The subject of suicide was one of the reasons I became interested in psychiatry. Few events are more tragic, often cutting short lives of people in their prime. No other living creature defies biology due to a perceived lack of purpose or meaning. The act has strong cultural overtones and correlates closely with how we organise society.
The extreme psychological manifestation of Western individualism is a disconnected, psychic desolation best described by the French sociologist Emile Durkheim as anomie, translated as ''without a name''.
In more collectivist societies such as in Asia or the Arab world, suicide relates to abnormal relationships with the social group, resulting from shame and dishonour or from a pathological commitment to the group, known as "altruistic" suicide. Suicide bombing is one such example.
The awarding of the Australian of the Year prize to Professor Patrick McGorry was a massive affirmation of psychiatry, long considered the bastard child of medicine. The field remains hazy and enormously complex, an arena where diagnosis and treatment are poorly correlated and where clinical energies focus on symptom relief.
The discussions to reform the Diagnosis and Statistical Manual of Mental Disorders are enormously important to the future of suicide prevention. While most psychiatrists do not take the classification system too seriously and apply it in moderation, it has significant implications for pharmaceutical marketing, the legal profession and pop culture. No other field in medicine sees such intense lobbying and advocacy to influence prospective diagnoses.
Although his comments about refugees were highlighted, McGorry's comments about suicide are significant. Every day, six to seven Australians die by their own hand, according to Suicide Prevention Watch. For each person lost to suicide, about 30 others make an attempt. The death rate is at least 40 per cent greater than that attributed to road fatalities.
Media coverage plays an important role in public perceptions of suicide. Reporting guidelines are designed to stop copycat attempts and divert the vulnerable to helping organisations. McGorry believes the guidelines may have gone too far, and are hampering the public policy response to suicide.
Research has repeatedly shown suicide increases in the month after a front-page suicide story. A 2006 Australian study in Social Science and Medicine found the effect is bigger for famous people and gruesome attempts.
In 1998, the Hong Kong media reported heavily on a case of carbon monoxide poisoning by a specific method. In the 10 months preceding the reports, there had been no such suicides. In November there were three; then in December there were 10; and in the next year there were 40. There are numerous other examples.
Suicide presents difficult choices to newspapers. Some newspapers always report the cause of death in obituaries. Others do not report suicides unless they involve someone prominent or occur in public. Most suicides occur in private and families often ask authorities to keep it quiet.
The combination of reporting guidelines and the understandable stigma and secrecy associated with suicide may be limiting its exposure as a major issue. Suicide has a publicity problem. Some journalists baulk at covering a suicide story. Furthermore, the restrictions on reporting suicide can mean the stories acquire a bland sameness, another feature hampering possible publication.
As McGorry freely admits, the fact a psychiatrist can win the country's top honour is proof the stigma associated with mental health has improved dramatically. He could not have won even a decade ago.
But the field remains poorly resourced. In the past 10 years, mental health funding has risen no faster than the rate of increase in health expenditure, in spite of its growing importance in the overall burden of disease, accounting for 13 per cent of the total health burden but receiving only 6 per cent of its funding.
Preventing suicide is the top priority for mental health workers.
While the mysteries of suicide will continue to defy our complete understanding, under-reporting, ongoing stigma and the complexities of its media coverage are combining to ensure the attention it commands is well below the damage it causes.
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