AUTHOR: Philip O’Keeffe PhD MSc Reg MBACP (Accred)©2017 [Comments & queries: firstname.lastname@example.org ]
Almost the same number of lives were sacrificed in Northern Ireland’s (NI) 30 year ‘Troubles’ (3,600) as were extinguished by suicide (3,300) in the 15 years following the Good Friday / Belfast Agreement (1998). It is suggested that NI society’s response to political murder (1968-1998) attracted unlimited state investigative resources while domestic suicide (1998-2012) was largely ignored. The lives of survivors of bereavement, whether by political murder or by domestic suicide, are changed utterly as they attempt in the aftermath to come to terms with their unconscionable losses. This article argues therefore that each death by suicide, should be as fully investigated as if it were by murder. To fail to do so represents an ongoing missed opportunity to understand the actualité of suicide in NI and to supply an evidence base for realigning currently unsuccessful reduction and prevention policies. (140 words)
AFTERMATH OF POLITICAL MURDER
Over 3,600 deaths by violence in UK/Ireland resulted from a 30 year-long attempted coup d’etat by a few hundred armed, Irish, irredentist revolutionaries that was vigorously resisted by UK state police and military power, allegedly in collusion (Cadwallader, 2013; Urwin, 2016) with renegade UK state forces and armed loyalist paramilitaries, in a ‘dirty war’ (Dillon, 1990) from mid-1969 until a truce was ratified by way of the Belfast/Good Friday Agreement (http://cain.ulst.ac.uk/issues/violence/cts/fay98.htm#tables; Belfast Agreement, 1998).
Each fatality and alleged perpetrator is given a brief, cursory mention in the Cain Website (2005 et seq) and in Lost Lives (McKitterick et al., 1999-2008). However those left to mourn these horrendous, but essentially and ultimately purposeless losses of their family member, merit little mention and negligible attention. Today – June 2017 – what are now known as legacy issues – the unanswered “when?”, “how?”, “where?”, “why?” and “by whom?” questions about each of a vast majority of these killings – dominate the North’s/Northern Ireland’s/North-east Ulster’s (hereafter NI) political agenda. Along with current issues related to Irish language and “equality” – the latter still undefined but whose civic & cultural absence from NI is said to be evident to all – what to do to assuage the unresolved predicament of grief-burdened survivors of 3,600 plus unjustified and savage losses, remains unaddressed: hence legacy issues.
An attempt was made in 2007/09 by a Consultative Group on the Past (2009) whose remit was summarised in the report’s Executive Summary, as follows:
“On 22 June 2007 Peter Hain, the then Secretary of State for Northern Ireland, announced the formation of an independent Consultative Group. The Group was asked to:
consult across the community on how Northern Ireland society can best approach the legacy of the events of the past 40 years;
make recommendations, as appropriate, on any steps that might be taken to support Northern Ireland society in building a shared future that is not overshadowed by the events of the past;
present a report, which will be published, setting out conclusions to the Secretary of State for Northern Ireland, by summer 2008 (Note: Report published in 2009).
The Right Reverend Lord Eames OM, former Archbishop of Armagh, and Mr Denis Bradley, the first Vice-Chairman of the Policing Board, co-chaired the Consultative Group on the Past. The following were members of the Group: Mr Jarlath Burns, Rev. Dr. Lesley Carroll, Professor James Mackey, Mr Willie John McBride MBE, Ms Elaine Moore, and Canon David Porter.
Mr Martti Ahtisaari, former President of Finland, recent Noble Peace Prize winner and founder of the Crisis Management Initiative, and Mr Brian Currin, former chair of the South African Prison Audit Committee and founder of the National Directorate of Lawyers for Human Rights, acted as international advisers to the Group. Mr Jeremy Hill acted as the Group’s Legal Adviser.” (Consultative Group on the Past, 2009)
Unfortunately, following a massively negative response in a public consultation upon the report, NI political parties could not agree to implement any of the Report’s recommendations (BBC, July 2010). Eight years on, the ‘Troubles’ legacy issues continue to fester, unrecognised, unacknowledged, unameliorated: they remain painfully alive in the memory for thousands of surviving relatives and friends of the murdered – including seriously injured people – their numbers gradually diminishing by time’s attrition.
I recall what my ‘boss’ (deceased, RIP, 1985) in the civil service said – he was given to thinking aloud – in the late 1970’s about the then ongoing so-called “Troubles”: he said that our ability to keep careful, accurate, objective, criminal statistics offers confirmation that society hasn’t broken down: in other words each of these cowardly assaults, each one of these premature deaths, each of these inhuman crimes merits close attention so that when the killing stops, justice might be upheld.
This topic – referred to by some optimists as a truth and reconciliation process – is notionally on the agenda for current UK election (June 8) and possible ‘second Stormont election in a year’ although our uncompromising, solution-resistant, mirror-opposites bigotry could ensure little if any change in NI’s political, cultural or civic architecture, as expressed in 19 July 2010 (BBC, 2010).
AFTERMATH OF DOMESTIC SUICIDE
Recently some academics calculated that the numbers of NI citizens deceased by suicide, viz. 3,300 premature dead, during 1998 to 2012, i.e. 15 years since the above-mentioned truce (see ‘Belfast Agreement, 1998), was on a par with (See http://www.thedetail.tv/articles/suicide-kills-as-many-as-the-troubles: Torney, 2014) those 3,600 poor pawns, murdered during NI’s futile, power-lust driven slaughter by neighbours of their neighbours.
So what about a truth and reconciliation process for the grief-burdened survivors of these 3,300 innocent dead? Estimates vary (Berman, 2011) about how many individuals bereaved by a suicide, may be adversely affected materially and psychologically:
“. . . at least six loved ones are directly affected by the death . . . likely an underestimation [that] may not account for the emergency responders, health care providers, co-workers and acquaintances also affected by the suicide.” (Young et al., 2012)
Are these suicide deaths not as equally ‘horrendous, but essentially and ultimately purposeless’ as those murdered souls? The author’s family suicides (1982 & 1989) seriously adversely affected at least 31 immediate family members, partners, children, parents, siblings, nephews/nieces, in-laws. Could ‘public opinion’ in NI, per a consultation process and some level of political agreement generate a humane way to alleviate, assuage, and ease the pain generated by each of these losses, other than in our customary short-lived wringing of hands, that frequently morphs into longer lasting feelings of complicated grief, confusion, impotence? The wise Shneidman (2001) had no doubt that:
“each sad case [of a death by suicide] should be assessed, understood and treated in its own idiosyncratic psychological terms.” (Shneidman, 2001: 203)
The forward focus of the NI Stormont Government’s health department and local academic researchers to some extent ignores suicides legacy issues other than to add ‘bereavement by suicide’ as an additional suicide risk factor, to an already burgeoning list (Scottish Government Social Research, 2008) for relatives, friends, and colleagues of the suicide deceased. This has a well intentioned purpose – honourable we must accept – to reduce future suicide quanta. Interestingly, their joint policy approach relies almost exclusively on an emphasis upon a disputed relationship that’s said to exist between ‘mental ill-health’, including ‘Troubles’-related trauma, and suicide. This ‘cause/effect’ myth and the psychiatric energy invested in adhering to it have not yet halted NI’s escalating ‘suicide rates’. See Torney (2014) for references to Bamford (Ulster University), and Stormont health department, illustrating their reliance upon this failed ‘all our eggs in one basket’ approach.
In the author’s view, the sooner we move away from ineffective ‘mental ill-health-related’ suicide prevention approaches, policies and practices, the sooner we might come to understand, as a starting point, that human suicidal behaviour in another person is as idiosyncratic as that person’s unique fingerprint, and may not otherwise be comprehended. The late Edwin S Shneidman, PhD, acknowledged in suicidology as one who knew more than anyone about human suicidal behaviour, did not rely upon portmanteau metaphors like mental health, mental ill-health or mental disorder when communicating his insights into suicide in innumerable books, journal articles, and media and personal interviews:
“It is my belief that our best answers, as therapeutic suicidologists, cannot come from medicine or physiology or group behaviour or epidemiology or sociology, not from Kraepelin nor the Diagnostic and Statistical Manual of Mental Disorders, and certainly not from Smith-Kline Beecham.” (Shneidman, 2001: 201)
Rather, as a psychologist, he focused on psychological needs, emotional responses and ‘psychache’, a word he invented to describe unbearable psychological pain:
“Shneidman . . . described suicide as a "drama of the mind." He coined the term psychache, which is the psychological pain -- consisting of negative emotions and unmet psychological needs -- that an individual experiences. It differs from physical pain since it stems from emotional, rather than physical, discomfort. Psychache creates an overwhelming amount of distress in an individual so that he or she perceives suicide as the only way to escape the pain” (Clinical Tools, 2017).
Shneidman (2001: 203) explained further that if unrelieved psychological pain was a major source of suicide ideation, then, as an initial step, the helper might gently and compassionately invite the sufferer to answer questions like: ‘Where do you hurt?’ and ‘How may I help you?’
Earlier it was noted that ‘bereavement by suicide’ is a risk factor for suicide (The Right to Health Campaign, 2016). The “Safer Campaign” relied upon a World Health Organisation (2014) report to assert that:
“Studies . . . show that people who die by suicide often know someone who did the same recently and that ‘those who are affected or bereaved by suicide have themselves an increased risk of suicide’” (Right to Health Campaign: the SAFER campaign, 2016: 6)
And so the ‘where do you hurt?’ question may also usefully be gently put by therapeutic helpers to survivors of bereavement by suicide. This might be a start: but unless the helper – whether psychiatrist, psychologist, general medical practitioner, mental healthcare worker, psychotherapist/counsellor, Samaritan volunteer, social/community worker or simply friend, neighbour, colleague or bystander – has the knowledge, the time, the capacity, the humanity, and the developed skill to listen to the sufferer, actively and with compassion for as long as it takes, then we waste everyone’s time and need not have bothered. Such listening may need to be available to sufferers for a lifetime, because the pain of loss of a loved one by suicide may indeed be life-long for survivors. But is this all that’s required?
TRUTH PROCESS FOR SURVIVORS BEREAVED BY SUICIDE
You’ll have begun to notice that, in the author’s view, there may be a cross-over that connects the psychological needs of survivors of loss, due to NI’s bigotry-fuelled, political conflict (1969-1998) with survivors of loss by domestic suicide subsequently, viz. 1998-2012, and currently. The obvious difference here is that murder is against the criminal law while suicide, since 1966, in NI, 1961 in England/Wales and 1993 in Irish Republic, is not. [Suicide is not unlawful in Scots Law (https://en.wikipedia.org/wiki/Suicide_Act_1961).] With murder, the perpetrator is guilty of a serious offence, punishable in UK/Ireland on conviction by lengthy imprisonment. With suicide, the alleged perpetrator is not amenable, being dead. But legacy issues for both sets of bereaved, although different, do have much in common.
Four of these questions immediately arise – see above – for suicide bereaved as for murder bereaved: these are the unanswered “when?”, “how?”, “where?”, and “why?” queries. The fifth “by whom?” question becomes the focus for a criminal investigation where murder is suspected while a crime file is not opened where death is by apparent suicide. Readers will be familiar with the UK/Irish police statement’s formulaic words, viz. no suspicious circumstances, customarily used where cursory investigation of a death scene by police, that rules out natural, accidental or homicidal causation, leads rapidly to a conclusion by police that no crime has taken place, i.e. death was probably by suicide. Answers to the above four questions represent overlapping territory occupied by both sets of mourners. A truth and reconciliation process to examine legacy issues for survivors of political murder would seek answers to all five questions while such a process for suicide survivors would focus only upon four questions. At this point, any practical outcome from these comparisons evaporates: legacy issues for murder are on NI’s current political agenda while legacy issues for suicide are not.
Such contrasts between ‘Troubles’ murders and post-‘Troubles’ suicides are blatantly evident in media responses. Each of our 3,600 murders was fully reported in depth by print journalists who based their articles on police statements and later court reports. Editorial decisions about what ‘news’ is reported rely upon that nebulous concept known as ‘newsworthiness’. Very few of our 3,300 suicides made it to print media. Murder in NI, particularly political – or using the current, ‘peace process’ mantra, conflict-related – killing is always newsworthy. Suicide is not. Exceptions exist where editors may consider that a particular suicide-related incident meets ‘public interest’ criteria that facilitate media reportage. The term ‘public interest’ belongs to a parasitic class of imprecise, but influential subjective terms like ‘mental health’, ‘mental illness’ , ‘mental disorder’, national interest, ‘the right thing to do’, ‘what matters’ and so on employed by journalists, politicians and propagandists and described by an unnamed senior BBC news figure, in a study about the media, privacy and public interest (2002):
“[public interest] will always be a grey area . . . I don’t see how you can logically, and rationally, impose some sort of blueprint which enables you to know whether it’s in the public interest or not . . . . National interest these days can mean whatever the government wants it to mean, in a particularly cynical way. Public interest, by the same token, could easily mean whatever the editor [or owner] of a newspaper wants it to mean.” (Morrison & Svennevig, 2002: 8)
Relevant local examples where ‘public interest’ may determine the extent, if any, of media reportage of suicide include public coroner’s inquests, murder/suicide incidents, multiple suicides meeting specific, restricted, geographical or time-related criteria, sometimes referred to as ‘suicide clusters’, so-called celebrity suicides, child/young person suicides, suicides enacted in public places, and so on:
“The Coroner will seek to establish the cause of death and will make whatever inquiries are necessary to do this e.g. ordering a post-mortem examination, obtaining witness statements and medical records, or holding an inquest . . . The NI Coroner’s Service ‘inquire into deaths that appear to be . . . unexpected or unexplained, as a result of violence, an accident, as a result of negligence, from any cause other than natural illness or disease, or in circumstances that require investigation.’ NI Courts Service (2017)
Because public inquests into deaths by suicide in NI are infrequent, the outcomes of coroners’ investigations do not often enter the public sphere. In recent years academic researchers have secured restricted, partial access to records of deaths by suicide, and by undetermined intent, as identified by NI’s local coroner’s service. Some recent findings are described next.
SUICIDE RESEARCH AND THE FOUR QUESTIONS – WHEN, HOW, WHERE, WHY.
With few honourable exceptions, suicide research in UK/Ireland uses quantitative methods, focused on numerically large-scale statistical analyses of commonalities rather than a qualitative approach that may focus upon one or more individual case studies. Each approach seeks to understand human suicidal behaviour as a window into suicide reduction and prevention. The four questions may be considered by either research model.
A recent research paper (Benson et al., 2017) explored the use (and abuse) of prescribed medication by suicide deceased using a quantitative analysis of coroners’ records of 1,371 suicides, including ‘police reports, medical notes, and statements from next of kin’ (p3). At the outset, it is clear that researchers’ interest was narrow, being largely restricted to deceased’s use (or not) of prescribed medication in relation to their medical status before and at death. However, researchers also had access to each deceased’s ‘socio-demographic variables [and] details relating to the suicide [that] included the method of suicide, adverse events prior to suicide and . . . suicide notes (if any)’. It’s evident that only the ‘why?’ question remained unanswered since coroners files may have provided adequate factual evidence regarding the ‘when?’, ‘how?’ and ‘where?’ of each suicide.
The paper (Benson et al., 2017) identified that medication prescriptions for over half of the deceased were for ‘mental health disorders’ (51.7%) while under half of the deceased were prescribed for ‘a physical condition’ (45.2%) and almost a third (31.6%) were prescribed medications ‘for both mental and physical health conditions’ (p6). Over one in 20 (6.7%) died by overdose while under one in 10 (7.9%) died by drowning. No information was available in the paper about how the remainder (85.4%) died.
The glaring absence in this research, albeit meticulous, cautious and expert, but limited, is that it tells the reader nothing about the deceased individual’s suicide trajectory: we learn nothing about the ‘why?’ question. Edwin Shneidman’s classic text (2004) examined in detail one man’s death by suicide: he demonstrated that it is possible to get close to an answer to the ‘why?’ question – but only if a coroner or a researcher completes the potentially complex investigative work involved and can command sufficient resources to achieve this.
SUICIDE – A DRAMA OF THE MIND
Essential reading for researchers who customarily employ quantitative methodology is Edwin Shneidman’s classic case study (2004). In a short text (177 pages) Shneidman joined eight expert colleagues in investigating the recent death by suicide of Arthur, a 33 year old lawyer, apparently by drug overdose. Arthur’s mother Hannah gave Edwin a copy of Arthur’s eleven page hand-written suicide note which he included in his book (Shneidman, 2004: 165). Hannah asked Edwin if he might be able to offer her some insights and some solace about her boy’s death (p3). This is indeed the ‘why?’ question that family members, friends and colleagues of our 3,300 deceased ask: please may we have some insights and solace about the sudden, violent, premature, tragic death of our fellow human? [The author has personal experience of this continuing unmet need, 34 years later, for ‘insights’ into his family members’ deaths that were not available despite his participation in two excruciating public inquests.] Shneidman’s response to Hannah was that he ‘would try to generate information, hoping there would be insights and solace in that new material’ (p5).
This ‘new material’ consisted of nine verbatim, (edited for anonymity) transcribed interviews with Arthur’s relatives (4), friends (3), his psychotherapist and his treating physician. This ‘evidence’ – described by Shneidman as a ‘psychological autopsy’ (p xiv) – along with the suicide note were shared with eight of Shneidman’s professional colleagues, all ‘world-class experts in suicidology’, and each produced a short report. In particular, they were invited to comment upon what, if anything, might have been done to save Arthur’s life.
Readers can access and read Shneidman’s text for themselves. I recall being surprised and a bit disappointed when, during a ‘networking’ conversation at a local suicide prevention seminar, a professional acquaintance, reputedly an expert in suicidology, conceded that they had neither heard of nor read Shneidman’s text. It may be that a psychological autopsy following a suicide is as good as it gets for survivors. Clearly Arthur’s grieving mother did not have access to such a detailed investigation into Arthur’s death prior to Shneidman’s intervention. Nor have I regarding our two family deaths.
I have no knowledge as to the extent of use of a ‘psychological autopsy’ (PA) methodology for some, all or even any of the 3,200 suicide deceased in NI from 1998 to 2012. Some perhaps serious flaws have been identified in psychological autopsy, for example, the illogical attempt to assign a reliable psychiatric diagnosis of mental disorder upon someone – the deceased – by interviewing someone else (Hjelmeland et al., 2012). Further, Salvatore (2015) offers a detailed, somewhat critical examination of PA that also suggests the need for change:
“. . . psychological autopsies remain a practical and viable research strategy for use in gathering information about the background, actions, and experiences of suicide victims. However, their use should be untethered from the mental illness model of suicide and not be restricted to trying to define the mental states of the deceased who took their lives.” (Salvatore, 2015: 13)
What has been briefly examined above is the clear contrast that separates NI society’s approach to political murder from its consideration of domestic suicide. Whether there is ever a determined attempt to reduce the existing gulf between the quantum of scarce public, taxpayers’ resources variously deployed in investigating these tragedies remains to be seen. Unlimited public funds appear to be available to investigate the consequences of 30 years of political murder, while comparatively negligible amounts are dedicated to the aftermath of domestic suicide. Currently this latter issue does not feature strongly enough as a discrete element in NI government programmes (Right to Health Campaign, 2016). Local human rights charities, like Participation and the Practice of Rights (PPR), have had some recent success in highlighting the physical and psychological health needs of potentially thousands of survivors of bereavement by suicide. What remains ‘off the table’ however is energetic strategic action in NI with respect to Edwin Shneidman’s dictum regarding the uniqueness of each suicide death:
““each sad case [of a death by suicide] should be assessed, understood and treated in its own idiosyncratic psychological terms.” (Shneidman, 2001: 203)
This represents a lost opportunity for learning about, and enhancing, our understanding of the actualité of human suicide, and how more insightful prevention and reduction strategies might be designed and implemented so as to replace over time our current, largely unsuccessful policies.
[3634 words (excl references)]
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Philip O’Keeffe PhD MSc Reg MBACP (Accred)©2017
Caveat: This paper may be copied and circulated but only if the author’s name and copyright are acknowledged.