We must examine the reasons why at a time of unprecedented prosperity so many people feel so despairing that they chose to take their own lives.
The continued rising trend since the 1960’s highlights an extremely concerning trend and challenges the state to immediately implement, as a matter of urgency, programmes to reduce this rising figure.
The National Task Force on Suicide, which was set up by former Minister for Health, Mr. Michael Noonan T.D, in November of 1996, published its recommendations in January of 1998. This outlined a list of 86 areas where interventions should be made to reduce the suicide levels. This indicates the complexity of the issue. There are no simple solutions. In order to tackle this growing tragedy in our society it is essential that a systematic approach to the prevention of suicide and suicidal behaviour be put in place.
The National Task Force identified the various authorities with jurisdiction in suicide prevention strategies and their responsibilities. In 2005 “Reach Out” a National Strategy for Action on Suicide Prevention 2005 to 2014 was published. This outlined 94 recommendations and 26 action areas for intervention to reduce suicide. Society must adopt a compassionate and informed response to those who feel suicidal. In an effort to reduce the high levels of suicide, especially amongst young males, we must identify the reasons that lie behind it.
Among the factors, which in other countries have been found to correlate highly with the suicide rate is the increase in indictable crime, the increase in alcoholism, the increase in births to single mothers and the rate of marriage breakdown. This can be taken as representing the level of integration or cohesiveness within society.
Let us examine this situation in an Irish context. The level of births to unmarried mothers shows an increase in each successive year since 1970. In 2009, 26,541 or in excess of 33% of children were born to single mothers. In 1975 the number of indictable crimes was 48,387. In 2009 the figure was 281,803. There has been an increase in alcoholism as measured by the admissions to hospitals for the disease. There has been an increase in the per capita consumption of alcohol. In the 1990s reach completed in the north east found that there was an increase of 41% in alcohol consumption and an increase of 44% in suicide rates. In 1970 the marriage rate per 100,000 was 706. In 2009 it was 483. The number of separated and divorced persons increased form 87,800 in 1996 to 166,797 in 2006, 107,263 separated and 59,534. These four measures, the rate of births to single mother, the crime rate, the alcoholism level and the insecurity of marriage confirm international figures in an Irish context. This does not offer a causative explanation but suggests that the same forces that lead to these changes are also influencing the rates of suicide.
Unemployment affects the suicide rate. Unemployment has a profound affect on a person, especially on the young and on those in middle age. Irish society awards status and prestige according to a person’s position and contribution to work. Unemployment is associated with loss of face and of prestige. The unemployed are 6 times more likely to be suffering from a psychiatric disorder than those in employment. Studies show that there is significantly more unemployment, job instability and occupational problems amongst suicide victims compared to those who did not die by suicide. Of the men who took their lives in the Kelleher/Daly Cork Study some two thirds were out of work at the time of their deaths.
The influence of traditional religious values has waned, particularly amongst the young. The growing secularisation of society has changed the value system. Social controls are less strict and often people feel alone and lost. There is no longer a pre arranged set of relationships with certainty within the relationship as was the case in past generations. Religious practice also has not only a spiritual aspect but also a communal one in the sense that people met at the same time in the same place with their communities which had a socialising effect. Lessening religious ties and individualism leads to increased risks, especially for young people in transitional periods of their lives.
In his address to the Irish Association of Suicidology Conference Youth Suicide in September 2000 Mr. Alan Apter of Tel-Aviv University, Israel, stated, “among the diverse and manifold risk factors for suicidal behaviour several personality characteristics stand out as being important for both fatal and non fatal suicidality.
One cluster of traits related to suicidal behaviour seems to centre around impulsive aggression. These individual appear to be highly sensitive to minor life events, which cause them to become anxious and angry and then depressed. Many have histories of abuse as children, are extremely unstable emotionally and abuse drugs and alcohol. They are usually young with multiple attempts and self-mutilating behaviour. They use defences such as regression, displacement, and splitting and can be identified by characteristic features of their human figure drawings.
A second cluster of traits seems to revolve around narcissm and perfectionism. These individuals appear to have depression related to self-criticism and are unable to tolerate failure or imperfection. Many of these subjects seem to be quite successful in their lives and their suicides often come as a total surprise. Their suicide attempts are usually well planned, not impulsive and quite lethal. These persons are often described as “private people” and on empirical measures seem to be low on self-disclosure and intimacy and high on loneliness.
The onset of economic recession in 2008 means an increasing demand on our psychiatric services. There is a higher levels of depression and suicide amongst the unemployed and the pressures caused by financial difficulties has been identified in the by Durkheim in the 1890s.
Finally there is a group of suicidal individuals in whom suicide appear to be related to a psychopathology especially effective disorders and schizophrenia, although similar patterns of behaviour have been found among patients with eating disorders, obsessive compulsive disorders and panic syndromes. This group is characterized by depressive symptomatology of an “analytic” type, hopelessness, helplessness and a feeling that they are overwhelmed by their psychiatric illness.
A New Zealand report offers a perspective on young suicides stating “the prevailing materialistic, worldly values that equate individual success with wealth, good looks and power make young people feel quite worthless and cast out by society”.
It is clear that suicidal behaviour has a large number of underlying causes, which are complex and interact with one another. Identifying these factors and understanding their role in both fatal and non-fatal suicidal behaviour is central to preventing suicide. Factors, such as living in poverty, unemployment, loss of loved ones, arguments with family or friends, bullying, breakdown in relationships and legal or work related problems are all acknowledged as risk factors affecting those who are predisposed or otherwise especially vulnerable to self-harm. Other predisposing factors include alcohol and drug abuse, a history of physical or sexual abuse in childhood, and social isolation. Psychiatric problems, such as depression and other mood disorders, schizophrenia and a general sense of hopelessness also play a central role. Physical illness, particular those that are painful or disabling, are also important factors. Having made a previous suicide attempt is a powerful predictor of subsequent suicidal behaviour, particularly in the first 6 months after the first attempt.
A number of factors nevertheless appear to protect people against suicide feelings or acts. They include high self-esteem and social “connectedness” especially with family and friends, having social support, being in a stable and happy marriage and commitment to religion.
In his research entitled “Suicide rates between the Health Board Areas” the late Dr. Michael Kelleher demonstrated that the rise in suicide has been a rural rather than an urban phenomenon, a male rather than a female phenomenon, affecting the young and the young elderly and that some counties have exhibited rates of suicide much higher than neighbouring counties which overall could not be explained by variations and recording practices.
Dr. Kelleher speculated that the services are better, more accessible and more user-friendly in urban areas. This would counter the frequent claims in the medical press that there is a shortage of psychiatric beds in the Dublin area. By contrast, are the services in other, more rural Health Boards too remote or too inaccessible. There may also be a less pronounced level of change in the acceptance of the need when in crisis to seek help in rural areas. In other words the stigma persists more in rural rather than in urban areas.
It has been stated by the Combat Poverty Agency Report of 1997 that medical card-holders in the West of Ireland are 10 times more likely to be more than 5 miles distant from the nearest Health Care facility. In country areas public transport is less frequent and perhaps, because of distance more expensive for the individual. It is also possible that having psychiatric services in a community increases the exposure to the reality of the high instances of mental illness. This could help to reduce the stigma and isolation that, otherwise, sufferers might experience and does make them more willing to contact such services when in difficulties.
To quote the late Dr. Kelleher. “It has been shown that male suicides are less likely than female ones to have been in touch with the medical services in the year before their death. In a study of 100 consecutive suicides adjudicated by the Coroners in the City of Cork it has shown that only half the men had been in touch with Social Services. Amongst young men the figure was as low as one in five.”
It is quite possible that youth suicides are even less likely to seek medical or physiological care. A study of 100 third level students has shown that, whereas most knew personally of a suicide and some 40% experienced suicidal thoughts, with 13% having made an attempt in the past, practically none knew how to summon help. Each of these students had achieved very high points in the Leaving Certificate. The research clearly points to the need for the development of a more acceptable and assessable service for those at risk of suicidal behaviour, especially in the less urbanised areas.
This should not be imposed on the local community and will only be successful if the services are developed in co-operation with existing resources such as Youth Clubs, Community Group, Sports Clubs whose local knowledge would be valuable.
Gender and Suicide
Professor Michael Fitzgerald, former Chairman of the Irish Association of Suicidology and Henry Marsh Professor of Child and Adolescent Psychiatry at Trinity College, Dublin has pointed out that there is a paradox in a way in that we have increased suicide particularly in males and hopelessness while at the same time Ireland has been booming economically. Why is this?
Males find it:
- Harder to find a role and an identity in society.
- Young males are often lost.
- If unemployed they are unsuccessful. They feel discarded and have increased likelihood of considering suicide.
- They tend to se the strategy of the stiff upper lip/machismo.
- Females rearing children in some ways has not changed over the years but of course the massive increase in working outside the home has. Nevertheless in agricultural communities women always worked on the farm so it not that radically new.
Professor Fitzgerald points out that males and females have different brains. Males are more technologically minded, females are more empathically/social skills/communication minded and this is probably a factor in preventing males from seeking help. The male is the hunter and the female since the beginning of time has had to have children and to nurture them and to communicate with them.
All the institutions we put our faith in, the church, state agencies, the police, political system, have lost face in recent years and lost the trust of people to a greater of lesser extent. All these have been declining in stature and the rate of suicide has been increasing.
Maybe the youth of Ireland facing the massive changes are coping with the changes by increased drinking and there has been a massive increase in alcohol consumption in Ireland. It is harder for a male to get a meaningful identity. The people in Ireland that are valued are males that are successful, who are winners, who are in third level education and who are earning ‘big bucks’. People who are not in that trajectory find it more difficult to find an identity, to find a position, which would earn them respect, to find support, to find a place in society. Ireland is a place for winners. If you are not in that category then there is no place for you in current society. The critical issue for the male adolescent is to derive an identity, self esteem, and personal meaning from their position in society.
People who are not winning are marginalized and devalued by society. There is no place for them. Clearly those who fall out of education are more vulnerable. In the past the young Irish male could have gone to church, could have identified with God, with the idea that there is something out there beyond the euros. In Ireland there is a fundamental breakdown in the relationship between the person and their socio-cultural setting. The Euro is what is worshipped. All happiness comes from the euro. We are told that a credit card is all we need. Many males are left marooned. They are disconnected and alienated and lost. There is a lack of integration of the individual into society (egotistic suicide).
There is a lack of solidarity tat comes from attending religious service with the same people in the same church every week. This whole social and spiritual phenomenon is fading. We do not have religious festivals as we had in the past. Now we have drinking festivals. Aspirations and wants have increased dramatically. The ability of some individuals to meet their aspirations and wishes are just too much. Now issues of self are linked to materialism, consumerism and globalisation. Increased materialism has led to weaker social ties and weaker neighbourliness. We live in the age of uncertainty, and age of anxiety and an age of narcissism.
Irish and international research has established that Lesbian, Gay, Bisexual and Transgender (LGTB) young people are at significant health risk due to isolation, fear, stigma, the ‘coming-out process, bullying and family rejection. YouthNet have indicated that issues of particular concern in relation to LGBT youth include suicidal ideation and self harming behaviour. For instance LGBT young people were found to be five times more likely to be medicated for depression, two and a half times mere likely to self harm, and at least three times more likely to attempt suicide, than their hetrosexual peers.
Young men and women of same-sex orientation have also been identified as one of the high-risk group for youth suicide in a evidence briefing on youth suicide published on behalf of the UK and Ireland Public Health Evidence Group, and are included as an ‘at risk’ marginalised group in Reach Out, the Government’s 10-year strategy on suicide prevention.
Suicide is as old as the human race itself. In ancient Greece the bodies of suicide victims were buried outside the City walls, the right hand severed and buried separately. Ancient Roman citizens could get permission from the Senate to take their own lives but slaves or criminals were refused on economic grounds. The traditional Christian approach was very strict. The self-inflicted death of Judas was construed as a more heinous crime than the betrayal of Christ. Church Authority acted in concert with civil law depriving suicides of dignity in death and the relatives of their material resources. The affects of such practices may have had devastating affects on the social and psychological welfare of the bereaved. There is no compelling evidence that it diminished the frequency of the event of suicide. It undoubted influenced the recording of statistics relative to self-inflicted death.
From St. Augustine onwards the condemnation of suicide strengthened and by the start of the 8th Century suicide was deemed to be a grave mortal sin.
Christian theology on suicide was quickly incorporated in civil legislation and for over 1000 years the families of suicide victims were ostracised and persecuted. This severe approach did not wane until the late 17th Century when many of the legal penalties fell away by default.
Desecration of the corpse, denial of burial on concentrated grounds, profiture of goods to the state, were being side stepped by the judiciary who devised an approach of bringing in verdicts of suicide “whilst the balance of the mind was disturbed”.
Hanging for attempted suicide took place in London up to 1860. There are people alive in Ireland who remember victims being denied burial in concentrated ground.
The last charge in our courts of attempted suicide was in 1967, the same year as suicide was decriminalised in the UK.
Stigma is a pervasive phenomenon. It may be more prevalent in males than in females. Boys may be less in touch with their negative emotional feelings than girls. When they are, they may be less likely to admit the fact to themselves or others. As a part of this “tough guy” orientation, they may be less likely to seek or present themselves for treatment.
The Irish Association of Suicidology is a practical step towards the de-stigmatisation of suicide . It has set itself the aim of increasing and improving awareness of the phenomenon. We must find ways of encouraging the distressed to seek help whether voluntary or clinical. The Association reaches out to the many organisations and individuals who for many years and in many ways are helping those for whom the burden of life has become too great.
See Change is Ireland’s national programme working to change minds about mental health problems in Ireland. We’re working in partnership with over forty organisations to create a disruptive, community driven social movement to reduce the stigma and discrimination associated with mental health problems.