Wednesday, 28 March 2012

Comparative Suicide Studies of The Pacific Islands to Aboriginal Suicide

Geoffrey White has a valuable metaphor in relation to suicide studies: ‘The international literature is full of studies which have compared suicide rates of different nations or social groups, as if this was a more or less straightforward way of taking a society’s pulse.’ In many ways, the 1984 conference on suicide in the Pacific,
held at the East-West Center in Honolulu, provided a salutary lesson about the reasons why we should broaden suicide studies by subjecting them to analysis by academics from different disciplines, with different approaches.

This is not the place to summarise all the commentaries and reports on Pacific suicide. I touch only on those aspects which could be useful in Australia and New Zealand.

The ‘Pacific’ in this set of studies includes the Northern Mariana Islands, the Marshalls, the Federated States of Micronesia, Nauru, Kiribati, Western and American Samoa, Fiji, Tonga, Vanuatu, the Solomons, New Caledonia, Tuvalu, Tokelau, and Papua New Guinea. While there are significant variations in suicide causes and methods, it is clear that many Pacific suicides have little to do with the ‘pulse’ of Western, industrialised societies. For example, among the Truk and the Samoans, young male suicide is closely associated with parent-child relationships and specific cultural routines for communicating about conflict. In other words, ‘suicide is a social action which usually involves not just a single individual, but an entire family or community’. (This is what Hillman says is true of all suicide, but something which most of us, in the West, refuse to acknowledge.)

In each of the Pacific regions, there are ‘reasonably coherent explanations’ of suicide based in traditional patterns of culture. People understand the manner of dealing with emotion, conflict and its resolution. ‘Cultural concepts shape suicide as a meaningful social action.’ White concludes his overview with the strong assertion ‘that a concern with cultural meaning is not separate from medical or public health concerns with suicide prevention.’ No one who is ignorant of cultural interpretations of suicide can deal effectively with the ‘complexities of either suicide counselling or prevention’.

Western Samoa is of particular interest because many have migrated to New Zealand, where suicide of a similar kind to that of the homeland is evident. This takes the form of young males and females swallowing ‘paraquat’, a weed-killer which causes a painful, lingering, untreatable death. In the 1980s, the Western Samoan male rate for the 25 to 34 group reached 167 per 100,000, and for 20 to 24-year-olds it was 75.7. There has been a dramatically increasing use of paraquat (which was introduced into the region only in 1972). The research shows a marked increase in parasuicide, ‘more often female than male’, amongst those who have ‘no history of mental illness’. The author, Bowles, describes these parasuicides as occasioned by flight from ‘an intense and intolerable situation, with death not always the well-formulated goal’. ‘There is an element of ambivalence, risk-taking, a surrender to fatalism and chance in many cases’. They involve a communication directed at significant others, ‘with an operant quality which puts pressure on this complementary person to respond in some way’. This, I believe, is an adequate description of what is occurring among young Aboriginal females. It is also a description which doesn’t require medical diagnosis or prescription. However, Western Samoans, like so many Pacific people, and unlike Aboriginal people, have a long cultural tradition of suicide. Words for the act were first recorded in the 1860s. Hezel notes ‘suicide, embedded as it is in Trukese culture, will no doubt remain as endemic to Truk as cholera’.

A ‘national awareness campaign’ —‘to reduce the incidence of suicide in Samoa’—began in the 1980s. The program had significant philosophical premises and goals.

Micronesia has had an ‘epidemic’ of youth suicide since 1960. The rate was 8 per100,000 in 1960–63, increasing to 48 in 1980–83, and 110.6 by 1987 for the 20 to 24-year-old cohort. The suicides are ‘patterned culturally, in terms of the characteristics of the actors, the method, and the situations’. The predominant relationship involved in suicide is one of tension between adolescent and parent. It is the youth’s conflict about parental authority, support and recognition, that leads to self-harm. The method most commonly used is hanging, in some 85 per cent of cases.

The suicide rates vary in Papua New Guinea’s Highlands—from 34 to 72 per100,000 for both sexes. Pataki-Schweitzer has given ten ‘ranked’ causes for this latter group: ‘bereavement, no reason, witches, quarrelled, scolded, adultery, accused as witch, frustration, misfortune, and fright’. He believes the causality is much more complex than the list suggests. Of note is the consistency of scolding, as in a parent admonishing a child, as a major factor in many Pacific suicides.

The research consensus is that ‘suicide is deeply embedded in the unique cultural context of the local situation, and that suicide is often attributed with more than a single meaning within a locality’. Suicide should not be studied apart from the cultural context which provides its patterns and meanings in each of these societies. Hezel suggests three divisions of ‘labour’: attempting to elicit the cultural patterning of suicide; inquiring into psycho-social aspects of suicide; and suicide prevention. Under cultural patterning, he suggests three questions:

1. Historical—What is the historical, ethno-historical or mythological occurrence of suicide in the culture? Is there a lexical term for suicide? What were the typical methods and traditional interpretations of suicide?
2. Contemporary—Is there a cultural script for suicide today? What are the commonly recognized situations, methods, actors, emotions, and messages communicated by the suicides in a culture?
3. Cultural evaluation—Do members of the society evaluate suicide positively or negatively? Do people make attributions or accusations of responsibility or blame for other people’s suicide?
Several of these questions have validity in my Aboriginal context. Hitherto I have criticised the monocultural ‘mental health’ approach and suggested the co-relevance of historical, political and social factors. On reflection, some of these cultural evaluations must be included, even in groups which appear to have none of the strong traditional relationships which sustain Truk or Palau or Samoan societies.

Hezel’s psycho-social questions are also pertinent:
1. Social cohesiveness—Do villages or areas of high suicide rates show evidence of alack or a disruption of cohesiveness, due to cultural change, political fragmentation or conflict, etc?
2. Social bonds—What is the strength of affiliation between victims and their family, kin group or society? Are victims generally marginal individuals?
3. Psychological profile—What is the psychological profile of the victim? Is there any mental abnormality? Can certain high-risk personality types be identified? Are suicide victims typically described, in local cultural terms, as being ‘strong’ or ‘weak’, etc?
4. Impulsivity—To what extent is the suicide an impulsive act? Does spatial or temporal clustering, or other signals, also suggest a high degree of impulsivity in the suicide acts?
5. Emotions—What are the emotions generally associated with suicide? Especially, what is the nature of ‘anger’ and ‘shame’ and how do these two emotions interplay in cultural interpretations of suicide?

These questions form a useful agenda for those seeking prevention strategies outside those which I later describe as the ‘conventional’ mould. Several key ‘political’ questions need to be added, such as the role and effect of racism, and the exclusion of native peoples from many values, systems, rights, benefits, goods and services available to a mainstream societies.

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