A Suicide Researcher’s Reflections on Dying and Living

May 8, 2016

by — Posted in Peer Edited Submissions

When I tell people I research suicide intervention, I often encounter one of two responses: 1) “That’s depressing,” or 2) they change the subject. As a suicide researcher, it is presumed that I am interested in death and dying. The aim of this brief article is to explain that I am actually focused on life and living – the other side of the coin.

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Encountering Death

My interest in suicide as a child and youth care practitioner/researcher was sparked approximately 15 years ago when working at a crisis shelter for street-involved and homeless youth in beautiful Vancouver, British Columbia. Our crisis shelter was nestled in the midst of mountain views and ocean smells, amid the high-rise condos that scraped the sky and were populated with the LuLuLemon-dressed, high-end professionals in Yale Town, and among the busy bars on Granville Street where “night-life” rolled into dawn. Our shelter also sat adjacent to The Strip on Seymour Street where women/girls and transgendered persons walked as Johns, potential Johns, and onlookers cruised by, and near Boys Town where male youth – who tried hard to look as pubescent as they could – huddled in condo building entrances pretending to just be hanging out. It was in this environment that I met Violet, and lost the opportunity to know her more the night she walked out of the shelter and jumped off a nearby bridge. Hers was my first funeral, and her death rocked the cohesiveness of our youth work floor, leaving us figuratively huddled for support as we struggled to make sense of what had happened. As a supervisor in the organization, I was at a loss as to how to move us forward. So, like many people faced with the uncertainty and powerlessness that not knowing brings, I decided to pursue a Ph.D.

Examining Mental Health Literacy

My supervisor at the University of Victoria, British Columbia, Dr. Deborah Begoray, introduced me to the concept of mental health literacy.[1] I began to examine this concept in relation to suicide intervention in youth work practice. I wondered how knowledge and beliefs about mental disorders according to the Diagnostic and Statistical Manual of Mental Disorders[2] helped, hindered, or influenced youth workers’ practice with suicidal young people. Mental health literacy research was overwhelmingly quantitative and focused on measuring individuals’ declared knowledge (e.g., recognition of the symptoms of depression),[3] viewing literacy as a measurable and static characteristic of individuals.[4]

As I qualitatively examined youth workers’ suicide intervention processes in my doctoral work and in two subsequent studies,[5], [6] I heard a lot about risk, protocols, and setting up defensive perimeters to keep youth ‘safe’ from death. Suicide interventions where standalone practices, suicide education ‘deposited’ skills in the youth worker (e.g., asking directly about suicide, checking enough boxes on a form to determine if the youth was ‘high’, ‘medium’, ‘low’ risk), and youth workers’ learned helplessness illustrative of their perceived limited capacity to help (e.g., “they have bigger screening tools than I do”).[7], [8]

And yet, some of my research has pointed to hope – where youth workers maintained relational proximity to the young person[9] and saw the adolescent (and themselves for that matter) as resilient. I began to write about principles that guide hope interventions[10] instead of protocols that outline step-by-step procedures emphasizing risk.[11] I learned from participants that practice experience was key to learning how to negotiate these uncertain and fluid conversations, and the importance of translating relational skills to our interprofessional collaborations, thereby building a support for ourselves and the adolescents we work with.

Re-Imagining Mental Health Literacy

From there, I re-defined mental health literacy as the collective knowledges, meanings, and experiences of mental health that aid in awareness and transformation, and that enable emancipatory action and full participation in maintaining and enhancing mental wellness across variable, localized contexts.[12] Social literacy theorists[13] who focus on context and fluidity, and critical literacy theorists[14], [15] who focus on empowerment and participation, informed my work.

I then had the privilege of working with a group of First Nations youth in the prairies alongside Dr. Warren Linds and Dr. Felice Yuen in an arts-based project designed to create a youth-informed suicide education workshop for youth-serving professionals. Prior to our arrival we were asked not to focus specifically on suicide, but focus on wellness – and in focusing on wellness, address suicide. Youth created arts-based projects, such as theatre, photo collage, and a video, that depicted life and living. Such projects incorporated a connection to others, environments, and ceremonies, as shown below.

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My mental health literacy research has increasingly become focused on literacy development and application in-context. I have come to recognize that the interaction, setting, cultural background, and multiple other situated variables are influencing – and influenced by – how literacy is enacted in practice. From this learning point, I designed a mental health literacy curriculum in partnership with child and adolescent psychiatrist, Dr. Stan Kutcher (IWK Health Centre/Dalhousie University), and several other contributors, which is in the process of being implemented as a way to examine how mental health literacy influences youth workers’ practice.

Flipping the Coin: Researching Life

I began my research career with what appeared to be a focus on death and have moved to a hopeful place. No event in my career as a youth worker or researcher has made this shift come to life – pardon the pun – more clearly than the pancreatic cancer diagnosis of my sister in July 2015. Survivorship of pancreatic cancer is in the single digits, as it often is not detected until it has spread significantly to other organs. She had tumors on her pancreas, liver, neck, and underarm. Like many oncologists, hers was a detached and dismissive grim reaper focused on statistics and rationalizations. She was told she had three months without chemo, or 10 months with chemo, and to “get your things in order.” For her oncologist, the coin had been flipped landing death-side up.

My sister turned the coin over and told everyone she was living. She was not going to let the oncologist, or the cancer, be the author of her life story. This is her skiing nine months after her diagnosis, and after 18 chemo treatments.

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But for her, the pain, headaches, vomiting, fevers, and loss of hair is living. It is in this lived life – and the lived lives of others – where we can learn about suicide, death, and dying. With this in mind, I would like to re-introduce myself – I’m Patti Ranahan and I research life.

[1] Jorm, A. F., Korten, A. E., Jacomb, P. A., Christensen, H., Rodgers, B., & Pollitt, P. (1997). “Mental health literacy”: A survey of the public’s ability to recognize mental disorders and their beliefs about the effectiveness of treatment. Medical Journal of Australia, 166, 182-186.

[2] American Psychological Association, (2015). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: Author.

[3] Olsson, D. P., & Kennedy, M. G. (2010). Mental health literacy among young people in a small US town: recognition of disorders and hypothetical helping responses. Early Intervention in Psychiatry, 4(4), 291-298.

[4] Ranahan, P., & Pellissier, R. (2015). Youth workers in mental health care: Role, mental health literacy development, and framing future research. Journal of Child and Youth Care Work, 25, 229-247.

[5] Ranahan, P., & Thomas, T. (under review). Mental health literacies for interprofessional collaboration: Youth workers’ perspectives on constraining and supporting factors.

[6] Ranahan, P., & Pellissier, R. (2015). Being green: A discourse analysis of youth workers’ initial touchstone experiences with suicidal youth. Relational Child and Youth Care Practice, 27(4), 11-22.

[7] Ranahan, P., & Thomas, T. (under review). Mental health literacies for interprofessional collaboration: Youth workers’ perspectives on constraining and supporting factors.

[8] Ranahan, P. (2013). Why did you call for them? Child and youth care professionals’ practice of flooding the zone during encounters with suicidal adolescents. Child Care in Practice, 19(2), 138-161. doi:10.1080/13575279.2012.750598

[9] Ranahan, P. (2013). Being with: Child and youth care professionals’ practice with suicidal adolescents. Relational Child & Youth Care Practice, 26(1), 6-17.

[10] White, J. & Morris, J. (2012). Doing hope together as a youth suicide prevention strategy. International Child and Youth Care Conference, Canmore, AB.

[11] Ranahan, P. (2016). Protocols or principles? Re-imagining suicide risk assessment as an embedded, principle-based ongoing conversation in youth work practice. Child & Youth Services, 0(0), 1-19. doi: 10.1080/0145935X.2016.1158095

[12] Ranahan, P. (2015). Mental health literacies in youth work practice with adolescents. In D. Begoray & E. Banister (Eds.), Adolescent health literacy and learning (pp. 119-134). New York: Nova.

[13] Street, B. V. (1995). Social literacies: Critical approaches to literacy in development, ethnography and education. Essex, England: Pearson Education.

[14] Norton, B. (2007). Critical literacy and international development. Critical literacy: Theories and practices, 1(1), 6–15.

[15] McDaniel, C. (2004). Critical literacy: A questioning stance and the possibility for change. The Reading Teacher, 57(5), 472–481.


This article was peer-edited by Shauna Pomerantz

About Patti Ranahan

Patti Ranahan is an Assistant Professor within the Department of Applied Human Sciences at Concordia University, 7141 Sherbrooke St. West, Montreal, Quebec H4B 1R6, Canada Email: patti.ranahan@concordia.ca
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