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FINAL REPORT: Suicide in Sri Lanka: Past, Present and Future Transformations, University of Colombo, 21-22 March 2013

FINAL REPORT

Suicide in Sri Lanka: Past, Present and Future Transformations, University of Colombo, 21-22 March 2013

Introduction

Since the middle of the 20th century, rates of suicide and self-harm rose to ‘epidemic’ proportions in Sri Lanka. From the mid-1990s a series of restrictions placed on the import and sale of the most toxic agrochemicals led to a substantial decreased in the suicide rate. However, emerging evidence – much of it presented at this symposium – suggests that the rate of self-harm has increased exponentially since then. The objective of this symposium was to engage academic researchers and policy makers and intervention practitioners in a dialog concerning the socio-cultural causes and meanings of self-harm and suicide in Sri Lanka, and the implications of this for the development and delivery of effective interventions.

Methodology

The symposium was organised by Dr Tom Widger (University of Sussex) and Ms Tharindi Udalagama (University of Colombo). In February 2013 a Call for Papers (CfP) was announced via academic and policy/practice channels. The CfP attracted twelve abstracts from local and international researchers and interventionists. The resulting programme spread across two days and included five sessions, including a final roundtable debate seeking to integrate the results of discussions from the previous sessions:

Opening session:         Welcome & Plenary Address

Session 1:                    Reading Sri Lanka’s suicide rate

Session 2:                    Self-harm and suicide in ethnographic contexts

Session 3:                    Interventions: transforming suicidalities in Sri Lanka

Session 4:                    Roundtable debate

Formal invitations were sent to a list of academic and policy/practice stakeholders, including representatives of the Ministry of Health, Ministry of Social Services, and local and international NGOs. A few days before the symposium feature stories were published in the Sri Lankan press, which elicited requests for further information and/or requests for an invitation to attend. The symposium was also publicised on the website of the Forum for Suicide & Culture Research (FSCR), and via FSCR Twitter feeds. This helped to raise the profile of the symposium among local researchers.

Results of the sessions

Welcome & Plenary Address

The symposium was introduced by Dr S.M.K. Herath (Head, Department of Sociology, University of Colombo). Dr Herath reminded the audience of the importance of social scientific studies of suicide, especially in Sri Lanka where suicide rates are so high. Next to speak was Dr F.R. Metha (country representative, WHO), who pointed out the heavy psychological and social burden represented by, and caused by, Sri Lanka’s suicide and self-harm epidemic. The plenary address was given by Professor N. Fernando (National Institute of Mental Health). Professor Fernando’s talk provided a general introduction to self-harm and suicide from a global perspective. A lively debate followed concerning the relationship between suicide and mental illness, with one side arguing for a strong relationship with depression and the other suggesting only a weak correlation.

Session 1: Reading Sri Lanka’s suicide rate

The aim of this session was to establish the quantitative framework of suicide and self-harm in Sri Lanka. Three papers were presented, each exploring the rise and fall of the suicide rate from, broadly, medical epidemiological, sociological, and anthropological perspectives. Results of the session included an increased awareness that even though suicide rates have fallen, the rate of self-harm is increasing. A consensus was reached that self-harm remains a major health and social problem and renewed commitments to prevention should be made.

Session 2: Self-harm and suicide in ethnographic contexts

The aim of this session was to provide context to the quantitative picture. Three papers were presented, including two concerned with self-harm and suicide in southern Sri Lanka and one with suicide in northern Sri Lanka. The papers included discussions of suicide and gender, suicide and kinship, and suicide and war. The papers showed how acts of self-harm and self-inflicted death are caused by relational disputes and accusations of shame, and exist as a social practice rather than the consequence of deep-seated psychopathology.

Session 3: Interventions

The aim of this session was to provide an overview of suicide interventions in Sri Lanka and to assess their effectiveness. Five papers were presented, including a review of government policies and in particular the national suicide prevention strategy published in 1997. While the GoSL was lauded for being the first government in Asia to produce such a document, consensus was reached that a new policy is urgently needed and that this should include an implementing body. Building on the findings of the previous sessions, it was also generally agreed that interventions based on Euro-American approaches were unlikely to be effective in the Sri Lankan socio-cultural context.

Session 4: Roundtable debate

The aim of the debate was to address the theme of the conference – what are the social and cultural challenges of suicide prevention in Sri Lanka, and how might they be overcome? – by building of the results of the past two days’ discussions. Six panelists took part, representing the GoSL, local and international suicide prevention organisations, and academia. Results of the debate included calls for greater communication and collaboration between academic researchers and interventionists, and for greater commitments to research targeting the needs of policy and practice experts. It was also expressed that interventionists rely too much on Euro-American approaches to understanding suicide and suicide prevention, and that greater attempts should be made to engage with socio-cultural approaches relevant to the Sri Lankan context.

Outcomes of the symposium

The symposium generated a large amount of interest. Among those who presented at or attended the symposium, there was keen enthusiasm to maintain the momentum started and to forge lasting networks of researchers and prevention experts. To facilitate this, the presentations were made available on the FSCR website. Selected papers will be published in English, Sinhala, and Tamil as part of a special issue of the University of Colombo’s sociology journal.

Among policy/practice stakeholders the symposium provided further impetus to start new projects. The World Bank, in particular, has showed a strong interest to build on the results of the symposium. The Development Partners Secretariat requested a one-page brief to distribute amongst donor organisations and INGOs in order to raise further awareness of the issue. A few days later, the organisers and WHO met with the World Bank’s Senior Health Specialist to discuss how intervention programmes could be taken forward and these meetings are still continuing.

Overall the symposium demonstrated that a large network of researchers and policy/practice experts exists in Sri Lanka, which until the event had not met or had the chance to hear about each other’s work. The symposium suggested that there is significant potential to develop a consortium of experts to conduct policy/practice orientated research studies and develop socio-culturally relevant suicide interventions. As a direct result of the symposium several stakeholders are now in discussions about how this might happen.

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Suicide and the ‘Poison Complex’: Toxic Relationalities, Child Development, and the Sri Lankan Self-Harm Epidemic

Widger, T. (2015). Suicide and the ‘Poison Complex’: Toxic Relationalities, Child Development, and the Sri Lankan Self-Harm Epidemic. Medical Anthropology, DOI:10.1080/01459740.2015.1012616

Suicide prevention efforts in Asia have increasingly turned to ‘quick win’ means restriction, while more complicated cognitive restriction and psychosocial programmes are limited. This paper argues the development of cognitive restriction programmes requires greater consideration of suicide methods as social practices, and of how suicide cognitive schemata form. To illustrate this, the paper contributes an ethnographically grounded study of how self-poisoning becomes cognitively available in Sri Lanka. I argue the overwhelming preference for poison as a method of self-harm in the country is not simply reflective of its widespread availability, but rather how cognitive schemata of poison – a ‘poison complex’ – develops from early childhood and is a precondition for suicide schemata. Limiting cognitive availability thus requires an entirely novel approach to suicide prevention that draws back from its immediate object (methods and causes of self-harm) to engage the wider poison complex of which suicide is just one aspect.

Suicide in Sri Lanka: The Anthropology of an Epidemic

Suicide in Sri Lanka-book coverWhy people kill themselves remains an enduring and unanswered question. With a focus on Sri Lanka, a country that for several decades has reported ‘epidemic’ levels of suicidal behaviour, this book develops a unique perspective, linking the causes and meanings of suicidal practices to social processes across moments, lifetimes, and history.

Extending anthropological approaches to practice, learning, and agency, anthropologist Tom Widger draws from long-term fieldwork in a Sinhala Buddhist community to develop an ethnographic theory of suicide that foregrounds local knowledge and sets out a charter for prevention. The book highlights the motives of children and adults becoming suicidal, and how certain gender, age, and class relationships and violence are prone to give rise to suicidal responses. By linking these experiences to emotional states, it develops an ethnopsychiatric model of suicide rooted in social practice. Widger then goes on to examine how suicides are resolved at village and national levels, and traces the roots of interventions to the politics of colonial and post-colonial social welfare and health regimes. Exploring local accounts of suicide as both ‘evidence’ for the suicide epidemic and as an ‘ethos’ of suicidality shaping subjective worlds, Suicide in Sri Lanka shows how anthropological analysis can offer theoretical as well as policy insights.

With the inclusion of straightforward summaries and implications for prevention at the end of each chapter, this book has relevance for specialists and non-specialists alike. It represents an important new contribution to South Asian Studies, Social Anthropology and Medical Anthropology, as well as to cross-cultural Suicidology.

Cultural, social, and medical equity could provide lasting solutions to Sri Lanka’s suicide epidemic

Following a decade of decline, Sri Lanka’s suicide rate – once amongst the highest in the world – is reported to be on the rise once again. It’s too early to tell whether this is a temporary blip or the beginnings of something more serious. But what is known is that the fall in the suicide rate was the result of ‘means restriction’ – chiefly sales restrictions placed on the most toxic pesticides – and not the result of falling levels of suicide attempts per se. In fact, the evidence suggests that the number of suicide attempts has actually increased in the same period, with suicidal behaviour remaining a leading cause of serious injury and death in youth and older persons in Sri Lanka. Continue reading

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.

Continue reading

Publication

Reading Sri Lanka’s Suicide Rate

Tom Widger

By the final decade of the twentieth century, rates of suicide in Sri Lanka ranked among the highest in the world. However, in 1996 the suicide rate began to fall and was soon at its lowest level in almost 30 years. This decline poses problems for classic sociological theories of suicide and forces us to question some fundamental assumptions underlying social scientific approaches to the suicide rate. Drawing from sociological, medical epidemiological, historical, and anthropological secondary sources as well as 21 months of original ethnographic research into suicide in Sri Lanka, I argue that there are four possible readings of the country’s suicide rate. While the first three readings provide windows onto parts of the story, the fourth—a composite view—provides a new way of thinking about suicide, not just in Sri Lanka but also cross-culturally. In so doing the paper poses questions for how the relationship between suicide and society might be imagined.

Event

Suicide in Sri Lanka: Past, Present, and Future Transformations

21-22 March 2013

University of Colombo, Sri Lanka

Rates of suicidal behaviour have existed at ‘epidemic’ proportions in Sri Lanka for several decades, and in recent years there has been a marked increase in the number of ethnographic and other qualitative researchers investigating the problem. However, to date there has been little opportunity for qualitative researchers to present their findings in dedicated forums and this has reduced opportunities for debate and the development of collaborative projects as well as scope for impacts on practitioners and policy makers.

The aim of this symposium is to provide an opportunity for anthropologists, sociologists, and public health specialists employing ethnographic and qualitative methods to share the results of on-going research, recently completed research, and research proposals currently in the planning stage. The objectives will be to:

  • Provide an overview of current anthropological/ethnographic research into suicide in Sri Lanka underway, and debate empirical and theoretical issues and themes;
  • Discuss ethical and practical issues and challenges faced when studying suicide ethnographically, including how to ensure the wellbeing of researcher and research participants; and
  • Debate, as part of a roundtable discussion, how anthropological studies of suicide can inform the development of more culturally relevant treatment and prevention programmes.

The theme of the conference is past, present, and future transformations. We are interested in the concept of transformation in both temporal and social dimensions.

  • Past: How have suicide in Sri Lanka, and the Sri Lankan suicide rate, transformed across time? Over the second half of the 20th century, the suicide rate spiralled to epidemic proportions, before significantly falling after the mid-1990s. While sociologists attributed the rise in the suicide rate to macro-level forces of social change (Kearney & Miller 1985), epidemiologists associated the fall with controls placed on the most lethal pesticides, which had hitherto accounted for the majority of suicide deaths (Gunnell 2007). However, in recent years there have been growing reports that levels of both self-harm and suicide are increasing once again (IRIN 2009; Bandara 2012; Senerathna 2012; Silva 2012), calling into question the efficacy of pesticide control measures. Meanwhile, state and lay narratives of suicidality have equally transformed, informing each other through looping processes (Widger 2012b).
  • Present: How does suicide transform social relations? However meanings of suicide might have transformed across time, in everyday practice in the contemporary moment they often cohere with established narratives (Marecek 1998, 2006; Marecek & Senadheera 2012). Self-harm and suicide can be understood as offering transformations at the personal and inter-personal levels. On one level, suicidal practices offer a means of redress for powerless people – an avenue for expression and communication which works by ‘putting the idea of death into other people’s minds’ (Widger 2009, 2012a). But on another level, suicidal practices offer ways of transforming psychological and social statuses and positionalities and as such, the fabric of sociality itself. Performed as much to create as to negate (Widger 2012b), suicidal practices in Sri Lanka can be understood as driving social change through ‘a thousand cuts.’ Engagements with suicidal behaviour can be understood as commentaries on society at large (Hewamanne 2010).
  • Future: In what ways might suicide in Sri Lanka be transformed? If suicide is the by-product of a self-harm endemic, how can the endemic be addressed? Much of the literature would seem to suggest that suicidal practices are intractable: they are not caused by discreet illnesses which can be treated through direct interventions but rather are the product of social structures, cultural traditions, and deeply ingrained ways of understanding and acting in the world. Given this, it is not as clear what might work, as it is what does not work – perhaps it is time to reevaluate how we consider the possibility of suicide prevention, beginning with the very terms we use.

Paper submissions (30 minutes in length) are invited which engage with these or similar themes.

Please contact Dr Tom Widger (t.widger@sussex.ac.uk) for further information!