Tony White

Escape hatches and the suicidal

As far as I know the term “Escape hatch” and its relationship to the suicidal was coined by a man called Bill Holloway who wrote a number of unpublished monographs in the early 1970s. These were on a variety of topics one being the area of suicide and its management. After that a man called Harry Boyd picked up the term and wrote more about it in the late 1970s. I have not seen the term ‘escape hatch’ and the suicidal being used since that time.



The term escape hatch is an intersting one and a very apt choice by Holloway. An escape hatch is usually a good thing. It provides a way to get away from danger or bad things. Most people would like to have an escape hatch as it would make them feel safer and more comforatbale and indeed better able to deal with any current dificulties. The individual can think,”As I have an escape hatch that means I can always get away and cannot get cornered”. If they know this then they will deal better with what they are currently involved with day to day.

However the way it is used by Boyd and Holloway is in a negative frame of reference. They see it as necessary to close the suicide escape hatch. They acknowledge that suicide can be seen as an escape hatch that alows one to escape from very undesirable stress, feelings of depression and so forth. Of course they see suicide as a very poor method of escape. They would suggest other means by which the person escape from the emotional pain. A commonly held view I think it is safe to say.



Suicide as a solution.
Inherent in the concept of suicide as an escape hatch is the idea that suicide is a solution to a problem. There are some who don’t like this idea at all and will argue vehemently that suicide is not a solution. They may argue that suicide does not solve problems because the person is dead and therefore has no knowledge of the problem being solved.

If suicide is seen as an escape hatch then that implies that the person is escaping from something such as their problems. This is a view that I agree with in part and that suicide does solve problems in the sense that if the person is faced with divorce, then dies, thus he does not have to face it. So in this sense the problem is solved.

Those who work with the suicidal would most often see closing the suicide escape hatch as a worthwhile thing. I would suggest that this is so as well but needs to be considered in another light as well. It is not as simple as it seems. It also shows another dimension or factor that must be taken into account when working with the suicidal patient.

As I mentioned above most people would see an escape hatch as a positive thing. Below are two examples of the suicidal escape hatch and one way in which it can be a positive psychological function.



Louise in discussing the option of killing herself:

“Having the option there in the back of my head actually serves to help me. It doesn't help once the danger is more immediate. When it starts making messes. But on a day to day basis it is nice.”

“It helps with the more minor bad things like 'yes this situation is bad, but it's not quite bad enough to kill myself over, which if it does get worse is an option.'

Most of the time I have a method picked out. I'm very protective of the method of the moment. I feel like sharing it corrupts it.
There have been times where I felt my method had been corrupted or somehow made unusable. And it immediately has pushed me into a depression, often times making me want to die more. I've had times where I became suicidal because I felt my option to kill myself was ruined. Feeling that option is taken away from me makes everything feel like it is crumbling around me.
It's such a strongheld belief that I will kill myself eventually, I just don't know when. It might be at 90. It might be at 25. A threat to that belief I have trouble handling

I visualize the method in my head a lot though during times of stress. It's soothing”
(end quote)


Soothing? One of the most basic tasks of the developing child. Learning how to self soothe.




Marissa in describing what she does at home sometimes:

Sits in a chair in her lounge room and can see the drawer in her kitchen that has many pills in it. It gives her a sense of security or relief somehow. She reports that the pills give her a sense of security for whenever everything just gets too bad.

She imagines putting the pills into little piles and taking one and then two and so forth. She has created a ritualised suicidal fantasy that gives her a sense of solace and relief because it reminds her that she has an escape hatch should she require it one day.

Marissa states:
“The pills are a comfort because they give me a sense of choice when I am in that place.”

“What happens when those pills beckon me?
When my eyes go back to the drawer time after time
What do I imagine when I'm staring at it
Thinking about the pills inside
And the oblivion they could bring to my mind”
(end quote)

Clinical implications
First one needs to be clinically aware that closing the suicide escape hatch can in fact make the situation worse. In such circumstances the client needs to be able to see other ways of easing the pain (alternative escape hatches) before the therapist suggests closing the suicide escape hatch. If one is using the closing escape hatch approach as suggested by Harry Boyd one would need to monitor closely the client’s reaction to that over the next week or two.

If one is suggesting a no suicide contract then the therapist must be clear to the client that the NSC is not closing an escape hatch, all it does is delay the person taking the escape hatch for a certain period of time. It may in fact be a good way of monitoring how much the individual sees alternative escape hatches as viable options.



Secondly, as the case examples show the suicide escape hatch can provide some positive feelings to the Child ego state. This means that if a therapist is working with a suicidal client so they no longer have suicide as an option then they are taking away something that feels good to the Child. Hence we end up with a Parent contract. So the therapist has to deal with a Parent ego state contract contained within the treatment plan for the client to cease being suicidal.

Graffiti

References:

Holloway, W.H.
“Shut the Escape Hatch” in The mongraph series. 1973. Midwest Institute: Ohio.

Boyd, H.S. & Cowles-Boyd, L.
“blocking tragic scripts”. Transactional Analysis Journal, 1980, 10(3), 227 - 229.

Cyberfriend asks:

“I guess the circumstances triggered the dont exist injunction to be acted upon.

But what can determine the when?”
(end quote)




That is a very Gordian question my pommy friend. Why a person would act on the Don’t exist injunction at one point and not at another? As is hypothesised people most often will make these early decisions like the Don’t exist decision within the first 6 years of life and then it remains in their psyche and only becomes ‘operational’ when certain conditions in life arise. They have decided that suicide is a viable solution to certain life events.

One way to answer your question is to look at the different form the Don’t exist decision can take. Seven alternative suicidal decisions have been proposed:

1. If you don’t change I will kill myself
2. If things get too bad I will kill myself
3. I will show you even if it kills me
4. I will get you to kill me
5. I will kill myself by accident
6. I will almost die (over and over) to get you to love me
7. I will kill myself to hurt you.


If one finds they belong no where that may activate the Don't exist decision



These give some idea as to the life circumstances that a person will need to have before acting on their internalised Don’t exist injunction. For instance with number two decision we find that person known as the share market simpleton. This person has taken great risks in shares and now they have lost everything and this could be in their mind when - things get too bad - and thus they will act on the Don’t exist injunction.

With such people one would be questioning them on what - “If things get too bad” - means. It may be related to the loss of money, or marriage or even their reputation. Once you have identified this then you can begin to understand and make predictions about when this person will act on their Don’t exist injunction.

One could take decision number five - “I will kill myself by accident”. Enquiry into the individual’s life on what they are doing that is risky and then looking at any Child ego state magical thinking around the risks they are taking. This will again allow one to make predictions about when this person will carry out their suicidal decision.


This mother made a smart decision




Suicide decision four - “I will get you to kill me” - sometimes happens in domestic violence situations. Alternatively people on death row can have made this type of Don’t exist decision early on in life.

Decision three - “I will show you even if it kills me” - is sort of suicide from a rebellious position. In this situation one would be seeking information about the person’s current relationships and finding out who and what they would want to ‘show’. Once the information is elicited then one again is more capable of answering the question that Cyberfriend asked - How does one determine when a person will act on their Don’t exist injunction?

Graffiti

Cyberfriend makes note of an instance of self harm and suicide

“The person I discussed here...

The self harm rapidly escalated
He put his partner in hospital (she was lucky not to be killed by him)
He was imprisoned on remand,
a week later (the day after coming off suicide watch) he hung himself.

I still think him stabbing himself was manipulation,
not sure whether hanging himself was.

Though in honesty he did his partner a favour,
as she in now safe and doesnt need to go into hiding.

So how does his original self harm fit within your categories?”
(end quote)



Suicide and self harm are two completely different psychological processes although often the layman puts them together.

Having said that one can have three groups:
Those who are suicidal and not self harming
Those who are self harming and not suicidal
Those who are both suicidal and self harming

So some people will have both but they still involve quite different psychological motivations

The truly suicidal individual has the definitive feature of having a Don’t exist injunction. This is the psychological process that makes for the ‘true’ suicidal person. A message they have in their head, that for some reason they, others or the world would be better off if they were dead.



Self harming has nothing to do with the Don’t exist injunction. Instead it serves other psychological functions such as I showed in my original list:

1. Gang behaviour tattooing type of self harm
2. To make self feel real. Dissociation, detached from reality. Cutting closes the gap.
3. To make self feel something. No feelings at all just numb
4. Tension relief and pressure stress build up
5. Physical expression of emotional pain. Cutting provides concrete evidence of pain
6. Cutting as self nurturing. Allows caring of self. Munchausen Syndrome
7. Self punishment and self hate
8. Manipulation and to get attention

None of this includes a Don’t exist injunction nor is it about attempting to kill self. Instead the self harm is being done for alternative reasons as I have listed.



However there are people who do make suicidal statements and gestures who are not suicidal. These people are not suicidal as it is never their goal to kill self and they do not have a Don’t exist injunction. If they do die by their own hand then it is an accident not a suicide as their intent was not to kill self. Some make these gestures for manipulation of some kind. So people can use both self harm and suicidal gestures for manipulative reasons.

Regarding the person you described who was on remand in prison I can make some guesses as I did work in a prison where I ran the suicide watch programme for three years. Those who are making suicidal gestures for manipulative reasons are usually seeking to get onto suicide watch and mostly are not the truely suicidal person.



The inmate you describe was on suicide watch. He must have then made all the right noises and behaviours to appear to be not at current risk and then he is taken off suicide watch. The next day he completes a suicide by hanging in a prison which is usually not an easy thing to do. So he must have done some prior planning which means he probably made a decision to kill self days before and then simply played out all the necessary moves and completed his goal.

This has all the hallmarks of the truly suicidal person who has a Don’t exist injunction. So it is unlikely that it was a suicidal gesture to manipulate the system in some way. This means he falls into the group that are both suicidal and self harming.

Graffiti

There was a recent newspaper article written by Michael Grose (Sunday Times, 29.3.09) that raised a good point on siblings and the parenting of children. It spoke about what happens when you have two children who are quite different in their natural abilities and talents. That is when one child has considerable natural talent in say school work, sport, socially or otherwise and the other sibling has either just average or below average talent. This creates a quite difficult domestic situation for all concerned.


Natural talent. Some kids get it and some kids don't.




It is bad enough when the more talented child is the older sibling but the potential damage is magnified even more so when it is the younger sibling who is the more talented one. I am seeing this right at the moment in that I know people in my personal life who have this scenario and I also have some clients where in one instance the younger sibling is much more naturally talented in the three areas of school work, sport and socially. Then there are two other children who are twins where one is also more naturally talented and as a result they seem to breeze through life whilst the same age sibling struggles much more.

A very difficult situation for the parents indeed. They will tend to not want the older less talented child to feel bad, so parents can easily down play the successes of the younger more talented child. However that is not fair to that child because they deserve all the praise and encouragement for their success so that they can go on and achieve their fullest potential in life.

Such praise of course highlights to the other sibling that they are not getting the same success in life. If they are the older child then that is made even worse if the younger one actually ‘beats’ the older one in what ever area that maybe. This makes it very easy for the less talented sibling to just give up and stop trying at all. “If I don’t try and succeed then my younger sibling can never be shown to beat me”.



I know in the case of the twins, their parents have them at the same school but different class rooms so as to avoid the inevitable comparisons that will be made. This is indeed one of the suggestions made in the newspaper article - avoid making comparisons. Whilst good advice, the children will of course inevitably make their own comparisons them selves and so will their peers and others at school like their teachers and so forth. This can be made much worse of course if the younger more talented one uses such comparisons as a way to get at or antagonise their older sibling in the inevitable sibling rivalry that occurs.

The worse case scenario is if the less talented child not only gives up but makes the decision “If I can’t be good at being good then I will be good at being bad”. This is not an uncommon scenario in the histories of drug abusers and those in the prison population. Those situations where the drug user is seen as the black sheep of the family can include this decision. I have also seen similar situations of what Richard Erskine referred to as the ‘Negative narcissist’. Narcissism is usually defined in terms of the person strives to achieve greatness or fantasies of achieving great success. Thus they are noticed and get lots of attention from everyone. The high profile criminal achieves the same. They can get massive attention for being as bad as they can and a large amount of time, effort and money is spent dealing with them. Such as in the penal and legal systems.


If I can't be good at being good I will be the best at being bad. Look how it makes me the center of attention and its all about me. Negative narcissism.




So the less talented child can just give up trying (“thus I cannot be beaten”) or may decide to be recognised by being bad. I know of one family situation where the older less talented sibling moved geographically away from the family and took up a completely different life style and career. To my mind this was at least partly due to the fact that his younger much more talented brother left him with only that option, (in his mind).

A child’s sense of worth will inevitably be eroded if, at least in their own mind, they are not winning as much as they are meant to (in comparison to their sibling), all through childhood. If one is living in close quarters with the more talented sibling it will be in the child’s face all the time in the most formative years of their life. Unfortunately there is very little else the parents can do except to avoid comparisons, give the less talented one lots of love and strokes and so forth.

The newspaper article also states one other thing that parents can do. It says that whilst recognising results the parents can also focus on the effort put in. Thus one can give the less talented child lots of praise for the effort they put in. One needs to be careful with this as it can easily give quite a different message to the child.

There is an old saying which says: What you stroke is what you get

Consider this diagram.



It shows that there are two parts to any task weather that be completing an assignment, running a race or building a model aeroplane. Firstly one must put in the effort to complete the task. Once done the task is complete and the person has reached their goal.

The question at hand for the child is what does the parent give the most attention for? Is it for the effort they put in to complete the task or is it for basking in the success of completing the task. At times one hears parents say, “Son it does not matter if you win or lose as long as you try your hardest”.

What does this say to the child? It says that the first part of the task - effort to get to the goal - is important and gets lots of attention and reaching the actual goal is of less or little importance. What you stroke is what you get.

The child is getting all the strokes or attention for trying to get to the goal and not for achieving the goal. When this person grows up they get what is called a Try Hard driver. They put all their effort into achieving a gaol and when they actually achieve it, it is sort of an anti climax. It has little psychological meaning because its not what the parents gave all the attention for.


Its all about getting attention.



So the person spends their life putting in lots of effort and struggle to get to their gaols and once they get there they loose interest or it has little importance to them. So the quit or move another another goal and then set about doing exactly the same again. So life in essence ends up being one struggle after another with little appreciation or basking in the good feelings of achieving the gaol.

And my point is? One needs to be careful taking the advice of the newspaper journalist. Focusing on giving the less talented child encouragement and attention for trying hard and less focus for the achievement. It could in fact end up with the ‘less’ achieving child actually achieving even ‘lesser’ but trying awfully hard whilst doing that.

There is just one other point that merits mentioning. And it should be noted that I am mentioning it at the end of this article. The article in the newspaper was about the problems for the less talented sibling. One rarely, if ever reads articles about the problems for the more talented sibling. In the professional literature this would be the same as well.


Competition




One could assume that most parents will think, “The talented one has the talent so he will survive or get through OK anyway with less parental encouragement”. Or parents could even think, “Its not really fair so the talented one can achieve a little bit less for the sake of the less talented one”.

Is it not the birth right of every child to be afforded the maximum parental encouragement and assistance such that they can achieve their full potential? It seems safe to say that some if not most talented siblings will be damaged by the domestic situation of having a less talented sibling. The parents will not as openly and enthusiastically encourage and support the talented sibling in its pursuits when such family dynamics apply.

Indeed a similar situation applies when there is one child in the family who has significant intellectual and physical disabilities. One reads numerous articles on how to help the disabled child but it is very rare to read articles on the damage that can be caused to the other non-disabled siblings in such a family.

Graffiti

The research shows that different drugs have different ages of peak drug use. For example:
Marijuana 14 - 30 years
LSD 23 - 34 years
Amphetamines 20 -34 years
Heroin 20 - 30's years
Cocaine 18 - 30 years
Inhalants adolescence
Nicotine & alcohol teens - lifetime.



Age first tried illicit drugs
Young drugs
Average age less than 18
Proportion who have tried it before age 16 above 20%
Marijuana
Barbiturates
Inhalants

Older age drugs
Average age above 18
Proportion who have tried it before age 16 below 20%
Heroin
Amphetamines
Cocaine
LSD

When first studying the area of alcohol and drug use I always found this an interesting statement. It suggests that different drugs meet different needs in human development. The good part about this is that when one gets older than the age of peak use then they will probably be less driven to use. One could say less ‘addicted’ perhaps.


The latest weapon in the war on drugs.



There are 10 main reasons why people use drugs with 4 common ones being
* Experimental use - "I always wanted to try that stuff". This is typical reason for adolescent and early adulthood drug use.
* Recreational use - this involves using drugs for recreational leisure activities. This is typical of longer term adulthood drug taking.
* Symptomatic use - this involves the use of a drug so one can avoid unpleasant experiences or memories of childhood. The drug is used to ‘numb’ the user.
* Dependent use - here there is a very strong compulsion to use the drug such as is implied in 'drug addiction' or 'drug dependency'.

I have long maintained that for the drug addict or ‘dependent’ type user it is more productive to use a management strategy that gets them through the age of peak use, rather than trying to get them to stop. Of course one wants them to stop using but at times that realistically is just not going to happen. In such instances the ‘treatment’ strategy is more about assisting the person to get through the age of peak use as best they can. Avoiding as many legal, familial and health issues that confront them is the goal of treatment.

From what I have seen of the literature this is a novel concept that I have not heard articulated before. I have just recently been working with two 50 year old men who both have used heroin in an addicted way since their teenage years. They have very long histories of ongoing heroin addiction and thus have lives which are quite tragic with a number of stints in prison and living a life style that is very damaging to themselves and others.



They also articulate the change in attitude that one sees from a 20 year old heroin addict to the 50 year old heroin ‘addict’. Thus it provides some insight into why certain drugs are used at certain ages and not at others. As you will see from a drug treatment point of view therapy now is much more likely to be successful as they are out of the age of peak drug use for heroin.

Person A states that for his entire adult life he has either been addicted to heroin, in prison or on methadone. He has managed to stay heroin free for about the last 6 years and has used methadone successfully in this way. He has no plans to stop his use of methadone. He expresses no desire to recommence his use of heroin and has little urge to do so.

Person B has not used heroin for the past year and is by and large drug free. He has no interest in alcohol and never has, he has no interest in methadone, he uses marijuana and other drugs like valium spasmodically. His use of heroin has reduced slowly over the past 10 years.

He reports that at this time that he has no urge at all to use heroin and states that in the past 10 years he has gets off heroin when his work and family life are going OK. When they turn bad he then has the urge to use.



The difference is:
Both men do not have that attitude you find in the 20 year old habitual heroin user where there is a very strong desire to seek out an use heroin. Where ones thinking is dominated by thoughts about obtaining and using drugs. They both report they are tired of using heroin and they know where using and dealing drugs leads and they have no desire to go those paths again.

This is also different from the 20 year old user who has an interest in the excitement of the drug scene and believes that he can be heavily involved and avoid trouble with the police and so forth. “He can handle it and not get into trouble like others do” he thinks. These two men basically say that they have been there and done that and it is no longer for them. One of them also reports about feeling embarrassed about being 50 years old and still a drug user.

It simply gets too tiring to live the active heroin addict life style which is a high energy, excitement laden way of living. This for example is quite different from the nicotine or alcohol dependent user who can quite easily keep using until well into old age

Graffiti