Wednesday 17 January 2018

The truth about suicide must be told

Media focus on situational explanations hampers a true understanding of mental illness

The late L’Wren Scott with her partner Mick Jagger.
The late L’Wren Scott with her partner Mick Jagger.

Patricia Casey

There is a phenomenon in psychology called the fundamental attribution error. An attribution error occurs when a causal connection, that is incorrect, is made between a prior event and a subsequent one.

The fundamental attribution error refers specifically to our tendency to blame external events as causing subsequent events in those we know while we tend to blame internal attributes as responsible for these same occurrences in those we don't know. So when a robbery occurs we blame broken homes, poverty and so on when we have some familiarity with the individuals or the group concerned.

When they are strangers to us, we blame internal predispositions such as greed, antisocial traits and so forth.

We don't consciously know that we are engaging in these predictable psychological exercises.

A further point is, that even when we know from our general knowledge and reading what the likely causes are, we still invoke these explanations. And even more striking is that even when the cause isn't known, we still resort to this predictable theorising.

Nowhere in the mental health sphere is this more apparent than in relation to suicide. Suicide is deeply distressing for those directly affected. It is also a political issue since prevention strategies sometimes form part of government policy. Even some of the treatments used to prevent suicide have been subject to political comment, especially antidepressants.

Health ministers, without any training or expertise in mental health, have commented in public in this country that these medications should not be used for long-term treatment, while opposition spokespersons on mental health have offered opinions on the causes of suicide ranging from bullying to unwanted pregnancy.

These comments are incorrect and not supported by research. These represent external attributions when we can identify with the individuals or group likely to be affected, ie young women in our own country.

By far and away the most common antecedent to suicide is depressive illness, which is either untreated or partially treated. For decades numerous studies have identified the importance of aggressively treating depression, bearing in mind that hospital admission may be required if the person is suicidal.

Yet depressive illness is seldom mentioned in this context and if it is, it too is believed to be triggered by some external event such as a financial loss, a relationship breakdown or some such event. The mantra is: "Wouldn't you too be depressed if you had to go through that experience?"

I am not proposing to discuss in any detail the sad case of L'Wren Scott, the dress designer and girlfriend of Mick Jagger, who was found in her New York home, having reportedly taken her own life. Since her death, the focus has been on the financial problems she faced in her company and her relationship with Jagger.

The fact that, according to reports, she had self-harmed before the final event and may have suffered with depression has been a side issue. It is as though depression is not something that affects the rich and beautiful, only those who are poverty-stricken and unattractive. But depression does not discriminate on the basis of appearance, wealth or social class.

Should we be concerned about these attribution errors? Do these simplistic explanations make any difference to society or to individuals? If the media is reluctant or ambivalent about the reality of mental illness, preferring instead situational explanations for problems such as suicide, depression, bipolar disorder, then how can those of us who treat mental illness or who are advocates on behalf of our patients, possibly convince governments that we require sufficient funding for the services we provide?

We will not be able to win the support of family members when we diagnose their loved ones with mental illness if the public wisdom, conveyed by the media, is that it is a situation-dependent phenomenon.

And what of those whose symptoms and incapacity persist despite improvements in their personal and social situation? Will they not be stigmatised and criticised because of their failure to overcome life's adversities? And what about those who are suicidal due to untreated mental illness?

Mental illness exists and were it not for the recognition and assertive treatment of mental illness, suicide rates internationally would be far steeper than they currently are.

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