There are multiple questions and preoccupations that have constantly emerged in the process of this research. Some of these have been lingering prior to the conception of the present work, while others have developed from interactions with the university, and the clinic, as spaces. The main question this research attempts to grapple with is: how do we engage with suicidality – its expressions and communications – in the setting of a clinic situated within the university, in a context where universities in themselves are a site of considerable socio-political turbulence?
As stated in the Prologue, engaging with suicide, as an event that is difficult to think about and symbolise, has gained significant prominence for me, through my own life history. This desire to engage with the phenomenon initially came upon me as a need to understand the untimely loss of a friend, and the impact this loss had on me. The question presented itself as: why would someone take their life? What would prompt that kind of a decision? I think, at an affective level, these were my attempts to mourn and symbolise the nature of this loss and its untimeliness. Though the work of mourning remains a continuous process, these questions no longer grip me as a need to solve the riddle of this ‘why,’ but turn me towards other curiosities which further shaped the direction of the present work. This work is thus impacted by these prior questions through my life historical, but does not remain governed by them, alone.
The present times, in which this work has been thought about, have been turbulent in many ways. Apart from a life stage development that has taken place, as I moved from my Masters in Psychosocial Clinical Studies to my MPhil training in Psychoanalytic Psychotherapy and further still, there have been changes, both structurally and phenomenologically, within two identities that I had begun to occupy: the student in a university setting and a therapist in training.
As mentioned earlier, for my student identity, Rohith Vemula’s death by suicide remains an important event. This tragedy brought to the forefront a series of questions and debates about the education systems, and the rising rates of suicide in the university space. However, what appeared most significant to me was how the student community began to mourn Rohith – not just as a student, but as a Dalit student. The bringing together of caste and suicide has been significant for student movements that have followed in the wake of the incident, and has impacted a larger discourse around the “university” as well. I hadn’t considered or thought about the link between caste and suicide, until Rohith’s death by suicide. This unfortunate event, forced me to think about my own privileges and blind spots, owing particularly to this reality.
For my therapist-in-training identity, the introduction of the Mental Health Care Bill, and the subsequent decriminalisation of suicide, were a significant moment. The bill doesn’t repeal section 309 of the IPC, but amends it to include “mental illness”. Though decriminalisation is a step in the right direction, the definition of mental illness within the bill provoked a lot of questions in my mind. How would the bill and the law constitute the subject of suicide? And equally importantly, how would the practitioner work with him/her? What was this definition in the service of, given that the populations that are showing an increasing rate of suicide are usually from marginalised sections – farmers, Muslims, Dalits, even students. In the current political regime of the country, there have also been trigger groups and dissenting groups, constantly in conflict with the government. Another question that arises then is, what could decriminalisation of suicide come to mean, in the present context? What is the network of meanings being attributed to this act?
With these questions in mind, I began my training within the context of a clinic located within a university. There was much anxiety and trepidation in this phase, from being assigned referral forms, to establishing contact, to initial consultations, to the process of therapy. As I navigated these various stages, I cannot say the initial hesitation ever went away completely, but a sense of method began to develop, along with a sensibility which further informed my work thereafter. I began to realize that what was being presented to me wasn’t as much about the act of taking one’s life but a preoccupation with it. It was sometimes represented in the form itself as “suicidal ideations” or “suicidal thoughts,” while at other times it found no mention in the form. It would find representation in speech, in moments where the subject would say: I just want this all to end, I wonder what would happen if I just banged my car into a tree, I need to get out of this, I am drowning, or even in more straightforward terms, I plan to take my life in March 2018, it has to be done by then, this has to end.
On hearing these, though a sense of a potential acting out would come to mind, what I seemed to be seeing was more a preoccupation with suicide: a tendency toward suicide began highlighting itself, each influenced, shaped, marked by a life history in a shared historical context. From here, the research question transitioned into a dialectic between suicidality, a tendency and suicide, the act. What was this suicidality trying to communicate? What could it tell us about the location of the subject, not just in their life history but their context as well? It became important, in my understanding, to decipher and engage with this suicidality if there was to be a possibility of working with it. To understand suicide as well, engaging with suicidality could allow us to gather a semblance of the constitution of the act itself. In bringing this symptom to dialogue, giving it a space for representation, perhaps we would be able to reach an ethics of care, which could inform a model of prevention.
A tension remains in my mind, especially around terminology, that hasn’t been resolved during the course of this work: how do I address this individual who occupies their patienthood, in both conscious and unconscious ways, enters the clinic with an awareness of some level of distress and a desire to communicate the same, while also occupying a position, within his/her own unique context, which in itself remains an important factor? In understanding the nature of the subject, Parker (2005, cited in 2015) states that the subject is “contradictory, divided between consciousness and what is unconscious, trying to make sense of reality that is not always clearly represented to it, struggling to hold together competing explanations of the world”. To use the word “subject” here then, is to highlight that there is more than just a patienthood at play with(in) the individuals whose cases have been represented in the present work. This patienthood, however, has been the first point of contact; it is where the work began.
In the clinic, though working with the ‘here and now’ between the dyad occupied a centrality, I also began to think about my own subject position and what it brought to the nature of this interaction. The field between me (as the therapist) and the subject of the clinic, was in interaction with me (as a student) within the university as a space, a space which also had within it this clinic. A space that was located within the context of considerable turmoil. This work, then, attempts to reflect on these therapeutic encounters, within this context while examining my own role and movements among these various locations. Having terminated work in the clinic and in the process of reflecting on it, and going back to it, in both thought and writing, my sense was that I was looking at something more than patienthood and clinical presentation, where the term “subject” appears to be more fitting to the representations being brought forth in this work. The subject, then, is “an agent of action combining awareness and forgetfulness, mindfulness and recklessness, reasoning and unacknowledged motives”.
The interplay between the subject and the environment is thus highlighted, which has also been methodologically important to the present work, not just because of the nature of the subject, but also to understand the complexity of suicidality in its manifestation and signification. My own subject position too, remains marked not just by the position of being a student, a trainee within the university clinic, along with my own life history and responses to the turbulence within these spaces, but also by P’s loss, whose death by suicide becomes an event that I continue to process, as I am writing.
Excerpted with permission from Interruptions in Identity: Engaging with Suicidality among the Indian Youth, Ambika Singh, Yoda Press.
