The Patient and the Family Structure

Some patients come to the hospital because they have problems and some come because they "are problems". This may sound like a cold observation but it is in a way a very accurate description. The patients that I would describe as "being a problem" were raised in a manner that the only way they received attention from their family was by being manipulative and doing negative things, as this was the only type of behavior that was rewarded by the patient’s family, that is, the only behavior that elicited any attention at all. Some of these patients were sexually molested and some were abused physically and mentally. In just about all of these scenarios, the child was not given attention for doing positive character building behaviors, but rather the only way that the child received attention was to "get in trouble". This happens every day,  millions of times a day.

One common way children that come from this type of environment receive attention is by doing something that makes them suffer, in this way they believe that their parents will suffer along with them. An all to common example of this is when a mentally ill person attempts suicide. In most of these cases, the patient is not really trying to die, he or she is more likely to
be seeking attention and trying to punish a loved one. For example, attempting suicide by taking a quantity of aspirin can kill a person, but  it must be in significant quantities. Taking aspirin won't cause immediate death, but can cause a slow agonizing death (sometimes taking weeks) caused by liver failure. Usually, when a patient has taken aspirin to kill him or herself they didn't count on spending the remainder of their days in intensive care receiving treatment for liver failure. Instead, (on an unconscious level) they believed that aspirin was non lethal. When a person has a true desire to die they don't want to end up it intensive care with greater problems than they had before the suicide attempt. This is why, when a patient is interviewed by a health care worker concerning suicide ideation, the first question is, "how do you intend to kill yourself".

Whether or not the patient is truly attempting to kill himself is obvious to the trained observer once the method of suicide is known. In cases where the patient is trying to seek attention, it is usually an attempt to hurt a loved one, by making the loved one suffer along with the patient. The patient believes that the loved one will suffer because the loved one does not want to see harm done to the patient. This behavior is a way of getting attention from family members and other loved ones and is a very common and maladaptive way to receive it. In most suicide attempts the true motivation behind the action was to receive attention, not die. This statement may appear quite offensive to people who have attempted suicide. The truth is that a true desire to kill yourself is not spontaneous, it is usually planned and executed in a methodical fashion in a way that doesn't give you a significant chance of living. Most people know what can kill them, and if there will be anyone around to prevent their death. Someone that secretly goes out to purchase a 12 Gauge shotgun and intends to stick it in their mouth and blow their head off would be considered a person who truly wants to end their life.

Although it may sound like the mental health professional could worry less about a patient that is using a suicide attempt as an attention seeking device, this is not the case. If the patient perceives that you believe that the they are just seeking attention, the patient will go out of their way to prove that they are serious about suicide. The patient will prove this (usually) by some type of self mutilation, most of the time by cutting their arm with a sharp object. Again, usually, when this action is preformed, the laceration is not deep enough to hit an artery, or if it is deep enough, the patient is within range of someone to that can request medical attention.

When patients in the psychiatric hospital attempt suicide, unless they are in possession of a weapon (which is quite rare because of the body and personal items search upon admission) the attempt is obviously an attempt to seek attention. As all psych patients are perfectly aware of, the psychiatric ward staff are required to do Q15 Rounds. This means that the a staff has to visually see the patient every 15 minutes and chart what the patient is doing.  Patients that are considered a serious suicide risk receive continuous visual observation.

The ward itself is searched daily for articles that could be used for self destructive actions. So basically if a patient is attempting suicide inside of the ward, if they don't have some method of self execution that is immediate, the action is observed as an attention seeking. Even in light of this observation, the behavior is still viewed just a seriously as if it were a true attempt at suicide, because many psychiatric patients have killed themselves, just to prove that they were serious.

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