The Benefits of Robust Debate About the Place of Qualitative Research in Suicide Prevention

We write in response to the rebuttal of our work, “What can we learn from first-person narratives? The case of non-fatal suicidal behaviour” (Bantjes & Swartz, 2019) by Hjelmeland and Knizek (2019). We are grateful to our interlocutors for raising important questions about our arguments, for pointing out the problems with some of the examples we cite, and for helping us to think carefully about what we do as researchers committed to suicide prevention. There are issues of detail in the critique with which we agree, and others with which we do not. We affirm, as clearly set out in our work, that

We dispute the claim that we discredit qualitative suicide research or the voices of people with lived experience of suicidality (Hjelmeland & Knizek, 2019), as a careful reading of our work will show. Hjelmeland and Knizek (2019) take issue with our selection of examples from their work, and we apologize for any misrepresentation. They do not, however, offer any rebuttal to our core argument, which is that there are distinct limitations to using first-person narratives of suicide to advance the goals of suicide prevention. It is these limitations and the reasons for them that constitute the body of our paper. Academic rigor demands that these limitations be made explicit before any claims are made about how to translate qualitative research into suicide prevention practices.

It seems that at the heart of their critique is Hjelmeland and Knizek’s fear that we may undermine the voices of people with lived experience of suicidality and discredit qualitative suicide research generally and their research specifically. We very much regret that our discussion may have contributed to this fear. We believe that attending to the lived experience of people is very important in all qualitative health research, and we have no wish to undermine these voices. We also strongly affirm that we do not in any way want to undermine efforts to advance qualitative suicide research. On the contrary, in our qualitative suicide research and in other qualitative health research in which we are engaged (see, for example, Bantjes, 2017; Bantjes et al., 2015, 2017, 2019; Frenkel et al., 2018), as well as in our contributions to texts developing qualitative research methods (Bantjes & Swartz, 2017, 2018; Keikelame & Swartz, 2019; Swartz, 2014; Swartz & Rohleder, 2017), we have positioned ourselves as part of the movement of scholars arguing for the rightful place of qualitative methods in our field and align ourselves with recent activism asserting the value of qualitative health research (Greenhalgh et al., 2016; Morse, 2016). We dispute Hjelmeland and Knizek’s assessment of the fragility of the place of qualitative research in the field of suicidology; we believe the field is robust enough to tolerate scrutiny and disagreement.

The key question we raise in our work is not whether qualitative suicide research has value, but rather, how do we work with narratives about suicide in a way that explicitly affirms the value and limitations of the data to advance the practice of suicide prevention? In common with many contemporary thinkers in qualitative and postqualitative research (Hiemstra, 2017; Hollway & Jefferson, 2012; Lather & St. Pierre, 2013; Ryan-Flood & Gill, 2013; Simandan, 2019; St. Pierre, 2014; Stamenova & Hinshelwood, 2018), we believe that researchers have a key responsibility to think carefully and deeply about what “hearing the voices” of any group of people means, and of ways in which qualitative evidence may responsibly be used to inform real-world interventions (Lewin & Glenton, 2018). We will not repeat here the arguments we have made for attending carefully to questions of context, motive, bias, genre, and performance, but we think it is a mistake to conflate a critical (and self-critical) approach to understanding and interpreting qualitative data with the undermining of the voices of excluded and marginalized groups.

The whole field of suicide prevention research is methodologically and theoretically fraught and complex, and the impact of suicide prevention efforts is hard to demonstrate. When authors claim that certain insights, however conceptually sophisticated these insights may be, have important consequences for suicide prevention, they should be able to provide evidence for this claim. We hope the claim is true, but we are not aware of studies of suicide prevention which have provided this evidence. Furthermore, Hjelmeland and Knizek cannot have it both ways—how can they claim to work within a paradigm that rejects ideas about linear cause-and-effect thinking in suicidology, and then also assert that insights from this paradigm will have a cause–effect impact on suicide prevention? To us, this reads as logically inconsistent. It may well be that we misunderstand Hjelmeland and Knizek’s argument, and we are more than willing to be corrected on our interpretation, but within the field of qualitative suicide research, we need to know what kind of relationship between the insights gained from qualitative studies and the very tricky real-world practice of suicide prevention is being asserted. We look forward to learning more about this from our colleagues. Qualitative researchers have considered a range of ways to bridge the gap between insights from qualitative research and real-world action (see, for example, Huffman & Tracy, 2018; Lewin & Glenton, 2018), but we have not seen our interlocutors make these kinds of links explicit and we remain unconvinced that there is a necessary relationship between every insight about a social phenomenon and the potential to change, or prevent, that phenomenon.