Wednesday, 28 March 2012

Comparative Suicide Studies of Canada and the United States to Aboriginal Suicide

The literature on suicide among Native American and Canadian Indian, Alaskan Native and Canadian Inuit has grown remarkably in the past decade. In 1989, for example, David Lester’s Suicide from a Sociological Perspective covered New Mexico Indian suicides in three pages; in 1997, he was moved to publish a
full-length book on Suicide in American Indians. Indian suicide is increasing each year.

In 1994, the American and Alaska Mental Health Research Center published the proceedings of a major conference. Calling from the Rim may well be the most important and coherent account of youth suicide amongst indigenous peoples. Dozens of medical and psychiatric journal papers cite quite diverse rates of Indian suicide within tribal groups, while others point to sharp differences in prevalence between tribes.

As discriminating as these studies appear to be, there remains the problem of the all-embracing title of ‘tribe’. Custer Died for your Sins by Vine Deloria Jr, a well-known Indian rights advocate and a former Executive Director of the National Congress of American Indians, remains the most searing, and unrebutted, indictment of American Indian policy, and of white academic attitudes, especially those of anthropologists. He deplores the Little Big Horn and wigwam stereotyping of his people, and I suspect that, while he has not written specifically about suicide, his admonitions of anthropology would apply as strongly to suicidology. In essence, he condemns academe for creating ‘unreal’ Indians in their attempts to establish ‘real’ Indians. Thus, the ‘bicultural people’, the ‘folk people’, the ‘drink-too-much people’, the ‘warriors without weapons people’, the ‘between-two-worlds people’ are academic constructs imposed on a people who then came to believe, and live out, these external perceptions. Deloria reminds us that when academics talk of the Chippewas or the Sioux, they appear not to recognise that ‘there are nineteen different Chippewa tribes, fifteen Sioux tribes, four Potawatomi tribes’, and so on.

Anthropology may well have committed many ‘sins’ against Indian peoples. But the anthropological approach at least attempted to get to know ‘their’ people and ‘their’ tribes. Other social science and medical disciplines have adopted a distant, statistical approach, even where there are attempts at differentiation between reservation and non-reservation residents, as in a Manitoba study. There is no detail of lifestyle difference, only difference in geographic domain. In short, there is no context—social, historical, political—provided in these studies, apart from stating the inevitably obvious that these communities are impoverished with high rates of unemployment, and so on

Every study is concerned about under-reporting and about inadequate protocols for identification. The ‘Manitoba aboriginal’ paper states ‘suicide among aboriginal people cannot be studied through the use of such traditional data sources as vital statistics records, since ethnic background is not recorded on the death certificates in any jurisdiction’.

Every study reports more attempts by females, but makes an important point that clustering is commoner among females and that more females succeed in their purpose when among the cluster. Without being explicit, there is a strong message that female youth attempted suicide is in need of serious attention.

The following summary gives us an overall picture of rates of youth suicide per100,000 of a population generally, or for particular periods:
• The rate per 100,000 for Shoshone and Bannocks in Idaho is now 98, but it was as high as 173 in the period 1972 to 1978.
• The Shoshone rate for the United States is 100.
• The rates vary enormously: from 4 for the Lumbee in North Carolina to as high as 230 for Shoshone-Arapaho.
• The rates in New Mexico range from 175.19 for the Apache, to 45.68 for the Navajo and 79.06 for the Pueblo.
• The Indian rates for Yukon, Alberta and Saskatchewan are 61.9, 52 and 35.1respectively.
• The Manitoba rate is 31.8. but there are interesting differences between those living on the reserve, 83.9, and those off the reserve, 59.5. Noteworthy is that the rate in the 10 to 14 cohort is 5.25, 21.7 in the 15 to 19 group, and 55.7 in the 20to 24 year group.
• Canada, as a whole, has an Indian suicide rate of 38.4 as opposed to the national rate of 14.1.
• In the Alaskan town of Alakanuk, in a population of 550, there were 8 suicides in a 16-month period, a figure which would equate to a rate some 20 to 24 times the national figure.
• The Alaskan attempted suicide rates are alarming: in 1971 to 1977, between 205 and 302 per 100,000. Between 100 and 251 youth had to be hospitalised. The Indian male rate of attempted suicide is 2.7 times the national figure; the female rate is 7.5 times the national rate.

Lester provides the best statistical summary of youth suicide, albeit with data at least a decade old. Despite regional differences, there is a sameness about many of the figures and ostensible causes. The ‘indigenous’ rates are at least ten times higher than the national rates. The attempted suicides are vastly more prevalent.

Lester admits the unreliability of standard psychology tests when used with Indians. His checklist of the ‘standard’ underlying factors is similar to the one in common use in Australia and New Zealand: depression, hopelessness, immaturity, aggressiveness, a history of suicidal behaviour, psychiatric problems, substance abuse, parent and family conflict, lack of family support, physical and sexual abuse, and recent stress. He lists the sociological factors as social disintegration, cultural conflict, and family breakdown. However, he adds, ‘rarely is cultural conflict listed among the precipitating causes’. It is not clear whether he is being critical of that omission or whether he, himself, believes it not to be significant.

David Bechtold is one of the few researchers who talks about ‘culturally sensitive risk factors’ for males aged 12-plus:
• physical and intellectual developmental precocity (12–14);
• conceptual maturity regarding death;
• conceptual familiarity with suicide through family or peer group or media exposure;
• substance abuse, depression, antisocial behaviour;
• previous suicide gestures and attempts;
• cultural mismatch between the youth and the environment;
• suicidogenic messages from family, especially parents;
• family disruption and dysfunction;
• availability of lethal means.

Bechtold is the only author I have read who may have read Deloria. He is concerned about the negative impact of suicide publicity and asks how one establishes unequivocal moral proscriptions against suicide without calling undue attention to suicide. He also asks whether we can delineate a generalisable, culturally relevant set of risk factors for Indian people. ‘Or do we have to do it by tribe or clan? Is tribal-specific research methodologically possible?’ Deloria’s plea is for ‘a leave-us-alone-law’; ‘what we need is a cultural leave-us-alone agreement, in spirit and in fact’.

What we can learn from this brief excursion into North America is that there may well be room for a philosophy which is neither proactive nor intrusive, one which waits patiently until one is asked to intervene, explain, or better still, to understand. Of all human behaviours, suicide may just possibly be the one that always needs attention, that cannot be left alone, but which needs an attention of a very different kind from the present strategies.

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