The Relationship Between Suicide and Disturbance in the Society - Case Study Example

Critical Evaluation of the Relationship between Suicide and Disturbance in the Ties between the Individual and Society) Introduction and Background Death is the inevitable end of all living beings, and brings with it grief for the lost one. The healthcare sector is one area of human activity that repeatedly witnesses death in its environments and has to develop the means to cope with the distress that death brings. When death occurs as a culmination of the aging process or the consequence to arrest a disease process, the distress is easier to cope with than in suicide, where life is terminated suddenly. Suicide involves the complex behaviour of the individual that has both biological as well as psychological components. Prevention of suicide requires an understanding of the relevant factors that lead to suicide and interventions that diminish the impact of these factors on the individual (Draper, Snowdon & Wyder, 2008). According to Soreff (2006), p.1, “suicide means killing oneself. The act constitutes a person willingly, perhaps ambivalently, taking his or her own life”. Thus, suicide is an act of self-destruction, which is a worldwide problem, as estimates of the World Health Organization (WHO) for the year 2000 show that nearly one million people around the world died from suicide. The number of deaths due to suicide represents only a small percentage of the number of people attempting suicide, which is ten to twenty times the number of deaths from suicide. Therefore, every twenty seconds a death due to suicide happens globally, while every one to two seconds there is a suicide attempt (Worldwide Suicide Information, 2008). This paper will critically evaluate and discuss the notion of suicide that has been seen as a result of a disturbance in ties between the individual and society Risk Factors for Suicide Wide regional disparities can be seen in the global suicide rates, with the Eastern Mediterranean Region and the Central Asian region showing the lowest suicide rates, while India and China account for almost thirty percent of worldwide suicides. There is also a greater tendency for suicide during the earlier periods of life, with fifty-five percent of suicides occurring in the age group of less than forty-five years and forty-five percent at forty-five years and older. The suicide rate among youth shows the highest growth among all age groups (Worldwide Suicide Information, 2008). An evaluation of the worldwide suicide rates as provided by the WHO in May, 2003, show that men have a greater propensity for suicide than women with this greater risk being more than fifty percent globally (Suicide Rates, 2003). In comparison to the developed western world, the developing world led by India and China show a much higher risk for suicide in the perspective of Jacob (2008), who also cautions that suicide figures may not be reliable due to inefficient civil registration systems, non-reporting of deaths and the variable standards in certifying the death. The behaviour patterns in suicides are not simple, but complex and are acts carried out by diverse people living in a variety of conditions and situations. This makes attempts at identifying risk factors for suicide an exercise fraught with the danger of being too simplistic, without covering the wider aspects of it. Jacob (2008) highlights this argument in the comparison of India as a developing nation as having one of the highest suicide rates with that of the developed Western world and points out that the larger proportion of suicides in India do not occur in groups that are considered at high risk in the Western world. Such disparities in suicide rates and the risk factors for suicide are also evident in urban and rural areas around the world. In the United States of America, the rural suicide rate of 17.9 for every 100,000 population exceeds that of urban areas at 14.9. Evaluation of the data shows that this increase in suicide rates in rural communities goes across all communities and can be associated with the remoteness of the rural areas and the life in agricultural communities (Hirsch, 2006). Moreover, Hirsch (2006) classifies the risk factors that are characteristic of rural communities as rural life and culture; geographic and interpersonal isolation; and economic and socio-political distress, all of which contribute to the increased suicide rates seen in rural communities. In Canada, an even higher disparity in the urban and suicide rates can be seen, with the rural and frontier areas having a suicide rate of 41 per 100,000 people, while the overall suicide rate stands at 13. The rural and frontier communities are much smaller than the urban communities and one of the reasons cited for the increased suicide rate in rural communities is the smaller size of the communities (Hirsch, 2006). Moving on to Australia and New Zealand, a similar disparity in urban and rural suicide rates is seen. Among the young and old, the suicide rates suggest that individuals in rural communities are thirty to fifty percent more likely to commit suicide than individuals in urban areas (Hirsch, 2006). The indigenous populations in both Australia and New Zealand, consisting of Aborigines and Maoris essentially living in the rural areas, also demonstrate a much higher suicide rate than for others (Hirsch, 2006). The mental health of an individual is a significant risk factor for suicide. Evidence shows that psychiatric or mental disorders with particular emphasis on depression and anxiety are leading causes of suicides. Findings of these studies show that attempting suicide in persons with a disturbed mental state occurs from 78% to 89% of the time during major depressive episodes (Pirkis, Burgess & Dunt, 2000). Based on their study of data from the Australian National Survey of Mental and Health and Wellbeing (NSMHWB), Pirkis, Burgess, and Dunt (2000) point to mental disorders being a considerable risk for suicide in Australia, with the components of affective disorders and anxiety disorders contributing more to this considerable risk for suicide in the case of poor mental health. The risk factors for suicide can thus be classified into three groups consisting of psychosocial factors including adverse life situations, psychiatric factors including major mental disorders, and demographic factors including male gender (Rihmer, 2007). Social, Cultural and Mental Health Impact on Suicide Identifying a single cause for suicide is fraught with difficulties. Psychosocial stressors have an impact on an individual vulnerable to suicide through the promotion of thoughts or ideas as a means to get away from these stressors, which lead to behaviours that may have disparate degrees of lethality and intent. Yet, there is evidence to suggest that impaired mental health and mental illness, which include mood disorders, substance abuse disorders and antisocial behaviours, also have an important role to play in the ideation and execution of suicide by an individual (Judd, et al, 2006). Furthermore, evidence suggests that anti-depressants that are frequently used in the developed world for the treatment of depression may trigger suicidal tendencies in individuals on such medications (Laje, et al., 2007). Jacob (2008) provides more clarity on this difficulty in pinning the responsibility for suicide solely on disturbances in ties between an individual and society without allowing for the impact of mental disorders and mental illness on suicide, in his comparison of evidence on suicide between the Western developed and the developing world, with India as the example of the developing world. Though suicide rates are low in the western developed world in comparison to many of the developing countries like India, there is sufficient evidence from data to show that there is a high prevalence of mental illness in those who commit suicide, whereas verbal autopsy data from suicides in India have shown that suicides are impulsive and stress oriented, with socio-economic circumstances, interpersonal, social and cultural conflicts being the factors that impinge on the stress experienced by the individual (Jacob, 2008). This suggests that the notion that suicide is the result of disturbances in the ties between an individual and society may be more relevant to the developing world than in the developed Western world. Life in the developing world, when looking at India and China, demonstrates a greater involvement of stress (Hirsch, 2006). Interpersonal conflicts, marital and familial discord, financial problems and unemployment contribute to individuals finding themselves in discord with society and the disruption of social ties. In such circumstances, there is a greater impact of social alienation of the individual leading to contemplation of suicide and acting on these thoughts of taking one’s life. A similar extension of the toughness of life in rural areas of the developed world, when compared to urban areas of the developed world, is possible, leading to the possibility that social alienation may be more involved in suicidal thoughts and acts. Furthermore, there is the element of rural ideology, which points to a greater emphasis on a strong work ethic, independence or rugged individualism, religiosity and patriotism, with a life that revolves around the family and the community. Rural areas are far flung, with the inhabitants widely separated from one another. Migration of the workforce, the aging population and the economic decline common to these rural areas have made the inhabitants more isolated and caused the loss of means to livelihood, political power and status, and personal control for these rural residents. The reduced economic strength within the rural areas and the reduced transportation means has led to less social interaction or the means to maintain social ties and bondage. The economic misfortunes of the rural residents are thus faced by them by themselves without the supportive function of society. This isolation and loss of meaning of life and the ease with which the tools for suicide like pesticides and firearms are available make the conversion of suicidal thoughts into actions easier (Hirsch, 2006). Whitley, Gunnel, Dorling, and Smith (1999) argue further, based on their studies of suicide data, that high social fragmentation by itself leads to higher rates of suicides in those communities where social fragmentation is widely present, even without issues of deprivation and loss of economic strength, pointing strongly to the notion that disturbance in ties between the society and the individual result in suicide. However, Beautrais (2000), in studying the comparative high incidence of suicide among the youth of Australia and New Zealand, while agreeing with the notion of disrupted social and familial ties enhancing suicidal tendencies in the youth, also lays the blame at the doors of the diminished mental health seen in the youth. Culture can have a moderating impact on suicidal tendencies, as it plays a key role in many of the factors like value and meaning of life and moral objections to suicide (Mignone & Oneil, 2005). In a world where there is a growing alienation of the youth from the native cultures and interaction with other cultures, this meeting could be tumultuous in their life and reduce the moderating impact of their culture and social networks. This is particularly so, when one thinks in terms of indigenous communities and the enhanced impact increased frequency of their interaction with cultures of the dominant society, the nature of which may be alien to them (Mignone & Oneil, 2005). The mitigating impact of suicide can be clearly seen in the buffer that culture offers the African American people. Strong religious beliefs, collective social orientation and strong family bonding form the basis of the cultural buffer that African Americans enjoy through their culture. As they move away from the individual and collective strength that the culture provides against suicidal tendencies, so does the tendency towards suicide (Utsey, Hook & Stannard, 2007). Yet culture need not always be a mitigating factor, when the cultural concepts support suicide, as can be seen from the Japanese experience. Suicide is not a rarity in Japan and springs from the “inseki-jisatsu”, which can be translated as responsibility driven suicide. Such suicide is witnessed in individuals who have achieved success in life and are in high social positions Takei, Kawai & Mori, 2000). Failure to live up to the social expectations of them could lead to despair and suicide taking the responsibility for this failure. Inseki-Jisatsu can also result from the shame that an individual brings to the family through their actions like acts of crime. Such suicide patterns, which contribute the high incidence of suicide in Japan, demonstrate the manner in which culture can impact on the suicidal intent of an individual in the face of deteriorating social ties (Takei, Kawai & Mori, 2000). Discussion Suicide is increasingly seen in all societies, though there may be regional and demographically disparities. Identifying the cause of why individuals should choose to end their lives may provide the means to try and prevent suicides. Finding a single cause for suicide is not an easy task, as suicide is complex and the risk factors for suicide are several. Suicide is impacted on by age groups, the place where one lives, the society one belongs to, social support and the culture of the community and the mental health status of the individual. The young and the elderly are age groups wherein there is a high risk for suicide. The difficulty of life in many of the countries of the developing world increases the incidence of suicide. In a similar manner, the stresses and strains of rural life lead with the lack of social networking and social support promotes the incidence of suicide. While in general, culture with its built-in values for social networking and social support for individuals, acts as a buffer against suicide, any culture that supports suicide as a means out of becoming a social outcast increases the rate of suicide in the society. The mental health of the individuals to withstand the frustrations and failures that are part of the experiences of life may lead to mood disorders, substance abuse disorders and antisocial behaviours. This weakening of the mental health of the individual could lead to increased suicidal tendencies. In examining the role that social ties and mental health plays in the incidence of suicide, it may not be wrong to attribute a higher responsibility for social ties for increased suicidal tendencies in many parts of the developing world and a higher role for mental health in the developed world. Conclusion The notion that suicide is seen to be the result of a disturbance in the ties between the individual and society is too simplistic an evaluation of the causes of suicide. Social ties are a dominant factor that impinges on suicide, but it is also necessary that mental health is taken into consideration in any evaluation of suicide. References Beautrais, L. A. (2000). Risk factors for suicide and attempted suicide among young people. Australian and New Zealand Journal of Psychiatry, 34, 420-436. Draper, B., Snowdon, J. & Wyder, M. (2008). A pilot study of the suicide victims last contact with a health professional. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 29(2), 96-101. Hirsch, J. K. (2006). A Review of the literature on rural suicide: Risk and protective factors, incidence, and prevention. The Journal of Crisis Intervention and Suicide Prevention, 27(4), 189-199. Jacob, K. S. (2008). The prevention of suicide in India and the developing world: The need for population-based strategies. The Journal of Crisis Intervention and Suicide Prevention, 29(2), 102-106. Judd, F., Cooper, A., Fraser, C. & Davis, J. (2006). Rural suicide- place or people effects. Australian and New Zealand Journal of Psychiatry, 40(3), 208-216. Laje, G., Paddock, S., Manji, H. & Rush, J. A. (2007). Genetic markers of suicidal ideation emerging during citalopram treatment of major depression. The American Journal of Psychiatry, 164(10), 1530-1538. Mignone, J. & O’Neil, J. (2005). Social capital and youth suicide risk factors in first nations communities. Canadian Journal of Public Health, 96(S51), 71-80. Pirkis, J., Burgess, P. & Dunt, D. (2000). Suicidal ideation and suicide attempts among Australian adults The Journal of Crisis Intervention and Suicide Prevention, 21(1), 16-25. Rihmer, Z. (2007). Suicide risk in mood disorders. Current Opinion in Psychiatry, 20(1), 17-22. Soreff, S. (2006). Suicide. Retrieved August 25, 2008, from, emedicine, WebMD Web Site: http://www.emedicine.com/med/TOPIC3004.HTM. Suicide Rates. 2003. Suicide rates. Retrieved August 25, 2008, from, World Health Organization Web Site: http://www.who.int/mental_health/prevention/suicide/ suiciderates/en/. Takei, N., Kawai, M. & Mori, N. (2000). Sluggish economics affect health among Japanese business warriors: A high rate of suicide. The British Journal of Psychiatry, 176, 494-495. Utsey, Hook & Stannard, (2007). A re-examination of cultural factors that mitigate risk and promote resilience in relation to African American suicide: A review of the literature and recommendations for future research. Death Studies, 31(5), 399-416. Whitley, E., Gunnel, D., Dorling, D. & Smith, D. (1999). Ecological study of social fragmentation, poverty, and suicide. The British Medical Journal, 319, 1034-1037. Worldwide Suicide Information. (2006). Worldwide Suicide Rates. Retrieved August 25, 2008, from, Suicide and Mental Health Association International Web Site: http://suicideandmentalhealthassociationinternational.org. Read More