1) The document discusses new communication approaches for addressing suicide in families, stemming from fields like endocrinology, physiology, and anthropology. It focuses on regulatory mechanisms within relationships and how communication contains both a content and incentive component. 2) There are two main types of regulatory relationships - explosive (dominate-submissive) and counterbalanced/mutual. The suicidal crisis presents an opportunity to shift an explosive relationship to a mutual one based on ethics of reciprocity. 3) A health care professional can help facilitate this shift by taking an initial role as a third party and addressing the reciprocity between all people to find non-violent solutions and new values for problem-solving. This establishes the

1. The New Communication Applied to
the Problem of Suicide in Families
Suzanne Lamarre MD FRCPC DLFAPA
Assistant Professor in McGill
Department of Psychiatry

2. What’s the New Communication
• Stems from Endocrinology, Physiology,
Mathematics, Anthropology at the beginning of
the 20th century
• It’s about regulatory mechanisms and the change
and stability of living systems and organisms
• It has been called Cybernetics, a new
transdisciplinary discipline
• New communication is part of the systemic
approach and family therapy theories in
psychiatry

3. The double elements of any
communication
• Within any communication there is
– a content (digital) (what I say) (telegram)
– an incentive (analogic) (how I say it)
• on the identity of the actors
– “It is not what you say that bothers me it is the tone you use
to say it” (You make me feel worthless by the way you talk to
me)
• on the attribution of responsibility
– “You are asking me about my wish to die”
“It means without saying it is your responsibility now to
protect me from doing it and you should respect my rights”

4. Regulatory mechanisms within a relation
between two persons communicating
• Explosive type
– Up-Down (dominant – submissive)
– Rivalry or symmetrical
• Counterbalanced or a mutuality relation
– Always a possibility of a temporary rupture or
STOP

5. The regulatory mechanisms in suicidal crisis
1. Explosive relation between protector and protegee
Suicide is a symptom to be controlled by the HCP who ends up
controlling the suicidal person who opposes to the control of the
protector in order to save his identity of an autonomous person
2. Mutuality relation between 2 autonomous persons
proposed by the HCP when addressing the Ethic of Reciprocity in
the family meeting
“how would you feel if your loved one in a state of distress would think of
suicide as you do?”
Let’s agree on this golden rule: “don’t do to others what you don’t want
others do to you, killing your loved one”
The reequilibrium is in a mutuality relation and a change
in the values and in the ways to address problems

6. Installing the mutuality relation
• A change in an explosive relation can only be
brought up by a third party which usually is
the HCP in a suicidal crisis

7. The catch 22 of the protector role
Communication
Doing more and more of the same until it
explodes
“I am despaired and I don’t want anyone to upset me more”
“Leave me alone and don’t hurt me more”
“Life cannot continue the way it is going”
“Something needs to happen! An explosion”
The HCP needs
• to recognize the impossibility to be in this
situation and
• to take at first contact the role of the third party
in addressing the explosive relation

8. New communication and autonomy
• One cannot control someone’s mind
– The unpredictability of an autonomous person
• When someone thought of death as the only way out,
it means this way out could be used again
• The suicidal crisis is the key moment to address
another way to manage problems among people who
care about each other
• There should be a place for everyone’s sensitivity as a
human being by choosing values and behaviours
– where interpersonal violence is excluded and
– the need of interconnectedness is recognized

9. New values for a life without violence
• Suicide is a violent, explosive, way to change a
situation
• New types of values and new ways in
managing problems for a life without violence

10. 1st phase
• Safety aspects : context of self protection (no
more violence) based on the engagement in
the ethics of reciprocity where people adopt a
new rule in their communication: RRAV-LR
Rule of Respect of the Autonomy of everyone and Vulnerability
(sensibility) – I can talk about my Limits to Reorganize the situation
• Treatment aspects: a choice
• New values to manage problems without
interpersonal violence

11. 2nd phase
Applying new Values
• See www. lasantementale.info

12. On the individual level
Roads of victimization in
a Protectionist context
Roads toward a quality of
life and ethic of
reciprocity
WHAT TO STOP DOING WHAT TO TRY
Withdraw from others when in
despair 1
Reach out to others when in despair
and manage problems in a different
way
Assume that depressive ideas and
depressive mood don’t interact with
each other
2
Practice mindfulness, stay grounded
in the moment, and choose one’s
thoughts
Ignore brain neuroplasticity,
communication and principles of
relations, action recursivity and final
causes
3
Count on brain plasticity: new
patterns can emerge when one
becomes aware of the contexts that
maintain them
Act impulsively or emotionally 4 Be aware of one’s emotion and deal
with the frustration after reflection

13. Roads of victimization in
a Protectionist context
Roads toward a quality of
life and ethic of
reciprocity
WHAT TO STOP DOING WHAT TO TRY
Ignore the entrance pathway towards
victimization and death 5
S (STOP ) or STEP
T (take a breath)
O (observe) or E (explore)
P (proceed)
Change nothing and wait for someone to
die 6 Put the problem on the table, mourn
losses and let the brain process the info
Ruminate on unfairness and continue with
“I should have” or avoid those thoughts in
engaging in dead ends
7
Forgive: decide to choose pleasant
thoughts and moods – Get oriented to
the future “I should” rather than anger
Waste time on “why” – the initial cause of
the problem – rather than identifying the
final cause (the aim)
8
Switch quickly from “why” to “how” to
reorganize the situation with others and
foster collaboration to solve problems
Burn out 9
Be aware of energy renewal and
feedback loops; get a perspective on
relations to maintain peaceful and
fulfilling contexts

14. Roads of victimization in
a Protectionist context
Roads toward a quality
of life and ethic of
reciprocity
WHAT TO STOP DOING WHAT TO TRY
Stay cornered in a protectionnist system
(saviour’s role) by overprotecting the
suffering one
10
Address oneself to a third party so as to
change from a rule of the game a rule of
collaboration and self-protection and for
the ethics of reciprocity
Avoid or hide problems, or look for guilty
people to exclude or to punish 11
A good leader acknowledges the
existence of problems and installs a
context for everyone to participate in
solutions
Maintain oneself in controlling,
manipulative behaviours by being even
more so, imposing solutions, blaming,
and disqualifying others (see the wheel
of victimization)
12
Become an expert in identifying
dysfunctional, explosive systems by
focusing on relations rather than on
individuals
Assume the right to bully and humiliate
another for self defence 13
Exclude all violence and explosive
means for self protection and do time-out
in love in case of tension.
Blame oneself, blame others or let
others blame us 14
Recognize one’s mistakes and discuss
how to repair with neither guilt nor
shame.

15. Roads of victimization in
a Protectionist context
Roads toward a quality
of life and ethic of
reciprocity
WHAT TO STOP DOING WHAT TO TRY
Fall into wrongdoing that needs to be
hidden, and engage in self denial and
blackmailing
15 Expect honesty and discretion and
defuse all time bombs
Force the other to agree so as to be ‘one
of us’ 16 Love and collaboration does not mean
having to say “yes” to every request.
Compare oneself to others, be envious,
maintain oneself in shameful and guilty
feelings, continuously excuse oneself
17
Gain self confidence by accepting one’s
own mistakes, without assuming the
identity of the ‘bad boy’ or ‘bad girl’: be
aware there is suffering in all action, but
acting is much more interesting than
waiting for the authorization to act.
Keep trying to prove one’s value 18 Learn to risk trusting others, and expect
others to reciprocate

16. Lessons to take home
• Momentum for change
– 1st psychiatric contact
– Don’t let the suicidal loved one alone with the HCP
– It is a key moment to change your way to care about each other
and to manage problems
• Real change
– Relational rule
• From controlling each other, to collaborating with each other
• From overcompensation, to partnership in reciprocity
• Who has the lever for bringing such a change?
– The Health Care Professional and
– When the reciprocity rule is adopted, the family including the
suicidal one