Commentary on: The Journal’s concerns about suicide

‘The Journal’s concerns about suicide’ is a thoughtful essay by Snowdon (2017) who has addressed the ongoing concern and, one might add, fascination with suicide. The latter words are included, as a recent book by Beattie and Devitt (2015) explored persuasively what they described as a ‘modern obsession’ with suicide.

Suicide lends itself to such speculations, as so many papers commence with statements such as ‘suicide is a multifactorial issue’. While that is technically correct, the sometimes assumed corollary is that all such issues are of equal importance … every player wins a prize and every opinion carries the same weight, a populist approach in keeping with a postmodern or even a post-truth approach.

But psychiatry has a more solid foundation. For example, the Population Attributable Risk statistic has given us the relative risks of suicide in different populations, and there have been advances in establishing the biological substrate of suicide (Goldney, 2013).

Snowdon refers to longer term changes in the patterns of suicide, which he has explored elsewhere, but his addition of a comparison between 2013 and 2015 is perhaps unwise because of it’s short time-frame. He also notes the increase in female suicide in China, and he endorses the usual view that Chinese decedents have less definable mental illness. However, probably still the most rigorous exploration of the latter point, utilising a standardised assessment instrument, demonstrated no such difference between Chinese and Western suicides or between three different Chinese ethnic groups. Therefore, while socio-cultural factors may be more important in understanding the preponderance of female suicide in China, mental illness issues should not be ignored (Goldney, 2013).

The continued debate about the importance of mental disorders in suicide was also alluded to. Indeed, it has persisted for over 200 years, with Moore in 1790 noting that ‘there is a sort of madness in “every” act of suicide, even when all idea of lunacy is excluded…. such distinctions of sanity and insanity are too fine spin to be just or equitable’ (Goldney, 2013).

Of course psycho-social stressors are involved, more so in different countries and between socio-economic groups within a country. But why do some persons succumb to such stressors? After all, stress is ubiquitous. The emerging field of epigenetics is shedding some light on the gene-environment interaction in this regard. It is also germane to emphasise that the previously referred to Population Attributable Risk studies have placed the role of such stressors in perspective, with the primacy of mental disorders in societies similar to Australia being evident. Furthermore, an innovative study from Canada, a country similar to Australia and New Zealand, reported in an examination of those who had died by suicide that those who did not have sufficient symptoms to warrant a formal psychiatric diagnosis were more similar to the diagnosed suicide group than to a living group (Ernst et al., 2004).

Snowdon argues that we have ‘much to learn from others’, but, at the risk of being considered xenophobic, our society’s contributing factors may be significantly different to those of other countries. As suggested elsewhere, suicide research can be broadly categorised as ‘useful’ or ‘interesting’ (Goldney, 2014), and some information from other countries, as well as some from our own, may well fall in the second category.

He also argues that ‘The Journal has a responsibility to provoke such discussions’, and that is certainly part of the scientific process, particularly with the inevitable differing interpretation of data. However, the further suggestion that it ‘can and should contribute to protest and advocacy’ is potentially contentious. Is the Journal primarily a vehicle for scientific reporting? It would be regrettable if we jeopardised our scientific credibility by protesting and advocating in advance of the science.

There is much food for thought in Snowdon’s timely contribution.

See Debate by Snowdon 51: 210–211.