Translation: Paraskevi Bassioti « …As I cannot find justice, I cannot find another struggle of reaction except from a dignified ending… »
(Excerpt from the suicide note of D. H. at Syntagma Square)
The present paper discusses the subject of suicide from a psychological, sociological, anthropological and existential viewpoint. According to the statistical data of the World Health Organization, approximately 800.000 people died of suicide in the year 2017, while the suicide number in Greece for the year 2013 is 533. The low-risk as well as the high-risk factors of suicide acts are cited according to the international literature. Assuming that a behaviour can be explained within the context it occurs, suicide becomes comprehensible through the lens of the intense social phenomena observed in Greece, such as uncertainty, fear, financial instability, unemployment, etc. An attempt is made to analyze philosophically the suicide causes in Greece, during the period 2009-2012, based on the publications of the Greek press, and finally, ways for its prevention on a social level are discussed.
**Key-Words: ** Suicide, Greece, General systems theory, crisis, unemployment, society
Introduct ion and Purpose of the Present Study
Suicide is an act of desperation of the individual that has no interest in living, and at that particular time they consider it as their sole way out of their mental pain (Belegrinos et al., 2014).
According to the statistical data of the World Health Organization (WHO), approximately 800.00 people died of suicide in the year 2017. It is the second most frequent cause of death for the ages between 15 to 29 years, while 78% of suicides is recorded in countries of low and medium income (WHO, 2017).
The present paper focuses on the definition of suicide, makes a reference to the most important protective factors and describes the main causes for people to commit suicide. It should be noted, however, that while many reasons have been postulated in the literature, the aim is not a thorough description and analysis of each one of them, but the approach of this issue from a philosophical, socio-political viewpoint. More specifically, emphasis is placed on a sociological, anthropological, even existential study of suicide and on its connection and explanation in the light of the social and financial crisis in Greece. Simultaneously, a classification is undertaken of suicides, based on the Greek press publications between 2009 and 2012, a period of intense economic recession in Greece. Finally, using as a starting point the social and symbolic dimension of suicide, ways for its prevention in a social level are suggested.
Definition of Suicide
It comes as no surprise that until the 19th century, the study of suicide had been the object of research mainly of theology and secondarily of philosophy. Today, however, the interest has shifted towards the fields of sociology, social anthropology and psychology, posing crucial questions about the reasons for this act. At the same time, in literature, poetry and the arts as a whole the act of suicide has been and still is a source of inspiration. It is even considered an act of liberation, the last free choice of doomed heroes.
Suicide is believed to be “an indication of crisis of a society, a serious phenomenon that deserves our attention” (Tatz 2005: 108). Today in Greece, many are those in this kind of situation who choose the path of suicide. An act which is a complex human situation and involves many factors, hence an accurate definition is difficult to pinpoint. According to Durkheim, suicide is defined as “every case of death that is the direct or indirect result of an act positive or negative, that the victim themselves commit, knowing the result” (p. 8).
However, regardless of its definition, which is not common in all social and anthropological sciences, suicide constitutes a taboo act. It is inconceivable for most cultures that an individual cancel their own existence. “The cultural standards of every social group, the various ways of living, the perceptions and the traditions about death and the most powerful of them all, the sense of religious beliefs, situations that vary from region to region, determine the attitude with which suicide is dealt” (Christakis, 1994: 27). It should be noted at this point that according to Greek legislation suicide is forbidden, since the protection of life is absolute for the legislator. Consequently, suicide goes against a peculiar legal obligation of the individual “to live” (Androulakis, 1974. Papacharalampous, 1997).
Moreover, the lack of sufficient and positive information cultivates and perpetuates old prejudices and stereotypes that define suicide victims more or less as cowards (Ramphele, 1997), “defective” or “weak” to deal with the difficulties of life (Tatz, 2005). The result is that social crises emerge as individual crises, perhaps because it is not easy for us, beyond the psychological interpretations, to focus on the social dimension of suicide as well. In western civilization this act has been an indication of antisocial and irrational, violent behaviour. But, this one-sided view only reveals the side of the suicide victim, proposing explanations for their act without shedding light on suicide as an act in the context of social logic.
A person who has lost faith in the future - their own future - are more likely to manifest suicidal ideation and behaviour (Turecki & Brent, 2016). And where volitional adaptability does not offer meaning to life through redeeming practices, physical death (usually suicide) or mental death becomes the outcome, the end of the whole matter (Daniel, 1997).
High Risk Factors and Statistical Data
The reason why people commit suicide is a deeply humane and perennial question. In all times, suicide victims act almost identically, irrespective of the social systems, religions, beliefs, morals and traditions of the people they come from, and any effort to attribute this self-destructive impulse to a sole cause is unrealistic. The suicide act is a complex multifactor human behaviour and the cause – motive of every case is as different as every human being is unique, with their own existence, idiosyncrasy and logic. As J. Zubin puts it: “It is the end of a process, not the process itself. In suicide, what we usually have is the final result that emerges from a variety of factors. The detection of the causes is almost impossible after the event” (in Alvarez, 1974: 74).
Nevertheless, scientific studies have been conducted and have revealed the most important factors that are related to a high risk of suicide attempt. These include high introversion, intense hopelessness, helplessness and the sense of impasse (that might originate from depressive symptomatology), the existence of psychiatric diagnosis, traumatic events during adolescence, grief, financial or legal difficulties, interpersonal stressful factors, chronic or incurable illnesses and a lonely life. On the other hand, low-risk factors include the powerful reasons for life, the responsibility for young children, effective problem management and problem-solving skills, a strong supportive social network, extroversion and religiosity (Turecki & Brent, 2016).
As far as Greece is concerned, the economic crisis seems to have inflicted on citizens a direct impact, not only financial but also psychological, as the mental resilience of many is tested under the weight of responsibilities that their role in their immediate or broader social environment entails. _“The economic crisis does not constitute the “cause” of suicides in strict terms… But it is the trigger factor for vulnerable people. People are not the same; some can take more, others less. Crisis is a potent stressful factor which can, under certain conditions, lead you to extremes” _ (interview of the psychiatrist E. Bekiari to the journalist L. Giannarou at 2012).
Experts now refer to a “national depression” (an expression borrowed from G. Keramidiotis’ documentary, 2012) that may escalate to an epidemic. In addition, it is considered indisputable that individuals in need of psychiatric and psychosocial care, as well as their families, suffer the consequences of this crisis on a greater scale as a vulnerable social group. Poverty, insecurity, exclusion and lack of prospects and hope for the future can activate the deficit of resilience of the individual, who experiences abrupt changes in their relationship with the social structures. Disorganization, intense stress and identity crisis are likely to affect individuals as well as collective institutions, such as the family and the society. This human “cauldron” that boils does not remain in the sphere of theory, but is already reflected in clinical practice: A high correlation is observed between expression of death wish and unemployment and development of severe psychopathology and unemployment (Madianos et al., 2011, Ekonomou et al., 2012).
Quoting more extensively the available statistical data, in 2008 373 suicides were recorded, 391 in 2009 , 377 in 2010 , 477 in 2011, 508 in 2012 and 533 in 2013 (Hellenic Statistical Authority, 2017). During the period 2007 – 2009, when unemployment in the 26 state-members of the European Union increased by 35%, the suicide rate rose by at least 5%. More specifically, at 17% our country was proclaimed “champion” with regards to the suicide increase (Stuckler et al., 2011). During the triennial 2009 – 2011, the prevalence rate of a one-month major depressive episode marked an increase of 4,9%. And while in 2008 the prognostic factors of major depression corresponded to its common epidemiology, in 2011, an increased risk of developing depressive symptomatology was presented by persons of younger age and married individuals; whilst all layers of the Greek population were affected (Ekonomou, 2012).
Meanwhile, as Associate Professor of Psychiatry of University of Athens, D. Ploumpidis, reported in an interview, an increase in the development of symptoms from the mental sphere is observed –mainly generalized anxiety and depression – but also psychosomatic complaints – tachycardia, shortness of breath, intense headaches, abdominal pains etc. - that are not attributed to some disease. In most cases, the factor is psychogenic, although there are no aggregated data for these (Tsolis, 2011). The result of this progress was a increase in the suicide rate from 2.8 per 100,000 population in 2008, to 5.2 in 2010 (Giotakos et al., 2011).
Suicide in the Greece of Crisis
As to why Greeks proceed to suicides or suicide attempts, the classic quadruple typology that was developed at the end of the 19th century by the French sociologist E. Durkheim is no longer in a position to classify them, as it is deficient in contemporary statistical foundation. Therefore, an attempt is made to integrate the suicide cases of 2009 - 2012, based on reports in the Greek press, into three basic groups. It should be noted at this point that under no circumstances is the mental health experts’ official research questioned – as it is conducted with the appropriate scientific statistical methods – neither is this classification proposed to the scientific community. The present effort is more of a philosophical approach to this issue, taking into account the current socioeconomic conditions in Greece and combining them with the predominant theories, without proceeding to an interpretation and analysis of the deeper personal psychological causes.
a. Suicide as protest:
A few cases, but very characteristic ones. It is about suicides of individuals of higher educational level with socio-political concerns and interests: On April 4, 2012, the 77-year-old retired pharmacist D. H. commits suicide at Syntagma Square before the Greek Parliament. Talking to himself immediately prior to pulling the trigger, he said that he was doing this in order not to leave any debt to his children, while a note found on him afterwards stated that the “occupation government” had left him with little chance of a respectable living and, unable to find justice, he was left with no option for struggle other than a decent ending, before he was forced to search for food in garbage bins. The perpetrator and victim had been an active citizen who participated in social struggles and events, not heavily in debt yet no longer willing to struggle in society. It is a similar story with the cases of Tibetan monks (almost 120 individuals from 2009 until 2012), who have publicly set themselves on fire, protesting the injustice and oppressionthey experience by the regime of China (La Franiere, 2012), as a way out from an environment of suppression and prohibitions.
Of course, all this is not to say that the Syntagma Square suicide victim should become a hero and his act sanctified; the only purpose is to explain his behaviour in its broader context. Although it could be characterized as rare and extreme, it still symbolizes the impasse and the cynicism that the constant degradation by the state itself has brought upon our lives. All of an individual's freedoms are political; they are enjoyed individually, but at the same time and before anything else, collectively, i.e. as part of a society. Their participation alone in a society is a necessary and essential condition that enables them to create and enjoy such freedoms (Paparizos, 2000). When these are taken away by the authorities and institutions, then the individual lashes out at them. While suicide appears to aim only at the destruction of the individual themselves, it is simultaneously an act of aggression towards “the others” (Wekstein, 1979). In essence, it constitutes a protest against all those who dominate and “institutionalize” us in the very society that we live in; for the individual is wont to long for the restoration of their freedom of movement at every level, when it has been removed, and to protest in every way when it is denied them (Reser, 2004).
b. Suicide as shame:
It concerns individuals of a high profile, local or otherwise, and also individuals who had a stable, above average financial and social standing. These are mainly men of 35-55: the generation that experiences the greatest impact today, carrying the responsibility for both the older and the younger generation, and those that find it harder to "metabolize" thwarting. So when all of a sudden they stop being the cornerstone, when they are deprived of income or they are standing in the queues of the unemployed, they feel inadequate and weak as their identity and self-image collapse on a symbolic level. They feel that they failed as fathers, husbands and men, as they are no longer in a position to provide the essentials to their families, whom they have thus shamed. Apart from the practical issues that arise, employment, affluence and the attendant social confidence affects on many levels the way of interacting with others, be they friends, family or life partners (Bouras & Lykouras, 2011). They have not lost everything, but they cannot maintain the lifestyle that they themselves, their families and their broader social circle had been used to. They feel to have "come down in the world" and to have "lost face".. They cannot adjust to the new facts, the sudden and almost violent change of their lifestyle. Their suicide is not as much a protest, but more a confession of "failure" in a society where familial and professional success or failure is of special importance. A classic example was the 57-year-old V. P., a wholesaler from Heraklion, Crete – an island with an intense sense of patriarchal tradition and an almost old-fashioned sense of honour and dignity – who, in July 2010, was to use a rifle and not miss the target. In his last words he spoke about debt and the unbearable pressure from banks and individual lenders (Giannarou, 2012).
c. Suicide as a result of social pain, uncertainty, existential fear and insecurity:
The greatest, the overwhelming proportion of suicides in Greece in this period concerns this group which contains individuals of every age, sex, social and educational level and origin. People who face difficulties in silence, because they can no longer survive, be integrated into a society that is now a stranger towards them, rejects them, marginalizes them and deprives them of the means to survive with dignity – a case similar to that of Australia’s Aborigines (Tatz, 2005). For them, the economic crisis is a “spark”, while the deeper reasons are traced elsewhere. As Saraceno (2010) characteristically mentions: “The mental health problems… will be more and more problems of urban… suffering” (p.3).
Social, Cultural and Humanitarian Crisis
Given the emphasis placed on the relationship between individual and society, it is deemed important to examine this fundamental theoretical framework. The General Systems Theory could prove useful, as it advocates that an organism’s preservation lies with the complex interaction of its components (Goldenberg & Goldenberg, 2005). A basic assumption of the theory is that if we want to comprehend the behaviour of a member of a family, we should try to comprehend it within the pattern of behaviour of all members (Triantafyllou, 2002).
“The same ‘rationale’ is also applicable to the systemic understanding of ideas and beliefs of the individuals as they connect, join and interact with the ideas, the beliefs and the history of those around them, of their wider systems” (Triantafyllou, 2002: 57). Therefore, people and the social groups they create need to be approached dynamically as processes (a series of events that repeats itself in time and space) and not separately from their environment. The individual and the social groups are open systems and they are integrated in larger groups – supersystems, meaning their subsystems. They exchange information, matter and energy with supersystems and in this way they maintain their structure and functionality, and also develop new structures with functionality and relationships of their own (Sigalas, 1987).
Today, the individual is unexpectedly in a situation where their established relationship with community, society, structures and institutions seems to collapse, creating disorganization, intense stress and possible loss of control. They become mere observers of developments that concern them and take place suddenly and rapidly. According to C. Marx (2003), in this social context, suicide is but one of the thousand symptoms of the generalized, continuous social struggle, from which so many abstain simply because they are tired of constantly being among the defeated and the victims.
Decades ago, the German historian Norbert (1997) had claimed that democratization entails the monopolization of violence on the state’s part: a constant and above all subcutaneous “structural violence”, an intangible violence of socioeconomic structures (Nordstrom & Martin, 1992), of poverty and deprivation, of inequalities and discriminations that causes casualties and equally intense social suffering, which also transforms itself into practices of “daily violence” (Bourgois, 2001). Thus, one could argue that the result is the institutionalization and the “routinization” of a special anthropological violence, its acceptance by increasing layers of the population, its refraction and reflection in other areas of social life, its diffusion into the wider web of social relationships, practices and contexts. Now, violence is the organizational principle of society, capable of constructing part of the social experience, of the perceptions and values (Abbink, 2000).
Several researchers say that after the outbreak of the crisis, Greek society became “lawless”. Perhaps our society had been lawless for decades: _“No living being can be happy unless their needs correspond sufficiently to their means… Unlimited desires are by definition unsatisfied while greediness is correctly considered as a sign of morbidity” _ (Durkheim, 276 & 278). A possible reading, therefore, is that the more the social connections weakened, the more individuals ceased to put boundaries to their desires and ambitions. And this constituted a form of “lawless” situation, where the social and/or moral rules were confusing and vague. In a situation where rules and predetermined behaviour boundaries are absent, the result is that citizens cannot perceive their position in society.
However, the sense of lawlessness does not refer only to the individual delinquency, but also to the violation of rules and/or laws by the state itself. This form of lawlessness conceals the deeper weakness of the state to satisfy the needs of its members. In this context, “urban suffering” increases and implicates in a rambling web all the categories of the social mosaic produced by the financial crisis: the unemployed, homeless, middleclass people who lose their houses, their lifestyle, their identity. Social suffering reflects the inadequacy of the whole of national politics and the welfare state, which seem to address the issues of poverty, exclusion, hopelessness among the young and the lack of prospect.
This violent change of the situation, the insufficient knowledge of how to manage it, the prolonged fear, the sense of loneliness, isolation, social stigmatization and shame are likely to affect even the most mentally resilient. The changes that the financial crisis has induced in every aspect of our social life, whether it is our family or workplace or our friends, could cause feelings of sadness and despair that are possible risk factors for increased suicidal ideation and behaviour. Humans are by nature free and independent beings, destined, of course, to act and organize themselves socially and collectively. But when social norms and social contracts, harsh and inhuman laws threaten their dignity, could it be that they feel freer before death? (Paparizos, 2000). Certainly, those who suffer more are not necessarily the ones that have the greatest tendency to commit suicide. But one can claim that those who lose abruptly and violently their belongings and are forced, due to the newly shaped circumstances, to redefine themselves and their position in the society, are more likely to be led to despair.
Apart from financial, the crisis is now also deeply social, cultural and with humanitarian dimensions. Once the social fabric tends towards disintegration, instability and insecurity, one is “marked” both mentally and socially, with the lack of hope for the future as the main characteristic. Ultimately, the crisis perhaps touches something even deeper, that relates to the loss of functional roles or the fragmentation of well-established identities, such as those that composed the social role of the regularly employed and the pursuit and/or accomplishment of financial security. Any individuals who believe that they no longer feel able to continue as functional social agents in all the environments they belong to, may think of choosing the path of suicide. Therefore, in essence, it is about “existential suicides”, caused by the pain from the absence of substantial motives and the sense that life, as it is, has nothing more to offer (Cammy, 1973), other than a painful search for new purposes. Nevertheless, existential disillusionment in itself is neither pathological nor pathogenic. The individual’s concern, even when their despair has excceded the value of life, is an existential anxiety. And according to Cammy (1973), “the sense of irrationality can hit to the face any person, at the turn of any road… [as]… when hope is lost, absurdity dominates” (p. 26 and 28).
Suicide Prevention on a Social Level
It is difficult for the society but also for each member separately to realize this aspect of itself, its tendency towards self-destruction. Therefore, it is driven to “exorcise” the act of suicide. However, this kind of reaction did not produce creative interventions. Insecurity, poverty, mental disorders, suicides cannot be dealt with through prohibitive laws and regulations alone. What is needed is active, hands-on support by the services and the development of a social support mechanism that will intervene promptly and effectively, especially for prevention and the provision of support to the more vulnerable social groups. This suggestion is supported by research data: “School, workplace, and community-based interventions, and multi-component primary care interventions can reduce the incidence of suicide of suicidal behaviours, as can access to care… _” _ (Turecki & Brent, 2016), while awareness campaigns have also been effective, procided that treatment is readily available (Feltz – Cornelis et al., 2011).
Therefore, suicide prevention means strengthening the social fabric through a sound welfare state with protection mechanisms for the citizens, in order for society to be able to reconstruct itself and solve its pathogenic problems, deal with its bad “daemons”, strengthen and reinforce the sense of collectivity and solidarity, deal with lawless violence, give hope, reinvest life with meaning and purpose, provide opportunities for creation and dignified living.
Certainly, information and awakening also concern the institutions of socialization-family, school, neighbourhood, services. The solution is not simple but multidimensional. The first step is to recognize the meaning that each of us as a person produces; the second, to get our fellow citizens to recognize this meaning. Thus, it is essential both to empower the individual and cultivate tolerance within the society. Education and empathy for the situation could bring about the changes needed, meaning the mental empowerment and knowledge we all need in order to deal with difficulties.
Finally, focusing on a different aspect of this issue, no one denies that systems may experience periods of instability which provide the opportunity for change. And while most of us tend to describe only the conditions of stability, we do not make the most of the opportunities for change that arise from chaotic situations (Cecchin et al., 2009). Similarly, as we saw, it is a fundamental principle that systems possess the potential to develop their own internal relationships (Sigalas, 1987). As a reasonable consequence of this theoretical context, the question arises of whether the current chaotic situation could in reality be the springboard for change, on an individual or a collective level. And even if no one knows with certainty which direction this change will take, it should not be forgotten that every probability of change and, by extension, every probability of hope for a better future, constitutes one of the most important protective factors against suicidal ideation or behaviour.
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