SUICIDE AS GOAL-DIRECTED
Konrad Michel and Ladislav Valach
The generally disappointing results of systematic evaluations of the treatment of suicidal behaviour, including the prevention of repeated suicide attempts as described in the previous chapter, indicate the need for a new approach towards the suicidal patient. An obvious prerequisite for establishing a trustful working relationship must be that patient and therapist have a mutual understanding of the reasons for suicidal thoughts or deliberate self-harm. Traditionally, suicidal behaviour has been understood within the framework of the biomedical-illness model. This model implies that the health professional has to find the cause of the patient's pathology and then treat the disorder. However, both suicide and attempted suicide are actions that are planned and carried out by individuals, involving conscious processes, and they are thus not mere signs of illness and pathology. An approach based on action theory may well provide an alternative framework to understand suicidal behaviour and to establish a meaningful communication between health professionals and suicidal patients. Fundamental to this approach is the assumption that a better therapeutic relationship with suicidal patients will help health professionals to become more effective in preventing suicide.
Actions are associated with cognitive and emotional processes, which involve planning, steering, monitoring and decision making. Actions are part of mid- and long-term systems consisting of projects and