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Abstract
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Suicide is not well understood - leading to unrealistic expectations about the prevention of this behaviour. We have failed to examine suicide across history and accept the ubiquity of suicide around the world. We have also failed to properly examine the influence of sociological, cultural and economic factors on self-killing. A major reconsideration is essential.
The belief that suicide was a sinful act was replaced in the early 19th century by the belief that suicide is always a response to a mental disorder (the mental disorder model of suicide). The WHO described this medical explanation as a 'myth'[1], but it persists. In the last decade, the Zero Suicide model has been described holding that appropriate medical/behavioural management will eliminate suicide[2]. There is no credible evidence to support such beliefs, and these cause damage.
In mythical Greece, Aegeus (Athenian) wrongly believed his son had been killed and threw himself in the sea, which was named in his honour. In Classical Greek times, Plato condemned suicide, but listed exceptions such as when the individual had committed inexcusable actions or was experiencing protracted suffering. In ancient Babylon, the lovers Pyramus and Thisbe died by suicide when each mistakenly thought the other had died. The Bible contains some 10 reports of suicide - Judas betrayed Jesus and then killed himself to relieve his guilt[3].
There are multiple recent examples in which mental disorder played no part. In 1780, Kuyili (an army officer in India) applied a flammable agent to her body, set herself alight and leapt into a British armory resulting in the defeat of her enemy. In 1917, during a particularly turbulent period of Russian history, Aleksandr Krymov (a military General) refused the order to send his troops into Saint Petersburg. Rather than stand trial, he shot himself. In 2004, in England, Dr Harold Shipman, a medical practitioner, who had killed at least two hundred of his patients, hanged himself in the Wakefield Prison. He had been convicted of murder and had exhausted the appeal process. He stated he would kill himself if he was not released. In 2018, in India, M. Jaishankar, an infamous Indian rapist and murderer, cut his throat and died in the Bangalore Central Prison. In 2019, in the USA, Jeffrey Epstein, a sex offender, hanged himself in a New York prison. He had been convicted once before and was facing further charges. All these men were in custody - they had been considered at risk of suicide and were under supervision and psychiatric care. That these men were able to kill themselves in spite of the best possible care proves that suicide is not always preventable. Other examples of suicide completed under the tightest security are the half dozen suicides which have been completed at the Guantánamo Bay detention camp[4]. When suicides occur in custody, various authorities who are ignorant of the difficulties of preventing suicide express anger and seek to blame and punish staff. It would be better if authorities gained a better understanding of these difficult events and expressed support rather than blamed the staff ...
Language: en |