Rates of suicide and violence are much higher amongst male prison populations than in the general population. One phenomenon found to be associated with both suicide and violence in a range of general and clinical populations is alexithymia, though to date these associations have not been explored amongst male prisoners. Alexithymia can be defined as an inability to identify or describe feelings and is related to externally oriented thinking styles (i.e., a lack of imagination). The first aim of this thesis was to investigate the relationship between alexithymia and suicidal and aggressive thoughts and behaviours within adult male prisoners. A second aim of this thesis was to explore and develop new ways of working with people with lived experience of the phenomena relevant to this thesis. A mixed-methods approach was taken to address these aims, incorporating a review of existing literature, qualitative interview studies and a cross-sectional questionnaire-based study. Chapters one and two (study one) of this thesis give a narrative review of the literature to date and also outline the overarching aims of this thesis. Chapter three provides a detailed consideration of the methodology of this thesis. Chapter four (study two) provides a systematic review and meta-analysis of the extant research, finding a large association between alexithymia and suicide ideation and a small association between alexithymia and suicide behaviour. Chapter five (study three) outlines a qualitative interview study with a range of prison staff (n=20). Staff identified a process whereby prisoners struggle to identify, understand and communicate feelings which leads to intense, sudden outbursts of emotions. In turn, this was felt to lead to harm to self and others. This process was placed in the historical context of upbringing as well as the current context of the prison environment. Chapter six (study four) echoes these findings but from the perspective of the male prisoner. Qualitative interviews (n=15) identified that male prisoners did not discuss their emotions due to environmental pressures (e.g., the jungle environment of prison) and internal difficulties (e.g., difficulty identifying and articulating emotions). This was thought to lead to a build-up of emotions, which resulted in either an âemotional voidâ or an âemotional overloadâ; both experiences were related to harming self or others. Chapter seven (study four) details the process of involving an individual with lived experience in a co-analysis of qualitative data and provides key learnings about this process. Chapter eight (study five) reports findings from a questionnaire study with 80 male participants, which found that whilst alexithymia independently predicted suicide ideation and behaviour, the association with suicide ideation was no longer significant after controlling for depression, hopelessness, and anger. There was no association found between alexithymia and violent ideation / behaviour and dual harm ideation / behaviour. Finally, chapter nine (study six) shows that participants in studies four and five viewed their participation positively. All studies in this thesis highlight the importance of external influencers of the relationship between alexithymia, suicide, and violence, such as the prison environment, gender identities and clinical factors such as depression. Future research should therefore aim to explore these factors in greater detail to delineate their impact on the relationship between alexithymia, suicide, and violence in male prisoners. Clinical implications from this thesis can be seen to fall under four important areas: i) assessment of alexithymia ii) staff training around alexithymia iii) interventions targeting internal difficulties and iv) interventions targeting external difficulties, such as reducing environmental pressures to stifle emotions.
- Suicide
- Alexithymia
- Forensic Psychology
- Violence
The association between alexithymia, suicide, violence, and dual harm in male prisoners: A mixed methods PhD
Hemming, L. (Author). 31 Dec 2021
Student thesis: Phd