Suicide and Social Justice

New Perspectives on the Politics of Suicide and Suicide Prevention

Mark E. Button, Ian Marsh

• Publisher: Routledge
• Year: 2019
• ISBN:
  9780429863875
• Edition: 1
• Topic: Politics & International Relations
• Subtopic: Social Policy
• Index: Politics & International Relations

Suicide and Social Justice unites diverse scholarly and social justice perspectives on the international problem of suicide and suicidal behavior.

With a focus on social justice, the book seeks to understand the complex interactions between individual and group experiences with suicidality and various social pathologies, including inequality, intergenerational poverty, racism, sexism, and homophobia. Chapters investigate the underlying and often overlooked connections that link rising rates and disproportionate concentrations of suicide within specific populations to wider social, political, and economic conditions.

This edited volume brings diverse scholarly and social justice perspectives to bear on the problem of suicide and suicidal behavior, equipping researchers and practitioners with the knowledge they need to fundamentally rethink suicide and suicide prevention.

Part I

1 Suicide and Social Justice

Discourse, Politics and Experience

Ian Marsh

Introduction

Over time, suicide has variously been considered from theological, philosophical, moral, ethical, sociological, psychological, literary, autobiographical, psychiatric, epidemiological and medical perspectives (to name just some of the most obvious). One way to approach the subject of suicide is to examine how the issue is framed in such accounts, and the relationship of representation to practices and experience. Obviously, it would be a huge task to attempt to map all perspectives and related practices. However, a tighter focus on the dominant ways in which suicide is constructed at particular times in specific places allows us to cast light on not only the meanings that get attached to suicide, but maybe, more complexly, on the relationship between the ways in which suicide is represented or framed, what gets done in relation to the issue, and the effects in terms of people’s experiences of suicidality and suicide.

In previous work (Marsh, 2010, 2016) I have suggested that contemporary mainstream ways of framing suicide are grounded on particular assumptions that decisively shape thought and practice: namely, that suicide is pathological (“People who kill themselves are mentally ill”); suicidology is science (“We will come to the best understanding of suicide through studying it objectively, using the tools of Western medical science”); and suicide is individual (“Suicidality arises from, and is located within, the ‘interiority’ of a separate, singular, individual subject”). I would argue that despite the advances of a broader public health approach in the field of prevention, suicide is still, for the most part, understood as primarily a question of individual mental health, and that as a consequence, wider economic, social, historical and political contexts of suicide have remained relatively under-examined. More recently, however, work explicitly linking suicide to issues of injustice, inequality, exclusion and oppression has emerged – constituting what could be called a political or social justice approach to suicide. In this chapter, I am interested in what links these approaches, in how the relationship between social injustice and suicide is variously formulated, in the assumptions underlying such accounts, and also in what possibilities for thought and action are opened up through the discursive construction of suicide as a question of social justice.

Approach

The aim here is not to survey all papers, chapters and books that have dealt with suicide in relation to issues such as poverty, social exclusion, oppression of minority groups, and so on – a historical mapping of texts that link suicide to social problems is not the purpose of the chapter. Rather, it has more modest and focused goals. The approach taken here is, broadly speaking, a discourse analytic one (Bacchi, 2009; Marsh, 2010, 2016). I am interested in how, within particular texts, questions of social justice are brought into relationship with suicide; that is, in how that relationship is conceptualised, and on the styles of thought (Rose, 2000), vocabularies, stories, ideas and images which are drawn on in accounts that link social injustice to suicide. Of particular interest are the ways in which traditional bio-medical, psychiatric and psychological approaches to suicide are conceptualised within social justice discourse – as I believe a yet-to-be settled question is the extent to which the relationship between existing dominant “psy” approaches and emerging political or social justice formulations of the issue could be said to be complementary or necessarily in opposition.

There are also questions relating to the assumptions which could be said to underlie different accounts of suicide – how the relationship between language and experience is formulated, what sort of claims to truth are made and on what basis, and how notions such as personhood, agency, intention and causation are conceptualised, and to what effect.

I am also interested in what possibilities for thought and action are opened up through the discursive construction of suicide as explicitly a question of social justice. By this I mean, what might the different ways of framing suicide as a political or social justice issue mean for practice, for research, and for how people might come to understand and experience suicide and suicidality differently. Or to put it another way, what alternative ways of understanding and responding to suicide are made possible through a social justice approach to the issue. The question of how suicidal subjects are formed in relation to social-political conditions is central here.

The analysis thus focusses on addressing the following interrelated questions:

1 How is the relationship between social injustice and suicide formulated (that is, what style of thought, vocabularies, stories, images and conceptual schema are drawn upon in making the link between suicide and social justice issues)?

2 How are traditional bio-medical, psychiatric and psychological approaches to suicide conceptualised within social justice discourse?

3 What assumptions underlie such accounts (particularly in relation to ideas of personhood, agency and causation)?

4 What possibilities for thought and action are opened up through the discursive construction of suicide as a question of social justice?

In terms of selection of papers, I have sought out ones that explicitly take a social justice stance towards the issue of suicide, and these are analysed in terms of the divergences and convergences in their formulations, conceptualisations, and theoretical assumptions in relation to the above questions.

The Formulation of the Relationship between Social Injustice and Suicide

Most obviously, social justice approaches to suicide emphasise the contexts – political, economic, social, cultural and historical – within which suicide occurs (Mills, 2017; Reynolds, 2016; Wexler & Gone, 2012; White, 2016, 2017; White & Kral, 2014). Often, this consideration of wider contexts is explicitly contrasted with dominant “psy” (psychiatric, psychological, psychotherapeutic) approaches, where the main focus tends to be on the individual, somewhat separated or seen in isolation from these factors. White and Kral (2014), for instance, argue that traditional psychological theories provide, an “excessively individualistic and technical account of suicide, which serves to both de-contextualize the act and strip away its inherently relational, ethical, historical, and political nature” (p123). Rather than seeing distress and suicidality as somehow being free of these contexts, such experiences are instead taken as socially and culturally constituted, and the relationship between them theorised. Drawing on social justice approaches in mental health (e.g. Morrow & Weisser, 2012), White and Kral (2014) argue that social and historical contexts “produce environments of discrimination and social inequality, which place a disproportionate burden of suffering on some groups of people and not others” (p130). Reviewing the extensive research on risk factors for suicide, White and Kral (2014) point to adverse living conditions, socioeconomic disadvantage, unemployment and economic hardship, poverty and social fragmentation as factors that increase the likelihood of suicide. Research on racism, prejudice and discrimination in relation to suicide is also cited, as is that relating to postcolonial trauma of indigenous peoples, and the specific experiences of sexual minority youth. They conclude, “suicide is thus tied to social inequalities and injustice” (p130), yet individualised, “psycho-centric” (Rimke & Brock, 2012) understandings of the act have tended to dominate the field of prevention. By such means, as White (2017) argues elsewhere “colonial violence, racism, heteronormativity, patriarchy, social exclusion, capitalist greed, and injustice” come to be obscured (p474).

It is arguably this step, from evidence of the relationship between inequality and suicide, to the framing of the issue in terms of injustice and politics, which marks the application of a social justice (as opposed to say, a “social determinants”) approach. For whilst a relationship between social status or level of integration, economic hardship, unemployment and so on, and deaths by suicide may have been recognised by researchers for a long time, arguing that behind those issues and inequalities there are socio-political drivers or forces – such as colonialism, racism, heteronormativity, patriarchy and capitalism (Cover, 2012, 2016; Kral & Idlout, 2016; Mills, 2017; Reynolds, 2016; Wexler & Gone, 2012; White, 2017; White & Kral, 2014) – that have a direct and systematic effect on rates of suicide, is fairly new.

Once that move has been made, a number of further questions open up. How to formulate and represent the relationship between social injustice and suicide? What forms of research to undertake and draw upon in making claims to truth, based on what epistemological and ontological commitments? For whilst “traditional” psychological, psychiatric and epidemiological (and even sociological) research on suicide has tended to look for variables which could be isolated and measured, a social justice approach has, arguably, a need to make use of means and methods of knowledge production more suited to understanding complex relationships and contexts.

For the most part, this has led to the use of qualitative research methods over quantitative (but not exclusively, see for example Mark E. Button’s chapter in this collection), marking a further shift away from mainstream suicidology, where the quantitative is usually (strongly) favoured over the qualitative (see Joiner, 2011). In a way, there is no categorical imperative to use one form of research method over another, as the nature of the evidence is such that the link between socioeconomic disadvantage, say, and suicidal behaviours is sufficiently well-established that fairly well-grounded claims to truth can be made (see Platt, Stace, & Morrissey, 2017). Rather, it is in the bringing together and foregrounding of that evidence, and the nature of its interpretation, that social justice approaches distinguish themselves from more traditional sociological and epidemiological ones.

So, in terms of the representation and interpretation of knowledge on the relationship between inequalities and suicide, social justice approaches can be distinguished from more traditional ways of framing the issue by the primary, and overt, focus being on the ethical and political context of such a relationship. This can perhaps be illustrated by comparing two studies into deaths by suicide in the UK in recent years: a report by The Samaritans, “Dying from inequality” (Platt, Stace, & Morrissey, 2017), which draws on academic research to analyse the relationship between “socioeconomic disadvantage and suicidal behaviour” (p3), and China Mills’ (2017) paper, “‘Dead people don’t claim’: A psychopolitical autopsy of UK austerity suicides”.

“Dying from inequality” presents evidence of a “significant association between socioeconomic disadvantage and suicidal behaviour” (Platt, Stace, & Morrissey, 2017, p4), and poses questions as to why this might be: what it is about socioeconomic disadvantage that increases the risk of suicidal behaviour, and what can be done about it (ibid). The report considers research evidence at three levels: societal, community and individual, and “sets out the actions needed to reduce the number of disadvantaged people taking their own lives” (p6). Whilst making clear connections between socioeconomic disadvantage – including homelessness, poor housing, unemployment, job loss and financial crises – and poor mental health and suicidal behaviours, “Dying from inequality” stops short of taking a social justice stance on these issues. By this, I mean the connections and associations highlighted, the analysis in terms of increased risk, and the recommendations for policy and practice changes, are framed rather narrowly as economic and public health inequalities and only implicitly as political issues. Suicide, the report concludes, “is everybody’s business and recommendations arising from this report are aimed at a range of agencies, both local and national, to address issues at societal, community and individual levels” (p179). So at a society level, improved mental health services, a focus on high risk groups, the provision of “adequate social welfare payments” and “universal high quality public service provision in health, education, housing and social security” (ibid), the destigmatisation of poverty and debt; at community and individual levels, greater awareness of the impact of economic hardship, specialist training for staff dealing with those experiencing economic hardship on “recognising, understanding and responding compassionately” (p181) to those in distress or suicidal. These are all, undoubtedly, important recommendations, but there is a sense that the report remains conservative in its analysis and proposals for change.

By contrast, China Mills’ (2017) “Dead people don’t claim” utilises a “psychopolitical autopsy” approach to analyse the relationship between specific policies, socially produced and maintained structures and hierarchies, moral economies of human worth, the psychic/emotional life of people caught up in such a regime (specifically experiences of shame and anxiety), and deaths by suicide. On the surface, China Mills’ paper bears many similarities to “Dying from inequality” – analysis at different levels (national policy, community and individual/psychological), drawing on empirical epidemiological and public health data to support arguments, and a desire to understand the ways in which socioeconomic hardship relate to deaths by suicide. I would argue, though, that the approaches diverge in terms of the extent to which the analysis of such deaths takes into account, in Vikki Reynolds’ (201...

Table of contents

• Cover Page
• Half Title
• Praise Page
• Title Page
• Copyright Page
• Table of Contents
• Acknowledgements
• List of Contributors
• Introduction
• PART I
• PART II
• PART III
• Index