71 | Stitching What Remains: MEND

MEND – After the Rupture, the Reweaving Begins

After a suicide attempt, survival is not the end of the story — it’s the fragile beginning of another chapter. In this episode, we explore the MEND phase of the STEPS framework:

• Meaning-Making: searching for fragments of understanding in the aftermath.
• Emotions in Motion: navigating the waves of guilt, relief, anger, or quiet.
• New Stressors & Support: facing stigma, disclosure, and the shifting responses of others.
• Direction Forward: beginning to reweave identity, purpose, and values into daily life.

Through Ari’s story, we witness how survival carries both weight and possibility. Healing doesn’t arrive all at once — it is stitched together thread by thread: a sketchbook rediscovered, a message sent, a small gesture of presence.

This is the phase of re-entry into life, where compassion and values-based conversations can guide recovery. MEND is not the conclusion of crisis, but the weaving of a future that holds both scars and strength.

Connect with Assoc Prof Manaan Kar Ray on Linkedin
Follow us on www.progress.guide

Transcript

1. Intro Song – Still Weaving 

2. Welcome and Recap

Welcome back to the STEPS podcast, where we trace the journey through suicidal pain not as a straight line, but as a tapestry — threads fraying, rupturing, and sometimes being mended again.

Each episode, we step into a different part of that weave.
 So far, we’ve travelled with Ari through four phases:

• FABRIC — the silent patterns of predisposition, the vulnerabilities woven long before crisis arrives.
• THREAD — the first fragile emergence of suicidal ideation: whispers, flickers, the “what ifs.”
• NEEDLE — where those flickers sharpen into intention, and thoughts begin to form into plans.
• TIP — the rupture itself. The moment when thought pierces into action. When Ari’s pain overflowed into an attempt.

And now… Ari is still here.
 Breathing. Surviving. But not untouched. Something is altered — in her body, in her emotions, in the silence that follows.

Today, we step into the MEND phase.
This is the post-attempt space. A place where survival is not yet a victory lap, but a fragile pause. A pause that might hold shame, numbness, confusion, exhaustion — or sometimes disappointment.

MEND is not about fixing.
 It is not about stitching the cloth so tightly that the tear disappears.
 It’s about holding what remains. Sitting beside the wound without rushing to close it.

For Ari — and for so many who survive an attempt — this is where the possibility of re-stitching begins. Not with certainty. Not with clarity. But with care.

3. Recap of TIP (Tension–Impact–Postscript)

In our last episode, we sat in the immediacy of rupture — the TIP phase.

We walked slowly through its three parts:

• Tension: the hours, days, sometimes even weeks of build-up. Those moments when the thread pulled tighter and tighter — a cluster of triggers, a sense of being cornered, the feeling that nothing else remained. We listened to how Ari’s mind circled here, not out of confusion, but out of punishment and despair.
• Impact: the act itself. We explored how it unfolded — impulsive yet deliberate, desperate yet strangely methodical. We noticed how the body carries the mark of this phase, and how every detail matters — because each detail is a thread we might one day return to in safety planning.
• Postscript: the immediate aftermath. The silence after rupture. The space filled with monitors and machines, paramedics and registrars, but also with unanswered questions. What did survival mean to Ari in that moment? Relief? Regret? Nothing at all?

And together, we noticed something important: the rupture didn’t end everything.
 Something still remained.

It’s in that fragile “still” — in the ache of survival itself — that MEND begins.
 Because MEND isn’t about erasing what happened. It’s about sitting in what follows. Bearing witness to the rawness of survival, and beginning, ever so gently, to imagine that the torn cloth might still hold.

4. Episode Focus – The MEND Framework

MEND is the fragile aftermath — the space after rupture.
 Survival has occurred, but it doesn’t always feel like survival. For Ari — and for many — this is not a triumphant return to life. It is a liminal pause, tangled with exhaustion, shame, disorientation, and sometimes disappointment.

And yet, in this space, there are threads. Threads of meaning, of shifting emotions, of fragile supports, of tentative direction. Each letter of MEND helps us listen for them.

M – Meaning-Making

The first thread in MEND is meaning.
After a suicide attempt, survival is not the end of the story — it is the start of a painful reckoning. For many, the days and weeks that follow are filled with questions that rarely have simple answers:

• “What was I really trying to end?”
• “Did I want death — or just escape from pain?”
• “Was I hoping to be found — or hoping not to be?”

These questions circle not as neat puzzles, but as fragments of intent, pain, and value.

The Equation of Intent

Sean Shea’s equation of intent reminds us that intent is never reducible to what is said in the aftermath. It is a weave of three strands:

• Stated intent — the words: “I didn’t want to die. I just wanted the pain to stop.”
• Reflected intent — the behaviour: Was the method lethal? Were steps taken to avoid discovery, or to ensure someone might intervene? Was there careful planning, or sudden impulse?
• Withheld intent — the silence: the dissonance between word and act. The clinician’s gut sense that something is missing, or the gaps in the narrative that don’t quite align.

Meaning-making asks us not to treat intent as a number — but as a story still unravelling.

Behavioural Incidents

One way to gently trace this story is through behavioural incident questioning. Instead of asking, “Were you serious?” we walk step by step:

• “What happened first?”
• “And then what did you do?”
• “Where exactly were you at the time?”
• “What happened next?”

When steps are skipped, we pause softly:
 “Can we go back for a moment? I want to make sure I really understand what that was like for you.”

This isn’t interrogation. It is respect. By retracing each action, we begin to see whether Ari’s attempt was rehearsed, interrupted, impulsive, or carefully concealed. And in that, we glimpse the values beneath the act: the unbearable pain of rejection, the need for relief, the longing to be understood.

Beyond Intent: Narrative Reconstruction

But meaning-making is more than intent. It is about weaving insight from chaos. Shneidman taught that suicide emerges from unbearable psychological pain — psychache. To name this pain is itself therapeutic.

Narrative psychology aligns here: when people tell their story, they begin to make sense of it. They transform raw fragments into a thread of continuity. Existential therapy, too, finds its place: after surviving a near-death act, many revisit questions of mortality, freedom, and purpose.

This is where unexpected insights often surface:

• “I realised how much I wanted someone to notice before it was too late.”
• “I thought it would be an ending, but it felt like an interruption.”
• “I thought I was invisible. But I wasn’t.”

Curious and Compassionate Questions

Clinicians can support this reconstruction with open and curious questions, not to explain away, but to discover:

• “Has this experience taught you anything about yourself that you didn’t expect?”
• “How do you feel you’ve changed, if at all?”
• “What were you expecting the outcome to be at the time?”
• “Do you feel regret, relief, or something else about surviving?”
• “At this moment, do you wish the attempt had been fatal?”
• “Have your feelings about the attempt shifted over time?”

These questions honour ambivalence. They allow multiple truths to sit together — regret and relief, shame and gratitude, fear and curiosity.

Meaning as a Compass

Meaning-making does not excuse the attempt. It doesn’t tidy the cloth back into wholeness. Instead, it says:

• “This mattered so much, it almost took you.”
• “So let’s listen to what it’s telling us now.”

The goal is to honour what was precious enough to cause such pain — and to ask how those values might be held differently moving forward.

Mending begins not with certainty, but with listening. Not with rushing to repair, but with allowing the story of intent, pain, and value to emerge — thread by fragile thread.

E – Emotions in Motion

In the days after an attempt, emotions don’t sit still. They swing like a pendulum, often violently.
 Ari may feel relief at being alive in one moment, then crushing shame in the next. Guilt floods in, then numbness, then fear, then exhaustion. Sometimes there is even anger — at herself, at others, at the fact that she is still here.

From a Trauma-Informed Care (TIC) stance, we normalise this turbulence as a natural response to extreme distress, not as pathology. It is the body and psyche recalibrating after rupture. DBT’s radical acceptance helps us hold these contradictions without judgement: the truth is that two opposing emotions can exist side by side.

A Motivational Interviewing (MI) approach leans on curiosity and non-judgement:

• “Looking back, how do you feel about having survived?”
• “Has your view of yourself shifted — even a little — since the attempt?”
• “What’s the first thing that runs through your mind each morning now?”
• “It sounds like part of you feels grateful to still be here — and another part wishes the attempt had worked. Can we sit with both sides of that?”

Solution-focused questions can map even micro-shifts:

• “Have there been moments, however brief, when you’ve felt a little lighter?”
• “If a small pocket of calm appeared in the day, what helped it happen?”

By slowing down and naming ambivalence as normal, we turn chaos into a conversation. These shifting states are not signs of brokenness — they are signs of life still moving, still searching for balance.

N – New Stressors and Supports

Survival doesn’t press pause on life’s demands. Often, it multiplies them.

Ari may leave hospital to find her inbox full, her relationships strained, her parents’ eyes heavy with fear. There may be medical bills, stigma, or the sense of being watched. Survival itself can feel like another burden.

But alongside these stressors, supports can emerge. A text from a friend. A nurse who shows kindness. A neighbour who leaves food at the door. A dog who still curls up beside her bed. These anchors, however small, can tilt the balance.

Here, TIC reminds us to ask about both risk and resource, without assuming either. MI helps explore ambivalence about receiving help:

• “Since the attempt, what’s felt heavier to carry?”
• “What — or who — has made things feel even a little lighter?”
• “Have any routines, people, or activities helped you get through the days?”
• “What would meaningful support look like right now?”

DBT’s radical acceptance can be a lifeline here:

• “Some stresses may not shift quickly. Can we think together about how to carry them differently, rather than waiting for them to vanish?”

Solution-focused scaffolding can convert supports into stabilisers:

• “Which of these supports do you think you could lean on again tomorrow?”
• “If things got difficult tonight, who or what might help you get through the hour?”

Mapping stressors and supports creates a realistic picture of Ari’s environment. It acknowledges the cracks while also noticing the anchors — because both shape whether the mend holds.

D – Direction Forward

Direction does not mean certainty. It does not mean erasing the past or drawing a perfect roadmap.

For Ari, direction may be as small as one reason to stay alive for the next hour. One thread of curiosity. One stitch of purpose.

Here, MI opens up possibility gently:

• “What might still be possible, even if small?”
• “Is there something — or someone — that could make tomorrow worth testing out?”
• “If you don’t have the whole map, what’s one next step that feels less heavy?”

DBT radical acceptance allows us to sit with what cannot change:

• “Some wounds may remain. What’s one thing you could carry with you that makes the weight feel a fraction lighter?”

Solution-focused planning reframes survival as active choice:

• “Have you noticed moments where you were able to manage suicidal thoughts differently since the attempt?”
• “If those moments became a little more frequent, what difference might it make?”
• “Suppose tonight passes without crisis — what would you notice tomorrow that tells you you’re edging forward?”

Trauma-Informed Care keeps us grounded in safety and agency: direction is not imposed, but discovered together. Even if suicidal thoughts remain, their texture matters: are they commanding or more manageable? Are they static or shifting?

Direction forward is not a victory lap. It is fragile, stitched together one thread at a time. And yet, even the smallest tilt toward tomorrow can be the beginning of re-engagement with life.

5. Ari’s Story Segment (Deeply Embellished with Back Story & Self-Conversation)

Ari woke to the hush of hospital monitors and the sour tang of antiseptic. Five days had passed since her attempt. Her body had survived before her mind had caught up.

She hadn’t spoken much. Just short answers. Just enough to say, “I’m still here.”
But inside, the questions pressed in louder than any nurse or machine.
Am I glad I’m here? Or am I just here?
The thought circled like a restless bird, never landing.

Her sister visited most evenings. Sometimes she spoke about groceries, sometimes about a TV show, sometimes about nothing at all. Ari rarely replied. But she noticed the way her sister lingered, thumb scrolling absently on her phone, as if leaving would make the silence unbearable.
 She doesn’t know what to say, Ari thought. Neither do I. Maybe silence is the only language we share right now.

The mornings were the hardest. She would lie still, watching the rectangle of sunlight crawl across the ceiling. Some mornings it felt like a small kindness. Other mornings it felt like punishment.
 You don’t deserve another morning.
But you’re here anyway.
The voices argued in her head, neither winning. Nothing stayed steady — grief and guilt one hour, a flicker of relief the next.

She thought of the pills. Not as drama, not as a headline, but as erosion — slow, silent, a thread pulled too tight for too long.
 Why didn’t you hold on differently?
Because I was tired.
Tired of what?
Not of life. Just tired of disappearing.

Her mind slid back to the weeks before. The long hours at work, smiling at colleagues while her inbox grew heavier by the hour. The family dinners where she nodded in all the right places but said little. The late nights scrolling social media, comparing her own hollow reflection with everyone else’s highlight reels.
 You fade in the background anyway, the thought had whispered then. No one notices when you don’t show up. You could vanish, and it would be quieter for everyone else.

Now, in the ward, she could see her sister’s face — tired, worried, stubbornly present. Maybe she hadn’t vanished after all. Maybe absence wasn’t invisible.

One afternoon, her therapist asked softly,
 “When you look back at that moment… what do you think it was trying to say?”

Ari’s throat caught. She hadn’t expected the question to sound so close to her own thoughts.
 “That I was tired,” she whispered. “Not of life. Just of disappearing.”

The words landed like a stone dropped in water. Not an explanation, but a fragment of meaning. A ripple she hadn’t known she was waiting for.

That night, her sister brought a bag from home. Inside was her old sketchbook. She opened it almost without thinking, pencil moving in restless patterns: one jagged line, then a curve, then a swirl.
 It doesn’t matter what it is. Just keep the pencil moving.
She didn’t know what was taking shape — only that the act itself felt like breathing again.

The next morning, she unlocked her phone, stared at her messages. She hovered over a dozen names. Deleted half-formed words. Finally, she sent a single heart emoji to one friend. No words.
 It’s nothing. It’s everything.
The reply came quickly: I’m here.
She stared at those two words until they blurred. It wasn’t rescue. It wasn’t solution. But it was a thread.

Still, the edges of her mind buzzed with new worries.
 What will Mum say? Will Dad cry? What about work — do they all know? Will they ever look at me the same?
Survival had opened a door, but behind it was a corridor lined with questions she wasn’t sure she wanted to walk through.

And yet, by the end of the week, something had shifted. She couldn’t call it hope — not yet. But she could feel a faint openness, a breath that hadn’t been there before. Not a plan. Just a possibility.

Her therapist asked gently,
 “If there’s one thing you might want to carry with you, just into tomorrow… what might it be?”

Ari searched for words but found none. Instead, she pressed her fingers lightly to her chest.
 This. Just this.

A small gesture.
 A new thread.

The beginning of mend.

6. Closing Reflections

As we close today’s episode, I want to honour something we often forget in post-attempt care:
 Survival is not the end of the story.
 It is the beginning of a new pattern — frayed, imperfect, but still possible.

Mending is not about stitching so tightly that no one can see the tear.
 It’s about honouring the rupture — and choosing, thread by thread, to stay.

In our next episode, we step into FLOW — where healing continues in motion. We’ll explore how people live forward: fluctuating, learning, reaching, and rebuilding.

Until then, thank you for being part of this story.
 And if today is one of those days where you’re just holding on — that matters.
 Because sometimes, the most powerful stitch is simply staying.

7. Outro Song – Still Weaving