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Means to an end

As the war of words rages on about mental health funding and prevention versus intervention, Colin Tatz wonders if we’re asking the wrong questions when it comes to the final taboo.


Colin Tatz writes:

Much about suicide doesn’t add up.

Statistics fudge the issue. The sole cause is deemed by the medical world to be mental illness: in the words of psychiatrist Robert Goldney, ‘depression, depression, depression’.

The prevention people insist on more money. But does prevention prevent — in the manner of measles or smallpox vaccination? Have the suicide rates dropped? Does more money mean we are winning, breaking even, or losing out, badly?

The adamance with which suicide is equated with mental illness must be questioned.

One in five Australians is said to suffer ‘mental illness’ at some point in their lives. If close on five million suffer that condition, how is it that suicide numbers average about 2687, or 0.5 per cent, annually?

Is there evidence from the biomedical professions as to why, and what proportion of, the mentally healthy commit suicide? Of some dozen categories of suicide, why is ‘mentally ill’ singled out as the only category?

The Australian suicide rate is said to be 12 per 100,000, and the Aboriginal and Torres Strait Islander rate is listed as 25 to 30. Since the prevalence of mental health issues in the latter group is said to be the same as that of the mainstream, what accounts for the doubling?

That gap is widening, daily.

Intervention is not prevention

Intervention is not prevention. Crisis counselling in the manner of beyondblue and Lifeline clearly has an important role, but we have yet to see evaluations, even anecdotal ones, of their success rate.

Prevention programs often tend to shrug off evaluation on the grounds that by definition they are engaged in good works, and review is both unnecessary and intrusive.

More and more money is always the prevention theme.

In the 1970s, Richard Nixon began a billion dollar war on cancer, money that has led to some important new therapies for those afflicted but has gone precisely nowhere in stopping that disease.

We are spending millions on suicide prevention and yet the rates are increasing.

Admittedly the rates are higher because our coronial systems are getting so much better, but the under-reporting is still at an unacceptable level. The reality is that more people are taking their lives, more youth are self-destructing, and even more Aboriginal youth are going down that path.

When suicide is rational

Where are we, here in Australia, in the critical suicidology that has emerged in Europe and North America?

Men and women of credentials and credibility have been looking hard outside the biomedical box, Professor Goldney’s box, finding that a great deal of suicide has nothing to do with mental illness.

We forget that suicide ‘while of unsound mind’ was a nineteenth century legal device to prevent a suicide’s assets being forfeited to the Crown, and had nothing whatever to do with doctors and other ‘-ologists’. Doctors came into the arena when the priests and lawyers vacated the field.

The critical movement tells us to look outside the conventional boxes.

It suggests we look more to socio-economic factors, to politico-legal environments, to the historical and the geographic contexts of the suicide. We need much more in the way of sociological and anthropological approaches to the subject rather than pushing for more research into ‘suicide genes’ and ‘chemical imbalances in the brain’.

After some 25 years investigating suicide — especially among Aborigines, Maori and Inuit — I have found that much of the suicide in those communities is quite rational.

When people decide that being between the rock and the hard place is insurmountable, a solution comes to mind, and they set about ending the impasse. If we listen to the Italian suicide historian, Marzio Barbagli, he will inform us that suicide is of two general types: those who do it for themselves and sometimes for others, and often enough, against others.

The renowned Albert Camus once said that there is only one philosophical problem — and that is suicide.

Addressing that problem is a task before all of us — and not simply the biomedical men who are rarely trained in the ages-old phenomenon of self-cessation of life.

Colin Tatz is visiting professor, Politics and International Relations, ANU.

He is currently studying how coroners do or don’t determine suicides in Australia and New Zealand.

Comments 2

  1. Di Ebsary says:

    I volunteered for 10years with Lifeline and I’m so encouraged to see someone asking the hard questions and putting it out there. Whenever I spoke with someone who was in that dark place of thinking suicide was the only option, things would inevitably turnaround for them when we explored their “meaning” of life. So when exploring a person’s suicidal thoughts, understanding their meaning would include understanding how they saw themselves in the bigger scheme of things, Most crisis callers are not trained in how to have these conversations yet these are the ones where a non-judgemental yet discerning ear can hear how someone is trying to bring “meaning” into their life, often within the constraints of oppression … some haven’t yet understood how they are oppressed even though our modern world can contain much oppression at an everyday level. These deeper conversations help callers explore their reality within a safe and caring space; and they are encouraged to find the answers that match “meaning” with “reality”. It can be something as simple as a realisation that altering work commitments will reduce overwhelming stress yet without the deeper exploration, someone may not understand this importance TO THEM. In the article an unconventional approach is encouraged and that “we look more to socio-economic factors, to politico-legal environments, to the historical and the geographic contexts of the suicide”. I fully agree and current suicide prevention approaches come nowhere near addressing anything like this. Yes, let’s redirect some funds into employing top-notch (not necessarily professional) people at the front-line, maybe starting in places like sporting clubs and schools.

  2. Rick Lewis says:

    I am encouraged by this article as it steps outside of a singular system process of “we know what’s best for you”. My history of over 20 years volunteering in a service that’s origins were based on a singular thought from a caring person who was touched by the level of internal struggle and frustration that led to a human being choosing not to endure the isolation that comes with a level of confusion becoming so powerful it dissolves options . I have experienced changes in people who have a similar moment that have reached out hoping that someone will care. A system doesn’t care, data does not care. It categorises , and forms judgement while not being in the moment and passes this information to people that concern themselves with “value for dollar” and “social returns”.
    These while important don’t sit in the moment of deep despair to discover what the meaning or source of pain is for the individual. I choose to write this in honour of the people that have been on the edge of an abyss and have responded to a hope and shared their pain. Many are too afraid to even glimpse at these moments for the fear of being confronted with their own past or present struggles that well may be the vehicle to re-engage them with that which they choose to “lock away”. Consider this when wanting to categorise and read about in the comfort of an armchair and surrounded by light to keep out the dark. The people who are there to answer the call of desperation aren’t on your statistical analysis, they are going about their lives invisible to the many.

    I write this also in the hope that one person within the system can change a thought.
    The same process that helps people stand back from the edge.

    May be we could ask the many that have been in the moment with someone if the change that is being handed down will make a “positive” difference.

    If you have ever struggled with being put on hold and then had to try and communicate your issue with a worker who doesn’t have or try to understand as it doesn’t impact on their everyday, then rethink your acceptance of a process that depersonalises at every turn. Ever wonder why the “cleverness” that is sold to us hasn’t reduced the numbers?
    How many frontline workers do you see at an executive meeting?
    Thanks to Colin for his efforts to challenge.

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Media Doctor Australia
media-related issues
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Royal Commission
Social determinants of health
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NBN
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Summer reading 2020-2021
Tasmanian election 2021
Testing Croakey News category 1
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
#OKtoAskAu
#OTCC2017
#ResearchTranslation17
#TheMHS2017
#VMIACConf17
#WCPH2017