A Sociology of Suicidology

1. A Sociology of Suicidology David Webb Victoria University david.webb1@research.vu.edu.au Revisioning Institutions Change in the 21st Century Annual Conference of The Australian Sociological Association (TASA) La Trobe University, Beechworth Campus December 8-11, 2004 A Sociology of Suicidology

2. Research Question and ‘Method’ Why is my experience of suicidality absent from suicidology? ‘Method’: • detailed, first-person (phenomenological) description of one person’s lived experience of suicidality • use first-person story as an analytical tool or ‘prism’ through which the discipline of suicidology is examined for gaps • requires a socio-cultural critique of suicidology Other aims/methods of PhD (not this presentation): • phenomenology seeks a better understanding of the lived experience of suicidality No attempt at generalisations, new theory … or ‘treatment’ A Sociology of Suicidology

3. Academic/Professional Discipline of Suicidology Three ‘parent’ disciplines: sociology: Durkheim - anomic, egoistic, altruistic suicides psychology: Shneidman - ‘psychache’ psychiatry: DSM and biological psychiatry (not the psychoanalytic tradition - e.g. Freud’s thanatos, Menninger’s selbsmort, or Hillman’s Suicide and the Soul) Comprehensive Textbook of Suicidology: • “the science of self-destructive behaviors” • “surely any science worth its salt ought to be true to its name and be as objective as it can, make careful measurements, count something” • “suicidology has to have some observables, otherwise it runs the danger of lapsing into mysticism and alchemy” A Sociology of Suicidology

4. Dominant Discourse of Suicidology Dominant discourse of suicidology can be seen in: • the literature - texts, journals, conferences etc • the key participants - i.e. most influential (on gov’t policy etc) 1. The ubiquitous epidemiological study - Durkheim’s legacy • population studies to identify ‘at risk’ demographic groups • the search for risk and protective factors • so far only weak predictors of individual suicides • strongest predictor - previous suicide attempt 2. The medical (i.e. psychiatric) model of ‘mental illness’ • DSM for diagnosis • biological psychiatry for treatment [3. Psychological - i.e. mental rather than brain ‘disorders’ • marginalised by psychiatry though (sadly) following it] A Sociology of Suicidology

5. Dominant Discourse - Modern Psychiatry 1. Diagnosis - The DSM, ‘Mental Illness’ and Depression “Depression is the major cause of suicide” (e.g. beyondblue) Bob Goldney’s “real estate analogy” of suicide: • “The most important contributing factors to suicidal behaviors are depression, depression, depression” • “depression is the most common diagnostic condition associated with suicidal behavior” • Confuses correlation with causation: equivalent to saying flu caused by a runny nose and a cough 2. Treatment - Biological Psychiatry The ‘chemical imbalance of the brain’ school of psychiatry Maris: “Put Prozac in every major city’s water supply” • is he joking … or only half-joking? A Sociology of Suicidology

6. What is a Discipline? “… disciplines are sets of individuals, socially related, differentiated in status and power. They offer their own systems of social control which sanction some forms of behaviour and reward others. They develop norms and value systems. They have mythologies which legitimate their structures and belief systems. They have rituals which re-enforce them. They have socialising and induction processes which not only impose acceptable measures of conformity, but like all such effective socialising processes objectify and internalise the limits of behaviour so that to the socialised they appear good, just and rational. The disciplines are established in a social environment. … Finally, like all social entities, their present life is conditioned by their past. The past offers them a paradigm within which acceptable forms of evidence, acceptable questions, acceptable criteria of judgments, acceptable languages of communications and acceptable modes of transmission from one generation to another, have a cultural and social form.” (Greg Dening) A Sociology of Suicidology

7. The Wider Suicide Prevention Community - 1 The ‘back room’ participants at suicide prevention conferences: • psychosocial services - incl. ‘talking therapies’ (psychology) • drug and alcohol - ‘dual-diagnosis’ and ‘comorbidity’ • complex trauma (Post-Traumatic Stress Disorder - PTSD) • childhood abuse - sexual, physical, emotional • victims of crime - esp. domestic violence • indigenous, rural blokes, refugees, returned soldiers, jails etc Biopsychosocial approach - the ‘state of the art’: • disability rather than illness • recovery rather then treatment • sought after by consumers but minimal access to services • marginalised by biomedical model of psychiatry A Sociology of Suicidology

8. The Wider Suicide Prevention Community - 2 ‘Suicide survivors’ : • those bereaved by suicide • unique and difficult form of grief • known to be at increased risk of suicide themselves • strong voice in suicidology - in contrast to ‘consumer-survivors’ Governments: • looks to suicidology for policy guidance • massive subsidies to biomedical interventions (Medicare, PBS) • non-biomedical services in constant financial crisis and getting worse, despite demand from consumers The Media: • vital role for suicide to come out of closet as public health issue • severely constrained by guidelines … from suicidology A Sociology of Suicidology

9. What’s Missing from Suicidology? ... Suicidal ‘thinkers’ (contemplators, attempters) • the first-person voice of the subjective, lived experience • the phenomenology of suicidality: “What is it like to be suicidal?” • contrast with 1st-person voice of ‘suicide survivors’ Concepts of self: • the ‘sui’ in suicide - both victim and perpetrator • suicidology’s most central concept • parent disciplines’ concepts of self often contradictory Spirituality: • recognised ‘spirituality gap’ between those struggling with suicidality and professionals we seek help from • spiritual values and needs often vital to sense of self • also potential pathway to recovery A Sociology of Suicidology

10. And Why? An obsolete commitment to the myths of modernity: • the “false epistemology” of DSM and bio-psychiatry • pathologises/medicalises human distress and suffering • denies subjective truths - phenomenology, self, spirit • locates pathology in (the brain of) the individual • colonisation of the psyche by science/medicine/psychiatry The politics of vested interests and exclusion: • ‘evidence based’ medicine and the politics of funding • ideological, illegitimate, oppressive and harmful A Sociology of Suicidology