Understanding Suicide: Why Gender and other Protected Characteristics are Important to Consider - Part One

It’s coming up to the end of Suicide Prevention month this year, and while I have put up a few posts about this topic over the past month I wanted to dedicate a bit more thought to the issue than just a few Instagram slides and short captions. Also, I am launching (as of this moment) my efforts to provide newsletters about things that I think maybe need more expansion on to run alongside my podcast. Basically, I have a lot of things I want to talk about and write about, so I am using all possible mediums to inundate you with the things I think are important (and hopefully you do too – otherwise I am not sure why you’re reading this...)

A few weeks ago I listened to a podcast in which the host asked their guest a question along the lines of, “Why do we think of suicide in terms of how it affects men and women? Why can’t we just think of it a just suicide, something that can and does affect everyone?”

I could see where the host was coming from. The context of the conversation was amidst a wider discussion about the often polarising nature of discussing gender issues online in social media spaces. Specifically mental health issues and the more commonly discussed issue of men’s mental health. When I say “more commonly discussed”, what I mean is that there are often conversations that occur about mental health online, but when it comes to discussing mental health difficulties of a particular demographic, there seems to be a more visible focus on men’s mental health. I am not saying there shouldn’t be a focus (we’ll get into why it is a focus later on); I am simply noting an observation of mine – which may or may not be an accurate reflection of the landscape of online mental health discussions.

The podcast guest very helpfully highlighted that in their view suicide should be both discussed and considered as a subject in and of its own right, and at the same time there are specific factors that relate to why men and women either attempt or die by suicide that can and should also be considered. I would further add that these differences along gender categorisation are further influenced, and potentially exacerbated by, other categorisations such as sexuality, race, and class.

I agree with the guest. I think both discussions have their place; and so I thought it might be useful to unpick why consideration of categorisations – which fall into what’s also known as protected characteristics within law – are helpful to expand the conversation around suicide and how their consideration may assist with suicide prevention. Therefore, it is these two specific focuses – suicide itself, and the influence that societal categories (or protected characteristics) have on acts of suicide – that will be discussed in this newsletter series.

It’s also worth mentioning (although you may have already noticed by the title) that this topic was initially meant to be explored in one newsletter… But seeing as I can never keep things brief (I end up researching things a bit too intensely – which may or may not have something to do with my own unrelenting standards) it became too long. And so I have decided to split the topic of this newsletter into two parts. For this first part of the newsletter will focus on trying to understand suicide in general. While the second part will focus more on why thinking about protected characteristics is helpful.

To help think about and understand suicide as a topic in and of itself – and a phenomenon that results in approximately 700,00 deaths a year – I have drawn on research for the Interpersonal Theory of Suicide (ITS). The ITS is a model developed by Kimberly Van Orden and her crew (formally known in the world of academia as et al) and published in 2010, that seeks to understand why individuals may engage in suicidal behaviours. When referring to suicidal behaviours, there are a number of behaviours (or acts) that someone can engage in. Firstly, there is suicidal ideation (i.e., thoughts or fantasies about suicide), then non-lethal or parasuicidal behaviours (i.e., self-harm – although not all self-harm is necessarily motivated by a desire to die). And finally near-lethal acts (i.e., attempts at suicide were made with a non-fatal outcome) or lethal suicide acts (i.e., suicide attempts with a fatal outcome). ITS puts forward the idea that there are three conditions (as it were) that need to occur for someone to attempt a near-lethal or lethal suicidal act. These are thwarted belongingness, perceived burdensomeness, and acquired capability (see the figure below, which is taken from the ITS research paper).

It is very possible that there are other models of suicide out there, but from what I can tell, the ITS has been developed through consolidation of several theories of suicide. Therefore, it is likely that you may not agree with everything the models puts forward, but this is one way to conceptualise and understand suicide.

Thwarted belongingness is based on the concept that as human beings we all desire connection and wanting to belong; to be accepted by others. However, through various internal factors (i.e., perceptions we have of ourselves) and external factors (i.e., messages we receive from the environment around us) we can feel disconnected, separate, or isolated. In fact, it has been noted that “social isolation is arguably the strongest and most reliable predictor of suicidal ideation, attempts, and lethal suicidal behaviour [sic] among samples varying in age, nationality, and clinical severity” (Orden, et al., 2010).

Linked to, but distinct from thwarted belongingness, is the concept of perceived burdensomeness, which is defined (by good old Wikipedia) as “the belief that one is a burden on others or society”. The emphasis here is on the belief of ones burden on others; meaning that those whom suicidal individuals believe they are a burden to (e.g., family, friends, spouses, partners) might not actually see the suicidal individual as a burden at all. I am sure there are instances where people are explicitly told they are a burden (e.g., abusive parents might tell their children they were a mistake); but that also does not necessarily make the burdensomeness true. Alongside these beliefs of liability to others, it is noted that perceived burdensomeness is additionally characterised by “affectedly-laden cognitions of self-hatred” (i.e., feelings of self-hate accompanied by low self-esteem, and feelings of guilt or shame).

The ITS notes that thwarted belongingness and perceived burdensomeness are what create the desire for suicide; however, both these conditions are not enough for someone to engage in lethal or near-lethal acts of suicide. A desire for suicide may, for example, lead to suicidal ideation, but not necessarily any suicidal acts such as self-harm. This is where acquired capability comes in. The idea goes that humans inherently fear death, and by and large will engage in behaviours that avoid fatal outcomes. Therefore, to get to a place where someone is willing to engage in suicidal acts they need to acquire the capability to take their own life; essentially to overcome the in-built defences we have against death.

Acquired capability occurs in two ways: through a reduction in fear of death, and a higher tolerance for physical pain. Reduction in fear of death can occur through persistent or continued exposure life threatening or fear inducing events – such as combat or childhood maltreatment – and exposure to acts of suicide by others (i.e., the occurrence of multiple deaths by suicide in one’s social network).  While increase in pain tolerance can occur through repeated acts of self-harm (i.e., getting used to the pain of cutting) and previous suicide attempts (i.e., experimenting with different types of methods and becoming more used to engaging in this type of behaviour). The idea goes that through the process of habituation (i.e., things happening over and over), a person will get used to the idea of something and it can start to feel normal. Or in this case, less scary and more achievable.

An example of this is that of riding a roller coaster. Initially one might be nervous and maybe even a little scared; but once you have ridden a rollercoaster a few times you get used to it, and may even find it exhilarating and exciting – this is called an opponent process (i.e., basically feeling different about something after a while than what you did earlier on). Similarly, difficult life events repeated over time, that cause psychological pain, may make the option of death seem more appealing. Or someone might find that self-harm can bring relief (i.e., through tension relief or through an increase in endorphins, which numbs physical pain), which may change their perception of the self-harm and may prompt them to engage in more and more dangerous acts of suicidal behaviour.

It is therefore the occurrence of all three of these conditions, thwarted belongingness, perceived burdensomeness, and acquired capability, that results in individuals engaging in suicidal acts. I am not going to lie, this was a very brief overview of the ITS. If want to know more I would suggest reading the paper – it goes into much greater detail about the mechanics and processes of the model. However, I hope this summary has helped orientate you the internal processes that are required for someone to engage in an act of suicide beyond the desire to die.

I guess these three conditions are perhaps universal to any and all individuals, but what requires further exploration are the factors involved that would facilitate why a person might come to feel disconnected or isolated from others, and why they might feel like they are a burden to those around them. This is where we might start to think about a person’s protected characteristics in a bit more detail, and this is what the second newsletter in this series will focus on.

I hope you have enjoyed reading this newsletter. And when I say enjoy, that is obviously a loose, subjective term – I know that reading about suicide is not necessarily an activity one might enjoy, but I hope it was at least informative and that learning something new was helpful. As always, my aim is to spread knowledge and to try and increase understanding about the more difficult and challenging aspects of the human condition. So, hopefully this has achieved that aim in some way.

If you think this was informative enough to share, please do so. And if there is anything you wanted to discuss you can find me on Instagram. Don’t be a stranger, come say “hi”. I am also going to shamelessly plug my podcast (despite the fact that is you are reading this you already know about it); but if you think that’s also worth sharing, please do.

Thanks for reading this far – hope it wasn’t too shit.

All the best,

Nice-ish.

P.S. If you noticed any spelling errors, keep them to yourself! K, thanx. Bye!