Tag Archives: Research

Suicide in Sri Lanka: Understanding the Crisis

Suicide and deliberate self-harm represent significant health and social crises in Sri Lanka, placing extraordinary burdens on individuals, families, communities, and public services. By the final decade of the 20th century, the Sri Lankan suicide rate was one of the highest in the world; since then the rate has dropped, but rates of deliberate self-harm have significantly increased. The cause of the fall in the suicide rate was mainly the result of means restrictions – banning the most toxic pesticides used in self-harm – and improved health services implemented from the late 1990s, as well as an apparently spontaneous shift to medicinal drugs as a popular method of self-harm, which have a lower fatality rate. This briefing note aims to provide an overview of suicide and self-harm in Sri Lanka in relation to rates, demographic and social patterns, causes, and interventions.

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Publication

Suicide in South Asia: Ethnographic Perspectives

The June issue of Contributions to Indian Sociology is a special issue entitled, ‘Suicide in South Asia.’ Guest editor James Staples writes in his introduction:

“This volume has its roots in a two-day international workshop,
‘Ethnographies of Suicide’, which was held at Brunel University in West
London, UK, back in July 2008. The 15 papers presented there drew on
fieldwork from across the world, with contributions from Afghanistan,
Israel, Japan, South Africa, Greece, Portugal and the UK. It was noteworthy,
however, that a third of the papers, as well as an additional film
presentation, all focused on work that had been conducted in South Asia,
particularly in India and Sri Lanka. Despite having recently begun fieldwork
on suicide in the region myself—in Andhra Pradesh—until I organised
the conference I had been unaware of the wider interest in the topic
among fellow South Asianist scholars, and began to realise that there
was a strong case for bringing more of this work together in a single collection.” (1)

‘Girl Still Burning Inside my Head’: Reflections on Suicide in Sri Lanka

Malathi de Alwis

“This chapter reflects on why suicide has become such a pervasive phenomenon in Sri Lankan society by engaging with the extensive scholarly literature that exists on this subject. Rather than trying to provide some overarching, mono-causal explanation, it seeks to illuminate the complexity of the issue and the varied and nuanced ways in which we might try to apprehend it, be it in conjunction with homicide or political conflict, social change or sexual anomie, restraint or collectivism. While problematising our re-course to the ‘work of culture’ and reading statistics against the grain, this chapter also highlights gendered dimensions and broader conceptual strands where we may not have thought to seek them.”

‘I drank it to put an end to me’: Narrating girls’ suicide and self-harm in Sri Lanka

Jeanne Marecek and Chandanie Senadheera

“Sri Lanka experienced a spiral of suicides in the 1980s and 1990s, with deaths rising to nearly 48 per 100,000 in 1995. Although reported rates of suicide have declined since then, the incidence of suicide and deliberate self-harm remains high, especially among young people. Data on hospital admissions showed that the number of adolescent girls admitted for deliberate self-harm more than doubled between 2001 and 2007. We conducted in-depth interviews with girls in the south of Sri Lanka who were hospitalised for deliberate self-harm. The interviews revealed several common themes in the girls’ accounts of the circumstances that prompted self-harm episodes, their motives and emotions, and others’ responses. Most episodes involved accusations and disputes regarding the girls’ sexual comportment and heterosexual relations. They often involved harsh scolding and beatings by parents. Themes in the girls’ accounts included anger, disappointment, shame, and acute distress; descriptions of their self-harm as an expressive act directed toward others; and disavowal of responsibility for their actions. We suggest that the rise in girls’ self-harm results from the clash between emergent expectations that young women hold regarding advanced education, heterosexual relations, and out-of-home employment and traditional ideals of appropriate feminine comportment and sexual respectability held by their parents.”

Suicide and the morality of kinship in Sri Lanka

Tom Widger

“Ethnographic research amongst Sinhala Buddhists in community and clinical settings in the Madampe Division, northwest Sri Lanka, suggests that local understandings and practices of suicidal behaviour reflect the kinship structure. In particular, acts of self-harm and self-inflicted death arise in response to the breaking of core kinship rights, duties and obligations, or as a challenge to inflexibility or contradictions within the system. In either case, the morality of kinship is closely associated with the causes of suicidal behaviour, as the ‘inevitability’ or ‘evitability’ of kin relationships is negotiated and lived in practice. This article analyses how local political economies give rise to particular kinship and moral conditions, with special attention paid to those between household (gē) members and brothers-in-law (massinā).”

The suicide niche: Accounting for self-harm in a South Indian leprosy colony

James Staples

“This article analyses the circumstances under which attempted suicide became an increasingly common possibility of thought and action among the young, healthy generation of people who had grown up in the South Indian leprosy community where I conducted long-term fieldwork, despite suicide remaining relatively uncommon amongst their leprosy-affected, and often physically disabled, parents and grandparents. Alert to the pitfalls of analytical approaches that either privilege over-arching structural explanations—like those favoured by Durkheim—or, conversely, give too much credence to individual agency and psychology, my analysis here attempts to chart a course through these polarities. It does so by drawing both on Ian Hacking’s ‘ecological niche’ metaphor—to explore how particular configurations of events and circumstances, at different times, might render suicide related behaviour more or less likely among different groups; and on Pierre Bourdieu’s notion of the ‘habitus’—to consider how particular sets of bodily dispositions might generate certain styles of attempted suicide and self-harm.”

Suicide in a central Indian steel town

Jonathan Parry

“Over the past 15 years ‘farmer suicides’ have occasioned grave public concern; and it has recently been claimed that Chhattisgarh has the highest incidence in the country. This article suggests that the representation of such cases as the major public policy problem to do with self-inflicted death is politically inflected and that there are good grounds for supposing that—at least in certain pockets—the urban suicide rate is as high, if not higher. In the industrial area around steel town of Bhilai, this has risen dramatically over the last 20 years and it is the aristocracy of public sector labour that is significantly most susceptible. This is ultimately attributable to the liberalisation of the economy and the consequent downsizing of this workforce, which has led to a crisis in the reproduction of class status. Such workers are privileged; think of themselves as different from the informal sector ‘labour class’ and fear sinking into it. Suicides are significantly under-reported and the official statistics are systematically inflected by fear of the police and the law, which encourage both concealment and the deliberate obfuscation of likely motives, and almost certainly increase the ‘lethal probabilities’ of suicide attempts.”

Farmers’ suicides and the state in India: Conceptual and ethnographic notes from Wayanad, Kerala

Daniel Munster

“This article reflects on the challenge of making ‘farmers’ suicides’ an object of ethnographic inquiry. This challenge is not just a matter of methods, ethics and access but also a matter of categorical choices involved in studying this over-determined and politicised category of self-killing. Drawing on fieldwork in the Wayanad district of Kerala, the article argues that ‘farmers’ suicides’ are not self-evident types of rural death, but become reified and visible through the state’s enumerative practices. This state-defined category, conveyed and scandalised by the media, rests on a connection between suicide and—–an equally reified—‘agrarian crisis’. The ethnographic endeavour of ‘chasing’ the elusive object of farmers’ suicides may destabilise this seemingly self-evident link. Despite this, farmers’ suicides have taken on a political life of their own. They have become a constructed yet real interface for the reworking of the relationship between state and rural citizens in liberalising India. The Indian state has launched unprecedented relief and rehabilitation measures in response to the suicide crisis. This article makes a strong case for grounding the study of farmers’ suicides in ethnographies of agrarian practice and the local developmental state.”

The volume ends with an Endnote by Isak Niehaus, Comparing South Asian and South African Suicide. Niehuas argues:

“Contemporary ethnographers and anthropological researchers face a dual
challenge. On the one hand, we are admonished to guard against treating
our units of study as self-contained, island-like entities, immune from
broader forces and from connections with global impact (Appadurai 2000;
Hannerz 1996). On the other, Marshall Sahlins sounds a stern warning
about ‘endangered specificities’ in the social sciences today, suggesting
that the imposition of external analytical frameworks might well cloud
out, or even annihilate, valid local cultural constructs, perspectives and
understandings (Sahlins 1996; Smith 2002). Our challenge is to situate
our units of study within broader analytical frames without losing sight
of local contours and dynamics. It is to tread softly and to steer a careful
balance, elucidating both the generalities and particularities of our research
information”.

Resource

Mental Health First Aid Guidelines for helping a suicidal person: a Delphi consensus study in India

This study, by Erminia Colucci and colleagues, surveyed suicide prevention experts in India to develop a more culturally relevant set of suicide prevention guidelines:

Background

This study aimed to develop guidelines for how a member of the Indian public should provide mental health first aid to a person who is suicidal.

Methods

The guidelines were produced by developing a questionnaire containing possible first aid actions and asking an expert panel of Indian mental health clinicians to rate whether each action should be included in the guidelines. The content of the questionnaire was based on a systematic search of the relevant evidence and claims made by authors of consumer and carer guides and websites. Experts were recruited by SC, EC and HM. The panel members were asked to complete the questionnaire by web survey. Three rounds of the rating were carried and, at the end of each round, items that reached the consensus criterion were selected for inclusion in the guidelines. During the first round, panel members were also asked to suggest any additional actions that were not covered in the original questionnaire (to include items that are relevant to local cultural circumstances, values, and social norms.). Responses to the open-ended questions were used to generate new items.

Results

The output from the Delphi process was a set of agreed upon action statements. The Delphi process started with 138 statements, 30 new items were written based on suggestions from panel members and, of these 168 items, 71 met the consensus criterion. These statements were used to develop the guidelines appended to this paper. Translated versions of the guidelines will be produced and used for training.

Conclusions

There are a number of actions that are considered to be useful for members of the public when they encounter someone who is experiencing suicidal thoughts or engaging in suicidal behaviour. Although the guidelines are designed for members of the public, they may also be helpful to non-mental health professionals working in health and welfare settings.

Similar guidelines have also been published for Japan and the Philippines.