’re coping with things, what their daily schedule or routine looks like, what types of thoughts go through their minds, and what emotions they feel. When they have a hard time getting out of bed in the morning, we try to get to the heart of the matter by figuring out what’s better about staying in bed compared with getting up and back into life.
We take this approach to suicide as well. In DBT, we view suicide as a possible solution to a problem. The problem might be isolation and loneliness, difficulties in relationships, difficulty functioning or supporting oneself, chronic physical or emotional pain, and so on. We want to understand what the problem is so that we can help clients solve it. We also want our clients to learn to see suicidal thoughts as a signal that they are trying to solve a problem. Then, the next step is to think about what the problem is and consider how it might be solved. I learned from Marsha Linehan (developer of DBT) that, when suicidal, often the best question to ask oneself is, “What problem am I trying to solve?” Then, the idea is to try to work on solving it, and this often requires help from other people, such as therapists, loved ones, and so on. When problems are really big, complex, miserable, and long-term and it doesn’t seem like they will go away anytime soon, the brain sometimes looks for an escape hatch. If you can’t seem to solve the problem another way, suicide starts to seem like a viable solution. The problem, however, is that suicide roadblocks problem solving. For many people, as soon as they start thinking about suicide, they stop thinking about how to understand and solve their problems and improve their lives. When suicide is on the table, there’s no room on the table for anything else! Therefore, one of the first steps in overcoming suicide is to make a firm commitment to oneself (and ideally also to one’s therapist or loved ones, etc.) to get suicide off the table. Then, when suicide thoughts come up, the idea is to ask oneself, “What problem am I trying to solve?” Get to the essence of the problem – the problem that, if it were gone, you would no longer be seriously considering suicide. Then, try to chip away at that problem. Don’t try to do it alone. More on this in a future blog. ~ Alexander L. Chapman, Ph.D., R.Psych.