Why don’t prisoners wear belts? For most of us, the answer is obvious. Faced with years of abuse and mistreatment, insidious frustration and no control over one’s life, hanging oneself is such an anticipated response that in the United States, removing prisoners’ belts on arrival is standard procedure.
Yet, would it be fair to say that all prisoners who contemplate suicide under such circumstances suffer from mental illness? Who among us, if plucked from our present situation and placed in a prisoner’s cell with a life sentence, could honestly say we would never have the same inclination?
This is not to say that many prisoners do not suffer from mental illness, or that mental illness isn’t a very real cause of suicide. But it is to question whether mental illness is the only driver of suicide. The reason why many of us could answer the question— “why prisoners don’t wear belts?” —without hesitation is likely because we could envision suicide as the result of real, or logical, despair when faced with a life sentence without parole.
If we can see suicide as the result of despair in that situation, then why is it that we fail to see suicide in the same light in situations where young people have no control over their own future: whether or not they go to school, can get a job, who they marry, how their body is used, or how many children they have? Why is it not seen as an understandable response when one is faced with endemic poverty, violence, abuse and frustrated aspirations and cannot envision a better life in the future?
In his groundbreaking work, The Structure of Scientific Revolutions, Thomas Kuhn argues that when people have an established paradigm through which they see their world, they cannot recognize phenomena that might undermine the very premise upon which that paradigm is built. Phenomena that cannot be explained, or that run counter to the established paradigm are ignored or cast off as mere “anomalies.” According to Kuhn, it is only when those anomalies start to pile up such that we cannot ignore them anymore, that a new paradigm is created. In order for it to explain these new anomalies, the old paradigm must be discarded. This, he argues, is the way scientific knowledge occurs.
Logical despair: A new paradigm
In 2015, just as suicide or self-harm eclipsed maternal mortality as the leading cause of death for adolescent girls worldwide, the International Centre for Research on Women hosted a pioneering meeting on the topic. Why had this leading cause of death for adolescent girls (and boys) gone so unnoticed by the international development community for so long?
At this meeting, Professor Vikram Patel, the Founding director of the Centre for Global Mental Health at the London School of Hygiene and Tropical Medicine, presented a new paradigm through which to view the raising scourge of adolescent suicide. Instead of framing it within the paradigm of mental health, Patel offered up the notion of “logical despair.”
When interviewing suicide survivors throughout the world, Patel found that, “50 percent of those attempting suicide in China and India do not have a mental illness. They suffer logical despair.”
According to Patel, the source of this logical despair for both adolescent girls and boys is rooted in traditional gender norms. He noted that in India, “female suicide rates are highest in parts of the country with the best education and economy, probably because women grow up with greater aspirations only to find their social milieu limits them.”
While suicide rates for boys are lower than those for girls, they are still unacceptably high. Here too, Patel attributes gender norms as a major driver. “Boys face great pressure to succeed and provide…. it’s a different problem from those suffered by women, but it’s still a problem rooted in a rigid gender role.”
Recognizing a problem
From my perspective having worked in the field of gender in development for over 25 years at that time, the thought that suicide was the number one cause of death for adolescent girls knocked the wind out of me. Like other historic moments, I remember where I was when I heard it for the first time. I was breathless. How did I not see this coming?
Yet, despite the data that was staring us all in the face and the significance of this news, it got very little traction. Life for many of us in the development world went on as if nothing had happened. We treated this data as an anomaly. It did not fit within our existing paradigm. We continued to see suicide as a mental health issue rather than one driven by logical despair and rooted in traditional gender norms.
Today, these anomalies have hit a tipping point.
In the latest World Health Organization data available, suicide has the dubious honor of being the third leading cause of death among adolescent girls and boys globally. In 2015, suicide and death from self-harm was the second leading cause of death of adolescent girls aged 10–19 years.
In Tunisia, the suicide rate has doubled or nearly doubled since the Arab Spring. In 2012, Nicaragua “femicide suicide” – a term used to describe abusing women with the intention to cause them to attempt suicide – was made illegal. Joining violent gangs, participating in violent extremist groups and suicide by cop are not phenomenon of those suffering from mental illness. They are the manifestation of logical despair.
Addressing the drivers, providing hope
At Creative Associates International the paradigm has already shifted. While we value the need for more mental health programming, we also know that it is not the only driver of suicide.
We know this because we have seen it emerge organically throughout our programming from our work to prevent and end gang violence in Honduras to our work to curb the appeal of joining violent extremist groups. We have seen in it our work in education in conflict and in our work-readiness programming.
Our programming does not ignore the mental health needs of youth, but it does provide youth with something very practical – hope. Whether it be by transforming restrictive gender norms or equipping youth with the skills, information and tools to be resilient and drive their own future – unconstrained by the artificial limitations placed on them by socially constructed and outdated gender norms – our programs have enabled youth to assume meaningful social roles and envision better life options. While we cannot quantify the number of suicides our programs have thwarted, we can say that we have provided youth with an alternative to logical despair.
On International Youth Day, we lend our voice to the call for increased attention to adolescent mental health, but we also invite our colleagues to be part of this paradigm shift in recognizing that while mental health is a very real cause of suicide, it is not likely to be the only one. We call upon international donors to recognize the dire imperative of addressing logical despair among youth, and we invite our colleagues in the international development community to join us in finding practical solutions to the practical realities that today’s youth face. We believe that collectively, we can be the village it takes to raise a child.
Suicide is preventable. If you are feeling suicidal, you must get help. Anyone who is suicidal may receive immediate help by logging onto Suicide.org. In the United States, call 1-800-SUICIDE. If you are not in the U.S., please call your local emergency number.
Rebecca Sewall, Ph.D., is the Senior Advisor for Gender & Social Inclusion at Creative Associates International.