Book review

Citation

Ashton, J. (2022), "Book review", Journal of Public Mental Health, Vol. 21 No. 3, pp. 271-273. https://doi.org/10.1108/JPMH-09-2022-158

Although suicide is recognised as one of the leading causes of death in many countries, research devoted to the subject is not proportionate to the scale of the problem. It is only relatively recently that research has focussed on social, economic and/or political aspects of suicide, and attempted suicide. The book, edited by Mark Button and Ian Marsh, covers 11 aspects, exploring the role of social, cultural and economic pointers to a person’s decision to end their life:

Part 1: a critical assessment of some philosophical and ethical sources from is derived which an engagement with suicide as a question of social justice.

Part 2: the intersections of specific populations affected by high rates of suicide and relevant public policies.

Part 3: the experience of those living with and confronting suicide and suicidal ideation.

Contributors are from the USA, UK, Canada, Iran and Ghana.

There is a powerful recurrent theme across a number of chapters, to the effect that state-controlled elements have a major influence on suicide (or attempted suicide). I have selected a few chapters to illustrate the theme, and also to give a glimpse of the range of issues explored. Amy Chandler uses accounts from various countries, to highlight the sense of shame, connected with lack of self-determination. The underlying reason for this is often found to have a social/political basis. However, she sees a limitation of her approach, in that respondents may not have the knowledge or language to identify structural disadvantage. Therefore, she argues for a critical approach to such accounts.

A small number of the other chapters rely extensively on narrative material from those who have attempted suicide, or those close to them. For example, the chapter by Silvia Canetto and Mohsean Rezaiean takes the reader close to the minds of Muslim women, who carry out protest suicides (Spehr and Dixon, 2014). Such action is a purposive political act, intended to change oppressive policies or practices, often including institutionalised violation of human rights, such as the right to education, or paid work, or to get married/divorced, or to be safe from abuse. Usually at the root of the problem, is the principle of male guardianship.

China Mills’ chapter (“Strengthening Borders and Toughening Up on Welfare: Deaths by Suicide in the UK’s Hostile Environment”) examines the social and economic policies of the past two decades in the UK, particularly for disabled people and immigrants. The systems have worked on the assumption that immigrants have no right of entry, even before they can be assessed. Assessments of people with disabilities have been carried out for many years, by non-medical staff, using criteria that are largely non-medical. Mills quotes from a Guardian journalist, Frances Ryan (2018), who wrote that Britain’s social security system is itself defined by an increasingly hostile environment, with changes to immigration policy whose aim is “deport first, appeal later”. The parallel for disabled people is “remove benefits first, appeal later”. Mills makes it clear, how the benefit system makes disabled people feel worthless, in more than one sense. She also mentions that those claiming benefit for mental health reasons are framed as faking it.

A question that might arise in the reader’s mind is: how does individual psychology relate to these severely limiting factors? The authors generally argue that up to now, the tendency has been to put all the emphasis on the individual’s psychology. I believe this is illustrated by the fact that, often a person who took their own life was said to do so “while the balance of their mind was disturbed”, even if there had been no signs of mental disturbance. The chapter by Rebecca Morse et al., “It Takes a Village” – discusses the position of mental health in public health, with a focus on the contribution of “para-professionals” to suicide prevention and crisis intervention, with some excellent current examples, and reference to well-established services. One example of training for lay people and gatekeepers is QPR – Question, Persuade, Refer. This may sound rather simplistic, but there is evidence for its effectiveness. I would add some quite recent evidence for the connection between inflexible state policies, and individual mental health, namely, Resignation Syndrome (Pressly, 2017). First identified in Sweden, people fall into a long-term comatose state when they have no hope of being given leave to remain in the country. This shows that if a person seems to have no future, due to official policies, their mind can literally shut down. In some cases, the treatment by the authorities has been simply to stop processing the claims, but that makes no difference! It may be because it is immigrants who are affected, that this syndrome is under-reported.

Ian Marsh’s chapter sets out to understand the ways in which “suicidal subjects come to be formed in relation to modern regimes of truth and power”. To me, that has an Orwellian ring to it; in Nineteen-Eighty Four (Orwell, 1949) the state aggressively controls what people think and believe. The lowest members of that society, the “proles” had very few rights: “The party taught that the proles were natural inferiors who must be kept in subjection, like animals, by the appliance of a few simple rules” (Orwell, 1949, Chapter VII). This is of course an extreme expression of the idea, but I think those researching suicide and social justice might have parallels.

I have not mentioned other chapters, which are also based on good quality research. The book is also readable for non-academics, but if I were asked to identify one area lacking, I would point to direct narrative quotes. A few of the chapters make particular use of such accounts, and other have some references, but some content may appear too academic, through a lack of quotes. In my opinion the narrative accounts make it possible to engage more closely with the subject.

At the end of their Introduction, the Editors write “It is our belief that […] critical engagements have the potential to open up new possibilities for thought and action in relation to suicide and suicide prevention beyond traditional philosophical, sociological, medical or psychiatric approaches”. I am confident that the book has done and will continue to do this.

More recent work by China Mills and Amy Chandler can be found in the Special Issue of the Journal of Public Mental Health, published earlier this year.