Edited by

Kathy McKay and Jann E. Schlimme

Making Sense of Suicide

Series Editors Dr Robert Fisher Dr Daniel Riha

Advisory Board Dr Alejandro Cervantes-Carson Dr Peter Mario Kreuter Professor Margaret Chatterjee Martin McGoldrick Dr Wayne Cristaudo Revd Stephen Morris Mira Crouch Professor John Parry Dr Phil Fitzsimmons Paul Reynolds Professor Asa Kasher Professor Peter Twohig Owen Kelly Professor S Ram Vemuri Revd Dr Kenneth Wilson, O.B.E A Probing the Boundaries research and publications project. http://www.inter-disciplinary.net/probing-the-boundaries/ The Making Sense Of: Hub Suicide

2011

Making Sense of Suicide

Edited by

Kathy McKay and Jann E. Schlimme

Inter-Disciplinary Press
Oxford, United Kingdom

 Inter-Disciplinary Press 2011 http://www.inter-disciplinary.net/publishing/id-press/

The Inter-Disciplinary Press is part of Inter-Disciplinary.Net a global network for research and publishing. The Inter-Disciplinary Press aims to promote and encourage the kind of work which is collaborative, innovative, imaginative, and which provides an exemplar for inter-disciplinary and multi-disciplinary publishing.

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Inter-Disciplinary Press, Priory House, 149B Wroslyn Road, Freeland, Oxfordshire. OX29 8HR, United Kingdom. +44 (0)1993 882087

ISBN: 978-1-84888-068-9 First published in the United Kingdom in eBook format in 2011. First Edition.

Table of Contents
Introduction Kathy McKay and Jann E. Schlimme Resurrecting a Life through Storytelling: A Healing Process for Survivors of Suicide Mixon Ware Talking Ourselves Down (to Earth): Preventing Ecocide David Franklin Who is Responsible when Attempted Suicide Goes Wrong? Gavin J. Fairbairn Self-Determination and the Suicidal Experience: A Phenomenological Approach Jann E. Schlimme Suicide: Ancient Indian Perspective Debashis Ghosh The Value of Human Life in Islam: Physician Assisted Suicide Hossein Godazgar Religious Attitudes and Behaviours among Suicide Attempters in Turkish-Muslim Society Zuhal Agilkaya What does the Music I Hear Have to do with My Death and Life Views? Social Representations of Life, Death and Suicide Rute Rodrigues and Abilio Oliveira Passionate Inscription: Love in the Performance of Suicide Kathy McKay and Diego De Leo I Would Die For You: Love, Suicide and Redemption in the Cinema of Fellini, Dreyer and von Trier Angela Tumini vii

11

19

27

35

45

51

59

69

79

Suicide and the Limits of Narrative: Ludwig Binswangers Case Study of Ellen West Christopher R. Trogan Recovery from a Suicidal Crisis: Where Theres Hope, Theres Life James C. Overholser and Abby Braden Learning from the Bereaved by Suicide in the Face of Stigma Dorothy Ratnarajah and Myfanwy J. Maple Suicide and Irish Travellers Mary Rose Walker

87

95

105

113

Introduction Kathy McKay and Jann E. Schlimme

... I got to know Sylvia Plath in that extraordinarily creative period which preceded her death. We used to talk about suicide at times but coolly, as a subject like any other. It was only after she took her life that I realized that I knew little about the act, despite the large claims to understanding I had been privately making to myself for so long. This book is an attempt to find out why these things happen. 1 In 1973, A. Alvarez published the seminal and evocative work The Savage God: A Study of Suicide. Inspired by his personal experiences of suicide, Alvarez sought to deconstruct the myriad myths which shrouded suicide at the time and delve into the reasons behind different suicidal performances. By looking at the act through various lenses, Alvarez sought to make sense of suicide; how something so destructive, so taboo, could also be something spoken about just like any other conversation topic, depending upon to whom you were speaking. Similarly inspired, in November 2010, the first Inter-Disciplinary.Net Global Conference on Suicide was held in Prague, Czech Republic. In an intimate conference arena, a group of people from various countries around the world, from many different backgrounds and possessing myriad lived experiences, tried to make sense of suicide. Mixon Ware, an Associate Professor of Child and Family Studies at Eastern Kentucky University, Kentucky/USA, narrated the journey of a Survivor of Suicide. She brought an evocative voice to her paper which detailed a daughters experiences after the suicide of her mother. The therapy of life review was explored in terms of the way it could help a survivor reconstruct the life of their loved one. Gavin Fairbairn, currently the Running Stream Professor of Ethics and Language at Leeds Metropolitan University, England, sparked interesting debate concerning the intentions of those who perform the act of suicide; the interconnection between outcome, desire and intent. His paper explored the aims of three separate suicide stories by examining who was responsible, the meanings and gestures of the acts, and the enactment of cosmic roulette. Jann E. Schlimme, lecturer for Psychiatry and Psychotherapy at Hannover Medical School, Germany, and currently the Marie Curie Fellow at the Department of Philosophy at the University of Graz, Austria, offered a phenomenological approach to the question: can suicidal acts be experienced as self-determined acts, or not? Although this does not answer the question whether suicidal acts can be called self-determined, it is of interest to address this topic from the first-person-

viii

Introduction

__________________________________________________________________ perspective and point out connections between this moral question and the suicidal persons experience. Debashis Ghosh, a research scholar at Special Centre for Sanskrit Studies, JNU, New Delhi, India, and presently teaching at Scottish Church College, Kolkata, India,, explored the changing definitions, nature, and purposes attached to suicide, as retold and reconstructed through ancient Indian mythology and history. Deconstructing a phenomenon such as suicide within such an ancient construct provided a unique and fascinating perspective. Hossein Godazgar, a Reader in Sociology of Religion at Al-Maktoum Institute for Arabic and Islamic Studies, University of Aberdeen, Scotland, explored how religion itself is defined can impact on the un/acceptability of different forms of suicide. By deconstructing the definitions of Islam, and its interpretations of suicide, a better understanding of the ambivalent state in which physician-assisted suicide currently exists was achieved. Zuhal Agilkaya, a Ph.D. student from Marmara University, Istanbul, Turkey, and Bielefeld University,Germany, gave voice to the interplay between the lived experiences of religion and suicide within the frames of Turkish-Muslim society. Her paper explored how people who had attempted suicide perceived, experienced, and justified the act in terms of their religious faith. Rute Rodrigues, a Research Assistant at CIES-IUL Centre for Research and Studies in Sociology, Lisbon, Portugal, and Abilio Oliveira, Assistant Professor at ISCTE-Lisbon University Institute and Researcher at CIES-IUL, discussed actual data of social representations of life, death and suicide in correspondence with the style of music young people hear. Connections between ones favourite style of music and ones attitude towards life and death could be detected, which also mirrored gender differences. Kathy McKay, a researcher at the Australian Institute for Suicide Research and Prevention and Professor Diego De Leo, an internationally-respected Doctor of Science, Professor of Psychiatry and Director of the Australian Institute for Suicide Research and Prevention, Griffith University, Australia, examined the ways in which traditional ideals of love, sex and suicide are inscribed upon modern female bodies. By deconstructing two stories of female suicide, attached to the very modern phenomenon of sexting, the vulnerability of young girls trying to balance shame, reputation and reality was explored. Angela Tumini, an Assistant Professor at Chapman University, California, explored and deconstructed the powerful triad of Love/Sacrifice/Redemption within the frames of three compelling and confronting films. Further deepening this analysis, she dissected this triad within that of another a Pagan/Christian/Romantic triad. This provided a dark and rich tapestry of feminine love, life and death. Christopher R. Trogan, an Assistant Professor of Humanities at the United States Merchant Marine Academy in Kings Point, New York/USA, discussed the

Kathy McKay and Jann E. Schlimme

ix

__________________________________________________________________ limits of Ludwig Binswangers Case Study of Ellen West. He demonstrated that Binswangers view where neither he nor Ellen West had any control over the outcome suicide can not only be interpreted as an expression of his understanding of the inevitability of the course of schizophrenia but also, and especially, as a narrative trying to provide a psycho-logical explanation for the inevitability of its end, namely Ellen Wests suicide. Trogan draws our attention to the fact that this failure of Binswangers narrative can shed some light on the near impossibility to make (narrative) sense of suicide in any given case. James Overholser, Professor of Psychology and Director of Clinical Training at Case Western Reserve University, Cleveland, Ohio/USA, and Abby Braden, advanced graduate student in clinical psychology at Case Western Reserve University, presented clinical data about the recovery of depressed patients from a suicidal crisis. They differentiated between a short-term and a long-term recovery process, highlighting especially the need of reliable interpersonal support in this process, which aims at helping patients to regain control over their life and future again. Dorothy Ratnarajah, a Doctoral Scholar at the University of New England, and Myfanwy J. Maple, a Senior Lecturer in social work at the School of Health at the University of New England, New South Wales, Australia, presented findings from three studies which explored the experiences of those bereaved by suicide. Her poignant examples provided unique insights into how grief is differently constructed for, and experienced by, the suicide bereaved and society around them. Mary Rose Walker, a social worker for Wicklow County Council in Ireland, gave a fascinating account of suicide among the Travellers in Ireland an Indigenous minority group. She explored demographic, pathological and sociocultural factors attached to Traveller suicide. This not only provided a confronting comparison with those attached to suicide among the general Irish population, but also illustrated the unique suicide experiences of Travellers themselves. David Franklin, Department of English Language and Literature, University of West Bohemina, Pilsen, Czeck Republik, presented a study resurrecting a metaphorical understanding of our actual global ecological crisis as suicide. He emphasized that the ways to overcome a suicidal crisis can well be considered similar to the ways which seem to be possible in order to overcome the global ecological crisis, highlighting the danger of repeated suicide attempts if searching only for short-term solutions. Indeed, what has been discovered in this intellectual discourse is nothing more, and nothing less, than the never-ending-quality of the process of trying to make sense of suicide. The narratives, which we produced in our challenge, not only demonstrated that we, as human beings, are narrative animals in our need to make (narrative) sense of ourselves and our situations. They also demonstrated that we are, in normal life as well as in our narrated selves, embodied, bodily and ecologically, and embedded into interpersonal, and herewith socio-cultural,

Introduction

__________________________________________________________________ situations. In striving for a profound understanding of suicide and suicide attempts, as a comprehensive and/or meaningful behaviour, it became clear: although we may never know, exactly, why a person kills herself or which cultural concept of suicide is the ultimate one, we will always suspect that we can at least make some sense of it. Indeed, there is not only a need for a voice to be given to survivors of suicide, most pointedly presented in Mixon Wares approach, but also a need for metaphorical speakers of suicide, as David Franklin pointed out in his talk of ecocide. In the end, we fall back on our finite understanding of suicide as a nearly classical example of human finitude. Yet, we are not speechless in this, even though we, as scientists, are not able to have the last word in the face of this wellknown fact. We therefore give our final words to the woman who inspired the beginning of our editorial: By a mad miracle I go intact Among the common rout Thronging sidewalk, street, And bickering shops; Nobody blinks a lid, gapes, Or cries that this raw flesh Reeks of the butchers cleaver Even as my each mangled nerve-end Trills its hurt out. 2

Notes
1

A. Alvarez, The Savage God: A Study of Suicide, Bantam Books, New York, 1971, p. x. 2 S. Plath, Street Song, Cambridge Review, February 7, 1969, pp. 244-245 & 253.

Bibliography
Alvarez, A., The Savage God: A Study of Suicide. Bantam Books, New York, 1971. Plath, S., Street Song. Cambridge Review. February 7, 1969.

Resurrecting a Life through Storytelling: A Healing Process for Survivors of Suicide Mixon Ware
Abstract Suicide not only ends a life, it obliterates it. The persons life becomes a permanent obituary shrouded in stigma, shame, and silence. The death eclipses the life lived. Because of the enormity of the act and all that religion and society lay upon it, we no longer see the laughter, love or accomplishments of the perpetrator of suicide. Referring to one who chooses suicide as a perpetrator, rather than a victim, connotes the legacy their action inflicts on survivors who loved them. This case study explores the stories of a perpetrator of suicide and her daughter, a Survivor of Suicide (SoS). The case of the daughter presents a childhood fraught with confusion, conflicted feelings, and fear of certain abandonment considering her mothers multiple suicide attempts attempts that occurred regularly throughout the daughters formative years. A journey toward understanding something that can never be understood typifies the difficult voyage of many survivors those left behind have to understand and explain the inexplicable. An interdisciplinary therapeutic intervention, life review, is explored as a potential healing process for SoS. This chapter will present the mother-daughter case study to describe the SoS journey and examine this potential method of healing. Key Words: Survivors of Suicide (SoS), adult children, life review. ***** He went outside under a tree and shot himself. It was all the town talked about for weeks. I was in high school. I hate that town; I will never go back. She seemed so at peace and happy that morning. My brother came home from school and found her that afternoon. He was never the same. Neither was I. The call came at one oclock in the morning: fatal gunshot to the head, the death certificate read. After all the years of previous attempts, it was a relief really. I felt guilty for feeling that. The matter-of-fact, vacant tone in which these comments were made belies the maelstrom of underlying emotion. Spoken by three adults whose parents had committed suicide, the apparent lack of affect carried a tell-tale tinge of sadness, even though the deaths had occurred many years earlier. They state the facts, they

Resurrecting a Life through Storytelling

__________________________________________________________________ tell about the death. The suicide eclipses the life lived. Because of the enormity of the act and all that history, religion, and society lay upon it, we no longer see the laughter, love, or accomplishments of the perpetrator of suicide who was our loved one. 1. Survivors of Suicide The speakers who shared these reflections are survivors of suicide. 1 The designation survivors of suicide (SoS) is attributed to Albert Cain and his 1972 book by that name; it refers to friends and family left behind in the aftermath of a loved ones self-inflicted death. Although some refer to people who have survived a suicide attempt as survivors, the term as used here is widely accepted by suicidologists as referring to the post-suicide bereaved. 2 The American Foundation for Suicide Prevention (AFSP) estimates at least six survivors for every suicide. According to AFSP, approximately one million people worldwide die by suicide each year. 3 This leaves some six million survivors to cope in the aftermath. Cains Survivors of Suicide was a pioneering work in examining factors associated with these survivors responses. In the foreword to this book, American Association of Suicidology founder Edwin Shneidman referred to SoS as the largest mental health casualty related to suicide. 4 Shneidman advocated for SoS postvention, a term he used to refer to prevention and intervention related to issues stemming from the aftermath of suicide. According to McIntosh, in spite of Shneidmans strong words about the plight of survivors of suicide and the appearance of Cains book, only a small number of researchers, clinicians, and other suicidologists studied or wrote about this topic for some years after Survivors of Suicide was published. 5 However, survivors have been the subject of increased research in the last two decades, including comparison group studies with various relationship categories. Relationship groups studied include: spouse survivors; child survivors of a parents suicide; parent survivors of a childs suicide; sibling survivors; and, therapist survivors of client suicide. 6 Partner survivors (e.g., same-sex, cohabiting) and surviving children who were in late adolescence or adulthood at the time of a parents suicide are notably absent from this research. The relationship group addressed here entails this latter group, operationally defined as adult-child survivors. The term suicide is used to refer to a deliberate act of self-destruction. 7 Though technically considered suicide, euthanasia, whether passive or active, is not included in the term suicide as used in this chapter, nor are suicides related to terminal illness. In this chapter a possible post-vention strategy is described in detail, basically explored in response to a

Mixon Ware

__________________________________________________________________ phenomenon which is termed stalled reminiscence and was observed by the author among adult-child survivors of parental suicide who remained astonishingly healthy. 2. The Aftermath for Survivors of Suicide Referring to one who chooses suicide as a perpetrator, rather than a victim, connotes the legacy their action inflicts on survivors who loved them. In a vein similar to Shneidmans survivors being the largest mental health casualty of suicide, 8 Wright and Partridge present a strong case for comparing parental suicide to child abuse. They found that combining the model of child abuse with traditionally used models of bereavement and trauma helped them better understand the child survivors predicament, resulting in more effective therapeutic interventions. 9 Casualty, trauma, child abuse: these words invoke the severe imprint a parents suicide has on their childs life. This authors experience with adult-child survivors indicates that this severity is a constant, even among older survivors. Regardless of the age of the survivor or relationship category, bereavement and grief processes following a suicide involve broader issues than those following a normal death. This is true even in the case of unexpected deaths, such as a fatal accident or homicide. Suicide is stigmatized. In spite of great strides in mental health awareness and public education campaigns about mental illness, suicide is still considered socially unacceptable. A history of judgmental cultural and world religions attitudes applied labels such as criminal, self-murder, and sin to suicide that resulted in punishing behaviours such as funerals and burial denied to the perpetrator and ostracization of their families. 10 Although punitive attitudes are much less common today, the stigma persists. While stigmatization of one who commits suicide appears to have lessened in recent years, SoS continue to face the stigma. 11 The cause of death may be shrouded in secrecy with social support systems for grieving afforded other forms of death lacking for suicide survivors. Stigmatization leads to awkwardness and silence surrounding the death as people struggle with words to say to loved ones of a suicide perpetrator. While researchers disagree on the degree bereavement differs between suicide survivors and those of other causes of death, the evidence is convincing related to factors specific to survivors. In addition to documented stigma and lack of social support, survivors report higher levels of shame, rejection, blaming, and a need to conceal the cause of death. 12 Stimming and Stimming cite personal depression, isolation, social stigma, guilt, and fear of becoming suicidal themselves as common themes among SoS. In this authors 28 years of SoS work, she has identified stalled reminiscence in working with adult-child survivors. Given that the impact of a sudden, stigmatized death looms so large in their memory and experience, adult-child survivors have a

Resurrecting a Life through Storytelling

__________________________________________________________________ difficult time getting past feelings and memories of the suicide. This is their first point of reminiscence, even years after their loved ones death. They exhibit a lostin-time effect where the death becomes a locked focus, sublimating memories of the persons life before the painful end. This can be seen in the context of KublerRosss stages of grief as a stalled and incomplete healing among SoS. Kubler-Ross asserts that: if a patient has had enough time (i.e., not a sudden, unexpected death) and has been given some help in working through [stages one through four], he will reach a stage during which he is neither depressed nor angry about his fate. 13 Applied to both the terminally ill patient and the familys grief process, the stage described here is Kubler-Rosss fifth stage of death and dying: acceptance. Hope is said to follow stage five. 14 Regarding working with the family, she says: The most meaningful help that we can give any relative, child or adult, is to share his feelings before the event of death and to allow him to work through his feelings, whether they are rational or irrational. 15 This is not possible in the case of suicide because of its sudden, unexpected occurrence and the fact that stigmatization suffocates bereavement and grief with silence. The case of Hannah, an adult-child survivor speaking more than 35 years after her mothers death, provides insight into stalled reminiscence. A process she embarks on unintentionally in response to a friends questioning suggests a formalized process for postvention with adult-child survivors that may be a powerful tool to cease the silence and restore reminiscence. 3. Case Study Hannahs case represents one survivors foray into finding meaning in the life discarded by her mother. Leah committed suicide when Hannah was 23. 16 Throughout her adult life, Hannahs narrative of her mothers life was of her death. Prior to her suicide at age 46, Leahs life had been marred by multiple suicide attempts and hospitalizations occurring when her daughter was aged 4, 11, 14, 19, and 22. Hannahs childhood and adolescence were fraught with confusion, conflicted feelings, and fear of certain abandonment. Following this emotional roller coaster, Hannah felt relief when the call came telling her Leah had finally succeeded in taking her own life. Hannah acknowledged feeling guilty for this, but said it was like

Mixon Ware

__________________________________________________________________ finally being able to take a deep breath and let it out. It was as if I had been holding my breath all those years, waiting for that final shoe to drop. Determined to give some meaning to her mothers death, and refusing to live in the denial and shame exhibited by other family members, Hannah became an advocate for mental health and suicide prevention. She talked openly about her mothers suicide, studied suicide, availed herself of counselling and expended worked to come to terms with Leahs death: Intellectually I understood that suicide was a death that could never be explained; that we would never know why. But I kept trying to make sense of it. I read somewhere that suicide was murder turned inward. I wasnt sure I agreed with that statement, but I knew its intent was to help survivors stop blaming themselves to see that the person made a conscious and violent choice directed at themselves independent of those of us left behind. Still, I couldnt help wondering what I had done or not done to cause my mother to have so much aggression that she could turn it on herself so violently. In spite of Hannahs outward smiles and successes, Leahs suicide remained a central theme in her life many years after the incident. It was such a major event that no matter how much Hannah overcame the effects of the experience, memories of her mothers life were overshadowed by the trauma of her death. On her 46th birthday, 23 years after her mothers suicide at that same age, Hannah experienced fears and feelings common to surviving children at the milestone age marking the parents suicide. Quieting the fears, she forged ahead as usual. Still, no portraits of Leah graced Hannahs home. Not long after the 35th anniversary of Leahs death, Hannah was talking with a friend about her work in human rights and social justice. When asked how she became interested in this work, Hannah described the impact her mother had on her and the values she had instilled. She sounds fascinating, replied Hannahs friend. Tell me about her. Because her focus was on work she loved and the role her mother had played in teaching her these values, Hannahs story brought forth the Leah who had been a scholar, a master teacher, and a vibrant woman who acted on strong convictions as a champion of human rights and dignity. She fought battles for the freedoms of others, freedoms frequently denied her during her institutionalisations, Hannah reflected. She had a genius-level IQ but sometimes I think she was too brilliant. Her analytical skills predicted conflicts and social problems we are just now seeing today. Hannah felt that her mother tried to take on the burdens of the world, a tendency complicated by bipolar disorder. But she

Resurrecting a Life through Storytelling

__________________________________________________________________ could sure laugh and she loved convertibles!, Hannah recalled as she described a beauty in bobby socks with lustrous dark hair posing by a new convertible she had managed to get in spite of rationing in WWII. Throughout this storytelling about her mother, Hannahs eyes radiated pride as she talked about Leah and the impact she had on the lives she touched. She smiled as she remembered the side-splitting, uproarious laughter she and her mother had shared. This effusiveness went on for quite awhile before she realized that not once had she talked about Leahs tragic finale. Your mother sounds incredible, Hannahs friend said. You really should write down her story. With this in mind, Hannah began to assemble pieces of her mothers life: photos buried in albums never opened, notes and writings hidden from sight in dusty drawers, and memories that had lain fallow. It was a slow process, but, through the review of Leahs life and writing her story, Hannah realized that for the first time since she lost her mother, she felt like she had found her again. Hannah was able to resurrect Leahs life and silence the suicide story. She began to think of herself not as a SoS, but as Leahs daughter a title she had not claimed for many years. When the anniversary of her mothers death came again, Hannah celebrated Leahs life, letting go of her death. 4. Life Review The process Hannah went through is rooted in gerontology. Known as life review, it was proposed by Robert Butler as an intervention for use with older adults. 17 A theoretically-based process of reflecting on ones life, life review addresses unresolved conflicts in the final stage of life to achieve integrity over despair. 18 In addition to applications in geropsychology and hospice, the life review process has been adapted and used in therapeutic interventions with depression; midlife transition; college student adjustment; families of dementia patients; caregivers; HIV diagnosed individuals; sexual abuse victims; and, trauma victims. The interdisciplinary nature of gerontology is reflected in the life review process. It encompasses not only social and behavioural sciences but also techniques drawn from the arts and humanities. In Hannahs case, storytelling, writing, photos, historical documents, oral history, and art added to her cognitive understanding of her mothers mental illness and death. Having come to terms with her loss years before her friends question launched a life review process, Hannah finally embraced her mothers life with reminiscences set free. 5. Implications for Practice and Research The phenomenon of focusing on the details of a suicide at the expense of happy memories has been observed in such a significant number of adult-child survivors in the course of this authors SoS work that she has designated it stalled reminiscence. 19 Similar to frozen grief in ambiguous loss, 20 the survivors

Mixon Ware

__________________________________________________________________ memory of the lost loved one is frozen in their mind at the time of the violent loss and abandonment. Life review is proposed as a postvention strategy to address this phenomenon and as part of an interdisciplinary healing process for SoS. According to the AFPS, the question of how best to help survivors of suicide remains pressing. Very little research evidence exists about the impact of those efforts that have been tried. 21 In particular, from a vantage point of both a survivor and scholar, this author notes a lack of research in the long-term effects of parental suicide, particularly among adult-child survivors. In considering life review for this population, the varied applications for which it has been used and narratives akin to the written component of a life review are noted. In addition to Hannahs experience with life review, Harvard child psychiatrist Nancy Rappaport recounts similar exploration and discovery related to her mothers suicide 22 as do survivors Mary and Maureen Stimming in their presentation of narratives of adult-child SoS. 23 Music and poetry have been used in the life review process with hospice patients, 24 and components of life review can be seen in portrayals of suicide survivors grief and loss in literature and art. 25 Life review represents an interdisciplinary, therapeutic strategy that may be helpful for adult-child SoS in reclaiming the parent they knew before suicide stole the happier times preceding the event. As depicted in Hannahs case, the journey toward understanding something that can never be understood typifies the difficult voyage of many survivors those left behind have to understand and explain the inexplicable. Through a life review process, Hannah was able to resurrect an incredible life that ended prematurely. The process of life review and storytelling points to a healing process for SoS. It is hoped that this mother-daughter case study describing a survivors life review as one method of healing may stimulate additional research into this process as an innovative and effective tool.

Notes
A.C. Cain (ed), Survivors of Suicide, Charles C. Thomas, Springfield, IL, 1972. J.L. McIntosh, Suicide Survivors: The Aftermath of Suicide and Suicidal Behaviour, Handbook of Death and Dying, C.D. Bryant (ed) Sage Publications, Thousand Oaks, CA, 2003, pp. 339-350. 3 American Foundation for Suicide Prevention (AFSP), Facts and Figures, International Statistics. Retrieved July 25, 2010, from http://www.afsp.org/. 4 E. Shneidman, Foreword, Survivors of Suicide, A.C. Cain (ed), Charles C. Thomas, Springfield, IL, 1972, p. ix. 5 McIntosh, op. cit., p. 339. 6 Ibid. 7 G.A. Theodorson and A.G. Theodorson, Modern Dictionary of Sociology, Thomas Y. Crowell Co., New York, 1969. 8 Shneidman, op. cit., p. ix.
2 1

Resurrecting a Life through Storytelling

__________________________________________________________________ B. Wright and I. Partridge, Speaking Ill of the Dead: Parental Suicide as Child Abuse, Clinical Child Psychology & Psychiatry, Vol. 4, 1999, pp. 225-231. 10 G. Stone, Suicide and Attempted Suicide, Carroll & Graf Publishers Inc., New York, 1999. 11 H. Sudak, K. Maxim and M. Carpenter, Suicide and Stigma: A Review of the Literature and Personal Reflections, Academic Psychiatry: The Journal of the American Association of Directors of Psychiatry Residency Training and the Association for Academic Psychiatry, Vol. 32, 2008, pp. 136-142. 12 C.A. Sveen and F.A. Walby, Suicide Survivors Mental Health and Grief Reactions: A Systematic Review of Controlled Studies, Suicide: Life Threatening Behavior, Vol. 38, 2008, pp. 13-29. 13 E. Kubler-Ross, On Death and Dying, Macmillan Publishing Company, New York, 1969, p. 99. 14 Ibid., p. 122. 15 Ibid., p. 159. 16 Leah and Hannah are pseudonyms for the mother and daughter described here. 17 R.N. Butler, The Life Review: An Interpretation of Reminiscence in the Aged, Psychiatry, Vol. 26, 1963, pp. 65-76. 18 E.H. Erikson, Childhood and Society, Norton Publishing, New York, 1950; Butler, op. cit.; D. Haber, Life Review: Implementation, Theory, Research, and Therapy, International Journal of Aging and Human Development, Vol. 63, 2006, pp. 153-171. 19 M. Ware, Resurrecting a Life through Storytelling: A Healing Process for Survivors of Suicide, 1st Global Conference: Making Sense of Suicide, Prague, Czech Republic, 2010. 20 P. Boss, Ambiguous Loss: Learning to Live with Unresolved Grief, Harvard University Press, Cambridge, MA, 1999. 21 American Foundation for Suicide Prevention (AFSP), op. cit. 22 N. Rappaport, In Her Wake: A Child Psychiatrist Explores the Mystery of Her Mothers Suicide, Basic Books, New York, 2009. 23 Stimming (eds), op. cit. 24 N. Wlodarczyk, The Use of Music and Poetry in Life Review with Hospice Patients, The Interdisciplinary Journal of Practice, Theory, Research, and Education, Vol. 22, 2009, pp. 133-139. 25 R. Brown, Art of Suicide, Chicago University Press, Chicago, IL, 2004.
9

Bibliography
American Foundation for Suicide Prevention (AFSP), Facts and Figures, International Statistics. Retrieved July 25, 2010, from http://www.afsp.org/.

Mixon Ware

__________________________________________________________________ Boss, P., Ambiguous Loss: Learning to Live with Unresolved Grief. Harvard University Press, Cambridge, MA, 1999. Brown, R. Art of Suicide. Chicago University Press, Chicago, IL, 2004. Bryant, C.D. (ed), Handbook of Death and Dying. Sage Publications, Thousand Oaks, CA, 2003. Butler, R.N., The Life Review: An Interpretation of Reminiscence in the Aged. Psychiatry. Vol. 26, 1963, pp. 65-76. Cain, A.C. (ed), Survivors of Suicide. Charles C. Thomas, Springfield, IL, 1972. Erikson, E.H., Childhood and Society. Norton Publishing, New York, 1950. Haber, D., Life Review: Implementation, Theory, Research, and Therapy. International Journal of Aging and Human Development. Vol. 63, 2006, pp. 153171. Kubler-Ross, E., On Death and Dying. Macmillan Publishing Company, New York, 1969. McIntosh, J.L., Suicide Survivors: The Aftermath of Suicide and Suicidal Behavior. Handbook of Death and Dying. Bryant, C.D. (ed), Sage Publications, Thousand Oaks, CA, 2003, pp. 339-350. Rappaport, N., In Her Wake: A Child Psychiatrist Explores the Mystery of Her Mothers Suicide. Basic Books, New York, 2009. Shneidman, E., Foreword. Survivors of Suicide. Cain, A.C. (ed), Charles C. Thomas, Springfield, IL, 1972. Stimming, M. and Stimming, M. (eds), Before Their Time: Adult Experiences of Parental Suicide. Temple University Press, Philadelphia, PA, 1999. Stone, G., Suicide and Attempted Suicide. Carroll & Graf Publishers, New York, Inc., 1999.

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__________________________________________________________________ Sudak, H., Maxim, K. & Carpenter, M., Suicide and Stigma: A Review of the Literature and Personal Reflections. Academic Psychiatry: The Journal of the American Association of Directors of Psychiatry Residency Training and the Association for Academic Psychiatry. Vol. 32, 2008, pp. 136-142. Sveen, C.A. and Walby, F.A., Suicide Survivors Mental Health and Grief Reactions: A Systematic Review of Controlled Studies. Suicide: Life Threatening Behavior. Vol. 38, 2008, pp. 13-29. Theodorson, G.A. and Theodorson, A.G., Modern Dictionary of Sociology. Thomas Y. Crowell Co., New York, 1969. Wlodarczyk, N., The Use of Music and Poetry in Life Review with Hospice Patients. The Interdisciplinary Journal of Practice, Theory, Research, and Education. Vol. 22, 2009, pp. 133-139. Wright, B. and Partridge, I., Speaking Ill of the Dead: Parental Suicide as Child Abuse. Clinical Child Psychology & Psychiatry. Vol. 4, 1999, pp. 225-231. Mixon Ware is an Associate Professor of Child and Family Studies at Eastern Kentucky University. As a certified family life educator, board certified human services practitioner, and survivor of suicide, she has worked in suicide prevention and survivor support throughout her career.

Talking Ourselves Down (to Earth): Preventing Ecocide David Franklin

Abstract Three salient features of the global ecological crisis parallel the narrative of suicide: (1) we likely stand at the brink of irreversible changes to life on Earth with far-reaching long term consequences; (2) the changes could be catastrophic, including not only the deaths of millions or even billions of individuals, but also the potential deaths of cultures or civilizations and, in the most extreme scenarios, the extinction of the human species; and, (3) we are doing it to ourselves. Unlike earlier periods of history, we are increasingly aware of the fact that we are the conscious agents of destructive ecological change, and these changes are potentially suicidal. If we are conscious agents, this implies that the will to make the decision to avert suicide is at least as important as the technical and social engineering fixes that tend to be the focus of public policy debate concerning ecology. In this context, we can pose several pertinent questions. What are the narratives of suicide averted? What are the motivations of the individual who withdraws from the brink of suicide? What are the strategies and methodologies for intervention used in the field of suicide prevention? Can we imagine these strategies being applied in some form to the global ecological crisis? To the degree that the ecological crisis results from decisions and actions that in turn are rooted in values and beliefs, merely technical solutions are akin to nothing more than a tourniquet on the wrist, averting the crisis temporarily without addressing motivations; a short-term solution that is likely to be followed by other attempts. Paralleling the suicidal individual, who may be talked down by another who intervenes with compassion, as a species we must play both roles in the narrative in order to talk ourselves down to earth. Key Words: Ecopsychology, ecological crisis, deep ecology, ecological suicide, ecocide. ***** 1. Can We Justify Using the Term Ecocide? Suicide conjures up images of acts of destruction that are self-inflicted, irreversible, catastrophic, and intentional or conscious. Much brouhaha has recently surrounded issues of global warming in the media, both regarding its reality and the question of whether it is anthropogenic. However, global warming is only one of a host of interrelated ecological crises appearing like yawning chasms immediately beneath our feet, threatening to swallow our sense of stability and the certainly of our continued survival as a civilization, if not a species. 1

12

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__________________________________________________________________ A quite depressing list of threats other than global warming can be culled from media reports. They provide good cause to believe that the current effects, or nearterm risk, of all of them are on the rise rather than the wane: habitat destruction and mass extinctions; acidity of the oceans, with associated collapse of the aquatic food chain and fisheries; depletion of essential resources such as fossil fuels (including the issue of peak oil); overpopulation; depletion of fresh-water aquifers; environmental toxicity; deforestation; soil depletion or salinization; collapse of the industrial food system and resulting food insecurity; radioactive contamination resulting from nuclear weapons insecurity; and other such threats. The following limited examples illustrate how such problems may be interrelated: a large portion of our global food supply is dependent on fossil fuels. Basic caloric staples, as well as meat, fish and vegetables, are planted, farmed, harvested, refrigerated, transported and/or prepared using technologies based on oil or natural gas. Alarmingly, by some estimates the basic caloric requirements of two-thirds of all humanity are fulfilled by reliance on the Haber-Bosch process, 2 by which the energy in natural gas is converted into a form (chemical fertilizers) that can be utilized by agricultural crops. Thus, as a species, we are literally eating up fossil fuels which, regardless of how large the supply is, exist in limited quantities on the planet. When combined with a tendency toward exponential growth rates of all biological organisms, 3 it seems likely that our dependence on chemical fertilizers has only delayed, but not prevented, a Malthusian crisis. The use of such petroleum-based agricultural chemicals also strips land of its topsoil, with the result that ever-increasing amounts of chemical fertilizers are required merely to maintain yields (never mind increasing them), while pressure to increase yields is exerted by the ballooning population. Agricultural chemicals may seep into groundwater and pollute aquifers, causing toxic effects such as blue baby alerts 4 and requiring that potable water be transported from elsewhere thereby adding to the consumption of fossil fuels. Simultaneously, agricultural chemicals can flow downstream into the oceans, causing algae blooms and other malicious ecological effects such as dead zones, which can impact the fisheries on which large numbers of people depend. 5 Phytoplankton blooms may in turn influence weather patterns, causing an increase in large storm systems, 6 which damage farmland. Consequently, pressure to further increase yields on the remaining land is enhanced and the only currently widespread technology available to do so is petroleum-based agricultural chemicals. Further, we have yet to mention the effects of deforestation, the potential for political instability in geopolitically sensitive regions caused by famine or migration to escape famine, and many other problems. How seriously should we take such catastrophic-sounding descriptions of the predicament? Hasnt our species, and our civilization, survived the predictions of eco-Cassandras from Malthus onward? As a species, we have survived so far. As for our civilization, other societies in the past have collapsed under the weight of ecological crises that pale in

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__________________________________________________________________ comparison to those that face us now. While the collapse of a civilization is often associated with cultural losses such as traditions, art, libraries, music, languages, and other intangible products of the nosphere, it should be noted that Jared Diamond defines the collapse of a society as a drastic decrease in human population size and/or political/economic/social complexity, over a considerable area, for an extended time. 7 Thus, if we imagine contemporary societal collapse on a global scale, it implies widespread suffering and death. To state it more concretely, societal collapse includes the inability to maintain the material infrastructure and dysfunction of the administrative apparatus needed to deliver basic necessities (such as distribution of safe food and water, construction of shelter, sanitation) to the population, resulting in either migration or death of large numbers of people and a resultant dissolution of the social fabric that defines a group as a society. 8 The more global in scale (and consequently the larger the affected population), the more limited are the options for migration of course, leaving the other option death of large populations as the only possibility. If the situation is so dire, one may ask: why are we still here, our global industrial system apparently so successful in polluting and devastating our home planet? One part of the answer is that, in fact, many of us are no longer here. History is littered with societies that failed (Easter Island, Sumer, the Maya, the Anasazi), sometimes leaving behind a remnant population, but too few surviving members to continue the cultures traditions. Many of these societies failed for reasons that include ecological problems similar to those facing us today: deforestation, population growth exceeding the carrying capacity of the land, soil salinization. 9 The other part of the answer is that our society has not collapsed because the loan we have taken out against natures capital (mainly in the form of non-renewable fossil fuel resources), on which our entire oil-age civilization is built, has not come due yet. There are two important differences between these past societies and contemporary industrial civilization. One, alluded to above, pertains to scale. As Ronald Wright describes the ancient world: Ancient civilizations were local, feeding on particular ecologies. As one fell, another would be rising elsewhere. Large tracts of the planet were still very lightly settled. A fast film of the planet would show civilizations breaking out like forest fires in one region after another; others were carried from place to place across the centuries, sparks on the cultural wind. 10 However, with nearly seven billion people on the planet today, the situation is quite different. The impact of contemporary civilization(s) on the world ecology is not limited to being local. As the possibility of ecological problems bringing

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__________________________________________________________________ about global societal collapse increases, the possibilities for mass migration become more limited with each passing day. The other difference is the crux of the matter, and determines whether one can apply the terms ecological suicide or ecocide. Ancient civilizations did not know as much about their ecological problems as we do. They did not have tool such as satellite images of deforestation, chemical measurements of soil salinity, or computer models of global weather patterns. We do. They were less aware of the consequences of what they were doing to themselves until it was too late to forestall processes already set in motion; even then their awareness of the causes of the problems was quite limited. Our ability to observe, measure, and understand global ecological processes expands every day (this in spite of increasingly frequent attempts to politicize or co-opt the scientific enterprise). Crucial to the appropriateness of applying the metaphor of suicide to the global ecological crisis are the questions: Is it conscious? Is it intentional? With these questions in mind, it becomes clear that, while large-scale self-destructive environmental activities are nothing new, ecocide strictly speaking may be considered a recent phenomenon. Our ability to bury our heads in the sand and ignore the severity of the global ecological crisis is diminishing daily. Evidence mounts that, as Walt Kellys Pogo famously said, We have met the enemy, and he is us. 11 So far, we are taking a few meagre steps to limit the damage we are doing, never mind initiating the massive global re-organization of human activities (economic, technological, political, sociological) that would be necessary to halt or reverse the processes of anthropogenic ecological destruction. If we can no longer deny that we may be committing ecocide, this begs the question: how can this realization serve us? Is it merely terrifying, or does the narrative of global ecological suicide offer us anything constructive? 2. Applying the Narrative of Suicide Prevention to Ecocide Public policy debate concerning the ecology tends to focus on technical and social engineering fixes. However, if we take the narrative of ecocide seriously, our unwillingness to avert ecological destruction (or wilful denial of the nature of the problem) constitutes a conscious decision. To the degree that the ecological crisis results from decisions and actions that, in turn, are rooted in values and beliefs, merely technical solutions are akin to nothing more than a tourniquet on the wrist, averting the crisis temporarily without addressing motivations; a solution that is likely to be followed by other attempts. Michael I. Church and Charles I. Brooks summarize the connections that Eric Fromm draws in his classic work The Sane Society between the values of the society and the psychic suffering of the individual: Fromm said that increasing industrialization produces greater alienation, dissatisfaction, meaninglessness, and apathy in

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__________________________________________________________________ members of a society. He saw the vast majority of people not utilizing their intellectual and creative potentials while having little share in their employers goals and profits. This state of futility tends to be masked by the individuals compulsive activities or craving for power, money or prestige. Thus, Fromm saw advanced industrialization as capable of creating, or worsening, psychological distress that can induce suicidal tendencies. 12 We can turn Fromms thesis somewhat on its head, and also ask if there are analytical and interventional tools relating the context of individual suicide prevention to that of understanding and re-forming (reforming) the values and world-view of the society. One candidate, Martin Seligmans concept of learned helplessness, seems to apply to the disconnect between what we know about the potentially dire consequences of ecological problems and our apparent inability to act effectively to deal with many of them. Learned helplessness denotes a situation in which the experimental subject (Seligmans original experiments were with dogs) is able to avoid something painful or harmful, but takes no action because it has learned through previous experiences that it will be unable to do so. The subject perceives that it has no control over the situation even though it does. Learned helplessness may play a role in depression and mental illness and, in the view of Church and Brooks, it is one aspect of subtle suicide (a constellation of self-destructive behaviours lying on a continuum from self-damaging behaviour to overt suicide): [S]ubtle suicide sufferers often show a pattern of having learned to think and act in helpless ways, causing them to stop trying to avoid negative circumstances. 13,14,15 One can speculate that learned helplessness plays a role in suicide in general, and in ecocide specifically. Ecological problems are intractably complex and not only have many of them arrived unforeseen, solutions based on a silver-bullet approach are likely to have unforeseen consequences that may be just as bad as the problem they were intended to solve. Failures to have solved complex large-scale ecological problems in the past, combined with an on-going crisis mentality, may lead policymakers to offer quick and simple solutions, even if they are unlikely to succeed. They may even ignore long-term problems of importance, in favour of short-term solutions to minor problems, just because those are the ones that they are able to solve. Of course, learned helplessness need not apply only to policy-making bodies and governments (which are, after all, composed of people), but also to the collective actions of members of the society. One of the crucial factors in the global ecological crisis is the differential in per-capita environmental impact of people in different societies. As Jared Diamond emphasizes, [o]n the average,

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Talking Ourselves Down (to Earth)

__________________________________________________________________ each citizen of the U.S., western Europe, and Japan consumes 32 times more resources such as fossil fuels, and puts out 32 times more wastes, than do inhabitants of the Third World. 16 Therefore, it becomes clear that either way successfully dealing with or merely suffering through the global ecological crises will require a significant lowering of the standard of living of First World citizens. 17 These are changes that we may feel helpless to implement voluntarily, or changes that, when forced upon us by circumstance, will evoke feelings of helplessness, anger and depression. If the concept of learned helplessness applies, then we may feel ourselves to be seemingly unable to implement a voluntary lowering of our standard of living, even though it is possible and necessary to help us to avoid harmful personal, societal, and ecological outcomes. Moving step-by-step toward a deep ecological or ecopsychological approach to the issue, another strategy explicitly related to suicide prevention is motivational interviewing. Originated by William Miller and Stephen Rollnick, and mentioned by Church and Brooks, motivational interviewing comprises four procedures: 1. Express empathy; 2. Help to bring out the discrepancies between the clients present behaviour and underlying value systems; 3. Explore the pros and cons of change from the perspective of the client; and, 4. Increase the clients self-efficacy. 18 As we move along the continuum from the aggregate scale of whole societies to the problems facing individuals, it may help us to imagine the paradoxes that people may encounter in their lives and the role that narratives of suicide prevention might play. For example, when ones standard of living goes down (voluntarily or otherwise), it can be an uncomfortable or painful process: less living space, less convenient transportation, less heat or hot water, and so on. These changes have the potential to be quite depressing (especially if they are not voluntary), but the individuals and societys value systems play a great role in determining how they are perceived. The person who views their discomfort as a necessary condition for averting global ecocide will feel differently than one who considers him/herself entitled to all the material creature comforts of modern consumer society. In this context, the procedures of motivational interviewing listed above can take on significance beyond intervention in the suicide of a single individual. Another suicide prevention methodology that may have bearing on personal reactions to societal and ecological changes is turning points. Turning points are described by clinical psychologist Ed Wilks as the emergence of an instinctual drive for survival that may occur during a suicide attempt, thus prompting the potential victim not to carry out the attempt. 19 Wilks advises interviewing clients to

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__________________________________________________________________ bring their own motivations to consciousness; the essential question becomes What prompted you to decide to keep living? This of course is the fundamental question and, without an awareness of its importance, no amount of tinkering with policies and regulations concerning the increase in parts per million of CO2 caused by burning the deck chairs on the Titanic to keep warm will forestall the cold blackness of ecocide. However, if we can pull one important trick from the hat of the collective unconscious lets call it eco-transference then we have a chance. If we can transfer the instinctual drive for survival that emerges during a suicide attempt to motivate our collective behaviour toward the whole biosphere, then we can imagine ecocide averted.

Notes
J. Diamond, Collapse: How Societies Choose to Fail or Succeed, Penguin Group, New York, 2005, p. 7. 2 M. Pollan, The Omnivores Dilemma: A Natural History of Four Meals, Penguin Group, New York, 2007, p. 43. 3 Diamond, op. cit., p. 312. 4 Pollan, op. cit., p. 47. 5 Diamond, op. cit., p. 488. 6 A. Ananthaswamy, How Plankton Spawn Storms, New Scientist, 21 August 2010, p. 11. 7 Diamond, op. cit., p. 3. 8 R. Wright, A Short History of Progress, Canongate Books, Edinburgh, 2005, p. 103. 9 Diamond, loc. cit.; Wright, loc. cit. 10 Wright, op. cit., p. 103. 11 Wikipedia, Pogo (Comics), Retrieved 24 September 2010, http://en.wikipedia. org/wiki/Pogo_(comics). 12 E. Fromm, The Sane Society, Henry Holt, New York, 1955, cited in M. Church & C. Brooks, Subtle Suicide: Our Silent Epidemic of Ambivalence about Living, Greenwood Publishing, Santa Barbara, 2009, p. 123, Retrieved 24 September 2010, http://books.google.com/books?id=oeLDs2HXiHcC&lpg=PA143&ots=t_4 3dwmuVJ&dq=%22learned%20helplessness%22%20suicide&pg=PR4#v=onepag e&q&f=false. 13 S. Maier, From Helplessness to Hope: The Seminal Career of Martin Seligman, The Science of Optimism and Hope, Templeton Foundation Press, Radnor PA, 2000, pp. 5-6, Retrieved 10 December 2011, http://www.swarthmore.edu/SocS ci/bschwar1/helplessness.pdf. 14 Church & Brooks, op. cit., p. 146. 15 Ibid., p. 143. 16 Diamond, op. cit., pp. 494-495.
1

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__________________________________________________________________ Diamond, op. cit., p. 7. S. Rollnick & W. Miller, What is Motivational Interviewing?, Behavioral and Cognitive Psychotherapy, Vol. 23, pp. 325-332, cited in Church & Brooks, op. cit., p. 136. 19 E. Wilks, Uncovering the Turning Point with Suicide, Training Institute for Suicide Assessment & Clinical Interviewing, July 2009, Retrieved 24 September 2010, http://www.suicideassessment.com/tips/archives.php?action=prod&id=113.
18 17

Bibliography
Ananthaswamy, A., How Plankton Spawn Storms. New Scientist. 21 August 2010. Church, M. and Brooks, C., Subtle Suicide: Our Silent Epidemci of Ambivalence about Living. Greenwood Publishing Group, Santa Barbara, 2009. Accessed 24 September, 2010, http://books.google.com/books?id=oeLDs2HXiHcC&lpg=PA14 3&ots=t_43dwmuVJ&dq=%22learned%20helplessness%22%20suicide&pg=PR4# v=onepage&q&f=false. Diamond, J., Collapse: How Societies Choose to Fail or Succeed. Penguin Group, New York, 2005. , Pogo (Comics). Wikipedia, the Free Encyclopedia. Accessed 24 September 2010. http://en.wikipedia.org/wiki/Pogo_(comics). Pollan, M., The Omnivores Dilemma: A Natural History of Four Meals. Penguin Group, New York, 2007. Wilks, E., Uncovering the Turning Point with Suicide. Training Institute for Suicide Assessment & Clinical Interviewing. July 2009. Accessed 24 September 2010. http://www.suicideassessment.com/tips/archives.php?action=prod&id=113. Wright, R., A Short History of Progress. Canongate Books, Edinburgh, 2005. David Franklin is an Academic Worker at the University of West Bohemia in Pilsen, Czech Republic. He is occasionally a performance artist and filmmaker, and a practitioner of Shintaido (a non-violent Japanese martial art).

Who is Responsible when Attempted Suicide goes Wrong? Gavin J. Fairbairn

Abstract About four years ago, the British media were full of reports about a woman, brain damaged after taking an overdose while suffering from post-natal depression, who had won 2.8m from Lancashire Ambulance NHS Trust, in the North of England. The story raises many issues, some of them ethical. Setting aside questions about whether compensation of this level was, or could be justified, where does responsibility for Mrs Burchells tragic condition lie? With the ambulance crew who took twenty six rather than ten minutes to reach her or with Mrs Burchell herself? It is important to engage with such deeply unsettling questions. In this chapter, drawing on Mrs Burchells story and on two other stories that overlap with it in some respects, I discuss questions of responsibility in suicide. En route, I map out a little of the conceptual and ethical territory that surrounds suicide and a range of other related human acts. Key Words: Suicide, attempted suicide, gestured suicide, cosmic roulette, responsibility. ***** 1. Davids Story Like his estranged wife, Anne, David was receiving treatment for depression. One day he called at her home during a visit by her social worker, who had only known Anne since her recent discharge from hospital. Shortly after arriving David asked Anne whether she loved him. When she answered, not only that she didnt, but that she never had, he walked out of the living room into the kitchen where, a few minutes later, she and the social worker found him swallowing handfuls of sleeping pills. Rejecting the social workers suggestion that he should stop what he was doing and seek help at the local hospital, David said You cant stop me doing what I want. The social worker said that he had no intention of trying to do so, but said that he would stay close to David until he fell asleep, as he surely would quite soon, then call an ambulance and have him taken to hospital. At this, David rushed out of the flat and, true to his word, the social worker followed. When, after about half an hour, David almost collapsed outside a pub, the social worker took him inside and

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Who is Responsible when Attempted Suicide goes Wrong?

__________________________________________________________________ telephoned for an ambulance, which took almost half an hour to arrive, despite the fact that the hospital was quite close by. David was taken to hospital where his stomach was pumped, and spent several days in intensive care, towards the end of which the social worker went to visit, despite the fact that he had no professional responsibility towards him. Two segments of the conversation between David and Annes social worker are of interest. First, when David said, You had no right to stop me killing myself the social worker responded by explaining that he had had no option other than to have done so, since it was more than his job was worth to have done anything else. Secondly, on hearing this response, David changed tack and said, Anyway you had no right to just stand there and let me take them pills Davids story illustrates the complexity that is often present in the motivations that underpin the acts of people who act in apparently suicidal ways. Did he want to die? His first remonstration with the social worker, You had no right to stop me killing myself implies that he did. On the other hand, his second, and somewhat contradictory complaint, You had no right to just stand there and let me take them pills suggests the possibility that his act in taking the pills might have been little more than a pretence at suicide, intended to provoke others into action to prevent his dying. Who was responsible for what happened to David? For the fact that he took the pills? For the fact that he went to hospital, and was prevented from killing himself? For the fact that though he was saved, he was very poorly for a time? Who would have been responsible for Davids death, had he died? And who would have been responsible if he had ended up disabled as a consequence of his overdose? David? His wife? The ambulance personnel who were a little late in arriving? The social worker who saved his life, though he did not prevent him taking the pills?

It is clear that David carried the bulk of the responsibility for taking the pills. However, his wife shared that responsibility to some extent, because her saying that she didnt love him and never had, triggered his overdose. And while the social worker shares responsibility for saving Davids life with the ambulance personnel and the hospital staff, he also shares responsibility for Davids being

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__________________________________________________________________ quite poorly for a while, because he refrained from intervention to prevent him taking the pill. 1 If David had died, my view is that he would have been responsible for his death, regardless of whether he could have been saved had he been treated for the overdose earlier, because he chose to take the pills and ignored the social workers suggestion that he should seek help. And the same would have been true had he ended up disabled as the result of his actions. Davids story was a real one. The events I have described really happened, and though the words I have put into Davids mouth and the social workers are not their actual words, they accurately represent what was said. 2 But now consider a similar story with a different outcome. In this case the story is not about real people, though it is true to life, because stories like it really happen. 2. Georges Story George is distressed because his wife Sarah has just told him that she intends to leave him, their marriage and their home, to begin a new life with Ingrid, who is one of their oldest friends. Although she says that she still cares about him and wants to stay friends, she has told him that their life together has largely been a lie. George goes upstairs to his study and drinks several large whiskies before taking the bottle out to the garage with him, where he attaches a length of hosepipe to the exhaust of his car and feeds it into the passenger compartment. Then he sits in the drivers seat, puts a note saying Look what youve made me do. Ive always loved you and I always will, but I cant live without you on top of the glove compartment, and switches on the engine. A short time later, realising that George is not in the house, Sarah goes into the garden to see if he is there. Though she is looking forward to her new life with Ingrid, she is genuinely concerned about him. When she sees fumes coming out from under the garage door, she opens it, but is overpowered by fumes as she tries to get to the car to switch off the engine. However, she manages to detach the hosepipe from the exhaust, before rushing into the house to phone for an ambulance.

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Who is Responsible when Attempted Suicide goes Wrong?

__________________________________________________________________ As in the story of David, the ambulance is slow in arriving. However, in this case, despite the best efforts of the paramedics, George is dead by the time he arrives at the local hospital. What could have been going on in Georges mind, as he enacted what turned out to be his death? His note seemed to imply that death was his aim. In that case his act would have been a successful suicide, aimed at avoiding the life that he now saw stretching out before him. On the other hand, since he did not enact it in an isolated spot, thus reducing the likelihood that he would be found and rescued, his act might have had some aim other than death. For example, rather than suicide, Georges act might have been no more than a gesture at suicide, aimed at bringing about some effect in Sarah. Alternatively, his act might have been a kind of gamble with life and death, of the kind that I refer to as cosmic roulette. 3,4 In gestured suicide the protagonist feigns suicide by acting in a way that looks as if it was aimed at death, often in the hope and expectation that others will come to his aid in ways that they might not have done otherwise. The writer Laurie Lee refers to situations that are clearly suicide gestures in his book Cider with Rosie: He committed suicide more than any other man I know but always in the most reasonable manner. If he drowned himself, then the canal was dry; if he jumped down a well, so was that: and when he drank disinfectant there was always an antidote ready, clearly marked to save everybody trouble. In this passage, Lee demonstrates remarkable insight, not only about the fact that sometimes people who act in apparently suicidal ways do not intend to die but merely to have an effect on others, but also about the fact that some people act in such ways as a matter of habit. 5 A suicide gesture is like a one person play in which the actor creates a dramatic effect, not by killing or even attempting to kill himself, but by feigning an attempt on his life. The suicide gesturer does not aim to achieve his death, but to change his life, by changing the ways in which others think about him, and act towards him. 6 And so Georges expectation as he acted might have been that Sarah, noticing how upset he was, would have rescued him before the fumes from the exhaust had done any real damage, and perhaps even, that she might have been so alarmed that she would have decided not to go off with Ingrid after all, but to carry on the same as before. After all, he had good reason to believe that she still cared for him. Let me return for a moment, to David, who overdosed because his wife told him that she didnt love him anymore. My view that his act was a suicide gesture seems justified by the fact that he performed it in front of others who he believed would intervene to save him; and his remonstration with me about the fact that I didnt try to stop him taking them pills supports this view.

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__________________________________________________________________ Turning now to cosmic roulette. Sometimes people who act in an apparently suicidal way, give little thought to whether they want to live or to die, but merely act on a whim, not thinking before they do so, what they are actually doing, or what the outcome might be. However, protagonists in cosmic roulette, act in a way that has some possibility of bringing death, because they intend to gamble on the wheel of life and death. In other words, though cosmic gambles resemble suicide and may be physically identical with it, they are underpinned by different motivations and have an entirely different set of possible meanings. In effect, the cosmic gambler turns to either God or the cosmos and says Do what you will. It is easy to imagine how some people might view cosmic roulette as a win-win option. If they die they will no longer be suffering whatever led them to spin the wheel, while if they live, others are likely to rally round, offering support and care, thus helping at least for a time to make their life better. And so George may have been a cosmic gambler, rather than a suicide, because he may have acted with the idea in mind that depending on the spin of the wheel, he might be found and saved. He might have believed that in that event, Sarah would have come to her senses and decided to stay, while consoling himself with the fact that if she didnt, at least he would not have had to face life without her. Unlike David, who survived his apparently suicidal act, George was dead on arrival at hospital. As in Davids case, it seems clear that George was chiefly responsible for the act in which he engaged, whether it was a suicide that went right; a gesture that went wrong, or a cosmic gamble in which the wheel of fortune dictated that his number was up. Of course his wife played a role in provoking the act that led to his death, and thus shares some responsibility at least of a causal kind, for it. As to the ambulance staff, who arrived a little late, my view is that it makes no sense to hold them responsible for the outcome of an act performed by George, whether or not he intended by his actions to bring about his death. Or at least this is my view, provided, for example, that they did not arrive late because they had chosen to finish a cup of coffee before responding to the emergency call, and that in treating George, they were not negligent, in the sense of having made decisions about how to treat him, without good enough reason. Finally, let me turn to the real case of Claire Burchell, an English woman. 3. Mrs Burchells Story In 2001 Claire Burchell took 45 painkillers combined with alcohol. She was still conscious when she was found by her husband, who called an ambulance. 7 Mrs. Burchell, who had been suffering with post-natal depression after the birth of her child in 2001, survived her overdose. However, she did so with brain damage; confined to a

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Who is Responsible when Attempted Suicide goes Wrong?

__________________________________________________________________ wheelchair, with weakness in her limbs and severe memory loss. Her thinking was said to be rigid and simplistic. On her behalf, Simon Maskrey QC, made a legal claim against the ambulance service on the grounds that these impairments came about because the ambulance took too long to arrive 8 and because the crew made mistakes in treating her enroute to hospital (a journey during which they allegedly became lost). He told the judge that Mrs. Burchell would need care 24 hours a day for the rest of her life. In 2005 Mrs. Burchell was paid 2.8 million by the Lancashire Ambulance Service NHS Trust, which admitted the delay in reaching her, but denied that it resulted from negligence. In the High Court, Mr Justice Newman described the damages award as wholly appropriate. We will probably never know what Mrs. Burchell intended when she acted whether, for example, she wanted to kill herself or merely to draw attention to her distress. Given that she was suffering from postnatal depression it is possible that even if she did act with the intention of ending her life, she did not do so rationally, in other words that she might have tried to kill herself, without really knowing what she was doing. Of course, it is also possible that though depressed and emotionally distraught, she was aware of what she was doing, and that her act was one of gestured suicide or of cosmic gambling, rather than of suicide. Who was responsible for the state in which Mrs. Burchell ended up? There are several candidates, chief among whom is Mrs. Burchell herself, who was the agent of her own harm, as well as the victim of the circumstances that led to her ending up alive, but disabled. Of course there is a long line of others who contributed in some way to what happened, including the physician who prescribed the pills that damaged her; the ambulance personnel who were late in getting her to hospital and were alleged to have made mistakes in her treatment, and her husband, who understandably telephoned for the ambulance, because had he not done so, she might have died, rather than ending up brain damaged. In suggesting that Mrs. Burchell was chiefly responsible for the state in which she ended up, I am conscious that I could be accused of a lack of empathy, because Mrs. Burchells postnatal depression meant that she could not be expected to take responsibility for her own actions. But if that was the case then those who were charged with caring for her, including her husband and family members, as well as health service personnel, would surely move higher up the list of candidates. In any case, it is and will always be true that Mrs. Burchells act in taking of the pills was responsible, at least in a causal sense, for the damage she suffered, just as it would be true that had her husband telephoned for the ambulance earlier; had it arrived

Gavin J. Fairbairn

25

__________________________________________________________________ earlier, and had the ambulance crew acted differently, they might have been responsible for a different outcome.

Notes
Though who could blame him for this decision, when David was obviously in an emotional state, as he washed the pills down in a kitchen with several large and very sharp knives in view? 2 I know this, because I was the social worker in the story. 3 G.J. Fairbairn Contemplating Suicide: The Language and Ethics of Self-Harm, Routledge, London, 1995. 4 G.J. Fairbairn Suicide, Language and Clinical Practice, Philosophy, Psychiatry and Psychology, Vol. 5, 1998, pp. 157-169. 5 L. Lee, Cider with Rosie, Vintage, London, 2002. 6 If he ends up alive, having managed to persuade those he aimed to impress that he wanted to die, his act will have been successful. If on the other hand, he ends up dead, it will have been an unsuccessful, what we might call a self inflicted death by accident. 7 W. Pavia Mother Wins 2.8 after Suicide Bid, Times Online, 6 June, 2005, http://www.timesonline.co.uk/tol/news/uk/article746142.ece, Accessed on 17 September 2009. 8 The 26 minutes it took to arrive was 16 minutes more than it was estimated it should have taken and as it turned out, they were very costly minutes.
1

Bibliography
Fairbairn, G., Contemplating Suicide: The Language and Ethics of Self-Harm. Routledge, London, 1995. Fairbairn, G., Suicide, Language and Clinical Practice. Philosophy, Psychiatry and Psychology. Vol. 5, 1998, pp. 157-169. Lee, L., Cider with Rosie. Vintage, London, 2002. Pavia, W., Mother Wins 2.8 after Suicide Bid. Times Online. http://www.timesonline.co.uk/tol/news/uk/article746142.ece, Accessed 17/09/10. Gavin J. Fairbairn is a teacher and jobbing philosopher who has ongoing research interests in the ethics of health and social care, including issues in mental health, disability and at the end of life. He also has strong interests in philosophical and ethical issues that arise in relation to peace and conflict, including nuclear deterrence and the relationship between reconciliation, truth, apology and

26

Who is Responsible when Attempted Suicide goes Wrong?

__________________________________________________________________ forgiveness. Finally, he has strong interests in the use of storytelling in teaching and research and as a model for academic writing of all kinds. In the past he worked for many years as a practitioner in special education, social work and teacher education, mainly in mental health and learning disability. He is currently Running Stream Professor of Ethics and Language in the Faculty of Health and Social Sciences, at Leeds Metropolitan University, UK.

Self-Determination and the Suicidal Experience: A Phenomenological Approach Jann E. Schlimme

Abstract People usually think about suicide in a suicidal state of mind. A profound understanding of the suicidal experience is therefore of importance for answering the question whether people kill themselves out of free will or not. Since the phenomenological method allows a detailed description of experiential structures, it seems suited to help us in our search for an answer. In my chapter, I will demonstrate that the structure of the suicidal experience is inherently reflective in a special way. This does not simply include consciousness about oneself or ones mortality (being necessary, but not sufficient conditions). Nor does it simply mean that a suicidal person is despairing (even though this is the other side of the suicidal experience). It means: the assurance of the possibility to kill oneself as ones last option to behave in an effective way with respect to changing ones feelings is prescribed by one's desperation (ones absolute helplessness in every other way with respect to changing ones feelings); while simultaneously the prescriptive structure of this insight stays preconscious with respect to its prescriptive quality. The possible reflection in the suicidal state of mind is therefore limited (with respect to its own prescriptions, usually named as narrowing in psychiatric and psychological models), but self-related nonetheless. Due to this special kind of reflection, the afflicted person is usually convinced about having determined the option of suicide independently (which fosters the conviction of being able to decide it freely). The phenomenological description demonstrates that a minimal sense of self-determination in the decision to live on or to kill oneself cannot be denied. Apparently, the controversy regarding the selfdetermined quality of suicide is rooted in the suicidal experience itself. Key Words: Experiential structure, minimal sense of self-determination, desperation, suicide, self-effectivity. ***** 1. Introduction In my chapter, I will approach the question whether the act of suicide is usually a personally-justified behaviour in a self-determined way of living or whether it is usually not personally-justified? I will do this using a phenomenological method, which allows a fair description of the suicidal experience and also of the experience of behaving self-determinedly. Although the space of this chapter is limited, it is necessary to spend at least some time (section II) clarifying a few basics concerning my own understanding of phenomenological work. In the third

28

Self-Determination and the Suicidal Experience

__________________________________________________________________ section, I will sketch out two basic assumptions often made when debating the above-named question, so that it becomes clearer where my own approach fits in. Then, in the following two sections, I will describe briefly in phenomenological terms the structure of experiencing oneself as being suicidal (section IV) and of being and/or behaving self-determinedly (section V). After that, some closing remarks, drawing on these phenomenological descriptions (section VI), will be presented. 2. Some Remarks on the Phenomenological Method According to its founder Edmund Husserl (1859-1938), the phenomenological method starts with a step called epoch which implies the phenomenologist abstains from all forms of judgement with respect to what is given to him. Even though the abstention of prejudices is a standard claim of nearly every method, the phenomenologists abstention is a fairly special one: the phenomenologist embrackets the so-called general-thesis (Husserl) through (reflectively) changing the attitude towards his experience. The general-thesis means the pre-predicative and pre-reflective statement the world exists (which is the most natural, accustomed and automatically given aspect of all our experiences). This does not mean that phenomenologists are sceptics, but that they are interested in the way things are given to us in our conscious experience. In other words: doing phenomenology means to describe how an experienced givenness is given in ones own conscious experience (phenomenologists are interested in the consciousnessof-things-themselves, as Klaus Held reformulates the famous Husserlian claim Zu den Sachen selbst 1). The phenomenological method is therefore perfectly suited to describe experiences in the first-person-perspective, but it is, of course, and just like every other method, not able to describe our natural experiences exhaustively. According to this understanding of phenomenological work, I admit that it is obviously impossible to debate the question of this chapter in terms of abstract moral rules, or a Pflichtethik in the Kantian sense, with the help of phenomenology. However, and this is the major benefit of a phenomenological approach, we should be able to describe the experience of being self-determined in the suicidal experience. Of course, even if such an experience is usually given in suicidality, this does not imply that it is compatible or sufficient with what Kant would require in order to call a behaviour morally justified. Yet, such a phenomenological description of the structure of experienced self-determination in the suicidal experience will not only be helpful for a better understanding of what is going on in a suicidal person, but may thereby help us to comprehend the experiential basis of the actual pro- and con-debates taking place in most Western countries regarding questions of suicide prevention, suicide counselling or assisted suicide. As can be seen, the benefit of a phenomenological approach seems comparable with the famous and re-owned approach to suicide by David Hume,

Jann E. Schlimme

29

__________________________________________________________________ who was also interested in the everyday experiences and ways of decisions even though he was surely no phenomenologist in the sense proposed above. 3. Modern Scenarios of Rational Suicide Many contemporary research attempts claim that suicide is a self-determined act if the suicide can be called rational. This affords basically that it is intended, thoroughly and coherently thought through, and can be (or could have been) consciously defended against (possible) counter-arguments with coherent arguments (e.g., in a talk with a suicide counsellor). In our time, the conceptualized scenario of rational suicide usually relies on at least two assumptions: IIIa) a comparative attitude towards life and death is not justifiable (that is, being alive and being dead cannot be compared in a meaningful way with each other); IIIb) every suicide act has more or less rational aspects and should therefore be rated on a scale between completely irrational and completely rational. 2 The first assumption derives from the simple fact that we cannot know what it is like to be dead. Therefore, being dead cannot be compared to any state of mind we know of and that we are able to verify with experiential evidence. Following this insight, many philosophers of our time propose that a suicide would be rational if the preferred way of living ones life can never be achieved again and the actual state is unbearable (thereby proposing a comparison between different states of mind). Surely, even though it is never really possible to know what the future has in store for us, the inability to achieve a certain way of living can well be justified (e.g., if you suffer from a certain disability caused by an accident, a severe disease or old age). Still, the claim I will never be happy again could nevertheless be premature in a strict sense, since the ways to pursuit ones happiness are not only very different but can also change throughout ones life according to the ones circumstances and ability to behave to oneself (the latter is the standard position of suicide prevention). This apparent difficulty to decide whether it is the right time or not, whether there will or can be a change in the future or not, seems to imply the second assumption. Even if a completely justified suicide may not be possible due to the openness of ones future (further intriguing is the fact that ones future ends the very instance one kills oneself, so that one can and will never know whether a change would have been possible), and a suicide in the strict sense of a perfect passive experience may be equally impossible (can it be called suicide if a person kills herself without knowing it is her?), it seems sensible to conceptualize the rationality of suicide acts on a dimensional scale between completely irrational and completely rational (without necessarily claiming that these extremes are possible; but with claiming an evaluative concept of rationality).

30

Self-Determination and the Suicidal Experience

__________________________________________________________________ 4. About the Suicidal Experience People usually think about suicide in a despairing state of mind. To put it quite simply: the suicidal experience is basically the experience of desperation coupled with the knowledge of suicide as ones last option to behave in an effective way with respect to changing or altering ones feelings (ones desperation). Despairing people want to change this unbearable state of mind. Yet this inherent direction towards changing ones desperation does not, and this is the basic feature of desperation, lead out of despair. On the contrary, one has repeatedly found out, and ones situation has repeatedly demonstrated, that a positive change is impossible. All usually fruitful behaviour, and every behaviour one could think about, failed and turned out to be fruitless. In this situation, the possibility to put oneself to death offers a last and reliable option to change ones experience and to end ones desperation (which is the reason why suicide has been called a remedy, e.g., Juliet in Shakespeares Romeo and Juliet). Being able to kill oneself can also rescue someone simply via the knowledge of being able to do it (which is a well known feature of (early) suicidal states of mind in suicidology and f.e. was the key feature in the suicidal dialectic in late stoic philosophy). Anyway, even though the experience of being rescued typically implies a passive quality (the experience of being rescued is given as and when), and suicide is only therefore experienced as a promise to rescue oneself because one knows about ones ability to actively put oneself to death in an effective way, the major difference between simple desperation and suicidality is this experienced rescue-quality of ones own death. All of this is, of course, dependent on the fact that death is ultimately and radically different from all possibly thinkable states of mind and that the afflicted person knows about this (see IIIa). There is a second difference between experiences of being rescued and the experienced promise of being rescued via killing oneself is the fact that the deep change of oneself (or ones situation). This characteristic of the experience of being rescued - also promised to take place when one dies - can only retrospectively be determined as having really rescued oneself. 3 Apparently the structure of the suicidal experience is inherently reflective in three ways: IVa) consciousness about oneself; IVb) consciousness or knowledge about ones mortality; IVc) proved knowledge of ones possibility to kill oneself as ones last option to change ones desperation effectively. While the first two structures are necessary, but not sufficient conditions (apparently we are not usually suicidal when becoming aware of ourselves and/or our mortality), the third characteristic is the crucial and sufficient condition for the suicidal experience. It is crucial to notice that it basically relies on a desperate state

Jann E. Schlimme

31

__________________________________________________________________ of mind. In other words: One already has to be despairing in order to see ones death as ones rescue. Being despairing can therefore be described as a prereflective and experiential prescription of being suicidal. Obviously, the possible reflection in this despairing state of mind is, in a special way, limited with respect to its own pre-reflective prescriptions (usually named as narrowing in psychiatric and psychological models, see IVa). However, the suicidal experience is inherently self-related nonetheless, implying that it is the afflicted person who has determined the option of suicide. According to this phenomenological description of the experiential structure of being suicidal, we have to admit that there is always, and in every suicide, a quality of self-determination (minimal sense of self-determination). Sometimes this may mean nothing more than: it is the afflicted person herself who discovers that suicide is a possible behaviour to effectively alter her experience of desperation, her feelings of despair, her despaired state of mind. 5. About the Experience of Self-Determination The experience of behaving in a self-determined way affords, of course, more than simply being the one to consciously determine certain aspects of ones life in a justifiable or coherently defendable way. We usually live our life in a selfdetermined way without having to think about it every second (unless we are actually suffering from severe cultural restrictions, ongoing ecological or natural disasters or, maybe even worst, war or war-like conflicts). The experience of being self-determined obviously has, beside its possible reflective quality, a prereflective quality. As I laid out in a recent paper drawing on the phenomenological method, the experience of being self-determined has a pre-reflective and a reflective dimension and is further related to oneself on two sides: a) to the initiation of ones behaviour in oneself (including being affected by others and the situation); and b) to the effects of ones behaviour in the world (including oneself and others). These relationships of ones behaviour to oneself imply not only that one is responsible for the initiation of ones behaviour; one is also for the wanted and - at least partially, since I am the one who has set the cascade of events into motion with my behaviour - unwanted effects of ones behaviour. 4 Laszlo Tengelyi especially highlights the fact that we are not only active agents of our own behaviour but also passive subjects of its (wanted and unwanted) effects, which is important for a phenomenological description of life-conduct and behaviour. 5 This also seems to correlate with the evaluative dimension of autonomy, which is named as necessary in almost all philosophical approaches. Indeed, simple effectivity of intentions cannot be sufficient for free agency. 6 It seems therefore sensible to differentiate three domains of a self-referential effectivity that are given when experiencing oneself as a self-determined agent of ones behaviour.

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Self-Determination and the Suicidal Experience

__________________________________________________________________ Va) the effectivity of ones intentions with regard to ones behaviour (which seems to be conceptualized often from a psychological point of view as an intrapsychic effectivity); Vb) the effectivity of ones behaviour in order to pursue and achieve ones intended goal (which stands near to the folk psychological and psychotherapeutic term of self-effectivity); Vc) the effectivity of ones behaviour on oneself following this behaviour (which is a directly self-related effectivity, in the sense of a materialistic, worldly or interpersonal feedback, and an inherent aspect of ones behaviour, since we suffer its intended and unintended effects). 7 Of course, responsible behaviour has, besides the characteristic of being evaluable from some future point, an interpersonal dimension, which can also be described in phenomenological terms; see the description of second order goods of agency by John J Drummond. 8 6. The Experience of Self-Determination in Suicidality According to phenomenological descriptions, we can suspect that suicidal acts are usually, or at least mostly, experienced as self-determined in the first domain (Va: people who kill themselves usually intend exactly that, even though they often remain unsure about whether suicide is really the last rescue-option or not, or may primarily intend their suicidal behaviour as a cry for help 9) and second domain (Vb: suicide is an option to change ones desperation, which is connected with the rescue-quality of suicide). In addition, the option of suicide is determined personally (minimal sense of self-determination). Even though this self-related effectivity is given, or can be prospectively imagined as being given, suicidal people know that they will not be there after killing themselves (at least not in this world; see IIIa, IVa and IVb) and that it is therefore unprovable whether or not other options (in ones life) could have been possible. Therefore, the major limitation with respect to the above-described three dimensions of the experience of behaving self-determinedly is that a personal retrospective evaluation, whether the suicide behaviour was really adequate, will be impossible. In short: the third domain (Vc) is only given with respect to oneself dying. All other future-aspects can only be prospectively imagined or fantasized (this is often the case, as already pointed out by Erwin Ringel; 10 such fantasies are usually recognized as such, even though suicidal people may feel disturbed), but will never be experienced in this world (of which the suicidal person is usually well aware). According to these phenomenological descriptions the following three statements are possible: VIa) one experiences ones death only as ones last rescue, if one is utterly despairing (even if the despairing person knows about this connection, her ability to kill herself is pre-reflectively experienced as a promise of being rescued or, at

Jann E. Schlimme

33

__________________________________________________________________ least, relieved of her despairing situation, indicating a special heteronomous quality of every suicidal experience); VIb) the aspect of an effectively achievable change is crucial with respect to the rescue-quality of ones death in a despairing state of mind (indicating a minimal sense of self-determination). It also prevents suicidal behaviour being described as self-determined in a full sense (Vc is limited to the irreversible effect of dying, all other effects are only prospectively imagined or fantasized, a fact usually wellknown by suicidal people); VIc) suicide is experienced as personally-justified, in the best way possible for this behaviour, if an (unachievable) way to conduct/live ones life is also deemed worth dying for.

Notes
K. Held, Edmund Husserl, Klassiker der Philosophie, Bd II, O. Hffe (ed), 3. berarb Aufl, Beck, Mnchen, 1995, pp. 274-297. 2 T. Schramme, Rationaler Suizid, Unentschiedenheit und Selbstttung Vergewisserungen der Suizidalitt, J.E. Schlimme (ed), Vandenhoeck & Ruprecht, Gttingen, 2007, pp. 29-49. 3 It is possible to differentiate five rescue-qualities with respect to ones ability to end ones life and to demonstrate that they were, at least partially, well known in historical understandings of the suicidal experience. J.E. Schlimme, Verlust des Rettenden oder letzte Rettung - Untersuchungen zur suizidalen Erfahrung, Karl Alber, Freiburg/Breisgau, 2010, pp. 564ff. 4 J.E. Schlimme, Addiction and Self-Determination: A Phenomenological Approach, Theoretical Medicine and Bioethics, Vol. 31, 2010, pp. 49-62. 5 L. Tengelyi, Narratives Handlungsverstndnis, Deutsche Zeitschrift fr Philosophie, Suppl 17, 2007, pp. 61-73. 6 G. Watson, Free Agency, The Journal for Philosophy, Vol. 72, 1975, pp. 205220. 7 For a more detailed development of such a description, see Schlimme, op. cit., pp. 630ff. 8 J.J. Drummond, Moral Phenomenology and Moral Intentionality, Phenomenology and Cognitive Science, Vol. 7, 2008, pp. 35-49. 9 E. Stengel, Selbstmord und Selbstmordversuch, Psychiatrie der Gegenwart Forschung und Praxis, Bd III Soziale und angewandte Psychiatrie, H.W. Gruhle, R. Jung, W. Mayer-Gross and M. Mller (eds), Springer, Heidelberg, 1961, pp. 5174. See also about suicide gestures, G.J. Fairbairn, Contemplating Suicide, Routledge, London, 1995, pp. 57-69. 10 E. Ringel, Der Selbstmord - Abschluss einer krankhaften psychischen Entwicklung, 7. unvernd Aufl, Dietmar Klotz, Eschborn bei Frankfurt/Main, 1999.
1

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Self-Determination and the Suicidal Experience

__________________________________________________________________

Bibliography
Drummond, J.J., Moral Phenomenology and Moral Phenomenology and Cognitive Science. Vol. 7, 2008, pp. 35-49. Fairbairn, G.J., Contemplating Suicide. Routledge, London, 1995. Held, K., Edmund Husserl. Klassiker der Philosophie. Hffe, O. (ed), Bd 2, 3. berarb Aufl, Beck, Mnchen, 1995. Ringel, E., Der Selbstmord - Abschluss einer krankhaften psychischen Entwicklung. 7. unvernd Aufl, Dietmar Klotz, Eschborn bei Frankfurt/Main, 1999. Schlimme, J.E., Verlust des Rettenden oder letzte Rettung - Untersuchungen zur suizidalen Erfahrung. Karl Alber, Freiburg/Breisgau, 2010. Schlimme, J.E., Addiction and Self-Determination - A Phenomenological Approach. Theoretical Medicine and Bioethics. Vol. 31, 2010, pp. 49-62. Schramme, T., Rationaler Suizid. Unentschiedenheit und Selbstttung Vergewisserungen der Suizidalitt. Schlimme, J.E. (ed), Vandenhoeck & Ruprecht, Gttingen, 2007. Stengel, E., Selbstmord und Selbstmordversuch. Psychiatrie der Gegenwart Forschung und Praxis, Bd III Soziale und angewandte Psychiatrie. Gruhle, H.W., Jung, R., Mayer-Gross, W. and Mller, M. (eds), Springer, Heidelberg, 1961. Jann E. Schlimme is Marie Curie Fellow at the Department of Philosophy, Karl Franzens University Graz, Austria. He is also lecturer for psychiatry and psychotherapy at Hannover Medical School. He is interested in phenomenological psychiatry and psychopathology, especially with respect to addiction, delusional disorders, schizophrenia and suicidality. Currently, his research is devoted to a phenomenological description of the sense of self-determination and its special alterations and/or impairments in various mental disorders. Intentionality.

Suicide: Ancient Indian Perspective Debashis Ghosh

Abstract The present chapter aims to study the phenomenon called suicide from an ancient Indian perspective. Whenever we go through the ancient Indian (Sanskrit) literature, we come across innumerable cases of suicide. The major characters of the greatest Sanskrit epics Rmyaa and Mahbhrata seem to have committed suicide. Such suicidal tendencies were found across all the social classes and gender. Cases of Rma, Lakmaa, St, Andha-muni, Dhtarra, Gndhr, Kunti, Mdr, Bidur, Balarma, Amb, and others, bring forward many more facets of suicide. The following points will constitute the main thrust of the chapter: A study of the ancient Indian social norms and structure to know whether society kept the possibility of suicide open to avoid further social complexities, as altruistic suicide was glorified. What are the opinions of the judicial and legal codes of that time (i.e., several Smti-stras)? Whether suicide among the higher castes of society became a lifestyle choice? Methods and types of suicide: finding patterns among suicide attempts. Suicide as a spiritual practice. Since the early age suicide as a part of spiritual practice is continuing in some religious groups of Indian society, i.e., Jainas. What does suicide by spiritual power (Yoga-vala) mean? What are the philosophical arguments provoked in order to substantiate suicide as a rational choice? An analysis of the concept of Icch-mtyu (willed-death) and philosophical possibility of it. Key Words: Rmyaa, Mahbhrata, sallekhan, tmahaty, taptakcchra, India, Smriti, Manusamhita. ***** The scope of this chapter is very much limited to a study of the characters from the two great epics Rmyaa and Mahbhrata from their coeval socio-philosophical standpoint. Two things must be clarified before we move into the chapter: first, the word ancient is used here to imply the period from the later Vedic age (cir. 500 B.C. 1) to 600 A.D; second, the present chapter uses suicide, dharmastra,

36

Suicide

__________________________________________________________________ the word suicide in the limited meaning of self-killing of biological body. Vedic literature reflected the desire of the members of society to live life for the most possible length of it (hundred years). 2 Examples of suicidal tendencies are so rare as to not be found. The words equivalent to suicide from post-Vedic works (i.e., Rmyaa and Mahbhrata) are: tma-vadha, tma-haty, tma-nidhana, and tm-pradna. All these compound words are clearly formed from two distinct words: the former means tm and the latter killing. Thoughts of two dominating philosophical schools 3 from the above-mentioned period have been reflected in these epics and influenced them. If we go through the definition of tm provided in these two philosophies, it becomes clear that tm means soul, which is eternal and many in numbers, 4 and not only that volume of tm is equal to the volume of body, as tm is delimited by the volume of body. However, the eternal tm cannot be killed or destroyed. This is referred to in several contexts by Mahbhrata, especially in Gt, and innumerable Upanisadic verses can also substantiate this notion. This shows us that the word tm, in the context of the above-mentioned compound words, is being used with the sense of its own physical or biological body, even in Rmyana, Mhbhrata and smti-stras. 5 Since the dharmastras, all smti-stras (collections of normative socio-legal codes) advocated the duties of four varas (social categories) and four ramas (stages of life), and applied obligation over these. According to these codes brhmana (the priest and academic class), katriya (the warrior class) and vaiya (the class of businessmen and agrarians) were eligible to go through all four stages of life (i.e., brahma-carya[stage of study], grhastha[stage of householder], vnaprastha[stage for forest-dwelling] and sannysa[stage for renunciation]) with specific duties peculiar to that varas. However, even after such socio-legal restrictions, suicide was readily available to the important and respectable katriyas in these epics. Suicide was also available to the relatively lower classes, such as stas (charioteers or wise advisors), who were a mixed caste born of a ktriya father and brhmaa mother. The stas were inevitably related to kings but did not always follow the conventional path. Either they committed suicide while still in the vnaprastha stage of life or directly out of grhastha stage. In order to understand the nature of suicide prevalent in ancient India, the present chapter proposes to classify ancient Indian suicides into two major divisions according to their acceptability in society: a. socially unacceptable; and, b. socially acceptable. It seems for societys greater purpose, smti stras could not allow society members to commit suicide. Again and again, they advised the individual not to suicide. Their consultations might involve the complete 700 verses of Gt (a sub-section of Mahbhrata) that was composed to provoke Arjuna to awaken his mind for the war and Anugt which helped Arjuna recover

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37

__________________________________________________________________ himself from the hangover of the enormous stress caused by the mass execution of that so-called great dharmayuddha (war for the sake of duty). However, consultations may not work always and then suicide was the only choice to rid oneself from the stress of life. Manu mentioned that, if a person is clear to his/her conscience, s/he need not to go to the river or mountain or tirthas (place of pilgrimage). Conscience pain was identified as a major reason for suicide during this time. Further, the suicide of kings or important figures in society could not be shown as objectionable because that would give those figures a bad name. Subsequently, law makers had to find a way around this. In addition, as kings were the patrons of the Brahmans, Brahmans had to glorify the kings deeds and mention their popularity among the people, otherwise the mutual dependency of these two classes would have been in danger. It seems then that the mythical stories regarding these suicides are later interpolations. So, the burning question is whether the act of suicide had social sanction or not. Lawmaker Brahmins found a way out of this problem. Suicide was distinguised into two major divisions that considered the social status of the person, time and methods used in the suicide (a) respectable ways of the great persons or Mahprasthna and (b) heinous ways. The Jain school of thought also created similar divisions and tried very strongly to emphasise the difference between the two. The first type of suicide allowed a person to become dharmya or sacred; the other becomes objectionable and punishable even after death. Ways of Killing the Self

socially unacceptable/astrya 1. Socially Unacceptable Suicide:

socially acceptable/strya

Reasons of astrya suicide 6

Extreme ego

extreme anger

love/attachment

fear

Parara-sahit was very strict on astrya suicides. 7 His judgement regarding these cases was as follows:

38

Suicide Those people who committed such suicide were immersed into blinding darkness full of blood; They had to spend sixty-thousand years in hell; No performance of mourning (aauca) could be completed; No water was to be be offered to them by their next generation in their posthumous life; They would not obtain any kind of sacred fire while burning on the pyre; No one would shed tears for them; and, If anyone performed any of these deeds, s/he would have been punished by society and would have had to perform a tapatakcchra sacrifice in order to become socially acceptable.

__________________________________________________________________

2. Socially Acceptable Suicide: Socially acceptable suicides can be observed from three different vantage points: 1. who were eligible to perform 8 this type suicide; 2. when (i.e., time and reasons) were they permitted to perform suicide; and, 3. what were the permitted methods of suicide. A. Suicide by Starvation Earlier Dharmastras, such as Gautama-dharma-stra and Arthastra, presented suicide as a very heinous deed; later texts like Manusmti provided a special option for performing suicide and glorifying it. Still, these rules were smartly coded to keep suicide out of reach of the majority. Manu mentioned that, within a restricted condition, if a person is suffering from an incurable disease, s/he could reject food, becoming thinner gradually from taking in water and air only, and die. The condition under which aged people were permitted to perform this suicide were: 9 A person with an incurable disease (beyond the possibility and skills of doctors) A person who was then unable to perform daily hygiene (auca) A person who had lost his/her memory A person who had rejected all kinds of medical assistance. B. Suicide by Following Mahprasthana Methods Manus deviation is justified by the Kulluka Bhaa which implies that only the Mahprasthna version of suicide is socially acceptable; 10 so, the question as to

Debashis Ghosh

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__________________________________________________________________ the identification of the Mahprasthna methods are so important. If the person is aged, but does not come under the above-mentioned reasons, such as disease, then there are some more ways prescribed by Manu: When body of an aged person has started to decay that is the right time for Mahprasthna. One may go to the dangerous roads or to the mountains covered with ice or can drown himself/herself at the confluence of rivers (prayga) or can hang himself/herself from the branches of the banyan tree. These are the ways not to be called suicide and the persons who committed suicide by these processes get higher heaven after death. All living creatures of all Varnas irrespective of their gender are allowed to follow these paths. 11 Now the question will be why the later time period narrowed the options. One possible reason might be the dominance of Jainism and Buddhism in society where they popularized non-violence. Another reason might be the influence of the rigorous Jaina method called sallekhan (i.e. willingly starving to death). A close study of the Rmyaa and Mahhrata provides us with another indication, or proof, of our inference that suicide was more permissible in the earlier society and later become more strictly regulated. In Rmyana, which was written earlier than Mahbhrata, suicides were being justified in the later versions. In the case of suicide of Rma, no esteem personality of that time such as Vaiha, did not try to interfere in the process. Rather they took it as very natural to do whereas in Mahbhrata protagonists themselves are trying to find a way out through which these heinous deeds can be justified and glorified. In the case of Dtarra we see that Sajaya arguing how Dtarras death by fire can be justified. In this process even the mass suicide done by the followers of Rma, was glorified. C. Suicide by Yogic Power Vidur commits suicide by his power of Yoga; he himself enters into the body of Yudhisthira, leaving his earthly body behind. This story provokes us to enquire how Yoga, as a philosophy and system to study the spiritual practices, substantiates this concept. While describing the results that a yog or spiritual practitioner can obtain by concentrating on different objects, Patajali, the author of Yoga-stra, wrote: a. Eighteen results can be obtained by concentrating on different objects. By doing deep concentration on the internal cavity that is stretched from mouth to chest, Yog can control and cease thirst and hunger (kaha-kpe ktpips-nivtti 12);

40

Suicide b. When a Yog realizes the causes of binding on his mind, the binding becomes unfastened and that leads to the next level of consciousness. In this level, a practitioner becomes able to enter the bodies of others (bandha-kraa-aithilytpracrasavedancca cittasya paraarrvea 13).

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D. Committing Suicide for Expiation Another major reason for suicide in ancient India was the expiation for certain types of sins or crimes. Death as a result of different ways of suicide, were advised by the dharmastras in the following cases: Incest relations 14 suicide was the only way to get rid of sin in the case of intentional sexual intercourse with a stepmother, aunt (paternal and maternal), sister or teachers wife. Two methods of suicide were prescribed in this case: a) death by embracing a burning female figure made of iron on a burning hot iron bed; and, b) death by self-castration. Drinking of liquor 15 according to dharmastras, drinking liquor was one of the major crimes that could be committed by a Brahmin. If a Brahman was found to drink liquor willingly, then he had to commit suicide by drinking boiling water, liquor, butter or the urine of a cow. According to Manu, this was the only way to wash off his/her sin. The case of Laka is an example of suicide due to social rejection. Laka was assigned to guard the royal gate by the king Rma as Rma was busy in discussion with a sage; he was ordered to kill the person who interrupted the discussion. Meanwhile, another sage called Durv arrived and Laka informed his brother King Rma about Durvas arrival immediately. On the advice of the sages, as Laka interrupted the discussion, Rma sent him away from his country due to his negligence. Laka went to the Saray River and committed suicide. In his book Le Suicide, Durkheim truly identified the reason behind the altruistic suicides: The individual absorbed and controlled by the group had an under-developed and so undervalued sense of individuality. 16 Society strived to keep individualistic desire of suicide under its control and the individuals commitment to society made this possible. This conclusion can be justified by the case of Bhima. Bhima was rewarded with the boon that he could choose the way and time of his death. After living a long active life, Bhima decided to die in the battle field. He helped his enemies by showing them the way to kill him (Bhima). Arjuna, who was on the enemys side, pierced Bhimas body with innumerable arrows. However, there was a scriptural injunction that if a person dies during the time of dakiyana (winter season when the sun stays nearer to the southern

Debashis Ghosh

41

__________________________________________________________________ pole), they go to hell. In spite of his boons of will-death, Bhima had to wait till the commencement of uttaryaa (time of northern transit of sun i.e. January to July in India) in order to go to heaven. His individual will was subordinated by society. A fascinating passage of the Yama-sahit 17 documented the possibilities surrounding the situation of someone who tried to commit suicide but failed. What would societys response be to that? Yama gave an exhaustive list of suicide methods available during his time and gave his judgement that initially society boycotts them. However, after their completion of the cndryaa or taptakcchra sacrifice, society again accepts them as members. In the Jaina tradition, one had no choice to come back from the path of suicide if they had willingly chosen it earlier. As Jaina scholar Padmanabha S. Jaini puts in his book Jaina path of Purification: 18 Occasionally, it may happen that a supposedly fatal illness undergoes remission or complete cure during the course of progressive fasting. In such cases the vows which have been taken cannot be rescinded; the aspirant must continue to take no more food per day than his current allotment for as long as he lives. This possibility explains the usual practice of refraining from a vow of total fasting until such time as death is clearly at hand. Jainas believe that the entire spiritual life of a layman (and, to an even greater extent, of a mendicant) is in fact preparation for a sacred death. It seems that the psychological reasons for suicides were neglected in ancient India. The context of Gt and Mahbhrata shows that, from an ancient Indian perspective, psychological suicides were pathological. However, spiritual reasons were separated from psychological reasons as the attitude and treatment of contemporary society were different towards both cases. Epics and mythical narratives keep the fact in a codified form. There could be many access points to that fact. The present chapter, in its limited scope, has tried to decode the underlying truth using a socio-philosophical access point. A thorough study of the nature of suicides prevailing in ancient India can lead us to better understanding of condition of human life and society of that time.

Notes
Lord Buddha was born in this particular time period and Jaina guru Mahvira was also his contemporary and all the major legal codes (dharma-sahitas) in verse form had been codified by that time. 2 The length of human life is mentioned as hundred years. Common men wanted to live those years by performing daily activity such as agnihotra sacrifice. (kurvvan eva iha nirvvarttayan eva karmmi agnihostrdni jijviet jvitumicchet - ata
1

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Suicide

__________________________________________________________________ atasakhyak sam savatsarn| tvaddhi puruasya paramyu- nirpitam| akara-bhya on opaniad verse no. 3). 3 Though there were many more philosophical school existing in the society such as Buddhist, Jaina, Upanisadic, early Yoga, Nyya etc., Skhya and Vieika were on the pinnacle of popularity. 4 These two philosophies believe in plurality of soul. 5 Only few cases of adhytma-prakaraa are the exceptions. 6 Atimnd-atikrodht snehd v yadi v bhayt | udvadhnyt str pumn v gatir-e vidhyate Parara-sahit 4/1; jalgnyudvandhanabhra pravrajrynaanacyut | viaprapatanapryaastrghtacyutca ye || sarve te pratyavasit sarvalokavahikt | cndryaena udhyanti taptakcchradvayena v || Yama-sahit verse 2-3. 7 pya-oita-sampre andhe tamasi majjati | ahi vara-sahasri naraka pratipadyate || nauca nodaka ngni nruptaca krayet | vohrognipradtra pacchedakarstath || Parara-sahit 4/2-3. 8 Usually commit goes with suicide, I would rather prefer perform instead of commit, as commit bears a negative connotation. 9 aparjit v sthya vrajet diamajimhaga | niptccharrasya yukto vryanilana || maharicary tyaktvnyatamay tanum | vtaokabhayo vipro brahmaloke mahyate || Manu-sahit 6/31-32; acikitsitavydhydyudbhave aparjitmain diamritykuilagatiryukto yoganiho jalnilana arraniptdgacchet | mahprasthnkhya stre vihita ceda maraa Kulluka-bhaas commentary on Manu 6/31-32. 10 mahprasthnkhya stre vihita ceda maraa, tena na puryua svakm preyditi srutypi na virodha | yata svakmiabdaprayogt avaidha maraamanay niidhyate na striyam (Kulluka-bhaas commentary on Manu 6/31). 11 gacchet mahpatha vpi turagirim-dart | prayge vaakhy dehatyga karoti ya || sva dehavinasya kle prpte mahmati | uttamn prapnuylloknntmaght bhavet kacit || etemadhikrastu sarvvem sarvvajantuu | narmatha nrm sarvavareu sarvad || (abdakalpadruma, 131) . 12 Yogastra 3/30. 13 Yogastra 3/38. 14 tapte ya ayane srddhamyasy yoit svapet | ghitvotktya vaau nairty votsjettanum || Yjavalka-sahit 3.258, Viha-sahit 20 etc. 15 sur ptv dvijo mohtagnivar sur pivet | tay svakye nirdagdhe mucyate kilviattata || gomtramagnivara v pivedudakameva v | payo ghta v marad goakdrasameva v ||- Manu-sahit 11.91-92. 16 E. Durkheim, Suicide: A Study in Sociology, Routledge, London, 2005, p. 44.

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__________________________________________________________________ jalgnyudvandhanabhra pravrajrynaanacyut | viaprapatanaprya astrghtacyutca ye || sarve te pratyavasit sarvalokavahikt | cndryaena udhyanti taptakcchradvayena v || Yama-sahit verse 2-3. 18 P.S. Jaini, Jaina Path of Purification, Motilal Banarsidass Publ., New Delhi, 1998, p. 231.
17

Bibliography
Durkheim, E., Suicide: A Study in Sociology. Routledge, London, 2005. Dundas, P., The Jains. Routledge, London, 2002 (2nd edition). Dev, R., abdakalpadruma. Rastriya Sanskrit Sansthan, New Delhi, 2006. Jaini, P.S., Jaina Path of Purification. Motilal Banarsidass Publ., New Delhi, 1998. Sukthankar, V.S. (ed), Mahbhrata (etiext of Critical edition). B.O.R.I., Puna, 1996. Tarkaratna, P., naviati-sahit. Sanskrit Pustak Bhandar, Kolkata, 2001. Werth, J.L., Rational Suicide? Implications for Mental Health Professionals. Taylor & Francis, 1996. Debashis Ghosh is a research scholar at Special Centre for Sanskrit Studies, JNU, New Delhi and presently teaching at Scottish Church College, Kolkata. His interest lays in Indian logic and Indian philosophy of language. His research and recent writings are related with understanding of life, death and salvation reflected in Indian philosophical texts.

The Value of Human Life in Islam: Physician Assisted Suicide Hossein Godazgar
Abstract Through examining the notion of physician-assisted suicide in Islam, this chapter aims to illustrate that religion has no fixed, homogeneous and universal definition. Its definition, interpretation and construction with reference to various issues of the everyday life vary from one social agent, authority and context to another. This chapter shows the ambivalent status of Islam with regard to suicide by focusing on a Quranic verse, some Ahadith (plural of hadith) and their different interpretations. It concludes with a social constructionist approach, which makes the definition of Islam in relation to physician-assisted suicide even more ambivalent. Key Words: Religion, Islam, life, value, physician assisted suicide. ***** One day I had Bertrand Russell in the cab. So I said to him, Well, then, Lord Russell, whats it all about? And, do you know, he couldnt tell me. 1 In 2005, in order to mark its 35th anniversary, the journal Foreign Policy invited 16 leading scholars to reflect on ideas, values, and institutions taken for granted by the world at that time, but which may disappear in the next 35 years. One of these scholars was the Princeton University professor and author of influential books in ethics, Peter Singer. In reply, emanating from his general consequentialist view, he predicted that: During the next 35 years, the traditional view of the sanctity of human life will collapse under pressure from scientific, technological, and demographic developments. By 2040, it may be that only a rump of hard-core, know-nothing religious fundamentalists will defend the view that every human life, from conception to death, is sacrosanct (highlighted by the author). 2 In the next issue, Gordon Preece, the Director of Macquarie Christian Studies Institute in Sydney, used a deontological approach to counter Singers view on death and life: Singer uses the f word to dismiss anyone who upholds the fundamental value of human life. Nor should Singer be so

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The Value of Human Life in Islam

__________________________________________________________________ sure that the future is secular. Even in Europe, secularism is being challenged by the rising tide of Islam (highlighted by the author). 3 In a similar, yet more reasonable, approach another well-known figure of bioethics, Daniel Callahan, the Director of International Programme at the Hasting Center, in New York, argued that: Peter Singer is not the first to be misled by the claim of some religious fundamentalists that theirs is the traditional view of the sanctity of life. Fundamentalists just co-opted that principle. Singer ignores the fact that even among those who subscribe to the view, including many of those who do so on religious grounds, there are division and uncertainties. Far more distressing is Singers claim that only those with some level of self-awareness count as persons. That standard is just a variant on an old and terrible story: Those in power determining which human beings are to be respected and protected. Whites once believed the wrong skin colour permitted slavery; men once thought womens worth stemmed from male evaluations; Jews were exterminated for having the wrong faith and ethnic group (highlighted by the author). 4 1. Religion, Modernity and Diversity For me, as a sociologist of religion, Peter Singers prediction of the collapse of religion in giving sense and meaning to life and death is more reminiscent of the 19th- or early-20th-century classical social theorists view of religion, which reflected their subjective wishes and desires, rather than the realism of religion in social life. Like the classical social theorists, Peter Singer fails to imagine modernity in concomitant with religion. For him, the meaning of life is either associated with modernity and secularism or it represents the sense of tradition, which is merely associated with fundamentalism in the late modernity of the contemporary world. However, as the dream of the classical social theorists has not been realised in more than a century, I doubt Peter Singers dream will come into existence in 35 years. Although it is hard to figure out what Gordon Preece means by secular, his proposal that Nor should Singer be so sure that the future is secular, acknowledges the social reality of religion in the contemporary world is appreciated. However, it seems his statement is, at best, vague when he claims that Even in Europe, secularism is being challenged by the rising tide of Islam. This is because it is not clear whether he means Islam, as an example (besides other religions), that challenges secularism; or Islam, as the only religion, that

Hossein Godazgar

47

__________________________________________________________________ challenges the rest of Europe, which is associated with secularism. If the latter is the case, at its worst it can be implied that religion is merely restricted to the social realm of the followers of Islam and non-existent among the followers of other traditions. Yet, Callahans view sounds more sensible from three perspectives. First, it differentiates between religion and religious fundamentalism. Second, it recognises the existence of diverse views within religious grounds towards the various issues addressing the beginning and the end of life. Third, and more importantly, although he reaches a conclusion that is deontological, by implication, his argument acknowledges the social constructionist nature of religion, along with race and gender, through indicating the role of power in giving meanings to them. However, what all these accounts of the sanctity of life have in common is that they fail to define what they mean by religion and, by implication secularism. They also fail to consider that the meanings of life and death are also social and contextual. In this brief article, my main argument is that, in order to accept physician-assisted suicide, one does not necessarily need to resort to so-called secular ideas. Physician-assisted suicide can also be established within the framework of religion. It merely depends on how religion is constructed and interpreted by social agents. Inspired by Jonathan Brockopps report of Islamic ethics and James Beckfords theory of social constructionism, I explain this by taking Islam in association with suicide. 2. Islam and Suicide The concept of suicide may be consistent with the notion of Islam in various ways: A. Suicide may be admitted under the claim that the Quran does not make an obvious or specific reference to it. A verse that has often been referred to by Tantawi and others to argue that suicide is prohibited in Islam is: Do not kill yourselves (anfusakum), surely God is merciful to you. 5 Yourselves or anfusakum is a key word here. It may be translated either as do not kill yourself or do not kill each other. Abu Jafar al-Tabari (d. 923) chooses the latter and claims that it means: some of you should not kill others, since you are people of a single faith, a single creed, and a single religion. 6 Having said this, al-Tabri does not rule out the likelihood of reasoning the prohibition of suicide from this verse. Another very important Quran commentator, Imam Fakhr al-Din al-Razi (d. 1209), correctly notes the context of Arabia at the time and claims that the commentators are agreed that this verse is a prohibition of some killing others,

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The Value of Human Life in Islam

__________________________________________________________________ for [the Prophet] used anfusakum in his statement the Muslims are like a single person (nafs). 7 B. The interpretations that argue its association with a presumed prohibition on suicide, show sympathy and understanding about suffering at the end of life. In addition, Imam Fakhr Razi suggests that some disapproved of the verses association with the prohibition of suicide because, for them, it was obvious that no-one would kill themselves! Therefore, prohibition is unnecessary. However, he goes on to note that: even the believer, despite his status as a believer in God and the last day, may suffer so from censure and injury that death seems easier to bear than these. In fact, we see many Muslims killing themselves for such reasons as we have listed. So in this case, the prohibition is beneficial [Even] So He, the Most High, has made clear that He is merciful to His servants. 8 The Prophet also recognised that suffering may make life intolerable. A hadith that belongs to Anas b. Malik, quotes the Prophet as having said that: Do not any one of you desire death out of any need which oppresses you. If there is no way out, then say: Oh God, revive me if life is better for me, or take me away, if passing away is better for me. 9 This hadith has led Tantawi and others to rule in favour of passive euthanasia in Islam. C. Some comments on relevant hadith seem to be compassionate toward those who have committed suicide. A commentator quotes a hadith from Jabir b. Sumara: The Prophet came to a man who had killed himself with an arrowhead, and he did not pray over him. Then the commentator adds that: [he] did not pray over him personally to warn the people from doing the same act, but the companions prayed over him. 10 This explanation has been supported by Islamic scholars such as al-Hasan, al-Nakhaei, Qatada, Malik, Abu Hanifa, and al-Shafii. These clearly show the ambivalence of classical sources with respect to suicide. D. Again as Brockopp points out, the prohibition of suicide seems to be inconsistent with Islamic teaching on martyrdom. 11 Few Islamic scholars have been successful in differentiating between suicide and martyrdom, though the distinction has been very important in Islam. Martyrdom is usually applied to those

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__________________________________________________________________ who die on pilgrimage to Mecca or while fighting in a religious war (jihad). Both the Quran and hadith attribute martyrdom to those who risk their lives for the hope of a heavenly reward and doing so in Gods path. In other words, according to Islamic tradition, the intention (niyyah) of the person is essential. If this is the case, human life tends not to have an intrinsic value. Islamic theology may then allow suicide in certain conditions by embracing this teleology and focusing on Gods promise of eternal life in paradise, rather than on pain and suffering at the end of life in this world. 3. Islam: A Social Constructionist Approach Not only may suicide be permitted in the Islamic framework by arguing for an instrumental value for life, I tend to maintain that it may also be allowed by conceptualising and understanding Islam and life as personal values. I believe this is compatible with the social constructionist approach of understanding both Islam and life. A social constructionist approach of any religion, including Islam, avoids a unitary, fixed and universal view. 12 In other words, from this perspective, the way in which Islam is understood and conceptualised varies from one person, one condition, one aspect of life, one episode of life to another. It is neither fixed nor universal. It is always contextualised. Of course, the social constructionist view of religion or Islam has nothing to do with the denial, or even approval, of the supernatural origin of religion. Religion may originate from a realm beyond social life but, when it comes to be understood or conceptualised, it cannot escape the issues surrounding it in a social life. In other words, religion or Islam may be understood and constructed in different ways in terms of the extent and quality of education, subject of study, family conditions, geographical circumstances, social class and status, gender, occupation, ethnicity, nationality, and other aspects. From this perspective, the definition of Islam may change from one individual to another in association with various aspects of everyday life; so too, the meanings of life and death. Different Muslims, or the same Muslim in different conditions, may construct different meanings for life and death; their different approaches in adopting or refusing the action of suicide, or appealing or not appealing for physician-assisted suicide, can be an example of this. A social constructionist approach recognises neither intrinsic nor instrumental value for life, but a personal value. In other words, its meaning depends on each person who feels its existence or lack of meaning in a certain condition or episode. Thus, I tend to suggest that the suggestion of life is meaningful or meaningless is itself meaningless.

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The Value of Human Life in Islam

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Notes
London taxi driver, quoted in C. Belshaw, 10 Good Questions about Life and Death, Blackwell Publishing, Oxford and MA, 2005, p. 109. 2 P. Singer, Here Today, Gone Tomorrow: The Sanctity of Life, FP [Foreign Policy], Vol. 150, 2005, p. 40. 3 G. Preece, Singers Death Ethics, FP, Vol. 151, 2005, p. 4. 4 D. Callahan, Singers Death Ethics, FP, Vol. 151, 2005, p. 6. 5 Quran, 4, 29. 6 Tabari, cited in J.E. Brockopp, The Good Death in Islamic Theology and Law, Islamic Ethics of Life: Abortion, War, and Euthanasia, J.E. Brockopp (ed), University of South Carolina Press, Colombia, 2003, p. 183. 7 Imam Fakhr al-Din al-Razi, cited in Brockopp, op. cit., p. 184. 8 Ibid. 9 Sahih Muslim bi-sharh al-Nawawi, cited in Brockopp, op. cit., p. 185. 10 I. Hajar, cited in Brockopp, op. cit., p. 188. 11 Brockopp, op. cit., p. 183. 12 J.A. Beckford, Social Theory and Religion, University of Cambridge Press, Cambridge, 2003, pp. 11-29.
1

Bibliography
Beckford, J.A., Social Theory and Religion. University of Cambridge Press, Cambridge, 2003. Belshaw, C., 10 Good Questions about Life and Death. Blackwell Publishing, Oxford and MA, 2005. Brockopp, J.E., The Good Death in Islamic Theology and Law. Islamic Ethics of Life: Abortion, War, and Euthanasia. Brockopp, J.E. (ed), University of South Carolina Press, Colombia, 2003, pp. 177-193. Callahan, D., Singers Death Ethics. FP [Foreign Policy]. Vol. 151, 2005, p. 6. Singer, P., Here Today, Gone Tomorrow: the Sanctity of Life. FP. Vol. 150, 2005, pp. 40-41. Hossein Godazgar is Reader in Sociology of Religion at Al-Maktoum College of Higher Education (validated by University of Aberdeen) in Scotland. Whilst the core of his research interest and expertise lies in the areas of religion in relation to various aspects of everyday life, currently his research is devoted to religion, diversity and physician assisted suicide in Scotland.

Religious Attitudes and Behavio rs among Suicide Attempters in Turkish-Muslim Society Zuhal Agilkaya
Abstract This chapter aims to examine religious dispositions among Turkish-Muslim people who attempted to commit suicide. In order to find out religious attitudes and behaviors, 24 suicide attempters were interviewed. The interviews were analyzed under the following categories: meaning of life, religious beliefs and behaviors, God image and relations. Content analysis of the interviews showed that the whole sample, except one atheist participant, had religious beliefs. Further analysis showed that differentiation had to be made concerning religious beliefs, since the sample demonstrated that 67% had formal religiosity and 29% had individual religiosity. However, the individual believers who emphasized a faith in God but not in a particular religion had confused religious feelings and thoughts. Both groups showed low engagement in religious practices. Key Words: Suicide, suicide attempts, religion, religious attitudes and behaviors. ***** 1. Introduction Suicide is one of the dramatic evidences of mans defeat in his struggle for saving his existence and maintaining a happy life. Thus, as an attack not only towards the self but to others, suicide has been celebrated as a victory against (natural) death and also as a right of freedom that cannot be robbed. Throughout history, motivated by its narcissism, one part of mankind has been keen to realize its desires of immortality while another part, not wanting to suffer any longer the uncertain wait on how and when this unbearable life will end, has exercised its right over life. As Camus states: what is called a reason for living for is also an excellent reason for dying. 1 However, one thing has been a common obstacle for both: religion. Religion has displeased the former by attributing immortality to God only and declared to the latter its exclusive authority over life and death. Therefore, the fact of death, as an event most upsetting and disorganizing to mans calculations, is perhaps the main source of religious belief. 2 Further, considering its source, religion has always been almost the only competent authority over the knowledge of death. 3 This study aims to explicate the attitudes and behaviors towards such an authority, of those who have wanted to exercise exclusive power over their lives and deaths. There is a public opinion within Turkish-Muslim context and I believe also in different religious communities that religious people or better-said people with

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Religious Attitudes and Behaviours among Suicide Attempters

__________________________________________________________________ religious faith would not commit or attempt to commit suicide. And or but if they do so, they do not possess any religious beliefs. In order to find out if this was true, I posed my research question like this: Do people who have attempted to commit suicide have religious attitudes? If they do, what kind of are they? To answer this question, I interviewed 24 persons aged between 15-34 years who had attempted suicide. My research findings relating to demographic features (age, sex), 4 suicide stories (reasons, motivations, affective states), 5 and statistical data (number of repeated attempts, types of suicide) 6 not only confirmed the literature in general but also the statistics of suicide attempts in Turkey. The especially well-known suicide motives like escape/rescue, give a message as punishment/revenge/spite (especially to parents), cry for help, and selfapproval were very obvious. This reflected the characteristics mostly mentioned with adolescent suicides, namely the need to communicate or the cry for help. After all this statistical data relating to age, sex, motivations, reasons were affirmed, I had a great personal experience. As a fresh researcher doing empirical research, you start excitedly collecting data for your study; you read and read all these findings, results, and statistics and so on; and, you get fairly bored after a short time and all of your enthusiasm is taken away. Yet, after my first interviews I realized: This is all true! This was a moment for me in which I experienced how statistical data became reality! It was a dramatic and shocking experience for me to hear the cry for help from 16-17-year-old girls stating: I wanted them to suffer, too. I wanted to make them see All of this, in order to communicate with their environment by means of such a dangerous method, like suicide, and without truly considering the possible results from their act, namely death. Coming to from this shock, and in order not to lose my scientific objectivity, I continued on my search for religious attitudes among my suicidal sample. In order to find these attitudes, I used religiosity scales applied in the psychology of religion, 7 together with James Fowlers Faith Development Interview 8 questions as guides. Subsequently, the interview questionnaire was prepared and the resulting interviews analyzed under the following indicators: giving meaning to life, religious beliefs, God imagination and relationship, and worship. 2. Meaning of Life Einstein notes that: To be religious is to find an answer to the question What is the meaning of life? 9 Victor Frankl defines faith and belief as trust in the ultimate meaning. 10 Following these ideas, the participants were asked if religion played a role in their will to meaning. In determining religious attitudes and behaviors, an important criteria was whether the subjects used religious references in their outlooks on life or not. The result showed that the vast majority of the sample (71%) was not using religious references. This showed that, for the majority of the sample, even when they had faith, the concept of religion was not a

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53

__________________________________________________________________ determinant factor in their lives. This fact can be interpreted as religious references and attributions are not used in life events, thus belief is not embedded in their lives. 3. Religious Beliefs A. Religious Beliefs and Thoughts The second group of questions related to religious beliefs. Beliefs are the cognitive part of attitudes and determine the formation of an attitude. In the context of religious attitudes, the cognitive part is shaped by an individuals religious thoughts and knowledge. In terms of religious thoughts, it was found that some participants suicide motivations consisted of faith questions, lack of faith, or the loss of faith. The question after religious beliefs revealed that the whole sample except one participant who was an atheist, described themselves as believers. However, a differentiation among the believers had to be made: 29% of the sample expressed no belief in a specific religion but rather belief in a God (God-believers), while 67% related their belief to a religion (religious-believers). According to this separation, participants with institutional religiosity (religious-believers) did not make any further definition of their religiosity. In contrast, almost all of the subjects with individual religiosity, who devoted themselves only to God, defined their religious identity as deist or agnostic. In taking only God as a reference, these people filled in the concept of religion with their personal perceptions and presented their individual religiosity as follows: I actually dont accept any religion. I mean, I do believe that there is a creator and that I have to pay reverence to God to expect help from him, but I dont believe in anything else or I dont belong to a religion. There is a world I live inside, no rules, no book, only its existence and I judge myself that is to say I live my religion in myself yes I do have a religion but even if I live it in myself, I am someone with religious beliefs. Religion is also a response to psychological needs like refuge, attachment, protection and provides its believers comfort and peace. Evidence of the fulfillment of such needs by religion was found among the majority of the sample (68%) who used religious beliefs as a coping method in stressful life situations. This finding showed that the majority of the sample (78%), with religious beliefs, was acting coherently with its religious attitudes. On the other hand, religion with its prohibitive, controlling, and restraining aspects places pressure on individuals. This was reflected by statements like: Belief means to me God but not a certain religion, only God. I mean Ive never had doubts in my faith in God but wasnt able to decide for a certain religion. Some rules in religion make me think.

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Religious Attitudes and Behaviours among Suicide Attempters

__________________________________________________________________ B. Perception of Sin Previous research has demonstrated that members of different religions have different attitudes towards suicide as a sin. I found that members of the same religion could differ in their perception of sin, including suicide attempts. The majority of the participants who believed that they had not sinned were among the God-believers (57%); most of the religious-believers (74%) felt that they had sinned. An interesting finding was that some set a precondition for sinning due to their suicidal act, namely death. Their thoughts were like this: I am sure he [God] was very angry but I apologized, I think he forgave me, look Im still alive, otherwise he would take my life. If I had died, I would have gone to hell, I would have sinned. Im still living, here I am in the world, I dont think that Ive sinned or God forgave me thats why he rescued me. I dont think Id make it again. But still Im thinking of it. Actually it is a sin to kill oneself, but I think that he forgave because I regretted. When you think of suicide you drift away from everything, even your religious feelings remain in the background or rather I didnt think at that moment, that I am sinning. When the participants were asked what God might have thought about their suicide attempt, almost half of them answered with negative; many also thought angry as they added: He might have assessed it as foolishness, stupidity. Here a difference can be made among those who attributed negative/angry thoughts to God. Most of them (67%) were religious-believers, while fewer (27%) were Godbelievers. It is not surprising that such a difference appeared between those who built up a personal relationship with God without institutionalized rules and specific religious guidelines and those committed to a traditional and institutionalized religion with its dogmatic teachings, which lead them to believe that suicide is a sin and God might have negative thoughts about them. C. Religious Feelings Another determinant part of attitudes is the affective component, which is especially important in the formation of religious beliefs. Yet, while almost the whole sample defined themselves as believers, only half the sample expressed that their religious feelings and thoughts influenced their suicidal act. Further questioning as to the outcome of this influence revealed consistent behaviors like praying, ablution, disobedience, and asking for forgiveness. However, the expression of the interviewees I didnt think of it [religious feelings/thoughts] at all makes it clear that in spite of religious belief and thoughts, the religious attitudes of the sample did not gain a central and consistent character, which could prevent them from committing a sin. D. Belief in the Afterlife Within the religious beliefs of the participants, the meaning of death and the hereafter was also analyzed.

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55

__________________________________________________________________ Since the sample consisted largely of participants with internal and external problems, it was not surprising that 25% (n=6) considered death as a release. The fact that this response came mostly from God-believers (4 of 6) was interesting. On the other hand, participants who regarded death only as the end were mostly religious-believers; all of those who did not believe in, or had doubts in the hereafter, were entirely God-believers (29%). There is a perception that the afterlife is a time and place for restitution, where evil will be punished and injustice will be judged. Some participants believed that justice will be done this way. 4. God Imagination and Relationship In the search for religious attitudes, the aspects of God imagination and relationship with God were also examined. All participants, except the atheist, had an idea about God. The most frequent answers were creator who created all out of nothing and helper who helped in moments of prayer/need/wish. Further detailed analysis revealed a God imagination of a loving-caring God, which was only expressed by religiousbelievers (16%). This suggests that feeling attached to and believing in a divine existence that helps in crisis may be protective against suicidal ideas. Consequently, the fact that almost all participants who had the helper imagination (17%) had only one suicide attempt makes this finding more meaningful. As for the relation with God, most of the sample (38%) felt a permanent connection and nearness to God without waiting for a special occasion/situation. Some of the participants (29%) had an occasional relationship with God; there had to be certain occasion for the participant to get in touch with God. Fewer participants (17%) communicated with God occasionally/worship; the subjects experienced Gods nearness and presence only in moments of worship but performed worship only in special situations like demand, trouble, shelter, pain, happiness, night, well-being, disease. Calling on God only occasionally points to the server God imagination and is quite understandable since these responders are in the age group 16-24 years, where personal and social problems are faced intensively. Statements like when I prayed he helped me a lot or I prayed to God for help make clear that the mentioned occasions were either to fulfill a need, to be released of something, or to ask for help for something. It has been noted that individual religious life decreases the incidence of suicide ideation and behavior. 11 This claim was tested by interpreting individual religious life as performing religious practices. Therefore, 75% of the subjects who worshipped had only one suicide attempt while the remaining 25% had made three attempts. The interesting point in this finding is that participants with more than one attempt were mostly from the individual religious group; in other words all God-believers (29%) had more than one suicide attempt. In turn, and taking the relation of God-believers and religious-believers in this sample into account, this

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Religious Attitudes and Behaviours among Suicide Attempters

__________________________________________________________________ supports claims that institutionalized religiosity has more positive effects on mental health, at least in the sense of preventing repeated suicide attempts. In contrast, claims which emphasize individuality conclude that individualized religiosity would have more positive effects on mental well-being by enhancing mans search for meaning and providing spiritual support. 12 If suicide attempts are regarded to be a potential mental health problem whether as a sign for such problems or even deemed as such a problem in themselves and if the above findings are assessed in respect to the argued advantages of individualized religiosity, it must be asserted that the God-believers experienced distress with God/faith and had felt unsure, especially in their search for meaning. 5. Religious Behaviours/Worship In determining attitudes towards a certain object, behaviors are important clues. The behavioral part in religious attitudes is worship. The main responses to the worship question were: yes (33%), occasionally (33%), or formerly (25%). All participants with institutionalized religiosity performed either formal exercises or prayer only; the individually-religious participants (God-believers) only used prayer. Studies have found that using religious coping methods within institutionalized religiosity, namely joining collective worship, is protective against suicide. 13 The fact that subjects performing formal practices within institutionalized religiosity had fewer suicide attempts could be considered to confirm this finding. Since prayer was the most performed method, the samples preferred worship methods require further explanation. Starting with Vergote, 14 many psychologists of religion affirm that prayer is a cry for help, the confession of weakness, and the search for trust. Considering the search for communication and help within the motivations for suicide illuminates the samples special tendency for prayer. In the last question of the interview, participants were asked whether their suicide attempt affected their responses and if it made a change in their lives. Half of the sample answered positively (yes). Those who described their experience as a turning point in their lives were asked about the direction of this change. Most of them (67%) explained that they experienced a change in their religious life, some (22%) a change in their outlook on life, and some (11%) a change in both. Changes in religious life were explained to concern increased worship and finding faith in God. Changes in social life were described as social support and the stability in life it provides and to be sensitive and careful against caring and supporting people around. 6. Conclusions Against the public opinion that people who have religious beliefs do not commit or attempt to commit suicide the sample showed that it has religious attitudes even positive. However, it should be made clear what is meant and

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__________________________________________________________________ examined: belief with an individual religiosity or religiosity devoted to an institutional religion. Data concerning repeated suicide attempts in the sample revealed that all multiple attempts were committed by individually-religious participants (God-believers). Therefore, it may be concluded that formal religiosity might be a more protective and preventive factor against suicidal acts. The sample did, however, only consist of suicide attempters and did not include people who actually committed suicide. In order to confirm these preliminary findings it would therefore be necessary to perform psychological autopsy studies with respect to the distinction between God-believers and religious-believers. Furthermore, it could be recommendable to perform cross-cultural studies addressing these questions. Another observation was that the samples attitudes were not supported by behaviors and that they did not show centrality and consistency regarding other attitudes on the subject. This explains why and how they could make a suicide attempt against their religious beliefs and perceptions of sin. Thus, it can be concluded that centralized religious attitudes, supported by religious practices or worship, may decrease suicide risk. Therefore, social and individual precautions and practices in order to reinforce or develop positive religious attitudes and behavior could be helpful in preventing suicide by religion if we have or should have such an intention, aim or right.

Notes
A. Camus, Der Mythos von Sisyphos: Ein Versuch ber das Absurde, Hamburg 1972, p. 9. 2 B. Malinowski, The Role of Magic and Religion, Reader in Comparative Religion, W.A. Lessa and E.Z. Vogt (eds), Harper & Row, New York, 1972, p. 72. 3 Z. Kara, The Phenomenon of Death: A Sociological Approach, Paper presented at The University of Marmara Faculty of Divinity, Young Scholars Theology Studies Symposium, 1-2 May 2008. 4 Age: 15-34 years; sex: 13 females, 11 male. 5 Adolescents reasons: family conflicts, emotional relation problems, pubertal identity conflicts and crises. Elder subjects reasons: negative life experiences like disease, prison etc. Affective states: despair/hopelessness, distress due to inner problems like feelings of emptiness and faith problems. 6 Repeated attempts: 12 subjects (50%); type of attempt: impulsive (75%). 7 P.C. Hill and R.W. Hood (eds), Measures of Religiosity, Religious Education Press, Birmingham, 1999. 8 J.W. Fowler, Stages of Faith, Harper Collins, New York, 1995. 9 V.E. Frankl, The Unconscious God, Simon and Schuster, New York, 1975, p. 13. 10 Ibid. 11 A. Yapc, R Sal ve Din, Karahan Kitapevi, Adana, 2007, p. 290.
1

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Religious Attitudes and Behaviours among Suicide Attempters

__________________________________________________________________ Ibid., pp. 290-291; S.C. Hilton et. al., Suicide Rates and Religious Commitment in Young Adult Males in Utah, American Journal of Epidemiology, Vol. 155, No. 5, pp. 413-419. 13 S.D. Molock, et al., Relationship between Religious Coping and Suicidal Behaviours among African American Adolescents, Journal of Black Psychology, Vol. 32, pp. 366-389. 14 A. Vergote, Religion, Foi, Incroyance, Pierre Mardaga, diteur, Bruxelles, 1983, p. 259.
12

Bibliography
Camus, A., Der Mythos von Sisyphos: Ein Versuch ber das Absurde. Rowohlt, Hamburg, 1972. Fowler, J.W., Stages of Faith. Harper Collins, New York, 1995. Frankl, V.E., The Unconscious God. Simon and Schuster, New York, 1975. Hill, P.C. and Hood, R.W. (eds), Measures of Religiosity. Religious Education Press, Birmingham, 1999. Kara, Z., lm Fenomeni: Sosyolojik bir Yaklam. Paper presented at the University of Marmara Faculty of Divinity. Gen Akademisyenler lahiyat Aratrmalar Sempozyumu, 1-2 May 2008. Malinowski, B., The Role of Magic and Religion. Reader in Comparative Religion. Lessa, W.A. and Vogt, E.Z. (eds), Harper & Row, New York, 1972. Molock, S.D., et al., Relationship between Religious Coping and Suicidal Behaviors among African American Adolescents. Journal of Black Psychology. Vol. 32, 2006. Vergote, A., Religion, Foi, Incroyance. Mardaga, P. (ed), Bruxelles, 1983. Yapici, A., Ruh Sal ve Din. Karahan Kitapevi, Adana, 2007. Zuhal Agilkaya, Phd Canditate in Psychology of Religion at Marmara University, Turkey and Bielefeld University, Germany.

What does the Music I Hear Have to do with My Death and Life Views? Social Representations of Life, Death and Suicide Rute Rodrigues & Ablio Oliveira
Abstract This empirical research, framed on the theory of social representations, aimed to understand how life and death are represented among an adolescent population (boys and girls, from 15 to 19 years old). It was our central goal to examine how these social representations may differ according to the adolescents musical preferences and the opinions of significant others (such as parents, friends and colleagues). The findings indicate that boys particularly tend to listen to rock/metal while girls show a special predilection for pop and (soft) rock music. Girls, more than boys, are most likely to represent life as the proximity to other people (like friends) and as a certain uneasiness; they anchor death particularly with feelings of malaise, ritualism, and in the departure of significant others. Death was, surprisingly enough, scarcely anchored on suicide as adolescents may tend to represent suicide as a runaway and not so much as finitude and cessation. Younger adolescents (15-16 years old), more than the older, understand life as a personal accomplishment. The opinions of others proved to be relevant not only regarding musical preferences, but also in understanding life and death. In short, we have found significant associations with the social representations of life, death and with the musical preferences. Key Words: Adolescence, Death, Life, Music, Social Representations, Suicide. ***** 1. Introduction Life and death. The beginning and the end. Everything that we are, think, do or feel happens in between. Death is the most frightening, feared, and yet fascinating, subject known to men. As adults, we think about it and come across its many faces every single day. In this study we aimed to understand how adolescents represented life and death and how these thoughts and feelings might be associated to their social universe. Adolescence is a period of identity affirmation and the testing of boundaries, where friends play a major role. 1 It is quite straightforward to place music among the most significant activities of adolescence since it plays a relevant part in identity structuring. 2 Music provides relief from boredom, filling in the silence and facilitating expression of feelings and identification towards particular sounds or lyrics; 3 music is, for itself, an agent of socialization, 4 subsequently influencing thoughts and behaviours. 5

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What does the Music I Hear Have to do with My Death and Life Views?

__________________________________________________________________ According to Lifton, representing life and death as one unit, a two-faced coin, 6 implies the assumption that thoughts regarding death are constant in every human being since his birth. Nonetheless, since death is a unique experience, we are not able to learn and comprehend how to deal with it; as such, we cannot process the idea of finitude. 7 Although aware of human mortality, adolescents often do not accept their own finitude as factual. To most adolescents, death is a distant and unlikely event, similar to old age. 8 Yet to others, death is an adversary that must be defeated in order to continue to live within what is expected. To rule over death means to rule over life, to give it its utmost significant meaning. 9 Due to their natural tendency and need to experiment, feel and live everything as intensely as possible, adolescents sometimes find themselves close to death. 10 In crossing these limits, adolescents may frequently perform some risky behaviours such as alcohol or drug abuse, reckless driving, unprotected sexuality; 11 self-harm (cuts and burns mainly on the arms and upper legs), 12 and even suicide attempts. 13 The idea of suicide may come to mind as a fast, yet desperate, way out of severe life events. Although not every thought about suicide, necessarily leads to a suicide attempt, the fact is that the single ideation alone may be a risk. 14 Death and Life are the two most intricate phenomena within (or beyond!) our reach, which we may only understand through social representations (SR). 15 Moscovicis theory postulates representations as social constructions 16 through which it is possible to modulate our perceptions and conceptions of an object and reality itself, since that what is unknown and strange comes as a threat because there is no category to fit that in. 17 Further, social representations are structures that comprise, simultaneously and inextricably, cognition, affection and action 18 and are, therefore, a body of values, ideas and practices that assist our intent to interpret and think our daily reality. 19 The present study aims to: 1) comprehend and analyse the social representations (SR) of life and death amongst an adolescent population; 2) comprehend and analyse their musical preferences; 3) understand how SR vary according to gender and age; and, 4) verify how SR of life and death may be associated with musical preferences and the opinion of others. 2. Method and Materials Participants - A population of 262 adolescents, 54% male, 46% female; 61% between the ages of 15 and 16 years and 39% between the ages of 17 and 19 years. Variables - We considered gender and age as independent variables and the dimensions for musical preferences, the opinion of others, as well as SR of life and death, as dependent variables. Instruments and Procedure - We developed a questionnaire with six groups of items; these closed questions followed an ordinal scale (1 to 5). These questions were based on results from other research 20 and a previous focus-group which

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__________________________________________________________________ involved talking to adolescents about life, death and music. The data was collected in a class context; each student answered it anonymously in an individual protocol. 3. Results The data was analysed using Factor Analysis (FA) with the items considered for each theme in order to reduce and reveal the internal structure of the data and Variance Analysis (ANOVA) on the factors obtained. In terms of musical preferences, FA revealed an eight factor solution: rock/metal; north-american rock; english metal/indie; hip-hop/new metal; reggae/pop; classical/rock; emotional rock and feminine pop. The opinion of others in musical preferences was aggregated in three dimensions: friends and colleagues; family members; and, acquaintances. Regarding SR of life, a five dimension solution was found: well-being; will to live; personal fulfilment; attachment to others; and, feelings of malaise. The opinion of others in SR of life was aggregated in two factors: family and friends; and, acquaintances. In terms of SR of death, FA offered a four dimension solution: feelings of malaise; ritualism/causes of death; closeness to death; and, questioning/transcendence. Finally, the FA for the opinion of others revealed a two dimensional solution: friends and family; and, acquaintances. Further, through multivariate analysis of variance, we found some significant effects for several representations.

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What does the Music I Hear Have to do with My Death and Life Views?

__________________________________________________________________ Concerning musical preferences, boys revealed a greater preference for rock/metal music and hip-hop/new metal while girls favoured emotional rock and feminine pop. For girls, more than boys, life is anchored through attachment to others but it is also understood as an uneasiness and malaise. To those adolescents, aged between 15 and 16 years old, life is strongly associated with the desire and will to live as well as a clear sense of personal fulfilment or achievement. On the other hand, death is represented, particularly for girls, as restlessness or feelings of malaise. They also related death to its rituals and the loss of others. No significant effects for questioning/transcendence were found. When we proceeded to some correlation analysis, between the musical preferences of these adolescents and the representations of life and death (from what they thought and felt about life and death), the results evidenced that for those who had a preference for reggae/pop, emotional rock and feminine pop, life was understood as personal fulfilment. A predilection for emotional rock was also associated with the representation of life as malaise. The more adolescents listened to rock/metal, the lower their tendency was to represent death as feelings of malaise and to anchor it in rituals. For adolescents who enjoyed classical/rock, death strongly suggested questioning and transcendence. Another ANOVA showed that representations of life as well-being, a will to live, and personal fulfilment and relationships with others, were strongly influenced by the opinions, thoughts and images of family and friends. However, the opinions of acquaintances also played an important role. Regarding social representations of death, adolescents again disclosed the importance of others in their own conceptions. When adolescents regarded death in terms of feelings of malaise, and the departure of loved ones, the opinions of family and friends were of great meaning. When it was anchored in ritualism and questioning, the opinion of acquaintances seemed to be more relevant. We argue that it might be easier for adolescents to discuss the topic of mortality and death with people who are emotionally more distant. In short, it appeared that the social representations of life were mainly associated with friends and joy; death was largely represented as a sense of loss, suffering, sadness and with family. Nonetheless, these social representations had a weak association to suicide. Adolescents may not have seen suicide as the ultimate step or final solution. Conversely, it may mean that these adolescents did not believe that suicide is a valid way of dying for people their age. 4. Conclusions Rock, metal and pop were amongst the most relevant musical preferences of these adolescents. This has been a valuable tool to understand the way they usually feel and how they socially behave.

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__________________________________________________________________ Death was strongly connected to its ritualistic sense (e.g., cemetery, black, burial, coffin, and skull). This may play an important therapeutic role, acting as a social construction that signs the end, the farewell. 21 Although it is so often forgotten or hidden, death is the main event in our lives. And, as such, it is a considerable source of anxiety. 22 Family and friends proved to be a vital reference in the thoughts and feelings of these young people. They influenced the development of the adolescents attitudes, values and interests, by acting as role models or yardsticks from which adolescents could assess their own thoughts, attitudes and behaviours. 23 Undoubtedly, this influence was a reciprocal experience, given that adolescents influence and are influenced by those who surround them. This is a central aspect of SR theory; we are all agents, active and passive, in the creation, manipulation and conveying of social representations. 24 Understanding how teenagers think about life and death is presented as an asset to mental health professionals. It is a precious contribution for youth suicide prevention programs 25 given that understanding suicide is a key to prevent it. 26

Notes
J. Bowlby, Apego e perda, Martins Fontes, So Paulo, 1998; P. Heaven, Contemporary Adolescence: A Social Psychological Approach, Macmillan Australia, Melbourne, 1994; D. Sampaio, Ningum morre sozinho (12 ed.), Caminho, Lisboa, 2002 . 2 C. Barros, Msica e juventude. Vulgata, Lisboa, 2000; D. Sampaio, Vozes e rudos. Caminho, Lisboa, 1993; A. Vallejo-Ngera, Os adolescentes e os pais, Presena, Lisboa, 2003. 3 V. Strasburger, Adolescents and the Media: Medical and Psychological Impact, Sage Publications Inc., CA, 1995. 4 P. Abreu, Prticas e consumos de msica(s): ilustraes sobre alguns novos contextos da prtica cultural, Revista crtica de cincias sociais, Vol. 56, 2000, pp. 123-147; C. Borralho, Msica, preferncias musicais e a ideao suicida na adolescncia, Monografia, ISPA, Lisboa, 2002; M. Cabral & J. Pais (eds), Condutas de risco, prticas culturais, e atitudes perante o corpo: resultados de um inqurito aos jovens portugueses em 2000, Celta/IPJ, Oeiras, 2003. 5 C. Gard, MusicnMoods, Current Health, Vol. 2, 1997, pp. 24-26; B. Mills, Effects of Music on Assertive Behaviour during Exercise on Middle-School-Age Students, Perceptual and Motor Skills, Vol. 83, 1996, pp. 423-426; P. Nunes, A msica no universo juvenil: prticas e representaes, Tese de Mestrado, Faculdade de Cincias Sociais e Humanas, UNL, Lisboa, 1997. 6 J. Lifton, The Broken Connection, Simon and Schuster, New York, 1979. 7 D. Reanney, After Death: A New Future for Human Consciousness, Avon Science, New York, 1991.
1

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What does the Music I Hear Have to do with My Death and Life Views?

__________________________________________________________________ G. Petter, Concerto di morte nel ciclo de vita, Il volto della gorgone la morte ei suoi significati, Massa & Marti, Milano, 2001, pp. 222- 257. 9 Ibid.; A. Oliveira, O desafio da morte (2 ed.), ncora Editora, Lisboa, 2008b. 10 M. Hanus, Estudes sur la mort: Ladolescent et la mort, LEsprit du Temps, Paris, 1998; A. Oliveira, L. Amncio & D. Sampaio, Arriscar morrer para Sobreviver, Anlise Psicolgica, Vol. XIX, 2001, pp. 509-521. 11 A. Braconnier & D. Marcelli, As mil faces da adolescncia, Climepsi, Lisboa, 2000; P. Crepet, A dimenso do vazio, mbar, Porto, 2002; K.R. Jamison, Night Falls Fast: Understanding Suicide, Picador, London, 2001; M. Laufer, O adolescente suicida, Climepsi, Lisboa, 2000. 12 J. Hende, Preventing Suicide, John Wiley and Sons, Chichester, Lda, 2008; Oliveira, Iluses na idade das emoes representaes sociais da morte, do suicdio e da msica na adolescncia; C. Saraiva, Para-Suicdio, Quarteto, Coimbra, 1999. 13 A. Oliveira, L. Amncio, & D. Sampaio, Da desesperana ao desafio da morte e conquista da vida: Olhar sobre o adolescente suicida, Psychologica, 2004, Vol. 35, pp. 69-83; G. Trainor, Adolescents and Developmental Group Psychotherapy, New Approaches to Preventing Suicide, Jessica Kingsley Publishers, Philadelphia, 2004, pp. 178-193. 14 C. Donnellan, Self-Inflicted Violence, Print Group Lda, Great Britain, 2004. 15 M. Bradbury, Representations of Death, Routledge, London, 1999. 16 S. Moscovici, La psychanalyse, son image et son public, Presses Universitaires de France, Paris, 1961/1976. 17 R. Farr, Reprsentations sociales, Psychologie Sociale, S. Moscovici (ed), Presses Universitaires de France, Paris, 1984, p. 386. 18 S. Jovchelovitch, In Defense of Representations, Journal for the Theory of Social Behaviour, Vol. 26, p. 135. 19 D. Jodelet, Les representations sociales: phnomnes, concept et Thorie, Psychologie Social, S. Moscovici (ed), Presses Universitaires de France, Paris, 1984, pp. 357-378. 20 Oliveira, Iluses na idade das emoes representaes sociais da morte, do suicdio e da msica na adolescncia. 21 T. Walter, The Revival of Death, Routledge, New York, 1994. 22 M. Maeterlink, A morte, Garrido Artes Graficas, Alpiara, 1997. 23 J. Nurmi, Socialization and Self-Development: Channelling, Selection, Adjustment and Reflection, Handbook of Adolescence Psychology (2ed.), R. Lerner & L. Steinberg (eds), John Wiley and Sons, Inc., New York, 2004, pp. 85124; A. Ryan, The Peer Group as a Context for the Development of Young Adolescent Motivation and Achievement, Child Development, Vol. 72, pp. 11351150, 2001.
8

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__________________________________________________________________ Oliveira, Iluses na idade das emoes representaes sociais da morte, do suicdio e da msica na adolescncia. 25 E. Brown & W. Hendee, Adolescents and Their Music: Insights into the Health of Adolescents, Journal of the American Medical Association, Vol. 262, 1989, pp. 1659-1663. 26 B. Blackburn, What You Should Know about Suicide, World Incorporated, Waco, 1982, p. 11.
24

Bibliography
Abreu, P., Prticas e consumos de msica(s): ilustraes sobre alguns novos contextos da prtica cultural. Revista crtica de cincias sociais. Vol. 56, 2000, pp. 123-147. Arnett, J., Adolescents and Heavy Metal Music: From the Mouths of Metalheads. Youth & Society. Vol. 23, 1991, pp. 76-98. Barros, C., Msica e juventude. Vulgata, Lisboa, 2000. Blackburn, B., What You Should Know about Suicide. World Incorporated, Waco, 1982. Bowlby, J., Apego e perda. Martins Fontes, So Paulo, 1998. Borralho, C., Msica, preferncias musicais e a ideao suicida na adolescncia. Monografia, ISPA, Lisboa, 2002. Braconnier, A. & Marcelli, D., As mil faces da adolescncia. Climepsi, Lisboa, 2000. Bradbury, M., Representations of Death. Routledge, London, 1999. Brown, E. & Hendee, W., Adolescents and their Music: Insights into the Health of Adolescents. Journal of the American Medical Association. Vol. 262, 1989, pp. 1659-1663. Cabral, M., & Pais, J. (eds), Condutas de risco, prticas culturais, e atitudes perante o corpo: resultados de um inqurito aos jovens portugueses em 2000. Celta/IPJ, Oeiras, 2003. Crepet, P., A dimenso do vazio. mbar, Porto, 2002.

66

What does the Music I Hear Have to do with My Death and Life Views?

__________________________________________________________________ Donnellan, C., Self-Inflicted Violence. Print Group Lda, Great Britain, 2004. Farr, R., Reprsentations sociales. Psychologie Sociale. Moscovici, S. (ed), Presses Universitaires de France, Paris, 1984. Gard, C. MusicnMoods. Current Health. Vol. 2, 1997, pp. 24-26. Hanus, M., Estudes sur la mort: Ladolescent et la mort. LEsprit du Temps, Paris, 1998. Heaven, P., Contemporary Adolescence: A Social Psychological Approach. Masmillan Australia, Melbourne, 1994. Hende, J., Preventing Suicide. John Wiley and Sons, Chichester, Lda, 2008. Jamison, K.R., Night Falls Fast: Understanding Suicide. Picador, London, 2001. Jodelet, D., Les representations sociales: phnomnes, concept et Thorie. Psychologie Sociale. Moscovici, S. (ed), Presses Universitaires de France, Paris, 1984. Jovchelovitch, S., In Defense of Representations. Journal for the Theory of Social Behaviour. Vol. 26, pp. 121-135. Laufer, M., O adolescente suicida. Climepsi, Lisboa, 2000. Lifton, J., The Broken Connection. Simon and Schuster, New York, 1979. Maeterlink, M., A morte. Garrido Artes Graficas, Alpiara, 1997. Mills, B., Effects of Music on Assertive Behaviour during Exercise on MiddleSchool-Age Students. Perceptual and Motor Skills. Vol. 83, 1996, pp. 423-426. Moscovici, S., La psychanalyse, son image et son public. Presses Universitaires de France, Paris, 1961/1976. Nunes, P., A msica no universo juvenil: prticas e representaes. Tese de Mestrado, Faculdade de Cincias Sociais e Humanas UNL, Lisboa, 1997.

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67

__________________________________________________________________ Oliveira, A., Iluses na idade das emoes representaes sociais da morte, do suicdio e da msica na adolescncia. Fundao Calouste Gulbenkian, Lisboa, 2008a. Oliveira, A., O desafio da morte (2 ed.). ncora Editora, Lisboa; 2008b. Oliveira, A., Amncio, L., & Sampaio, D., Arriscar morrer para Sobreviver. Anlise Psicolgica. Vol. XIX, 2001, pp. 509-521. Oliveira, A., Amncio, L., & Sampaio, D., Da desesperana ao desafio da morte e conquista da vida: Olhar sobre o adolescente suicida. Psychologica. Vol. 35, 2004, pp. 69-83. Petter, G., Concerto di morte nel ciclo de vita. Il volto della gorgone la morte ei suoi significati. Massa & Marti, Milano, 2001. Reanney, D., After Death: A New Future for Human Consciousness. Avon Science, New York, 1991. Ryan, A., The Peer Group as a Context for the Development of Young Adolescent Motivation and Achievement. Child Development. Vol. 72, 2001, pp. 1135-1150. Sampaio, D., Vozes e rudos. Caminho, Lisboa, 1993. Sampaio, D., Ningum morre sozinho (12 ed.). Caminho, Lisboa, 2002. Saraiva, C., Para-Suicdio. Quarteto, Coimbra, 1999. Strasburger, V., Adolescents and the Media: Medical and Psychological Impact. Sage Publications Inc., CA, 1995. Trainor, G., Adolescents and Developmental Group Psychotherapy. New Approaches to Preventing Suicide. Jessica Kingsley Publishers, Philadelphia, 2004. Vallejo-Ngera, A., Os adolescentes e os pais. Presena, Lisboa, 2003. Walter, T., The Revival of Death. Routledge, New York, 1994. Rute Rodrigues is a Social Psychologist currently working on Suicide Symbolisms and Representations as Research Assistant at Centro de Investigao e Estudos de Sociologia (CIES-IUL), Lisboa, Portugal.

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What does the Music I Hear Have to do with My Death and Life Views?

__________________________________________________________________ Ablio Oliveira is an Assistant Professor at Instituto Universitrio de Lisboa (ISCTE-IUL) and a Researcher at Centro de Investigao e Estudos de Sociologia (CIES-IUL), Lisboa, Portugal. He is the author of several books, namely 'O Desafio da Morte', Iluses na Idade das Emoes - Representaes Sociais da morte, do suicdio e da msica na adolescncia. and 'O Desafio da Vida'.

Passionate Inscription: Love in the Performance of Suicide Kathy McKay and Diego De Leo
Abstract Traditionally, suicides performed for reasons of love have been largely romanticised and more likely forgiven. This chapter compares the ways in which love, sex and suicide have been inscribed on female bodies in historical and modern times. Love suicides have predominantly concerned heterosexual love; the woman inspires the emotions, the man acts upon his desires. Consequently, religious and social theorists have warned about the dangers of love and the corresponding dangers of women. Without love, men were strong and certain, society ran smoothly. If men were made vulnerable when they loved a woman, women needed to be chaste and distant so as to become unlovable. They could not tempt men into desire; they could not positively react to male desire. This interplay between desire and denial has become a dangerous game for young women in the modern world illustrated by two teenage suicides in America. Love has been replaced with sex in meaning and in action. These suicides are not romanticised. Women have become vulnerable in a balance between shame and honour, reputation and reality. Socially-perceived goodness is considered to protect women from suicide it appears that to lose ones goodness is to lose ones claim on life. Key Words: female, suicide, sex, love, bullying. ***** In September 2009, 13-year-old Hope Witsell hanged herself in her room. In January 2010, Phoebe Prince was found in similar circumstances. Both stories were covered in the American media, yet constructed in remarkably different ways. According to reports, both were relentlessly bullied by their peers at school; both were regularly called sluts after they exhibited sexual desires and behaviours perceived to be inappropriate. 1 Neither felt they had a future after seeing their reputations destroyed. Both chose the same violent and lethal method. However, Phoebe Princes alleged bullies are facing criminal charges; Hope Witsells are not. Phoebe Princes story has warranted articles in international papers by itself; if mentioned at all, Hope Witsells death manages a paragraph in articles regarding the dangers of sexting. 2 The difference appears to lie in the sexual desires and behaviours displayed by both girls. Phoebe Prince had brief relationships with two popular boys, both of whom were perceived to be involved with other girls; one of these relationships was sexual. She was primarily bullied by girls who felt that she was stealing other peoples men. 3 Hope Witsell was bullied after she sent topless photos to two different boys; one was forwarded throughout her school, the other was intercepted

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__________________________________________________________________ by a teacher. She was bullied by both boys and girls at her school. 4 Both girls showed evidence of self-harm that went unrecognised and untreated in the days before their deaths; neither girl received adequate intervention from their school. Yet, the American media has tended to paint Phoebe Prince as a good victim. While she was sexually active, she is still considered passive the boys fell for her. In contrast, there remains a lingering sense that Hope Witsell played a part in her bullying. By sending the photos herself, she is constructed as an active sexual agent, even though she never had sex. 5 Yet, distinguishing between good/passive-bad/active sexual agency reinforces the danger of desire among girls who are still learning about their sexed bodies and their sexual desires. 6 While the media has appeared to easily distinguish between the behaviours of both girls (Phoebe/good-Hope/bad), few commentators have recognised that these girls may not have known how to communicate their desires any other way or, indeed, that their sexualised performances reflected other vulnerabilities. In order to better understand how the sexed and dead bodies of Phoebe and Hope have been constructed in the media, this chapter will analyse how the female body has historically been understood throughout Western history within the frames of desire. This has consequently influenced how female suicides inspired by love and sex have been perceived. Love suicides were traditionally constructed as a romanticised fantasy. Yet, these suicides were considered to place women in a position of power where men and, as a consequence, society were weakened. In contrast, sex suicides have primarily been constructed in terms of atonement and punishment. Within this suicidal frame, women become passive victims where judgements are made about their goodness. The media construction of these two modern suicides remains founded in the past. The myriad reasons behind the deaths of Phoebe and Hope have become distilled into dramatic and sensational stories. While it can be argued that the turbulent emotions and social repercussions following their sexual performances could have led to anomie, and increased their vulnerability to suicide, it cannot be certain that bullying directly caused the deaths of these two girls. The continuing distinction between good/passive-bad/active sexual behaviours ignores Phoebes history of depression and previous suicide attempts, which arguably impacted on her suicidal process just as surely as the bullying. It ignores the lack of awareness among the adults who did not recognise or follow up the suicide risk factors exhibited by both girls. It ignores the fact that modern girls are still judged on sexuality ideals where, regardless of the truth of the situation, they tend to be constructed as victims trapped by their bad or promiscuous actions which leave them no other escape but death. Unlike the romanticised love suicides of the past, these deaths are tainted with the everydayness of real life.

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__________________________________________________________________ Indeed, it can be argued that the American medias initial framing of Phoebe Prince as a good sexed body demonstrates the problems with complacent and stereotypical construction. Phoebes photos showed a beautiful, happy girl and her story was indeed a tragic one. In the story that was constructed around her death, Phoebe was not the pursuer, but the pursued. In this way, the media has created a simplistic trajectory: Phoebe was bullied because she was loved, she suicided because she was loved. The fantasy created here by the American media echoes the romantic fantasy of traditional love suicides. The love promoted by the chivalric romantic tradition of medieval Europe was pure, devoid of any possible physical taint. The man idolised the woman from afar; never meeting her to realise that she did not meet his ideals. Instead, this love promised gain to both parties; they had each other, without need for another, for the rest of their lives. This love became unreal. 7 In a sense, it created a perfect woman; she was not a physical body but a vessel for chivalric desires. Only death could ensure that this romantic ideal was never sullied. While love may have provided a potent catalyst for suicide, it also banish[ed] the awful loneliness of suicide. The heart that has lived for love and sunk under adversity consummates its love in death. 8 Love that ended in death could be constructed in terms of ultimate purity because of the very fact that it had ended. Enshrined only in potential, it was no longer tainted with the everydayness of the real world. Indeed, the most famous love suicides are not real but myths and legends; their retelling has made them tangible. Inspired by the myth of Pyramus and Thisbe, Shakespeares Romeo and Juliet demonstrated the overwhelming power of love in their suicidal performance. The very moral of this tale is intrinsically tied to their deaths. The romanticised stories of love suicides inspire by reason of their unreality; they cannot be lived because, by their very nature, passion and romance fade and change with time. Arguably, the love between Romeo and Juliet could not have remained as powerful as they grew old. As Byron once said, there is no such thing as a life of passion any more than a continuous earthquake, or an eternal fever. 9 The media romanticised Phoebes death in a similar vein to these love suicides. She was constructed within the frames of abandonment; the media subsequently became her rescuer leading to the exposure of her bullies. However, just as love suicides were only made real by their retelling so too was the media construction of Phoebes dead body. While the tragedy of her death should in no way be diminished, the media construction made Phoebes dead body unreal. As this unreality unravelled in light of how real events unfolded, it made her death seem like a lie, although Phoebe herself played no part in the creation of her dead body. Similar to the danger of chivalric love, the real girl (Phoebes sexed body) could simply not be as good as the romantic fantasy (Phoebes dead body); especially as the dead body was also a sexed one.

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__________________________________________________________________ Due to their very unreality, romanticised suicides came to be perceived as dangerous. While Phoebe died alone, in traditional love suicides, women could be powerful, or at least equal to men. Men killed themselves for women and, in this way, love harmed men; it made them weak and vulnerable. Consequently, love began to be reframed in terms of the female body in different cultures. A womans sexual body could arouse the lust of man and thereby cloud his precious reason. 10 Giving himself to a woman, a man risked the loss of his masculinity which also threatened social order; the power the female body was perceived to hold when men desired it was feared. No matter how chaste or good the woman, she was continually betrayed by her physical body, which made her fundamentally sexual and inherently dangerous. Women were subsequently constructed as desirable (to men) and desiring (of men). When men capitulated to their desire for the female body fell in love with a woman and had sex with her, although the two were not mutually exclusive destruction ensued. In Christian theology, love was painted to be the root of humanitys downfall and original sin as Adam would not have eaten the apple had it not been for his love of Eve. 11 Indeed, folklore and superstition focused on mens seemingly uncontrollable desire of the female body and the biological truth that conception required men give something (sperm) without women giving anything in return at least not until a child was born. 12 Yet, the very social necessity of conception required sex to be reframed so as not to leave men, or society, vulnerable. Women needed to be bound and restrained, their desire contained. Consequently, female sexuality became inextricably linked with destruction and chaos. Patriarchal Christian beliefs, which demonised female sexuality, retold ancient mythologies where women were divine and powerful the purity of love was reshaped into dirty sex. Aphrodite was transformed from a powerful love goddess into a nymphomaniac; 13 ancient totems of fertility with their big breasts and wide hips were turned into objects of ridicule. 14 Indeed, doctors even performed clitoridectomies to restrain desire and enjoyment where a womans sexuality was perceived to be dangerous or uncontrollable. 15 Women who were sexual and desirable, who desired and enjoyed sex, began to be punished in both intangible (loss of reputation) and tangible ways (surgery and death). The sexed body of a young girl continues to be confronting. It can be argued that the American medias framing of Hope Witsell as a bad sexed body demonstrates the struggle between traditional ideals and modern life. There are fewer photos attached to Hopes articles but they too show a beautiful and happy girl; these articles also convey a tragic story. Yet, in the story constructed around her death, Hope was the pursuer, not the pursued which is a flawed argument if one considers whether she had the ability to formulate such articulate sexual desires. 16 Once again, the media created a simplistic trajectory: Hope was bullied because she desired, she suicided because she desired. Unlike Phoebe, Hope did not have sex; she desired but was not desirable.

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__________________________________________________________________ The fantasy created here by the American media is not romantic but echoes the dirty reality of pornography. In the pornographic fantasy, women are only physical bodies; at times, they are not even a whole body but simply the parts men find pleasurable. Indeed, pornography continues to predominantly value male orgasm above female orgasm which, no matter the enjoyment displayed, places the woman in a position submissive to the man. 17 Music videos are awash with almostentirely-naked women; some for the unabashed pleasure of men, others claiming their nudity is akin to sexual empowerment. 18 Enveloped by this environment, Hope may have been performing the only behaviours she knew. She may not have realised that, within this construction, sex was conceptualised as a loss; people lose their virginity, women can lose their reputation. By becoming a sexed body, Hope not only became vulnerable to every physical danger associated with sexual activity but also to the social punishments meted out. As Tolman writes: the bottom line within this unchallenged arrangement of gendered sexuality: that any girl who has sex is, in the end, vulnerable to others passing judgement on her. 19 Perhaps because desire has needed to be hidden, the poetics of virginity, 20 and the passion and desire surrounding its loss, has long inspired writers. Traditionally, if virginity was lost outside the strict bounds of acceptability, a woman risked punishments that continue to place the female at the site of blame. Unlike love suicides, sex suicides were not traditionally performed to preserve some perfect moment; they were performed because something had gone wrong. Suicides related to sex were an attempt to atone for a sin, to seek penance from a higher power (be it society or religion); 21 the stern moral undercurrent of such tales was unmistakable and unforgiving. Yet the basis for the expectations of a sex suicide could be as unreal as those for love suicides. Shakespeares The Rape of Lucrece may have been a fictionalised account of an event in ancient Rome, but Lucreces actions continued to be held as a high standard for real women in Victorian and Edwardian England. The suicide occurs despite the protestations of both her father and husband as Lucrece believes that to continue living would give an undeserved absolution to other lesser women. 22 Female suicides have often been constructed as passive victims of the situation in which they found themselves. A womans suicide by drowning was shown as the reluctant last resort of the seduced and abandoned (and therefore starving and despairing). 23 Men had a choice to live; women appeared to have little choice but to die. A girl who was seduced and abandoned was not alone in her sin but she was alone in her death. The media of Victorian and Edwardian England painted sorrowful images of desperate girls, in white dresses, standing atop a bridge above a swirling river in a rain-swept night, abandoned by their (upper-class) lover who had left them nothing but a shameful pregnancy. 24 The men, hidden in shadows, only contemplated death if they were caught and faced legal or financial retribution. Yet, a girl who drowned herself may have received great public

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__________________________________________________________________ sympathy but, while alive, bad women were often condemned for their immorality. 25 While nothing has suggested that Hope actually had sex, the American media has placed these same judgements of immorality upon her. Consequently, Hopes dead body has been constructed in terms of atonement and penance. Thusly framed, death cleansed her sin but the media felt no need to rescue Hope and accuse those who bullied her. While Phoebes dead body became powerful, Hopes dead body remains as powerless as it arguably was in life and this too is a tragedy. She became a victim of the medias complacent construction, just as unreal as Phoebes dead body. In this way, it has become apparent that we continue to live in a world in which you can risk serious disenfranchisement and physical violence for the pleasure you seek, the fantasy you embody, the gender you perform. 26 In response to her sexual performance, however real or perceived, Hope suffered social disenfranchisement and emotional violence. By choosing to suicide, she turned the violence onto herself. The dead bodies of Phoebe and Hope linger. Both deaths are tragic and, arguably, could have been prevented if their warning signs had been recognised and treated appropriately. These suicides have highlighted the continuing precarious nature of sexual desire and the sexed female body and the complacency of a society that presumes its sexual norms are right. Judgements of goodness, and the severe repercussions experienced when one is perceived to be deviant, continue to inscribe themselves upon vulnerable young women in selfharm and suicidal performances. There needs to be greater vigilance in how social perceptions and ideals tangibly impact upon the lives of women as, in these cases, traditional ideals of absolution and penance have appeared to force the performance of suicide as a solution.

Notes
E. Bazelon, Could Anyone have Saved Phoebe Prince?, Slate, 8 February 2010a, Viewed on 14th September 2010, http://www.slate.com/toolbar.aspx?action =print&id=2244057; E. Bazelon, What Really Happened to Phoebe Prince?, Slate, 20 July 2010b, Viewed on 20th August 2010, http://www.slate.com/toolbar. aspx?action=print&id=2260952; E. Bazelon, Was Phoebe Prince Once a Bully?, Slate, 17 August 2010c, Viewed on 18th August 2010, http://www.slate.com/tool bar.aspx?action=print&id=2263470; E. Bazelon, The Phoebe Prince Case, Slate, 10 September 2010d, Viewed on 14th September 2010, http://www.slate.com/tool bar.aspx?action=print&id=2266923; M. Inbar, Sexting Bullying Cited in Teens Suicide, Today Show, 12 February 2010, Viewed on 29th July 2010, http://today. msnbc.msn.com/id/34236377/ns/today-today_people/; K. McCabe, Teens Suicide Prompts a Look at Bullying, The Boston Globe, 24 January 2010, Viewed on 30th July 2010, http://www.boston.com/news/local/massachusetts/articles/2010/01/24/
1

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__________________________________________________________________ teens_suicide_prompts_a_look_at_bullying/; A. Meacham, Sexting-Related Bully Cited in Hillsborough Teens Suicide, St Petersburg Times, 27 November 2009, Viewed on 29th July 2010, http://www.tampabay.com/news/humaninterest/article1 054895.ece; L. Tanenbaum, Two So-Called Sluts, Two Deaths, Only One Uproar, The Huffington Post, 13 April 2010, Viewed on 29th July 2010, http:// www.huffingtonpost.com/leora-tanenbaum/two-so-called-sluts-two-533425.html. 2 In a search conducted on the 30th July 2010, 6 full articles were found regarding Phoebe Prince in the Sydney Morning Herald. Only one article mentioned Hope Witsell and this was a brief paragraph. Already linked with two female suicides in America, sexting is a colloquialism for sending messages and/or images containing sexual content via text message. 3 Bazelon, 2010b, p. 6. 4 Inbar, 2010; Meacham, 2010. 5 Tanenbaum, 2010. 6 D.L. Tolman, Dilemmas of Desire: Teenage Girls Talk about Sexuality, Harvard University Press, Cambridge, 2002. 7 J.A. Schultz, Courtly Love, the Love of Courtliness, and the History of Sexuality, The University of Chicago Press, Chicago, 2006. 8 M. Pinguet, Voluntary Death in Japan, Polity Press, Cambridge, 1993, p. 153. 9 Lord Byron, in a letter to Thomas Moore, 5 July 1821. 10 O.W. Woolley, ...And Man Created Woman: Representations of Womens Bodies in Western Culture, Feminist Perspectives on Eating Disorders, P. Fallon, M.A. Katzman and S.C. Woolley (eds), The Guilford Press, New York, p. 46. 11 R. Weitz, A History of Womens Bodies, The Politics of Womens Bodies: Sexuality, Appearance, & Behavior, R. Weitz (ed), Oxford University Press, New York, 2003; Wooley, 1994; M.R. Miles, Carnal Knowing: Female Nakedness and Religious Meaning in the Christian West, Vintage Books, New York, 1991. 12 M. MacSween, Anorexic Bodies: A Feminist and Sociological Perspective on Anorexia Nervosa, Routledge, London, 1993; T. Laqueur, Making Sex: Body and Gender from the Greeks to Freud, Harvard University Press, Cambridge, 1990. 13 D.A. Leeming, Oxford Companion to World Mythology, Oxford University Press, New York, 2005. 14 Miles, 1991. 15 MacSween, 1993. 16 See arguments in Tolman, 2002. 17 A. McKee, K. Albury and C. Lumby (eds), The Porn Report, Melbourne University Press, Melbourne, 2008. 18 N. Walters, Living Dolls: The Return of Sexism, Virago, London, 2010; A. Levy, Female Chauvinist Pigs: Women and the Rise of Raunch Culture, Schwartz Publishing, Melbourne, 2005. 19 Tolman, 2002, p. 123.

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__________________________________________________________________ Schultz, 2006. G. Minois, History of Suicide: Voluntary Death in Western Culture, The John Hopkins University Press, Baltimore, 1999; M. MacDonald and T.R. Murphy, Sleepless Souls: Suicide in Early Modern England, Oxford, Clarendon Press, 1990; O. Anderson, Suicide in Victorian and Edwardian England, Clarendon Press, Oxford, 1987. 22 Shakespeare, 1988, pp. 138-139. 23 Anderson, 1987, p. 196. 24 MacDonald and Murphy, 1990; Anderson, 1987; H.I. Kushner, Women and Suicide in Historical Perspective, Signs, Vol. 10, 1985, pp. 537-552. 25 Minois, 1999; P. Grimshaw and C. Fahey, Family and Community in Nineteenth-Century Castlemaine, Families in Colonial Australia, P. Grimshaw, C. McConville and E. McEwen (eds), George Allen & Unwin, Sydney, 1985. 26 J. Butler. The Question of Social Transformation, Woman and Social Transformation, E. Beck-Gernsheim, J. Butler and L. Puigvert (eds), New York, Peter Lang, 2001, p. 10.
21 20

Bibliography
Anderson, O., Suicide in Victorian and Edwardian England. Clarendon Press, Oxford, 1987. Bazelon, E., Could Anyone have Saved Phoebe Prince? Slate, 2010a, 14 September 2010, http://www.slate.com/toolbar.aspx?action=print&id=2244057. Bazelon, E., What Really Happened to Phoebe Prince? Slate, 2010b, 20 August 2010, http://www.slate.com/toolbar.aspx?action=print&id=2260952. Bazelon, E., Was Phoebe Prince Once a Bully? Slate, 2010c, 18 August 2010, http://www.slate.com/toolbar.aspx?action=print&id=2263470. Bazelon, E., The Phoebe Prince Case. Slate, 2010d, 14 September 2010, http://www.slate.com/toolbar.aspx?action=print&id=2266923. Bazelon, E., Hope Witsells Sexting Suicide, Slate, 2009, 14 September 2010, http://www.slate.com/toolbar.aspx?action=print&id=2237706. Beck-Gernsheim, E., Butler, J. & Puigvert, L. (eds), Woman and Social Transformation. Peter Lang, New York, 2001.

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__________________________________________________________________ Fallon, P., Katzman, M.A. & Wooley, S.C. (eds), Feminist Perspectives on Eating Disorders. The Guilford Press, New York, 1994. Inbar, M., Sexting Bullying Cited in Teens Suicide. Today Show, 2009, 29 July 2010, http://today.msnbc.msn.com/id/34236377/ns/today-today_people/. Kushner, H.I., Women and Suicide in Historical Perspective. Signs. Vol. 10, 1985, pp. 537-552. Laqueur, T., Making Sex: Body and Gender from the Greeks to Freud. Harvard University Press, Cambridge, 1990. Leeming, D.A., Oxford Companion to World Mythology. Oxford University Press, New York, 2005. Levy, A., Female Chauvinist Pigs: Women and the Rise of Raunch Culture. Schwartz Publishing, Melbourne, 2005. MacDonald, M. & Murphy, T.R., Sleepless Souls: Suicide in Early Modern England. Clarendon Press, Oxford, 1990. MacSween, M., Anorexic Bodies: A Feminist and Sociological Perspective on Anorexia Nervosa. Routledge, London, 1993. McCabe, K., Teens Suicide Prompts a Look at Bullying. The Boston Globe, 2010, 30 July 2010, http://www.boston.com/news/local/massachusetts/articles/2010/01/24/teens_suicid e_prompts_a_look_at_bullying/. McKee, A., Albury, K. & Lumby, C. (eds), The Porn Report. Melbourne University Press, Melbourne, 2008. Meacham, A., Sexting-Related Bullying Cited in Hillsborough Teens Suicide. St Petersburg Times, 2009, 29 July 2010, http://www.tampabay.com/news/human interest/article1054895.ece. Miles, M.R., Carnal Knowing: Female Nakedness and Religious Meaning in the Christian West. Vintage Books, New York, 1991. Minois, G., History of Suicide: Voluntary Death in Western Culture. The John Hopkins University Press, Baltimore, 1999.

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__________________________________________________________________ Pinguet, M., Voluntary Death in Japan. Polity Press, Cambridge, 1993. Schultz, J.A., Courtly Love, the Love of Courtliness, and the History of Sexuality. The University of Chicago Press, Chicago, 2006. Tanenbaum, L., Two So-Called Sluts, Two Deaths, Only One Uproar. The Huffington Post, 2010, 29 July 2010, http://www.huffingtonpost.com/leoratanenbaum/two-so-called-sluts-two-d_b_533425.html. Tolman, D.L., Dilemmas of Desire: Teenage Girls Talk about Sexuality. Harvard University Press, Cambridge, 2002. Walters, N., Living Dolls: The Return of Sexism. Virago, London, 2010. Weitz, R. (ed), The Politics of Womens Bodies: Sexuality, Appearance, & Behavior. Oxford University Press, New York, 2003. Kathy McKay is a researcher at the Australian Institute for Suicide Research and Prevention, Griffith University, Australia. Diego De Leo is an internationally-respected Doctor of Science, Professor of Psychiatry and Director of the Australian Institute for Suicide Research and Prevention, Griffith University, Australia. The authors would like to gratefully acknowledge Allison Milner and Naoko Ide for their careful reading and insightful comments.

I Would Die For You: Love, Suicide and Redemption in the Cinema of Fellini, Dreyer and von Trier Angela Tumini
Abstract Sren Kierkegaard said that Love is all, it gives all, and it takes all. But what does it mean to love unconditionally? Is dying for love the ultimate sacrifice and the ultimate demonstration of love? This chapter will discuss the way in which these questions are addressed by three major film-makers: Dreyer, Fellini and von Trier. In spite of some differences in their cinematic styles, these three directors treat this subject with both measured scepticism and reverence, forcing us to distance ourselves, even if only temporarily, from our personal beliefs, so that we might reexperience true faith in unconditional love free of cultural baggage and biases. My aim will be to demonstrate how the love/sacrifice/redemption triad in three European films - La Strada (1954) by Fellini, Day of Wrath (1943) by Dreyer, and Breaking the Waves (1996) by von Trier - is itself supported by a triadic structure of traditions: the Pagan, the Christian, and the Romantic one. The Pagan tradition is represented by superstition and by the archetypal fear and of the other, intended as a different other, and by opposing primeval symbols such as water and fire. The Christian tradition is embodied in the Biblical images proliferating throughout the three stories; in these films, the heroines are seen to love completely, unquestioningly, almost madly. The Romantic tradition is supported by the concept of absolute and unconditional love. It is discernible in the eternal and existential life-pattern of the individual female protagonists who strive to overcome the suffering caused by impossible relationships. Key Words: Sacrifice, redemption, love, death, Fellini, Dreyer, von Trier, self, other. 1. Sacrifice for the Other Each one of these three films is concerned with the liberation of the individual and the directors give large space and primary importance to their female characters. All three films are built upon a specific structure supported by a study of contrasting forces: brutishness opposing gentleness, individuality struggling against clannish behaviour, rationality fighting passion. In Federico Fellinis La Strada (The Road), Gelsomina, a simple-minded young woman, is sold by her family to an itinerant brutish, carnival man, called Zampan. The film is best understood as an existential journey of hope and dreams undertaken by Gelsomina who is abused and mistreated by Zampan. Gelsomina remains faithful and devoted to him until she is driven first to madness, then to withering and sickness, until she finally dies. Lawrence Russell points out that:

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__________________________________________________________________ Zampans profession of gypsy-artist and circus performer really belongs to another time, another century, as do his values. He performs his trick of expanding his lungs and chest to break a girdle of chain in waste lots, yards and grubby circus rings in a simple Promethean fable of Man breaking free but his personal world depends upon the abuse and slavery of others. 1 Gelsominas slavery is largely predicated on Zampans assumption that he occupies a superior position by virtue of his beast-like physical strength, broadly formulated on his exposure to a Darwinian street-life survival. This ability that he possesses, nurtured by an abdication of sensitivity towards Gelsominas needs, furnishes his knowledge of what constitutes justice. The dynamics of power in La Strada, in this master/slave relationship, is based on Zampans erupting abusive attitude which impacts on Gelsominas perfect balance of innocent vulnerability and sympathetic openness to others that we see continually bruised in her dealings with him. Along the road they encounter Il Matto (The Fool), a circus acrobat who teaches the girl that there might be more to life than her servitude to this brute. This dangerous triangle leads to a final event in which Zampan confronts The Fool and, in the fight that follows, he accidentally murders him. Fellini delineates the two contrasting male figures in a Caravaggio-like manner, as if painting in chiaro/scuro a series of life scenes on an enormous moving realistic canvas. Indeed, grace or salvation is still the directors philosophical preoccupation. 2 Gelsominas bonding with The Fool relates directly to a question of ethics and perception of good on her part as she regards his walking a high tight rope to indicate an almost angelic dimension. Each of the three principal characters is an archetypal pillar for this film. The Fool is the embodiment of the clever mind, Zampan represents a well-developed body, and Gelsomina embodies human spirit and aesthetic sensitivity. In many ways, the affirmation of good as identified with the feminine, reflects Fellinis position regarding the importance of women within a patriarchal system ruled by religious norms and perceptions, and centering on male needs and interpretations: I go to church only when I have to shoot a scene in church, or for an aesthetic or nostalgic reason for faith, you can go to a woman. Maybe that is more religious. 3 In La Strada, Fellini acknowledges the need for a post-patriarchal age in which women and men find possibilities of fulfilling their life, not through rule over one another; rather, through freedom and mutuality, trust and ecstasy. Gelsomina responds to a subconscious need to aspire towards a redeeming spiritual dimension that finds its roots in a Jungian conjuctio oppositorum. The first stage of union, the unio mentalis, is represented by the womans recognition of what she is and not who she would like to think she is. It is the recognition of her own simple image associated with the way of the cross, which each of us must carry for our good and bad sides. The second stage in the conjunctio sees

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__________________________________________________________________ Gelsomina moving towards a union through her bonding of spirit and mind with The Fool; a union that can only be realised on a symbolic level both real and unreal. As Peter Bondanella reminds us: Fellinis early works create completely atypical characters who are unique and almost unbelievable and, therefore, more amenable to the personal symbolism and mythology of an auteur unrestrained by a social message. They are examined philosophically and psychologically, a necessary step in Fellinis evolution to his increasingly introspective or self-reflexive films. 4 According to Fellini: La Strada is about loneliness and how solitude can be ended when one person makes a profound link to another. The man and woman who find this bond may sometimes be the least likely, on the surface, and yet the bond is in the depth of their souls. 5 There is a dichotomy of despair/hope dictating the story line of this film which tastes of compassion and soulful nourishment, and speaks of sacrifice: it is crystallised in the form of the two men. While one represents everything that is vulgar and plain in human existence, the other personifies everything that is wondrous, poetic and graceful. Gelsominas opening of her self to these two disparaging sides constitutes her strength, and it is what lies at the heart of her power of redemption. In the final scene of the film, Zampans salvation is assumed on the grounds of a new baptism, that is to say his wading into the sea where he symbolically returns after hearing of Gelsominas death. As the camera pulls back, Fellini leaves us with a tragic tableau where the brutes atonement is revealed with an outburst of tears framed into a musical context of a stirring full orchestra version of The Fools sad song. La Strada starts by the water, and ends on the water, in a cyclic motion of being and nothingness, as Zampan weeps helplessly on a beach at night. Fellini suggests the possibility of transcendence of the visible world and an experience of rebirth; Gelsominas sacrifice for the love of other signifies the ultimate fulfilment of individual redemption in a loveless story, in the sense of the human denial of love. 2. Gendering the Christ figure Like Fellini, both Carl Theodor Dreyer and Lars von Trier experimented with the limits of sacrificial notions and atonement by gendering their Christ figures as females who sacrificed their lives for the men they love. In addition, they denounce the sense of moral superiority pervading two dominant communities that sought to

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__________________________________________________________________ purge themselves of their tainted humanity in order to become clean surfaces on which to radiate the unstained image of the Christ. 6 Using a richly symbolic, precisely structured mise-en-scne, Dreyer creates a rigid and austere atmosphere in Day of Wrath. Set in 1623, one hundred years after the Protestant reformation in Denmark, we enter an archaic universe through the eyes of Anne, the young second wife of Absalon Pedersson, a well-respected but much older pastor. The couple live under the disapproving gaze of his mother, Meret, who sees in Anna a sinner, a free spirit, a sexual being. In Fellinis La Strada, the clashing of good and evil in the characters were rendered with a brush stroke of cinematic chiaro/scuro; in Day of Wrath, we are reminded of the stern artistic countenance of the Dutch Masters. The spare style of this film speaks to us directly about Dreyers profound admiration for the works of Danish painter Vilhelm Hammershoi. The references to art are then skillfully juxtaposed with scenes that depict the cruelty of the time which was supposed to be the workings of divine law. One of the two central characters admits under torture that she is a witch; the other volunteers to die convinced of her own evil. Absalon and Meret, wearing dark, stiff-collared clothing, sharply contrast against Martins and Annes softer, accessible personas. Anne falls desperately in love with her stepson when he returns to their small seventeenth-century village. Having given refuge to an alleged witch, she discovers that her own mother was saved from the stake by the pastor in exchange for her hand. Wracked with guilt, Anne confesses her love for Martin to her husband who dies from the shock. The usual accusations of maleficia are presented, and Anna is indicted of the murder of her husband by magic. Anne initially denies the charge but, when Martin turns against her, she is faced with the loss of his love and trust; she chooses to die by confessing to have sought the Devil's help, sealing her own fate. Under this atmosphere of extreme suspicion and godly brutality, Dreyer beautifully captures the terrible collision of superstition and matters of the heart. By burning the women at the stake in Day of Wrath, fire comes to represent a dichotomous element of the plot. While fire burns everything, bringing nothing but ruin, it also banishes the darkness. We are reminded of Prometheus who risked the wrath of the Titans to bring fire to man: it cleanses and purifies, and becomes the Love spoken of as an eternal flame. Minimal lighting and shadows create a pervasive sense of darkness, reflecting society's cruelty and intolerance in an age of spiritual enlightenment where Annes suicidal response is rationalised by the uncompromising nature of her sentiment for Martin. Annes own self-fashioning steps outside the bounds of the villages rigid codes; her idealism and martyrdom are meant to be sensibly perceived by the audience as what underlines a non-negotiable concept of idealistic Love. In line with the other two mentioned films, Lars von Triers Breaking the Waves is constructed on a series of triadic associations, the most poignant of which [] [is] God-Jan-Bess triad. 7 Breaking the Waves is a powerful fable set on a Northern Scottish island, where a young woman, Bess, defies the traditional dislike of the

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__________________________________________________________________ elderly for strangers by getting married to Jan, a strapping oil-rig worker and an outsider. The union is looked upon with disapproval by the Presbyterian village elders, who muzzle womens voices in church and take their greatest satisfaction in consigning sinners to damnation. Bess symbolises the challenge to the normative of the elders who interpret her disobedience as a menace of seduction, something insidious that forces un-invoked deviant changes which can threaten the wholeness of the community. As is the case for Dreyers Anne, the cardinality of Bess as a character comes from her as a figure embodying two elements: femininity and Puritan fear. In addition, Bess has a deeply personal relationship with God, talking with Him aloud at great length, rendered by von Trier in some of the most inventive and moving scenes in the film. Glancing directly at the camera, Bess takes both sides of the conversation, speaking for herself in a soft and humble voice, and speaking for God with a stern one and a dark frown. Bess and Jan are transformed by their love and passion for one another. An accident on the rig makes Jan paralysed from the neck down, while Bess is left feeling responsible for the accident because she had prayed for Jan's return. Out of concern for her loss of sexual pleasure, plunged into despair and guilt, or under the influence of strong pain medication, Jan asks Bess to have sex with other men. In the name of love and devotion, Bess decides to prostitute herself to spare Jan from a premature death. In so doing, she escapes the drudgery of the activities of the island community which are unable to curb her unconventional behaviour, her unruly feminine side and its transgressive power. As Jans condition worsens, Bess places herself more at risk by insisting on returning to a boat where her life had previously been threatened. After being violently abused, Bess dies while Jan gains a speedy recovery. According to Lars von Trier, Breaking the Waves is a simple love story; yet, as James Berardinelli points out in his review of this film, simple hardly begins to describe this deeply disturbing, multi-layered drama. He stresses on the fact that nowhere is the pictures complexity more evident than in its study of contrasts it is highly spiritual yet anti-religious, triumphant yet tragic, and personal yet universal. 8 Jeanette Solano remarks that: Bess last words, as she lays dying on the gurney, are: Ive freed Jan. They are eerily reminiscent of another battered and broken figure: Jesus, whose last words were: It is done. Earlier Jan had insisted he wanted to free Bess from her life of regimented conservative Christianity. In the end it is a healed Jan back at sea that is freed. In yet another way, the female savior has turned the tables, broken the rules, and turned our expectations on their head. 9

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__________________________________________________________________ 3. Conclusion All three films are effective visual parables capable at striking at our heart for their compassion and humanity; they are about the nobility of the spirit set against the reality of a human earthy existence, in the context of a shared oppression of women. These women struggle to assert themselves as individually thinking entities in the face of social, political and religious forces that treat them as objects. Through the use of a wide range of cinematic forms, ranging from vaudeville performances, theatrical style, and extreme visual sensitivity, these three directors fore-ground an analysis of love through a discursive framework; this framework condemns the privileging of sameness over difference. If by love we intend a multifaceted emotion transformative love, sacrificial love, redemptive love, destructive love, romantic love, and sexual love , then all three film-makers draw attention to the way in which femininity can exceed the boundaries imposed on it by a patriarchal system. The analyses of these three characters results in a final meditation on tragedy, individual will and the refusal to compromise that offer no happy ending or easy solutions; they seem to suggest that sacrifice and selfdestruction is a way to re-claim the heroines intellectual independence. Their feminine voices speak words with a subversive potential which are outside of their societies and have no community of listeners. In most cases, it is the vision of love as a sentiment that is misunderstood and even punished by the world, a love that is more esoteric than romantic, exacerbated by the inevitable impossibility of communicating such feeling.

Notes
http://www.culturecourt.com/F/Fellini/LaStrada.htm, Viewed Sept. 11, 2010. P. Bondanella, Italian Cinema from Neorealism to the Present, Ungar Publishing Press, New York 1983, pp. 137-138. 3 Fellini, 1965, http://www.adherents.com/people/pf/Federico_Fellini.html, Viewed September 12th, 2010. 4 Bondanella, loc. cit. 5 http://oldschoolreviews.com/rev_50/strada.htm. Viewed September 15th. 6 B. Sacvan, The Puritan Origin of the American Self, Yale University Press, New Haven, 1975, p. 14. 7 J. Solano, Blessed Broken Bodies: Exploring Redemption in Central Station and Breaking the Waves, Journal of Religion and Film, Vol. 8, 1 April 2004, http://www.unomaha.edu/jrf/Vol8No1/BlessedBroken.htm, Viewed Sept. 12th, 2010. 8 Breaking the Waves, A Film Review by J. Berardinelli, http://www.reelviews.net/movies/b/breaking.html, Viewed September 14, 2010. 9 Solano, loc. cit.
2 1

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Bibliography
Bainbridge, C., The Cinema of Lars Von Trier: Authenticity and Artifice. Wallflower, London, 2007. Bjrkman, S., Trier on Von Trier. trans. Smith, N., Faber and Faber, London, 2003. Bondanella, P., Italian Cinema from Neorealism to the Present. Ungar Publishing Press, New York, 1983. Brackenbury, C.M., Women and Religion. Beacon, Boston, 1965. Breaking the Waves, A Film Review by Berardinelli, J., http://www.reelviews.net/movies/b/breaking.html. Viewed September 14, 2010. Drum, J. and D.D. Drum, My Only Great Passion: The Life and Films of Carl Th. Dreyer. Scarecrow Press Inc., Lanham, Maryland, 2000. Hill, J. and P. Gibson, World Cinema Critical Approaches. Oxford University Press, Oxford, 2000. Hjort, M., Small Nation Global Cinema: The New Danish Cinema. University of Minnesota, Minneapolis, 2005. Rosenthal, S., The Cinema of Federico Fellini. The Tantivy Press, South Brunswick and New York, 1976. Ruether, Radford, R., Women and Redemption: A Theological History. Fortress Press, Minneapolis, 1998. Solano, J., Blessed Broken Bodies: Exploring Redemption in Central Station and Breaking the Waves. Journal of Religion and Film. Vol. 8, 1 April 2004, http://www.unomaha.edu/jrf/Vol8No1/BlessedBroken.htm. Bercovitch, S., The Puritan Origin of the American Self. Yale University Press, New Haven, 1975. Wagstaff, C., Italian Neorealist Cinema: An Aesthetic Approach. University, Toronto, 2007.

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__________________________________________________________________ Angela Tumini is an Assistant Professor of Italian Studies at Chapman University in California. Her research interests span nineteenth & tentieth century Italian Literature, Italian Cinema and comparative European cinema. She has just completed a book in which she analyzes the connection between Italian literature, cultural movements such as Futurism and Neo-realistic cinema with contemporary Danish cinema and the works of Lars von Trier in particular. .

Suicide and the Limits of Narrative: Ludwig Binswangers Case Study of Ellen West Christopher R. Trogan
Abstract: Ludwig Binswangers Case Study of Ellen West: An Anthropological-Clinical Study was published in 1944. The English version is approximately 127 pages long and is comprised of a life narrative and existential analysis. The former, which is approximately one-quarter the length of the latter, is a fascinating account of Ellen West. At the end of her life, she was treated by Binswanger, a Swiss psychiatrist and one of the founders of existential analysis, for schizophrenia and a severe chronic eating disorder at the Kreuzlingen Sanatorium, outside of Zurich. After Binswanger and his associates decided that she was incurable, West was released. As he expected, she then poisoned herself and died. The case study is most often read as an exemplar of existential psychoanalysis (Daseinsanalyse). However, rather than focusing on this aspect of the case study, this article focuses on the first part the life narrative leading up to the existential analysis proper. In addition to contextualizing Wests case, this article draws attention to the failure of the narrative to make sense of the suicide. Although the narrative attempts to make sense of suicide (and to justify Binswangers decision to permit it), it raises more questions than answers. Indeed, Binswangers failed attempt to make sense of Wests death through narrative may suggest something about the inability of narrative to make sense of the fundamental and indelible ambiguity and paradox of self-death overall. Binswangers narrative failure is, more than just a failure of his or its own, an inherent failure of the narrative form one that is inherently artificial and imposed to control, contain, and resolve a problem that is fundamentally uncontrollable, uncontainable, and irresolvable. Key Words: Suicide, narrative, Binswanger. ***** 1. Introduction Binswangers Case Study of Ellen West: An Anthropological-Clinical Study was published in 1944. The English version is approximately 127 pages long and is comprised of a life narrative and existential analysis. The former, which is approximately one-quarter the length of the latter, is a fascinating account of Ellen West. At the end of her life, she was treated by Binswanger for schizophrenia and a severe chronic eating disorder at the Kreuzlingen Sanatorium, outside of Zurich. After Binswanger and his associates decided that she was incurable, West was released. As he expected, she then poisoned herself and died.

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__________________________________________________________________ The case study is most often read as an exemplar of existential psychoanalysis (Daseinsanalyse), a form of psychoanalysis influenced by Heidegger, Husserl, and others. It deals holistically with the patient's situation, rather than with his/her past; it emphasizes emotional experiences rather than rational thinking, and stresses a person's responsibility for his/her own existence. However, rather than focusing on this aspect of the case study, this chapter will focus on the first part the narrative aspect leading up to the existential analysis proper. Indeed, the life narrative is an interesting case in its own right. In addition to contextualizing Wests case, it also demonstrates the failure of narrative to make sense of suicide. Many have argued that the existential analysis is an attempt to do what the narrative could not. Although the narrative attempts to make sense of suicide (and to justify Binswangers decision to permit it), it raises more questions than answers. Indeed, Binswangers failed attempt to make sense of Wests death through narrative may suggest something about the inability of narrative to make sense of the fundamental and indelible ambiguity and paradox of self-death overall. Binswangers narrative failure is, more than just a failure of his or its own, an inherent failure of the narrative form one that is inherently artificial and imposed to control, contain, and resolve a problem that is fundamentally uncontrollable, uncontainable, and irresolvable. 2. Facts and Context John T. Maltsberger offers a relatively succinct and quite accurate summary of the facts and context as Binswanger presents them. 1 Though she had been ill with depression and a serious eating disorder for 13 years, Mrs. West, a 33-year old, married Jewish woman who had emigrated to Europe at the age of 10, became much worse during her second attempt at psychoanalysis. A first attempt had resulted in some improvement, but the patient broke it off. The second analyst, contrary to the husbands wishes, urged a separation. She deteriorated sharply after the separation and attempted suicide for the first time. We are told that, two days after the separation, she took 56 Somnacetin tablets but vomited most of them. Her husband visited and then returned to stay with her because she was weeping, suicidal, and roaming the streets. A day later she took 20 barbiturate tablets but survived. She then tried several times to jump in front of a car; the next day, she tried to jump out of her analysts window. She was subsequently admitted to a private clinic under the care of her internist. Obsessed with food, abusing laxatives, agitated, filled with feelings of dread, she became increasingly cut off from others. Prof. Emil Kraepelin was consulted and diagnosed melancholia. Wests analyst disagreed and continued to work with the patient, but she grew more and more suicidal. Her internist insisted that he stop analysis; West was transferred to Kreuzlingen and placed under the care of Binswanger. She broke out wailing when she was being admitted and was quieted with great difficulty. Her husband moved into the sanatorium and was constantly with her. She became increasingly suicidal

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and it appeared that, if suicide was to be prevented, she would have to be placed in a locked ward. She begged to be shot. Binswanger told her husband that if Ellen was not transferred to a locked ward, he would have to remove her from the sanatorium. Her husband said he would agree to transfer her to a closed ward only if a cure, or at least a far-reaching improvement, could be promised. Binswanger then concluded that West suffered from progressive schizophrenia, the case was hopeless, and he should give in to the patients demand for a discharge. He suggested a consultation with two other psychiatrists who agreed that West had a debilitating schizophrenic illness and her condition was unlikely to improve. West wanted to leave the sanatorium. Her husband did not want to lock her up under any circumstances, and Binswanger, with the agreement of the consultants, agreed to her discharge. After two-and-a-half months in his care, with West having spent twelve of the last thirteen months in therapy with three different analysts, Binswanger decided to give in. Binswanger writes: On the third day of being home she is as if transformed. At breakfast she eats butter and sugar, at noon she eats so much that for the first time in thirteen years! she is satisfied by her food and gets really full. At afternoon coffee she eats chocolate creams and Easter eggs. She takes a walk with her husband, reads poems by Rilke, Storm, Goethe, and Tennyson, is amused by the first chapter of Mark Twains Christian Science, is in a positively festive mood, and all heaviness seem to have fallen away from her. She writes letters, the last one a letter to a fellow patient here to whom she had become so attached. In the evening she takes a lethal dose of poison, and on the following morning she is dead. She looked as she had never looked in life calm and happy and peaceful. 2 3. The Limits of Narrative: Questioning the Inevitable Binswangers attempt to make sense of and justify Wests suicide involves investing the narrative at the levels of both content and form with a sense of the inevitable. One recalls that, as a particular narrative form, the case study lends itself nicely to this. Its formula is generally straightforward: the writer/clinician describes the patients background, makes a diagnosis, prescribes a treatment, and reports the outcome sometimes (as in this case) offering an analysis of that outcome. From the beginning, the reader is propelled forward by anticipation of the inevitable end. Indeed, the sense of the inevitable is crucial for Binswangers existential analytical approach. He writes that: From the standpoint of existential analysis, the suicide of Ellen West was an arbitrary act as well as a necessary event. Both

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__________________________________________________________________ statements are based on the fact that the existence in the case of Ellen West had become ripe for its death, that the death, this death, was the necessary fulfilment of the life-meaning of this existence. 3 He regards Wests suicide as the logical, coherent, and inevitable end of her life; his narrative is meant to reinforce and reflect this. The narrative tells the story of a life on a collision course with suicidal fate. It is constructed as if it were itself a ticking time bomb. He begins with a description of Wests heredity. The message is subtle, but clear: if virtually all of her familial relations have suffered from mental illness, her fate can be no different. Heredity is insurmountable, and no mental health professional (no matter how skilled) can save her from the curse of her genetic inheritance. He describes West as an outsider a non-Swiss and the daughter of a Jewish father who was very soft and sensitive and suffering from nocturnal depressions. 4 Although she had a healthy brother four years older, he is described as dark. 5 Her younger brother was nervous, soft, a womanly aesthete and was committed to a psychiatric clinic for some weeks at the age of seventeen because of suicidal thoughts. 6 Binswanger continues with a litany of these afflictions: A sister of the father became mentally ill on her wedding day. One of the fathers five brothers shot himself, a second committed suicide during a period of melancholy, a third is severely ascetic, and the last two both died of strokes. 7 Then comes a description of Ellens birth and life history. She was born overseas and moved with her family to Europe when she was ten. She was a headstrong and violent child who refused milk after nine months and had difficulty feeding. 8 Even at a young age, she had days when everything seemed empty to her, was a good student but a perfectionist, preferred boys games and clothes and wanted to be a boy, and was a thumbsucker until she was sixteen. 9 Binswanger writes that, at seventeen, a year which cut deeply into her existence, there were two profound developments in Wests life. First, she read J.P. Jacobsens Niels Lyhne (1880), a stark, melancholic novel about a disillusioned artist who commits suicide. 10 The novel transformed West from a deeply religious person one with faith in god and the afterlife to a complete atheist. 11 He claims that the works individualism and religious nihilism captivated many young people and strengthened their faith; yet it had the opposite effect on West she identified closely with the suicidal protagonist. Binswanger writes that West, [f]eeling no longer any trust in, or obligation to a deity[was] in the words of Niels Lyhne, entirely a solitary individual. 12 After a trip she takes to Sicily at the age of twenty-one, Binswanger describes her life as a steady decline. She sees her body and soul as united on a path to mutual destruction driven by a relentless desire to be thin. She is on the lowest rung of the ladder and it is only a matter of time before she surrenders to death. 13

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He reports that her suicidal thoughts have become much more frequent indeed, that she feels that death welcomes her as a friend: In a poem, grim distress sits at her grave, ashy pale sits and stares, does not flinch nor budge; the birds grow mute and flee, the flowers wilt before its ice-cold breath. Now death no longer appears to her as terrible; death is not a man with the scythe but a glorious woman, white asters in her dark hair, large eyes, dream-deep and gray. The only thing that still lures her is dying If he makes me wait much longer, this great friend, death, then I shall set out and seek himOnly the certainty that sooner or later the end must come consoles me a little. 14 Binswanger repeatedly points out that there can be no chance of altering the course of Wests life so that she might have been saved from her progressively debilitating mental illness and suicide. He frequently reminds us that her options disappeared well before he even came along. He cannot possibly be held responsible for the result of events that had long been set in motion and are now inexorably unfolding toward the end. He brings the reader ever closer to Wests death, but stops short, interjecting a final digression about his patients life-long preoccupation with suicide a final attempt to harness the power of narrative to contain, control, and resolve Wests decision to kill herself: In response to my request her husband gathers together the following material on the theme of suicide. The wish to die runs through her entire life. Even as a child she thinks it interesting to have a fatal accident for example, to break through the ice while skating. During her riding period (at nineteen, twenty, and twenty-one) she performs foolhardy tricks, has a fall and breaks her clavicle, and thinks it too bad that she does not have a fatal accident; on the next day she mounts her horse again and continues to carry on in the same manner. When sick as a young girl, she is disappointed each time the fever subsides and the sickness leaves her. 15 The pace of the case study increases even further, culminating abruptly in Binswangers last words a description of Wests post-mortem state as calm and happy and peaceful. 16 Although the narrative comes to a full stop, important questions remain: Was Wests suicide really inevitable and what exactly would this mean? Could it mean that suicide at least in some cases cannot and/or should not be treated? What, if any, responsibility do others have for those who wish to end their lives? Is suicide an existential issue or is it a clinical one?

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__________________________________________________________________ Nothing in the narrative itself answers these questions. Binswanger must resort to the existential analysis in Part Two to take up these questions. Many have argued that the problems remain just as irresolvable there as they do here. 4. Conclusion While one might see Binswangers life narrative of Ellen West merely as a prelude to the existential analysis that follows, his carefully constructed narrative is independently valuable. Albeit a failed attempt, it is a genuine effort to give form and clarity to Wests suicide through an insistence on the inevitability of her death as conveyed through the content of the narrative and as mirrored in its linear (inevitable) form. However, the inherently artificial attempt of narrative to control, contain, and resolve Wests suicide draws attention to the nature of the problem of suicide itself and suggests that any attempt to solve or make sense of it would require similar artifice. Far from faulting Binswangers life narrative of Ellen West (much less narrative itself) one might see this narrative as providing an important reminder about the inherently ambiguous and paradoxical nature of the problem and of our tendency to and, to be fair, even the necessity to construct solutions that are, at best, short-sighted and one-dimensional, and, at worst, wholly artificial.

Notes
1

J. Maltsberger, D. Clark, and J. Motto, The Case of Ellen West Revisited: A Permitted Suicide, Suicide & Life Threatening Behavior, Spring 1996, pp. 87-88. 2 L. Binswanger, The Case of Ellen West: An Anthropological-Clinical Study, Existence: A New Dimension in Psychiatry and Psychology, Basic Books, New York, 1958, p. 276. 3 Ibid., p. 295. 4 Ibid., p. 237. 5 Ibid., p. 237. 6 Ibid., p. 237. 7 Ibid., p. 238. 8 Ibid., p. 239. 9 Ibid., p. 239. 10 Ibid., p. 239. 11 Ibid., p. 239. 12 Ibid., p. 239. 13 Ibid., p. 242. 14 Ibid., pp. 242-243. 15 Ibid., p. 265. 16 Ibid., p. 267.

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Bibliography
Binswanger, L., The Case of Ellen West: An Anthropological-Clinical Study. Existence: A New Dimension in Psychiatry and Psychology. Basic Books, New York, 1958. Maltsberger, J., Clark, D. and Motto, J., The Case of Ellen West Revisited: A Permitted Suicide. Suicide & Life Threatening Behavior. Spring 1996. Christopher R. Trogan is Assistant Professor of Humanities at the United States Merchant Marine Academy in Kings Point, New York.

Recovery from a Suicidal Crisis: Where Theres Hope, Theres Life James C. Overholser and Abby Braden
Abstract When a client enters a suicidal crisis, their problems do not resolve quickly. It takes many months for a suicidal crisis to fully resolve. Effective treatment focuses directly on suicide risk instead of indirectly targeting depression. A comprehensive framework for the treatment of suicidal clients can be organized into three stages that change over time. First, acute crisis management is designed to protect suicidal clients from their own self-destructive urges. Second, the period of short-term stabilization occurs when the acute suicidal crisis has passed, the intense feelings of depression have been reduced, and the client may appear to be no longer suicidal. However, the risk for suicidal urges remains high. Therapy can focus on reducing the client's desire to die, aiming to remove the suicidal motives by mobilizing the client's internal restraints. Therapy aims to ignite a spark of hope, cultivate positive attitudes toward the future, and develop numerous reasons for living. Third, the long-term recovery process often involves outpatient treatment over subsequent months. Because suicidal urges can be quickly re-activated through common life events, a sudden resurgence of suicidal ideation can quickly trigger a subsequent suicidal crisis. Key Words: Suicide, treatment, hope. ***** 1. Understanding Suicide Risk Suicide is a critical international problem, ranking 14th as a leading cause of death worldwide. 1 Psychiatric diagnosis may improve suicide prediction by providing a glimpse into the mind of the suicidal individual. Individuals who made a lethal suicide attempt were likely to be diagnosed with depression, and frequently were struggling with the recent loss of an important social relationship. 2 In addition, these suicide attempters frequently reported high levels of hopelessness, helplessness, and worthlessness. 3 Sinclair and colleagues evaluated 127 depressed patients who later died by suicide, as compared to 195 controls. Results showed that the suicide completers were much more likely to report feeling hopeless at the time of their original hospital stay, and they were almost twice as likely to report a prior suicide attempt as compared to the control patients. 4 The prediction of suicide remains an elusive goal. Even when all available information is used, mental health professionals are unable to predict, and therefore unable to prevent, suicidal actions. It is imperative to have high quality treatment available for individuals who survive a suicide attempt. Unfortunately, many

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__________________________________________________________________ depressed and suicidal clients receive little or no treatment. In a study of 71 suicide completers who met criteria for a Major Depressive Disorder at the time of their death, most suicide completers had received no treatment for their depression. 5 Suicide attempters and completers appear to represent different, but overlapping, groups. 6 Some attempters will recover and never become suicidal again. Alternatively, some completers die during their first (and only) suicidal crisis. Treatment is particularly important for a core group of suicide attempters with subsequent suicidal behaviours who remain at elevated risk. One study found that 19 percent of male suicide completers and 39 percent of female suicide completers had made a previous nonfatal suicide attempt in the year prior to their death. 7 There is an important subgroup of individuals who unsuccessfully attempt suicide, yet eventually complete suicide. In a 14-year follow-up study that evaluated 1,018 patients who had attempted suicide, 68 committed suicide during the follow-up period. The suicide completers were likely to be males who reported a desire to die after their initial suicide attempt. 8 These high risk individuals are desperately in need of a comprehensive treatment plan designed to evaluate, monitor, and reduce their suicidal urges. Recovery from a suicidal crisis follows a slow and dangerous path. Moss and Hamilton reviewed the medical records of 50 suicidal patients, searching for clues to the recovery process. 9 Based on the commonalities across patients, Moss and Hamilton viewed the recovery from a suicidal crisis as following three distinct stages, which they labelled: acute crisis, convalescence, and recovery. In a similar manner, prior research has supported the notion of a slow path to recovery following a suicidal crisis. Overholser, Miller, and Norman conducted a longitudinal assessment of depressed and suicidal patients who were evaluated over the course of their therapy and followed for 16 months. 10 Compared to depressed, non-suicidal patients, the suicidal patients took longer for their suicidal thoughts and pessimistic attitudes to subside. Even though suicidal clients displayed reductions in their depressive symptoms within a few weeks, they remained at elevated risk for suicidal thoughts for several months following a suicidal crisis. Four months after they were discharged from the hospital, essentially all non-suicidal patients had recovered from their depressive episode. In contrast, the majority of suicidal patients remained quite depressed, very hopeless, and reported ongoing struggles with suicidal thoughts. Therapy of suicidal clients requires patience, persistence, and a comprehensive plan to guide the intervention. When clients enter a suicidal crisis, their problems do not resolve quickly, and their risk remains elevated. A comprehensive framework for the treatment of depressed, suicidal clients can be organized into three stages that change over time.

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__________________________________________________________________ 2. Management of the Acute Suicidal Crisis During a suicidal crisis, most clients express extreme levels of depression, dissatisfaction, and despair. During the acute crisis, the most important task is to protect the client from self-inflicted injury. Acute crisis management involves several strategies designed to protect suicidal clients from their own selfdestructive urges. The primary therapeutic goal is to preserve the clients safety, whether the client continues to report, or suddenly denies, any suicidal intent. During the acute crisis period, it is useful to monitor the clients suicidal thoughts and remain prepared to intervene quickly. Suicidal ideation can be monitored by several structured measures (e.g., Beck Scale for Suicidal Ideation), or through a series of questions in a clinical interview. 11 When assessment indicates high suicidal intent and imminent risk for suicide, the therapists only option may be to contact police to protect the clients life. During the acute crisis period, the therapist remains active and directive. An important goal during the acute crisis involves removing access to methods that could be used in an act of self-destruction. 12 The therapist may ask the clients close family or friends to participate in a suicide prevention plan. Sometimes, the therapist may need to suggest positive things in the clients life in an attempt to highlight reasons for staying alive. These directive strategies may be needed during the crisis period, but are not included as part of long-term therapy. Throughout the acute crisis, therapist and client should realize there are always other options. Suicidal clients often feel there is no other option left for them but to die. Problems are seen as unsolvable. Therapy can help to plant the seeds of hope, and later long-term therapy may be able to help these seeds begin to grow. For many clients, the desire to die arises from the toxic combination of depression and hopelessness, when clients feel that their life situation is bad, and things are unlikely to improve. A brief inpatient stay can provide time to begin the recovery process, whereby the client is removed from their current stressful existence. The hospital provides a safe environment where clients are protected from their own self-destructive urges. However, most inpatient stays are too brief to accomplish meaningful life changes. Most suicides that occur following discharge from a psychiatric hospital tend to happen during the first two weeks post-discharge. 13 Nonetheless, the mere suggestion that hospitalization is an option for the suicidal client can be enough to reduce some of the clients intense distress. The acute crisis management stage is brief, and focused on helping the suicidal client survive the few days surrounding the acute crisis. However, because of the persistence of suicidal thoughts, crisis intervention strategies alone are insufficient for helping suicidal clients. Even when the crisis seems to pass, most suicidal clients remain at elevated risk for several months. Ongoing therapy is essential for the treatment of suicidal clients.

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__________________________________________________________________ 3. Short-Term Stabilization Following a Suicidal Crisis The period of short-term stabilization occurs when the acute suicidal crisis has passed, the intense feelings of depression have been reduced, and the client may appear to be no longer suicidal. However, the risk for suicidal urges remains high. It is important to design a treatment plan that confronts suicide risk even when the client is no longer actively suicidal. It is important for the therapist to convey empathy, warmth, and genuineness in all sessions. The therapeutic relationship may be the most potent quality in many therapy sessions. Many suicidal clients feel alone, lonely, rejected, and inadequate. Time spent with a caring and compassionate therapist can help to reduce the sense of isolation for many clients. A crucial aspect of the short-term stabilization phase includes helping clients begin to learn more adaptive ways of coping. Therapy can focus on reducing the client's desire to die, aiming to remove the suicidal motives by mobilizing the client's internal restraints. This is the core of psychological treatment, aiming to change the clients negative and pessimistic attitudes. The desire to die must be confronted and challenged so that reasons for living can be cultivated. Suicidal individuals report significantly fewer reasons for living than non-suicidal individuals. 14 Reasons for living can be increased by strengthening a sense of responsibility to ones family and promoting concern for children. Therapy for suicidal clients typically aims to identify, assess, and confront the clients feelings of helplessness, hopelessness, and worthlessness. These negative attitudes lie at the foundation of most cases of suicidal depression. Hopelessness is an important predictor of suicide risk, even ten years later. 15 Unfortunately, most strategies for pharmacological intervention and psychological treatment aim to reduce feelings of depression, while largely neglecting attitudes of pessimism and hopelessness. Cognitive therapy can be focused directly on the suicidal urges, and thereby help to reduce the risk of subsequent suicide attempts. 16 Ideally, therapy can serve to ignite a spark of hope, and consequently begin to cultivate positive attitudes toward the future. Realistic optimism is the key to successful change. Clients need to believe their life situation can get better, and they can bring about positive life changes. 4. Long-Term Recovery from a Suicidal Crisis The recovery from a suicidal crisis is not a fast or simple path. The long-term recovery process often involves outpatient treatment over subsequent months. Because suicidal urges can be re-activated quickly through common life events, a sudden resurgence of suicidal ideation can quickly trigger another suicidal crisis. Furthermore, persistent depressive symptoms following a suicidal crisis reflect an important warning sign that the individual remains at substantially elevated risk for subsequent suicidal behaviour. 17 The therapist should remain aware of the ongoing risk and be prepared for dealing with the resurgence of suicidal thoughts and feelings.

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__________________________________________________________________ Therapy can help clients to take control over their future by promoting proactive coping strategies. Suicidal clients often display passive and unproductive coping styles that are characterized by verbal complaints, procrastination delays, or perfectionist indecision. When clients begin to accept personal responsibility for the problems, they can also accept responsibility for change. 18 At the core of the change process lies hope for a better future, while remaining realistic about one's opportunities, strategies, and goals. Therapy can help to cultivate useful problem-solving skills in clients. 19 Suicide attempters are often deficient in their interpersonal problem-solving skills. 20 Often, a problem that appears overwhelming can be divided into smaller and simpler components, making it easier to manage. Effective therapy can help to broaden the clients vision of acceptable options and coping solutions, and then make rational decisions about their plan of change. 21 Many suicidal individuals feel isolated, rejected, or ashamed. Therapy can help patients renew or initiate supportive relationships and intimate bonds. 22 Improvements in social functioning during the first three months after a major depressive episode predict the full path to long-term recovery from the depression. 23 Clients can learn assertiveness and effective methods of communication that will increase relationship satisfaction. As their social environment improves, the suicidal risk should be reduced. 24 Therapy may help clients learn to deal with their intense negative emotional reactions. Many suicidal clients suffer from strong feelings of sadness, anger, apprehension, and despair. Effective therapy occurs when emotional content pervades the therapy session. 25 Clients can learn to regulate their negative emotions, helping them to improve their ability to experience, express, and tolerate negative mood states. During the recovery stage, the therapist aims to develop new attitudes and coping skills in the client. The therapist relies on the Socratic Method and guided discovery to help clients find their own solutions to their ongoing problems. Systematic questioning by the therapist allows clients the opportunity to independently recognize problematic patterns and make sense of their difficulties. 26 A disavowal of knowledge by the therapist demonstrates genuine interest and curiosity in the client. 27 A Socratic approach to therapy may allow clients to explore deeper issues such as sources of meaning or purpose in their lives. Suicidal individuals report significantly less meaning in their lives than nonsuicidal individuals. 28 The process of therapy may help suicidal clients cultivate a sense of meaning in life. Finally, therapy of suicidal clients can benefit from relapse prevention strategies. Clients can prepare for a possible lapse in their coping abilities and a resurgence of suicidal thoughts and urges. However, clients can learn to identify their high risk situations in order to prepare and plan their coping efforts. Instead of feeling overwhelmed and distraught, clients need to use their stressful periods as

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__________________________________________________________________ opportunities to test their positive attitudes and coping skills, as part of an ongoing effort to refine and improve their new adaptive habits. 29 Finally, improvements in coping skills and social support can help to prevent the relapse into another depressive episode. 30 5. Recommendations for Therapy with Suicidal Clients The treatment of suicidal clients is a difficult but important area for mental health experts to improve. No single treatment is appropriate for all suicidal clients. Furthermore, therapy must change to adapt to the needs of the client during different stages of the recovery process. Therapy should remain flexible to the client's needs. 31 Finally, the goal of therapy is to instil hope in the desperate individual. Therapy of suicidal clients can be effective and rewarding for the therapist. Unfortunately, too many mental health professionals are afraid to work with suicidal clients, perhaps because of the emotional drain on the therapist, or because of the legal liability that overshadows work in this area. However, when therapists remain knowledgeable, skilled, and hopeful, therapy with suicidal clients can make for a great contribution to the field and to society overall. Ultimately, the key to successful change is hope. Positive expectations should be clearly present in both the client as well as the therapist. 32 Therapy requires an ever-present faith in the client's ability to make positive life changes, and move forward toward a more optimistic future. Without hope, there is no chance of effective therapy, positive change, or recovery from a suicidal crisis. With a bit of hope, clients can live a long and productive life. Suicide is a complex a problem that is unlikely to be understood through the theories or methods involved in any single field. The best efforts involve a sincere working collaboration and communication across numerous fields. Every mental health professional who might work with suicidal clients must possess an adequate level of hope and a realistic faith in their ability to help the desperate client. Without a strong belief and sincere trust in the ability of words to change the clients life, there is no reason to try a course of therapy. A sincere compassion and a genuine optimism will help to carry the client through their struggles and guide them toward a realistic path to recovery.

Notes
M. Nock, et al. Cross-National Prevalence and Risk Factors for Suicidal Ideation, Plans, and Attempts, British Journal of Psychiatry, Vol. 192, 2008, pp. 98-105. 2 R. Hall, et al., Suicide Risk Assessment: A Review of Risk Factors for Suicide in 100 Patients who Made Severe Suicide Attempts, Psychosomatics, Vol. 40, 1999, pp. 8-27.
1

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__________________________________________________________________ Ibid., pp. 8-27. J. Sinclair, et al., Suicide in Depressive Disorders, Journal of Affective Disorders, Vol. 87, 2005, pp. 107-113. 5 E. Isometsa, et al., Suicide in Major Depression, American Journal of Psychiatry, Vol. 151, 1994, pp. 530-536. 6 T. DeJong, et al., Apples to Oranges: A Direct Comparison between Suicide Attempters and Suicide Completers, Journal of Affective Disorders, Vol. 124, 2010, pp. 90-97. 7 E. Isometsa & J. Lonnquist, Suicide Attempts Preceding Completed Suicide, British Journal of Psychiatry, Vol. 173, 1998, pp. 53-535. 8 J. Suokas, et al., Long-Term Risk Factors for Suicide Mortality after Attempted Suicide, Acta Psychiatrica Scandinavica, Vol. 104, 2001, pp. 117-121. 9 L. Moss & D. Hamilton, The Psychotherapy of the Suicidal Patient, American Journal of Psychiatry, Vol. 112, 1956, pp. 814-820. 10 J.C. Overholser, et al., The Course of Depressive Symptoms in Suicidal vs. Nonsuicidal Depressed Inpatients, Journal of Nervous and Mental Disease, Vol. 175, 1987, pp. 450-456. 11 A.T. Beck, et al., Assessment of Suicidal Intention, Journal of Consulting and Clinical Psychology, Vol. 47, 1979, pp. 343-352. 12 D. Lester, Preventing Suicide by Restricting Access to Methods for Suicide, Archives of Suicide Research, Vol. 4, 1998, pp. 7-24. 13 J. Meehan, Suicide in Mental Health Inpatients and within 3 months of Discharge, British Journal of Psychiatry, Vol. 188, 2006, pp. 129-134. 14 M.M. Linehan, et al., Reasons for Staying Alive when You are Thinking of Killing Yourself, Journal of Consulting and Clinical Psychology, Vol. 51, 1983, pp. 276-286. 15 A. Beck, et al., Hopelessness and Eventual Suicide, American Journal of Psychiatry, Vol. 142, 1985, pp. 559-563. 16 G. Brown, et al., Cognitive Therapy for the Prevention of Suicide Attempts, Journal of the American Medical Association, Vol. 294, 2005, pp. 563-570. 17 L. Wingate, et al., Empirically Informed Approaches to Topics in Suicide Risk Assessment, Behavioural Sciences & the Law, Vol. 22, 2004, pp. 651-665. 18 J.C. Overholser, Contemporary Psychotherapy: Promoting Personal Responsibility for Therapeutic Change, Journal of Contemporary Psychotherapy, Vol. 35, 2005, pp. 369-376. 19 M. Eskin, et al., Efficacy of a Problem-Solving Therapy for Depression and Suicide Potential in Adolescents and Young Adults, Cognitive Therapy and Research, Vol. 32, 2008, pp. 227-245. 20 L. Pollock & J. Williams, Problem-Solving in Suicide Attempters, Psychological Medicine, Vol. 34, 2004, pp. 163-167. 21 Overholser, op. cit., pp. 43-57.
4 3

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__________________________________________________________________ J.C. Overholser, Cognitive-Behavioral Treatment of Depression, Part II: Techniques for Improving Social Functioning, Journal of Contemporary Psychotherapy, Vol. 25, 1995, pp. 205-222. 23 G. Keitner, et al., Psychosocial Factors and the Long-Term Course of Major Depression, Journal of Affective Disorders, Vol. 44, 1997, pp. 57-67. 24 L. Wingate, et al., pp. 651-665. 25 L. Greenberg & L. Korman, Assimilating Emotion into Psychotherapy Integration, Journal of Psychotherapy Integration, Vol. 3, 1993, pp. 249-265. 26 J.C. Overholser, Elements of the Socratic Method: I. Systematic Questioning, Psychotherapy, Vol. 30, 1993, pp. 67-74. 27 J.C. Overholser, Elements of the Socratic Method IV: Disavowal of Knowledge, Psychotherapy, Vol. 32, 1995, pp. 283-292. 28 I. Orbach, M. Mikulincer, E. Gilboa-Schechtman & .P Sirota, Mental Pain and Its Relationship to Suicidality and Life Meaning, Suicide and Life-Threatening Behaviour, Vol. 33, 2003, pp. 231-241. 29 J.C. Overholser, Cognitive-Behavioural Treatment of Depression, Part X: Reducing the Risk of Relapse, Journal of Contemporary Psychotherapy, Vol. 28, 1998, pp. 377-392. 30 B. Backs-Dermott, et al., An Evaluation of an Integrated Model of Relapse in Depression, Journal of Affective Disorders, Vol. 124, 2010, pp. 60-67. 31 J.C. Overholser, Cognitive-Behavioural Treatment of Depression: A ThreeStage Model to Guide Treatment Planning, Cognitive and Behavioural Practice, Vol. 10, 2003, pp. 231-239. 32 J.C. Overholser, et al., Youve Got to Believe: Core Beliefs that Underlie Effective Psychotherapy, Journal of Contemporary Psychotherapy, Vol. 40, 2010, pp. 185-194.
22

Bibliography
Backs-Dermott, B., Dobson, K., & Jones, K., An Evaluation of an Integrated Model of Relapse in Depression. Journal of Affective Disorders. Vol. 124, 2010, pp. 60-67. Beck, A.T. Kovacs, M. & Weissman, A., Assessment of Suicidal Intention: The Scale for Suicide Ideation. Journal of Consulting and Clinical Psychology. Vol. 47, 1979, pp. 343-352. Brown, G., Have, T., Henriques G., Xie, S., Hollander, J. & Beck, A.T., Cognitive Therapy for the Prevention of Suicide Attempts. Journal of the American Medical Association. Vol. 294, 2005, pp. 563-570.

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__________________________________________________________________ DeJong, T., Overholser, J. & Stockmeier, C., Apples to Oranges: A Direct Comparison between Suicide Attempters and Suicide Completers. Journal of Affective Disorders. Vol. 124, 2010, pp. 90-97. Greenberg, L. & Korman, L., Assimilating Emotion into Psychotherapy Integration. Journal of Psychotherapy Integration. Vol. 3, 1993, pp. 249-265. Hall, R., Platt, D. & Hall, R., Suicide Risk Assessment. Psychosomatics. Vol. 40, 1999, pp. 18-27. Isometsa, E., Henriksson, M., Aro, H., Heikkinen, M., Kuoppasalmi, K. & Lester, D., Preventing Suicide by Restricting Access to Methods for Suicide. Archives of Suicide Research. Vol. 4, 1998, pp. 7-24. Linehan, M.M., Goodstein, J.L., Nielsen, S.L. & Chiles, J.A., Reasons for Staying Alive when You are Thinking of Killing Yourself. Journal of Consulting and Clinical Psychology. Vol. 51, 1983, pp. 276-286. Isometsa, E. & Lonnquist, J., Suicide Attempts Preceding Completed Suicide. British Journal of Psychiatry. Vol. 173, 1998, pp. 53-535. Meehan, J, Suicide in Mental Health Inpatients and Within 3 Months of Discharge. British Journal of Psychiatry. Vol. 188, 2006, pp. 129-134. Moss, L. & Hamilton, D., The Psychotherapy of the Suicidal Patient. American Journal of Psychiatry. Vol. 112, 1956, pp. 814-820. Orbach, I., Mikulincer, M., Gilboa-Schechtman, E. & Sirota, P., Mental Pain and Its Relationship to Suicidality and Life Meaning. Suicide and Life-Threatening Behaviour. Vol. 33, 2003, pp. 231-241. Overholser, J.C., Elements of the Socratic Method I: Systematic Questioning. Psychotherapy. Vol. 30, 1993, pp. 67-74. Overholser, J.C., Elements of the Socratic Method IV: Disavowal of Knowledge. Psychotherapy, Vol. 32, 1995, pp. 283-292. Overholser, J.C., Cognitive-Behavioural Treatment of Depression, Part II: Techniques for Improving Social Functioning. Journal of Contemporary Psychotherapy. Vol. 25, 1995, pp. 205-222.

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__________________________________________________________________ Overholser, J.C., Cognitive-Behavioural Treatment of Depression, Part IV: Improving Problem-Solving Skills. Journal of Contemporary Psychotherapy. Vol. 26, 1996, pp. 43-57. Overholser, J.C., Cognitive-Behavioural Treatment of Depression, Part X: Reducing the Risk of Relapse. Journal of Contemporary Psychotherapy. Vol. 28, 1998, pp. 377-392. Overholser, J.C., Cognitive-Behavioural Treatment of Depression: A Three-Stage Model to Guide Treatment Planning. Cognitive and Behavioural Practice. Vol. 10, 2003, pp. 231-239. Overholser, J.C., Contemporary Psychotherapy: Promoting Personal Responsibility for Therapeutic Change. Journal of Contemporary Psychotherapy. Vol. 35, 2005, pp. 369-376. Overholser, J.C., Miller, I. & Norman, W., The Course of Depressive Symptoms in Suicidal vs. Nonsuicidal Depressed Inpatients. Journal of Nervous and Mental Disease. Vol. 175, 1987, pp. 450-456. Overholser, J.C., Braden, A. & Fisher, L., Youve Got to Believe: Core Beliefs that Underlie Effective Psychotherapy. Journal of Contemporary Psychotherapy. Vol. 40, 2010, pp. 185-194. Wingate, L., Joiner, T., Wingate, R., Rudd, M.D. & Jobes, D., Empirically Informed Approaches to Topics in Suicide Risk Assessment. Behavioural Sciences & the Law. Vol. 22, 2004, pp. 651-665. James C. Overholser is Professor of Psychology and Director of Clinical Training at Case Western Reserve University. He has interests in depression, suicide risk, and their treatment. Abby Braden, is an advanced graduate student in clinical psychology with interests in suicide risk and meaning in life.

Learning from the Bereaved by Suicide in the Face of Stigma Dorothy Ratnarajah and Myfanwy J. Maple
Abstract Three qualitative research studies have been undertaken in Australia into the bereavement experience following the suicide of a family member. Narrative inquiry was used to interpret the data gathered from the in-depth interviews with bereaved informants. This methodology allowed for the exploration of the complex and influential aspects of the informants grief experiences, such as relatedness to the deceased, the informants age at the time of death, developmental influences, family patterning, and the environmental and social context in which the family lived. This analysis allowed in-depth exploration of the meaning making undertaken by the bereaved family members following the loss of a family member to suicide. Stigma was a pervasive finding through all three studies, in relation to the end of life decisions of the deceased family member, along with those bereaved. It was common that all those bereaved by the suicide of a family member spoke of being silenced in their grief, of not being able to speak openly of their deceased family member, of shaming and blaming experienced from neighbours, their communities and family members. Frequently, the stigma of a suicidal death resulted in fractures or breakdown in the wider family system. This chapter will inform its readers of the wide ranging damaging effects of stigma in relation to suicide, in that it prevents those who have suicidal thoughts from seeking help prior to their decision to die, and for those bereaved by suicide from being able to share their grief and find understanding. Key Words: Family experience of suicide, bereavement, stigma, grief narratives, meaning making. ***** 1. Introduction and Background Suicide is a major health issue worldwide. In 2008, the Australian Institute of Health and Welfare review of suicide statistics estimated the number of deaths from suicide at approximately 2500. 1 While the exact number of people affected by each suicide remains unknown, conservative estimates indicate that at least six family members are affected by the loss. 2,3 This results in the possibility of 15,000 Australians affected by the loss of a family member each year. The loss of a loved one through suicide is known to be profound and long lasting. 4 Thus, not only is it important to identify those newly bereaved, but also those whose grief is long lasting and potentially disabling. At present, there is no way to identify such individuals, nor who within this group will require further assistance. Thus, understanding the needs of this group is vitally important. Prior

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__________________________________________________________________ research has indicated that these family members are themselves at greater risk of suicide following the death of a loved one. 5 The three qualitative research projects explored the experience of bereavement following the suicide death of a family member. These research projects sampled parents, children, siblings, partners and other first-degree relatives using narrative inquiry to explore in depth the way in which these individuals make sense of the suicide death of their loved one, their grief journey and support needs. Still in its infancy, this growing area of research is yet to reach consensus as to whether suicide bereavement is quantitatively different to other forms of traumatic grief. 6 However, some research has indicated that there are unique issues related to this bereavement that are experienced more intensely than other types of loss, 7 such as prolonged grief reaction and depression. 2. Methodology Findings of three discreet, yet related, studies are reported. Study 1 explored the grief experience of 22 mothers and fathers bereaved through the suicide death of their young adult son or daughter. Study 2 explored the suicide bereavement experience of ten adults who lost a parent through suicide when they were children, adolescents or young adults. Study 3 explored the family experience of the death of a first-degree relative through suicide; 18 participants were interviewed. 8 The study samples were all purposive and convenience, primarily recruited through media reporting. The in-depth interviews were audio-recorded and transcribed verbatim. Narrative inquiry methodology allowed the meaning attributed to the family members suicide deaths to be explored, as well as the grief journey of the participants. 3. Findings An important issue strongly identified in all three studies is that every participant proactively discussed the difficulty they have faced since the suicide death of their family member in talking about the life and death of their loved one. While death is an uncomfortable topic for the general Western population to engage in dialogue, the stigma associated with a suicide death was profound. In contrast to their everyday experience, the research interview provided the participant the freedom to speak at length about their deceased family member to an empathic and interested listener, an experience that was deeply appreciated. The participants commonly were longing to share descriptions of their deceased family member and especially the place and role they held in the family. The importance of the role of dialogue in coming to a meaningful narrative about the deceased persons life and death is known to be of assistance in the grief journey. 9 Complicating this meaning making narrative for family members of those who have died by suicide, these family members questioned their own role and relationship with their deceased family member. Also questioned were the

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__________________________________________________________________ reasons that may have attributed to the choice to die, as well as whether there was something they could have done differently that would have changed the outcome. Yet without the opportunity to talk about these issues, all participants identified being silenced in their grief. 10 For example, Helen says when speaking of her 26year-old son, James, who had died by suicide three years previously: I could sit here all night and tell you over the years, and even though his years were numbered, I love to talk about him. But its hard to find people who are comfortable enough. 4. Discussion: The Impact of Stigma in the Face of Suicide The impact of stigma, as experienced by the family members of the suicide bereaved, comes from all facets of society. Many were shocked that some of their friends and support networks were no longer comfortable in their presence. This discomfort can be traced back to the earlier condemnation of suicide in previous societies in which suicide was seen as sin against the Holy Ghost. 11 The awkwardness of neighbours, friends and colleagues when first meeting a person bereaved by suicide can also result from their uncertainty of what to say or even knowledge of how to be supportive. This awkwardness may not be malicious in intent, but is isolating and painful for those bereaved. Furthermore, this isolation and internalised sense of a spoiled social identity may lead individuals to commence censoring their own dialogue in relation to the death. While being unable to talk about a deceased loved one with friends and the community more broadly, it is the processes within families that have been explored more closely in these studies. Importantly, the relationships within families influence the ways in which the suicide is viewed, along with the strengths and challenges of the relationship prior to the death, and with the surviving family members post death. Each relationship will be briefly explored. A. Spousal Suicide Commonly, the participants in this research study shared their own feelings of guilt and shame, or spoke of the suicidal death of their family member as being a stigma. In spousal or partner suicides, where the death came as a complete surprise, guilt and shame were frequently mentioned. This was explained by Darryl, after his wife Josie died: For a husband not to know how crook his wife was, to ignore the signs, to push it all under the carpet with a hollow promise of things will get better. That is unforgivably not good enough. Not only were individuals self-blaming, some participants were blamed by other family members for causing their partners death. Lyn describes her interactions with her family following her husbands death only two months after

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__________________________________________________________________ the birth of their child. She recounted an incident with her sister, who is medical practitioner, some weeks following Dannys death. Lyn had hoped for more understanding of her grief: Then my sister comes in, shrieks at me, and telling me you are not acting like a normal person well this isn't a normal situation and I dont think there is any normal way to react to this kind of situation. Shes telling me I should commit myself to the psychiatric unit. B. Childrens Suicide Parents who self-nominated to take part in this study, clearly expressed to the researcher how they rarely felt permitted the opportunity to talk about their deceased son or daughter. These parents typically commented on the joy of using their childs name without discomfort during the interview, being able to speak freely about the child. Typically, parents monitored their conversations based on their own comfort and the perceived lack of comfort of their audience. They became reserved about what they would and would not say in public, always waiting to see how what they said would be taken before entering into further discussion about their child. This constant monitoring could potentially isolate parents, as it did Julia, who had very limited social support networks: The woman across the road thinks I am the weepiest person she has ever met. But I cant tell her. Like sometimes I watch a sad movie and I cry, but I cant keep going to her and saying: Im thinking of Luke. These dialogues drew the researchers attention to the importance of this narrative. During the interviews, many participants became upset reviewing the events leading up to the death and the period since. However, this did not inhibit their desire to participate or share their experiences and emotions, as Jane explains, it is upsetting, but it is not something that you dont want to do. I dont mind talking about it; it is a way of keeping him alive and part of my life. Janes comment emphasises an important point: parents need to find ways of keeping their child alive and part of their life. Being encouraged to talk about their child, and their experience of suicide bereavement, occurred in contrast to their usual experience, where they felt unable to talk openly and honestly. While discussion about their grief was inhibited, parents lamented that they were not given permission to reflect on times past, the happy times when their child was alive. In every other setting, parents are allowed to talk about their children, regardless of their age or activity. Yet, once their child had died, these parents

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__________________________________________________________________ found they were no longer socially permitted to engage in this activity associated with parenting. Negatively judging others in similar situations may serve two purposes. The first is that viewing others as worse off than oneself potentially assists in lessening the pain. The second reinforces social beliefs about how people should grieve, as these parents are also part of the broader community that holds these beliefs. It could be that, by engaging in negatively assessing other parents suffering of a similar fate, parents are unintentionally worsening their own experience. In effect, this process reflects how parents then view themselves, and is influenced by how we perceive others perceptions of us, as suggested by Brabant and colleagues. 12 Regardless of their perception of isolation, stigmatisation and discomfort, parents desired to talk about their son or daughter, and attempted to find avenues to do so. C. Parental Suicide Children of the suicide deceased are perhaps the most innocent of all, yet they too suffer from the stigma associated with their parents death. Laura speaks of her mothers suicide when, still a student, she heard her mother had deliberately stepped in front of a train: You can feel extremely isolated with this kind of death because even if people ask what happened and I normally just tell them but they don't know what to say. They sort of look away, and you do feel different, or that there is sort of a I don't know if the word is stigma. People still ask, and you can see that they don't know how to respond to you. D. Sibling Suicide Suicide bereaved siblings have previously been described as the forgotten bereaved. 13 The sibling will be in need of support, as they too are grieving; however, as the grieving parents may be unavailable for this support, the result is the siblings being silenced within the family, as well as within their social networks. They spoke of losing the one who shared all of their life experiences, who knew what it was like to be a child raised in that family. Sally stated: I felt very isolated in my family. My parents had each other At times I was aware of my parents shame and sense of guilt. Many times I comforted them. This was a conflicted role for me. I wouldnt have done it differently. Whilst Sally recognises that it can be a healing experience to share her story of her brothers suicide, she is self protective in that she selects with whom, and in what circumstances, she will share her story. However, she is beginning to take

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__________________________________________________________________ risks with her story and will share her experience. She explains her motivation in volunteering to share her story: For me to also contribute as a sibling just raises that profile a little bit more, and maybe that will have some benefit for others. I feel that it is a very particular journey as a sibling, and it raises very particular issues, which are different from a parent, of course. A lot of the focus, in my experience, is that the attention went to my parents. I really understand it, but it is also very hard, because family friends would forget or ignore the siblings. 5. Conclusion While each of the examples provided speak to the difficulty that those bereaved by suicide find in talking about their loved one, both within and outside the family, there is a strong need to create a memorial in recognition of the deceased loved one. This memorial story is unique to each individual living without the physical presence of his or her loved one. This is despite, and in contrast to, the many messages of shame or stigma that society places on the suicide bereaved to sever their bonds with the dead. That the suicide bereaved feel silenced in their grief has now been recognised in the literature in relation to suicide and more broadly in the grief literature is the importance of creating a memorial story. 14 These three research projects identified the effects of stigma following a family member suicide death which effectively silences and may isolate the suicide bereaved at the time in life when they are most in need of support. The ways in which this silencing contributes to the higher rates of suicide among the suicide bereaved is unknown; therefore, it is critical that these issues are explored more fully. Such an exploration will help to provide the evidence required to develop best practice guidelines for working with individuals following a suicide death. It is important that those who do come in contact with suicide bereaved members of the community listen with genuineness, interest and understanding. Each person, whether it is a mother, father, brother, sister, son or daughter, will grieve their loss in a unique and special way.

Notes
Australian Institute of Health and Welfare (AIHW), J.E. Harrison, S. Pointer & A.A. Elnour, A Review of Suicide Statistics in Australia, Injury Research and Statistics Series, Vol. 49, 2009, pp. 1-107. 2 S. Clark & R. Goldney, The Impact of Suicide on Relatives and Friends, International Handbook of Suicide and Attempted Suicide, K. Hawton & K. van Heeringen (eds), John Wiley & Sons, Chichester, 2000, pp. 461-478.
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__________________________________________________________________ J. Jordan & J. McIntosh, Suicide Bereavement: Why Study Survivors of Suicide Loss?, Grief After Suicide: Understanding the Consequences and Caring for the Survivors, Routledge, New York, 2010. 4 M. Myers & C. Fine, Touched by Suicide: Bridging the Perspectives of Survivors and Clinicians, Suicide and Life-Threatening Behaviour, Vol. 37, 2007, pp. 119-126. 5 D. De Leo & T. Heller, Social Modelling in the Transmission of Suicidality, Crisis, Vol. 29, 2008, pp. 11-19. 6 J. Jordan, Is Suicide Bereavement Different? A Reassessment of the Literature, Suicide and Life-Threatening Behaviour, Vol. 31, 2001, pp. 91-102. 7 J. Callahan, Predictors and Correlates of Bereavement in Suicide Support Group Participants, Suicide and Life-Threatening Behaviour, Vol. 30, 2000, pp. 104-124. 8 D. Ratnarajah, Sagas, Suicide and Sequels: Narratives of the Family Experience of Suicide, University of New England, Armidale, in progress. 9 R.A. Neimeyer, Meaning Reconstruction and Loss, Meaning Reconstruction and the Experience of Loss, R.A. Neimeyer (ed), American Psychological Association, Washington, 2003, pp. 1-9. 10 M. Maple, H. Edwards, D. Plummer & V. Minichiello, Silenced Voices: Hearing the Stories of Parents Bereaved through the Suicide of a Young Adult Child, Health and Social Care in the Community, Vol. 18, 2010, pp. 241-248. 11 T. Joiner, Myths about Suicide, Harvard University Press, Cambridge, Massachusetts, 2010, p. 2. 12 S. Brabant, C. Forsyth & G. McFarlain, Life after the Death of a Child: Initial and Long-Term Support from Others, Omega, Vol. 31, 1995, pp. 67-85. 13 K. Dyregrov & A. Dyregrov, Siblings after Suicide: The Forgotten Bereaved, Suicide and Life-Threatening Behaviour, Vol. 35, 2005, pp. 714-724. 14 R. Neimeyer, H. Prigerson & B. Davies, Mourning and Meaning, American Behaviour Scientist, Vol. 46, 2002, pp. 235-251.
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Bibliography
Maple, M., Parental Portraits of Suicide: Narrating the Loss of a Young Child. University of New England, https://e-publications.une.edu.au/vital/access/manager/ Repository/une:3248, Armidale, 2008. Maple, M., Plummer, D., Edwards, H. & Minichiello, V., The Effects of Preparedness for Suicide Following the Death of a Young Adult Child. Suicide and Life-Threatening Behaviour. Vol. 37, 2007, pp. 127-134.

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__________________________________________________________________ Maple, M., Edwards, H., Plummer, D. & Minichiello, V., Silenced Voices: Hearing the Stories of Parents Bereaved through the Suicide of a Young Adult Child. Health and Social Care in the Community. Vol. 18, 2010, pp. 241-248. Ratnarajah, D., The Construction of Meaning Following Parental Suicide. Unpublished Master of Counselling with Honours, University of New England, Armidale, 2005. Ratnarajah, D. & Schofield, M., Parental Suicide and Its Aftermath: A Review. Journal of Family Studies. Vol. 13, 2007, pp. 78-93. Ratnarajah, D. & Schofield, M., Survivors Narratives of the Impact of Parental Suicide. Suicide and Life-Threatening Behaviour. Vol. 38, 2008, pp. 618-630. Dorothy Ratnarajah is a Doctoral Scholar at the University of New England, New South Wales, Australia. The field of study undertaken over the last ten years is the family experience of suicide. Myfanwy J. Maple is a Senior Lecturer in social work at the School of Health at the University of New England, New South Wales, Australia and has a special interest in suicide bereavement.

Suicide and Irish Travellers Mary Rose Walker

Abstract Irish Travellers are an Indigenous, nomadic, minority group, who make up almost 1% of the total population of Ireland. The author has kept a nation-wide annual account of suicide among Travellers in Ireland from 2000-2006. In this research, she seeks to identify whether the incidence and profile of suicide among Travellers can be reliably ascertained and compared with national rates. The sources of data include Local Authority Social Workers for Travellers, the Department of Environment and Local Government annual statistics of the National Traveller population, and CSO data. The research examines available demographic factors of Travellers who have died by suicide and pathological indicators. It also looks at socio-cultural factors (family and group cohesion) generally seen as protecting individuals from suicide, and other factors (cultural change and erosion, discrimination) generally associated with higher risk of suicide. Certain behavioural patterns of those who have completed suicide can be identified. These account for only a fraction of total deaths and indeed are not causative factors. However, this information may assist service providers and Travellers alike in understanding the high number of Travellers who choose to end their own lives. Key Words: Irish Travellers, suicide, culture, family, bereavement, violence, shame. ***** Irish Travellers are an Indigenous minority group, of approximately 30,000, who make up almost 1% of the total population of Ireland. Traditionally nomadic, they have their own language, customs and traditions, and rarely marry outside the Traveller community. 1 Although theories regarding the origins of Irish Travellers are varied, historical sources suggest that they have been part of Irish society for centuries. 2 Travellers are widely recognised as one of the most marginalized and disadvantaged groups in Irish society. They fare poorly on every indicator used to measure disadvantage: poor health, lower life expectancy, sub-standard living conditions, low levels of education, and high levels of unemployment. 3 Working with Travellers as social worker for Wicklow Co. Council in the late 1990s, I was concerned by what I perceived as a high incidence of suicide among Travellers, especially young Traveller men. When I embarked upon this project in 2000, nothing had ever been documented on the rate of suicide among Travellers; the Central Statistics Office (CSO) does not categorise rates of suicide according to ethnic group, no literature on Travellers and no study on Traveller health referred

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__________________________________________________________________ to suicide, and the then recently published Report of the National Task Force on Suicide 4 did not mention Travellers. From 2000-2006, I kept a nation-wide annual account of suicide among Travellers in Ireland. 5 It is the first research that has been carried out with the purpose of documenting the incidence of suicide among Travellers. It is unique in that it covers the whole Traveller population over a seven year period, and information has been gathered regarding the family circumstances and underlying issues concerning the subjects of the research. At the outset of this research, a number of respondents were of the opinion that suicide was an extremely rare occurrence within the Traveller community. It was generally believed that the huge social, emotional and practical support provided by the extended family should serve to protect Travellers from suicide. However, between 2000 and 2006, the rate of suicide among Irish Travellers (3.70:10,000) was over three times the average rate of suicide of the total population, which was 1.2 per 10,000 during the same period. Among Travellers, the annual rate peaked at 5.44 per 10,000 in 2005, which was over five times the national rate. This chapter provides a summary of the key findings of my research. 1. Demographic Factors Suicide is most common among men. Between 2000 and 2006, the male to female ratio among Travellers was 9.6:1, compared to the male to female ratio of 4.2:1 among the total population. In particular, young single men are at risk, with men under 30 years of age accounting for almost 65% of all suicides. There is a considerable difference between this and the national rates where those under 30 years of age account for 34% of the total number of suicides. Furthermore, 52% of the Travellers who died by suicide were single; overall, 66% were single, separated or widowed. The most frequently used method is hanging which accounts for 80% of suicides among Travellers. This is significantly higher than the national rate, which stands at 57%. It is a particularly lethal method, leaving little possibility for rescue. Fewer than 15% reported previous suicide attempts, a disturbing statistic for service providers and families alike. Poisoning was the second-most common method at 9%; 4% of deaths were due to drowning. Among the total population, deaths by drowning exceed deaths by poisoning (17% vs. 14%). The typical profile of the Traveller who dies by suicide is similar to that of the typical Irish person who dies by suicide; young, single, male, with death due to hanging. However, in the case of Travellers, the figures of those falling into the typical profile are significantly higher. Few Traveller women have died by suicide, and this appears to be a more recent phenomenon. Generally speaking, they have been single women, in their 20s and without children. However, in every instance where the woman was married, very definite issues were related to me, which would have left those women in a

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__________________________________________________________________ state of utter hopelessness and isolation, from which the very strong attachment to their children could not rescue them. 2. Traveller Suicides Classified According to the Patterns which have Emerged from the Findings A. Troubled Suicides This refers to cases where the informant described a background of major social problems. In each case, there had been a childhood of abuse or neglect. Problems in the family home included violence (both domestic and feuding), alcohol abuse, legal conflict, and a family history of suicide. In over half of these cases, siblings had died by suicide or other violent means. Of those who reached adulthood, most went on to have relationship difficulties; lives were characterised by alcohol or substance abuse and violent behaviour, and a history of self-harm or suicide attempts. From the time they were children, these people found themselves in a situation where there was no future. The question here is not why they died, but how they had managed to stay alive for so long. It also refers to people who had been affected by several precipitating life events. Some of those who died had suffered a considerable degree of hardship and tragedy in a short space of time, which would render even the most resilient of characters vulnerable to suicide. B. Motiveless Suicides Many who died by suicide were described as coming from loving and secure families, and were frequently involved in sport or were working. According to respondents, they appeared to have everything going for them. These individuals showed no sign of suicidal ideation; they had none of the risk factors typically associated with suicide, such as depression, alcohol or substance abuse. Respondents said that there appeared to be no reason for the decision. They spoke of the incredible anguish experienced by those left behind, unable to understand why these people had actually chosen to end their lives. While both of the above categories could be found in any social group, the following three categories were closely linked to Traveller culture. As such, these are Traveller-specific suicides. C. Bereavement Suicides The most common pattern that has emerged throughout this research is that of the Traveller who, following the death of somebody close, takes his own life, usually by hanging. This appears to be a time of extreme vulnerability for Travellers. In addition to the loss, they may have to shoulder the organisation and financial burden of an elaborate funeral. Respondents reported drinking sessions, or binges, with vast quantities of alcohol and (possibly) drugs consumed. It is as if the group drinks to escape the pain and one takes it to the next stage by suicide.

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__________________________________________________________________ Not all bereavement suicides follow this pattern. Some Travellers have taken their lives following a death, without any assistance from alcohol or drugs. However, what is of major concern is that, in 40% of cases where a Traveller took his/her life following the death of somebody close, that death itself was also a suicide. Included here are suicides which very closely followed the news that a relative was seriously ill and may be about to die. The view of the respondent was that the anticipation of the death so greatly disturbed these individuals that they took their own lives. D. Violence Suicides Violence, whether domestic or feuding, was reported as a contributor factor in 27% of Traveller suicides. I was informed of eight suicides which occurred following a violent episode; four of whom were victims, four were perpetrators. In all but one case, a large quantity of alcohol was reported to have been consumed at the time. All eight died by hanging, a violent means of suicide in itself. In a study published in 2005 by the National Crime Council (NCC), in association with the Economic and Social Research Institute (ESRI), it was found that 49% of admissions to womens refuges are Travellers. 6 These statistics are extremely high as Travellers make up less than 1% of the total population; this is an issue which warrants further research. There are major difficulties facing a Traveller woman who wishes to escape from a violent domestic situation. In some situations, there have been ties of friendship and kinship between her family and that of her husbands. Escaping from a violent situation would mean severing links not just with her husbands family but also with her own; for a Traveller woman, this is not a realistic option. Respondents spoke of women, enduring lives of cruelty and oppression, who may have perceived death as a way to end the violence. The perpetrator of violence is also at risk of suicide. For those who grew up in families where conflict was resolved using violence, it may be the only way they know of asserting authority as head of the household. Episodes were referred to, especially where alcohol or drugs were involved, where an argument escalated out of control; following a violent episode, perhaps when the wife had taken shelter elsewhere, the perpetrator took his life. Some respondents have expressed the opinion that this form of suicide is one final act of vengeance a man punishing his wife for leaving the situation. Others have said that this type of suicide may be the consequence of an overwhelming sense of guilt and remorse as the anger subsides; by this form of self-punishment, he hopes to be released from all blame. E. Shamed Suicides This type of suicide, seven in total, took place following disclosure of an alleged criminal act or while the person was awaiting trial for a criminal act. In

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__________________________________________________________________ general, the older the individual, the more likely it was that the criminal act was more serious in nature. In all cases, respondents perceived that the act, or its disclosure, would bring shame upon the individual and dishonour to the family. The consequence of this could be that the individual and the family would be marginalized and ostracised from the whole community. The view of the respondents was that the pressure of this shame motivated these people to kill themselves. 3. The Family For Travellers, all life revolves around the family, which offers social and emotional support to its members. Living in multi-generational groups, children and adults work side by side; the aged, unmarried and sick remain with the family. All members contribute to family life. 7 In times of difficulty, the extended family and community offers complete support to its members; however, there are times when family ties are not enough to protect the individual from suicide. Outlined below are three situations where the family may not be able to offer its members protection from suicide. A. Although rare, it sometimes happens that a member is ostracised from the family, or a family from the extended family or community network. The consequences of exclusion for the individual are extremely serious as it results in a total breakdown of social supports. I would suggest that this is a factor in some suicides, especially those where there has been a legal conflict. According to Ligeois, 8 the individual acts not as an individual, but as a member of the family. It follows then that the misdeed of an individual is felt to be that of the family. It is possible that the perceived shame these criminal acts would bring upon their families was more than the individuals could bear. Respondents have spoken of rifts occurring among families, and an apportioning of blame, following such cases of suicide. B. Domestic breakdown occurs in families that are no longer stable due to a multitude of issues, such as poverty and overcrowding, domestic violence, addiction and depression. Parents may be so overwhelmed by, and totally absorbed with, their own problems, that they neglect their children. Although there are strong emotional bonds, they are not able to give their children the discipline and guidance that is essential for their development. Having learned not turn to their parents for support, these children are at risk of growing into angry and frustrated teenagers, who engage in anti-social behaviour, violence (sometimes directed at their parents) and excessive alcohol or drug use. In the case of Australian Aboriginal people, Tatz 9 refers to young people at risk of suicide, as they have nobody to turn to should they wish to change their present circumstances. The home is filled with family members in a similarly hopeless situation, and there is nobody to act as a guide or mentor in a transition to betterment. 10 Questions

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__________________________________________________________________ regarding parents or family background were not asked, and I would suggest that this is an area which warrants further research. C. When a death occurs, Travellers will travel great distances to attend a funeral and be with the bereaved. There are a number of grieving rituals, such as the 9th day and months mind masses, sometimes held every month for the first year, which offer ongoing support for families. However, without the loved one (or ones), the family is no longer the same as before. Unlike the situation above, where family members are so absorbed in their own problems that they cannot offer support, in this situation the individual views the family, and indeed life, as no longer complete. So great is the desire to be with the deceased, they may not allow the other family members to give the support which is vital as protection against suicide. 4. Why Now? In the past, Travellers had completely separate lives, only having minimum contact with the settled population. Today, young Travellers have a lot more in common with their settled peers than their parents generation; to a certain extent, there has been a loss of cultural traditions as they take on the values of mainstream society. However, public opinion of Travellers as inferior and threatening has not changed, and Travellers face huge rejection from the settled population. Unable to integrate into mainstream society, but no longer firmly rooted in their own cultural and social traditions, many young Travellers exist in a type of nowhere land. Some attempt to conceal their Traveller identity completely. They are not fully accepted as part of settled society, they may no longer be fully accepted as Travellers, and they have lost pride in their own ethnic identity. Many Travellers, even those on the roadside, no longer live a nomadic life. This is partly because the economic reasons for doing so are no longer viable for them, but also because finding a place to move to has become increasingly difficult. Similarly, tighter restrictions on the keeping of horses have taken away something which gives men a purpose in life. For those without work, who have lost the traditions of travelling and keeping horses, there is nothing to do. Particularly vulnerable are single young men. To alleviate boredom they may drink, take drugs, joy-ride, and engage in other forms of anti-social behaviour. All of these risk-taking behaviours are associated with suicide, and it takes little to persuade somebody for whom life holds no interest to end theirs. With recent years, Travellers have had to learn to cope with increased hostility, difficulty with identity, loss of culture and traditions, and lack of purpose in life. Given the existing vulnerabilities of Travellers today, factors such as alcohol or substance abuse, economic insecurity, violence, depression assume an additional risk level. It may therefore not be so surprising that an immediate crisis, such as death or marital conflict, can act as a trigger factor for suicide.

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Notes
P. McCarthy, The Sub-Culture of Poverty Revisited, Irish Travellers: Culture and Ethnicity, M. McCann, S.. Sochin and J. Ruane (eds), Institute of Irish Studies, Queens University, Belfast, 1994, pp. 121-129. 2 S. N Shinir, Irish Travellers: Ethnicity and the Origins Question, in Ibid., pp. 60-66; also J. Okely, The Traveller-Gypsies, Cambridge University Press, 1983, pp. 13-15. 3 J. OConnell, Travellers in Ireland: An Examination of Discrimination and Racism, Racism & Anti-racism in Ireland, R. Lentin and R. McVeigh (eds), BTP Publications, Belfast, 2002, pp. 49-62. 4 Department of Health and Children, Report of the National Task Force on Suicide, Stationery Office, Dublin, 1998. 5 M.R. Walker, Suicide among the Irish Traveller Community 2000-2006, Wicklow County Council, Wicklow, 2008. 6 D. Watson and S. Parsons, Domestic Abuse of Men and Women in Ireland: Report on the National Study of Domestic Abuse, From the National Crime Council in Association with Economic and Social Research Institute, Stationery Office, Dublin, 2005, p. 99. 7 J.P. Ligeois, Roma, Gypsies, Travellers, Council of Europe, Strasbourg, 1994, pp. 83-88. 8 Ibid., p. 83. 9 C. Tatz, Aboriginal Suicide is Different, Criminology Research Council, Sydney, 1999. 10 Ibid., p. 79.
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Bibliography
Department of Health and Children, Report of the National Task Force on Suicide. Stationery Office, Dublin, 1998. Ligeois, J.P., Roma, Gypsies, Travellers. Council of Europe, Strasbourg, 1994. McCarthy, P., The Sub-Culture of Poverty Revisited. Irish Travellers: Culture and Ethnicity. M. McCann, S. Sochin and J. Ruane (eds), Institute of Irish Studies, Queens University, Belfast, 1994. N Shinir, S., Irish Travellers: Ethnicity and the Origins Question. Irish Travellers: Culture and Ethnicity. M. McCann, S. Sochin and J. Ruane (eds), Institute of Irish Studies, Queens University, Belfast, 1994.

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__________________________________________________________________ OConnell, J., Travellers in Ireland: An Examination of Discrimination and Racism. Racism & Anti-racism in Ireland. R. Lentin and R. McVeigh (eds), BTP Publications, Belfast, 2002. Okely, J., The Traveller-Gypsies. Cambridge University Press, Cambridge, 1983. Tatz, C., Aboriginal Suicide is Different. Criminology Research Council, Sydney, 1999. Walker, M.R., Suicide among the Irish Traveller Community 2000-2006. Wicklow County Council, Wicklow, 2008. Watson, D. and Parsons, S., Domestic Abuse of Men and Women in Ireland: Report on the National Study of Domestic Abuse. National Crime Council in Association with Economic and Social Research Institute. Stationery Office, Dublin 2005. Mary Rose Walker works as a social worker for Wicklow County Council.