Suicide Cultures: Reimagining Suicide Research – Page 2 – A blog about the Suicide Cultures research project

In this post I reflect on an instance of interrupting a discussion about suicide. I explore how asking different questions about the relationship between suicide and social inequality allows for different kinds of engagements with suicide. These kind of interruptions are simultaneously challenging, uncomfortable and necessary.

On the 17^th of March, my colleague Sarah Huque and I attended an online roundtable discussion hosted by the Psychological Society of South Africa (PsySSA) entitled Suicide in South Africa: An Intersectional Dialogue. I was looking forward to the discussion, both as a researcher who works on suicide and as a research psychologist who previously trained and worked in South Africa.

I was particularly looking forward to the ‘intersectional’ focus of the discussion. The roundtable brought together the Operations Director of the South African Depression and Anxiety Group (SADAG); a mental health journalist who had lost her son to suicide; a psychiatrist; and a journalist who has survived “suicidal ideation/experimentation” (their words). The panel was attended by nearly 250 people, from across South Africa.

However, I was disappointed to discover that the discussion was dominated by a narrow, individualised, medicalised understanding of suicide. Someone repeated the phrase “the most dangerous kind of depression is an unmedicated one” and the psychiatrist proclaimed that “90% of those who die by suicide have a mental illness”[1]. The panelist from SADAG mentioned that since the beginning of the COVID pandemic they were experiencing a dramatic increase in calls to their crisis hotline but in the panel discussion there was no connection made between this increase and the particular social realities of South Africa, which has often been described as “the most unequal country in the world”. For me this was a clear and problematic missed opportunity to explore how the COVID-19 pandemic has intersected with existing social inequalities to make lives unliveable for millions of people in South Africa. This was but one example of the failure to engage with issues of inequality during the discussion.

By the end of the session I was feeling extremely frustrated and angry. In conversation with my colleagues in the Suicide Cultures project the next day, we reflected on how these kinds of discussions perpetuate decontextualised understandings of suicide. Spurred on by my colleagues’ shared concerns, I decided to write to the organisers of the event and express my disappointment. In my email I explained how I was especially disappointed by the lack of reflection on and engagement with the structural conditions which produce distress, in light of South Africa’s various intersecting legacies of inequality. I also noted that I felt PsySSA, as the representative body of psychologists in South Africa, had a responsibility to promote more holistic, ethical and contextually-relevant understandings of suicide rather than merely perpetuating individualised, psychiatric ones. I felt slightly better having, at least, articulated my frustration in this way but I did not have high hopes of a constructive response.

I was pleasantly surprised to receive a response a few days later acknowledging my concerns and inviting me to participate in a follow-up question and answer session. I was invited, during this session, to share my reflections on the initial discussion and to pose some questions to the panellists. I was both pleased and daunted at this opportunity to interrupt the discussion about suicide, especially as someone who is not a clinical professional. But I also felt a sense of responsibility to insert issues of inequality into the discussion of suicide, so I accepted the invitation.

I began my reflection by noting that the initial session had focused predominantly on identifying “signs” that people may be suicidal; promoting medication as the most effective treatment of suicidal distress; as well as suggesting that people who are experiencing suicidal distress can be protected using (coercive) forms of surveillance. I reflected on how these kinds of discussions are part of dominant ways of thinking about suicide, not only in South Africa but across the globe. I noted that it was important to expand understandings of suicide beyond these narrow focuses in order to more meaningfully contextualise people’s distress. Informed by many of the discussions we have had as the Suicide Cultures research team, as well as engagement with work of others in critical suicidology, I then posed the following questions:

How can we talk about ‘mental health’ and suicide in South Africa without centring issues of inequality and justice? By this I do not mean merely mentioning ‘social determinants of health’ or how some people’s distress may be caused by a lack of sense of safety in their communities, but rather what would it mean to reframe suicide as a social and political issue that is produced by social injustice, which demands social and political rather than merely individual responses?
What would it mean to shift from thinking about suicide as a mental health problem caused by depression to thinking about it as an expected and reasonable response to socioeconomic disadvantage or other kinds of social exclusion?
How do medicalised understandings of suicide and distress normalise social contexts which make life unliveable for many people?
How can we develop psychopolitical approaches which make connections between social inequality, injustice, and the emotional impact this has on people?
How can we shift from individual to collective efforts to repair ongoing social injustices?

Unfortunately, two of the previous panellists were unable to join the question and answer session due to load-shedding[2]. However, it seemed the questions I posed spoke to many of the challenges that South African psychologists and counsellors were facing, with many of them sharing their frustration about the difficulties of supporting people struggling with distress. There was also much discussion about inequalities in terms of being able to access mental health care, particularly for people living in rural areas. In this way, the critical interruption that I posed appeared to open up ways to talk differently about suicide. This was an important reminder of the power of interrupting normative conversations about suicide and how these interruptions can reframe suicide in relation to issues of social inequality. This is part of the work that we as the Suicide Cultures research team are doing through a variety of channels, including our seminar series, podcast and this blog.

[1] For reflections on the problematic nature of these kinds of statistics see Examining the Claim that 80–90% of Suicide Cases Had Depression – PMC (nih.gov).

[2] Load-shedding refers to scheduled rolling blackouts due to an insufficient supply of electricity, which is a relatively frequent occurrence in South Africa.

The image included here is “Unequal Scenes – Durban, South Africa” by Global Landscapes Forum, licensed under CC BY-NC-ND 2.0.

May 18, 2022

Working through the ethics of ‘Suicide Cultures’: Part I – In Good Faith

By Sarah Huque

On 9th March 2022

In Ethics

This post is the first in a new series on the Suicide Cultures blog, exploring the ethics of the project. We will periodically post new pieces discussing ethical challenges we encounter, discussions we have, and actions we take to try to find solutions.

The idea of moving discussions of complex ethical issues into actions came up during our most recent Suicide Cultures seminar, led by Fiona Malpass and Jennifer White. That presentation invited participants to discuss the Critical Suicide Studies ethics statement, and at the end, the facilitators asked us to think about what actions we would take as a result of the rich and challenging discussion during the session. [Keep an eye out for the recording/summary coming to the Seminar Series section of this blog soon.] To respect the privacy of participants, we will not discuss the details of the seminar in depth here – though many of the issues raised are similar to those raised within the Suicide Cultures team, which we will discuss throughout this ethics blog series.

The ethics application: Ethics 101

For all researchers working with people, an institutional ethics application is one of the fundamental actions we must take. In this first ethics blog post, we review some of the ethical challenges the Suicide Cultures team faces – discussing both the process of putting together our actual ethics application as well as some of the ‘less tangible’ ethical conundrums with which we struggle. We used the process of writing the ethics application as a starting point in moving our theoretical ethical questioning into the realm of the practical, as we prepare for fieldwork to commence this year. The process of engaging in what can feel like a bureaucratic ‘box-ticking’ exercise can be an action that jump-starts more complexity in thinking about ethics than the form may allow – if we engage with ethics as an on-going process, in good faith. For further reading, and a recent example of deep reflection on, challenging of, and expansion of thinking around the ethical considerations of suicide research, see Jaworski (2022).

There are plenty of scathing indictments of institutional ethics procedures, and for good reason. We will touch on some of these negatives but want to focus on the positives that can arise from engaging with institutional ethics – and the ways in which researchers can help their institutions evolve by putting more, and more in-depth thought, into their ethics applications. Here are some of the ways in which we tried to push the bounds of our ethics application.

One of the challenges can be when bureaucracy seeks to ‘protect’ ‘vulnerable’ participants in ways which provide legal cover but little real support. This tension can present in many ways, for example in researchers jumping through hoops to provide standardised procedures and token protections that do not allow for the development of individualised safety plans for participants. For the Suicide Cultures project, we contended with this challenge by creating a standard format for developing safety plans with participants, with some general resources populated, but also leaving space for one-to-one discussions of support needs with participants. By including this in our ethics application, we hope to build upon the idea of what protection means – and introduce agency and self-determination into the development of safety plans. This issue can also manifest in a tension between agency and protection – for example, we as researchers may be required to inform authorities if we believe a participant is intending to harm themselves in the immediate future. We stated this requirement clearly on our participant information sheets, in order to be up front with the constraints on researchers as professionals, which in turn can constrain participants’ agency. We hope this will enable participants to choose what they share with us carefully.

We are also working with a range of creative methodologies – which come with their own challenges, not least of which is the additional scrutiny applied to non-traditional methods. Part of ensuring we can justify the use and value of these methods involved exploring the lessons learned from those already using these methods; we read about photo voice, mapping, walking interviews (as well as interviewing in general and ethnography/participant observation) in-depth, discussed what we found, and explored legal and copyright rules and health-and-safety concerns. We continued this action by hosting a small internal seminar on all of these methods – to share this learning and discuss the implications of these methods – in a similar manner to the ethics seminar discussed in the introduction. These are small, early-stage actions that can help us to engage in research in as ethical a way as we can – and to continue the conversations beyond the forms.

Continuously engaging with ethics is important, because one of the major challenges we faced in trying to translate some of our ethical concerns into concrete actions for the research project was doing this with all of the uncertainties that accompany research planning. Realistically, we cannot predict every challenging situation that will arise across the lifetime of the project – especially since at the moment in-person versus digital is still a major question as Covid-19 continues to disrupt our ‘usual’ ways of doing research.

Institutional ethics is important in that it compels researchers to think about accountability and protection. It can also jump start more complex thought processes around ethics; we are challenged to think ahead and to think about ALL of the people who may be involved/impacted. For example, in a previous ethics application we submitted, for a review of Fatal Accident Inquiry (FAI) reports of deaths by suicide in prison, we had to consider the impact of our document review on (for example) the families of the person who has died, witnesses in the inquiry, and the sheriff who wrote the report. We also continue to grapple with the use of reports about a person who cannot consent or contribute to the process. [We plan to dedicate a separate post in this series to the ethics of these FAI reviews, and to issues around the use of information about and creation of subjectivity around someone who has died.]

Ethics beyond the application: The struggle to do no harm – and to try to do good

During a recent Suicide Cultures team meeting, we discussed the newsletter that we send to our mailing list with updates about the project. This discussion naturally segued into a conversation about how much to reveal, how identifiable areas we work in might be from different outputs we have/will produce, and the discomfort of writing about other people. We did not come up with any ‘good’ answers, but we agreed that having these discussions was a positive sign – and that engaging with ethics in research is an ongoing process that must be undertaken to the best of our abilities. We are trying to work in good faith – knowing that there is no such thing as perfectly ‘ethical’ research. Following this discussion, we took the action of dedicating a session of our monthly meeting series on emotions to think through the discomfort that comes along with trying to do research in an ethical manner – and how we can use, engage with, and sit with that discomfort.

To conclude this introductory post in our ethics series, we made a list of some of the concerns we continue to grapple with – engaging in discussions and imagining ways to translate these discussions into actions. We will explore some of these topics in future posts in this series – for now, we leave you with only (a limited list of) questions:

The tension between agency and protection (revisited).
- How do we engage communities?
- How do we incorporate feedback into our work?
- How do we navigate the line between agency/self-determination and qualitative analysis?
Moving online: ethics of research during Covid-19.
- Ensuring safety;
- Following rules;
- The impact of the digital divide.
How do we relate to ethics ourselves?
- In what ways are we implicated in systems (e.g. through analysis of FAI reports)?
- To what extent do we have the right to do this research? Why do we do it (anyway)?
How can we keep engaging in actions to do ethical research in good faith?

References

Jaworski, K. (2022). The ethics of facing the Other in suicide. Health, 26(1), pp. 47-65.

Mar 9, 2022

February 2022 Newsletter

By achandle

On 10th February 2022

In Uncategorised

The February 2022 newsletter for the Suicide Cultures project is now available, featuring updates from the project.

Suicide Cultures Newsletter 3 Feb 2022_final

Feb 10, 2022

Staying Alive: risk, resistance and responses to LGBT+ youth suicide in Scotland

By Hazel Marzetti

On 17th November 2021

In Events

Do you want to learn more about LGBT+ youth suicide? Are you keen to think about practical strategies for prevention? Do you want to meet others who are interested in doing similar work? Come along to our event on the 24th November 4-6pm to find out more!

Nov 17, 2021

What does it mean to investigate suicide cultures?

By Joe Anderson

On 7th September 2021

In Culture

As a project defined around the central aim of investigating “suicide cultures” in Scotland, we thought it might be a good idea to start talking about what we mean when we say we want to understand cultures of suicide. Culture is a concept that has been used to understand the ways that people live around the world. It brings out the nuanced nature of human connections and will be a useful tool in trying to decode the complexity behind why someone would take their own life.

The Evolution and Diffusion of Culture

Culture has been one of the most controversial concepts in the history of anthropology. Just as quantum physicists debate the nature and properties of particles, so anthropologists debate culture. The first theorists of culture in anthropology were firmly allied with European colonial power. The prominence of scientific racism in the 19th century opened the door to a hierarchical view of culture that saw different races on different stages of linear development that could be tied to characteristics such as skull size, social organisation, and “primitive Vs civilized” cultural practices (Chakrabarty 2007; Bridges 2011). Culture had a direction, said early anthropologists, who took for granted that European white culture was the most desirable and highest expression of human life, a form of organisation that all other societies would eventually arrive at.

Sep 7, 2021

A path is worn through a field of grass and heather leading up to a small evergreen tree.

Exploring grief, positionality, and landscape through film: Reflections and questions inspired by the documentary ‘Evelyn’

By Sarah Huque

On 30th August 2021

In Suicide bereavement

While exploring creative methodologies for approaching and understanding suicide, I came across a documentary film called ‘Evelyn’^[1]. The documentary follows the filmmaker, Orlando von Einsiedel, and his family as they spend five weeks walking in various scenic locations across the UK and talking about their brother, the eponymous Evelyn, who died by suicide 13 years prior.

The feature-length film provides a glimpse into one way in which art and landscape are used to work through grief, as well as raising questions about the experience of grieving a loved one who has died by suicide. How stories of suicide are built in art can indicate to what extent loved ones reflect common societal conceptualisations of suicide – arguably one way in which culture can impact on individual life stories. However, there is also room to demonstrate how families may ‘move beyond’ accepted narratives – for example, in public grieving and its impact in dispelling stigmas around suicide.

The director, as a professional filmmaker – the artist – and subject of the film, used his changeable roles in the project as a way at first to avoid talking about his own emotions to his family. This was raised by other participants and slowly worked through during the film, leading von Einsiedel to open up a bit more about his grief. This is interesting, as it indicates that while the assumption is that making art can be cathartic, it may also provide spaces to ‘hide’ from feelings. (Which is not necessarily negative but is an important point to note if the intention of arts-based working is therapeutic.) The filmmaker’s desire to hide, in part due to his position as the eldest brother and perception of his need to be strong for his siblings, also highlights that the loved ones of an individual who has died by suicide will experience their bereavement through the prism of their own positionality.

The film moves between different perspectives, highlighting how different experiences of grief (and engagement with the film-making project) may reflect a particular person’s social position – ultimately impacting the stories they tell. It also focuses on conversations between people who knew Evelyn – engaging in a process of building narratives about a loved one, which may evolve in the telling and in the adding from other perspectives. Importantly, some family members’ memories and experiences contradict one another, leading to moments of conflict in the film. The film attempts to share with the viewer a sense of who Evelyn was as a person. For me though, this also raises caution around interpreting these stories as ‘truths’ about him – Evelyn is no longer able to affect how his loved ones interpret his life, embodiment, and story. To the film’s credit, leaving some conflict in the film underlines the subjectivity of ‘knowing’ a person through our relationship(s) with them.

Absence-presence, landscape, and grieving through place

The film involves a great deal of movement and a sense of attachment to place. The family members retrace walks they had done with Evelyn and revisit the memories both stored and unlocked in place. Landscape – places of memory and importance to the individual – offers an interesting suggestion for a methodology that enables bereaved family members to engage with places that were important to them and their deceased loved one, and that impacted their relationships. Research methods that can embrace this place-centredness and mobility may ‘unlock’ different perspectives, expand understandings of a person through connecting with places special to them, and embed memories in materiality. (See for example the work of Maddrell^[2] in exploring absence-presence and place in grieving.)

While they walk, the family members begin to open up to strangers they meet who ask what they are doing – spurred to curiosity by the presence of the filming equipment. Throughout the course of the film, we watch the family members become increasingly comfortable with talking about Evelyn and suicide with those outside of their group. The story of the film shows viewers this process of emerging from an idea of suicide as a stigmatised, shameful topic that is not spoken about, and how the film, as an expression of mourning and healing, moves across the spectrum of the public-private. The film depicts interactions with other people who have lost individuals to suicide, clearly making an argument for the universality of this type of grief and expressing an opinion about the power of talking about it through the positive reactions from others with whom they engage. In this way, the film ultimately finds its thesis point, that silence about suicide is harmful, both within a public and a private context.

The film seems to present this point as somewhat deviant and/or revelatory, which is an interesting perspective given the prevalence of ‘talking about it’ as a major aspect of suicide prevention narratives and strategies. As a piece of art that reflects, creates, and comments on culture, the film’s sense of its own deviance draws together the various themes of the piece and raises questions about suicide culture(s) in the UK, outside of a policymaking/prevention/research setting. The film’s deviant mood may be a reflection of the filmmaker himself, and the evolution of his own ability and desire to talk about Evelyn’s suicide as the film progresses. Through his journey, the viewer understands how difficult it can be to actually practice ‘talking’ about suicide – and the ways in which this may be tied into ideals of stoic masculinity in the director’s need to take care of his siblings. This take on the filmmaker’s identity also reflects the focus on masculinity and emotional expression in research on men’s suicide – though less often on men’s grief. (For an example of work that has focused on men’s grief, see Creighton et al.^[3]) At the same time, this journey reflects change over time, and a change to the way the filmmaker but also broader society has approached suicide over the past thirteen years, suggesting momentum and improvement – a cultural shift, perhaps – around talking about suicide.

The sense of deviance at the end of the film also draws on the spaces in which we feel we can talk about suicide. Part of the film’s actual deviant action may be that the travellers spoke about suicide somewhat randomly, with strangers, in open, beautiful spaces – and with less hesitation as the film progresses. This in itself does feel somewhat deviant and reminds me of my (on-going) journey in being open to telling people that I research suicide when they ask what I do. As a culture, we are increasingly in agreement that we should talk about suicide, but there may still be barriers to where, when, and how we feel it is appropriate to have these conversations; should we only talk about suicide in proscribed mental health, death, and suicide-related spaces? The film says no, portraying these conversations as powerful, insightful, and relatable. It suggests a continuation of the emerging changes to talking about suicide the more people are willing to open up and within a greater variety of spaces.

[1] Evelyn (2018). https://www.evelynmovie.com.

[2] Maddrell, A. (2013). Living with the deceased: absence, presence and absence-presence. Cultural Geographies, 20(4), pp. 501-522

[3] Creighton, G., Oliffe, J.L., Butterwick, S. and Saewyc, E. (2013). After the death of a friend: young men’s grief and masculine identities. Social Science & Medicine, 84, pp. 35-43.

Aug 30, 2021

Reflecting on the release of ethnicity in ONS suicide reporting

By Emily Yue

On 23rd August 2021

In Theorising suicide

The Office for National Statistics (ONS) has recently published suicide data by ethnicity in England and Wales (not Scotland) by comparing 2012-2019 death registrations and self-reported ethnicity from the 2011 Census (ONS 2021). Having previously reported only age and gender, this development casts a new light on the UK’s “male suicide crisis” for middle aged and young men (see Samaritans 2012; CALM 2019).

I have argued elsewhere that in light of the UK’s recent and historic immigration practice and policy which produces Britishness as synonymous with whiteness, that the paucity of ethnicity in suicide reporting and thus the prevention campaigns such statistics generate, translates to the male suicide crisis being a crisis for white men (Yue 2021b forthcoming). Like Cohen, Katona and Bhugra (2020), I have called for intersectional suicide reporting which includes ethnicity, in order to better reflect the reality of British people.

Aug 23, 2021

Qualitative, sociological approaches to self-harm and suicide

By Hazel Marzetti

On 18th August 2021

In Uncategorised

This blog is written as part of the BSA Medical Sociology event MedSoc Month, which has invited attendees to think creatively both about the topics we research and about how we communicate and engage others with that research. When we saw the call for paper, as suicide and self-harm researchers we (Hazel Marzetti a post doc at the University of Edinburgh, Veronica Heney a PhD student at the University of Exeter and Amy Chandler a senior lecturer at the University of Edinburgh) were excited at the opportunity to work together and find connections between our qualitative, sociological work on suicide and self-harm, as these opportunities are few and far between within this primarily quantitative, psychologised area of research.

Aug 18, 2021

Challenging our well-rehearsed stories of suicide bereavement

By Kelly Stewart

On 22nd July 2021

In Suicide bereavement

My mother died by suicide when I was twenty. Two years earlier, she told me my grandfather, her father, had hanged himself nine days after I was born. I realised over time my relationship with my mother whilst she was alive had been sandwiched between two suicides. Two generations of suicide, two generations bereaved by suicide. My earlier master’s research, which explored the lived experience of losing a mother to suicide (Stewart and Thomas 2018), left me with an intriguing and difficult-to-sit-with finding. That suicide appeared to run in families. Something intergenerational happening. Indigestible feelings passed on to the next generation(s), along with a big dose of suicide risk. How might we understand this? Herein lies the foundation of my PhD, which explores the intergenerational trauma of suicide in families. And when I arrived at the crucial (and rather exciting) stage of recruiting participants, I encountered a surprising and deafening silence to my advert, for several months, causing me to pause and wonder what might be getting enacted or played out here.

Jul 22, 2021

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