Thanks for this. Understanding how prospective beneficiaries value their lives is difficult but important work. It seems a reasonable assumption that people who attempted suicide would lead negative lives. However, I think we can do better than resting on this assumption, and I think deeper analysis suggests this assumption is false.
Here’s CPSP’s answer on their FAQ in response to ‘Should people who want to kill themselves be allowed to die?’:
A high proportion of pesticide suicides are impulsive, with people contemplating harming themselves for less than 30 minutes. In fact, most persons who engage in suicidal or self-harming behaviour are ambivalent about wanting to die, with the act serving as a response to psychosocial stressors. Self-harm is used as communication – expressing for example pain, hurt, shame or anger.
Replacing the often lethal HHPs with less toxic alternatives allows more people to survive the acute stress and receive the community and medical help they need.
This is clearly shown by the Sri Lankan experience in which the bans of HHPs resulted in a remarkable 75% overall reduction in suicide. People who no longer died from pesticide poisoning with the less toxic pesticides did not then go out to kill themselves with another lethal method. This is because the spontaneity of pesticide poisoning results in the nearest pesticide often being drunk, with little thought. If this is highly hazardous, many people die. If it is less hazardous, because HHPs are no longer available, the person will survive.
We also believe that people with mental illness require mental health services and support to get better and live fulfilling lives.
As a start, most people who have a non-fatal suicide attempt don’t attempt again. This article suggests the broad pattern following a first non-fatal suicide attempt is ~70% don’t attempt again, 20% attempt but don’t succeed, and 10% commit suicide.
I couldn’t find much that was directly relevant to long-term quality of life, but this very small French study looked at 29 adolescents who had attempted suicide, and followed up 10 years later (with significant potential for selection bias—only two thirds could be traced and of those, two thirds responded). Over 75% said they were happy in their personal lives, over 50% were satisfied or very satisfied with their professional lives, and 2/3rds had no significant psychiatric problem reported. 17% had an ongoing chronic psychiatric problem, and 14% were in-between these groups.
This study looked followed up physical trauma cases in adults—they found 65 patients who had the trauma due to a suicide attempts, and followed them up at 6+/- 3 years. 14% had died before follow-up, none due to suicide and all were reported as coping well by next-of-kin. 3 patients couldn’t be traced and 2 declined follow-up. Psychosocial measurements of follow-up patients suggested a majority had decent functioning, with around 20-25% experiencing severe impairment of some kind. None had re-attempted suicide.
I suspect that the key determinant of quality of life after attempting suicide is mental illness, especially depression, and not the suicide attempt itself. But I’m uncertain about this, and even more uncertain given both the literature and my clinical training are based on a high-income country context—things could be very different in low/middle-income countries or those in absolute poverty.
I suspect that the key determinant of quality of life after attempting suicide is mental illness, especially depression, and not the suicide attempt itself. But I’m uncertain about this, and even more uncertain given both the literature and my clinical training are based on a high-income country context—things could be very different in low/middle-income countries or those in absolute poverty.
Thank you. I think so. I think that in high-income contexts, depression can relate to one’s loneliness and use of social media that use negative-emotions marketing as well as abusive/neglecting/rejecting family relationships (that the media (and people influenced by them) can draw from (and make one to assume as reality)).
In many low-income contexts, it can be argued that people are not as lonely, because agreements are based on community accountability (which requires mutually enjoyable or overall approved emotional navigation) rather than sound rule of law and business relationships are founded in friendship (gaining customers for undifferentiated goods). Also, in low-income countries family can play a key role. Forced marriage, female and child abuse norms, FGM, limited family planning can all worsen one’s mental health.
The key difference between high- and low-income countries can be that in high-income countries the negative perception of one’s relationship-related situation and limited enjoyment of others is motivated by media, while in low-income countries perceived due to actual and ‘necessary’ abuse (e. g. someone has to be beaten to make bidis because otherwise productivity would not increase).
A related thought is that if (low-paid and unpaid) productive people in low-income contexts suicide, the productivity decreases, ceteris paribus.
An EA who studies India’s media commented that the show of suicide in the TV is banned, because it increases suicide rates.
My small-sample study shows that some people can perceive their life quality below death, wish to live 0 additional years, and still live. I did not research suicide but the local enumerators, an elder, and an educator have not commented on it.
It can be hypothesized that the willingness to suicide is a part of a ‘dialogue’ between the ‘abused’ and the ‘abuser,’ used as a means to argue for more favorable treatment. It can be a statement that it is unacceptable to, for example, beat people for no perceived reason. Related concepts are described in The Wretched of the Earth by the psychiatrist Frantz Fanon.
The ability to suicide can increase people’s willingness to ‘lead this dialogue,’ which would otherwise be unthinkable, and thus (at least ‘during the discussion’) lower their quality of life. It can be assumed that this will have limited benefits, since external education and investment rather than internal redelegation of tasks is needed to highlight enjoyable cultural approaches and enable productivity without (human) abuse.
This would suggest that limiting the use of highly highly hazardous pesticides can improve the mental health of people (there is no need to feel emotions that intend to lead to the improvement of their situation when they can themselves very little about it). However, it can also be argued that once people know about suicide, but are prevented from it, their mental health decreases even more significantly, because they are perceiving the ‘trap’ of having to live in an abusive situation without the ability to affect this for themselves or future generations.
I am actually not describing depression as you may be understanding it: “persistent feeling of sadness and loss of interest,” which can occur when (I am not medically trained and am only suggesting ideas rather than intending to describe a medical condition) people feel uncompetitive/without the ability to become competitive, not needed/without unique skills (not considering individuals), or not bought in on the meaningfulness of hobbies/without developed interests.
I am describing ‘depression’ that is based in one’s knowledge of being abused due to one’s identity and inability to do anything about it, having urgent (family) issues that no close ones help with and one cannot resolve (for example, my research suggests that people would give up, on average 78% of their remaining life if ‘people around them cared about each other’s problems’ - but in context, people would give up large fractions of their life even for nutritious food, insurance, etc), cultural limited presence of/training in love, and limited prospects for improvement of one’s family situation.
Perhaps, the anecdotes on the CPSP website can be understood as ‘weird’ by people around the ‘story tellers.’ Most people understand the situation and just go with it. Suicide causes issues to the family.
Thus, the “assumption that people who attempted suicide would lead negative lives” should hold, if one looks at the situation from the perspective of one in the situation who assumes that their emotions can lead to a change or authority/peer understanding or from the perspective of someone not ‘at peace’ with the situation. This assumption would not hold if people are at peace with their roles/situations and depression is defined as the limited need to emotionally negotiate relationships.
I emphasize that I just wrote some ideas, which can be not indicative of anyone’s perceptions, based on my limited understanding of the intended beneficiaries and non-beneficiaries as well as understanding of some resources. Persons and their attitudes are individual. When I hypothesize a commonality, it can not hold true, can apply only to some, be taken out of context, and have other interpretations.
Thanks for this. Understanding how prospective beneficiaries value their lives is difficult but important work. It seems a reasonable assumption that people who attempted suicide would lead negative lives. However, I think we can do better than resting on this assumption, and I think deeper analysis suggests this assumption is false.
Here’s CPSP’s answer on their FAQ in response to ‘Should people who want to kill themselves be allowed to die?’:
As a start, most people who have a non-fatal suicide attempt don’t attempt again. This article suggests the broad pattern following a first non-fatal suicide attempt is ~70% don’t attempt again, 20% attempt but don’t succeed, and 10% commit suicide.
I couldn’t find much that was directly relevant to long-term quality of life, but this very small French study looked at 29 adolescents who had attempted suicide, and followed up 10 years later (with significant potential for selection bias—only two thirds could be traced and of those, two thirds responded). Over 75% said they were happy in their personal lives, over 50% were satisfied or very satisfied with their professional lives, and 2/3rds had no significant psychiatric problem reported. 17% had an ongoing chronic psychiatric problem, and 14% were in-between these groups.
This study looked followed up physical trauma cases in adults—they found 65 patients who had the trauma due to a suicide attempts, and followed them up at 6+/- 3 years. 14% had died before follow-up, none due to suicide and all were reported as coping well by next-of-kin. 3 patients couldn’t be traced and 2 declined follow-up. Psychosocial measurements of follow-up patients suggested a majority had decent functioning, with around 20-25% experiencing severe impairment of some kind. None had re-attempted suicide.
I suspect that the key determinant of quality of life after attempting suicide is mental illness, especially depression, and not the suicide attempt itself. But I’m uncertain about this, and even more uncertain given both the literature and my clinical training are based on a high-income country context—things could be very different in low/middle-income countries or those in absolute poverty.
Thank you. I think so. I think that in high-income contexts, depression can relate to one’s loneliness and use of social media that use negative-emotions marketing as well as abusive/neglecting/rejecting family relationships (that the media (and people influenced by them) can draw from (and make one to assume as reality)).
In many low-income contexts, it can be argued that people are not as lonely, because agreements are based on community accountability (which requires mutually enjoyable or overall approved emotional navigation) rather than sound rule of law and business relationships are founded in friendship (gaining customers for undifferentiated goods). Also, in low-income countries family can play a key role. Forced marriage, female and child abuse norms, FGM, limited family planning can all worsen one’s mental health.
The key difference between high- and low-income countries can be that in high-income countries the negative perception of one’s relationship-related situation and limited enjoyment of others is motivated by media, while in low-income countries perceived due to actual and ‘necessary’ abuse (e. g. someone has to be beaten to make bidis because otherwise productivity would not increase).
A related thought is that if (low-paid and unpaid) productive people in low-income contexts suicide, the productivity decreases, ceteris paribus.
An EA who studies India’s media commented that the show of suicide in the TV is banned, because it increases suicide rates.
My small-sample study shows that some people can perceive their life quality below death, wish to live 0 additional years, and still live. I did not research suicide but the local enumerators, an elder, and an educator have not commented on it.
It can be hypothesized that the willingness to suicide is a part of a ‘dialogue’ between the ‘abused’ and the ‘abuser,’ used as a means to argue for more favorable treatment. It can be a statement that it is unacceptable to, for example, beat people for no perceived reason. Related concepts are described in The Wretched of the Earth by the psychiatrist Frantz Fanon.
The ability to suicide can increase people’s willingness to ‘lead this dialogue,’ which would otherwise be unthinkable, and thus (at least ‘during the discussion’) lower their quality of life. It can be assumed that this will have limited benefits, since external education and investment rather than internal redelegation of tasks is needed to highlight enjoyable cultural approaches and enable productivity without (human) abuse.
This would suggest that limiting the use of highly highly hazardous pesticides can improve the mental health of people (there is no need to feel emotions that intend to lead to the improvement of their situation when they can themselves very little about it). However, it can also be argued that once people know about suicide, but are prevented from it, their mental health decreases even more significantly, because they are perceiving the ‘trap’ of having to live in an abusive situation without the ability to affect this for themselves or future generations.
I am actually not describing depression as you may be understanding it: “persistent feeling of sadness and loss of interest,” which can occur when (I am not medically trained and am only suggesting ideas rather than intending to describe a medical condition) people feel uncompetitive/without the ability to become competitive, not needed/without unique skills (not considering individuals), or not bought in on the meaningfulness of hobbies/without developed interests.
I am describing ‘depression’ that is based in one’s knowledge of being abused due to one’s identity and inability to do anything about it, having urgent (family) issues that no close ones help with and one cannot resolve (for example, my research suggests that people would give up, on average 78% of their remaining life if ‘people around them cared about each other’s problems’ - but in context, people would give up large fractions of their life even for nutritious food, insurance, etc), cultural limited presence of/training in love, and limited prospects for improvement of one’s family situation.
Perhaps, the anecdotes on the CPSP website can be understood as ‘weird’ by people around the ‘story tellers.’ Most people understand the situation and just go with it. Suicide causes issues to the family.
Thus, the “assumption that people who attempted suicide would lead negative lives” should hold, if one looks at the situation from the perspective of one in the situation who assumes that their emotions can lead to a change or authority/peer understanding or from the perspective of someone not ‘at peace’ with the situation. This assumption would not hold if people are at peace with their roles/situations and depression is defined as the limited need to emotionally negotiate relationships.
I emphasize that I just wrote some ideas, which can be not indicative of anyone’s perceptions, based on my limited understanding of the intended beneficiaries and non-beneficiaries as well as understanding of some resources. Persons and their attitudes are individual. When I hypothesize a commonality, it can not hold true, can apply only to some, be taken out of context, and have other interpretations.