Madam, - Prof Patricia Casey's compassion and concern with regard to the issue of youth suicide is widely recognised and appreciated. However, we must take issue with her article in your edition of September 24th, "Most suicidal adolescents are ill".
Contrary to Prof Casey's assertion, there is good evidence that general, problem-based, skills training courses have a place in our schools and that they have not been found to increase risk. In fact, Shaffer (cited in Prof Casey's article) has concluded that "a comprehensive, integrated effort, involving multiple domains - the individual, family, school, community, media, and health care system - is needed".
This runs contrary to Prof Casey's argument that preventive efforts be left in the hands of mental health "experts". Rather, as the Psychological Society of Ireland has stated, "suicide is everybody's business".
Prof Casey places inappropriate emphasis on suicide contagion, or so-called "copycat" suicide. In 2002, the American Centre for Disease Control reported "found no evidence that exposure to the suicidal behaviour of others is a risk factor for nearly lethal suicide attempts. Even among groups at relatively higher risk for suicidal behaviour (i.e. males, alcoholics, depressed persons, adolescents), we found that exposure to accounts of suicidal behaviour in the media and, to a lesser extent, exposure to the suicidal behaviour of friends or acquaintances were associated with a lower risk of nearly lethal suicide attempts" (our italics).
"Clusters" of suicides may occur in certain circumstances where there is a "sharing" of similar stressors, negative life experiences and other socio-cultural and environmental factors.
There is no mystery here, no "contagion". We believe the idea of "suicide contagion" is more dangerous than the idea of suicide itself! It relegates suicidal behaviour to that of an unmotivated act of imitation that might seep into the otherwise happy thoughts of an adolescent. What could be more discouraging than this fear, for parents wishing to broach the subject with a child about whom they are worried?
Prof Casey's choice of the death of Kurt Cobain to illustrate the negative impact of media reports of suicide is particularly regrettable. In fact, it is the most widely cited case of good practice surrounding celebrity suicide. It was not glamorised.
Cobain's wife made a detailed statement about the destructive and tragic nature of his death and its impact on his friends and family. His death was handled in a responsible and respectful manner and is an example of the powerfully positive role the media can play. Media reports were used as an opportunity to disseminate information on risk signs for suicide, the importance of seeking help, and information on counselling/support services.
In fact, research found that in the seven weeks after his suicide there were fewer suicidal deaths than for the same period in the previous year.
For too long there was such an unbearable stigma attached to suicide that those left behind felt unable to discuss their own pain and anguish.
While recognising Prof Casey's genuine contribution to this important area we must disagree with her when she suggests that enough is known about the social and cultural factors involved in suicide. On the contrary, far too little is known.
The challenge before us is to overcome the baseless threat that even the discussion of suicide in our homes, our workplaces or our schools will lead to an overhanging cloud of guilt, despair and risk. - Yours, etc.,
CAROLINE SMYTH, Prof MALCOLM MacLACHLAN, Department of Psychology, Trinity College, Dublin 2.