3 Nov 2004

be in it

By Gillian Bouras
'I learned too late about the signs of her intention: she seemed light-hearted, friends said, for the first time in ages, and she was giving people presents. Of course it turned out that they were her own possessions she was giving away.'

A wintry sun was shining on 2 January 1997, when the Greek phone emitted its long beep: my father, calling from Australia. To wish me a happy New Year, I thought. That's nice. Nice, nothing, for the promise of the New Year evaporated the moment Dad framed his second sentence. 'It's about your sister,' he said, sounding old. Very old, very suddenly. 'She's passed on.' Like most of his generation, he did not want to mention the word death. But eventually he had to, had to tell me that Jacqui had taken her life scarcely six weeks after her fiftieth birthday.

Jacqui had attempted suicide at least twice before succeeding, and had a psychiatric history that I have been trying to piece together for years; even in a fragmented state it makes very sad reading. She was only just seventeen when she had first had a 'breakdown' (there was no other word for it then). She walked out of her exams, out of health, away from the richness and promise of life. And now it seems to me quite probable that my sister died too soon - because she was born too soon.

Forty years ago mental illness inspired fear so great that few people acknowledged it; to the end of her own life our mother maintained that Jacqui's problems were complicated, yes, but merely physical. Of course Jacqui agreed with her. The rest of us played this particular game because it was the easiest way of dealing with endless and complicated pain and with a complex family dynamic, and because we were so ignorant. But then so were the doctors, who regularly professed themselves baffled. It was not until after Jacqui's death that her last psychiatrist told me he had diagnosed a severe personality disorder.

Way back then in the early sixties, when Jacqui was first ill, there was no family counselling; nor were there prevention programmes or any training in awareness of the warning signs. Depressed people were suspected of being not quite the thing, were thought to be lacking in will power and/or moral fibre. But by 1996 I should have been more aware. Mum, Jacqui's support against the world and its difficulties, had died, and Dad had speedily married the woman he met five weeks after Mum's death: both newlyweds soon claimed they could do nothing to help. I was not in Australia, and a problematical lover in Jacqui's life came and went. Usually he went.

Jacqui's brave spirit, which had coped with so much and for so long, eventually found such a degree of isolation too hard to bear. I learned too late about the signs of her intention: she seemed light-hearted, friends said, for the first time in ages, and she was giving people presents. Of course it turned out that they were her own possessions she was giving away.

In 2001, 2454 people completed suicide in Australia. Statistics are easily manipulated, but experts claim that since Federation the national suicide rate has hovered around 13-14 per 100,000 of population, a rate similar to those in comparable nations, with fluctuations occurring in response to the pressure of events such as war and economic depression. (And in 1996-7 the rate of male suicide in New South Wales rose, very worryingly, to 20.9 per 100,000.) The suicide rate now outstrips the road toll and homicide by far, and has the dubious distinction of being the leading external cause of death in Australia.

For every successful suicide there may have been as many as thirty attempts: the strain on the individual sufferer's family and friends can only be guessed at. US studies suggest that from six to ten people may be directly affected as a result of a successful suicide, but in Ireland, where suicide was not decriminalised until 1993, research indicates the number to be nearer fifty. The phenomenon known as 'the contagion of suicide' is especially dangerous, for people close to the deceased often come to be at risk themselves.

This contagion comes about because suicide bereavement is unique, with crippling grief being compounded by the pain of the ultimate rejection, and by disillusionment. You, the bereaved, were simply not worth hanging on for. Yet you manage to stagger on through this vale of tears, so why could not the deceased do the same? Your own self-esteem plummets alarmingly, your emotional defences are almost non-existent. And, at worst, you feel you have been given an odd sort of permission to kill yourself, too. Jacqui was always far more adventurous than I, and for months after her death I seemed to hear her old taunt: Go on. I dare you. But how could I infect my three children in this way?

The aetiology of suicide is extremely complex, but is almost always associated with mental illness, depression (either diagnosed or undiagnosed), life-changing events such as continued unemployment, financial ruin or marital breakdown, substance abuse, problem gambling, or extreme social isolation: suicide rates in both Australia and Scotland, for example, are considerably higher in places with populations less than 4000. Medical scientists study the levels of serotonin in the brain, while psychologists are becoming increasingly interested in impulsiveness as an important and decisive feature of personality. And in America, as in rural Australia, the ready availability of firearms has a great deal to answer for.

Under-reporting may be a problem with Greek statistics, but Greece's official suicide rate is low: in 1997 the World Health Organisation (WHO) put it at 3 per 100,000. In societies such as Spain and Portugal, where community and religion remain very influential, and supportive, the statistics are very similar, while in Scotland rates are much higher than in England and Wales, countries in which the rates are comparable with Australia's. While suicide rates in England and Wales have actually decreased by nine per cent from 1992-2002, in Scotland they have risen by 13 per cent, mainly because of a very significant increase in male suicide: in the 35-44 year old age group there was a rise of twenty nine per cent, accompanied by one of twenty per cent in the 25-34 year old age group.

In Australia the perception is that suicide is a growing problem among young men. In fact, rates peaked in 1997, since when older men's completion of suicide continues to cause grave concern: according to the Wesley Mission's report in 2000, a 'generational' influence must be considered, for the generation of Australian boys that began to suicide in significant numbers in the late 1970s is continuing this trend as it gets older: the Mission notes a forty four per cent increase in the 25-44 age group since 1979. Throughout human history individuals have often stood on the threshold of hunger, but now it can be argued that standing on the threshold of loneliness is much worse; it can also be argued that ageing men cope less well with loneliness than do women.

Suicide is overwhelmingly and paradoxically all to do with self. The emotional isolation, self-loathing, fear and pain are such that the only solution is the extinction of self: this is the logic of those people inhabiting that unique and despairing space pre suicide. And surely it is a truism that there is a strong connection between self- esteem and what sociologists call a validating environment, an environment, beginning in infancy, that allows and encourages a person to be his/her true self. Generalisations are to be avoided, but in the Western societies of the 1950s and 1960s biddable girls and sensitive boys could all too easily develop the Laingian false self: this was one way of coping with that era's shark net of conformity, with its lists of do's and don'ts, and its view of the ideal domesticated woman and the dutiful and conscientious man.

It has long been established that children thrive best when there is positive interaction between home, school and church/community. Not every parent is instinctively good at the job; somehow those who are floundering or lacking in confidence must be reached and given practical guidelines. Nobody can be a perfect parent, but through careful counselling provided by the community most people can learn to be a 'good-enough' one, and to learn to break the negative patterns of his/her own childhood.

A validating environment can also be provided by schools; one of the Wesley Mission's report recommendations was the establishment of school programmes which would encourage boys in particular to take greater interest in their health and self-esteem. It also recommended that programmes emphasising 'positive self-image' be incorporated into the mainstream educational curriculum. My own feeling is that the development of resilience should be emphasised, so that the young learn to treat Kipling's impostors, good and bad luck, in exactly the same way.

I can see now that Jacqui did not develop much resilience, and that her environment was invalidating in all sorts of ways, but especially in the way in which it either crushed or ignored her unique and lively spirit, and then conspired against an accurate labelling and expression of her psychic wounds. Which were then, because of this dire frustration, misunderstanding, and neglect, almost bound to become mortal ones.

And so, all those years ago, Jacqui put an end to her torment, and so ceased upon the midnight. But we, those left behind, are still coping with our own pain, and with the fact of her endless absence.

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