Cultural Differences and Role of the Media in Suicide: a Cross- Continental Literature Review

Ogbodo www.iaajournals.org IAA Journal of Communication 5(1):28-39, 2019. ISSN: 2636-7262 ©IAAJOURNALS Cultural Differences and Role of the Media in Suicide: A Cross- Continental Literature Review

Jude Nwakpoke Ogbodo

Department of Mass Communication, Ebonyi State University, Abakaliki, Nigeria. Email: [email protected]

ABSTRACT This study evaluates the cultural differences in the methods of suicide across continents. It further examines the possible association between media coverage and rates of suicide. The study employs systematic review method to weigh the debates around cultural differences in patterns of committing suicide as well as the so-called irresponsible media coverage and the spike in suicide. A total of 80 articles and government documents were systematically reviewed. The documents were sourced from Scopus, CINAHL complete and Google scholar. The study finds that reasons and patterns for committing suicide are mainly culture-specific. It observes that hanging, self-poisoning, burning, and abuse of substance are some of the leading methods of suicide across countries. The study also finds that irresponsible media coverage may have suggestive effects on the rate of suicide. The paper concludes that the media may provide a platform where the collective understanding of suicide can be generated and internalised, but it would be too simplistic to reduce spikes in suicide to media coverage given that other societal factors such as cultural differences also play a part in suicide ideation and completion. Keywords: Suicide, Media and Suicide, Culture and Suicide, Suicidology, systematic review of suicide studies

INTRODUCTION Suicide poses a global concern, and a themselves. This underscores the cross-cultural perspective to this issue centrality of culture to human existence, is important [1]. Suicide, from a broader and this can be linked to the importance historical perspective has been referred of culture to people‘s suicidality given to as a ‗Western neologism‘ [2]. From the that ‗‗suicidality is about what kinds of perspective of the ancient Greece, lives people have‘‘ [8]. In a similar suicide was not generally a wrong thing perspective, [9] argues that suicide in to do provided that the reason was itself is ‗‗culture-specific‘‘ because all justifiable [3]. For instance, Plato people who commit suicide have always reportedly opposed suicide except when done so with a reference to the the State legally ordered it; when a dominant normative cultural values and person is inflicted with painful and attitudes of the society they come from incurable disease; and when a person is or live in. That perception may have forced to it due to some intolerable informed the earlier conclusion that misfortune [4]. Like the ancient Greece, preventing suicide requires a good the ancient Rome had no prohibition on understanding of the prevailing suicide for its citizens except for slaves sociocultural context that nurtures and soldiers (the former for economic suicidal behaviour [10]; [11]. Recall that reasons, the latter for patriotic [12] had argued that people‘s culture considerations) [5]. has a ‗patho-facilitating effect‘‘ on their Emphasising the importance of culture, suicidal behaviour. What this implies is [6] noted that ‗‗people eat, drink and that culture contributes crucially to the breathe culture‘‘. Scholars such as [7] manifestation of suicidal behaviour have also been consistent in their across societies. avowal that human nature is not Furthermore, taking cognisance of the independent of culture, and that various definitions of culture, there is a humans are incomplete and unfinished sense in arguing that all countries are beings who use culture to complete multicultural. As such, there is a need to

Ogbodo www.iaajournals.org take the cultural aspects of suicide deaths [20]. Suicide is committed in all seriously [13]. Therefore, the assertion countries, and across religions and age that ‗‗psychology needs cultural groups. However, suicidal behaviour and research to be legitimate‘‘ [14], could its interpretation differ from culture to not be less important, and by that culture [21]. Yet, despite the available truism, ‗‗psychology‘‘ can actually be empirical evidence about the influence placed side by side with ‗‗suicidology.‘‘ of media and culture Therefore, to understand suicidal on suicidal behaviour, it has remained a behaviour, suicidal people, suicidal neglected area of research especially in ideation, and committing suicide, it is African contexts. crucial to foreground the cultural Research is consistent that perception of context of this phenomenon. suicide varies across cultures and Staggering statistics indicate the rate of religions [22]. While in some places and suicide and suicidal behaviours across religions it is considered a religious rite, societies. Reports from the Centres for or an honourable practice, others Disease Control (CDC, 2017) suggest consider it a mortal sin. Be it the that suicide accounted for the death seppuku of the Samurai in Japan [23] of no fewer than 47,173 individuals in or the mortal sin perception among the US in 2017. Globally, report Catholics [24], suicide remains an issue indicates that at least 1 of convoluted debate. Although million persons die by suicide yearly. attitudes and perceptions toward When broken down into bits, the suicide vary according to culture and global suicide rate stands at 16 religion, there is a common belief that per every 100,000 persons [15]. The rate individuals suffering from depression or of suicide in some Asia countries mental health who are vulnerable to is reported to be higher than the global suicide should be given support [25]. average. For instance, [16] report that Investigation into the methods and role South Korea (31), Japan (24) and Sri of the media in escalating suicide cases Lanka (23) have higher suicide rates across cultures could potentially than the global average. The authors provide useful tips for developing warn that these figures only give an efficient and effective preventive insight as many suicides go unreported strategies against killing of self [26]. A or are underreported in the Asian systematic review has examined the countries. effectiveness of certain suicide- While the above figures provide the preventive strategies derived from a working reference for the rates of comprehensive electronic literature reported suicides, they may probably be survey and arrived at two underestimating the true suicide rates complimentary conclusions: physicians because some causes of death can be need to be better educated in order to misclassified (World Health detect and treat depression; and the Organization [17]; [18]; [19]. The need to restrict access to lethal weapons misclassification of suicides means that [27]. premeditated accidents may be Major objectives of the review described as unintentional because  To evaluate the cultural of the uncertainties surrounding the differences in the methods of death or even an intentional cover-up by suicide across continent. the deceased family due to the social  To examine the link between stigma associated with deaths by suicide media coverage and rates of in some cultures or due to the rigorous suicide. legal procedures that follow such METHODS The study employs systematic review to reviewed. The documents were sourced weigh the debates around cultural from Scopus, CINAHL complete and differences in methods of suicide as Google scholar. Keywords searched well as the so-called irresponsible media include suicide and culture, media and coverage and the spike in suicide. A suicide, and suicidology. total of 80 articles and government documents were systematically

Ogbodo www.iaajournals.org The etiological context of suicide of suicide may be interpreted from across continents beliefs about what culturally constitutes The methods of suicide differ according an ‗acceptable‘ gender-specific means of to countries or cultures. According to self-destruction [42]. On the whole, the World Health Organisation [28], males have been found to have higher hanging ranks first as the dominant risk than females in committing suicide method of suicide for both genders across cultures [43]. except in the Unites States where In Western nations, the another study has found that firearm is majority of death by suicidal means is the number one means of committing traceable to diagnosable suicide [29]. In European countries, it mental illness, and clinical was also reported that hanging was the depression ranks most frequent in that most common means of suicide among aspect [44]. As such, psychiatric illness, males apart from Switzerland, where, emotional, psychological, social, like the United States, firearms ranked economic, genetic, environmental and number one [30]. In some European cultural factors have all been linked to countries such as Belgium, Finland, and factors that potentially trigger suicide Germany, it has been found that apart [45]; [46]; [47]. However, no known from hanging, firearm was the second empirical study has clearly established most frequent means of suicide among the relationship between depression or males. Whereas in Scotland, it was the other mental illnesses and suicide. lowest method of suicide [31]. Conceivably, the weak assumption that a Use of poisonous substances (liquid) relationship exists between depression such as pesticides has also been found (or other forms of mental illnesses) and as the most frequently used method of suicide found outside the Western suicide in Asia [32]. This was also the countries may not be wrong [48]. case in [33], and also in parts of South However, [49] argue that the scholarly and Central American countries such as evidence on which this truism is based Mexico, Brazil and Uruguay where is somewhat weak. This is because the pesticides are used for agricultural overwhelming majority (about 95%) of purposes in the rural areas [34]. In fact, those diagnosed of depression did not according to [35], the majority commit suicide [50]. This begs for of suicide cases in Asia clarification on the question of the is predominantly linked to impulsive difference between the relatively few acts, aided by the easy access persons who go ahead to commit suicide to pesticides rather than and those who do not commit after mental illness [36]. The scholar explains depression. One would argue that this that in many Asian countries, leading cannot just be tied to depression and method of suicide is by ingesting other related conditions. Arguably, this poisons or dangerous chemicals such as relationship has been overemphasized pesticides [37]. Beyond these areas in in the Western scholarship [51]. Asia and Central and Northern America, Nevertheless, this will offer clear [38] reports that the use of pesticides examples of how research from has gained global prevalence and divergent cultural perspectives can accounts for 30% of methods of suicides inform our knowledge of suicide globally, especially for both the low and phenomenon. While not dismissing the middle-income countries. dominant Western viewpoint, it appears [39] established that the rates of male that much attention has not been paid to suicide in Europe exceed that of females all cultures in search of the prevention to a great extent. Although the focus of of suicide. this review is not on gender differences In Singapore, a leading method of in suicide, it is important to point out suicide is jumping from tower blocks, that research has suggested that gender while in Hong- plays a part in the method of suicide Kong however, the majority [40]. Regardless of the choice of of the suicide deaths is by jumping into method, [41] warn that this does not a burning charcoal [52]. According to necessarily help in measuring suicidal [53], Singapore is regarded as only one intent. Gender variances in the methods of the few nations across the globe

Ogbodo www.iaajournals.org where it is illegal to attempt a suicide. etiological context of suicide across Regardless, the country‘s ministry of countries. health in conjunction with the police Cultural interpretation of suicide was quoted as saying that suicide Debates around the cultural attempts has increased to 20.5 per interpretation or construction of suicide 100,000 population [54]. This are shrouded in complexity, and form demonstrates that sanctions do not part of its intellectual history. In deter suicide attempts. whatever guise, suicide is interpreted In India, empirical evidence suggests varyingly as an ultimate act of that suicide has largely been driven by determination and defiance, as a lethal reasons such as sacrifice, honour, gesture of desolation, as a mark of the religion, substance abuse and freedom over oneself, or as an evidence sociocultural beliefs, while fewer cases of the subjugation of a person to forces are linked to mental disorder [55]. In beyond his/her immediate control [63] fact, India has been described as the [64]. ―Suicide Capital of South-East Asia‘‘ due Some societies treat suicide as a taboo, to the increasing rate of suicide in the while others condone it. For instance, country [56]. The scholar reported that unlike the Western world and African the major methods of self-killing in countries, some Asian cultures condone India include cut and hanging. This also suicide, which is considered adds to the cultural dynamics in as a legitimate way of dousing familial committing suicide. shame, or just for altruistic reason It has also been established that social [65]; [66]. Particularly among the blacks, process like urbanisation can be suicide is seen as a taboo and with associated with the variation in methods cultural and spiritual implications of suicide because it has a direct impact [67]. In general, empirical evidence on the choice and patterns [57]. In shows that suicide rates among the China, urbanisation has been identified ‗white‘ is higher than that of ‗black‘ [68]. as a factor aiding the decline of at least, This, indeed, shows that suicide varies suicide by pesticides because when across societies and regions, which people move out of rural areas where implies that culture plays a significant pesticides are common, the difficulty in role in suicide ideation and behaviour. accessing these pesticides in cities In another instance, [69] argues that potentially makes them to turn to other culture also informs the nature of methods [58]. condemnation of suicide. This may A cross-cultural study in Sweden has explain why there is a low rate of found that parents placed so much suicide among African-Americans for emphasis on their children‘s whom suicide is considered less performance and success, and this acceptable [70]. Therefore, research resulted in ambitious children who focusing on different cultural made work a central issue to their lives backgrounds can elucidate further on [59]. This prompted the conclusion that cultural interpretation of suicidal suicide typically emanated from a phenomena [71]. This will not only help failure in performance and the resultant to expand the field of suicidology, but damage to people‘s self-esteem [60]. It also to develop a comprehensive implies that suicide has cultural culture-sensitive knowledge base for implication. In addition to cultural preventing suicide [72]. implication, research shows that suicide Although suicide is one of the leading also has political implications for the causes of global mortality, data on its victim‘s family [61]. In one instance, epidemiology in Africa remain limited Lester reports that a rejected fiancée [73]. In their systematic review of later committed suicide and this led to a suicidal behaviour in African countries, political sanction on the family for [74] found that both the regional and rejecting her. [62] argues that the lady's national suicide-related data were only suicide led to a political intervention available for 16 out of 53 African that symbolically changed her status countries, which represents an from powerlessness to powerful. The estimated 60% of the entire Africa‘s foregoing explains the complex population. They reveal that data for

Ogbodo www.iaajournals.org suicide attempt were only available for 7 demise [32]; [33]. Despite this finding, out of 53 African countries, representing there is no empirical proof <20%. In all, [75] note that the crude that regular screening for suicide estimates from the available data in hospitals lessens the potentiality of suggest that there are more than 34,000 suicide mortality. Moreover, research ‗‗(inter-quartile range 13,141 to 63,757) predicting that individuals with suicidal suicides‘‘ (p.1) annually and this thoughts would attempt to represents an overall incidence rate of commit suicide cannot 3.2 per 100,000 persons in the be generalised with a mere high degree continent. Although this finding does of sensitivity/ specificity [7]. not represent the rate of suicide across Study also suggests that only few people Africa, it paints the picture of the nature from racial and ethnic minorities seek of suicide prevalence in Africa, which is help for suicide [55]. For instance, [43] arguably lower than the rates in other found that due to shame and stigma, continents. many Asian Americans do not acknowle In a study which thematically dge the depressions and mental analysed n =60 suicidal notes from illness leading to suicide. The scholars Turkish and US victims, [3] found both a quoted Dr Aruna Jha, the founder of the ‗culture-specific and culture-general Asian American Suicide Prevention dynamics‘ (p.261) in suicide Initiative as saying that the traditional intention. Evidence providers who are not familiar with the from surveys across 21 Asian cultural backgrounds cannot countries involving (n>100,000 ‗‗bypass the shame-based resistance‘‘ adults), indicates that nonfatal suicide that most Asians face when seeking help attempts within 12 months stood at or discussing suicidality and other approximately 0.3 to 0.4 % [15]; while mental illnesses. This revelation is the lifetime prevalence is pegged at 3% significant in understanding the cultural [27]. In 2015 alone, the US recorded 1.4 discrepancies in suicide rates across million attempted suicides by adults. In different cultures. the UK however, the Office for National Suicide and Media coverage: A causal Statistics [45] reported that 5,821 link? suicide-related deaths were registered in Extant literature suggests that the country, thereby providing and age- irresponsible media coverage or standardised rate of 10.1 suicide deaths mediatisation causes spikes in suicide per 100,000 persons in 2017. ONS among those exposed to the media reports that the report represents one of reportage [22]; [23]; [24]; [25]. Although the lowest rates since 1981 when it was mediatisation potentially triggers more 14.7 suicide deaths for every 100,000 suicide especially when it involves individuals in the UK. This statistic is celebrities [8], more recent empirical important because it shows a drastic research suggests that prominent reduction in the number of recorded newspaper reports about a youth‘s suicide in the country. In African suicide might lead to adolescent countries, the true nature of death by clusters [15]. The relationship between suicidal means cannot be generated media coverage and suicide rate has because they are not regularly updated. been debated widely, with some While there have been different research contending that the interventions in different settings, the relationship has been overemphasised. choice of seeking help varies across For instance, [35] argues that it would cultures (American Psychiatric be too simplistic to reduce spikes in Association, 2003). Primary healthcare suicide to media coverage given that providers may prevent some suicides other societal factors play a part in from occurring in view of suicide ideation and completion. Central their regular interactions with patients to this debate is that mediatisation does with suicidal behaviour [9]. Study has not necessarily trigger suicide [37]. also suggested that 80% of individuals Empirical evidence also suggests that who latter committed suicide, had been suicide by burning was hardly known in in contact with the clinicians Hong-Kong until the first reported at least within one year preceding their incident became widely publicized

Ogbodo www.iaajournals.org in the mainstream media [63]. This wide have a common feature that potentially coverage of the method has been linked limits a better understanding of suicide. to the soaring degree of suicide by This is because they fail to clarify the burning charcoal in the explanatory interface between suicidal country [67]. Thus far, it has been thoughts and suicidal demonstrated that culture, religion and behaviour. Differentiating the two mediatisation influence the motive and concepts is important because research patterns of death by suicide. Consistent has demonstrated that most individuals in this line of inquiry is that suicide is who develop suicidal ideation never go culturally interpreted and perspective ahead to attempt or commit suicide towards suicide varies from place to [73]. place. An important advance in suicide theory Understandably, media coverage of was recorded about two decades ago suicide varies according to house styles. when [52] proposed the now-widely Reporting suicide for some media referenced Interpersonal Theory of organisations may depend on the Suicide. [19] framework explained adopted house style or other factors suicidal ideation and how a progression [65]. In fact, according to [71], the media from ideation to attempted suicides can – suicide relationship is complicated. be explained as different progressions Media coverage of an issue such as with different risk factors. This suicide develops out of various framework specifically proposes that: social/cultural dynamics and contexts, ‗‗Perceptions of low belongingness and and frequently reflects on the existing high burdensomeness‘‘ can lead to the societal beliefs about the phenomenon intention to commit suicide, while high [9]. capability for killing oneself leads to At this juncture, it should be stressed possible fatal suicide attempts [32]. This that the knowledge of motives and theory therefore makes a significant patterns of suicide is important because contribution to our understanding of it explains the rationale or the socially suicide. and culturally constructed meaning of Inspired by Joiner‘s model, [38] lately it. The media as a powerful conduit for postulated an ―ideation-to-action‖ information dissemination also shapes framework as a guide for all suicide how people will remember or interpret theories and research. This is not quite an event. This suggests that the media distinct from Joiner‘s theory though. may provide that platform where the Indeed [48] admitted that the collective understanding of suicide can Interpersonal Theory proposed by Joiner be generated and internalised. Beyond (2005) should be regarded as number media‘s role in suicide, cultural one ‗‗ideation-to-action‘‘ suicide theory, differences in method of suicide should and that the framework has birthed a not be undermined. new set of suicide theories in modern Theorising Suicide: the old and times. For instance, [61] suggested the modern models Integrated Motivational-Volitional Different scholars have attempted to model, which like [42] proposes explain suicide using different different interpretation of suicidal models. Although some of the ideation and attempts. In [8] view, arguments are dated, they are worth defeat and entrapment represent two mentioning. For instance, major factors that drive suicidal in [65] perception, suicide is seen as a ideation, whereas acquired capability response to ‗psychache‘ or an and other related factors such as access enormous pain, [8] stressed the role of to harmful weapons and impulsiveness social seclusion, while [11] sees suicide could illuminate the inclination to from the prism respond to suicidal thoughts. It is of escaping a disinclined state of mind. therefore scholarly encouraging that More recently, [41] attributed suicide different theorists have embraced the to hopelessness. These ideation-to-action framework. theories unarguably offer tremendous [17] also highlighted that disrupted insight into the suicide research connectedness is the same as low and efforts at mitigating it, but they also ‗belongingness and burdensomeness‘

Ogbodo www.iaajournals.org explained by [7]. The difference research is therefore important in order according to [3] is that the chief to understand the cultural differences in function of connectedness is to shield methods of self-killing as well as how against strong suicidal ideation among this understanding can help in the individuals at high risk owing to painful interventional strategies aimed at or hopeless situation. They argue that containing the prevalence of suicide. disrupted connectedness potentially According to [7], the idea that media leads to pain and hopelessness, adding potentially triggers suicide ideation or that mental disorders, state of mind, completion is a fascinating one that has personality traits and experiences been undertheorized. Indeed, scholars cannot be dissociated completely from such as [14] suggest that exposure to suicidal ideation. media coverage of suicide could have Regarding Psychodynamic Models, [18] ‗suggestive effects‘ on vulnerable argue that a "retroflexed rage" persons who may try to mirror the characteristic in suicidal behaviour, publicised pattern of suicide. Previous makes the victims to redirect an research has attempted to examine how aggressive impulse initially meant for these ‗suggestive effects‘ work. For the ‗significant other‘ (e.g. wife, parent instance, drawing from the social or child) towards themselves. The learning theory, [54] concludes that position of this model is that suicide is suicide suggestion through the media triggered by different unconscious may teach people how to end their lives. drivers. In the same line of thought, [9] A research by [33] also found that after proposed that suicides have three main people were exposed to a TV show motives: the willingness to kill, modelled after suicide by self- especially the loved ones; the poisoning, there was an upsurge in the willingness to be killed, or to be number of suicide by self-poisoning. attributed with the guilt for murderous Similarly, more recent research found intentions; and the willingness to that admiring or identifying with a die. [21] contend that suicidal persons suicide decedent is crucial to the social are hopeless about their condition and learning process of committing suicide that is why they look at their decision to [20]; [21]; [22]. The implication of this is end their life as the only way out. that when people model suicide motive, Despite the observed variations in those who identify with or admire the methods of suicide across cultures, role model who committed suicide may studies suggest that the major drivers in attempt to see suicide as a panacea for a the choice of methods of suicide can be similar stressor. In other words, when narrowed to physical and cognitive the media glorifies suicide for any availability as well as socio-cultural reason, people may adopt suicide as a tolerability [27]; [28]; [29]. This norm. dimension of approaching the suicide CONCLUSION Without mincing words, the contribution would also give an accurate insight into of culture in understanding suicide the cultural variations of suicide given phenomenon, attempts, behaviour, or that most studies evaluating suicide ideation cannot be overemphasised, and prediction lack accuracy and can only be it could further be explored by limited to clinical utility. investigating the negative effect of Again, the literature review informs the relating cultural mechanisms to its conclusion that irresponsible media interpretation. Although studies such coverage is capable of triggering a spike as [73], [74], [75] have extensively in suicide rates, especially among reported on the cultural differences in celebrities or models. The implication is suicide statistics, a little is known about that when the media devotes excessive the specific cultural differences that time in covering celebrity suicide, underlie the risk of suicide and vulnerable fans may model their suicide protective factors. Such information is motive against their role models‘. The not only imperative for understanding media‘s approach to reporting or the culture-specific risk assessment and framing suicide is therefore important prevention of death by suicides, but in the perception and deeper

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