Healing from the Base: Prof Kevin Malone
To mark the launch of our 3Ts Blog, and kick-off our series of Guest Expert contributions, we invited eminent psychiatrist and co-founder of 3Ts, Prof Kevin Malone MD, to tell us about just one of the ground-breaking research projects he has undertaken into Suicide in Ireland.
Here, Prof Malone, speaks candidly of the nature of his most recently published research, touching on the physical and emotional nature of the project, and the therapeutic merits of its unique fusing of scientific research with art. The research findings & implications, together with Prof Malone’s personal reflections, provide us with a window into the lived lives behind the statistics and a 360 degree perspective on just what can be learned from these lived lives both from a human outlook and for future suicide prevention policies.
At the forefront of suicide research in Ireland, Prof Malone is a Consultant Psychiatrist in St. Vincent’s University Hospital Dublin and Professor of Psychiatry & Mental Health at UCD.
Prof Malone writes:
Healing from the Base
I’ve been invited to contribute a blog to 3ts website, so here goes.
My name is Prof Kevin Malone and I’ve been involved in research around suicide & suicidal depression for the past 25 years, both in Ireland & the USA, and I might refer in more detail to that another day. More recently, I spent 5 years doing in-depth interviews with 104 suicide-bereaved families as part of the “Suicide in Ireland survey 2003-2008”, a ground-breaking and innovative piece of research which culminated in a Report published in May 2013. I’ve no idea if the Report had any impact, it certainly carried recommendations, but I’ve yet to be consulted about the findings and their implications for either policy or practice.
Many people helped to bring this work to fruition. The project was undertaken in collaboration with artist Dr. Seamus McGuinness of GMIT, so we had the coming together of the worlds of Clinical Science & the Arts to focus on a huge and hugely human problem in Ireland. This integrated, inter-disciplinary, collaborative science and humanities approach to suicide in communities has not been attempted elsewhere.
We gave particular focus to youth suicide, as 36 of the suicide-deceased, or Lived Lives as we knew them, were aged under 21 years. We interviewed their families in their homes mostly, arriving at a pre-arranged time, and leaving whenever the families wished us to. The study was an intense project at every level; intense trust, intense sadness, intense loneliness, intense anger, to name a few. But above all, there was an overwhelming level of trust bestowed on us and our endeavours by the research families. Why? Seamus thought it was in part to do with our “going the extra mile”- going to their homes, and meeting the families on their terms, without judgement or pre-conditions; something to do with institutions leaving their towers and going to communities; something to do with the roots of democracy and empowerment? Perhaps.
We started this project 6 years ago, and looking back there from here, and forwards from then, it is possible that Seamus has a point, and one which still resonates in 2014 for many un-addressed / under-addressed festering social ills still at large, where faceless bureaucracy loses touch with the people. I will leave that point there for another day – food for thought.
Following on from the publication of the Suicide in Ireland report, later in 2013 I participated in the subsequent Lived Lost Lives project in Letterkenny, an exhibition / event drawn together by Dr Seamus McGuinness, commissioned by Letterkenny Arts Centre (Sean Hannigan), in collaboration with the National Office for Suicide Prevention Donegal branch (Ann Sheridan). Working with local statutory & voluntary suicide prevention services, a series of consultation meetings with local Donegal families was held and these informed the process.
The project included the installation of artworks from the Lived Lives Project related to lives lost to suicide between 2003-2008, and many of these were young lives. On opening night, Seamus & I presented an overview of our collaborative work to a public audience (including two Mayors), followed by a mediated tour through the art exhibit. The exhibition remained installed for the following 4 weeks, with the artist present during all opening hours. Additionally, our protocol insisted we ensure at least one bereavement counsellor was at hand during opening hours.
Over the four weeks, the exhibition drew several schools from the region. Teachers, who had visited and met with the artist a few weeks before, now brought their transition year students (average age 16 years) to the mediated exhibition. Students provided extensive feedback on essentially their suicide-deceased peers, and manifested extraordinary engagement. There was temporary and contained sadness, but no reported “negative” fall-out (apparently feared in some official health circles).
From the moment the visitor entered the exhibition to the moment they left, there was incredible attention to detail, both within the artworks and within the hosting team (and in the case of schools, much preparatory work was done in advance of their visit). Unlike typical art gallery visitors, many visitors spent several hours amongst the artworks, with many making more than one visit.
Hundreds of visitors of all ages from across Donegal shared valuable thoughts and feedback, and the entire process has been carefully documented, as a living artwork in progress.
In tandem, I also took part in a day-long “Think-In” with two components: a morning session drawing together a mix of 30 or so suicide intervention-related activists from both statutory & voluntary sectors – “the elders”; and an afternoon focus group with 16 year-olds from the local community – “the youngers”. Both took place in the midst of the artworks. This was intended to be the start of a conversation that will be continued, the artworks providing a neutral space for a deeper engagement with local (and universal) fears about elevated suicide rates within a community. Each participant was invited to leave his or her official hat outside the door and start this conversation from the common shared space of humanity.
And this is where the young people really came to the fore.
Whereas there was much information and experiences shared by the “elders” in the morning forum, much of the efforts were splintered, or fragmented. On a subsequent RTE Radio 1 piece I likened it to listening to an orchestra – they were playing the right music / tune – the unity of effort was visible and valiant, but the product lacked integration, synchrony or harmony.
By contrast, the group of 16 year olds, student volunteers who gave up their time after school, met under the focus group title “Thinkn Allowd”, and boy did they express themselves. They were magnificently honest, open, forthright, insightful, constructive, sympathetic, empathetic, sensitive, respectful, intent and intense, and their messages chimed through the installed artworks.
We are now in the process of typing up the transcripts from the “elders” and “youngers” for analysis, reporting, sharing, feeding back to the community and getting their feedback.
My point in this blog entry is the need for “healing from the base”.
In surgery, if a wound doesn’t heal, the treatment is to open the wound and actively keep it open, so it heals from the base of the wound, gradually to the surface. It needs careful tending and dressing, plenty of warm salt baths – active management as the healthy granulation tissue gradually forms from the base. Yes, there will be a scar, but the wound will heal.
We piloted a new model of bringing our integrated work around suicide and its aftermath into communities and putting it to work, indeed putting communities to work around the sensitive issue of suicide. Our model permitted the opening of the unhealed wound of suicide within a community, where there was active management by the team to keep the wound open to allow the community (young & old) to take some ownership of the process, to realise and release a voice – to instil a “healing from the base”.
And this is what is reflected in the feedback of the hundreds of visitors to the exhibition.
Our project will travel wherever, and whenever there is funding. Obviously it is a new model that requires further evaluation (and further testing and refining in other communities). But there is nothing to suggest that Donegal is any different from any other community or county in Ireland (or perhaps elsewhere) that is hurting from suicide. Indeed official statistics indicate many counties have higher rates than Donegal.
I encourage other communities around Ireland, statutory & voluntary, elder & younger, to ask themselves how they view their healing efforts.
Is there healing from the base – from the ground up?
If not, perhaps it is time it started in earnest.