Wednesday, 28 March 2012

Comparative Suicide Studies of New Zealand to Aboriginal Suicide

My professorial inaugural lecture at the University of New England in 1972 addressed comparative race politics in Australia, Canada, New Zealand and South Africa. While disputing the commonly expressed Pakeha (European) view that ‘New Zealand has the best race relations in the world’, I found much that
appeared positive, at least compared to Australia, in a period of radical social and political change. Re-reading the lecture, I note that I presented separatism in a positive light, not as apartheid but as a way of both reviving and maintaining cultural, social and political values while still participating in mainstream societal institutions. I talked of the need for ‘accommodation’, a notion totally antithetical to assimilation, one in which administrators and decision-makers modify their strategies in view of ‘indigenous realities’. Accommodation requires a radical change of mind and thought, including the abandonment of ‘them’ and ‘us’ as superior and inferior; it requires a mindset willing to view diverse peoples as having equivalent cultural sophistication, with each achieving, in its own way, for its own time and place. While it is clear that these cultures are not the same, invidious comparisons and distinctions block the path to accommodation, to achieving what Richard Thompson calls the necessary ‘community of communities’ in New Zealand. Writing in 1998, Thompson argues that the Maori role is not simply ‘separatist’: ‘it is not a threat’. ‘It serves a necessary and positive function in a shared society; it anchors identity and is a source of confidence and self-esteem’.

Thompson’s new discussion document, The Challenge of Racism, provides an excellent summary of all that has changed, or not changed, since my 1960s research in New Zealand. There is no need to traverse his discussion points, except to say that Maori suicide, like Aboriginal suicide, must be seen in the cultural, social and political contexts of the nation. Maori suicide is not simply an incidental subset of New Zealand suicide.

The 1996 census lists 2,879,085 people of Pakeha descent, (72.5 per cent of the population); 523,374 of Maori descent (13.2 per cent); 202,233 of Pacific Island descent(5.1 per cent); and 173,505 of Asian descent (4.4 per cent). Maori have tired of the array of definitions of them. They claim that self-identification is the only acceptable approach: ‘Being Maori is a state of mind.’ Of interest is that the introduction to the census states: ‘People have Maori ancestry if they consider they have Maori ancestors, no matter how distant’.

As an irregular visitor over a period of 30 years, and bearing in mind my Aboriginal-oriented lenses, there is much that is positive in and about Maori life. I do not forget Moana Jackson’s admonition that New Zealand is ‘the land of myths, lies and deceit, where things are never what they appear to be’. Whatever the truth within, Maori strength appears impressive from without: regular inclusion of Maori as stakeholders in public and social policy formulation; virtual bilingualism, at least in government language, in official documents and on public occasions; increasing use of Maori words and concepts as part of the national culture; a powerful Maori presence in national politics; an extraordinary presence, and applause, on sporting fields and in the artistic world; Maori perspectives as part of the national media, no longer relegated to quaint documentaries; Maori Studies as part of university curriculums; the new ‘ball game’ as a result of the Waitangi Tribunal and the resultant reparation, as well as restoring ownership and management of dispossessed lands. I have one especially important yardstick: that the Medical School at the University of Otago has introduced Maori material into every sub-discipline, and the material is examinable. For me, that is both ‘separatism’ and accommodation at its best.

New Zealanders dispute whether Maoritanga— Maori being, love of Maori-ness—is the exclusive property of Maori or should be available for all to share. ‘Our culture is our business’ is fairly common. At times, this assertion of sovereignty, exclusivity or even militancy spills over into matters like suicide. At the start of our research, we were ‘warned’ by a number of people that Maori are seeking to exclude non-Maori from this domain. Not so. Maori researchers, officials and parents of deceased youth were not only polite but sharing.

(i) Maori suicide
The Skegg, Cox and Broughton study examined Maori suicide from 1957 to1991. The Maori male rate was one half, and the female rate one third, of the non-Maori. For the 15 to 24-year-old cohort, the male rate was 35.2 per 100,000, and the female, 6 per 100,000. What the researchers found disturbing was the doubling of the Maori female rate, and a trebling of the male rate, over the 35-year period.

The 1987 to 1991 figures show an ‘equality’ of Maori and Pakeha youth suicide. Equally disquieting, according to John Broughton, is that youth steeped in Maoritanga are suiciding, whereas several opinions are that it is only, or mostly, the alienated-from-culture youth who take their lives. Poison is the chosen female method, hanging the male. In the 15 to 49 age group, 71 per cent of Maori suicides in the period 1980 to1988 were by hanging while in custody.

The study concludes that the under-reporting of Maori suicide is as high as 28 per cent. This is because ‘the recording of Maori ethnicity on a death certificate depends on the undertaker ascertaining that the person had 50% or more of Maori biological origin’. Death certificates use biological definition, whereas self-identification has been the census protocol since 1986. The researchers believe that Maori suicide rates, ‘already a cause for concern’, might now be even higher than non-Maori.

There is very little suicide beyond the age of 55. The researchers posit that elders have a greater involvement in cultural life, and that it is the culturally-deprived or alienated youth who suicide. They see culture as ‘providing a sense of belonging and purpose, and so a sense of meaning and self-worth, and a moral framework to guide[our] conduct’. Despite reports of culturally ‘orthodox’ youth committing suicide, there is clearly a much greater sense of security for Maori youth in family, in a hapu or iwi, than in their Aboriginal counterparts in New South Wales rural areas.

The Maori Suicide Review Group was established because of alarm that, between1971 and 1995, 47 incarcerated Maori committed suicide. Nowhere near the ‘awesome’ apparatus and agenda of the Royal Commission in Australia, it nevertheless covered some common ground, especially on ‘inmate management’. The 17-page account of ‘Suicide by Maori’ is comprehensive.

As can be expected, the Group examined risk factors in the ‘literature review’: psychological/psychiatric disorders, social and cultural factors, family factors, behavioural risk factors, biochemical and genetic factors, exposure to suicidal behaviour, stressful life events, and triggers. The custody suicides were believed to involve high levels of substance abuse and ‘psychiatric disorder’, poor ‘coping skills’ and social disadvantage. There is a significant difference between the Aboriginal and Maori experience of imprisonment: Maori experience ‘strong feelings of shame’, whereas Aborigines appear to experience anger and a sense of retaliation, rather than shame. The Group also found that Maori inmate suicides were more likely to be those serving longer sentences for violent offences. By contrast, much of Aboriginal suicide in custody occurs within the first 24 hours, a period of high risk. Compared with the New Zealand finding on long-serving suicides, the Royal Commission found that many Aboriginal custody suicides were, and are, by people jailed for minor infractions or alcohol-related misbehaviour.

The Group examined ‘factors specific to Maori’. Maori, who comprise 13 percent of the population, formed 47 per cent of the prison population, as at the 1993prison census! By comparison, Aborigines, some 2 per cent of the New South Wales population, are now 14 per cent of the prison population. Of the Maori inmates, 43 percent were under 25. Most were unskilled, unemployed, and one in four was ‘more likely to be affiliated to a gang’. Most were in jail for aggravated robbery. All Maori had longer criminal histories. In short, ‘it appears that Maori inmates are a higher risk group before they arrive in prison’. This is consonant with my view, that suicide in custody has less to do with custody than with the factors which are conducive to suicide before custody.

The Group posits that there is ‘increasing mental illness among Maori’. They are unsure whether this is something new, or something that has been evolving. The Group considered ‘economic and social disadvantage’, quoting Mason Drurie as defining this group [of inmates] as ‘caught between two cultures, isolated from both Maori and general society’. Two submissions to the Group are noteworthy:
(a) You could almost write the lives of each of these people. They grew up in sheer hell and hell is all they have lived all their lives and the only escape for them is death.
(b) The fact that they are in prison is not the cause. It is an avenue which allowed them to do what they intended to do; spiritually have done months before that. The rope was just ending the physical of an already spiritual death.

The Group analyses, at some length, the cultural factors, especially the ingredients which make for a healthy person. In Australia, we have no such equivalent analyses; nor can we say, with any certainty, that there are no Aboriginal, or vestigial Aboriginal equivalents. Te taha wairua, the spiritual quality (or Hillman’s ‘soul’), is the most basic and essential requirement for health. Te taha wairua also accounts for something very important in Maori life, mana, or status.

Then follows a detailed exposition of whakama, where a person perceives he has less mana than particular others, or has lost mana because of his, or someone else’ sactions. This is seen as an ‘illness with a spiritual dimension, an unease which affects the whole person, body, mind and spirit’. When whakama goes untreated, it can lead to breakdown. Doctors diagnose it as ‘psychiatric disorder’; Maori call it mate Maori, Maori sickness. There may, possibly, be some cultural equivalent in Aboriginal ‘jealousing’.

(ii) Non-Maori suicide
Suicide studies in New Zealand are, if one may so describe them, efficient, professional, compact and strongly directed towards the medical/psychiatric model. Coggan and Norton, who have done important work on youth suicide in Auckland, have also published strategy papers for reducing ‘self-directed harm’. Their work illustrates two themes I raised earlier: first, self-harm, of the suicide variety, ‘has significant individual and societal costs, compared with other health problems’; second, a strategy is needed ‘to improve the identification, referral and treatment of persons at high risk of suicide by various caretakers and “gatekeepers” in the community’.(Gatekeepers, in this context, no doubt means medical personnel.) This work is reasonably typical of non-Maori suicide research: it is steeped in the medicalised public health model, with an occasional reference to cultural factors, or socio-economic disadvantage. Rarely is there mention of the historical and political dimensions. New Zealand research generally posits the unlikely, namely, that there is more death, and more cost to the nation, in suicide than in road accidents, in alcohol consumption and drug abuse, and in criminal behaviour. It posits what Szasz and Hillman, among others, have shown to be quite unrewarding in terms of the prevention and handling of suicide—‘treatment’ by ‘caretakers’ and ‘gatekeepers’.

The Canterbury Suicide Project, and especially the work of Annette Beautrais, is renowned. The researchers have examined many facets of suicide: from risk factors among the 13 to 24-year-olds, to the prevalence and co-morbidity disorders among the parasuicides, to childhood circumstances and adolescent adjustment among parasuicides, to access to firearms and the risk of suicide. The paradigm in most of this material is that there is probably dysfunctional or disadvantaged family circumstance to begin with. This leads to increased vulnerability to psychiatric disorder and problems of personal adjustment, both increasing the likelihood of suicide. Further, the ‘odds of serious suicide attempt are related systematically to the extent of exposure to disadvantageous childhood experiences and family circumstances, adverse socio-demographic factors, and an individual’s current psychiatric morbidity.’

None of the New Zealand researchers indicate whether their samples include Maori, or if they do, whether there is anything Maori-specific about causality, suicidal behaviour and responses to psychological or psychiatric tests of various kinds. To read the Maori Suicide Review Group and the work of the ‘non-Maori’ researchers is to read about two different worlds, with only an occasional ‘cross-over’ about ‘psychiatric disorder’ which may be painful and diseaseful for Maori, but which hardly requires the conventional ‘gatekeepers’.

Dr David Fergusson contends that although suicide is fascinating for the media, it is not the most serious issue: rather, it is symptomatic of the conditions which give rise to it. He believes in the value of ‘early start programs’, the sending out of workers into the community to try to change community ways. ‘Good’ families can become the models for others to emulate. Suicide, he argues, will end when communities achieve a degree of social health, a view one could disagree with. It is, in essence, what Hillman calls the ‘interiorisation’ of the suicide within the community. However, in Aboriginal societies in New South Wales (and elsewhere), distance, geography, isolation within their domains, and the absence of role models, make movement towards ‘the middleclass’ and its (supposed) values not only difficult but somewhat impossible.

(iii) Some lessons
Much can be gained from studying New Zealand practice, and many of the positive aspects have been referred to, or alluded to, in earlier chapters. In summary, the following should be noted:

(a) Suicide research
There are, in effect, two streams of youth suicide research: one looks through universal (or Western) lenses, the other embraces a Maori perspective. The former is a distinctly medical/psychological model, the latter, a cultural/spiritual one. Neither appears to incorporate earlier or contemporary history, politics, or the consequences of racism (other than to talk about ‘social disadvantage’). The Maori perspective seeks liberation from conventional suicidology, and that, I believe, is positive. However, a joining of forces seems the obvious path to follow. Although Aborigines have yet to insist on a ‘separate’ perspective, such a differentiation between Aboriginal and non-Aboriginal suicide is crucial.

Cultural ‘orthodoxy’ and a steeping of youth in Maoritanga appears not to be prophylaxis enough. Acculturation, re-acculturation, or what Deloria calls revivalism, has many positive consequences, and it may well lower the level of suicidical behaviour. The Yarrabah Museum (near Cairns) certainly appears to have attracted the interest of youth. Winanga Li, the first volume in the series ‘The Moree Mob’ is an attempt to provide genealogies and photographs of the areas known formerly as ‘Top Camp’, ‘Middle Camp’ and ‘Bottom Camp’ when Aborigines were moved from Terry Hie Hieto Moree in the early 1920s. Aborigines in that region have only just begun to find themselves, geographically for a start.

(b) Illiteracy, deafness, grief and cannabis
More Maori suicides leave notes than do Aborigines. At a guess, the general level of Maori literacy is somewhat higher. No one has yet suggested illiteracy as a relevant factor for suicide, but there is at least a high order proposition that illiteracy, and illiteracy plus deafness, is a key factor in youth disadvantage. In 1988, the Mason inquiry into maximum security and suicide found that 80 per cent of Maori in prison had a hearing problem, and that 20 per cent had a severe hearing problem. Chronicotitis media, ‘glue ear’, burst eardrums and consequent deafness have been well documented across Aboriginal Australia. These social/physical factors have as much validity as the vaguely phrased (mental) ‘stress’ factors in both countries.

‘Five generations of grieving’ is the judgement of Dr Erahana Ryan. She believes the youth absorb feelings of racial alienation, emptiness, loss of culture, loss of self and the loss of esteem. ‘Stress of loss of who they are’ is the key to her therapeutic approach. To this end, she trains Maori health workers, preferably older women who have been ‘through the mill’. In the Aboriginal context, there are such Aboriginal women, and several are doing similar work. What they don’t have is the benefit of training and supervision, of being mentored, by someone like Dr Ryan.

There is strong anecdotal evidence that many Maori youth suicides have had a cannabis ‘problem’. A Maori couple, who lost their son to suicide and who now counsel bereaved families, told me that they know of several youth suicides who were heavily ‘into’ cannabis: ‘they can’t afford the hard stuff’. They observe that ‘it affects their emotions and they don’t hear. They agree with all you say but show no emotional reactions.’ This couple suggests a model for Australia: a counselling service by Aborigines for Aborigines.

Mate Frankovich, New Zealand’s senior full-time coroner, does not dispute any of the discourse about Maori suicide, but he does point to cases which appear to have nothing to do with the factors discussed thus far, and which appear quite banal. One Maori youth, who used carbon monoxide, left a long note: his message was to the effect, ‘to hell with life, if I can’t have pot and I can’t find a place to skateboard, I may as well die’. Another 16-year-old male, whose girlfriend looked after his 2-month-oldbaby, wanted sex; she said no, and he hanged himself. These may well have been the real reasons for the suicides; they may also have been the ostensible ones. We must beware the desire, or the need, to attribute deeper meanings to all youth suicides.

(c) ‘Secondary victimisation’
Keri Lawson Te Aho, a consultant psychologist, talks about the legacies of racism and alienation, adding that there is ‘a secondary victimisation of Maori youth’ in institutions, especially in the mental health system. This is consistent with the views of the Maori Suicide Review Group, who infer that Maori prison inmates are in a ‘special’ category in the eyes of corrective service personnel, long-term, violent, prone to suicide, and so on. Professor Mason Durie considers that the ‘mental health services for Maoris are hopeless’.

There is no need to argue the obvious case about such secondary victimisation of Aborigines in Australian institutions. It begins in schools, continues through hospitals, endures in prisons, and sometimes extends even to cemeteries. We need to ask why so few Aboriginal inmates in NSW prisons progress to the last two stages of minimum security classification.

(d) Purpose in life
We do not have statistics for Maori suicide in Hamilton, but there is a strong suggestion that the King/Queen Movement community there has a greater sense of cohesion and purpose, and a lower rate of violent behaviour. However, the Maori parents mentioned above, lost their son when he was boarding at a Hamilton school. They say that there were at least four suicides amongst that same school cohort.

Gordon Matenga, New Zealand’s only Maori coroner, is a Mormon. He is certain that the extensive participation of Maori in the Queen Movement and the adherence of so many to the Mormon Church account for the low rates of suicide. In Mormonism, the sanctity of human life is paramount. Many New Zealanders from Western Samoa, the Cook Islands and Tokelau are staunch adherents of the Catholic, Methodist and Pacific Island churches. Nevertheless, Samoans have a high rate of suicide: ‘it is part of their history’, says the Pacific Island co-ordinator of the New Zealand Research Council. She says ‘there is contempt for people who suicide, and they are buried upside down’; ‘It is worse to lose your face than lose your life’.

By contrast, Dr Rees Tapsell, a Maori psychiatrist, believes that ‘a large number of Maori do not have a social glue’ which would provide purpose or cohesion. ‘They live on the myth of alienation’: by which he means that mere membership of a group on the basis of a common feeling, or reality, of racial alienation is insufficient as a life-sustaining force in the way that nationalism, Mormonism, or Black Islam can be a ‘glue’.

Sport, as in Australia, is considered by all we interviewed as ‘one high spot’. In1997, the Aranui Sports Academy was established as a way of stopping the drift of Maori and Polynesian boys out of school. Aranui High School switched from rugby league, at which they were champions, to rugby union in order to accommodate these young men. In 1997, they beat St Bedes College in the final, to win the schoolboys’ championship, As the North and South magazine commented, such a predominantly Maori and Polynesian team victory would hardly arouse attention, but this was ‘Christchurch, the most WASPish of all New Zealand cities and until this season, the final bastion of pre-Polynesian rugby’.

The organisers realised ‘that one positive thing in many of these young people’s lives was sport’. All 33 members of the Academy were properly enrolled in the school. The Academy’s ‘take (purpose) is about changing the kids’ attitudes in order to make them more employable, not about winning on the sports field’. Students had to complete four years of senior schooling or have been away from school for a year. In addition to sports activities, classroom work is compulsory. The boys set the agenda, ‘no one else’. Needless to say, there was a howl of protest in Christchurch at the Academy’s victory, with allegations of Aranui’s bringing in professional rugby league adults to demolish amateur children in union. The Aranui project could be emulated in any number of New South Wales towns, where the residential divide between East side and West side (as in Christchurch) is as great.

(e) Coroners
Of the 74 coroners in New Zealand, only three are not qualified in law. The independence of coroners from the police is important. Under-reporting of suicide and identification of the deceased as Maori are still serious problems, but much less so, in my view, than in Australia. The police form, ‘P47 Report for Coroner’, makes provision for ‘Race’, but this does not resolve the biological versus self-identification conundrum. The officer does not always ‘get it right’ and the coroner is not obliged to distinguish who is or is not Maori. Coronial practice benefits enormously from virtually every larger police station’s having an officer designated as inquests officer. Most learn on the job. As few appear to reach the rank of sergeant, there is certainly room, in New Zealand, as in Australia, for a professional, career promotion category of inquests officer, or, as in Dallas, a death investigator, in New Zealand and Australia. Their approach and dedication are impressive, as are their symbiotic relationship with their coroners and their formal ‘distance’ from other police.

(f) Prevention strategies
There are a variety of prevention strategies in use in the Western world. In addition, there are two projects in New Zealand which were not devised for suicide but which hold promise as effective counters to a preference for death rather than life. ‘Going-for-Goal: a Sport-Based Life Skills Program for Adolescents’ uses a sporting metaphor to elicit young people’s frustrated goals and to assist them to overcome the obstacles to their attainment. Based on an American program, essentially for Afro-American youngsters, it has been trial led by the University of Otago in Dunedin. The other is the ‘Smoke free’ project run by the Health Sponsorship Council in Wellington. This is very much a peer group pressure exercise in breaking the smoking habit among teenagers. Its methodology could as readily be tried as a way of bringing youth to the point where it is ‘cool’ to stay alive! It has the singular merit of being run for Maori youth, by Maori youth, who have ‘been there’.

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