Suicide week 4 lecture

Suicide: week 4 lecture

“Suicide is the deliberate destruction of one’s own life” and is “always an intentional act” (Clinard and Meier 2008, 337).Thus, suicide can be defined as “deliberate, immediate acts that lead directly to termination of one’s own life” (Clinard and Meier 2008, 338).

Social / cultural nature of suicideContrary to popular belief, suicide is not an individual act, it is a social act. Although an act of an individual, suicide takes place within a social context. As social beings we are always defined to some extent by our society. And the same can be said for such a personal act as ending one’s own life. According to Clinard and Meier, “despite the approach of an individualistic act, people decide to commit suicide within a larger social context. As with other forms of deviance, suicide varies between groups, situations, and time periods. Suicide is a process, not just a single act. As with other forms of deviance, the norms that define social expectations involving suicidal death must underlie any understanding of its deviant character and social meanings” (2008, 337).They argue, as “most suicide attempts occur in settings that encourage or at least allow intervention by others. The strong possibility, and perhaps the probability, that others will prevent these acts suggests that most represent not serious attempts to die, but calls for attention and intervention” (Clinard and Meier 2008, 341).The feeling of social isolation is thought to be a significant contributor to suicide rates. Researchers found suicide rates decreased during WWII for all countries involved in the conflict. They speculate the reasons for this were thought to revolve around feelings of patriotism and greater social inclusion as communities pulled together. Wars also bring about a period of economic prosperity which may also negate suicide rates. Thus, the social context is very important for understanding suicide.

Social attitudes

There is variance found within western societies about people’s attitudes to suicide. “Most people evaluate specific suicides in different ways, depending on the circumstances surrounding those acts. Almost everyone regards the suicide of a teenage as a tragedy, while they may understand and perhaps even condone suicide by a terminally ill person” (Clinard and Meier 2008, 337).Some scholars such as Durkheim take a very broad brush to the concept of suicide arguing it can include the altruistic acts of martyrs, or even long term harmful behaviour known to cause death, such as excessive drug taking or smoking.Some societies consider suicide an honourable act, for example, the Japanese act of harakiri has widely been accepted as a desirable act in particular situations. In Switzerland assisted suicide has been legal since the 1940s. Christian countries generally consider the act of suicide abhorrent. Christian religious teachings stress the sacredness of life with suicides understood as violations of God’s laws. Catholic doctrine emphasises the belief that suicides cannot be admitted to Heaven thereby strongly discouraging this act among Catholics. The historically strong influence of the Church within western societies has meant that suicide has long been considered “a crime against the state” in many of these countries (Clinard and Meier 2008, 339).As we can see in Australia, a number of states had criminalised the act of suicide which they have now repealed. However the act of aiding a suicide is still considered a criminal offence in all states with penalties comparable with acts of homicide.

section 31 of the NSW Crimes Act abolishes the act of suicide but criminalises aiding suicide with 10 years imprisonmentDespite the history of criminalisation, research suggests that in western countries there is a growing tolerance for suicide that has been increasing over time (Clinard and Meier 2008, 340).

Suicide facts

Research into suicide rates indicates:• females are more likely to attempt suicide than males• males are more likely to successfully suicide than females. It is

argued, this may be due to the fact males are inclined to use more lethal methods than females, such as firearms, hanging, and poisoning • suicide rates vary for age groups, with rates increasing as people age

although the increasing rates for young people is of significant concern.

General risk factors for suicide:• for young people – relationship breakdown, immature/antisocial behaviours, and

depression are suicide risk factors – I would add to this drug use and abuse• for females in their 20s/30s, attempts to escape abusive relationships, and depression.

Females are most likely to be married or single, not divorced or separated• for males in their 40s, the risk factors are ill health, depression, marital difficulties, and

financial problems• increasing age brings increased social isolation, health problems and economic stresses – all

believed to contribute to increased suicide rates for older generations. Studies have shown people become more socially isolated with age thus correlating with increasing risk of suicide for older generations.

• separation and divorce are highly associated with suicide rates for men. Marriage appears to be a protective factor against suicide rates for both males and females (except females in abuse relationships).

• religion also appears to be a protective factor against suicide with Catholics and Jewish persons having lower rates than Protestant and non-religious persons

• some occupations/professions have high suicide rates

In the international context, risk factors are:• political and economic unrest• religion – Catholic countries generally have lower rates of suicide• occupation and economic status – lower socio-economic groups generally

have higher suicide ratesGenerally, however, it is extremely difficult to predict the effect of variables on suicide rates across the board as researchers have found that a variable may be related to high suicide rates in one society/community and that same variable may also be related to low rates in another society/community. Therefore we have to be cautious when trying to make predictions across jurisdictions based on risk factors. For example, in under-developed countries, young females have higher rates of suicide than young males. However researchers are unsure of the reasons for this.

A US study on people with psychological health issues aged between 45 and 60 yrs linked suicide to the following factors:• Feelings of social isolation• Knowledge of other suicides• Belief that aging was a detriment• Predicting poor treatment by relatives as they aged• General approval of suicide• Lack of belief in an afterlife• Many had suffered depression or had family history of depression

Statistics - Australia

In Australia, it is known that in 2009 there were 2,132 deaths recorded by the ABS attributed to suicide. By comparison, 1,417 people died from motor vehicle accidents in the same period. In 2010, this figure increased slightly to 2,361 deaths.There is a huge gender disparity in our suicide rates. It is calculated that males account for almost 80% of all suicides in Australia. This is a 333/100 male/female ratio. The age group for males with the highest suicide rate is 35-45 years (27.5 per 100,000)The next highest group is males aged 75-84 years (25.8 per 100,000)The rate for males in the 15-24 age bracket is relatively low (13.4 per 100,000) in comparison to these other age grouping, however, suicide accounts for a quarter of all deaths for these young men.In Australia, male suicide is second only to coronary heart disease.

Young people

Although the suicide rates for young people are relatively low compared to other groups, the concern is the increase over time of these rates. US statistics specifically looking at young people show that in the US:• The youngest recorded age for suicide is that by 6 yo who stepped in

front of a train• Rates for 10-14 yo’s increased by 75% between 1979-1988• Rates for 15-19 yo’s increased by 140% between 1960-1975• Rates for 20-24 yo’s increased by 130% between 1960-1975

Known risk factors for Australian males are:• Diagnosis of major depression• Relationship breakdown• Previous suicide attempts• Alcohol use• Financial factors• Rural location• Indigenous heritage Overall, mental health issues play an important role in suicide with depression, schizophrenia, substance abuse and personality disorders known to be major risk factors. Studies have shown the rate of suicide to be 10 times higher for people with mental health illnesses compared with the general population (Ford 2005, 29).

We can see from these two tables of suicide rates from the ABS that males significantly outnumber females in these figures. And that Indigenous males outnumber all other groups for recorded suicide rates. Interestingly, in the US the situation is somewhat different with white Americans having much higher rates than African Americans or other cultural/ethnic groups.

StatisticsSuicide rates in Australia have remained relatively static over the last 100 years with 11.8 deaths per 100,000 in 2002 compared with 14.6 per 100,000 in 1964, and in 1897 the rate for males was 20.6 per 100,000 and females 5.5 per 100,000. Whereas in 2000 these rates were, males 19 per 100,000 and females 5 per 100,000. However there are significant changes within the demographic and social and cultural categorisations within these figures (Ford 2005, 28). For every suicide death in Australia, there are known to be 30 to 40 unsuccessful suicide attempts. Thus, suicide is a much more significant problem for society than even the statistics indicate. The problem is that we cannot rely solely on statistics to give us an accurate picture of this social problem. For starters, suicide figures are not recorded in a uniform manner that allows for cross-jurisdictional analysis. The reasons for suicide often remain unrecorded. The number of attempted suicides is grossly underreported and researchers believe the actual recorded rates are less than half of all attempted or successful suicides, others believe it is actually only a quarter or a third of the true rate. In Australia, “in any given year the number of people who kill themselves can only be a preliminary statistic because the door is kept open for two years for additional suicides that will be determined by coroners’ reports which are ongoing at the close of the year” (AIPC). What this means is that you have to wait at least two years to obtain confirmed figures on known suicides in Australia.

As the figures discussed today indicate, suicide is a significant public health issue for Australia and internationally. It is “complex, confronting and tragic for individuals, families, friends and communities. It results most often from an accumulation of risk factors, and it intersects with problems and concerns across society: [such as] mental health, drugs and alcohol, family issues, employment, cultural identity, law enforcement and criminal justice, education and poverty” (Commonwealth Department of Health and Aged Care cited in Ford 2005, 28).

Types of suicides• Durkheim’s famous study into suicide created a number of classifications for understanding different types of

suicide.• Altruistic suicide – according to this type, people commit acts of suicide in order to benefit the greater good,

ie, old or infirm members of tribes when food or other resources were scarce may have committed suicide to avoid being a burden on the rest of the tribe

• Sometimes people commit altruistic suicide when they take an action to save another when they know that action will end their life, ie, pushing someone out of the path of a train or vehicle when you know there is no time for you to get clear as well, or letting go of someone’s hand when you think your weight may pull them over a precipice (such as mountain climbing etc). During conflict, many stories emerge where people give their lives for a mission or to save others (ie, Japanese kamikaze pilots – interestingly, post 2001, it is hard to imagine westerners identifying suicide missions as ‘altruistic’, rather, we are more inclined to think of them as acts of terrorism).

• Some researchers also associate euthanasia as a form of altruistic suicide.• Egoistic suicide – these acts of suicide are committed for personal/individual reasons. They are brought about

for varied reasons from economic/financial uncertainty, isolation, despair and depression. These acts are different to those of altruistic suicide which rely on a strong sense of social integration (ie, a strong connection to one’s society/community). Egoistic suicide is the opposite and thought to be associated with a lack of connection to society (ie, feelings of isolation).

Anomic suicide – ‘anomie’ means lack of social or moral standards. Thus, anomic suicide is thought to occur when people find themselves without the social/moral norms they hold important, such as demotion, decreased social standing, or even, interestingly, achievement of a long-standing goal. The thought is that such norms or goals may occupy the individual’s attention for such a long time or be critical to their sense of self that its absence leaves them with feelings of loss and disorientation bringing on the need to suicide to rid themselves of this loss. For example, significant increases in suicides after stockmarket crashes, the GFC where people lost jobs and/or financial security, the Queensland 2011 floods where people lost homes/businesses/jobs and found they were not insured or adequately insured, bankruptcies, marital dissolutions.According to Clinard and Meier, “sudden, abrupt changes in one person’s standard or style of living may produce a sense of normlessness” (2008, 354)Sociologists have added another two types to Durkheim’s original three classifications: Honour or virgin suicides – associated with traditional cultures where a female’s chastity is linked to the honour of her male relatives. It could be argued that this is not really a form of suicide as it results from social pressure to take one’s own life - often associated with Islam beliefs and mostly occurs in the Middle East.Adolescent suicide – due to the age of these individuals, society generally believes youth suicide to be especially tragic as they are thought to have the promise of adult lives ahead of them. Often linked to young people’s continuing cognitive and emotional development, it is thought youth suicide occurs as a young person’s lack of ability to rationalise fully with a problem often resulting in the over-reaction of suicide, ie, problems that adults may not consider so significant such as relationship breakups or poor educational grades can underlie youth suicide. “Suicide ideation appears to be relatively common among teens” (Clinard and Meier 2008, 356). Self-destructive behaviours such as substance abuse or misuse are also common factors in youth suicides.

Sociological theories explaining suicideThere are a number of sociological theories that attempt to explain suicide.The first, and most famous is Durkheim’s social and religious Integration – social and religious institutions play an important role for the integration of individuals within society, with greater integration correlating with lower rates of suicide, and lesser integration equalling higher rates. This is a theory that is still widely held today. Examples often cited are, Catholics having lower rates of suicide than Protestants, married people having lower rates of suicide than single persons; increasing age elevates suicide risks as partner/friends pass away people become more and more socially isolated.Criticisms of this theory are that there is no standard measure for social integration and empirical research shows mixed support for Durkheim’s theory.Status Integration – this theory suggests suicide levels are predicated according to status level and social group. That is, when someone’s status is elevated or lowered from that of their social group, they may experience difficulties integrating with the new status group which in turn increases the likelihood of suicide. Clinard and Meier claim “Stable status relationships protect members from role conflict and help them to conform to the demands and expectations of others” (2008, 358). However, there is limited empirical support for this theory.Status frustration – this theory attempts to link aggression with status frustration and suicide and/or homicide. According to this theory, the frustration of not being able to obtain or maintain a desired status causes suicides to direct their aggression against themselves, and homicides to direct it against others. This theory implies there should be a higher rate of suicide for higher status individuals, whereas the reverse appears to be apparent in suicide data.

Community migration – this theory places more importance at the micro level of the community individuals are living in rather that the macro of society as a whole. According to this theory, communities with high rates of immigration also have correspondingly high rates of suicide. The theory is based on the idea new comers often lack community ties as it generally takes a period of time to integrate into a new community. Those who find it hard to integrate into their new environment are at higher risk of suicide.Suicide socialisation – according to this theory, suicide is a learned behaviour. It is argued, suicide becomes an alternative option to hopeless or frustrating situations. Suicide socialisation relies on a level of social acceptance of suicide for particular situations so that individuals learn that suicide is an alternative option to frustrating or hopeless situations. For example, a dominant thread of thought in suicide discourse is that suicide attempts are actually cries for help. Understanding this, people wanting this form of attention will resort to suicide attempts in order to bring about their desired results – attention for whatever problem is ailing them. From this perspective, a successful suicide results when the cry for help is ignored, or responded to too late. It is argued, publicising suicides contributes to this social learning. Queensland Rail in Brisbane has an agreement with media outlets for blanket silence on suicides occurring on its rail network in order to prevent copycat events. Presumably, many other rail networks around Australia undertake this same practice.

To sum up, we know that the following factors are strongly linked to suicide:• Feelings of isolation• History of depression or other mental health problems• Alcohol and substance abuse• Feelings of frustration or hopelessness• Feelings of failure• Family history of suicide• Sudden change in relationship, status, and employment• Media attention on suicide (especially for teenagers)I would also add here, environmental factors. Although we have not discussed these today, there is growing research into the impact of environmental factors on suicide, such as droughts on rural deaths, extreme devastating weather events like the Queensland floods and the fires in Victoria, Tasmania, and New South Wales. There is also a strong link between homicide and suicide where people who commit homicide then go on to commit suicide. This often occurs around the breakup of relationships where a partner may kill an ex-partner and/or their children. This is why it is well-known with violent or abusive relationships that ending the relationship is generally more dangerous than remaining in it. This is also why refuges and shelters are not listed and the addresses kept hidden from the public.There is also a strong link to mental illness. There is a high association between suicides and people with a history of depression or mental illness. The deviance of suicide marks it as the behaviour of someone who is not currently rational.

Suicide prevention

In order to prevent suicide one needs to understand the social facts that contribute to it in the first place. In many western countries the predominant focus has been on mental health with many media campaigns and educational programs targeting this connection. There are also many telephone help lines set up to support people struggling with suicide issues. For example, the federal governments’ National Suicide Prevention Strategy’s main objectives are to:• Build individual resilience and the capacity for self-help• Improve community strength, resilience and capacity in suicide prevention• Providing targeted suicide prevention activities• Implement standards and quality in suicide prevention• Take a coordinated approach to suicide prevention• Improve the evidence base and understanding of suicide prevention. National R U OK day has been established to encourage dialogue in the community about depression and suicide.An Austrian study went to the extremes of adding lithium to drinking water in order to prevent suicides. Lithium is a component in many anti-depressant drugs.

Recently, there has been a growing awareness of other factors contributing to suicide. For example, the high stress associated with particular professions has for many years been acknowledged as a contributory factor but commitment to addressing this issue has been lacking until recently. To demonstrate, it has been well-known that the legal profession places extraordinary stresses on individuals operating in this field. Likewise, the same can be said for law enforcement, justice, the medical profession, etc. In recent years a number of universities and professional associations have undertaken initial steps to address the problem of the poor psychological health of their students and members. Many law schools now acknowledge the stress law students endure and have put measures in place to improve the psychological wellbeing of their students. The legal profession itself has a high rate of suicide.

In response to workplace bullying the Commonwealth Government is introducing tough new legislation to address the serious consequences like suicide that stem from this form of harassment.

Legal sanctions are another way of attempting to prevent suicide. As stated earlier, it is illegal in all Australian jurisdictions to help another commit suicide. Assisted suicide is a highly controversial topic in Australia and is most commonly associated with terminally ill individuals. This is the one area of suicide that is most hotly contested and debated.Assisted suicide has been legal in Switzerland since the 1940s and the country has two organisations that assist people to end their lives. The organisation Exit only assists Swiss citizens to end their lives whereas Dignitas accepts international clients, although there are restrictions. In his 2011 documentary (shown on SBS on 23 September 2012) literary giant Sir Terry Pratchett travelled with an English couple to the Dignitas facility in Switzerland. During this documentary Pratchett commented that the current British laws prohibiting assisted suicide meant that many people with terminal illnesses where choosing to die too soon as they needed to have sufficient mobility in order to travel to the Swiss facility. Moreover, people like himself suffering from Alzheimer’s disease had to ‘exit’ early or could not make that choice as informed consent, which is predicated on legal capacity, is a crucial factor for acceptance into the Swiss facility. It was also stated in the documentary that although most people who had used the facility had either a terminal illness or a significant disability, there were a smaller number who had simply ‘grown weary of living’.Terry Pratchett documentary “Choosing to die” screened on SBS 23 September 2012, 9:30 pm – available on Youtube.

[Must conclude with a note about anyone who is struggling with or knows someone they think is struggling with depression or thoughts of suicide to contact UNE counselling services, Beyond Blue, etc… ]References:Australian Bureau of Statistics. Suicides, Australia, 2010, http://www.abs.gov.au/ausstats/[email protected]/Products/3309.0~2010~Chapter~Suicide+in+Australia?OpenDocumentAustralian Institute of Professional Counsellors: AIPC Article Library “Suicide: statistics, characteristics and myths” http://www.aipc.net.au/articles/?p=320Beaton, Susan and Peter Forster. 2012. “Insights into men’s suicide”, Australian Pscyhological Society, http://www.psychology.org.au/inpsych/2012/august/beaton/.Clinard, Marshall B and Robert F Meier. “Suicide”, in Sociology of Deviant Behavior, 336-373, Australia, Thomson Wadsworth.Editorial. 2011. “Suicide: Lithium in drinking water and suicide mortality”. CML – Psychiatry, 22(3): 102-103.Federal Government response to workplace anti-bullying recommendations. http://www.findlaw.com.au/news/6674/federal-government-response-to-workplace-anti-bull.aspxFord, Greg. 2005. “Suicide in Australia: a public health perspective”, in Health Issues, 85: 28-31.R U OK? http://www.ruokday.com/

Further resourcesAlson, Margaret. 2012. “Rural male suicide in Australia”. Social Science & Medicine, 74, 515-522.AMA Queensland – Suicide Watch http://www.amaq.com.au/index.php?action=view&view=114544Australian Psychological Society – Insights into men’s suicide http://www.psychology.org.au/inpsych/2012/august/beaton/Bradley, Clare E, James E Harrison, and Amr Abou Elnour. 2010. “Appearances may deceive: what’s going on with Australian suicide statistics?”. Medical Journal of Australia, 192(8): 428-429.Department of Health and Ageing – National Suicide Prevention Strategy http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-nspsDoessel, Darrel P, Ruth FG Williams and Jennie R Robertson. 2011. “Changes in the inequality of mental health: suicide in Australia, 1907-2003”. Health Economics, Policy and Law, 6(1): 23-42.Durkheim, Emile. 1951. Suicide: a study in sociology. London, Routledge.Federal Government. Fact Sheet: Mental health, wellbeing and suicide prevention initiatives supporting children and young people.Field, Rachael and James Duffy. 2012. “Better to light a single candle than to curse the darkness: promoting law student well-being through a first year law subject”. QUT Law and Justice Journal, 12(1): 133-156.Go2 News – Deakin – Suicide in Australia http://deakinnews.wordpress.com/2012/10/01/suicide-in-australia/Hawton, Keith and Kees van Heeringen. 2009. “Suicide”. The Lancet, 373, April 18, 1372-1381.Kinsey, Brian. 2012. “Suicide”. Substance Abuse, Addiction and Treatment. Pearse, Jessica D. 2010. “Achieving standardised reporting of suicide in Australia: rationale and program for change”. Medical Journal of Australia, 193(3): 191.Pirkis, Jane, Andrew Dare, R Warwick Blood, Bree Rankin, Michelle Williamson, Philip Burgess and Damien Jolley. 2009. “Changes in media reporting of suicide in Australia between 2000/01 and 2006/07”. Crisis, 30(1): 25-33.Pridmore, Saxby. 2010. “Suicide and mental disorder: the legal perspective”. Medical Journal of Australia, 193(3): 184-185.Qi, Xin, Wenbiao Hu, Andrew Page and Shilu Tong. 2012. “Spatial clusters of suicide in Australia”. Psychiatry, 12(86): 1-11.R U Okay? http://www.ruokday.com/about-us/Reach Out.com – Suicide http://au.reachout.com/Tough-Times/Physical-health/Suicide?gclid=CNnKhNGPnLYCFYYhpQodtQMAIASimon-Davies, Joanne. 2011. “Suicide in Australia”. Parliamentary Library Services. Suicide Prevention Australia http://suicidepreventionaust.org/Suicide Web Resources. 2009. Journal of Mental Health, 18(2): 188-191.World Suicide Prevention http://wspd.org.au/