Long shadow of suicide

TIME was when suicide was associated with the outer darkness - the materialism of the avian countries, urban over crowding or…

TIME was when suicide was associated with the outer darkness - the materialism of the avian countries, urban over crowding or strange philosophies from the East. We in Ireland were innocent of such a heinous offence against nature. The severity of the religious stricture against suicide, its association with the despair of Judas Iscariot ("the sin against the Holy Spirit"), combined with the criminal law to make suicide a taboo subject.

Yet still lonely farmers died in excruciating agony from paraquat poisoning, depressed young mothers were found in rivers or canals and young men hung themselves in lonely bed sits. Journalists sat at coroners' inquests and heard the tragic stories but generally there was no reporting of these courts. Suicide was a fact of Irish life, profoundly scarring families and communities, but often it was a doubly unvoiced misfortune, not openly discussed and not officially recorded as suicide.

The first growth in awareness occurred when committed psychiatrists began calling for more open recording of self inflicted death. So in the 1960s and 1970s, suicide was aired as a fact of Irish life but, even taking into account some lingering under reporting the level of suicide in Ireland was found to be low.

Now leading experts in the field, such as Dr Michael J. Kelleher founder of the Suicide Research Foundation in Cork, are satisfied that the recording of suicide deaths in Ireland is on a parith, if not superior to, that in most other countries. But we find ourselves faced with a more worrying reality - a steady growth in deaths by suicide over 20 years. In 1995, the number of self inflicted deaths, 383, exactly matched the number of road accident fatalities.

Pointers to the increased level of awareness and debate about suicide are the setting up of a task force in the Department of Health, whose final report is due to be published next month, and the formation of the Irish Association of Suicidology, which brings together all the groups in Ireland interested in preventing suicide and alleviating the distress of suicide bereaved. The association has now called for a debate on media coverage of suicide.

This quickening of interest in suicide - is given added focus because of one dramatic undisputed trend which is emerging. The bulk of the rise in suicide deaths is accounted for by a trebling in the numbers of young male suicides between the ages of 15 and 24 in some parts of the State. Meanwhile the rate for young females (less than half the male rate from the start) has remained constant.

The death of a young person on the threshold of adulthood is always painful but, in the case of suicide, bereaved parents, relatives and friends carry a heavy additional burden. This legacy reaches almost intolerable proportions in cases, unfortunately not that rare, where suicide strikes more than once - in the same family.

"Suicide always casts a long shadow," says Dr Kelleher, who is also chairman of the Irish Association of Suicidology. Even when rigid taboos are eased, the distress of a suicide death sends ripple waves through entire families and communities.

SENATOR Dan Neville, who was very active in promoting the decriminalisation of suicide 993 and who is president of the IAS, believes that failure to address these profound scars is one of the most glaring omissions in the official response to suicide.

"It's left entirely to voluntary organisations like the Friends of the Suicide Bereaved and the Samaritans. There should be understanding, compassion and professional counselling for the families of victims. The State, through its agencies, the health boards and so on, should be reaching out to these families," says Senator Neville. "Very often it's left to the guards. There's no one else there.

"The neglect extends to those who attempt suicide. There is no proper counselling for them. Too often they are looked on as a nuisance in hospital casualty departments, taking up a bed which could be given to someone who was genuinely sick."

The association brings together health professionals, members of the voluntary organisations like Grow and Aware, politicians, religious groups and even philosophers to try to fathom the tormenting reasons which have always led people to end their lives and to try to discover what new causes are leading so many young men to take this option.

One of the main tasks is to dispel some of the myths which gather around suicide, such as the idea that suicide among young people is caused by exam stress or bullying. Dr Kelleher suggests this is one of the unfortunate effects of media highlighting of particular incidents of suicide.

He says that there is no general correlation between examinations and suicide and that it is wrong and immoral to associate "a common experience, examinations, with an uncommon event, suicide".

Another myth that Dr Kelleher is anxious to dispel is that the relatively common experience of depression leads inevitably to a consideration of suicide. First of all he says there is no evidence that all suicide victims show signs of a mental illness:

"Depression is indeed the mental illness most commonly linked with suicide. It is important to stress, however, that most depressed people never think of committing suicide. The common factor found most frequently among young suicide victims turns out to be alcohol abuse."

Dr Kelleher praises the responsible role the media have played in high lighting the changing trends in suicide but takes a restrictive view of the publicity which should be accorded to individual cases.

"Most individual cases of suicide do not merit reporting. There is no public interest in highlighting the individual and family tragedy behind most suicides. The exceptions would be where there is a suspicion of murder which turns out to be erroneous and some cases which come into the public domain where there is a court wrangle over insurance."

More awareness of at risk groups should not mean publicising cases, where there is a danger of "copy cat deaths or attempted suicides. Where there is inevitable publicity, such as the death of Nirvana singer Kurt Cobain, and the declaratory hanging of himself by writer, performer and HIV victim Pat Tierney, in church grounds last year, Dr Kelleher says there is a correlation between the "dose" of publicity and the likelihood of imitation.

"Those who speak and write about such events, including those giving funeral orations, have a very serious responsibility to choose their words carefully," he says. He cites Cobain's wife, Courtney Love, who criticised his act but did not reject him as a loved individual, as an example of treading this fine line.

Trends in attempted suicide, or parasuicide, diverge sharply from those showing up in suicide death statistics. Whereas self inflicted deaths are a phenomenon largely associated with young and elderly males, with a slightly higher incidence in rural areas, the at risk groups for parasuicide are predominantly urban and female, often characterised by repeated efforts.

"Attempted suicide by young women is usually a cry for help - an attempt to draw attention to unhappy circumstances," says Dr Kelleher.

The first meeting of the IAS in Adare, Co Limerick, last autumn was a demonstration of the coming together of interested groups from all parts of the country. More than 150 people turned up for the conference instead of the expected 50. Despite it not being a populist issue, there seems to be a political will to support new initiatives to prevent suicide and support the families of victims.

MEASURES likely to be put forward by the task force include tighter control of pharmaceutical products frequently used in suicide attempts, a media campaign to increase awareness of at risk groups, a national study and better back up for families.

Senator Neville would like immediate action on the paracetamol tablets issue. He says that more than 500 people in the Republic are suffering liver damage each year as a result of paracetamol overdoses, and such products should not be freely available in supermarkets and local shops.

Myra Barry, chief clinical psychologist with the Eastern Health Board and a member of the task force, emphasises the huge work of research and education that will be needed. Marital problems, unemployment, alcohol and drug abuse, mental illness, sexual abuse and the decline in religious practice may all play a part in increasing the incidence of suicide.

But she also draws attention to a subtle but significant cultural shift highlighted in a study of 88 young people in the 13-14 age group in west Dublin in 1994. Two per cent had made some attempt to inflict injury on themselves, which would be normal in international comparisons, 30 per cent had thought about it while 49 per cent thought that people had an individual right to commit suicide.

An emphasis on individual rights means that young people in difficult and stressful situations can see suicide as an option. The problem may no longer be shrouded the past - but sadly it seems little is being done about it as a result.