The politics of suicide prevention

In the twelve years since my last suicide attempt, I've been active – some would say an activist – in the overlapping areas of suicide prevention, mental health and disability rights. When asked to report to Santa on whether my "area of expertise" has earned its annual Xmas presents, I regret that my report is once again rather grim.

During my PhD research, I saw myself as working within the academic discipline of suicidology. I now see suicidology as just one component of a larger suicide prevention industry, which in turn is a branch of a larger mental health industry. As I approach my retirement from this industry, I now also see much more clearly the politics of suicide prevention. I'm embarrassed at how naive I was ten years ago. But I am also shocked by the political machinations of an issue that should be above such tacky, self-serving, vested interests. I'm shocked by the politics of power that controls and seriously constrains the public discussion of suicide in Australia – the self-appointed gatekeepers not only of suicide conferences and journals but also of the discussion of suicide in the mainstream media. And I'm shocked that the understanding – and prevention – of suicide is constantly thwarted by ignorance, prejudice and ideological dogma.

The politics of suicide prevention is the major obstacle to progress in reducing the suicide toll. My sad assessment is that the suicide prevention industry – and its mental health daddy – contributes to rather than reduces the suicide toll. This is a very serious charge which requires some justification. The short summary here of my report to Santa presents the two major reasons why I come to this grim assessment – the excessive medicalisation of suicide and the institutionalised discrimination of suicidal people. These are both political issues, not academic or scientific, nor are they funding or resources issues. The only resolution of them will be broad public debate.

Medicalisation

These days most people think that suicide is caused by mental illness, and in particular see Depression as the major cause. This is the most damaging of many harmful myths about suicide. Why has this belief become so popular when there is in fact no scientific evidence to support it?

The reason is that the last 20-30 years has seen a massive public relations exercise by the medical profession and the pharmaceutical industry to promote the belief that Depression is a genuine medical condition that requires medical treatment, most notably antidepressant medications. In Australia, the exemplar of this PR machine is beyondblue but it also includes a few influential individuals that today we might call Team McGorry. This campaign has been so successful that the myth of the "chemical imbalance in the brain" has colonised our cultural understanding of suffering and poisoned the public discourse on mental health and our emotional wellbeing.

The marketing rather than scientific origins of the "chemical imbalance" myth has now been thoroughly exposed so the medical spin doctors rarely utter it these days. But the damage has been done, the medical colonisation is virtually complete. The psychology of the mind has been thoroughly reduced to the biology of our brains and mental "illness" has become a biological malfunction of the brain. Neurotransmitters are in, emotions are out. As Francis Crick once famously said, "we are nothing but a pack of neurons".

The dehumanising medicalisation of suffering – and indeed of the human condition in general – diminishes us all. It also contributes to the suicide toll. The most serious consequence of the assumption that suicide is caused by Depression (or any other medical illness) is that we then stop looking for the deeper causes of why some people choose to die. Instead, superficial, ineffective and often harmful medical interventions have become the first line of "treatment". The massive antidepressant experiment of the last 20-30 years has been a demonstrable failure, at least for suicide prevention, and it's long overdue that we call an end to it.

One alternative is to resurrect the concept of "psychache" pioneered by one of the founding fathers of modern suicidology, Professor Edwin S Shneidman. Suicide is caused by psychache, says Shneidman, which he defines as unbearable psychological pain (not illness) due to frustrated or thwarted psychological needs. A few suicidologists are keeping Shneidman's great legacy alive, most notably the Aeschi Group, but psychache remains marginalised by the medical juggernaut of contemporary suicidology.

Psychache is a useful concept with rather more intellectual credibility and integrity than the mental illness myth. But I think we can do better. I argue that suicide is best understood as a crisis of the self, which accommodates not only the psychology of psychache but also the social, cultural and spiritual dimensions of any suicidal crisis. A truly holistic approach to understanding – and preventing – suicide must consider the whole person in their social, cultural and historical contexts. The current enthusiasm for blaming suicide on the brain is contributing to the suicide toll.

Discrimination – aka 'stigma'

Stigma is recognised as a fundamental obstacle to suicide prevention, though it should be called by its correct name, which is discrimination. Stigma is not an attribute of the stigmatised individual but comes from the stigmatising attitudes and prejudices of the society in which these individuals finds themselves living – i.e. just like racism, sexism, homophobia and other forms of discrimination. Discrimination (stigma) is a political, human rights issue.