Year: 2007 Source: Australian e-Journal for the Advancement of Mental Health, v.6, no.3, (2007), p.1-14 SIEC No: 20080017

On a 15 month Consultant Psychiatric placement in Central Australia the senior author learned that Indigenous suicide rates in this region over 2001 to 2006 were almost ten times as high as European ones. What accounts for this, and what can be done to reduce it? Within the limits imposed by organisational and service delivery priorities, the authors conducted an opportunistic qualitative study, investigating hospital records, opinions of colleagues, interviews with survivors, and CoronersÕ and Psychiatric reports, in an attempt to address these questions. Basic data patterns were similar to those in other Indigenous suicide studies; reflecting dire overall levels of chronic stress, and indicating an undermining of resilience. Canvassed opinions of medical colleagues, informed by contemporary epigenetic perspectives, developed this hypothesis further. Chronic deprivation and stress may have resulted in a transgenerational cascade of epigenetically impaired resilience to stress, mediated by the impact of stressed infant nurturing, resulting in Hypophyseal Pituitary Adrenal (HPA) Axis dysfunction and its behavioural sequelae (depression, anxiety, substance abuse, violence, suicide; but also impaired capacities for nurturance). The authors wondered about the impact of this on the development of that prefrontallymediated interiority (capacity for reflective inner life) that authors like Fonagy (2004) associate with the ability to deal with extreme emotional states. Survivor vignettes reflected something of the interior process of suicidees. The suicide gestures could be read as expressions of social powerlessness and implicit pleas for the kind of nurturance that might facilitate development of a capacity for reflectiveness that might lessen impulsive emotional acting out. The developing individualÕs impaired capacity for an inner life may be repaired to some extent, in psychotherapy, by the application of an empathic reflective nurturance (Fonagy, 2004; Meares, 2000). What is required in a social tragedy of this magnitude goes way beyond the psychotherapistÕs rooms. Informed by a post-Jungian sensibility, the authors extend this model of therapeutic nurturance, as heuristic metaphor, to the notion of the larger Euro-Australian milieu as failed nurturer, with a particular focus on psychiatric and forensic services. In an attempt to see how organisations might become more effective nurturers, we used a Leximancer Ôconcept analysisÕ of CoronersÕ Reports to explore organisational Ôcollective countertransferenceÕ. The Leximancer data suggested slippage between collective intentions and outcomes, prompting a discussion of ways of enhancing the nurturing capacities in organisations/services (in this case, Psychiatry and the Law). A ÔKanyini/nurturanceÕ project of repair is outlined.