How does the US mental health profession view suicide in other cultures?

Factual Questions
1

It’s my understanding that in the US, the mainstream view among mental health professionals is that suicide is always the result of a diagnosable mental illness. I assume that this is based, to some extent, that most Americans practice a religion that considers suicide a sin, which would result in the person committing suicide going to hell as a result. For the record, I do not necessarily believe this, but for someone who does, suicide would seem especially irrational, and I assume this plays a large role in the mental health community’s stance.

However, how would a mental health professional explain the suicide of an individual from a culture that does not condemn, and might even encourage, committing suicide in certain circumstances, or if the act was done in a manner to achieve a certain objective (i.e. martyrdom). For example, the 9/11 hijackers were influenced by a culture that believes that they would actually be rewarded in the afterlife because they would be a killing people and attacking institutions that they considered to be “infidels”. Also, in Japan during WWII, Japanese pilots volunteered for kamikaze missions for similar reasons, and it is my understanding suicide is still honorable in Japan in situations where an individual has disgraced themselves or has otherwise landed in unfavorable circumstances, and would be stigmatized if they remained among the living.

Is the view that suicide is be rational under these circumstances, i.e. are kamikaze pilots, suicide bombers, etc., considered rational individuals that are simply products of an unfortunate environment? Is this viewed as a gray area, in that these certain cultures may do more to foster suicidal beliefs than our own, but mental illness is still the intervening factor at the individual decision making level? Or are cultural beliefs completely irrelevant?

2

I am not convinced that this is the case at all.

Mental health professionals don’t seem to use the word “always” too often when it comes to the subject of mental illness…

3

Although I am not a mental health professional I suspect “often but not always” is closer to the mark. There are circumstances under which suicidal thoughts and even impulse are considered normal, such as severe disfiguring accidents or painful terminal illnesses. Under such circumstances suicide may still be culturally taboo but the impulse is not seen as a sign of mental illness.

4

Wait, why? A disfiguring accident can make your life a living hell. But so can less tangible things.

And what does “normal” mean? Rational?

It sounds like the line is arbitrarily being drawn at what can be shown to others. If you have a reason to kill yourself, but I can’t see it, then you must be unbalanced and aren’t seeing things as they really are.

5

“Normal”, in this context, means, “this is an expected finding in a patient with this condition.”

If you have COPD, then shortness of breath is “normal”. That doesn’t mean everyone has shortness of breath, it means that most people with COPD have shortness of breath. It doesn’t mean we ignore it or don’t treat it, it just means we don’t need to look for another diagnosis to explain your shortness of breath.

If you are over the age of 40, you probably have presbyopia. It’s normal. That doesn’t mean your eyes are working well, or that everyone has presbyopia, or that we won’t give you glasses, just that it’s an expected finding in older adults.

In this case, if you’ve just been in a horribly disfiguring accident, it’s normal to have thoughts of committing suicide. It’s an expected finding. That doesn’t mean everyone does, and it doesn’t mean we don’t address the issue and keep you safe until you’re able to cope, but it means that your suicidal feelings don’t need to be explained as a part of a mental illness like Depression or Schizophrenia.

If you don’t have a condition in which suicidal thoughts are commonly found, say you have a UTI, and you do have suicidal thoughts, then yeah, we’re not going to think your suicidal thoughts are related to your urinary tract infection. We’re going to dig a little deeper and see if there’s a mental illness going on so we can treat that appropriately.

But back to the OP: I don’t believe there’s a single answer. People who work in mental health have all sorts of opinions.

6

skdo23 writes:

> . . . most Americans practice a religion that considers suicide a sin . . .

Cite? I suspect most Americans, whatever religion they practice, believe that nearly everybody who commits suicide is mentally ill.

7

Thanks everyone, I appreciate all of your responses. After making my original post, I realized that it contained some generalizations and assumptions and I found your constructive criticism very helpful. My use of the word “always” in the first sentence of my OP was probably not a good word choice, however i think I am correct in my observation that the prevailing view among US mental health professionals is that suicide is always, to some extent, a mental health issue. And, while it certainly makes sense that individuals in certain situations may have a more “rational” basis for taking their own life than others, my understanding is that when confronted with any suicidal individual, the official policy of the medical profession and/or the legal system, is to intervene. By “official” I mean that there are sometimes “rogue” doctors, etc., such as Jack Kevorkian, who will buck the system and assist a patient in ending their life, but my understanding is that this is illegal in nearly every jurisdiction and also violates the rules of federal and most state medical boards, etc. As far as Wendell Wagner’s request for a cite for my original comment on suicide and religion, I have heard this many times and a quick look at Wikipedia (I know, I know) confirms my belief that most Christian denominations feel this way, and, of course, Christianity, for better or for worse, is the most prevelant fait in the US. As Wendell also said, most Americans feel the same way about suicide irregardless of religion. I don’t think this contradicts my OP however, as Christian values are so tightly interwoven in our legal and social norms that there is really no way to distinguish them.

All this being said, I think that I am correct in believing that there is an underlying assumption in the US that suicide, in almost every case involves at least some degree of mental illness, even though there is growing sympathy and political support for “right do die” or other assisted suicide issues in the US. I guess what I really wanted to know in my OP is, from the standpoint of a typical US mental health professional, after accounting for cultural, religious and other differences between American and other relevant cultures, and not making any value judgments (i.e., as tragic as 9/11 was, it does not automatically mean that those who perpetrated it were, by default, mentally ill), what role, if any, does mental illness play? Maybe a good example might be whether you think that, even though most members of al-Qaeda probably believe in martyrdom, did the individuals who actually carried out the 9/11 attacks likely suffer from some some sort of underlying mental illness that made them willing to volunteer for the mission?

I know that the very nature of these questions might simply be due to misunderstandings about suicide, psychology, etc. on my part, but I’ve always been curious.

8

I think the OP has to first show that mental health professionals from some cultures outside the US have a different view of suicide, in general, from those in the US. I have my doubts.

9

In every culture aren’t there people who willingly and knowingly die for the sake of something they value more than their life? Of course many suicides are not like this, but the ones that are surely are not considered mental illness. Maybe in the US we rarely face situations where our life can be exchanged for something we consider more important, whereas in a situation like WW2 Japan or present day Iraq, people may feel this is their chance to make a difference to benefit what they love. I don’t know that this means they are the victims of an “unfortunate environment.” If someone was magically given the ability to end world hunger or wipe out AIDS and malaria in exchange for their life, is that “unfortunate”?

10

skdo23 writes:

> As far as Wendell Wagner’s request for a cite for my original comment on
> suicide and religion, I have heard this many times and a quick look at Wikipedia
> (I know, I know) confirms my belief that most Christian denominations feel this
> way, and, of course, Christianity, for better or for worse, is the most prevelant
> fait in the US.

I’m still waiting for a cite that most Christians today consider suicide to be a sin. Can you name some recent theology books that ponder the issue of how great a sin it is? Can you tell us of great thundering sermons that you’ve heard from the pulpit warning that the surest way to hell is suicide? It’s my observation that most Christians today don’t even think about suicide when they worry about sin. So give us a citation that Christians today think of suicide as a sin or you’ve got nothing to start with.

11

I’d be more interested in viewpoints from a sociological standpoint. For societies that the OP describes, it seems the societal context, rather than the individual’s action, is open for some heavy criticism.

12

Bolding mine.

What about in a military culture? Do mental health professionals view the actions of soldiers, sailors or Marines who willingly jump on live hand grenade as a mental health issue per the OP? The people who have jumped a grenade know the explosive power of a hand grenade either through training or having witnessed their effect during combat. Yet, they did it to protect their comrades.

There have been many, this is an impartial listing:

Cpl. John W. Collier, US Army, KIA in Korea

Cpl. Gordon M. Craig, US Army, KIA in Korea

Cpl. Jack A. Davenport, US Marine Corps, KIA in Korea

MA2(SEAL) Michael A. Monsoor, US Navy, KIA in Iraq

Pfc. Ross McGinnis, US Army, KIA in Iraq

L/Cpl Matthew Croucher, Royal Marines, Afghanistan. He survived.

Pfc Fernando Luis Garcia, US Marine Corps, KIA in Korea

This is a list of Medal of Honor recipients during the Vietnam war. I counted 63 recipients who smothered a grenade with their own bodies. It can’t be mental illness.

13

I don’t know about “most,” necessarily, but in my Catholic upbringing (I am currently agnostic), there was no ambiguity about it–suicide was regarded as a sin.

14

And googling “is suicide a sin” suggests to me that my experience was not anamolous.

15

> I know that the very nature of these questions might simply be due to misunderstandings about suicide, psychology, etc. on my part, but I’ve always been curious.

Maybe you should start there. Have you considered asking a “mental health professional”, which covers a broad range, even if you know what it means.

I will ask my gf, who is a licensed psychologist in the US (CA to be more precise). But I predict she will say that suicide ideation is a symptom, and is not in itself an indicator of any particular diagnosis.

I further predict she will say this is independent of the person’s religion, upbringing, wider culture, language, etc.

I am comfortable that I can point you to DSM IV (google it) as the place where symptoms are tied to diagnoses, and virtually every symptom will show up under multiple diagnoses.

So, to the OP, what exactly do you mean by “mental health professionals”? Why do you think that that group simply makes diagnoses based on which way the wind seems to be blowing instead of based on the best available science?

16

You might want to read the wiki article on suicide.

It covers military suicides like in Japan in WW2, and suicide in the current US, and acknowledges different factors that can be involved with the varying types. Many other types do not involve mental illness, but are simply rare by comparison to mental health related issues in the US currently, eg suicide attacks.

Mental illnesses are very commonly present when suicide occurs in the US. These disorders were not invented in order to explain suicide, so the idea that sin has anything to do with it doesnt make a lot of sense to me.

It should also be remembered that mental illness will still be a serious risk factor for suicide in other cultures, its just that other risk factors can be present as well.

Otara

17

If suicidal ideation is a result of a Major Depressive Illness (or other conditions set out in the DSM IV) it would be considered a mental illness.

However the average mental health worker would take into account other reasons for attempting suicide, including the influence of drugs or perhaps extreme religious beliefs or “suicide” as a mechanism to wage conflict. And I think most would accept that some Kevorkian-type suicides are a reasonable and rational alternative to physical suffering.

The law is generally interpreted to mean that a primary goal is to protect an individual (successful suicide usually being irreversible and all) so the practical approach to suicidal ideation is incarceration until a formal evaluation and disposition are made.

I’m not aware that any of the impetus behind the approach to suicide has to do with it being a “sin” and I don’t think anyone who deals with evaluation of the public considers suicidal ideation to automatically result from “a diagnosable mental illness.”

18

Let’s phrase it this way. If a person of Japanese ethnicity living in the US told their US doctor that they were considering suicide because their business failed and they are $100k in debt, and that their family was fully supportive of the decision, which they agree is in keeping with the values and beliefs of their culture, would the doctor feel that this is something that would call for an intervention?

19

Why would they tell their doctor that knowing the doctor is likely to try to dissuade them? Isn’t the doctor required to try to preserve life? The Japanese person would be thwarting their own wishes and also causing problems for the doctor. From what I understand (I’m no expert) Japanese suicide is not discussed publicly in advance or generally “supported,” but rather can be “understandable” by other Japanese afterwards. It’s not a sin but it’s a tragic and uncommon decision.

But supposing the Japanese person did tell, I would think the doctor would urge them not to commit suicide, and would provide resources to help, but would not think of it as mental illness.

20

OK, “normal” in this context means anticipated finding, or the majority. Fair enough.

This touches on my point though.

If it’s possible to be suicidal because you’re disfigured, without being depressed, then…that’s an example of being suicidal without being depressed.
Why is the assumption made in other cases that the cause must be depression?

Is it just about non-disfiguring problems being intangible?