Updated: Feb 15
Trigger Warning: this post talks extensively about suicide, qualities of those who have committed suicide, and qualities of the bereaved parents. As this post intends to point out, suicidality is a multifaceted, complex topic. If you are a grieving due to the loss of a loved one through suicide, consider booking a session with one of our therapists.
Furthermore, while this post highlights the over inflated relationship between suicide and mental illness, risk of suicide for people with mental disorders should not be down-played (San Too et al., 2019).
The field of suicide research is heavily dominated by quantitative risk factor research based on the biomedical model. This model stands on linear cause and effect relationships that explain suicidality as being the result of particular risk factors--namely alcohol abuse and mental disorders (particularly depression). However, we still have very little knowledge on how these risk factors relate to suicidality.
A meta-analysis study by Franklin et al. (2017) of over 50 years of suicide research reveals:
Rates of suicide have not declined in several decades.
The dominant paradigm of "cause-and-effect" risk factors are weak & inaccurate predictors of suicidality.
Suicide research has done the same study, for 50 years in a row, with the same result!
This begs, the question, "Why haven't we changed the way we look at suicide?"
Despite the flaws in this mainstream paradigm, it is still widely believed (and taught) that 90% of all suicides are a consequence of a mental disorder.
Critiquing Suicide Research
Dr. Heidi Hjelmeland, a leading researcher in suicidology, encourages the use of qualitative research methodology which examines contextual factors (social, cultural, economic, and political) where suicidality is developed and maintained. This is because, suicide is defined as a conscious, intentional act--not something just determined by measurable risk factors. All of this begs, the question, "Why haven't we changed the way we look at suicide?"
Hjelmeland shares that the belief that "90% of all suicides are a consequence of a mental disorder" is based off of a form of retrospective research methodology called psychological autopsy (PA) which has numerous flaws and problems (Hjelmeland et al., 2012). Specifically, a problem of selection bias, where depression or other risk factors are assumed rather than discovered (Shahtahmasebi, 2013); and a significant lack of qualitative evidence where the bereaved are interviewed to speak about the contextual factors surrounding the life of the person who committed suicide.
A consequence of this long held belief, known as the 90% rule, is that those who experience suicidal ideation may avoid seeking help in order to avoid being labeled as "mentally ill" (Shahtahmasebi, 2015). Furthermore, it communicates the message that suicide prevention is something that only counsellors and psychologists can prevent--deemphasizing the critical role that parents and other care givers can play in suicide prevention.
In Hjelmeland's (2020) webinar "To prevent suicide, we need to understand (the meanings of) suicidality)" presented at the UK Suicide Prevention Summit Webinar, she reviewed the following qualitative research completed across various cultures and contexts.
Hjelmeland shares that a central issue connected to qualitative research of suicide across different groups and contexts is this: Not being able to live up to other's/one's own internalized expectations. These expectations could be: gender identity and roles, sexual identity, responsibilities, or taking care of oneself, etc.
While a biomedical perspective can understand suicidal behavior as being determined by pathology or deviance, a communication perspective interprets suicidal behavior as a communication of distress/control:
A way to escape unbearable expectations or circumstances
A desperate protest or rebellion
It is a relational phenomenon, rather than an individual one.
It is far more related to existential issues, rather than mental disorders.
Suicidality Among Men
In one study by Klamanesh et al. (2015), where young and adult men committed suicide, they were:
dependent on recognition and admiration
high fear of failure
high expectations and demands for themselves
needed complete control
worked hard to maintain a "perfect façade."
Suicide occurred when the "perfect façade" cracked.
Maladaptive perfectionism can be a result of a family environments where shame and humiliation were inflicted on the children. In their stories, the bereaved emphasized:
the family's status and façade were very important to the parents;
unrealistic expectations for sons; and
the sons received very little recognition and warmth.
Suicide became a way to restore their self-esteem--in other words, suicide became an act of compensatory masculinity.
For most of the sons, their father figure had:
viewed the sons as weak and immature;
tried to make "real men" out of their vulnerable/sensitive sons;
set standards for "being a man" that their sons failed to live up to; and
criticized/humiliated their sons, who blamed themselves and were ashamed.
These sons learned to put on a brave face, rather than express their feelings; and developed symbiotic/boundless relationships with an overprotective mother (Klamanesh et al., 2015)
A study by Rasmussen et al. (2014, 2017) revealed:
the combination of a sensitive emotionally dependent boy, caught between shameful dependency of mother and vehement anger related to never being good enough for father, and authoritarian parenting seems to be destructive;
tried to hide shortcomings with a constantly "more perfect façade";
when façade was about to crack, they staged themselves as heroic, a real man who took responsibility and didn't blame anyone else but themselves;
suicide became a way to restore their self-esteem--in other words, suicide became an act of compensatory masculinity.
Andoh-Arthur et al. (2018) Suicide among men in Ghana: The burden of masculinity
Suicidality Among Women
Women's suicide should be viewed through a human rights lens, rather than being connected to a mental disorder.
Studies by Fincham et al (2011) and Kuzmaniac (2012) revealed that women's suicidality was connected to:
expectations of others or society--related to gender identity/roles, body image, being a good mother, etc.
more specifically, it seems connected to not wanting to live up to expectations, rather than not being able to, as seems to be the case for men.
in this way, suicide appeared to be a sense of desperate rebellion from socio-cultural contexts.
Furthermore, Sylvia Canetto (2015) offers that women's suicide should be viewed through a human rights lens, rather than being connected to a mental disorder.
Hjelmeland & Knizek (2016) Suicide and mental disorders: A discourse of politics, power, and vested interests.
Suicidality Among the Elderly
Studies by Kjolseth (2010), and Kjolseth et al. (2009) revealed that:
Suicide was about taking back control what was lost--related to issues of mobility, capacity, etc.
Suicide had to with what their experiences meant when confronted with old age.
This blog was an adaptation of the work presented by Heidi Hjelmeland in her 2020 webinar "To prevent suicide, we need to understand (the meanings of) suicidality)" presented at the UK Suicide Prevention Summit Webinar. The aforementioned research cited was provided by Hjelmeland in her webinar and was not made accessible to the viewer.
Do you have any feedback/questions on this article? Feel free to leave a comment and let us know. We'd love to continue learning with you :)