“Why+did+Grandad+kill+himself+mum?”

** “Why did Grandad kill himself mum?” ** //An insight into the overlooked suicides//


 * Student Number: n8278768 - Tutor: Michelle Newcomb **

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‘Hurt’ was written by Trent Rezner and originally performed by the industrial rock group Nine Inch Nails in their album ‘The Downward Spiral’ in 1994. Country singer-songwriter Johnny Cash released a cover of ‘Hurt’ with accompanying video by director Mark Romanek in 2002. It was seen as Cash’s last epitaph as he passed away seven months after recording. The video of Cash, aged 71 at time, shows a montage of images from his life, both past and present based around the dilapidated ‘House of Cash’ museum in Nashville, Tennessee which is closed to the public indefinitely.

** LYRICS **

// I hurt myself today, // // to see if I still feel. // // I focus on the pain, // // the only thing that's real. // // The needle tears a hole, // // the old familiar sting. // // Try to kill it all away, // // but I remember everything. // // What have I become? // // My sweetest friend. // // Everyone I know, // <span style="display: block; font-family: 'Times New Roman',Times,serif; text-align: center;">// goes away in the end. // <span style="display: block; font-family: 'Times New Roman',Times,serif; text-align: center;">// And you could have it all, // <span style="display: block; font-family: 'Times New Roman',Times,serif; text-align: center;">// my empire of dirt. //

<span style="display: block; font-family: 'Times New Roman',Times,serif; text-align: center;">// I will let you down, // <span style="display: block; font-family: 'Times New Roman',Times,serif; text-align: center;">// I will make you hurt. //

<span style="display: block; font-family: 'Times New Roman',Times,serif; text-align: center;">// I wear this crown of thorns, // <span style="display: block; font-family: 'Times New Roman',Times,serif; text-align: center;">// upon my liar's chair. // <span style="display: block; font-family: 'Times New Roman',Times,serif; text-align: center;">// Full of broken thoughts, // <span style="display: block; font-family: 'Times New Roman',Times,serif; text-align: center;">// I cannot repair. // <span style="display: block; font-family: 'Times New Roman',Times,serif; text-align: center;">// Beneath the stains of time, // <span style="display: block; font-family: 'Times New Roman',Times,serif; text-align: center;">// the feelings disappear. // <span style="display: block; font-family: 'Times New Roman',Times,serif; text-align: center;">// You are someone else. // <span style="display: block; font-family: 'Times New Roman',Times,serif; text-align: center;">// I am still right here. //

<span style="display: block; font-family: 'Times New Roman',Times,serif; text-align: center;">// What have I become? // <span style="display: block; font-family: 'Times New Roman',Times,serif; text-align: center;">// My sweetest friend. // <span style="display: block; font-family: 'Times New Roman',Times,serif; text-align: center;">// Everyone I know, // <span style="display: block; font-family: 'Times New Roman',Times,serif; text-align: center;">// goes away in the end. // <span style="display: block; font-family: 'Times New Roman',Times,serif; text-align: center;">// And you could have it all, // <span style="display: block; font-family: 'Times New Roman',Times,serif; text-align: center;">// my empire of dirt. //

<span style="display: block; font-family: 'Times New Roman',Times,serif; text-align: center;">// I will let you down. // <span style="display: block; font-family: 'Times New Roman',Times,serif; text-align: center;">// I will make you hurt. //

<span style="display: block; font-family: 'Times New Roman',Times,serif; text-align: center;">// If I could start again, // <span style="display: block; font-family: 'Times New Roman',Times,serif; text-align: center;">// a million miles away. // <span style="display: block; font-family: 'Times New Roman',Times,serif; text-align: center;">// I would keep myself. // <span style="display: block; font-family: 'Times New Roman',Times,serif; text-align: center;">// I would find a way. //

<span style="font-family: 'Times New Roman',Times,serif;">** THE PUBLIC HEALTH ISSUE ** <span style="font-family: 'Times New Roman',Times,serif;"> The above artifact is a representation of not only depression, self harm and suicidal tendencies amongst the elderly but the mental anguish suffered within this age group. Unknown to many, the rates of suicide amongst the elderly in Australia is significantly higher than any other age groups (Australian Bureau of Statistics, 2009). The cost of suicide within Australia is three fold. Each suicide has personal, social and financial costs to society. Personally the cost to those closest to the suicide victim is often a complex mixture of bereavement with guilt, anger, grief, feelings of rejection and isolation and a slower recovery if at all. Socially, a completed suicide affects not only those close to the victim but additionally the wider community. Suicide within Australia ranks within the top 15 leading causes of disease burden (Mathers, Vos, Stevenson, & Begg, 2001). Financially, suicidal behaviour is difficult to measure due to debates on statistical value of life (Community Affairs Reference Committee, 2010). A New Zealand study into the cost of suicide proposed a cost of approximately $2.9 billion per suicide by taking into consideration the Disability Adjusted Life Years ( O’Dea D. & Tucker S., 2005).

<span style="font-family: 'Times New Roman',Times,serif;">** LITERATURE REVIEW ** <span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">Suicide is rated as the 14th highest cause of death annually in Australia as of 2009 (Australian Bureau of Statistics, 2009). This is higher than the total number of deaths caused by motor vehicle accidents in Australia in the same year (Australian Bureau of Statistics, 2009). The Australian Bureau of Statistics (2009) latest report on causes of death within Australia stated that of all suicides in 2009, the highest rate was from males ages 85 years and older (28.2 deaths per 100,000 population). On a global scale, the suicide numbers are also found to be highest amongst the elderly with the highest rates being shown to be from males aged 75 years and over (World Health Organisation, 2002). Conversely, the Australian Bureau of Statistics (2009) report actually showed that the lowest rate of suicide was from males aged 15 to 19 years old reporting 9.3 deaths per 100,000. This is a surprising fact to most as the general perception on suicide prevention is towards the youth, not the elderly. The question remains as to why the focus for preventing suicide is on the youth of Australia and not the elderly where the highest rates of suicide occur.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">Suicide amongst the elderly is not a new concept. In the 1993 report by the Australian Bureau of Statistics, suicide was reported highest amongst males 75 years and over (31 deaths per 100,000). So why is suicide so prevalent amongst the elderly? Empirical data from research is yet to prove adequate risk factors for suicide amongst all age groups however, many are very important. The key theorist on suicide in society is said to be Émile Durkheim who presents his theory that suicide is interrelated with a range of social and environmental factors that portrays suicide as a collective phenomenon (Durkheim, 1897). Understanding mental illness, self-harm and suicide is crucial to implementing preventative methods for addressing this complex phenomenon.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">Research studies have shown that there are particular predictors and risk factors associated with suicide amongst the elderly. The majority of suicide victims amongst this age group are suffering from some sort of mental disorder (primarily depression) however, physical health issues, chronic pain, grief, loneliness, isolation, alcoholism and loss of independence are also contributing factors (The Royal Australian and New Zealand College of Psychiatrists, 2009). Particular risk factors contribute to the elderly’s predisposition of performing suicide. Every person is different in genetic makeup, past illnesses and life experiences (traumatic or not), cultural influences and social support network (Living Is For Everyone (LIFE) Framework, 2007). All of these factors play important roles in the probability or predisposition to someone performing suicide and importantly some can be modifiable (Living Is For Everyone (LIFE) Framework, 2007).

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">A study into psychiatric and personality disorders associated with suicide in older people showed that 77% of all deaths by suicide in the elderly had a mental illness, depression being the most prevalent at 63% (Harwood, Hawton, Hope & Jacoby, 2001). Further research into the levels of depression amongst the elderly show that up to 37% of suicide victims suffered from a depressive disorder (World Health Organisation, 2001). This high rate of depression is most likely to be accentuated in the elderly that are already suffering from physical disability (Katona & Livingston, 2000).

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">A notable issue facing Australia and the world with elderly suicide is the fact that we are living in an ageing population and the rates of suicide are expected to rise accordingly. Within Australia, the predicted percentage of population over the age of 65 will increase from 13% (in 2007) to between 23% and 25% in 2056(Australian Bureau of Statistics, 2008). There is also an increasing amount of people living with chronic diseases (primarily the aged population) that adds to the detrimental strain Australia’s health system is predicted to be under in the future (Australian Bureau of Statistics, 2011).

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;"> The issue of suicide amongst the elderly is concerning however, there is suggestion that the known data may be limited by the methods currently used. The Australian Bureau of Statistics has reported that the total nationwide suicide rates are steadily declining from 2,683 in 1998 to 1,799 in 2006 (Australian Bureau of Statistics, 2009). However, caution should be made when interpreting these findings as there are known issues in obtaining accurate data. “It is important to note that the number of suicide deaths may be affected by the number of open coronial cases with insufficient information available for coding at the time of ABS (Australian Bureau of Statistics) processing.” (Australian Bureau of Statistics, 2009). Suicide rates amongst the elderly in particular are also suggested to be under reported by medical practitioners as a means to avoid the stigma associated with suicide for the families’ sake and also to eliminate suspicion of assisted suicides. Additional issues with recording quality data is in interpreting the person’s intention. Whether a death via drug overdose was intentional or accidental is impossible to prove without sufficient evidence such as a suicide letter by the victim.

<span style="font-family: 'Times New Roman',Times,serif;">** CULTURAL AND SOCIAL ANALYSIS ** <span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">It has been suggested that reasoning for someone to commit suicide are not yet fully understood in contemporary society (Hood-Williams, 1996). Are all incidents of self-harm and suicide related to a mental illness? Émile Durkheim presents his theory that suicide is interrelated with a range of social and environmental factors that portrays suicide as a collective phenomenon (Durkheim, 1897). Understanding mental illness, self-harm and suicide is crucial to implementing preventative methods for addressing this complex phenomenon.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">Durkheim defines suicide as “…all cases of death resulting directly or indirectly from a positive or negative act of the victim himself, which he knows will produce this result.” (Durkheim, 1897). This implies that suicide is an individual act however,, his studies showed that suicide rates differed from country to country and that within particular countries, rates would vary regionally at a historically stable level (Durkheim, 1897). This is why Durkheim produced the theory that suicide is interconnected with macro social and environmental influences (Durkheim, 1897).

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">He (Durkheim, 1897) categorized suicide into two main divisions based on levels of integration of a person into society and the amount of regulation within the society. These two divisions where then subdivided into either too high or too low categories producing four styles of suicide; altruistic, egoistic fatalistic and anomic (Durkheim, 1897).

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">Durkheim’s theories on how society and environmental factors are interconnected with suicide are evident even in modern day society. Gunnell, Platt and Hawton (2009) say that due to the recent global financial crisis, we can expect a rise in suicide rates as individuals which are dramatically affected are at higher risk of depression and suicide which is an example of Durkheim’s anomic suicide. Fatalistic suicide trends are being displayed commonly in Australia’s media in recent times, naming the mass number of suicides and self-harm incidents as an “epidemic” (Bardon, 2011).

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">To adequately address the issue of suicide amongst the elderly, social awareness and intervention must be initiated. There are macro and micro risk factors that can be modified in one’s life to reduce the likelihood of them committing suicide whether it’s as simple as reinstating social connectedness, maintaining independence or simply making them more comfortable in everyday living situations.

<span style="font-family: 'Times New Roman',Times,serif;">** ANALYSIS OF THE ARTEFACT AND YOUR OWN LEARNING REFLECTIONS ** <span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">The artifact posted above can be argued to be about many topics. This is the beauty of music; it can relate itself to so many aspects of anyone’s thoughts and/or life. Personally, I see the song ‘Hurt’ alongside the video above, as a symbolic representation of a man’s struggle through depression, self-harm and suicide. Primarily it is a good representation into the depressive and destructive behaviours of an elderly man that eventually leads to suicide. The very first four lines eludes literally to self-harm and self destructive actions commonly associated with depression stating “I hurt myself today, to see if I still feel. I focus on the pain, the only thing that's real”. The last four lines can be interpreted as a ‘final good bye’, hinting at suicide. They read “If I could start again, a million miles away. I would keep myself. I would find a way”. Personally this is a statement representing how in his final years, regret and despair have overcome him, leading to suicide.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">The imagery in the video portrays an old, frail man that comparatively was once young and vibrant. The general mood of the footage in present day compared to the flash backs is poignant and sad illuminating the current depression.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">Reflecting back upon completing this assessment piece, I have come to the significant but heartbreaking reality that is the extremely high rate of suicide, severe depression amongst the elderly population. What is most concerning is the ignorance that society has to identify and address this issue.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">Knowing now the “warning signs” of a person, not just elderly, that may be at a vulnerable position in their lives will most definitely aid me in my future work as a student paramedic. In the future, I will now be socially and emotionally aware to the determinants that can be used to signify a person may be at risk.

<span style="font-family: 'Times New Roman',Times,serif;">** REFERENCES **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">Australian Bureau of Statistics. (2011). Australian Social Trends. Retrieved from http://www.abs.gov.au/ausstats/abs@.nsf/mf/4102.0

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">Australian Bureau of Statistics. (2009). Causes of Death, Australia, 2009. Retrieved from http://www.abs.gov.au/ausstats/abs@.nsf/Products/3303.0~2009~Chapter~Suicides?OpenDocument

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">Australian Bureau of Statistics. (2008). Population Projections, Australia 2006-2101. Retrieved from http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3222.0Main+Features12006%20to%202101?OpenDocument

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">Australian Bureau of Statistics. (1993). Causes of Death, Australia, 1993. Retrieved from http://www.abs.gov.au/AUSSTATS/abs@.nsf/allprimarymainfeatures/55B1F550A7B025D6CA25722E001A3A04?opendocument

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">The Australian Government Department of Health and Ageing. (2007). Living Is For Everyone (LIFE) Framework. Research and evidence in suicide prevention. Retrieved from Living is for Everyone website http://www.livingisforeveryone.com.au/LIFE-Framework.html

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">Bardon J. (2011). Refugee advocacy group wants end to suicide 'epidemic'. //ABC News.//Retrieved from http://www.abc.net.au/news/2011-07-05/refugee-advocacy-group-wants-end-to-suicide/2782822

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">Community Affairs Reference Committee, The Senate (2010) The Hidden Toll: Suicide in Australia. Retrieved from http://www.aph.gov.au/Senate/committee/clac_ctte/suicide/report/

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">Durkheim, E. (1897). //Suicide: A study in sociology.// (J. A. Spaulding & G. Simpson, Trans.). London: Routledge & Kegan Paul LTD.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">Gunnell D., Platt S. & Hawton, K. (2009). The economic crisis and suicide. //British Medical Journal, 338,// 1456-1457. doi: 10.1136/bmj.b1891

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">Harwood, D., Hawton, K., Hope, T., & Jacoby, R. (2001). Psychiatric disorder and personality factors associated with suicide in older people: A descriptive and case-control study. //International Journal of Geriatric Psychiatry// (16) 155–165.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">Hood-Williams, J. (1996). Studying suicide. //Health & Place, 3,// 167-177. doi:10.1021/jf900623w

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">Katona C., Livingston G. (2000). Impact of screening old people with physical illness for depression. //Lancet//, //356//( 9224) 91. Retrieved from http://web.ebscohost.com.ezp01.library.qut.edu.au/ehost/detail?sid=8e443ebf-c137-494b-8d4332baa8113170%40sessionmgr111&vid=7&hid=105&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=afh&AN=3297026

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">Mathers C. D., Vos E. T., Stevenson C. E., & Begg S. J. (2001). The burden of disease and injury in Australia. //Bulletin of the World Health Organization// //79//(11), 1076-1084. Retrieved from http://www.scielosp.org/pdf/bwho/v79n11/bu0569.pdf

<span style="font-family: 'Times New Roman',Times,serif;"> O’Dea D. & Tucker S. (2005). The Cost of Suicide to Society. Wellington: Ministry of Health. Retrieved from http://www.moh.govt.nz/moh.nsf/0/BFA96AA9486D2C3BCC2570D4008009E6/$File/thecostofsuicidetosociety.pdf

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">The Royal Australian and New Zealand College of Psychiatrists. (2009). //Submission to the Senate Community Affairs References Committee: Inquiry into Suicide in Australia//. Retrieved from The Royal Australian and New Zealand College of Psychiatrists website http://www.ranzcp.org/publications/submissions-and-reports.html

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">World Health Organisation. (2011). Mental health. Retrieved from http://www.who.int/topics/mental_health/en/

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">World Health Organization(2002). Distribution of suicide rates (per 100,000) by gender and age. Retrieved from http://www.who.int/mental_health/prevention/suicide/suicide_rates_chart/en/index.html

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">World Health Organisation. (2001). World Health Report: Mental Health: New understanding New Hope. Retrieved from http://www.who.int/whr/2001/en/whr01_en.pdf

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;"> <span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;"> <span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;"> // Chlamydia, MTV and Pornography – Generation Y’s Sexual Revolution // <span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;"> First of all commendations on such a well written essay! I found your statistics very concerning and problematic for the health care system of Australia. It is amazing the influence the media and ‘pornification’ has had on Gen Y and their sexual habits and health. The fact that you made stating prime time television is now occupied by 90.5% sexual content is terrible. I would be interested to see what the influence social status and acceptance has played on the increases amongst sexual behavior especially influencing adolescents engaging in sexual activity earlier in life. Thank you for a great read! <span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;"> <span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;"> // Drinks and Gen Y? - Bloody Idiots // <span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;"> Well done Jordan. You have made some very good points here. It is very worrying to see first hand the damage binge drinking is having on our generation. The point you make that many adolescents “do not classify themselves as binge drinkers” is something I see to be very important in modern culture amongst the youth. Many people go out and binge drink to excess on a weekly basis and do not see this as hazardous to their health. Possibly because it is seen as a ‘right of passage’ into adult hood in Australia or is now ingrained in our culture as you noted with alcohol being a part of every social event from a BBQ to a funeral. I am relieved and glad to see you have reflected upon writing this and come to realize everything in society is not what it seems. If more people had the same mind set, I believe the world will be a better place for future generations. Well done! <span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">
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