Suicidality in Young Asian Women: the Role of Shame
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Suicidality In Young Asian Women: The Role Of Shame Sejal N. Patel D.Clin.Psy. Thesis (Volume 1) 2005 University College London UMI Number: U593205 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. Dissertation Publishing UMI U593205 Published by ProQuest LLC 2014. Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 CONTENTS Overview ............................................................................................................ 1 Acknowledgements........................................................................................... 2 Part 1: Suicidal Behaviour in Young South Asian Women: A Review 3 Abstract.............................................................................................................. 4 Introduction........................................................................................................ 5 Definitions......................................................................................................... 6 Prevalence of Suicide........................................................................................ 9 Models of Suicide............................................................................................. 25 Religion, Restriction and Role Conflicts: The Meaning of Suicide 35 Shame............................................................................ 51 Conclusions....................................................................................................... 60 References......................................................................................................... 62 Part 2: Suicidality in Young Asian Women: The Role of Shame 73 Abstract.............................................................................................................. 74 Introduction....................................................................................................... 75 M ethod............................................................................................................... 85 Results............................................................................................................... 90 Discussion......................................................................................................... 98 References........................................................................................................ 108 Part 3: Researching Shame and Suicidality in Young Asian 114 Women: A Critical Appraisal Why Study Suicidality in Young Asian W omen?.................................. 115 Strengths, Weaknesses and Limitations of the Study............................. 116 Researching Shame in an Asian Cultural Context.................................. 120 Why Might a Sharam Experience Lead to Suicide?............................... 123 Personal Reflections on the Research Process........................................ 125 References.................................................................................................. 129 List of Tables and Figures Figure 1. Proposed Etiological Model of Suicidal Behaviour (Yang & Clum, 1996).............................................................. 31 Figure 2. Interrelation of factors in deliberate self-harm in young Asian females (Thompson & Bhugra, 2000)......................... 34 Figure 3. Proposed Model of Suicidality in Young Asian Women 84 Figure 4. Revised Model of Suicidality in Young Asian Women 107 Table 1. Correlation matrix for all shame variables.............................. 94 Table 2. Correlation matrix for all suicidality variables....................... 94 Table 3. Means, medians, standard deviations, significance between groups and Chronbach’s alpha levels...................... 95 Appendices 132 Overview Part 1, the literature review, covers the main areas of definitions, prevalence and models of suicidal behaviour as well as current literature on shame, introducing the Asian cultural concepts ofsharam (shame) andizzat (honour). It concludes that these concepts are central to understanding the experiences of South Asian women, that Western models of suicide do not provide adequate explanations of a higher risk in Asian women and that current hypotheses that cite ‘culture conflict’ as a causal mechanism may be too simplistic. Part 2, the empirical paper, reports on a study of suicidality and experiences of shame in 159 female, Asian Hindu, Asian Muslim and White British university students aged between 18-24, using structured questionnaires in addition to a measure designed for this study to assesssharam. Cultural values conflict was also assessed in both Asian groups. The main findings gave support to the hypothesis that suicidality would be higher in Asian women and to the proposed model suggesting that conflict between culturally prescribed values and an Asian woman’s own values may lead to greater suicidality via the mechanism of a sharam experience. Part 3, the critical appraisal, discusses the strengths, weaknesses and limitations of the present study, with reference to community vs. clinical studies, self-report vs. interview measures and problems associated with defining suicidal behaviour andsharam, leading to difficulties in interpreting results. Finally, this part concludes with a discussion of issues of political correctness and anxiety in researching ethnicity and suicide. 1 Acknowledgements Firstly, I would like to thank Katrina Scior and Peter Scragg for their infectious enthusiasm about my research ideas and their excellent supervision. Their encouragement, support and determined efforts in keeping me motivated during the arduous task of writing up were very much appreciated. Thanks also to Pasco Fearon, for being so calm and patient during my statistical crises. When I was initially forming my ideas for this research, Professor Paul Gilbert generously gave his time to speak to me about his recent studies that were hugely relevant to this thesis and subsequently provided me with a measure that I adapted, forming the basis of my research question. I am very grateful for his time and generosity. To my family and friends who have been neglected over the past months, thank you for not minding too much and supporting me anyway. To Stephen, for the infinite amount of things you did to help, for your endless support and encouragement and for enduring my slight mania with a smile, thank you. 2 Part 1 Suicidal Behaviour in Young South Asian Women: A Review ABSTRACT The literature addressing suicidal behaviour in young South Asian women is reviewed. Most published literature cites ‘culture conflict’ as a causal mechanism for the high rates o f suicidal behaviour found in this group. Whilst this concept is undoubtedly o f relevance, it is ill defined and does not propose a mechanism through which conflicting cultural roles may lead to suicidal ideation and behaviour. Recent research suggests a role for shame in the suicidal behaviour o f young Asian women. A specific pathway is for the first time proposed in this study, by hypothesising that experiencing conflict between Western and South Asian cultures in terms o f acceptable moral and social behaviour for women may lead to or at least contribute to suicidal behaviour through the cultural concepts o f ‘sharam ’ (shame) and ‘izzat ’ (honour). The shame experienced is thought to relate more to a fear o f shaming one’s family and/or community, and thereby affecting family honour rather than to Western concepts o f shame. Religion is examined as a moderating variable, as research suggests that Muslim women may be at lower risk o f suicidality than South Asian women from other religious backgrounds; in particular Hindu women. A hypothetical model is proposed linking culture conflict, shame and suicidal behaviour with religion moderating the effect o f shame on suicidal behaviour. 4 INTRODUCTION In this paper, I review the literature on suicidal behaviour in young South Asian women. Firstly, I define suicidal behaviour, before considering its prevalence; beginning with general prevalence of suicide in the UK, then specifically in young Asian women in the UK and end this section with a comparison of suicide prevalence rates in young Asian women in Asia. I then examine current models of suicide in the literature, considering the value of these (Eurocentric) models for understanding suicide in a South Asian cultural context. This is followed by a discussion of the literature available on the meaning of suicidal behaviour in young Asian women, introducing the concepts sharamof andizzat (shame and honour). Finally, I review the (limited) literature on shame and suicide, beginning with definitions of shame and relevant psychological issues associated with an experience of shame. I then briefly explore affective and behavioural components of the experience of shame before discussing links between shame, honour and suicide. I highlight the gap in the literature addressing shame as a possible cause of suicidal behaviour rather than just as a result of the (failed) act. The terms ‘South Asian* or ‘Asian’