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Wednesday, 13 January 2010

What makes a nation suicidal ?

A list of the top nations in the world for suicide rates doesn't make for pleasant bedtime reading. However, as a source of ideas for explaining why people kill themselves (and thus what can be done to prevent it), it is an interesting source of data.

So....what do you think are the factors that are most likely to lead a country to be vulnerable to high suicide rates? Poor social welfare systems ? A poor sense of community or togetherness, maybe its poor mental health services ?

In the industrialised world who do you think scores highest ? The USA ? Many of you may think this is a trick question and answer "the Scandanavian countries". Maybe you think its the UK ?
Well...you would all be wrong and infact, as far as the UK is concerned, it has the lowest suicide rate of all the countries in Western Europe...

The latest edition of The Economist (10 Ocober 2009) has just published OECD data on this question, that begs more questions than it answers. Infact the country with the highest rate is Japan ( a country defined by its sense of community and public services, though arguably with a social tradition of suicide). However, most striking (in position number 3) is France - which has a suicide rate that is TWICE that of the UK and 40% higher than Germany.

The Economist offers explanations which I personally do not find credible - such as a restrictive employment policy that creates meaningless jobs. However, it is a fascinating question as to why a country that prides iteself on quality of life and the value of community should have so may people who want to kill themselves ?

I would like to explore this further at my next block of workshops on Suicide and Self Harm ( http://www.skillsdevelopment.co.uk/seminars.php?courseid=6 ) . Id be fascinated by your tho0ughts and theories on this (whether at the workshop or here on this blog). Let me know what you think.

Take care

Paul

Paul Grantham
Consultant Clinical Psychologist

17 comments:

  1. Dear Paul

    For the past eleven years I have worked as a bereavement counsellor. 2008 I assessed and counselled 16 clients bereaved by suicide (not all recent) The ages of those who took their life ranged from young teenagers to a pensioner.

    As each situation was so different I have found it difficult to find any sort of pattern apart from family break down, debt, drug or alcohol abuse, and mental illness.

    It would be useful if we could compare French and UK suicides, to look at differences.

    My knowledge of how the French lead there lives is somewhat limited, I with many others enjoy the country and their way of life.

    Their education system differs from ours, they are very proud and protective of all things French, a very strong agricultural community.

    If our lives are made so comfortable and employment policy is as such that we do not have to worry about losing our jobs. It takes the challenge and drive away from us and could become complacent which I feel is important as human beings we continue to learn develop our skills.

    I have also worked as a counsellor for Age Concern and at a training seminar it was said that if we changed our life style i.e. a more healthy life style it was possible to increase life expectancy slightly, by increasing our knowledge and taking up new challenges, life expectancy increased much more.

    Being over 65 still working part time and attending courses I find it hard to see some of my social circle watching T.V. and vegetating and losing any purpose life. Do my thoughts support the findings of the Economist?

    R.P.

    For me 2008 was unusual in the number of suicides. 2009 I have counselled 5 bereaved by murder or presumed murder (not all recent).

    ReplyDelete
  2. Good morning Paul

    I have two theories on the questions raised:

    When my mother-in-law took her own life by taking an intentional overdose of
    paracetamol, her death was recorded as 'liver failure'. I therefore wonder
    if many suicides in the UK are not recorded as such and this fact skews the
    statistics. It would be interesting to know whether France, for example,
    records suicide as such or as here. Does the UK still attach stigma to
    suicide and therefore to spare the relatives, records the death as the
    physical cause of the death. Eg is hanging recorded as a 'lack of oxygen to
    the brain'?

    I have not visited Japan but my sense is that its people are extremely
    'controlled' and regimented by the state and have to conform in ways we in
    the west, do not. Also, they have very little personal space - live in very
    cramped conditions with no separate bedrooms and fold away beds in their
    limited living rooms. If you do not 'fit' and want to break out perhaps it
    is extremely difficult and suicide is seen as the only solution by some.

    Best wishes
    From a snow-bound Buckinghamshire

    J.

    ReplyDelete
  3. Hi - Oliver James provides a view on this topic in his book The Selfish Capitalist, which may add ideas to your debate.


    Kind regards
    G.P.

    ReplyDelete
  4. Hi Paul,

    Thank you for your interesting email. I would like to suggest that the high suicide rate in Japan could be partly just because of the strong sense of community and service. There is no room for individualism, and it is necessary to stifle any thoughts which may be different from those accepted by society. Certainly any behaviur which would be seen as different is not allowed. This must be a strain I feel on anyone with any originality. Also because of the strong emphasis on everyone contributing to the community, it must be very stressful for those who for some reason or other are unable to fully contribute. I wonder what you think about this.

    I have no theory to offer about the high suicide rate in France unless it could be linked with the strong culture of wine drinking. Alcohol is,after all a depressant.

    Best wishes

    L.C.

    ReplyDelete
  5. Dear Paul,

    Just a few thoughts on this - admittedly, some are based on stereotype, but then, stereotypes are often based on genuine traits, and should no more be dismissed than they should be discriminated upon!

    Japan - Quite predictable (though I would have guessed USA, due to the gun ownership). Status, honour, and therefore shame are important concepts in Japanese culture, and shame is probably the strongest wholly negative emotion one can feel, which does very little other than lower self-esteem, and motivate self-destructive behaviour (although the avoidance of shame may motivate positive actions - which I suppose is what made it advantageous to be capable of shame, in an evolutionary sense).

    France - Increased suicide rate due to relatively high proportion of farmers and similar professions? This may be tenuous. What is the role of the retired person in French society? As so many suicides are in the elderly, is this a factor. Also, I think France has a relatively high life expectancy (as has Japan), so maybe this leads to more suicide.

    UK - low rate, possibly for the opposite reasons to France, but more important is the great British trait of cynicism. Cynicism is not only useful in testing out things, and being sceptical, but it is also a useful tool in putting things into perspective, and not feeling that one should adhere to expectations. For example, the success in defeating Oswald Moseley's British Nazi movement is often attributed to the great british cynic/sceptic, who saw how silly lots of men marching in daft uniforms were, going around blaming innocent groups of people for being different. There is also a paralell with religiosity- Britain is a comparitively secular country, which may suggest that people are less likely to think in terms of absolutes - including absolute success, failure, or shame - thereby reducing suicidality? I wonder whether the suicide rate for Netherlands is similarly low?

    ITALY - I don't think you mentioned them, but I remember doing an essay about the effects of religiosity, and looked at suicide rates. I remember that the rate of suicide in older Italians was quite high, despite the country being quite strongly catholic (a faith which prohibits suicide). Is this more evidence that scepticism and secularism protect us from suicide to some degree?

    ReplyDelete
  6. This question intruiged me so I asked some friends, who are French nationals, what their thoughts were......

    "French people are among the most medicated in Europe with a high consumption of anti-depressants and tranquillisers. Unemployment is high (pushing 10% over 20% for under 25's). The 'nanny state' is Sarkosi's primary target so lots of people are growing disillusioned due the ending of traditional perks and benefits. They see the traditional, protected, French way of life as under threat."

    Purely anecdotal of course but I suspect a big grain of truth in there. The impact o fchange is great on all of us.

    ReplyDelete
  7. I would presume there may not be the health and social servces in place whereas in this country we offer support to people with drug & alcohol problems (which are a factors which increase the risk of suicide). And also with the social benefits available it may reduce homlessness and strinken poverty. We also have helplines like Samaritans which may not be available in Japan & which may decrease suicide statistice, obviously it would be difficult to research this because who can say if somebody would have actually gone through with killing themselves had they not called a helpline or accessed free help elsewhere...

    ReplyDelete
  8. Not at all surprised, having travelled in that are of the world, that
    Japan has the highest. Children are not encouraged to show emotions, my
    daughter worked in Taiwan where she taught children English, 2 of the
    more demonstrative children who had wonderful imaginations, which she
    was keen to foster (as we would want to do here). These children were
    put on tranquilisers at the age of 7 years! If emotional literacy is not
    developed at a young age it becomes more difficult to deal with things
    later on in life.

    As for France, I found this surprising and going to read the article
    over the weekend and give you feed back.

    Thanks
    L.H.

    ReplyDelete
  9. hi paul,
    that's was some very interesting figures on Frances high suicide rate, as
    part of my work with a international counselling company , we sometimes have
    to try and find counselling support for employees in France, and there are
    very few and far between, they seem to have gone down the psychiatrist
    route, and do not recognise the benefits of counselling, where we have a
    strong, robust presence in this country. Germany has a better access system
    to psychologists but again counselling , as we have in the uk is not so
    available. i am probably biased but i do think working in the counselling
    industry that here in the UK we have moved away from the fear and stigma
    that counselling did have 10 - 20 years ago to be seen that talking about
    your situation, to people that have time to listen, reduces the isolation
    that often precedes suicidal ideation.
    i also do some work in cape town , south africa and was very surprised by
    their high suicide rates among young people, again a factor may be the lack
    of access to therapy.
    best wishes
    p.c.

    ReplyDelete
  10. I guess Japan is understandable- long history of pride in Hare kare.
    France is surprising.Could it be that illegal immigrants waiting to
    cross (unsuccessfully) from France to England have been somehow included
    in the French statistics- i.e thay cant find anywhere/get anywhere
    comfortable to live, they become frustrated and then comes the suicide?

    ReplyDelete
  11. A thought, but not entirely serious, that maybe the poor opinion of other countries towards certain nations e might be a contributory factor. Sneering at the French ('cheese-eating surrender monkeys' only the latest addition) is a popular pastime in many westernised countries, and Japan also not held in greatest regard. On this basis, one might expect Ireland and Poland to be towards the top of the table, but I have a feeling that Finland is quite high, so that doesn't fit the bill
    An interesting topic though
    G.T.

    ReplyDelete
  12. Thank you for all your replies. This has been one of the most stimulating delegate debates we have had for a number of months and is a good start to 2010. The weather may have been lousy but you have all made some very interesting points. Some of these I have wanted to follow up and my findings are included below.

    My research has focused on the French statistics which I found the most interesting.

    P.C. said that in his role of accessing psychotherapy services for a number of clients in France, he had found such services were thin on the ground and rarer than in the UK. He suggested that this might explain the higher suicide rates. N.D. who is French but has lived in the UK for 13 years suggested something similar. I decided to test this out with a rough and ready measure - the no. of Google hits for "Psychotherapy" on UK sites Vs. the no.of Google hits for "Psychotherapie" and "Psychotherapy"combined on French websites. There were TEN TIMES the no.of hits for UK sites. In other words, "psychotherapy" appears to have a much larger presence in the UK compared with France. Hence the point appears to have some validity.

    N.D. also suggested that there may be a comparable increase in the use of antidepressant medication. This of course would be reflected in the comparative absence of psychotherapy services. It would also however have implications for increased risk of suicide. We have known for quite a while that "access to means" increases suicidal risk and that O.D. on prescribed medication is a commonly used (though by no means the most commonly used) method of suicide. The figures on this are indeed fascinating. http://www.euphix.org/object_document/o5840n27170.html illustrates that antidepressant dosage per head of population in France is nearly TWICE that of the UK and outstrips the Scandinavian countries who hold 2nd-5th places for antidepressant consumption.

    L.C. wondered whether wine drinking in France made any difference ! Infact, there is something in this suggestion. We know that alcohol intoxication is very high in completed suicides wherever in the world and that alcohol consumption significantly increases risk in acting as an emotional (and respiratory depressant) and potentiating a number of drugs that people might take on overdose. Do the French drink more ? Infact, alcohol consumption is 30% higher in France than the UK, a factor which I suspect plays an important role in the overall pattern.

    I am sure there must be other factors that play a role in this situation. However, it does suggest that social factors may not be enough to explain mental health outcomes. Despite being recognised as having the best healthcare system in the world and having an excellent social care programme, it seems that the way a country and its people conceptualises psychological distress, alcohol and the opportunities there are for killing yourself still play a major role in determining whether people live or die.

    ReplyDelete
  13. Hi Paul,

    I am French and has lived in the UK since 1997. I have a few ideas as to what could begin to explaining this rate, but obviously it is based solely on my personal experience. I have not done any research into it, I have just seen my own brother and other family members struggle with depression, some of them for years.

    • In France, if you suffer with depression, you can get anti-depressants from your GP without difficulties, that’s it.
    • If you are educated enough and open minded regarding mental health issues, then you can self-refer to a psychiatrist, a psychotherapist, etc.
    • But there is very little support if you are not able to make that step by yourself, i.e. due to anxiety. As far as I know, there isn’t any community mental health teams, no CPNs, no mental health OTs that can visit you in your own home.
    • There are excellent specialised centres, with experienced professionals. i.e. in substance misuse, but only in big cities. If you live in the country, or if you are too anxious to push that door, then you are on your own.
    • My brother is lucky to have a good social network, but he is still struggling. I have often wondered how more isolated, less educated people are able to cope.
    • There are a lot less charitable organisations in France compare to the UK.
    • Also, volunteering is not as developed as here. To me, there is more community spirit in the UK than in France.
    • To finish, I have the feeling that in France, people with mental health problems carry a stigma heavier than here in the UK, where so much effort has been put into ‘normalising’ mental health.

    There are obviously many other factors to this high suicidal rate, such as youth unemployment, the ‘Nicolas Sarkozy’ effect, etc.

    I hope this brings food for thoughts. Thank you for such an interesting discussion.


    N.D.

    ReplyDelete
  14. It is a very interesting topic indeed which we have been looking at in NI as there are a high number of suicides in the Belfast area. Apparently over the summer months of 2009 there were over 30. Hanging seems to be the popular method. Paramilitaries still have an influence and this maybe a factor plus the increased drug problem since the ending of the troubles in NI. However, that does not explain the number of school children who have taken their own life in other areas of NI so bullying maybe another reason.

    I know that this does not answer your question with regard to other countries but it may add a little to the debate.

    E.McV.

    ReplyDelete
  15. It seems to me that our society has become so materialistic and ego driven
    that people are losing touch with their inner "life force". Adverts are for
    ever making people feel dissatisfied with themselves, feeling that they are
    in competition with their neighbours etc. Also of course, with money being
    the great goal and therefore working all hours God sends to support the life
    style they have been seduced into wanting, there is for many people no
    opportunity for useful interaction and mutual support. The result for many
    is I think a feeling of isolation, so I'm not surprised the take such
    actions.

    Anyway, for what it's worth that's my contribution.

    I hope to be well enough to attend some seminars again soon, meantime my
    best wishes.

    C.

    ReplyDelete
  16. Hi Paul,
    As you are aware suicide appears to have no actual cause - but is generally a cumulative effect - perhaps a succession of things going wrong. However added to this is personality traits - ie individuals with no social support network or those withdrawn from it are at increased risk. Our difficulty is we deal with consequences we do not have any preventative services. Medication is prescribed when perhaps therapies would suit that individual better. We are very short on therapies unless an individual has continued mental health services. Services offered by GP Surgeries are very limited.
    I dont know what the answer is but it always has been and always will be far more complex than we imagine because so many factors come into being: - personality trait, life experience etc

    ReplyDelete
  17. Hello and good morning,

    I have been giving my feedback on possible reasons for the higher rate of
    suicide in France compared with other nations. I lived in SW. France
    between 2005 and 2008. There is a definite divide north and then south of
    the Loire. The village life to the south has been affected by huge changes
    in agriculture with little work to be found. Farmers cannot eke a living
    out of the parcels of land they own: those farming around a 100 hectaires
    need to diversify and their partner also needs to work in order to support a
    family. Young people have to go to the big cities and often north of the
    Loire to find work. Many who are now of retirement age moved north during
    their working lives and now spend the summer months only in the rural areas
    giving a feel of abandonement to the small towns and villages from November
    till April. Families can often not get together for Christmas day owing to
    the work laws and the huge distances between members of one family. eg if
    that day falls at the W/E there is no day in lieu. Some of the Napoleonic
    laws still in existence today serve to create divisions within families
    which cannot be resolved. The employment situation keeps some employees in
    jobs they hate are are very unhappy in and employers are tied by laws which
    affect how many people he/she might employ. There are huge tensions in the
    cities like Marseille and Paris between North African people and 'French'
    people: some of the immigrants are 3rd generation and if their address is
    'wrong' they will not even be considered for work and so you have french
    families where 2 generations have not been in full-time work! Access to
    psychological therapies is expensive in France and there is still much
    resistance to enter the process even when available so medicating the
    problem/issue seems to be preferable. I did notice that peripheral
    therapies yoga, cranial massage, indian massage etc., seemed to be on the
    increase although the service did not last too long usually due to poor
    uptake.

    I hope this gives a little food for thought and does not merely clog the
    works.

    Best wishes
    E.M.

    ReplyDelete

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