Muriel Campbell's Web-based resources

© Muriel Campbell 2003

Where do you fit in the picture?

VISUALIZATION CONCEPT

• What does the TOMBSTONE/COFFIN represent?

  • The victim and his relationship(s) to the bereaved.

  • The bereaved that are affected by the suicide of the victim.

• COMPANION CROSS

  • The causes of the act.

• COMPANION CROSS

  • The methods of the act.

• PAIN is the lace that taints the whole puzzle.

  In the whole story of SUICIDE, we are all trying to figure out where we fit into the picture and to try and answer the question WHY?

My brother was gentle, the older of twin brothers. His family and friends were important to him. He was an excellent hunter and provider for his immediate and extended family. He had a young family of five children; the youngest was a daughter under the age of one. He was having marital problems. One evening when my husband and I had gathered with family to celebrate our fourth wedding anniversary we received a call from back home. We found out that my dear, loveable brother was “gone”; he had committed SUICIDE. What has followed has been years filled with unanswered questions, mainly “why?”. One day when I was chatting with one of my nieces, she told me how her cousin (my late brother’s youngest daughter who was now 20 years old) was searching for pictures of herself as a baby. After some thought, I realized that because SUICIDE is such a taboo subject (even the mention of the word seems to send a tingle down someone’s spine) that it was not only baby pictures she was missing, more importantly the story of her father.

I continued to think of my niece’s predicament and twenty one years after my brother’s suicide, and the reality of loss of more loved ones due to suicide, I decided to do some research on this topic. Upon reviewing the material that I had gathered I noticed that there is always mention of statistics. It seemed that every article referred to statistics on every angle on the “act” of suicide. Then I came across one article, I read it and re-read it. I noticed that only 7.5 lines made reference to the “victim” and the rest of the 107 lines were focused on the “act” itself.

It seemed that because of the focus always being on the “act” that the “victim’s” life story never seems to get a chance of being told. How can we wipe out the incidents of suicide if we cannot talk about the whole story? If we are not allowed to heal, how can we help each other? How can our efforts on intervention and prevention be effective? It seems that once you have been deeply affected by the loss of a loved one that it becomes an unwritten rule that suicide should never be discussed with you and furthermore that talking about the victim is unmentionable. If we do not deal with all aspects of suicide, how can we conquer it?

I am a proud Aboriginal person so I decided that the focus on my research on suicide would be in regards to the Aboriginal community and more specifically in Nunavut. I will share some of the statistics that I have found as well as methods of death, signals, intervention and postvention. I will try to look at as many pieces of this puzzle that we call “SUICIDE”. I will discuss how society fits into this puzzle. It is only by becoming aware of all the pieces of the puzzle that we can sit back and see the full picture.

PUZZLE PIECE: SOCIETY AND THE ACT:

Society has been aware that suicide is a problem, as in the words of one pioneer in Sociology stated: “…the aspect of intentionality is both elusive and difficult to define. Emile Durkheim in his classic study of suicide states: Suicides do not form, as may be thought, a wholly distinct group, an isolated class of monstrous phenomena unrelated to other forms of conduct, but rather are related to them by a continuous series of intermediate causes. They are merely the exaggerated form of common practices…they result from similar states of mind, since they also entail mortal risks known to the agent, and the prospect of these is no deterrent; the sole difference is a lesser chance of death” (Durkheim, 1897/1951). (HC:1994;1)

Canada is aware of the problem: “In North America and most European countries, suicide has ranked among the top 5-10 causes of death for many years. Any issue related to suicide prevention has become, therefore, an important issue of public health responsibility. Despite this, suicide has not received the same level of attention as other health problems which accounts for fewer deaths annually; there is a clear need for increased awareness, research and attention to suicide and its prevention (Mishara,1993). (HC 1994:3)

Our newspapers tend to sensationalize it “CANADA’S BLEAK NORTH IS FERTILE GROUND FOR SUICIDE”. http://www.canadianaboriginal.com/health/health21a.htm I disagree! I love the North and its people. There are a lot of success stories but all we seem to hear are the negative ones (MC:2003).

The Inuit community knows that it is a problem: “Challenge young Inuit to live rather than chose death, Anawak said….The Minister told the elders they can no longer wait for teachers, social workers or doctors to find a solution to Nunavut’s high suicide rate. He said the elders themselves will have to get together with the youth in their communities and teach them the traditional knowledge and skills that helped the Inuit survive.” http://www.nunatsiaq.com/news/nunavut/211018_11.html I agree with his statement, we all have to get involved (MC:2003).

The Aboriginal community in general is aware of suicide: “They told us that suicide was never seen by their ancestors as an acceptable way out of personal problems. In all likelihood, it was seldom considered: the family, clan and traditional caregivers provided a strong “safety net” for troubled individuals. These speakers also made it clear that although the safety net had some holes ripped in it by the erosion of traditional beliefs and values, suicide is in no way condoned in contemporary Aboriginal thinking.” (RCAP 1995:10) I have observed the same kind of thinking in the Cree, Dogrib and Inuit communities that I have lived in (MC:2003). The Royal Commission on Aboriginal Peoples stated: “The general picture of Aboriginal death in Canada is not one in which Canadians can take any pride.” (RCAP 1995:17) “Suicidal behaviour – self inflicted injury and death – is found in every human society.” (RCAP 1995:19) On dealing with this issue, the report goes on to say “Despite urgent calls for long-term, holistic, community-based and community-controlled prevention measures, suicide among Aboriginal people has never become a high priority issue for Canadian governments.” (RCAP 1995:70) “Aboriginal people destroy themselves at a phenomenal rate through violence, accidents and suicide – a fact that was brought home by Canadians in 1994 when the attempted suicides of a number of children on the Davis Inlet reserve made headlines across the country. As one western newspaper columnist noted in the late 1980’s , in a story about a young native boy’s suicide: “We used to hang them. Now they hang themselves.” However, it was not always this way. Long before the new settlers arrived on Canada’s shores, the country’s aboriginal residents lived in largely co-operative social structures, complete with a governing power and a system of justice.” (COMEAU 1995:ix)

Suicide knows no barriers, no boundaries; suicide does not discriminate. It is found in every part of the world. It has been studied and reports have been done. Yet, there always seems to be something else more pressing to be dealt with. We as a society have to take ownership of the problem and the causes and take the responsibility for finding the solution. (MC:2003)

PUZZLE PIECE: STATISTICS ON THE ACT:

The statistics are more then readily available, they are startling but true: “…Nunavut’s suicide rate is six times the national average.138 This latter statistic is perhaps the most disturbing. For the period 1986 to 1996, Nunavut’s crude suicide rate was 77.9 per 100,000 – and rising – compared to the national rate of 13.2 per 100,000. 391 The suicide rate was higher among those between 15 to 29 years of age, much higher among males, and higher in the Baffin regions than in the Kitikmeot or Kivalliq regions.” (DAHL:2000,89-90) “Suicide rates among Aboriginal peoples have increased dramatically in recent decades to more than three times the rate of the general population. Suicide occurs more commonly among the young than the elderly. Victims are most likely to be male”. (KIRMAYER:1994,23) “The rate of suicide among Aboriginal people in Canada for all age groups is 2 to 3 times higher that the rate among non-Aboriginal people. It is 5 to 6 times higher among Aboriginal youth than among their non-Aboriginal peers.” (RCAP: Choosing Life;1994,1) “Statistical analysis predicts a coming increase in the number of suicides by Aboriginal youth as the “population bulge” of children now under the age of 15 enters the vulnerable years of young adulthood.” (RCAP1994:2) “Populations of special concern include Aboriginal people, certain age groups, persons in custody (criminal justice system), gays and lesbians, and persons who have previously attempted suicide.” (Health Canada:1994,20)

The statistics confirm over and over again that it is a problem in areas where the population is predominately Aboriginal: “The annual rate of suicide for Nunavut in three year periods is as follows:

· 48.7 per 100,000 from 1985 to 1987;

· 66.7 per 100,000 from 1988 to 1990;

· 75.1 per 100,000 from 1991 to 1993; and

· 85.5 per 100,000 from 1994 to 1996.”

(GNWT:1998,section 2.4,pg2)

Yes, all of the data keeps confirming that suicide is a deep problem in the Aboriginal community. The statistics are startling. It is even more alarming to read that the rate in Nunavut is higher and the trend does not seem to be diminishing. They all refer to male youths (age 15-29) to be at highest risk. We have accumulated a lot of statistics over the years, we have to start doing something with these statistics. (MC:2003) “High rates of self-inflicted injury and death have persisted over many years, despite past reports and studies documenting the warning signs and countless cries for help from Aboriginal communities.” (RCAP 1995:1) “Despite widespread concern about these alarming statistics, there continues to be a lack of epidemiological data, ethnocultural information on suicide and evaluation studies of intervention programs” (KIRMAYER 1994:5)

PUZZLE PIECE: THE CAUSES OF THE ACT:

Referring again to a Sociologist’s research: “Emile Durkheim…. He believed that cohesion (integration of societal forces) reduced suicidal activity within a community, while anomie (social organization) promoted it (DURKHEIM,1897/1951). (Health Canada:1994;12) More recent research reports: “Kirmayer(1994) has published an extensive overview of research on suicide among Canadian Aboriginal people… The final common pathway of suicide is the hopelessness and pain of the individual. This hopelessness and despair is fuelled both by psychiatric disorders and by existential problems that follow directly from the rapidity of social change, the suppression of traditional knowledge, history and identity, as well as from persistent economic disadvantage and racism in the larger society…. The fact that the mental health literature tends to focus on the individual problems and solutions should not obscure this need for a broader perspective on suicide among Aboriginal peoples (p.42).” (HC1994:24) “Suicidal behaviour is not an illness, but the end result of a complex interaction of a number of neurobiological, psychological, cultural and social factors that have had an impact on the person. These factors have different levels of effect on the person, and no single one of them has been found to be a necessary or sufficient cause of suicide.” (HC 1994:xii) “Another major factor that has contributed to the high rates of suicide is the absence of sustainable economies to replace the traditional economies, which have been destroyed through contact with the dominant culture. Most First- Nations and Inuit communities are largely dependant upon non-native society to provide for most of the communities’ basic needs (e.g., food, shelter, health care). Consequently, there are few opportunities within these communities for meaningful employment and activities that can provide “a purpose for life”. Poverty and life-long dependence upon welfare are often the norm. It is little wonder that many native youth perceive such a future as helpless and fall into patterns of self-destructive behaviour, which often lead to suicide.” (HC 1994:93)

In a Government of Northwest Territories document summary relating to suicide in the Northwest Territories and Nunavut we find: “…a friend or family members death… depression… loneliness and rejection, family relationship problems, family discord, pending criminal proceedings, sexual abuse, financial loss, and alcohol or drug abuse.” (GNWT 1998:9.1) In a Health Canada report we read: “… They concluded that a high suicide rate tended to be associated with various community characteristics, including a higher number of occupants per household, more single parent families, fewer elders, lower average income and lower average education.” (HC1994:23)

In the Royal Commission on Aboriginal Peoples special report on Suicide among Aboriginal people we find: “…like other forms of violence and self-destructive behaviour in Aboriginal communities, it is also an expression of a kind of collective anguish – part grief, part anger – tearing at the minds and hearts of many people. This anguish is the cumulative effect of 300 years of colonial history: lands occupied, resources seized, beliefs and cultures ridiculed, children taken away, power concentrated in distant capitals, hopes for honorable co-existence dashed over and over again.” (RCAP 1995:10)

Causes or reasons for suicide tend to focus on personal problems and the lack of support in dealing with personal pain of all kinds. The alienation that Aboriginal people feel today seems to be a major contributor to the problems that they are facing. We have studied and researched causes, and reasons but has that taken us any further on the path to a solution? I don’t think we are there yet, we need to start doing something now, and we can’t wait for the perfect research, the perfect reasons, and the perfect plan. (MC:2003)

PUZZLE PIECE: METHODS FOR THE ACT:

“In our study, the method used in over 50% of the suicides was hanging or asphyxia. Both on and off reserve this method of suicide predominates whereas in the non-Aboriginal population it is relatively uncommon compared to other methods.” (Oakes:1997;V2, 146-147)

“Suicides most often occur in association with heavy alcohol consumption, and are carried out by lethal means ( guns and hanging).” (KIRMAYER 1994:23)

In a document summary of suicide in the Northwest Territories and Nunavut: “Hanging was the main method of suicide in 49 deaths (63%). Firearms caused 27 (35%). Drug Overdose caused two (3%).” (GNWT 1998:4,1)

PUZZLE PIECES: PREVENTION/INTERVENTION:

What do we mean by intervention? “Intervention: crisis action to stop an impending suicide or to address the immediate medical needs of those who have just attempted suicide.” (RCAP 1995:98)

What are we doing in areas of prevention and intervention and whose responsibility should it be? “In the view of Commissioners, responsibility for reducing suicide belongs to everyone: to Aboriginal people in their communities, to Aboriginal leaders and Governments, to Canadian leaders and governments, and to Canadians one and all.” (RCAP1994:ix) “Resolving social issues such as unemployment, poverty, poor education, lack of opportunity and loss of cultural identity may lower rates of suicide, which may resolve other issues such as crime, family violence, and alcohol or drug abuse, which contribute to suicide.” (GNWT1998:10,1) “Don’t worry about the size of the problem, and how complicated it is. Start somewhere. Paralysis is the biggest barrier.” “Dr. Ron Dyck (Chief Suicidologist for the Province of Albert), in National Suicide Prevention workshop, March 22-24,1993. Summary of Proceedings (Ottawa: Health and Welfare Canada, 1993),26.” (RCAP 1995:67)

Is anyone taking a special interest in this issue? “It is often Aboriginal youth, women and women’s organizations who are leading the search for innovative ways to address social problems and advancing the agenda of healing.” (RCAP 1995:68)

How can we find out who is at risk? “Risk Assessment: identification of individuals, families and groups in a community who are vulnerable to suicide and assessment of their immediate risk.” (RCAP 1995:98) “Generally, tribes whose beliefs and values promoted an interdependent and cohesive community, and who had limited contact with the dominant culture, demonstrated the lowest rates of suicide.” (HC 1994:92)

PUZZLE PIECE: POSTVENTION AND THE BEREAVED:

What do we mean by Postvention? “Postvention: aftercare for those who have attempted suicide, grief support for intimate survivors, and community support for the wide circle who may be profoundly affected by a suicide or suicide attempt.” (RCAP 1995:98)

In a Health Canada report we see: “The Task Force maintained that suicidal deaths should be investigated as thoroughly as accidental deaths. In the case of possible suicide, the intention of the deceased must be established through the social and psychological analysis of a psychological autopsy. Implementation of the collection of data in a uniform manner would not only improve the accuracy of death certification, but would also add information that is critical to the understanding of suicide. This measure would also allow the bereaved to talk about the suicide in a less stressful context that that of a quasi-judicial hearing.” (HC 1994:98) “Originally intended for immediate family members and close friends bereaved through suicide (often referred to as “survivors”) postvention services now cover a wider group of survivors, including professional caregivers, emergency personnel, and target groups, such as schools or communities, who have recently been affected by one or more suicides. Postvention techniques take several forms, including direct services (such as support and counseling) to the suicide bereaved; protocols in schools and communities to ensure appropriate multi-level response to suicide deaths; and the construction of psychological autopsies of the victims of suicide.” (HC 1994:72)

Children are also affected by suicide: “For children, bereavement reactions following a suicide are similar to those of the adults. However, these reactions may be expressed differently. Since children often express their grief through behavior and play. It is generally believed that children of all ages should be told from the beginning, openly and honestly, about the suicidal nature of death, using age appropriate language. This will help them grieve appropriately; it should help to avoid the formation of disturbing fantasies and mistaken ideas about death and about the lost person (Dunn-Maxim, Dunn & Hauser,1987) (HC 1994:74)

We seem to be learning that there is more than the immediate family that we need to be concerned about when we are dealing with suicide. We need to have intervention/prevention programs available to everyone who seeks them, or is not aware that they are in need of help. We are definitely moving in the right direction, we just have to keep going, and we have to make sure that we let the public know what is available. If the services and programs are inaccessible or not publicized, then how can we benefit from them. We have to make each other aware of our findings, our resources, our triumphs and our failures so that we can work side by side in understanding suicide. I am sure that we will get to our destination faster if we help each other. (MC:2003)

PUZZLE PIECE: THE VICTIM:

We seem to have problems talking about the victim in most suicides. The victim’s final act of suicide is the reason why we have the bereaved, the statistics, the studies, the reports, the programs for intervention, prevention and postvention. Why do we seem to have so much trouble talking about the victim? “…the grief response to a suicide can be qualitatively different in several ways. Emotions such as guilt and anger, feelings of rejection, a sense of stigmatization, suicidal ideation, and struggles to find an explanation may be more intense and can affect the grief process (McIntosh & Kelly,1988; van der Wal, 1989;McIntosh & Wrobleski, 1988). (HC 1994:72) “Research by Ness and Pfeffer(1990) found that social attitudes are often less sympathetic toward people who are bereaved by suicide than toward people bereaved by another kind of death.” (HC 1994:73) “Survivors of suicide exhibit a combination of high emotional need and low social expectations; while they often feel very keenly a lack of social support, they may fail to see others as potential sources of support (Rudestam,1990;Dunn & Morrish-Vidners, 1987). This may be because of feelings of stigma and shame, or simply because they perceive the pain of the loss as being too great to be helped by others.” (HC 1994:74).

What do Aboriginal people think about this stigmatization? “Commissioners heard from Aboriginal people that there is a need in their communities to recreate or develop new collective responses to relieve the contained pain of violent death. In traditional Aboriginal cultures, death was not simply “talked through” but acted through ceremony. Healing ceremonies gave people an opportunity to transform death into a time for family and community renewal.” (RCAP 1995:102)

It is in the attitudes that have been referred to in the preceding paragraphs that inhibit us from talking about the victim. Too often we feel that no-one will want to talk to us about the deceased. We need to share what the deceased meant to us, what they accomplished in life, what made them so affectionate, what idiosyncrasies did they have, what special moments we shared, how did we get to know them, how long did you know them, how old were they, how grateful you are that they were part of your life, what kind of child, son, daughter, brother, sister, wife, husband, mother, father, grandpa, grandma, auntie, uncle, acquaintance, cousin, counselor, leader, step-child, team mate sibling, friend, co-worker, boss, teacher, preacher, neighbour (and the list goes on)?

SUMMARY:

I have compared suicide to a puzzle with so many pieces. We have read how society knows that it is a problem, we also know that it is indeed a greater problem in the Aboriginal community. We have statistics to show that the rate in Nunavut is high and it seems to be rising. We have reviewed some of the information that is available on the causes of and the methods of suicide, the purpose and responsibility of and for prevention and intervention. I showed some views on postvention and the bereaved and last but not least I talked about the victim.

When someone dies, it seems that a little bit of us dies with them and a lot of what they meant to us stays with us for the rest of our life. We have to keep from dealing with just isolated cases and be able to discuss openly any case that we come across. We have to remember that the victim is also a piece of the puzzle. Somehow, that piece of the puzzle always seems to get lost in the discussion, and perhaps that is why proper healing is not taking place and why we can’t seem to get past the studies and reports. It is time to deal with the whole puzzle, the completed picture and maybe then can we have an action plan for the elimination of suicide.

My brother was 33 years old. He made friends easy. He was deeply loved by his mother and father, his brothers and sisters and his friends. Whenever he heard that I was home for a visit he would come and look for me – it didn’t matter when he found out. He would almost always wake me up just to greet me and give me a hug. He always kissed me on the forehead. The story of my brother, is longer than that but the point that I want to make is that there is more to suicide then just statistics. Perhaps we need to discuss it like it personally affected us very deeply.

Muriel Campbell's Web-based resources

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