Suicide;+Criminal,+Societal+and+now+Personal

Name: Rowan Faulkner Student No: 8285781 Tutor: Sophie Miller Topic: Green, Gold, and Blue: How Well does Australia deal with Mental Health in 2011? What is working, what isn’t, and what should be done?



Artefact Description
This is a still from episode 25 of the TV series Neon Genesis: Evangelion. It depicts the main character, Shinji Ikari, struggling with a barrage of internal thoughts. Throughout the series he is shown to suffer from many emotional and mental problems including depression, social anxiety, poor parental relations and considerable adolescent anger. In this particular scene he is listening to the voices of multiple characters who highlight his insecurities and limited perspective of the world, concluding that he exists only in relation to others and not as a true individual.

**Discussion Topic**
Global awareness, attitudes and treatment towards the problem of suicide is changing. Evidence is emerging that previous views and perspectives on this issue are giving way to ones with greater scientific grounding, leading to better treatment for sufferers in Australia and the rest of the world. Primary areas of improvement have been the link between overall mental health and suicide risk (Harris & Barraclough, 1997), greater efficiency of suicide prevention programs (Lapeirre et al, 2011), and coordinated strategies by healthcare organisations (Brown & Pirkis, 2009). However there is still progress to be made on addressing the sociological factors that contribute to suicide rates, originally outlined by Emile Durkheim (1951).

Literature Review
Suicide is a notable problem in most of the developed world. The World Health Organisation (2009) states that the global suicide rate is roughly 16 per 100,000 people, equating to around one million deaths per year. For comparison malaria, a highly prevalent infectious disease, also kills around one million people annually (World Health Organisation, 2009).

Suicide itself is not a mental disorder, but it is heavily linked to depression and other problems of the mind. Johannessen, Dieserud, Claussen & Zahl (2011) found that sales of alcohol and antidepressants, common medications for sufferers of depression, correlated strongly with female suicide rates. There are also connections with other mental problems. A meta-analysis by Harris & Barraclough (1997) on 44 psychiatric disorders found that 36 of them were related to more deaths by suicide in victim populations.

Considering that this is such a widespread phenomena it has prompted research into the cultural element. Park & Lester (2006) used South Korea as a subject for their study on socio-economic influences on suicide. It was found that over a 20 year period Korea has moved from traditional Asian collectivist values to a more individualised model similar to the Western world. During this same 20 year period the average suicide rate for South Koreans tripled, the majority being of this figure being concentrated in young males.

Another Korean study by Chen et al (2009) has revealed the effect media coverage has on suicide attempts. In their study they interviewed 63 Taipei citizens who had attempted suicide following the death of a prominent singer who had taken her own life. Of the 43 who said that they had been exposed to news coverage of the singer’s death, 37% stated that this coverage had directly influenced their own suicide attempts. Additionally there was a “positive modelling effect”, whereby those interviewed mimicked the suicide method of the reported singer.

However other sections of the North Asian region have addressed this problem of media influence. In Hong Kong local news outlets have moved towards reporting suicides using guidelines set out by the World Health Organisation, including removal of graphic imagery from articles and specific use of the word suicide (Fu & Yip, 2008).

In Australia actual recorded suicides for males aged 15-24 have tripled since 1960. Unlike in South Korea, Australia has not witness any radical social change, and so rather than an increase in self-harm cases this figure is more likely to represent overall willingness to be open about the issue. Suicide in 1960s Australia was something of a taboo topic, with it still being considered a criminal offence in states such as Queensland and Western Australia (Riaz, 1992, p29). However in 2011 where suicide is no longer considered something worthy of legal punishment there are clear indications that awareness and acceptance is increasing, such as the R U OK day initiative and Beyond Blue programs which actively target victims of depression and suicide. These would have been unlikely to receive widespread support in earlier times.

This increased knowledge and awareness of suicide and its causes has translated into positive action by world organisations, with mental health coming into the focus of the Australian medical industry in recent years. It was noted by Happell (2008) three years ago that nurses in the Australian healthcare systems were severely lacking skills and confidence to correctly assist patients with mental health problems. This deficit was not ignored, and one year later Brown & Pirkis (2009) stated that Australia has successfully coordinated a national mental health strategy working towards improving standards of care and treatment. This is an impressive feat considering that there are no less than eight individual agencies involved in Australian healthcare and will serve to improve standards of training for nurses.

Evidence of actual improved treatment is has be shown quite clearly in one of the more troubled population demographics; Western military forces. These organisations, especially the US Army, have extremely high rates of suicide compared to the civilian population since their very structure prevents those at risk of suicide being identified early enough for intervention (Black, Gallaway, Bell & Ritchie, 2011). This has been recognised and responded to by departments such as the US Air Force with their Suicide Prevention Program, resulting in greatly improved conditions for suicidal personnel (Knox et al, 2010). Action such as this would have been extremely unlikely to occur in previous decades when hazing, ritual forms of physical and mental abuse inflicted upon new recruits, were seen as important techniques for adjusting personnel from civilian to military life (Lenney, 1949).

Suicide prevention programs are not only becoming more common; but more effective as research into the area progresses. Lapeirre et al (2011) conducted a review of 19 suicide prevention programs, and found the most successful ones were those that promoted social inclusion and activities involving others. This appears to have been acknowledged by other institutions, as recent initiatives such as R U OK Day and Beyond Blue both focus on connecting sufferers of mental illness to the wider society.

Socio-Cultural Analysis
While the socio-cultural aspect of suicide has been observed (Park & Lester, 2006) it is yet to be fully integrated into any major strategy for dealing with it. This is interesting considering that a strong theoretical model already exists to explain societal influences on suicides. Emile Durkheim’s first sociological study was directed solely at the phenomenon of suicide, and resulted in the formulation of 4 distinct categories that influence suicide rates (Durkheim, 1951). These categories are based directly on social element scales. There is the Anomic/Fatalistic at the extreme ends of the social freedom spectrum, and the Egoistic/Altruistic set at the opposing ends of the social inclusion scale. Under this model suicide is not just influenced by social structure, but is directly caused by it.

For example Anomie is characterised by an extreme lack of direction, the point where a person has so much individual freedom that they cannot identify a reason for existing. Such a situation may very well explain the increased suicide rate in South Korea as its culture moves towards a Western individualist model (Park & Lester, 2006), increasing the occurrence of Anomics.

Incidents within military organisations fit the categories of Fatalism and Altruism, which describe low social freedom and high integration respectively. Fatalism is usually characterised by a total lack of will to live, where a person sees death as preferable to continued existence (Durkheim, 1951). Such views are have been documented in soldiers who have experienced prolonged combat situations (Maguen et al, 2011). Altruism follows a similar vein, where an individual is so highly integrated into a society that they place their own wellbeing below that of the group. Since armies traditionally follow ideals of group coherency and duty it is not surprising that such a structure can produce excess Altruism and resultant suicides.

Knowing the strong link between self harm and mental health (Johannessen et al 2011, Harris & Barraclough, 1997) it is possible to extrapolate this further; certain mental health problems are the product of the society in which one lives, not just individual brain chemistry. Isolated cases can be traced back to innate neurological issues, but the general trends of suicide around the world can be attributed to socio-cultural factors. Further evidence for this can by viewing geographic suicide data. As can be seen below some of the highest suicide rates are in East Asia and former Soviet bloc states.

Retrieved from http://www.who.int/mental_health/media/map_suicide.jpg

While Park & Lester (2006) noted the cultural trend for the increasing prevalence of Anomics in East Asia, suicide rates in Slavic states have been linked to a large culture of alcoholism (Razvodovsky, 2009) and a growing acceptance of suicide itself in younger generations (Jukkala & Mäkinen, 2011). Such factors combined with the low economic status of these nations are more akin to the Fatalistic suicide category, where intoxication or death are viewed as a method of escape from a bleak future (Durkheim, 1951).

A less causal analysis of these categories can simply look at how suicide has been perceived by the wider population. While not all mental health issues are caused by society, how others view it affects treatment, as demonstrated by Happell’s 2008 study that revealed Australian nurses did not have the correct skills and confidence to assist mentally ill patients in hospitals. This can lead to poor assistance to those at risk of suicide leading to more deaths, according to the Egoistic category. This suicide type is marked by overwhelming feelings of societal detachment (Durkheim, 1951), a likely consequence of poor healthcare professional training.

Interestingly a highly regulated society that fosters Altruistic category suicides may lower the overall rate as they increase social support. This is shown in the case of Iran, a highly regulated culture which has a suicide rate lower than most of the Western World despite over 12% of the population having life-long suicidal thoughts ( Malakouti et al, 2009).

Given that these categories can be used to explain not only how certain societal structures increase suicides but also how they can be prevented it is vital that current and future suicide prevention programs integrate them into their strategies.

Artefact Analysis
The final episodes of Neon Genesis Evangelion have undergone many interpretations (Crandol, 2002, para 5), but specific scene is explained well with suicide categories. Shinji Ikari is an almost perfect Anomie archetype. Despite being heavily involved with his society in the series, this scene shows how purposeless his existence is; he presents different selves to those around him to make them happy, while possessing no individual goals or true self. Anomie, according to Durkheim (1951) is exactly this, an extreme excess of personal freedom which leads to a sense of aimlessness despite how well a person may integrate into society.

Unsurprisingly in Ikari this has led to thoughts of worthlessness, a crucial component of depression and subsequent suicidal behaviour (Torpy, Burke & Glass. 2010). But the way this is shown in the episode is extremely personal. Rather than an external diagnosis by a doctor or labelling by his peers, Shinji Ikari presents his problems in a subjective, individual manner which highlights the fact that there is a person experiencing this, not some defective freak.

This kind of perspective can be interpreted as evidence for the changing views of mental illness and suicide in the late 20th century (Riaz, 1992 ), as Neon Genesis Evangelion was released in 1995. Its method is still being replicated in 2011, with Beyond Blue presenting everyday people in their advertising campaigns (Beyond Blue, 2008). Therefore this cultural artefact can be seen as a prediction of where attitudes on suicide are headed even today, a powerful symbol indeed and one of hope for victims around the world.

Link: http://healthculturesociety.wikispaces.com/Doctor-Patient+Relationships
An interesting insight into a somewhat overlooked area of the health industry.

Most Western medical systems still follow a strict problem solving model; you identify the issue and apply a solution, end of story. Unfortunately humans don't always react to solutions the way doctors would like.

A found a few parallels between counselling theory and aspects discussed in the literature review, particularly empathy. A decent client-counsellor relationship is vital in therapy for getting required information out of a client, and it would seem this is equally applicable for a doctor-patient relationship. You're meant to be able to tell your GP anything but maybe a lot of people hold back if they don't have that bond.

The power balance you discussed does raise some civil rights issues though. Should patients be allowed full access to their medical records and the right to question any medical intervention, even it might kill them? Or should doctors be given full control, streamlining solutions but possibly narrowing opinions and destroying that all important empathic bond?

Overall a decent piece, and shows that we should be studying this aspect of healthcare a bit more closely.

Link: http://healthculturesociety.wikispaces.com/For+The+Love+of+Earth+%26+Humanity
An excellent review of some of the current climate science research. I was not actually aware of Milankovic's eccentric orbit theory, and I'm curious to know if this has any bearing on previous Ice Ages.

In your social analysis it was good to see opposing views on fear campaigning compared, however I noted that these seemed to be based upon climate change supporters. If someone who heavily denied human induced climate change view An Inconvenient Truth then went outside to see perfect weather and low seas, I'm not sure that what foster that feeling of "helplessness" you describe. Rather it would probably just strengthen a prexisting belief, which is commonly known as the Backfire Effect. Check this for more info: [|http://www.dartmouth.edu/~nyhan/nyhan-reifler.pdf]