THE EXPRESSIONS OF disbelief widely reported following the death of Gary Speed resonate with stories surrounding so many Irish tragedies when young men “with so much going for them” have taken their own life. When a famous person takes their own life the conversation moves from the church car park to the national media, presenting an opportunity to analyse suicide as a public health concern.
One-dimensional explanations built around clinical depression have dominated the post-disbelief and shock phase of news coverage since Gary Speed sadly died last weekend. Maybe there is some comfort in being able to latch on to a tangible explanation of some sort, whether accurate or not.
Maybe the alternative would be to shrug our shoulders, hope and pray that we will never be affected by such a deep, personal tragedy and move on. Another alternative would be to provide a platform for those who have lost a loved one to suicide to tell their story, ready or not, and there has been a certain amount of that in the media this week too.
Regardless of whether Gary Speed experienced depression or not, that media analysis of his death, and suicide generally, being framed around depression is hardly surprising. The suicide of German goalkeeper Robert Enke has been clearly explained as resulting from clinical depression and this was discussed widely in the media during the past week as well. It’s human nature to look for logical answers to help us make sense of unpredictable events and extraordinary news.
While understandable, this one-dimensional approach does not help us, as a society or as potentially vulnerable citizens, to achieve a more full understanding of suicide and what we can do to prevent it.
In the first instance, depression itself is poorly understood and there are many subjective interpretations as to what the word stands for. In a medical context, clinical depression is a diagnostic category within the Diagnostic Statistical Manual (DSM) and the International Classification of Diseases (ICD) characterised by a mix of physical and psychological symptoms such as weight loss, difficulty sleeping and feelings of sadness and hopelessness. Depression is also a way of describing how we feel when bad things happen in our lives.
In recent years a campaign has developed within psychiatry to abolish diagnostic categories like depression because, according to consultant psychiatrist Dr Sami Timimi, “there is no evidence to show that using psychiatric diagnostic categories as a guide for treatment leads, through evidence based choices, to improved outcomes. There is some evidence to suggest that applying a psychiatric diagnosis… instead leads to a worse outcome for some”.
On the other hand, for the many thousands of people diagnosed with depression in Ireland, or those who suspect they may be depressed, the relentless reinforcement of suicide as an outcome of depression must be very scary. The strengthening association between suicide and depression will surely only serve to reinforce a seriously flawed medical understanding of human distress and prevent people from talking through their problems so that they can make sense of them and move beyond them.
Human distress, thoughts of suicide and suicidal behaviour are determined by more than biological accidents. If we are to understand and respond to human distress we need to be aware of the social and cultural context in which that distress takes place, and of the social and cultural barriers that prevent people from asking for help and support when they need it. We also need to accept that there is a limit to what we know about human distress and suicide.
If we continue to have a narrow focus on individual risk factors we won’t progress our understanding of the social determinants of the suicide problem. For one, why the gender ratio in Ireland of over three male suicides to one female suicide which is exceptionally high by international standards? Why young people when traditionally the risk increased with older age? What weight do individual risk factors (like unemployment) carry and is that risk fixed or does it vary depending on how common it is in our society?
When countries are at war, suicide decreases. Suicide increases during times of significant social and economic change as we have experienced in Ireland over the past twenty years. There are significant social and cultural factors influencing patterns of death by suicide.
Suicide was de-criminalised in Ireland in 1993. In 2005 a national suicide prevention strategy was published. For a number of years now we have had what the researcher Lisa Wexler refers to as “a moral and cultural mandate of suicide prevention”. Let’s not regress by offering singular explanations that serve to mystify suicide itself and the possibility of its prevention.
Gary Speed had a family and many friends. He was part of a community and there were many people who cared about him. In this, he had a lot in common with the hundreds of Irish people who have taken their own life this year. The greatest opportunity for the prevention of suicide does not lie in mental health service provision, it lies within communities. Whatever the unique and complicated mix of factors that bring any of us to contemplate suicide, the most likely way past those feelings is through engaging with another human being. For that reason, we all have the potential to prevent suicide despite the cruel unpredictability of it.
Depression is poorly understood, suicide is poorly understood and can be devastating to those affected. Let’s bring the conversation back to what we know rather than couch the conversation in something as misunderstood as clinical depression. All that does is reinforce a medical understanding of human behaviour and prevents us from empowering individuals and communities through an understanding of the social and cultural determinants of suicide, and the shared belief that suicide prevention is everyone’s business.
Derek Chambers is the director of programmes and policy at Inspire Ireland. Reachout.com is a service to help young people get through tough times.
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