Suicide fascinates us- it is at once appalling and yet, in the darkest places in our minds, appealing. Emile Durkheim described suicide as one of the ‘crudest expressions’ of social phenomenon since it is the most damaging sort of death.
Suicide, or the act of deliberately ending one’s own life, is a public health concern and a growing one among the younger age bracket, especially women (Durkheim & Spaulding, 1966).
In recent times, suicide has been the leading cause of violent deaths, more than all wars and murders combined.
The above quote is from ‘The Origin of Species’ (Darwin & Kebler, 1859). Natural selection was perceived to not produce anything injurious to itself, however, it apparently did exactly that in humans. Have humans developed natural defences against suicide?
Clifford Soper, a renowned psychotherapist, had done Ph.D. work concluding that the ravages of suicide are a consequence of human intelligence and have shaped our minds and cultures (Soper, 2018). This hypothesis may help explain why suicide is often impulsive.
Soper called his model ‘pain and brain’. When faced with agonizing pain, a sophisticated mind can think of death as an escape. He noted that suicidal thoughts and behaviors are vastly more common than the act itself. Moreover, Soper proposed that mental illness itself can be a safeguard against suicide.
He highlighted how certain mental disorders were associated with suicide because they were designed by natural selection to be last-line defenses against it. For instance, he argued that the lack of initiative that accompanies depression may help prevent suicidal acts.
Mental health is something that we all experience every day. The important thing is to talk to someone and get help if and when we need it. Despite the alarming rates and reports, one the leading reasons that renders people suicidal continues to be a much-ignored health issue- Depression.
There is still widespread social stigma attached to consulting a psychiatrist and in accepting the fact that you may also suffer from clinical depression. This vicious cycle does not end there. Depression is still misunderstood by many as a ‘mood swing’ that can be shrugged off at will or by thinking positive thoughts, and seeking psychiatric help is mostly looked down upon, even feared.
The prevalence, characteristics and methods of suicidal behaviour vary widely between different communities, in different demographic groups and over time. The reason for high suicide death rates among women can be attributed to lack of economic, social, and emotional resources.
More specifically, academic pressure, workplace stress, social pressures, modernisation of urban centers, relationship concerns and the breakdown of family support systems can add to the woes of women around the world.
Popular culture is rife with stories suggesting that urban environments, apartment living and public transit travel cause emotional stress and unhappiness.
Scientific studies also find higher mental illness and depression rates in urban areas. Are these claims credible?
If so, what are their implications? A timely and important question arises: How can communities and individuals maximise urban mental health and happiness?
According to Wirth (1938), both urban personality and collective behaviour accentuates ‘urbanism’ as a way of life. It is largely through the activities of the voluntary groups, be their objectives- economic, political, educational, religious, recreational or cultural, that the urbanite expresses and develops his/her personality, acquires status and is able to carry on the round of activities that constitute his/her life-career.
Under these circumstances, personal disorganisation, mental breakdown, suicide, delinquency, crime, corruption and disorder might be expected to be more prevalent in the urban than in the rural community.
It is expected that the urban population in developing countries will double in the next 30 years. While urbanisation is accompanied by health problems, population density can lower public health costs (Harpham, 1994). Only a small percentage of people with mental disorders seek primary health care and even less receive secondary or tertiary-level care.
Common mental disorders place a large burden on primary health care services, however, most of the patients suffering from mental disorders seek care for physical disorders that mask proper diagnosis and treatment.
Urbanisation in developing countries involves changes in social support and life events which have been shown to affect mental health, mainly depression and anxiety, particularly among low-income women. Strong links have been established between socio-environmental factors and common mental disorders within an urban environment.
Needless to say, those who suffer most from common mental disorders include women (especially between 15 and 49 years old) and low-income populations. Common mental disorders, such as anxiety, depression, insomnia, fatigue, irritability, and poor memory, account for 90% of all mental disorders, cause behavioural problems in offspring, and impede recovery from physical ailments.
Mental health in developing countries is gaining burgeoning attention as the attendant loss in economic productivity of human capital has become apparent. Thus, the World Health Organisation staunchly advocates for the introduction of ‘mental health’ components in primary health care services in developing countries.
In order to reach vulnerable women, who remain outside of the healthcare system, community-based interventions such as self-help groups and efforts to promote wider social changes or address poverty should be undertaken.
Technology brings a new twist to suicide, but it also makes it easier to prevent it. For instance, a 2018 pilot project between the Public Health Agency of Canada and Advanced Symbolics uses social media posts as a resource to predict regional suicide rates.
Therefore, the determinants, extent and outcome of the association between urbanisation and mental health requires multi-disciplinary policy research by social scientists, social psychiatrists and public health professionals. Previous social science research on suicide has looked at the matter from an economics perspective.
Economists have modelled suicide as a choice between life and death, wherein the ‘utility’ of staying alive or ending life are weighed against each other. If the utility of staying alive falls below the utility of ending life, suicide is an ‘optimal’ choice.
The prevention of suicide is every individual’s responsibility and ‘nudge theory’ could play an important role. The World Health Organisation has stated that ‘communities’ have a big role to play in suicide prevention, thus, fostering the role of Behavioural Change Communication (BCC).
Their new report, ‘Suicide Prevention: A global public imperative’, is a call to action to make suicide prevention a higher priority on the global public health agenda.
World Suicide Prevention Day, observed each year on 10 September, is an opportunity to raise awareness and promote joint action to protect those who are vulnerable to suicide, especially young girls and women.
Follow-up care by health workers for people who have attempted suicide is critical, as they are at great risk of trying again. Social support within communities can help protect people who are vulnerable to suicide by building their coping skills and sense of connectedness.
Communities must provide nurturing environments to those who are vulnerable and governments can set a good example to enable them to do so.
Every 40 seconds, a person commits suicide somewhere in the world. Indubitably, the impact on families, friends and communities is devastating and far-reaching. According to a new global report of the World Health Organisation, suicides accounted for over 800,000 deaths in 2012 alone.
A suicide attempt, as the doctor points out, is often a cry for help. But how often is this help provided? Since suicide is a sensitive issue- and even illegal in some countries- many cases go unreported.
The growing uptake, influence, and diversity of social media platforms pose new opportunities and challenges for the prevention of suicide and self-harm behavior, particularly in young people who are large consumers of new media.
A recent example of the potential confounding effects of the media on youth suicide prevention was demonstrated following the release of the 2017 Netflix series ‘13 Reasons Why’, which builds up to the graphic suicide of a 17-year-old student over 13 episodes.
Moreover, responsible media reporting has been shown to decrease suicide rates. This includes educating the public about suicide, risk factors and where to seek help, avoiding sensationalism and glamourisation and avoiding detailed descriptions of suicidal acts.
Since we now live in the digital age of social media, it becomes imperative to assess the role of technology and its linkage to suicide rates, which acts as a ‘double-edged’ sword. With the Coronavirus pandemic underway, the more we talk about mental health, the more we realise that these issues are intertwined in our daily lives and not unique to women. Now is the time to use this double-edged sword in our favour!
Darwin, C. & Kebler, L. (1859) On the origin of species by means of Natural Selection, or, The preservation of favoured races in the struggle for life . London: J
Durkheim, E., Spaulding, J. A., & In Simpson, G. (1966). Suicide: A study in Sociology.
Harpham T. (1994). Urbanization and Mental Health in Developing Countries: A research role for social scientists, public health professionals and social psychiatrists. Social science & medicine (1982), 39(2), 233–245.
Soper, C.A. (2018). The Evolution of Suicide. Evolutionary Psychology, Springer International Publishing.
Wirth, L. (1938). Urbanism as a Way of Life. Chicago