Suicide is also a cultural problem, UvA doctoral candidate observes
When it comes to suicide, psychological problems are often thought of worldwide. PhD candidate and psychotherapist Indra Boedjarath saw in her practice that suicide can also have cultural roots and entitled her dissertation Culture and Suicide - An exploration of cultural factors involved in suicide. “In Indian culture, many lyrics, songs, and Bollywood movies refer to suicide.”
Indra, you work as a psychotherapist in practice. How did you come up with the idea for this research?
“It came from a survey conducted by the Dutch Municipal Health Service (GGD) in the 1990s. That research mapped who in The Hague ended up in the emergency room after a suicide attempt. Hindustani girls and young women scored very high. I also saw this target group in my practice. That fascinated me: what causes this group of people to take such action more often? The problems in this target group were quite light from a psychological point of view: a quarrel between children and parents about wanting to go out and not being allowed to, for example. Often there was a lack of freedom of movement, or it involved the clash between parents' norms and values and the culture in which the child grew up. It was sociocultural causes and not depressive symptoms that led to a move for someone to take their own life.”
Why is less known about sociocultural causes?
“American research shows that 90 percent of all suicides are triggered by psychological symptoms, especially depression. That is what many treatment approaches to suicide are based on. They look at it from the perspective of psychological symptoms. So do I; that's how I was trained. But American research took place in Western countries among patients who had already been hospitalized with psychological symptoms. The same study conducted in China and India yielded much lower rates. But those results do not find their way into common knowledge, where Western thinking prevails. That is a side mission of mine, to question general, Western thinking and show that there are other realities as well.”
You chose six countries from the Indian diaspora for your research, including the Netherlands. How did you make this choice?
“The Indian diaspora is incredibly large. There are 30 million Indian people living outside India scattered through countries around the world. Therefore, I only looked at six countries (the Netherlands, Guyana, Trinidad and Tobago, Mauritius and Fiji) where most Indians live from the northern Indian states of Bihar and Uttar Pradesh. Contract workers were brought from these two states after the abolition of slavery because of the labor shortage. Within continental Europe, the largest group of Indian Hindus with Surinamese roots lives in the Netherlands.
“During the contract worker period, the suicide rate among Indians was high. Indians in Fiji, for example, were more than 300 times more likely to commit suicide during that time than native Fijians. No doubt this was due to the circumstances, but why did Indians turn to suicide? Why not drink, or run away, you name it. That gave me a clue to look for something intrinsic to culture. It has often been studied that there is a relationship between culture and suicide, but how exactly it's connected is not discussed in the literature.”
What is the relationship between culture and suicide?
“For that, I went looking for the explanation that people in the environment have after a suicide. This is how I discovered that many lyrics and songs, as well as Bollywood films, refer to suicide. The concept is so ubiquitous that it is taken for granted. There is also the concept of reincarnation in Hindu culture, the belief in life after death. Research shows that this can lower the threshold for suicide. In my research, I did not find that relationship one-to-one, but I did come across derivative concepts that hint at reincarnation, such as karma. I created a tool to name the cultural factors. It's a trial run, so I don't want to be pretentious about it, but it can be developed further.”
What ultimately leads people to commit suicide?
“Often honor plays a role. Honor can be very oppressive. That occurs in other cultures as well. In the Surinamese-Hindu culture, honor is very much linked to achievement. Parents have expectations about their children's academic success. In India, there is a spike in suicides during exam periods.”
How can these insights help in practice?
“By incorporating the insights into guidelines and treatment practices. In practice, you should not immediately assume that there are psychological problems at play. Because if you treat a cultural problem as a psychological problem then you start pushing the wrong buttons. Then you pump someone full of pills, or have someone compulsorily hospitalized ... you won't achieve anything. If you know what the cause is, then you can talk about that. I don't deny the psychological factors, indeed, I work with them. But suicide is a multifactorial phenomenon that can be caused by several factors including culture. I would like this to be much more on the minds of social workers.”
PhD ceremony - December 22 at 4:00 p.m. Location: Agnietenkapel. Admission: Free.
Are you thinking about suicide? Contact 113 Suicide Prevention 0800-113 (free) or chat at 113.nl.
