The Anthropology of Suicide - World Suicide Prevention Day

(Links updated 9.9.2019) It was around four months ago, I received the message of my friend’s sudden death. “Nobody knows", I was told, “why she stepped in front of a train". Afterwards I often wondered if her life could have been saved if we as a society had known and talked more about so-called mental health issues.

For these topics are still taboo. I was shocked to hear the stories from friends and colleagues who I told about what had happened: Many of them suddenly started telling about people they knew who have tried to end his/her life or who have committed suicide. They even mentioned people I know. Worldwide, more people die by suicide than by criminal acts or war - around one million per year. And up to 20 million people try to take their life every year. Europe and Asia have the highest suicide rates.

But this topic is hardly discussed. Neither in media (it was banned in Norwegian media until one year ago) nor in social sciences. The World Suicide Prevention Day that is held today (10.9.) wants to “improve education about suicide, disseminate information, decrease stigmatization and, most importantly, raise awareness that suicide is preventable".

What is going on in a person’s mind who has decided to step in front of a train? Many people - around one in ten - have contemplated suicide, but only a minority of them made an attempt. Why did they take this step? What has happened in their life? How could the worsening of their situation have been prevented? Are there warning signs? Would psychological treatment have helped? But after all those horrible stories about mental health clinics - can we trust such institutions? Might they even increase the risk of suicide? And is suicide always committed by people who are ill? Maybe their decision to end their life is rather rational and should be respected? Will it therefore be wrong - and selfish - to force people to continue living?

After lots of discussions with friends and googling the same terms again and again, I learned that there are no simple answers.

I also found out that literature about suicide is dominated by psychology and biomedical sciences. Committing suicide is presented as an individual issue. People who commit suicide seem to be people who for some reason no longer were able to cope with their life. There was something “wrong” with them. But maybe there is also something wrong with society or with specific developments? According to Eugenia Tsao, there many reasons why anthropologists should politicize mental illness.

Maria Cecília de Souza Minayo, Fátima Gonçalves Cavalcante and Edinilsa Ramos de Souza write in their paper Methodological proposal for studying suicide as a complex phenomenon in the journal Cadernos de Saúde Pública that “few studies have simultaneously examined the individual, social, anthropological, and epidemiological aspects of suicide". The micro and macro dimensions “remain dissociated in polarities that prioritize either the individual or society.”

They present an interdisciplinary approach to suicide that also includes an ethnographic study in a mining town. They show how the increase in suicide rates can be explained by a mix of factors, like radical structural changes that preceded and followed privatization of the mining company and also personal life histories of the workers.

But there seems to be an growing awareness also among researchers in biomedical sciences that their approach is reductionistic.

In a book review in the journal Jama - Journal of the American Medical Association, Antolin C. Trinidad explains that “suicide is best approached by getting out of the confines of biomedical sciences and into the domains of anthropology, sociology, and disciplines in the humanities":

It is not a surprise that physicians spend the lion’s share of whatever interest they have in suicide studying its prevention, treatment, and the sundry clinical bullets that are potentially deployable in the clinics, rather than its history or the vicissitudes of individual despair and anguished self-awareness of pain that breed self-destruction. This is exactly what John C. Weaver, author of A Sadly Troubled History: The Meanings of Suicide in the Modern Age, calls “meta-pain.”

And also Diego De Leo calls in his editorial Why are we not getting any closer to preventing suicide? in the British Journal of Psychiatry for “multi-disciplinary teams to set up more integrated approaches for large- scale, long-term and thoroughly evaluated projects". But “multi-disciplinary approaches to the prevention and investigation of suicide are often flagged up but virtually never practised".

Anthropologists have been almost completely silent concerning the problem of suicide, writes Stefan Ecks in the abstract of his paper “Suicide: reflexions on Medical Anthropology research of suffering". For hardly any other topic presents such great methodical and ethical difficulties for Medical Anthropology research:

Many methods that normally are standard for Medical Anthropology studies have to be radically re-evaluated when researching suicide: What role, for instance, does “participant observation” play in the context of extreme “tabooisation” on the part of the relatives? When is it acceptable to talk with relatives, how much time must have gone by? Also the ethical aspects of such research are enormous: Trauma, shame and speechlessness turn direct interviews into an ethically questionable method. How can suffering caused by suicide be examined as phenomenon in social context?

But Falk Blask who has taught suicide in his anthropology classes in Berlin, soon found out that it is a topic that attracts students. He prepared the course for 15 students, but 90 showed up according to today’s Mitteldeutsche Zeitung (updated link). Blask isn’t interested in suicide for no reason: Three years ago, one of his best friends took his life.

In his paper Urug. An Anthropological Investigation on Suicide in Palawan, Philippines (published in the journal Southeastasian Studies in 2003), Charles J. H MacDonald gives an overview over anthropology and suicide.

Also MacDonald states that anthropologists have dealt with suicide and suicidal behavior “much less frequently than their colleagues in the other social sciences". He didn’t travel to the Philippines to study suicide either. But ever since he set foot on that place, he heard constant references to self-inflicted death. Figures show that the suicide rates are probably the highest or second highest in the world:

Why? Why would suicide, in such staggering numbers, affect those people whose society and culture is in no basic way different from other Palawan people, their immediate and non-suicidal neighbors in the hills and mountains of Southern Palawan? Why would such happy-looking and comparatively well-off people, going about their lives in orderly fashion, fall victims to despair? So far I have found no clear answer. The phenomenon remains mysterious and a complete puzzle.

Suicides, I want to conclude, are not primarily a sign of “that there was something wrong with a person", but also that something might be wrong with society as a whole. Suicide prevention does not only or necessarily mean preventing people from committing suicide but also working towards a society where there are no reasons to take one’s life.

Unfortunately, these larger societal factors are totally missing in the current campaign for the World Suicide Prevention Day. Suicide prevention is also a political question. But the International Association for Suicide Prevention focuses on individual or so-called cultural factors ("People who are alienated from their country and culture of origin are vulnerable to various stresses, mental health problems, loneliness and suicidal behaviour.").

I would like to leave you with maybe the best article about suicide that i found in the section mental illness at neuranthropology . It is A Journey through Darkness by Daphne Merkin. It actually answers all my questions that I asked in the beginning. Merkin’s beautifully written text also shows that there are no final answers.

I found also this article with facts about suicide and depression and how to help very helpful

SEE ALSO:

Why anthropologists should politicize mental illnesses

Shanghai: Study says 1 in 4 youths thinks about taking own life

Financial expert jumped in front of train after predicting recession

Vandana Shiva: The Suicide Economy Of Corporate Globalisation

UPDATE 9.9.2019: It seems a lot has happend since I wrote this post ten years ago. Just search anthropology AND suicide, f.ex. the section on suicide in the Anthropological Perspectives on Death blog or the post about Special Issue: Culture, Medicine and Psychiatry, “Ethnographies of Suicide” at Somatosphere or Situating Suicide as an Anthropological Problem: Ethnographic Approaches to Understanding Self-Harm and Self-Inflicted Death by James Staples and Tom Widger