Saturday, 24 March 2012

The Movement of Aborigine Youths towards Suicide

‘The incompletes are bad and scary, the kids who are not trying to live’. That remarkable analysis is from an Aboriginal worker in the Homeless Youth Unit in Taree. She is talking about boys who threaten suicide every time they are taken to cells, and girls who ‘slash up’. Importantly, she is not talking about a few individuals,
but about a plurality, a collective and group phenomenon. The significance of this must be stressed: the suicidal behaviours in these communities have become patterned, ritualised and even institutionalised. David Lester, among many other suicide researchers, has come to recognise that attempted suicide and completed suicide fall ‘on a continuum of varying suicidal intent’ and are not separate, less serious actions.11 The threat, and the actuality, of self-harm in the cells is universal, and serious. ‘I’ll neck myself’, or ‘I’ll neck myself and you’ll be in trouble’ is common across the State. There is an urgent need to examine the female propensity for ‘slashing up’ when in custody or in police trouble. Throughout this study, youth was conveyed as being male, with very much secondary attention to, or concern about, girls.

Female suicide is somewhat neglected. The numbers and the rates are much lower, but there is evidence that attempted suicide is much more frequent in females than males among Aborigines, Maori and most North American Indian groups. The difference is probably due to method of choice rather than difference in intent. Aboriginal men use rope, cord or gunshot, and inevitably succeed. Women, and girls in particular, swallow whatever tablets are to hand. Often—and here illiteracy may be some kind of mixed blessing—they cannot read the labels on their mothers’ medication packages, and so take non-fatal substances such as vitamin tablets or hormone prescriptions. Paracetamol in sufficient quantities does kill, but in many instances these parasuicides are treated in casualty units.

‘Slashing up’ is common. Several informants contended that it is most common amongst those who have been sexually abused, and that the slashing begins at an early age. A suggestion worth serious consideration is that slashing and other similar forms of mutilation are not suicide attempts, but rather the reverse: a letting of blood in order to feel the warmth and the vitality of life, an affirmation that one is alive.

The responses to attempted suicide differ widely. Some police view it as a ‘neo-suicidal’ action based on despair and hopelessness. Others see it, not as an egotistical cry for attention but, if they were to use Mark Williams’ words, as ‘a cry of pain first, and only then a cry for help’.12 Some police describe, in their own words, what Shneidman calls a certain kind of psychological pain, or psychache.13 Some police insist that it is a threat that only occurs under drug or alcohol influence and is either bluff or bravado or both. One ACLO contends that the threat is a macho thing, producing hero-worship for he who dares. An experienced ACLO from Queanbeyan tells me that ‘young people of today have got no fear of dying. That’s the least of their worries; rather it’s a fear of living’. Another ACLO says it is a matter of ‘talking silly’. Others again see the threats as a political statement, a weapon, an evoking of the simplest reprisal weapon available to ‘disempowered’ people, namely, an action which could lead to Royal Commission-type investigations. Another Aboriginal perspective is that it takes alcohol to disinhibit the normally present but suppressed and masked suicidal feelings.

There is an abundance of suicidal behaviour in communities, yet most service personnel and almost all Aboriginal family members insist that there are no warnings, no signs, and few actions which warrant serious attention. The Aboriginal health education officer in Narooma insists, ‘when young people threaten, they try it’. He also describes what he calls ‘indirect suicide’, people living on the edge, who engage police in car chases, drink and then climb cliffs, the ‘kids who have no care about tomorrow’. Many others have endorsed this perception of ‘kids who don’t necessarily want to be dead but don’t want to be in life either’. In both Kempsey and Taree, there is evidence of young people, especially girls, running in front of trucks at night. One can speculate that knife-edge and dangerous behaviour is born out of a realisation that life is short indeed, especially for males. These youngsters do not read articles about their poor life expectation, but they do attend, from a very early age, an astonishing number of funerals of young relatives. In most towns in this study, one funeral a week would be normal, the deceased often a young victim of disease, accident or violence.

A few cases will illustrate my contention about the movement towards suicide.
• A police officer in Narooma related the following story about a 13-year-old girl ‘who is out to self-destruct’. She had not only been sniffing petrol, but drinking it. Her father reported her to the police as a runaway. The police officer found her, but couldn’t find anyone to consult professionally in Narooma. The step mother took her back home but found her too aggressive, and so she was taken to Sydney. Two days before this interview [with me], the girl jumped from the third floor of
her Sydney accommodation and broke both legs. The officer believes she has even injected herself with petrol.
• At Taree, many young people are seen as ‘risk-runners’ and one case of ‘sub-intentional’ suicide is worth reporting as a speculation. A man of 24 was in hospital for chronic golden staphylococcus infection, which was being treated with antibiotics, intravenously administered. Warned repeatedly to complete the treatment, one Saturday he discharged himself from hospital to play competition football. He died on the field.
• A professionally qualified Aboriginal mental health worker told me the story of a25-year-old male, a chronic alcoholic, who left school early and spent his whole life in town Z. He has low literacy skills. He threatens that he will get a gun, shoot all the nurses and then hang himself. He tells police he will shoot them all and hang himself. My informant is convinced he will do all or some of the above. He publicly displays his intentions by, for example, walking down the main street of Z with a coil of rope around his neck. He has attempted suicide in the cells and been cut down. He provokes police. When he gets no response, he beats up onwomen. My informant says there is no help for this young man in Z.
• An Aboriginal health education officer in Nowra relates the life of a woman, removed from her parents at age 2. She told my informant that, at the age of 25, she wanted to die because she was ‘old’. She was first raped when she was seven months pregnant with her first child. When the child was little, she was raped again. She has three children, all in care. She began painting as personal therapy, catharsis and self-salvation.
• The Aboriginal mental health counsellor at Nowra is treating a man of 50, a stolen child from aged 2, placed in Bomaderry until the age of 7. At Mt Penang juvenile institution, from the age of 7 to 18, he was repeatedly raped. Hired out to do farm work, he was repeatedly raped. Two years out of institutional life, he found his natural father, who raped him while drunk. He has attempted every conceivable form of mutilation and damage to himself.
• At Menindee in the far West, an 18-year-old hanged himself in the local park. He had mugged a kindly old lady and believed she had died. She had not. Since his death, three Aboriginal men—one aged 15, who has attempted suicide, one aged25, heavily sedated on Prozac and other anti-depressants (who persistently burns himself with cigarettes), and a 28-year-old who has tried hanging six times—meet at the cemetery to visit the grave. With a carton of beer, they commune with their dead friend: each drinks one beer, and they pour one into the grave mound for the deceased, until a sense of communion is achieved. I talked individually and at length with each man, and believe, as do their parents, that they will probably suicide before long.
•At Wilcannia in 1998, a girl of 8 placed a rope around her neck and tried to jump from a branch. Her 12-year-old female companion rescued her. The latter was interviewed by a female ACLO, a respected town elder, who asked her whether the 8-year-old was involved in an accident or a ‘game gone wrong’. The answer was ‘no’, that this was a serious attempt. The girl is small and immature for her age. She is related to a 12-year-old who hanged himself in the town. In New South Wales in 1999, the senior children’s magistrate ruled that a (non-Aboriginal)10-year-old boy, who deliberately pushed a 6-year-old into a dam, could not be tried for manslaughter because he was doli incapax, that is, because he was between 10 and 14, he lacked the mental capacity to commit a crime. This case raises the question of how an 8-year-old can, and does, form the intention to take her own life. My conclusion is that death is more readily familiar to Aboriginal children in their socialisation processes than it is to non-Aboriginal children. But I am not certain of the answer to a question about their knowledge of self-death?

Documenting and quantifying the attempted suicides is an impossible task. An important New Zealand study interviewed 129 attempted suicides in ‘semi-structured interviews ... to retrospectively construct a life history’. Interviews used a variety of standard psychological tests, including: the Parental Bonding Instrument, a 25–itemquestionnaire containing a 12–item subscale; and the Structured Clinical Interview for DSM-III-R to diagnose selected mental disorders. The study found that 90.1 per cent of those who made a serious attempt had a mental disorder. In Lismore, a public health nurse at the Public Health Unit has produced a protocol for use by admitting doctors or nurses at the local hospital.15 Each protocol questionnaire has multiple choice question sunder the headings: Thoughts, Plans, Psychiatric Disorder, Mood, Means, Medical Problem, Suicidal History, and Support. Apart from the inappropriate language, and the inappropriateness of the actual questions for Aborigines, the realities are: first, that Aboriginal parasuicides tend to hide, treat themselves, or seek out ambulance officers for non-hospital attention; second, they are most unlikely to respond to the phrasings of these protocol questionnaires; third, it is doubtful whether anything like 90 per cent(as in New Zealand), or even 50 per cent, were suffering from a mental disorder.

Many Aborigines have a strong antipathy to hospitals. They see Health, Mental Health, the hospital, and related agencies as the equivalent of ‘the welfare’, and it was ‘the welfare’ who used to dislocate families and remove children.

Professor Mason Durie, a Maori psychiatrist and educator, has given us an explanation that may well capture the attitude of Aboriginal youth to hospitals, ‘welfare’ agencies and questions about attempted suicide. He says the reason behind Maori objection to Pakeha intervention is that ‘it’s not just the whiteness, it’s the style’. ‘How do you feel?’, he argues, is a classic, white middle-class question. For ‘kids on the edge’, he says, ‘this question drives them either to explosion or no answer.’ However, I suspect that in the Aboriginal case, whiteness is as strong an emotion as style. Noteworthy is Drurie’s conviction that ‘mental ill-health is not the biggest cause of suicide; that the mental health strategies are too narrow and that mental health services for Maori are often hopeless’.

Two Aboriginal health workers in Coffs Harbour talk of suicide by negation of help, that is, people rejecting what the hospital has to offer for reasons of distrust mentioned above, or for spiritual reasons. The grandfather of one of these informants was the last tribal man to be fully initiated in the Coffs Harbour area. He developed gangrene in one foot. He refused to go to hospital, stating that amputation would destroy his spiritual wholeness. He died, untreated. Finally, there was hardly an interview conducted in which the Aboriginal interviewee did not mention either a personal attempt or attempts by one or more immediate family members. They consider themselves, in their words, ‘survivors’.

The extent of the idea of suicide among Aborigines is best demonstrated by the responses in a large number of in-depth interviews conducted by the professional staff at Bennelong’s Haven—site of the original Kinchela Boys Home—a major drug and alcohol rehabilitation unit. Interviews with 129 women residents from 1 July 1992 to15 July 1997 revealed that 53, or 41 per cent, had attempted suicide. Of 435 males interviewed between those dates, 223, or 51 per cent, had attempted suicide, making a total of 276 parasuicides in a sample of 564, that is, 49 per cent of the residents in the program. It would be unwise to relegate or diminish this finding on the ground that it was confined to addicts in one program. There are, literally, legions of people in this State who offer the same information about their experiences with attempted suicide. The Ministry of Maori Development gave us some preliminary, and unpublished, figures for attempted suicides.16 Two advisers on Maori policy talked at length about under-reporting of Maori suicide and of attempted suicide. In the latter category, and based solely on hospital sources, the Maori female numbers were exactly five times the Pakeha figures, and the Maori male numbers three times the non-Maori. This is consistent with the findings of the Maori Suicide Review Group, which recorded that in 1992, Maori had the highest hospitalisation rates for self-injury at 85.7 per 100,000persons, followed by a Pakeha rate of 78.

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