title: Exhausted without trust and inherent worth: A model of the suicide process based on experiential accounts.
abstract: Suicides are related to diverse demographic, socio-economical, medical and behavioural 'risk factors'. Theoretical work in suicidology attempts to construct models that explicate the mechanisms underlying these suicides; however, models taking first person perspectives as their primary evidential bases are scarce. Drawing on interviews carried out by researchers at a UK mental health charity during 2010-2012 with people bereaved by suicide (n = 25), suicidal individuals (n = 14) and their 'significant others' (n = 15), we present an explanatory model of the process of suicide derived from a Grounded Theory study.
  
  
  
  Suicide/attempt can be understood as the result of a complex interaction of three elements of experience: 'lack of trust', 'lack of inherent worth' and 'suicidal exhaustion'. The first two may be seen as conditions from which the third emerges, but so that all the elements are related to each other reciprocally and the exhaustion and the suicidal thoughts, feelings and behaviours it gives rise to feed back into the initial conditions. Trust, understood as an aspect of experience that allows a person to accommodate uncertainty in relationships and in thinking about the future, is lacking in suicidal people, as is a self-determined sense of worth that is independent of external factors. Substituting inherent worth with self-worth gained from extrinsic factors, and trustful experiencing with strategies of self-reliance and withdrawal, a person begins to consume mental resources at a high rate. 'Suicidal exhaustion' is distinguished from other types of chronic mental exhaustion in that it is experienced as non-contingent (arises from living itself) and hopeless in that the exhausted person is unable to envisage a future in which demands on his/her mental resources are fewer, and their replenishment available.
  
  
  
  The model has potential applications for public participation in suicide prevention, which should be mapped and assessed in further research.
authors.affiliation: SANE, St. Mark's Studios, 14 Chillingworth Road, Islington, London N7 8QJ, UK; University of Exeter Medical School, College House, St Lukes Campus, Exeter EX1 2LU, UK. Electronic address: o.benson@exeter.ac.uk.
authors.forename: Outi
authors.initials: O
authors.lastname: Benson
authors.affiliation: SANE, St. Mark's Studios, 14 Chillingworth Road, Islington, London N7 8QJ, UK; The McPin Foundation, 32-36 Loman Street, London SE1 0EH, UK. Electronic address: susannegibson@mcpin.org.
authors.forename: Susanne
authors.initials: S
authors.lastname: Gibson
authors.affiliation: SANE, St. Mark's Studios, 14 Chillingworth Road, Islington, London N7 8QJ, UK; London South Bank University, Division of Psychology, 103 Borough Road, London SE1 0AA, UK. Electronic address: bodenz@lsbu.ac.uk.
authors.forename: Zoë V R
authors.initials: ZV
authors.lastname: Boden
authors.affiliation: SANE, St. Mark's Studios, 14 Chillingworth Road, Islington, London N7 8QJ, UK; University of Exeter Medical School, College House, St Lukes Campus, Exeter EX1 2LU, UK. Electronic address: gareth.owen@powys.gov.uk.
authors.forename: Gareth
authors.initials: G
authors.lastname: Owen
mesh_terms: D000328:Adult; D000368:Aged; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D028723:Personhood; D036301:Qualitative Research; D012307:Risk Factors; D013405:Suicide / Q000523:psychology*; D035502:Trust / Q000523:psychology*; D006113:United Kingdom
keywords: Suicidal exhaustion; Suicide; Trust; UK; Worth