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The Weekend Neos Kosmos : 3 September 2016
DIGITAL.NEOSKOSMOS.COM THE WEEKEND NEOS KOSMOS | SATURDAY 3 SEPTEMBER 2016 23 COMMENT Self-destructive and suicidal behaviours can increase in a community that experiences trauma collectively – sharing around the trauma and the sense of hopelessness. Where governments continue to fail communities, especially those populated by minorities, with disparity and inequalities in social wealth and health that should be equivalent to the rest of the nation's social wealth and health, then often it is up to communities to tap into their trusted leaders to look out for one another and educate others to empowerment of the self, to a sense of self and place, and similarly so communally. People need people, especially in these communities that are deprived and discriminated by governments. Many communities have third-rate services, while some communities are effectively starved of some of the most basic services. In these discriminated communities, the residents cannot continue to cry out to governments, because it is the very government they cry out to that is their oppressor, that discriminates against them. Often if they cry out loud enough for long enough, the community is meted punitive measures and controls which are more about blaming the community than helping them. With some communities, governments have gone as far as shutting them down. Therefore the social and emotional wellbeing of the community is, with a sense of resignation, degraded. Hopelessness is a strong indicator of heightened vulnerability to self-destructive behaviour. Hopelessness has to do with the culmination of overwhelming feelings or beliefs that the future is bleak. Hopelessness exhausts motivation. Where hopelessness is ingrained as a whole of family experience or whole of community approach, the despair and self-destruction begins from a younger age: "It's our lot." "It's the burden of our people." "Things will never get better." The sense of hopelessness is chronic and for some becomes unbearable. Losing someone close to you is a devastating experience. Dealing with the distress in the lead-up to their loss is a devastating experience. Having to deal with familial distresses, as if recurring, with other family members is destructive – the objects and functions of the family take a toll, a real beating. For some they are psychologically and emotionally battered, and the damage takes on an overwhelmingly feeling of the irreparable. Having to deal with ongoing destructive behaviours, with a communal sense of hopelessness, with the overwhelming backdrop of a deprived and discriminated community, is tortuously exhausting and simply heartbreaking. Community distress and breakdowns occur collectively just like a family breakdown – indeed, a whole community can breakdown. Hopelessness and despair can be effected as if normalised. Suicide prevention must be understood in terms of who it is we are responding to: an individual overwhelmed by expectations, an individual overwhelmed by a sense of failure, an individual overwhelmed by a sense of hopelessness, an individual overwhelmed by trauma, an individual overwhelmed by a sense that their identity is a liability, a family overwhelmed by trauma and grief, a community overwhelmed by most of the above: hopelessness, trauma, discrimination, deprivation, racism – the sense that the future is 'bleak' and 'unfair'. In being honest about suicide prevention we must understand the person, family or community we are responding to. We must respond to who they are and therefore to how they should be treated. To act as if everyone in society is equal, as if there is no narrative of victimhood dangerously dismisses the stresses unique to some but not to others. To act as if life should be fair to people living in deprivation and discrimination when life is not fair to people living in deprivation and discrimination is to pass the buck. To quote Professor Taiaiakei Alfred, the 'chattering classes' can carry on all they like about 'reconciliation', and I'll add in, 'closing the gap' on inequalities, but life/society, the products of dominant cultures, of the ruling classes and of their governments, are unfair. In order to deal with the narrative of those in the now, rather than deal with a body politic, we have to accept that life is shit for far too many and acknowledge their anguish, pain, discrimination and suffering as real and longstanding. Our immediate aim must be to help them to develop and understand resilience and help them with a context of a meaningful life from which they can beat a path away from or around the effects of the unfairness. But to do this we cannot abandon them to the notion of 'resilience' alone and instead must work alongside them patiently, together navigating ways forward to opportunities once they build up a suite of protective factors and have a sense of wellbeing. We cannot dictate to everyone who is discriminated against while they are suffering that we must strive for a 'fair' or 'fairer' world. This will come at the cost of the immediacy of wellbeing. Let us work with people first, and worry about changing the world second. To understand people in terms of their discrimination, whether this discrimination is dished out inadvertently or intentionally by governments, and by some of the 'chattering classes', is a step in the right direction. When I say or write that ‘people need peo- ple’, I mean this in that we must focus on each other, not pass the buck to blaming someone for their lot. We can see the poor and marginalised are victims and blaming others will not help anyone. We must understand that racism and other imposts are the landscape for many. To pass the buck here by blaming racists for racism is a waste of time. The end to racism has quite a journey to go. In understanding this rather than denying this by getting angry at the unfairness of the racism, of the discrimination, by saying merely it should not be this way, is a step in the right direction. We should not posit the crap that the answer to someone's suffering is to change the landscape, because in doing so we leave behind the victims. We can do both, but the onus must be on those in the here and now. Each person, each family, each community in distress needs our undivided attention – this constitutes the biggest first step in helping those who are victim day in day out to the relentless brutality of discrimination. Suicidal behaviour does not mean that someone wants to die - this is another dangerous myth. Suicidal behaviour is a scream for help. It is a fallacy to presume 'self-responsibility' as a way forward for someone in a dark place. People need people to strengthen their resolve to the ways forward. Suicidal behaviour is destructive behaviour that can lead to impulsive actions such as a suicide attempt. Access to emotional support can save lives. It may never be realised this was the case but person-to-person support is a huge factor in the improving and saving of lives. Resilience and empowerment are gradually accumulated, to the point where there comes a time when there is no looking back. It is not true that once someone has exhibited suicidal behaviour that they are forever trapped in the heightened vulnerability to recurring suicidal behaviour. It is true that a powerful indicator to future risk of suicide is a prior suicide attempt, however, this does not mean the heightened risk shall be there for life. With the coming together of emotional wellbeing and meaningful contexts, there develops resilience within the individual that can make one stronger than ever before. With the right sort of support, protective factors can guard against the risk of suicide. Suicide prevention should not be focused alone on reducing risk factors but just as focused, if not more so, on increasing protective factors. The most powerful protective factors include building a connectedness with other people – they do not need to be about direct and targeted support. This connectedness with other people should include the types of engagements that allow the individual to directly and indirectly draw on information about wellbeing, about navigating one’s journey through society, and therefore predominantly focus on self-worth, identity and conflict management. Most importantly, healthy relationships will contextualise a meaningful life, an honest life, and this in itself is a relief from the conflict and discord that arise from unhealthy levels of expectations. Personal relationships are important, where the support person can understand that they are about support and not about any particular targeted responsibility to the individual. More research needs to be disaggregated on suicidal behaviour and mental disorders, but it appears the majority of suicidal behaviour is not linked to mental disorders and rather to a sense of deep unhappiness. Therefore families and communities can contribute significantly to the improving of the life understandings of a troubled person. The risk of suicidal behaviour increases when individuals suffer discord – such as relationship conflict or from a sense of loss or from a sense of failure. People need people. Isolation is dangerous. The best support comes from one’s closest social circle. Protective factors and profound support comes from the development of one’s context of meanings, but these too are contributed to by one’s social circle. Where whole communities are at heightened risk of community distress, the greatest success found in reducing the levels of communal distress is when the social circle that is the community comes together to support one another – therefore inherently working on the context of their meanings. Inherently rather than troubled individuals isolated and effectively judged, they are understood and supported. This type of coming together by families, friends and/or communities to a troubled and isolated individual is about wellbeing. There may have been childhood trauma, interrupted childhood development – a series of emotional instabilities and turmoils that have affected personality traits which have given rise to unhappiness and suicidal risk factors. But good self-esteem and protective wellbeing factors will come from people coming together with the troubled individual at whatever point in time. These developmental interruptions, life stresses and unhappiness are not mental disorders that require specialist health practitioner support. Rather this is all about people coming together to secure healthy and positive relationship building, to patiently assist one with their self-esteem, to contextualise the path to positive self-identity and the pathway to positive outlooks. Attitude is imperative but it is something shaped by the individual and by those around the individual. People do listen; they listen to the negative and to the positive. Positive adaptive outcomes must be patiently educated and shaped, and the familial and community support self-evident and generous. Once positive attitudes and positive coping understandings settle in as personality traits, the formerly troubled individual is effectively 'safe'. There needs to be in society greater onus on shared understandings of contextual meanings of what it takes to shape positive coping strategies in overcoming childhood adversity – abuse, maltreatment, of exposure to domestic violence, of parent mental disorders. There should be less focus and judgment on the fact of any difficult past, it should not be the focal point, but if you read newspapers it is the focus. This bent for the past is damaging because it is a trapping. The discourse needs to be focused on the ways forward and in not holding oneself hostage to any past, or in holding any person or any set of events as responsible for any ongoing damage. Positive meanings and positive attitudes will lead to an understanding and forgiveness of the past and that the present and future can be shaped. Destructive and self-destructive behaviours should be understood as situational and that individual, familial and community attitudes determine the length of these behaviours. Governments investing their attention in helping resource communities, for instance, to support others is imperative. Suicide is the leading cause of violent deaths. Self-destructive and suicidal behaviours are responsible for more hospitalisations and for the descent into more social ills than by any other behaviour. On average, eight Australians per day suicide, scores more attempt suicide each day, thousands ideate suicide each day and many more grieve and suffer alongside. Most suicidal behaviours are linked, and usually exclusively, to unhappiness. Therefore, suicidal behaviour is preventable. I would argue that suicide and suicidal behaviour are the major health problems society face, but of all our major health problems suicidal behaviour is the most preventable. Yet adequate suicide prevention is not prioritised by governments. Where causality is limited to relationship and social factors and to vulnerable individuals' sense or feelings of hopelessness, the descent into a sense of entrapment and the responsive trait of impulsivity, then this behaviour can be addressed by positive mentoring and by work towards a positive self. Unhappiness is something that can be addressed holistically rather than it being compartmentalised as some sort of mental disorder manifestation and as that of a runaway train risk factor to mental disorders. Unhappiness is not genomic and instead is a manifestation. The prevalence of suicide and suicidal behaviour is higher in high- and middle-income nations as opposed to in low-income nations. Similarly, rates of reported depressions and of hospitalisations from self-harm are higher in high- and middle-income nations. Life stresses that lead to suicidal behaviour in some cultures do not lead to suicidal behaviour in other cultures. Therefore the context of our meanings and our support groups are pivotal. Racism should never be played down. Racism plays out as a major cesspool of negatives and risk factors to high end levels of unhappiness, depressions and suicidal ideation. Racism goes to the heart of identity, to self-worth and esteem and their historical and contemporary identities become a liability. Racialised groups within oppressor societies report the world's highest rates of depressions, unhappiness, selfharms, suicidal behaviour and suicide. It is all about identity, whether for a vulnerable child, young adult, cultural group – the answers lay in respecting one another, being there for the other, empowering each other through meanings, relationships, freedoms and attitudinally. Suicide prevention is about the positive self and any comprehensive response includes everyone. A comprehensive national response for suicide prevention requires understanding the above. Loose understandings will tighten if we begin to understand that the majority of suicidal behaviours are directly linked to trauma and unhappiness – to situational events. Contexts and understandings can be changed before dangerous reliefs from substance abusing are sought or before serious mental disorders set in. * Gerry Georgatos is a suicide prevention and prison reform researcher and advocate with the Institute of Social Justice and Human Rights. He is a member of national projects further developing suicide prevention and prison to hope to wellbeing to education programs. He is also a prolific writer on the ways forward from racism.
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