Suicide and Anomie

A rising incidence of suicide and parasuicidal behaviour during the past few years has caused health professionals and social scientists to speculate on the possible underlying factors. Whatever these are, the medical profession is involved. Every day, the hospitals of our major cities have to assess hundreds of people, many of them young, who have deliberately taken overdoses of chemicals and drugs or harmed themselves with knives, firearms or ropes. Senior registrars in psychiatry spend much time trying to decide whether these people are 'genuinely suicidal' and whether they should be admitted or referred to some other agency. Many of these individuals have underlying psychiatric disorders; others are responding to interpersonal strife. But once they are registered with the hospital they become the local health authority's responsibility, and for medicolegal reasons their management is directed principally by attending medical practitioners. They have become medicalized. This dilemma was first discussed at the end of the last century by the French sociologist, Emile Durkheim, who challenged the prevailing view that suicide was always associated with psychiatric illness. The assertion that a person who kills himself does so because of temporary disturbance of his mind (as judges and coroners often propose) raises philosophical as well as psychiatric issues. In contemporary psychiatry this notion, that the precipitant of suicide must be an 'illness' depression, is reinforced by employment of strict classificatory systems such as DSM IV or ICD 10 and additionally by the use of depressive rating scales that imply severity of disorder. In Le Suicide, which was not translated into English until 19521, Durkheim identified three elements that contribute to suicidal behaviour: extra-social factors, which include climatic, geographical and psychiatric illnesses; social causes; and the social element. It is the second group, subdivided into altruistic, fatalistic, egoistic and anomic suicidal behaviours, that are of interest here.