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Suicide: Perspectives from Cultural Theory

Introduction

by Teo Yu Loong Melwyn & Goh Yan Qing

1.1 Preliminaries

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ndeed, who would? The question of suicide is a question that is as old as civilization itself. Centuries of philosophers, psychologists, sociologists and political scientists have tried to answer this question: if lifepreservation is a natural instinct that is present in all animals, why do humans continue to take their own lives?

or who would bear the whips and scorns of time, Thoppressors wrong, the proud mans contumely, The pangs of disprized love, the laws delay, The insolence of office, and the spurns That the patient merit of thunworthy takes, When he himself might his quietus make With a bare bodkin? Hamlet, Act 3 Scene 1

action where the individual allows herself to meet a premeditated end qualifies as suicide in the same vein as one who shoots herself. However, this definition is inadequate for two reasons. Firstly it doesnt differentiate between cases where the only other shortterm alternative to death by ones choice is a natural death, and cases where the perpetrator has a choice to live. Secondly this definition of suicide does not exclude the act of jumping off the building under the influence of alcohol, or hallucinatory drugs, acts where we would not expect the perpetrator to do so if she were of sound mind. A second condition, therefore, requires that the perpetrator of the deed, in a situation where the shortterm alternative to suicide is not a natural death, is conscious and aware that her actions may result in a lifeterminating finality. A distinction is often drawn between suicide attempts and suicide completions. OCarroll et al (1992) estimates that there are about 25 attempts for every completed suicide. Moreover, researchers find that teenagers who attempt suicide rarely have a sustained desire to die, and hence suicide attempts are often undertaken at the spur of the moment as a cry for help to elicit a response. The preponderance of research on this aspect of suicide has prompted researchers like Marcotte (2003) to consider suicide as a rational act to reap future gains. Taken in this light, it is doubtful whether the perpetrator of a suicide attempt has full recognition of the consequences of her actions. In cases where the perpetrator attempts suicide as a cry for help, it is ambiguous whether she wishes her attempt to result in a life-terminating finality. Should such suicide attempts be considered in the same light as suicides actually resulting in death? While studies in the past on suicidal behaviour have been constrained by the availability of reliable statistics on suicide attempts, there is a broad social consensus today that researchers need to devote more attention to suicide attempts because the underlying motives behind a suicide attempt have important policy implications. In the broadest sense, three schools of thought exist when it comes to explaining suicidal behaviour. We argue here that the differences between these three schools of thought are due to the different cultural biases, patterns of behaviour and social relations that characterize the four different social solidarities.

1.3 Attempts versus Completions

Different explanations, often conflicting, are prevalent in current thought, and we argue here that the different explanations and characterizations of suicide, and the policy debates that shape the discussion of suicide in the public sphere, are culture specific. Using Mary Douglass grid-group typology in characterizing social relations, we argue that the adherents of the four different social solidarities - namely individualism, hierarchy, egalitarianism and fatalism - have different conceptions of suicide. Each social solidarity has a different grid and group dimension, with grid referring to the extent to which rules and regulations circumscribe the behavior of individuals, and group the amount of influence communities have on individuals. These differences result in different perspectives of the nature and causes of suicide. What is perhaps more surprising is that within each set of cultural bias that justifies a particular way of life as well as the social relations and patterns of behaviour that characterize each social solidarity, one is able to find very thin fault lines in the social structure that lead to suicidal behaviour under certain circumstances. To the extent that suicide is an unqualified social ill that requires correction, prevention and treatment, a successful policy response that aims to reduce suicide must take into account these plural perspectives. We adopt Durkheims first formula: the term suicide is applied to any death which is the direct and indirect result of a positive or negative act accomplished by the victim herself (Durkheim, 1951). Therefore, a passive

1.4 A Brief Overview

1.2 Definition

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The first camp views suicidal behaviour as purely a psycho-instinctual response influenced by individual bio-chemistry. Psychiatric researchers, among them Dr. David Brent at the Western Psychiatric Institute in Pittsburgh, claim to identify a set of genes that contribute to psychiatric disorders among families, and subsequently suicidal behaviour. Though psychiatrists often suggest solutions that have a high-grid nature, the view that suicide is an individual affliction has a particularly individualistic and fatalistic flavour to it. Suicidal behaviour in a community, taken as merely a linear sum of independent units, is not particularly insightful if its causes and characteristics cannot be traced to individual factors.

Collective Predispositions to Suicidal Behaviour among the Four Social Solidarities The four different social solidarities are in a constant state of competition and flux in what Wildavsky et al (1990) calls the requisite variety condition that characterizes our social environment. Each social solidarity cannot exist in isolation of the others. As such, social environments contain elements of all four different social solidarities, across time and across space. The tendency to voluntary death is likely to be acultural as it exists in virtually all societies (a point that will be further explored in the paper). In 74CE, insurgent Jews committed mass suicide in the fortified town of Masada rather than face enslavement by their Roman oppressors. Death by voluntary ingestion of poison was considered to be a means by which a condemned man could preserve his honour in ancient despotic cultures of China and Rome. And history is far from replete of romantic, melancholic poets and artists who have chosen to die rather than face the sorrows of this world. It is possible, however to identify collective predispositions to suicidal behaviour within the cultural bias of each different way of life that accounts for the different forms of suicidal behaviour that we have seen over the years.

2.1 Preliminaries

The second camp, made up mainly of sociologists and political scientists, rejects this notion. Durkheim (1951) himself argues that the suicides committed in a given society during a given period of time is itself a new fact sui generis, with its own unity, individuality and consequently its own nature. Adherents of this camp argue that it is insufficient and erroneous to view suicide from a purely etiological perspective. For them, suicidal behaviour is a social pathology rather than an individual affliction. Adherents of this camp subscribe to social solidarities that have a high group culture, namely, egalitarianism and hierarchy. The centrality of collective values in the patterns of behaviour of these two social solidarities leads them to advocate holistic rather than patient-specific measures to curb suicide. Hierarchists would advocate elegant top-down institutional measures and egalitarians would advocate stronger communal support and mutual encouragement to prevent high risk groups of individuals from straying from the bounds of the group. For hierarchists and egalitarians, it is the responsibility of communities to prevent individuals from killing themselves. The third camp entered late into the suicide debate. Rather than viewing suicidal behaviour as a social pathology or an individual affliction, adherents of the third camp argue that suicidal behaviour is entirely rational, motivated by an intrinsic calculus of pleasure and pain that is in turn based on the economics of utility maximization. Researchers who subscribe to this third school of thought give more weight to suicide attempts, arguing that non-fatal attempts might elicit resources and care from others. Implicit in their arguments however, is that individuals have the liberty and right to make a suicide attempt. Such an argument is characteristic of low-grid cultures, particularly individualism and to a lesser extent, egalitarianism. These groups suggest measures that focus on incentivization and de-incentivization. For example, victims of suicide are denied consecrated grounds for burial (increasing the cost of suicide) and high-risk individuals are provided with better access to health-care and counselling resources, so as to tip the balance of incentives towards survival in the calculus of individuals.

Hierarchies are characterized by nested bounded groups of individuals who live together in a social environment where the activities of individuals are severely constrained by firstly, strict rules and regulations that are imposed from above, and secondly, group values that define the bounds of human interaction. In order to justify this way of life, adherents of hierarchy propagate the myth of nature that humans are fallible and redeemable only through near-perfect institutions that are engineered and managed by experts. Leadership is to be exercised only by those who are fit to lead those who are not have to live by rules and regulations that are set by these leaders. Although the social environment is stable and predictable, collective predispositions to suicidal behaviour are still present in a hierarchy. In his phenomenal work, Suicide, Durkheim posits that altruistic suicide is caused by too rudimentary individuation where society holds [the perpetrator] in too strict tutelage. (Durkheim, 1897 [1951]) In its most extreme form, a hierarchical society imposes upon individuals the compulsion to kill themselves, by virtue of the very social role that they play. Examples of this would include the willingness of a princes servants in ancient China to commit suicide after the death of their master, so as to be able to continue serving him in the afterlife. The cultural biases

2.2 Hierarchy

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of hierarchy, therefore, create an institutional sanction for suicide. One of the most famous forms of institutionallysanctioned suicides is seppuku (vulgarized: hara-kiri), the Japanese ritual of disembowelment. Fuse (1980) argues that Seppuku in Japan has been nurtured in Japans socio-cultural tradition as one of the socially and culturally prescribed and positively sanctioned [italics added] role-behaviour in hierarchical organizations. Seppuku is part of the bushido, the Japanese warrior code for samurais, and is undertaken by a samurai as a means of preserving his honour when he has failed in his role, for example, in the aftermath of a defeat at the hands of his enemy. A samurai can also commit seppuku under the orders of the daimyo or feudal lord that the samurai pledges allegiance to. Moreover, seppuku is a ritual that is committed in the presence of close friends and family, and samurais identify with the ritual as a means of ascending into the ranks of the ancestry. The high grid culture of a Japanese feudal society, therefore creates an obligatory commitment to suicide as and when is required by dictates from above or when the samurai has failed in a certain role or duty. But even then, the samurai commits seppuku as a means of redeeming himself and is an act of rejoining the community rather than as a means of leaving it, and this is evident from the fact that the seppuku ritual is observed by members of the community. Even today, suicide relating to role performance in the psychological tradition of seppuku dominates the discussion of suicide in Japan, as is evident in Fuse (1980), and Amagasa et al (2005). Amagasa et al (2005) studies 22 cases of karogisatsu, or workplace-related suicides in Japan and identifies huge occupation-related psychological demands as one of the most important contributory factors that explain suicidal behavior in the workplace. We argue here that karogisatsu is a modern-day manifestation of seppuku. To the extent that the workplace can be described as a hierarchical social organization, the pressures of role performance and the ascribed rules and regulations create psychological demands that are similar to those that Japanese feudal society imposed on a samurai. When such demands prove insurmountable, the individual commits suicide.

teen suicidal behaviour in American high schools by Guthrie (2002) similarly shows that high-performing and socially active teens at school are at a higher risk of suicide than is commonly perceived. Hence, within the hierarchical organizations of the school and the military, the pressure of role-fulfilment and feelings of inadequacy affects all individuals. Adherents of egalitarianism believe in a form of social organization that is characterized by high-group and low-grid. Hence, there are few rules or regulations and social differentiation that delineate individual roles and responsibilities. Egalitarians contend that nature is fragile and humans are malleable and easily corruptible by evil institutions. This myth of nature justifies a form of social organization that is exclusive, stresses on principles of equity, and is obsessed with purity.

2.3 Egalitarianism

Psychological demands of a hierarchical social setting also tend to weigh more heavily on individuals who belong to lower social strata, hence it might be tempting to conclude that the collective predisposition to suicide in a hierarchy affects only individuals who are at the lowest social strata. However, this is misleading. Durkheims study of suicide in the military organizations of Europe showed a greater propensity to suicide among the officer corps, precisely those who are best suited to its needs and most sheltered from its demands. A case study of

The myth that nature is fragile, that group members are perpetually poised on a precipice and predestined to perish should they stray outside the group boundaries, promotes a belief system that continually compresses their perception of time and space (Rayner, 1982). Egalitarians tend to compress the world into a pair of diametrically-opposed polar spheres, separated by a thin group boundary, or at best, a neutral buffer zone. Yet many sectarians also believe in the existence of a suprasphere that lies separated from them by the evil outside-world a supra-sphere that represents the most desired end-state of their existence. This belief compresses their view of time, thus they believe that in the immediate future, they will be able to leap-frog the evil outside world and the troubled times they live in, into the Garden of Eden that features so much in their imagination. The compression of space is a distinctive feature of the group psyche of an egalitarian community and this leads to suicidal behaviour. Durkheim identifies groups of sectarians in his exposition on altruistic suicide who commit suicide purely for the joy of sacrifice, because, even with no particular reason, renunciation in itself is considered praiseworthy. In the context of 21st century suicide-bombings by Islamic extremists, these words seem oddly prescient, yet in this instance, Durkheim was referring to Hindu Brahmins, Jainist believers and sectarians of Amida. In all cases, as Durkheim posits, the individual seek[s] to strip himself of his personal being in order to be engulfed in something which he regards as his true essence. This inherent compression of both space and time, as well as the negation of the individual identity in favour of the group identity or a supra-existential identity, are necessary stages that lead to what Durkheim terms as acute altruistic suicide which unambiguously refers to suicides of a particularly egalitarian nature. The mass suicides that occurred over the past three decades among fanatical and millenarian cults in the

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United States are very good examples of acute altruistic suicide. The Peoples Temple cult, founded by the fanatical pastor Jim Jones, was a highly egalitarian community where members of the cult worked the land together in Jonestown, Guyana, a tiny enclave promised to be a paradise on earth. When Jim Jones realized that the cult was falling apart, he forced his followers to commit suicide, resulting in the deaths of some 140 adults and children. Members of the Heavens Gate Cult in California believed that a flying saucer would accompany the Hale-Bopp comet and transport them to a higher existence, resulting in the mass suicides of 39 people in a luxurious mansion near San Diego. One sees the subsuming of the individual within the group identity, without which Jim Jones would never have been able to persuade his followers to follow him in death, as well as a deep belief that the end is nigh, among the believers of the Heavens Gate cult. The link between suicidal behaviour and the cultural biases of egalitarianism however, needs to be qualified by two observations. Firstly, not all adherents of strongly egalitarian social organizations display such suicidal behaviour. Amish and Hutterite communities certainly have a more positive outlook on life than the Heavens Gate cult members. Secondly, suicidal behaviour that can be traced to egalitarian elements is present in conformist mainstream societies as well. A lively debate ensued in the early twentieth century between Durkheim and Gabriel Tarde on the influence of imitation on social suicide rates. Durkheim was quick to discount non-social factors that attempted to account for suicide, arguing that the geographical clustering of suicides in France is explained totally by socio-political factors, like religion or national identity. Tarde however, argues that such geographical clustering of suicides is the result of an almost instinctual tendency for individuals to commit suicide after the observation of other suicides in the community. One can identify the strong egalitarian flavour in this argument, as only when there is a weakening of individual identity will such imitation effects be strong. Baller and Richardson (2002) found significant residual geographical clustering in the suicide rates of France and the United States after socio-economic variables have been controlled for. Meanwhile, Bollen and Phillips (1982) also provide evidence that the imitation effect on the community is reasonably strong, especially in the aftermath of a news report that a famous TV celebrity has killed himself. Recent studies therefore, support the Tardeian perspective. Low-group, low-grid, ego-focused networks characterize social relations that are organized on the principle of individualism. Individual decisions are neither constrained by group membership nor dictated by rules and regulations. The individual is free to conduct negotiations and enter

into mutually-beneficial contracts with other individuals, and this freedom results in transient social relationships that often involves only a transaction. To justify social relations of this sort, individualists propagate the myth that humans are inherently rational and self-seeking, constantly seeking to maximize their utility under certain constraints, and society is best served by the Invisible Hand of the market that coordinates all these micro-level, self-serving, utilitymaximizing behaviour to result in the larger social good.

Individualists are prone to suicide mainly because they do not have many shared beliefs other than that of profitmaking and voluntary mutually-beneficial exchange relationships. Unlike the high-group social solidarities, this lack of shared and prescribed beliefs together with the spirit of freedom of inquiry in individualism, increases suicidal tendencies due to the lack of communal support and well-defined values. (e.g. societal or religious limitations) This means that Individualists have little support structures to draw upon in times of need. (Dunman, 2003 & Durkheim, 1952) To illustrate this concept, the differences in suicide rates between Catholics and Protestants were used by Durkheim in his study. From samples of Catholic and Protestant communities, Durkheim posits that Catholics have a lower propensity for self-destruction because of the strict hierarchical organization of the Catholic Church and the numerous standardized and pre-scribed religious rituals. These rituals constantly reinforce a sense of belonging to the group and community amongst its adherents. Moreover, such organizations often have effective ways of dealing with problems. For instance, in the Catechism of the Catholic Church, sin is structured, institutionalized and sub-divided into numerous categories. Within each category, the book explicitly states how individuals can seek redemption through various ways. This allows individuals to channel their guilt and, with the support of their community, overcome these difficulties and seek forgiveness. These beliefs not only provide individuals with guidance, but are also a tremendous source of consolation and acts to ameliorate suicidal tendencies. On the other hand, Protestants have more individualistic leanings and Durkheim argues that this lack of membership and sense of group solidarity leads to a higher propensity to suicidal behaviour among Protestants. In the context of Mary Douglass grid-group typology, the individualists low-grid, low-group world of exchange relationships driven solely by self-interest results in what Durkheims calls egoistic suicide. But why would the Individualists ideal of the freedom of inquiry increase his pre-disposition to suicide? This is because the more he learns, the more he questions religion and his understanding of the world. As his social world loses its consistency, the individual, with no group mechanism to turn to, loses the basis for existence in his life, and resorts to self-destruction.

2.4 Individualism

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The low-grid aspect of Individualism also creates predispositions to suicidal behaviour. Without a proper guiding authority or a set of social guidelines of rules and expectations for individuals, an individual without constraint will allow his insatiable wants to consume him. This is because it is impossible for human nature to assign arbitrary limits to our needs and consequently these wants are essentially unlimited; since the means available to the individual are limited, he will never be able to reconcile this disparity. Hence, the distress that results from this conflict within the individual leads to suicide as well (Durkheim, 1952).

Moreover, as Moody (2003) points out, this conflict is closely related to the psychological effect known as Cognitive Dissonance. In this instance, the individual either has to reconcile the differences between his thoughts and actions, or, failing which, resort to more drastic measures like suicide to end her suffering. Hierarchists argue this justifies a greater need for increased regulation and authority. Furthermore, Durkheim illustrates the concept of anomic suicide in both economic and domestic settings (whether persistent or event-based). An Individualistic social setting lacks both the regulative force and rules necessary to restrain it. However, in some individualist settings where there are rudimentary regulatory authorities or institutions, abrupt changes in the economic or domestic environment (such as the cyclical nature of economic activity or the death of a spouse) or one of the other more persistent changes (like industrialization and modernization, or the changing role of traditional social institutions like marriage) can lead to an increase in anomic suicide. Empirically, this has been proven in countries like Finland (Stack, 1993), where both rapid changes in the economic and social environment led to an increase in the rate of suicide . However, one should note that the argument for anomic suicide stems from the anti-utilitarian agenda in Durkheims writings, and it is all too possible that Durkheim has overstated the case for anomic suicide to heap blame on the individualist sentiments across the Channel. Mary Douglass Fatalism (or Isolationism) is a form of social solidarity that is passive, because social relations in an isolationist social environment are high-grid, lowgroup. Individuals are constrained by arbitrary rules and regulations that are beyond any reasonable form of social control, and the social fabric is made up of amoral, atomistic and inherently hostile interpersonal relationships. As such, an individual in such a social setting is constrained by her environment, but unable to fall back on the support structure of closely-knitted human relationships, and this results in the belief in the inherent futility of intervention.

Moreover, Fatalism is a solidarity that is inherently difficult to study since we have to rely on the perceptual lenses of the other 3 solidarities for an account of their lives. In spite of this, one can still identify cultural biases within Fatalism that to some extent acts as an insulating buffer that works in the opposite direction of the other three social solidarities by diminishing the suicidal tendency among its adherents. This proves to be very counter-intuitive. In such a highly-regulated environment with neither a belief in its predictability nor a sense of group solidarity amongst individuals to fall back upon, one has to cope in order to survive. Hence, inbuilt into the fatalist psyche are ideas of self-preservation and survival in a harsh environment. It would therefore appear that Fatalists have a natural resistance to suicide. On the other hand, we still see suicides that are of a fatalistic nature. In a mere footnote, Durkheim claims that fatalistic suicide is the suicide deriving from excessive regulation, that of persons with futures pitilessly blocked and passions violently checked by oppressive discipline, which in the context of cultural theory, is precisely the suicide of persons in a fatalistic social setting, for example slaves and the married but childless woman. But such forms of suicide were not mentioned again in the book. Durkheim himself admits that these forms of suicide have little contemporary significance and that examples are hard to find, strengthening our hypothesis that there are fewer suicides in social settings where Fatalism dominates.

2.5 Fatalism

We try to reconcile both our hypothesis and Durkheims view with the following argument. While the coping mechanism ameliorates suicidal tendencies in a large social setting where Fatalism has become entrenched as a way of life, this mechanism may well fail for an individual within a smaller social environment where individual activities are nevertheless still checked by oppressive discipline. Storr (1988) highlights the condition of pretrial detainees in Denmark, who are often kept in solitary confinement while their cases were being investigated. In 1980, seven out of ten successful suicides in prison were those of pre-trial detainees. This form of suicide is the direct opposite of anomic suicide (forms of suicide resulting from the breakdown of regulation), but the lack of examples that we can find of fatalistic suicides in larger isolationist societies could well point to the fact that this form of suicide fades from view once fatalism becomes established as a way of life. Plural Perspectives

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Each different social solidarity tells a different story of suicide, and sets out to tell the story by answering the following questions: What is the nature of suicide? Is it a problem? Who are the victims? Who are the saviours?

3.1 Preliminaries

And if it is indeed a problem, what can be done about it? We argue here that because the four different social solidarities are in constant conflict and competition for supremacy in any social organization, blaming a different social solidarity for the fact that people would choose the path of self-destruction serves as a convenient means of discrediting the others. This shall be referred to as the scapegoat hypothesis in this paper. The very first hierarchist to define suicide as an issue that requires social attention was none other than Emile Durkheim himself. Not only did Durkheims Suicide serve ultimately as a vehicle for advancing his sociological thought, his efforts in showing that non-social factors had a negligible impact on suicide rates gave birth to a sociological tradition of relating suicide to the level of integration in a society. The hierarchist therefore formulates the problem of personal self-destruction as a problem of excessive individuation and insufficient social integration, committed by individuals on the fringe who, either by choice or circumstances, are outside the safe confines of social relations and social regulation. Gibbs and Martin (1958) built on Durkheims thesis to land the sociologists firmly in the hierarchist camp. Gibbs and Martin argue that suicide rates depend not only on the stability and durability of social relationships (as Durkheim argued) but also on the level of status integration in society. Status integration refers to the degree to which a person is able to perform his ascribed and achieved roles competently. This depends on variables like the extent to which the individual faces role conflicts and occupies incompatible statuses. Status integration, however, is notoriously hard to measure and in a later study, Stafford and Gibbs (1985) found that the thesis had poor predictive power, based on 1970 census data for the United Status.

3.2 Hierarchy

organized religion, or who are married are less likely to commit suicide than those who see religion as a matter of personal faith and unmarried individuals. Sociologists therefore argue that social institutions like religion, family and the government provide the answer to curbing suicidal behaviour, and this argument has, over the years, been backed by crosssectional studies. On the side of sociologists are various schools of psychiatry. Psychiatrists see suicide as a public health problem, and the measures that they prescribe are unmistakably hierarchical. Like sociologists, they claim that the victims of the story are individuals who lie outside the ameliorating influence of social institutions. In his book Solitude, Storr (1988) makes the observation that the more celebrated cases of philosophers, artists and poets who are recurrently depressed and profoundly suicidal, for example, William Cowper, John Donne and Sylvia Plath, are intensely solitary individuals. Psychiatrists identify a link between suicidal behaviour and mental illness, and prescribe measures that are heavily reliant on experts, which is a hallmark of any hierarchy. Swedlow (1994) identifies waves of reform in policies concerning mental illness, where the very first wave was initiated by Alan A. Stone as what was described as the thank-you theory of paternalistic intervention. Stone maintains that psychiatrists and judges need to make decisions to incarcerate the mentally-ill in asylums and state hospitals for the sake of the latter, whether or not they consent to psychiatric treatment, in the belief that the mentally-ill will retro-actively approve of his belief that some have the power to decide what is best for others. The Suicide Awareness Voices of Education (SAVE) Group, one of many suicide prevention groups in the United States, prescribes solutions for suicidal behaviour that are particularly hierarchical . SAVE sees people who commit suicide as being very sick and depression is a brain illness that can be diagnosed by a doctor. Therefore, they prescribe clinical solutions to the problem of suicide, which include a combination of anti-depressant medication and psychotherapy, to be carried out by wellqualified doctors. The institutional solutions that they suggest place them squarely in the hierarchy camp.

Despite its empirical shortcomings, the emphasis on social and status integration is the motivation behind the numerous studies that attempt to analyze the impact that social institutions like religion, the family, schools and the nation have on national suicide rates. Everything else equal, social institutions increase the degree to which individuals are integrated into the larger society that they live in. Steven Stack analyzes the prevalence and impact of social institutions like marriage and religion on suicide rates in Nordic countries, in an attempt to explain why suicide rates there are disproportionately larger. Institutional factors are also used to explain why, as mentioned above, the suicide rates among Protestants are higher than Catholics in France at the time of Durkheims writing or why the coefficient of preservation differs between men and women and between married and unmarried persons. For Durkheim, religion and family play important roles in integrating individuals to society. He shows that individuals who partake in

On a national level, the Surgeon Generals Office of the Department of Health and Human Services (DHSS) in the United States is probably the most important hierarchical body to quote for its views on suicide. Central to the measures that it proposes in a 1999 Call to Action Paper are calls for scientific research to advance knowledge on suicide, promote public awareness of suicide, using schools and workplaces as media to spread the message of suicide prevention and institute training programs for social workers and mental health professionals. These are measures that rely on social institutions and experts, which again have a particular highgroup, highgrid flavour.

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Since adherents of the fatalist mentality believe in the capriciousness of nature, it is worth noting that the arguments of clinical psychiatrists also ironically have a particularly fatalistic flavour.

3.3 Fatalism

but the point of departure comes when egalitarians view suicide as symptomatic of the larger ills of society, as a sign that something rotten is in the state of the system.

Psychiatrists have identified several relevant hormones that are naturally produced by the brain which are related to stress, depression and suicide. In 2005 , Zul Merali et al. found an abnormally high concentration of neuron-peptides of in the pre-frontal cortices of suicide victims. After controlling for other factors, they conclude that the variations in these chemicals lead to f luctuations in the anxiety states of the deceased. Similarly, another study by Leyton et al. (2005) found that patients who have made a highlethality suicide attempt have low serotonin synthesis in the pre-frontal cortex. This provides evidence that changes in the bio-chemistry of an individual lowers her natural threshold to suicide. Besides an individuals bio-chemistry and genetic makeup, sociologists have also found that individuals in a depressive state may be prone to the broken-promises effect (Gabennesch, 1988). This effect is related to temporal cycles (such as changes in calendar dates, holidays, etc.) and seasonality. An increased sense of expectation of a better future (for depressed and suicidal individuals) is associated with a change in the temporal cycle or season. However, such beliefs tend to be unfounded and when the cycle finally changes anew and no such deliverance arrives, the individual plummets to new depths of despair. This effect has been used to explain seasonal fluctuations in suicide rates, such as the fall in suicide rates before the New Gregorian Year as well as the day-of-the-week effect. Suicidologists of this particular stripe place a heavy emphasis on external forces that are beyond any individual or social control. We have highlighted individual bio-chemistry and changes in the natural environment as examples of these external forces that act as arbitrary rules and limits on individual behaviour. Such explanations have a uniquely fatalist f lavour and could well be the belief that the adherents of fatalism subscribe to. However, as fatalism is a passive social solidarity, we can hardly expect any suggestions or policy solutions to come from the fatalist camp, given that they believe in the inherent futility of intervention, especially when Man has to work against Nature or genetics. Egalitarians identify groups rather than individuals who are at the highest risk of suicide, owing to their particularly high group boundaries and their cultural bias that predisposes a tendency to the language of the collective. Like adherents of hierarchy, egalitarians tend to see the problem of suicide from a macro perspective,

Egalitarians identify teenagers as one of the high-risk groups. Suicide rates among teenagers aged 15 to 19 in the United States have rose by 6% from 1979 to 1998 though overall suicide rates have fallen. For those aged between 10 and 14, the suicide rates have increased by 100%. In Singapore, the suicide rates for teenagers are lower than that for older age groups, but there is still concern over teenage suicide rates and the causes behind them. In a 2003 study by the Institute of Mental Health, researchers identified problems in inter-personal relationships as a major trigger for suicide, rather than academic stress. Such an emphasis on teen suicides owe much to egalitarian sentiments in both Singaporean and American societies though there are authors like Mike Males who argue that the extent of teen suicide is exaggerated. Egalitarians tend to view the issue of suicide in dualistic terms: oppressor versus oppressed. For the egalitarians, the oppressed are teenagers who are attempting and committing suicide as a result of both institutional stress and individualist principles. Thus, they point the finger at adherents of hierarchy and individualism.

3.4 Egalitarianism

One of the debates surrounding gun control in the United States today is its impact on teen suicide. The Educational Fund to End Handgun Violence in the United States is an advocacy group that has a very egalitarian character. They highlight the fact that firearms suicides outnumber homicides in 40 of the 50 years between 1933 and 1982, and that firearms are the most common means of suicide for all age groups. In particular, teenagers have experienced a rise in firearm suicide rates greater than any other age group in the country. Hence, to protect teenagers against their own impulsive urges to shoot themselves in the foot, society needs to impose further gun control and regulation. Whilst egalitarians blaming excessive individuation would lean towards hierarchical solutions, egalitarians are no more enamouring of hierarchists. Julian Guthrie, quoted earlier, points out that the pressure to succeed in American high schools today create unnatural pressures, even in high-achieving students. In the local scene, the egalitarian flavour in Jack Neos socially-motivated motion picture I Not Stupid is unmistakable as he seeks to draw attention to how the streaming system in the Singapore education system has resulted in alarming suicidal tendencies in children as young as twelve. For egalitarians of this stripe, the finger is pointed at hierarchical elements in society for alienating the groups who need the most protection. Egalitarian groups therefore advocate awarenesspromotion programs, advocacy and lobbying as solutions. They advocate greater social participation so as to be able to build up awareness of their cause. Lobbying of federal agencies in the United States for greater regulation (in the case of gun control), grassroots initiatives that

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train teachers, friends and family members to look out for signs of suicidal behaviour in high-risk groups and broad fund-raising campaigns are key elements in the modus operandi of such egalitarian movements. In the United States however, there is a broad alliance between hierarchical and egalitarian elements on matters of suicide, with adherents of hierarchy recognizing the power of such egalitarian movements to organize and their strong presence on the ground. Groups like the National Youth Violence Prevention and the Yellow Ribbon movement are sponsored by federal partners and by the Centre for Disease Control and Prevention. Such groups are particularly valuable when the hierarchy believes it needs to have a mouth-organ on the ground level. Another added utility of egalitarian groups is their ability to provide close-knitted communal support in times of need. Egalitarians believe in the efficacy of prevention over cure, and suggest that one of the best safeguards against suicidal behaviour is the ability for friends and family members to recognize the signs early and provide the level of emotional support needed to bring the stray flock back into the fold. The Suicide Prevention Action Network in the United States allows an online platform for education and discussion of matters relating to suicide and many other help-groups provide toll-free telephone access to a listening ear in times of need. It is widely believed among such groups that closer human relationships ameliorate suicidal tendencies. While principles relating to an individualist way of life are constantly under attack from adherents of hierarchy and egalitarianism as a cause for suicide, adherents of individualism would argue that suicide is a perfectly rational course of action for the individual, and to them, it is rather the overwhelming control and the meddling of personal affairs by the high-group solidarities that have reduced the individuals threshold towards suicide. Individualists argue that the first basic inalienable right of individuals is freedom to life, and hence they argue that the rational individual has the right to choose not to live as well. Naturally, aspects of rational choice theory are used to explain how the individualist understands this social phenomenon. When humans are viewed as being self-seeking utilitymaximizers, suicide is not just the product of mental illness or social isolation, but the result of economic decisionmaking. In spite of critics who question the validity of adopting a positivist approach to such an issue, economists have managed to prove that their predictions using this approach hold up empirically and across time. One of the foremost economic theories of suicide postulates that individuals would kill themselves when their total residual lifetime utility reaches zero. This assumes that individuals prefer to consume today than

in the future (Hamermesh & Soss, 1974). The factors that will then affect an individuals proclivity for suicide are age, the individuals distaste for the act of suicide and her permanent income. The individual therefore engages in a decision calculus, as she weighs up the relative benefits and costs associated with living when she is deciding whether to commit suicide. Suicide would thus only occur when the cost of living or lack of benefits in living, outweighs the individuals personal abhorrence towards suicide. Drawing from empirical evidence, we can find a positive relationship between suicide and unemployment, age and income. Thus, rather than confirming Durkheims view and evidence of Egoistic suicide amongst higherincome groups, this theory contests those findings. Through this, it would thus seem that even for such extreme types of human behaviour, it responds in a similar fashion to the same economic incentives that govern other facets of our lives.

3.5 Individualism

A corollary of this argument is put forth by ultra-liberals who argue that as much as an individual has the right to live, she also has the right to die and that decision should be respected. While this may appear to be contradictory to the individualist viewpoint, we argue that since people are the owners of their own bodies, they have the right to determine if they should live or die, and no authority or individual has the right to violate that right (van de Haag, 1998). Hence, when suicide is viewed as a right and the result of rational decision making, it cannot plausibly be viewed as a social problem by the individualists. Also secularism refutes religious objections to suicide, while philosophical objections are refuted by the individuals right of property to his own body. Since suicide cannot be formally objected against, they argue that it is actually the negative reputation that has become associated with suicide that is to blame for current biases and objections to the act. In fact, rather than harming individuals, suicide may help numerous individuals alleviate their personal suffering (van de Haag, 2003). Attempted Suicide Unlike the other solidarities, adherents of individualism believe strongly that suicide attempts are equally important in the consideration of suicide. To account for suicide attempts, two additional modifications were made by Marcotte (2003) to the suicide model proposed by Hammermesh and Soth in 1974. Firstly, suicide attempts bring forth help and resources from others, thus the individual could benefit from increased utility or better economic prospects. Secondly, the probability that an individual will commit suicide increases when the individual feels that future earnings will be positively affected by the attempt provided that the individual survives (in the same vein, one can also argue that surviving a suicide attempt could also mean increased health costs resulting from the failed attempt,

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e.g. disability). Hence, rather than simply calculating the costs and benefits associated with living, the individual focuses instead on a cost-benefit-probability analysis when considering whether to attempt suicide or not. These two considerations are based on the rationale that individuals contemplating suicide are aware that their attempts may not always end in a fatal conclusion and that this would bias their decision-making. From empirical data, the greatest contribution that individualists bring to the debate of suicide is the conclusion that suicides, rather than being a drastic be all, end all situation, turns out to be a cry for help that can be planned as an effort to get attention and care to improve the individuals future. This can arise from greater concern by family members, access to better healthcare and counselling, or even an inflow of monetary funds. However, this is contingent on the fact that the attempt has to be perceived as genuine and that others have to be willing to help the individual. This is because is the more severe the attempt at suicide, the more that individuals benefit, in terms of utility , from the act itself. Marcottes research also supports the findings of Hammermesh and Soss, in particular the negative relationship between permanent income and suicide. Insofar as the individualists are willing to as concede that suicide is a problem that needs attention, the solutions they suggest involve increasing the appeal of life and decreasing the incentive to attempt suicide. Since the factors identified have been largely economical factors like unemployment and income, then the individuals most at risk are those who are economicallydisadvantaged, the cause of which is due to existing systems functioning inadequately. The economist (read: individualist) would then point to barriers to perfect labour mobility as examples of such inadequacies. Thus, through a perfectly competitive market system as well as the incentivization of the individuals benefits of living, and by increasing the costs of suicide, the individualist would argue that suicide can simply be priced out of the decision. In fact, the only instance that the adherent would argue for the government intervention is that of the provision of merit goods, in this case mental health services and institutions for the irrational. Clumsy Solutions

Satcher not only highlighted the need for increased scientific research and the institutionalized training of all health-care providers (hierarchical solutions) but also the increased need to raise awareness of citizens, provide resources to community-based support programs, eliminate private and public discrimination in mental health care, and provide access to professional healthcare to all who need such services (egalitarian solutions). The clumsiness of this solution extends as well to grassroots organizations like the Yellow Ribbon Project in the United States, who, like the hierarchists, view teenage suicide as a national health problem. Thus, we have both high-group social solidarities framing the problem in a similar manner and providing the same buffet of solutions. However, we feel that this still leaves out the individualist and fatalist perspectives. Suicide is more than just a group problem, and there are other issues at hand that need to be examined. There is a need to consider the perspective of low-group cultures. From the individualist camp, economic decision making in terms of incentives and costs can be a crucial factor in a suicidal individuals decision matrix. Similarly, there is a need to consider suicide attempts together with completed suicides. As Marcotte (2003) points out, existing literature and research has largely ignored this aspect of suicidal behaviour. From the fatalist camp, the environment, genetics and bio-chemistry all have an effect on an individuals proclivity to suicide, which to a large extent, can hardly be ameliorated by any social or individual action. But the insight provided from Gabenneschs broken-promises effect should serve to remind those formulating counselling strategies that assuring severely depressed people that things would get better when Spring comes is hardly consolatory. Furthermore, the fatalists view of suicide is of particular value to hierarchists seeking to formulate elegant top-down institutional strategies for bringing down the suicide rates. Rather than proposing institutional measures like incarceration and counselling for suicidal individuals, hierarchists ought to be reminded that the medicine is only effective if it treats the disease at its source. To the extent that suicidal behaviour is influenced by individual bio-chemistry, what mentallyill individuals need are not more counselling hours but the appropriate medicine that treats depression.

The solutions implemented today to curb suicide already have an element of clumsiness. A broad alliance of Hierarchists and Egalitarians exist, resulting in a combination of hierarchical and egalitarian solutions that are already being utilized to tackle the issue of suicide. Nonetheless, we argue that such solutions are still insufficiently clumsy to deal with this problem in its entirety. A good example is the U.S. Surgeon-Generals call to action to prevent suicide in 1999, In his paper, Dr

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Unless policy makers can learn to see the issue from these two aspects, then it can be argued that the solutions that are predominantly high-group in nature are still sub-optimal. Policy makers need to be aware of the different collective predispositions to suicide among the four different social solidarities, in order to formulate a successful policy response. While we do not disagree with egalitarians and hierarchists that suicide is a public health issue, egalitarians and hierarchists must adequately address the view of individualists that suicide

is a right, so as to build up a larger social consensus for their cause. Cultural Theory may be parsimonious, but in aiding policy-makers to formulate a policy response that is holistically complete (what we term as clumsy solutions) and successful in a wide variety of situations, its power and utility should not be underestimated. Limitations of Cultural Theory Cultural theory and the grid-group typology originate from ideas in social anthropology, and they seek to explain and account for the different ways in which social relations are organized and perceived in different societies. While each social solidarity has its own explanation for suicide, it is evident from the first section of this paper that collective predispositions to suicidal behaviour are present in the cultural biases, patterns of behaviour and social relations of all four social solidarities. While such collective predispositions are obvious and easy to identify, one should not neglect predispositions to suicide that stem from deeper psychological forces that are acultural in nature. Cultural theory is essentially not a theory of individual types and hence such characterizations of suicide fall outside its locus of explanatory power. In the subsequent discussion, we shall attempt to use Carl Jungs analysis of individual types as a foil to elucidate the limitations of cultural theory as a vehicle for explaining suicidal behaviour.

fifth Social Solidarity) explanation for suicide, but to do so is to dangerously stretch the limits of cultural theory into the realm of individual types. Conclusion In this paper, we have used the theory of sociocultural viability, as well as Mary Douglass gridgroup typology, for characterizing social relations, as a vehicle for evaluating and considering the different characterizations and explanations for suicidal behaviour in a cross-cultural and historical context. From the examples that we have cited, we have identified collective predispositions to suicidal behaviour within each set of cultural bias, pattern of behaviour and nature of social relations that characterize the four different ways of life, namely, hierarchy, individualism, egalitarianism and fatalism.

For Jung, suicidal tendencies arise as a result of a conf lict between conscious and unconscious attitudes, with the former referring to the predominant manner in which an individual orients himself to the outside world, and the latter referring to the residual needs and demands that are stif led or repressed by the conscious attitude. In most people, the unconscious acts as a compensating mechanism; for example, a consciously extraverted person motivated by a purely objective orientation to the outside world has unconscious demands that are egocentric in character, such that the individual continues to have some regard for his personal wellbeing. When such unconscious demands cease to be compensatory and instead impose themselves on the consciousness of an individual, this results in a conf lict that is irreconcilable. In the worst case, this split results in suicide. Jungs analysis is clearly acultural. Conscious and unconscious attitudes and the different individual types are culturally independent, as Jung attributes the decisive factor to individual predisposition, which is itself a result of the complex interactions of the complexes of the personal unconscious and the archetypes of the collective unconscious. The collective unconscious represents the common psychic heritage that all human beings share (Stevens, 1994) and is an inheritance that is species-specific and not culture-specific. We could well consider Jungs analysis as the hermits (the hidden

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