A paper presented over the internet last night (19 March 2016 Australian time) to a conference in Prague of the Czech Academy of Sciences, titled Suicidology’s Cultural Turn, and Beyond.
For previous published research by the author on this topic see Aboriginal suicide is different : Aboriginal youth suicide in New South Wales, the Australian Capital Territory and New Zealand
Suicide Prevention Australia is a major body in our field of interest. At the moment it is advertising a tourist trek though the Larapinta Aboriginal tribal lands in the Northern Territory. The seductive slogan is “Hike to Halve Suicides”.
There are dozens of suicide prevention programs in this country, each with subsidies, generous grants, and hardly short of money to address the very high rates of young suicide, increasing as I speak (by 13 per cent these past three years).
The word “innovation” in the title of this talk means something new in an idea or a product, or something transformed. Innovation is usually of two types: the adoption of something entirely new, like coffee enemas to treat cancer, a short-lived “cure” in America a few decades ago; or displacing an existing attitude or value in exchange for something new, like the value of quitting cigarettes.
My contention here is that suicide prevention strategies, while purporting to be new or different, remain what they always have been: optimistic beliefs that mankind can solve everything in time and that just as smallpox and polio have been defeated by medical innovation, so too with suicide.
If I were a gambler, I’d wager a cancer cure long before a suicide one. In short, I see an immense contradiction — innovation without change.
The most memorable book I’ve ever read on death is by Siddhartha Mukherjee —The Emperor of All Maladies: A Biography of Cancer. He won the Pulitzer prize for it in 2010. It isn’t a history, he insists, but a biography of something that has always been with us and always will be. And it is something that is only marginally more treatable, let alone curable, after a millennium of effort. There are echoes, parallels and metaphors with suicide all the way through, including a powerful deconstruction of the abject failure that was Richard Nixon’s “war on cancer”, established by the National Cancer Act in 1971, and emulated elsewhere in the West. Hundreds of millions were thrown at the disease, and two or three types of cancer responded.
Suicide doesn’t have as many varieties as cancer — dozens of categories rather than hundreds. In all of the suicide prevention programs, do we stop to ask what exactly we are targeting? Who we are targeting? What kind of suicide we are meant to be preventing?
The bile-and-vapour physicians of yesteryear are long gone, together with their leeches, purgatives and emetics (or perhaps not so in the case of the medical baristas). The priests vacated the field regarded by the Catholic Church as the ultimate sin of selbstmord, self-murder, when lawyers found a solution to the problem by requiring a suicide to forfeit his or her assets to the Crown. If the suicide could be shown to be “of unsound mind”, then a curator or guardian could act in loco for the deceased, and he, being of sound mind, could administer an estate for the family instead of enriching Britain’s treasury.
And so, in the nineteenth century, began a long history of medical hegemony over suicide — that the mind is ill, “unsound”. The biomedical apex of all this is “evidence-based medicine”, that is, the illness resides in the patient and must be diagnosed and treated, somehow, solely within the patient. The contexts and the surrounds — that is, geographic, historical, societal — are of no importance to those who are not trained or versed in those factors. (Ask any respectable medical or nursing school how much time they devote to suicide, or its possible causation.)
My observations focus on Australia’s Aboriginal peoples, some 600,000, or 2.5 percent of the 24 million population. Briefly, there is absolutely no recording of any suicides before 1960; yet in the past fifty years their rates of suicide have soared to among the highest in the world, especially in the younger age groups, not just 15 to 24 but also in the 10 to 14 cohort. Such official statistics as we have tell us that while the national suicide rate is 10.4 per 100,000 of the population, for Aborigines and Torres Strait islanders it is 21.4. In three states the rate is closer to 30. Some 20 years ago, I found rates closer to 44 for in specific New South Wales Aboriginal communities.
Aborigines trail a history like no other segment of the population: a genocidal era of physical killing from the early 1800s to 1928; a protection-segregation era of incarceration on isolated reservations from the late 1890s to the mid 1970s; a regimen of forcible child removal from the late 1830s to the mid 1980s. In those periods, they had no civil or civic rights as we understand them: they were wards of the state, with government officials and Christian missionaries their legal guardians, irrespective of age or ability to manage their own affairs.
However harsh it was in terms of fundamental freedoms and human rights, the institutional era did sustain ordered societies. There were containable levels of physical violence, usually in the form of traditional methods of conflict resolution. With the abolition of these open-prison-like regimes in the mid 1970s, disorder set in, with increasing deaths from non-natural causes. Officially called “accidents and poisonings”, this statistical category has —alarmingly —included homicide and suicide as causes.
No other sectors of the population here have such contexts. The only comparisons, in many respects, come from the Inuit and Native American communities. And since context is the essence of the pathway to understanding young suicide, we need to bear in mind the comments of Marzio Barbagli in his Farewell to the World: A History of Suicide, published in 2015. The Bologna professor posits two categories of motive: those who do it for self or for others, and those who take their lives as a form of revenge against others.
Both Louis Wekstein’s Handbook of Suicidology in 1979 and now Barbagli’s book provide us with categories of suicide. Both acknowledge something we seem to want to avoid: rational suicide. I am not denying or relativising the young suicides who are bipolar or schizophrenic, but I am emphasising that the majority of suicides I have studied did not have professionally diagnosed and confirmed mental illness. They may have been unhappy, sad, even given to forms of melancholia, but they were not clinically depressed. Often in rational ways — at least according to my many interviews of parasuicides — they were and are not merely seeking an exit from life but an entrance to another state, death, a “place” where life may possibly be better than what they have here. And as rationally, there are the many who reject our society, and tell us so, more often than not, by confrontational methods of death, like hanging in public places. Hanging (technically, asphyxiating) is hugely more prevalent than gun use, imbibing poison or jumping.
Can hiking halve these behaviours? Can sertraline, fluoxetine, or trazadone anti-depressants address such contextual self-deaths? Can counselling and talk therapy eliminate these compelling forces? I do not believe so. But has anyone seriously thought about the innovation of ceasing to assert and insist (without any real evidence) that suicide is almost always a result of mental illness, “depression”, a condition not clearly enunciated, defined or evaluated. Has anyone ever examined the Americanised ideal value of “life, liberty and the pursuit of happiness”? That “happiness” always means wellness and a feeling of well-being and if you don’t, can’t, or won’t feel that state of mind and being you are “sick” — and in biomedical need? Chronic “unhappiness” is deemed abnormal and, without justification, must be treated biomedically.
Do we ever question why we are so angry and so frustrated by suicide, a mode of death that takes the same number of lives annually as car accidents, drug-taking and overdosing? In 1995 Colin Pritchard wrote a book in which this professor of psychiatric social work questioned whether suicide was not explicable as our rejection of the suicide. I have another, quite different view: that our responses — usually “shame!”, “how could he?”, “look at what he/she has done to us, what a waste!”, and so on — are really an anger, often a savage anger, at the rejection of us. Not surprising when we consider what is involved here: what looks like the obvious insufficiency of our family, our love, values, society, our religion, our civilisation.
Do we ever entertain the thought that for the great majority of Aboriginal youth, their bodies are the only “things” over which they have sovereignty, some power and autonomy? They have few or no horizons, fewer prospects than the mainstream, few if any mentors, little or no experience in making decisions unassisted. Such is the social context of violent behaviour, of group behaviour: it often takes the form of violence towards others and towards self. If I may quote a famous dictum from psychiatrist and Holocaust survivor Victor Frankl: “Everything can be taken from a man but one thing: the last of the human freedoms — to choose one’s attitude in any given set of circumstances, to choose one’s own way.”
Suicide is the flip-side of homicide in many instances. Pills, doctors and nurses cannot get to first base in confronting, let alone addressing, the “soul” of the suicide, the deep issues of self-worth, independence, empowerment, sovereignty, purpose, of choice.
A last word on non-Aboriginal youth suicide. We have no long-term data on the connection between mental illness and suicide. Today we posit that the bipolar or schizophrenic is more likely to suicide than those not so afflicted, but that relationship hardly holds good as a general explanation of the increasing rates. Camila Batmanghelidjh talks about “the parallel existences of the destination-driven crowd, who move rapidly to complete a life task, and the destination-despondent, who decide that life is no longer worth pursuing.” Which is another way of restating Viktor Frankl’s philosophy on those who have purpose and those who haven’t.
My guess is that much of the suicide is explicable by looking at societal stress factors: competition for jobs, promotions, places to live, parental pushing, the crushing conformity of the social media world of teenagedom, the realisation that Twitter and Facebook aren’t real companionship, that the ecstasy tablets wear off or wear thin, and that “happiness” is not written into our constitution and is not available on tap. The destination-driven route detours into the despondent-drive. Can psychiatrists, psychologists or doctors deal with that road map? Of course not.
Pessimistic? Skeptical? Doubting? Yes to all three questions. But I think that those stances are more “evidence-based” and more warranted than unbridled optimism.
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