The FINANCIAL — All over the world, suicide and its treatment are linked first and foremost to mental health problems. Believing that this perspective is too limited, PhD candidate and psychotherapist Indra Boedjarath investigated the influence of cultural factors on suicidal behaviour according to University of Amsterdam.
She concludes that suicide can be so culturally embedded that resorting to suicide is seen as an example to be followed. This notion may be expressed in language, stories and films. She therefore advocates greater cultural sensitivity in research on suicidal behaviour and ways of treating this. Boedjarath will defend her doctoral thesis at the University of Amsterdam on Thursday, 22 December.
‘Mental disorders are often seen as the main cause of suicide,’ says Boedjarath. ‘As a result, the focus is on identifying and treating mental risk factors for suicidal behaviour. While there’s clearly a link between mental disorders and suicide, there are many other potentially contributory factors, including culture.’
Boedjarath considers this marginalisation of culture in the scientific field worrying. As a psychotherapist, she has experienced how mental health problems often do not or do not sufficiently explain suicidal behaviour. Moreover, research indicates that suicidal behaviour differs all over the world and is subject to cultural forces. ‘To give one example, 60% of all suicides worldwide take place in non-Western communities.’
Indian diaspora in six countries
In her research, Boedjarath reveals how cultural factors can play a role in suicidal behaviour. She focused on the Indian diaspora in six countries, including the Netherlands. ‘Within these groups, suicide occurs strikingly often. Besides, they form a transnational community that shares cultural practices such as language, religion and the consumption of Indian cinema.’ Thanks to her Hindustani origins, her role as a care provider and her specialisation in the field of suicide, she had access to this target group and much case material. To supplement this, she analysed international research on suicide, again with the aim of identifying the influence of culture according to University of Amsterdam.
The role of karma
Boedjarath concludes that several culture-specific concepts play a major role within the Indian diaspora. As an example, she cites the role of karma: the idea that present misfortune is the consequence of having done something bad in a previous life. ‘The international literature often refers to reincarnation – the belief in life after death – as disinhibiting suicide. In my research, I identified a derivative of this reincarnation concept in the role of karma. The belief that a following life will surely be better can lead to suicide being framed as a way out, a solution.’
Boedjarath also cites the influence of the concept of ijjat, or honour. ‘In the case of girls, for instance, this relates to their sexual behaviour and the honour of the family. In men, it mostly concerns a sense of not meeting the expectations and demands of one’s surroundings and family. When the loss of face is so profound that it shakes one’s sense of being, suicide becomes an option to consider.’
Suicidal behaviour has become ‘cultural heritage’
The frequent occurrence of suicide within cultural groups has a strongly legitimising effect, says Boedjarath. This helps to explain the high incidence of suicide in certain cultures. ‘It’s so strongly embedded in Indian Hindustani culture – in language, religion, stories, films, literature, memories, songs and suchlike.’ If you consume this from childhood onwards, and these examples are not criticised, it has a socialising effect, Boedjarath claims. ‘Suicidal behaviour then becomes a form of “cultural heritage” that is transferred from generation to generation. As a result, resorting to suicide may be seen as an example to be followed, as a way out.’
Making suicide prevention and intervention more inclusive
‘It’s difficult to apply the current guidelines, norms and protocols regarding strategies for suicide prevention and intervention to groups with different cultural backgrounds,’ concludes Boedjarath. She believes that professionals in the mental health and education sectors can make their approach more inclusive by focusing more on the cultural background and asking people to provide their own explanations.
Furthermore, Boedjarath hopes that policymakers will also learn from her findings. ‘The results offer important information for policymakers, including health insurers who to a certain extent define health policy. This can help them develop guidelines for a culturally diverse population and rectify the lack of a cultural focus in the health care system.’