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1 The ‘discovery’ of suicide in East and Southern Africai Megan Vaughan University of Cambridge In 1942 Tanganyika Notes and Records published a short piece by R.E. Moreau entitled “Suicide by „Breaking the Cooking Pot‟”.ii Symbolic pot- breaking is a powerful form of curse employed by communities in the Mount Meru region of Tanzania and has been described recently by a political scientist as a form of “indigenous accountability”. iii Moreau was a colonial district officer and his paper was based on the reports of a number of informants whose accounts, he wrote, “are in excellent agreement with one another” and who “regard suicide by this means as nothing out of the ordinary….”iv „Kuvunja chungu’ (to break the cooking pot) was, he wrote, a form of suicide practised by women and, very occasionally, by elderly men who had been neglected by their relatives. The women having recourse to this form of suicide were regarded as having held some grudge, some reason to be “bitterly chagrined”. Typical cases cited by Moreau were: a woman whose husband was neglecting her, another who could not bear the fact that her husband was taking a second wife, and another who had given birth to three still-born children. Such a woman, contemplating suicide, waits until she is alone, either in her house or in the bush, strips herself naked and then smashes her cooking-pot whilst addressing it with “ritual words” along the lines of :”Your purpose has been to cook my food. Now I wish that you may kill me if I look on you again.” Then she hides the pieces of the pot around the homestead or (in some cases) throws them into the bush. One piece of pot she reserves and reduces to a powder that she swallows. Sometimes this is the end of the story, a preparation without sequel. But in other cases, at some later date, in “an excess of chagrin” the woman may decide that she really will end her life, in which case she retrieves one of the hidden pieces of pot and looks at it. Immediately she will be “seized with a fever”, foam at the mouth and die the same day unless “magical aid” can be 2 given in time. The corpse of such a suicide case is feared as contagious, and whilst other suicides are given full burial rites, a person who has died by kuvunja chungu is placed far away from habitation, ideally in a rock-shelter or cave. As the psychoanalytic literature indicates, „magical thinking‟ in relation to suicide (or indeed death more generally) is hardly confined to African societies. v‟.In the introduction to his book on death, the philosopher Todd May, describes how reading, writing and teaching on death day after day finally „got to him‟.vi The rational philosopher writing a rational book on death started having nightmares. I have had a similar experience working on this project. I even tried to prepare myself for it. The rational part of my brain reasoned that, as my mother was elderly and not very well, there was a chance that she would die in the course of the project. She did – in fact, whilst I was on a research trip for the project in Malawi. But that rational side was struggling with a superstitious instinct that went like this : “Doing research on death is tempting fate – someone will die… you might die!”. So I was not altogether surprised (though I was deeply upset) when in the middle of writing a paper on the history of suicide in Malawi I checked my email and learned that an old friend of mine had ended her life by drowning. As May points out, amongst the many reasons why we find it difficult (some would argue impossible) to really confront our own deaths is that death is an absolute certainty, but one the timing of which we do not control. Every religious tradition attempts to deal with the fear that this engenders in us, and much current debate on euthanasia revolves around the question of whether taking control of our own deaths somehow renders us less human. Suicide is, of course, one way of taking that control, but it more often produces fear, guilt and even revulsion than it does comfort. In the extensive literature on the history of suicide, the societies of the African continent barely feature, except in brief discussions of folk beliefs and practicesvii Moreau‟s description of kuvunja chungu lends itself in many ways 3 to such a use, with its clear account of the supernatural and mystical dimensions of female suicide in this rural African setting and its reference to fear of the corpse. Yet, as Moreau implies, local people understood kuvunja chungu in commonsense terms that we might be inclined to label „psychological‟, at the same time as they stressed its supernatural dimension. One look at a pot sherd was enough to kill, but it was known that only women with certain kinds of resentments and sorrows would break the cooking pot in the first place.viii Any study of suicide must attempt to deal with this interaction between individual psychodynamics and specific social, religious and political contexts within people make their decisions to end their own lives. We know that some societies are more tolerant of suicide than others, and may regard certain forms of suicide as „honourable‟, and we know that attitudes to suicide can change over time. Suicide, strange as it may seem, is sometimes written into stories of nation-building, as in the case of Cuba, and the very definition of suicide is highly political. Suicide bombers are martyrs or murderers, depending on your perspective; bravery on the battlefield in some circumstances might be read as a suicide mission. This raises the question of whether suicide is a coherent category at all. In some societies certain types of suicide might be regarded as quintessentially „bad‟ deaths, whilst others are glorified as „good‟ deaths. Suicide in colonial Africa : an intellectual historyix Historically African societies have been assumed to have very low rates of suicide. This might be true, but we have no way of knowing, since we have no substantial longitudinal data to support or contradict this position. Whether true or not, this assertion has to be viewed as part of an intellectual history – in particular a history of colonial thinking on the „African mind‟ and on depressive illness on the African continent.x In both professional and lay colonial writing on African psychology, „Africans‟ were generally held to be a happy-go-lucky „race‟ of people with few cares in the world, and what cares they had they were likely to attribute to the actions of others (via the medium of witchcraft or the intervention of spirits) and rarely to their own actions. African people, it was argued, did not suffer from introspection and guilt and 4 so one rarely encountered depressive illness amongst Africans, and (since suicide was linked to depression in this literature, rather than to aggression) it followed from this that they rarely killed themselves. This was less a theory than a discourse, but it has had a long and vigorous life.xiThe political utility of these ideas in the context of colonialism is clear. Africans were not fully- formed individuals, and were incapable of taking responsibility for their own actions. Their fears and anxieties were externalised; their own mis-deeds and harmful thoughts projected onto others. Unfamiliar with the experience of guilt, lacking the internal world of introspection, they rarely fell into anything approaching suicidal despair. The first systematic study which questioned the view that depressive illness was rare amongst Africans was Margaret Field‟s book Search for Security: an ethno-psychiatric study of Ghana, published in 1960.xii Field, an anthropologist and psychologist, studied a cocoa-producing area of Ghana where a large number of new shrines dedicated to healing had recently been established. Women formed the vast majority of those visiting these shrines where, typically, the healing process was predicated on a prior „confession‟ of misdeeds, often involving witchcraft. Field argued that these women were „depressed‟ (in part as a consequence of the pressures of the new cash economy), and that rates of depression in this part of Africa had been under- estimated because its culturally specific manifestations had been mis- recognised. Not everyone agreed with Field that „anomie‟ was on the increase in Ghana or that the workings of the shrines could be interpreted in this way. xiii Field may have been guilty of some degree of psychological reductionism, but she had raised an important question concerning witchcraft. While witchcraft accusations usually point the finger of blame on an other, Field pointed out the frequency with which women accused themselves of being witches, inviting a different kind of interpretation, one focusing on internalised guilt rather than „projection‟. In 1967 Raymond Prince published a review of the literature on depressive illness in Africa (from 1895 onwards). He pointed out the biases in reporting during the colonial period, but also critiqued Field‟s methodology. He argued, 5 tentatively (and maybe even slightly tongue-in-cheek), that the political changes of Independence were likely to bring about both a greater willingness on the part of a new generation of African psychiatry professionals to label certain states „depression‟, and a real increase in rates of depressive illness: “…I believe that we can look forward to seeing increasing numbers of depressions in Africa and no doubt even depressions with a prominent component of guilt and self-deprecation.”xiv It is relatively easy to dissect and dismiss the biases of the „colonial mind‟ on the subject of depressive illness in Africa, but as Prince implied, there are some enduring theoretical and methodological questions concerning the cross-cultural definition and diagnosis of depressive illness, which continue to occupy mental health practitioners and researchers.xv Even if one concludes that depressive illness has been under-diagnosed in Africa, one should be aware of the dangers of extending the „empire of depression‟.xvi Studies of suicide in the colonial period were for the most part simple extensions of the argument about the rarity of „real‟ depressive illness in African subjects. The very low rates of suicide quoted by these studies were, as Collomb and Collignon pointed out in their review of the literature, highly questionablexvii. Though most of the data is unreliable in a statistical sense, and though some of it was clouded by colonial preconceptions, nevertheless there are some suggestive insights to be gleaned from material published in the 1950s and 1960s. For example, Tolani Asuni‟s study of suicide in Western Nigeria (published in 1961, the year after Independence) found suicide rates to be higher in rural areas than in urban ones, and concluded (contra Durkheim) that suicide was not a function of social isolation.xviii In reviewing the evidence for the place of suicide in African cultural models and value systems, Collomb and Collignon found that in many African communities suicide was viewed as a quintessentially „bad‟ death, one that denied the perpetrator a place in the spirit world of the lineage. But there were also marked variations in approaches, even between neighbouring peoples, with some groups viewing suicide not as a crime, but as an act of bravery. In highly stratified societies in Africa, suicide as a reparation for dishonour was 6 not uncommon, but „shame‟ was also a more widespread sentiment allegedly motivating suicide.xix Collomb and Collignon concluded that „shame‟ rather than „guilt‟ characterised African societies, producing a somewhat more sophisticated version of the familiar argument about the absence of guilt in African subjects. They also referred to the role ascribed to supernatural forces in some African explanations of suicide. This had been noted by, amongst many others, Jeffreys, who argued on the basis of African material that a fourth category of suicide should be added to Durkheim‟s typology. He called this „Samsonic‟ suicide, in which the subject commits suicide with the specific aim of taking revenge on another. The motivation for this form of suicide rested on the belief that the spirit of a man could return after his death.xx Supernatural forces were also prominent in the anthropological case-studies contained in Paul Bohannan‟s pathbreaking 1960 volume on African Homicide and Suicide.xxi Bohannan aimed to evaluate the available African evidence against Durkheim‟s analysis of suicide, but also to test out the theory that there was an inverse relationship between suicide and homicide.xxii Most of Bohannan‟s contributors found it difficult to draw any definitive conclusions on these issues, given the limits of their statistical evidence, but their case studies were revealing of social attitudes towards suicide. To varying degrees, the communities studied feared the consequences of suicides and performed modified burial rites on the bodies of suicide cases.xxiii In her contribution Jean La Fontaine reported that the Gisu people of Western Kenya considered suicide to be an evil act. It was not intrinsically evil, it seems, but evil in the sense that it was thought to result from an undesirable and dangerous set of circumstances characterised by bad relations between individuals, or between individuals and their ancestors. Suicide was also considered to be contagious, and contact with the body of a suicide extremely dangerous. La Fontaine argued that the Gisu believed that only the ancestors could make a man kill himself and they could do this in one of two ways: either by making him feel so ashamed by some anti-social act that he felt impelled to kill himself, or they could involve him in arguments with his close kin, such that he would ultimately commit suicide out of litima. Litima is translated by La Fontaine as 7 “temper”: a liability to fits of anger and violence that can be inherited across generations. If the Gisu people, according to La Fontaine, viewed suicide not as an act of individual will but as one impelled by supernatural forces, this did not prevent them from ascribing “motives” for suicides, the most common being “failure to have children, quarrels with close relatives or spouses, or the death of several children or siblings.” But La Fontaine also noted that “a striking number of suicides” were attributed to a person having suffered from a long-standing painful illness, and that in post-famine years the suicides of men, in particular, increased. As La Fontaine‟s contribution indicated, any thorough study of suicide in African societies would rest on an understanding of notions of personhood and related ideas about relationships, not only amongst the living, but also between the living and the dead.xxiv That these ideas go beyond the conventional colonial representation of the „African mind‟ is evident from a corpus of sensitive anthropological work. An comprehensive historical study would have to include the impact of both Islam and Christianity on attitudes to suicide (something which goes beyond the scope of the present paper), and any intellectual history of suicide in Africa would also need to go beyond a study of „traditional‟ beliefs and practices (important as these may be), to encompass political and legal discourses. It may have sounded fanciful to suggest, as Prince did, that with the coming of political independence Ghanaians would be more likely to kill themselves, but as much comparative literature shows, political discourses can have a profound effect in legitimising or de-legitimising suicidal acts.xxv Suicide in East and Southern Africa : moral panic or epidemic? In Uganda in August 2007 a leading newspaper published an extended discussion of suicide, and quoted a survey carried out in Kampala that had recorded a doubling of the suicide rate, from 1.31 per 100,000 in 1980 to 2.34 in 2004.xxvi Given that the “global” average suicide rate is around 16 per 100,000xxvii, this remains a low rate when viewed comparatively, but that is 8 perhaps not a relevant consideration to Ugandans experiencing such a marked increase. Suicide and attempted suicide are criminal offences in Uganda, as in most African countries, and this is widely thought to lead to under-reporting.xxviii Quoting the leader of the research team, the Ugandan press report concentrated on economic and “lifestyle” changes as the sources of the increase: “As the economy becomes more cash-based, psycho-social distress is mounting on those who cannot raise enough to earn a decent living…Modern life puts pressures on men to earn income and where that is not forthcoming they get depressed”.xxix A month later the Archbishop of Kampala added his voice to the debate, criticising the implication that poverty was some sort of justification for committing suicide. Suicide, he said, was a “barbaric” way of solving problems :”Just fight poverty by thinking and working hard. Does one get money after killing himself/herself?”xxx The pressures of the cash economy and frustrated expectations also feature in reports on rising suicide rates in Botswana, one of the wealthiest countries on the continent. If the figures quoted in the local press are correct, Botswana now has one of the highest suicide rates in the world. Here a lively debate in the media has been sparked by a wave of so-called “passion killings”, where young men kill their girlfriends and then themselves. Botswanans disagree on the causes of this phenomenon. The political opposition blames poverty, while others blame the consequences of Botswana‟s economic growth, the decline of traditional family structures and the ruthless materialism of “gold-digging” women.xxxi In Malawi, one of the poorest countries in Africa, newspaper reports in July 2008 focused on two cases of men who had committed suicide apparently because of marital problems and asserted that there was concern in “police corridors” over the escalation of such cases.xxxii Though many accounts of suicide in Eastern and Southern Africa are dominated by a rather ill-defined discourse on the ills of modernization, other, more explicit explanations are sometimes offered for apparently rising suicide rates. One refers to the HIV/AIDS epidemic which has had such a devastating impact on this region and where, until recently, drug therapies have been unavailable to the vast majority of people living with the disease. One of the 9 dominant narratives of organisations working with HIV/AIDS patients in the region is that which tells of their success in persuading suicidal sufferers that life is worth living.xxxiii Unsurprisingly, high suicide rates are also reported for communities that have suffered from conflict and displacement, including those in Namibia and Rwanda.xxxiv Psychiatry professionals in Eastern Africa are often quoted in the press as stating unequivocally that suicide rates are on the increase, but their publications in professional journals are generally cautious and point to the grave limitations of the data available to them.xxxv Often I have found scientific reports quoted in the press to be extremely elusive. For example, I have been unable to locate a scientific report on suicide widely quoted in the press in Botswana. Establishing current suicide rates is extremely difficult for most parts of the region; access to reliable longitudinal data even more so. But professional interest in the issue is undoubtedly increasing.xxxvi Recent initiatives in East Africa include the setting up of a African suicide research network, and the establishment of a Samaritans organisation in Kenya. East African psychiatry professionals have been central to these initiatives, and have contributed to a growing literature on suicide in the region. Dr Eugene Kinyanda and his colleagues in Uganda have published on suicide in Kampala; Professor David Ndetei and his colleagues have produced a string of papers on suicide and psychiatric illness in Kenya. Work has been carried out on parasuicide in Tanzania and Ethiopia on youth suicide and attempted suicide.xxxvii There is little doubt that psychiatrists in the region believe strongly that suicide and depressive illness are increasing problems and ones that have been neglected, in part because of the history of colonial thinking which I have summarised and because of the related problem of cultural bias in the psychiatric description of symptoms of depression. Their aim is to bring this problem to national and international attention and to develop more effective mechanisms of intervention. The overall effect, inevitably, is to „medicalise‟ suicide as part of a mental health issue - though this is part of a much wider phenomenon. But as the press reports indicate, this medical framing of 10 suicide is only part of the story. As in present-day Britain where a recent wave of teenage suicides in South Wales gave rise to an extended public discussion on the state of modern British society and the causes of teenage despair, so in East and Southern Africa, discussions of suicide are intrinsically moral and political. This is perhaps even more evident in the case of South Africa. The study of suicide in South Africa is unique in the region in the sense that it benefits from both a system of data collection which has vastly improved in recent years, and a small but important literature on the history of suicide in that country.xxxviii As far as I can discern, South Africa is the only country in East and Southern Africa to gather statistics of the kind that allow for evidence- based statements on incidence. Though suicide rates remain highest for the „white‟ population, there is a general agreement in the South African literature that apartheid period statistics were particularly unreliable for mortality in the „black‟ population and almost certainly under-estimated the suicide rate in that group. There is also general agreement that the suicide rate amongst young black men is increasing.xxxix Even so, there are large discrepancies in reported rates.xl In general, the press reports on suicide in South Africa appear to reflect wider concerns over developments in the country since the ending of apartheid and anxiety over high rates of violence. This is not to deny that suicide rates may be increasing amongst some communities in South Africa – the available evidence suggests that they are – but it is simply to point to way in which this issue is being framed and discussed publicly. The current literature on suicide in South Africa bears some resemblance to the historical literature on suicide amongst the African-American population of the United States. There are two respects in which this is the case. As in the U.S.A in the 1960s and 1970s, so in South Africa in the 1990s and 2000s, professionals have „discovered‟ black suicide.xli Secondly, though the study of suicide amongst black communities in South Africa is largely carried out by psychiatry professionals, and therefore can be said to contribute to a 11 „medicalisation‟ of the issue of suicide, more striking in the analysis is its contextualisation within the study of violence and of „life-threatening behaviours‟, ranging from alcoholism to reckless driving. xlii In this, too, the current psycho-sociological analysis of suicide in South Africa is similar to that which has dominated the literature on suicide in the African-American community. The essential critique of this approach is that by subsuming suicide in a larger analysis of the „social problems‟, African-Americans were denied agency in their own suicides, and that this in itself is a legacy of racist thinking.xliii Though there is a genealogy of racial thinking underlying analyses of suicide in Southern and Eastern Africa, it would be oversimplifying to argue that these issues are confined to questions of „race‟. Arguments around the interpretation of suicide are complex, and form part of a much more extensive intellectual history. The act of suicide can be interpreted as a supreme act of will and defiance, or as a fatal gesture of despair; as a mark of the autonomy of the self, or evidence of the subjection of the individual to forces beyond their control.xliv These are not questions confined to the African continent or to societies which have been subjected to colonial rule. Though the recent surge of work of psychiatry professionals in the region is to be welcomed, as I have indicated, modes of thinking about suicide have a life of their own and determine the kinds of questions asked about it. Since Bohannan‟s 1960 volume there has been very little work on suicide in Africa outside the professional psychiatric literature. In 2008, in tandem with historical research on suicide inquests in Malawi, I initiated a very small-scale piece of „fieldwork‟ on the subject. My historical research was based on an analysis of inquests dating from the late colonial period (1940s and 1950s). xlv One of the issues that arose in analysing this material (and which has been noted by historians working on other parts of the world) was the question of how far a state-run inquisitorial system itself had an impact on the way in which communities understood suicide cases. Though I have no answers to this question, the material was suggestive in certain ways. My intention in 12 carrying out some fieldwork was to explore the ways in which people framed the issue of suicide in present-day Malawi. Malawi, in common with other countries in the region, seems to be experiencing an increased interest in suicide at the level of the popular press and within its very small community of psychiatry professionals. Newspaper reports lament the apparent increased tendency for Malawians take their own lives; psychiatry professionals lament the lack of statistics and generally express the view that suicide cases are grossly under-reported in the country. For them, the neglect of suicide as an issue is closely tied to the larger neglect of mental health problems in the country. The country‟s only resident psychiatrist is Dr Felix Kauye (director of the Zomba Mental Hospital), who has been trying to raise funds for a nationwide survey of suicide incidence. At the St John of God centre in Mzuzu, a pioneering teaching and community mental health institution, clinical psychologists share the view that suicide, particularly that related to severe psychiatric illness is increasing and is under- reported. The only existing study of suicide in Malawi is a statistical analysis based on a „retrospective audit‟ of cases that were handled by mortuaries in Blantyre between January 2000 and December 2003.xlvi The researchers reviewed the mortuary records of all suicide cases and analysed by age, sex, residential location and mode of suicide. They found that suicide cases represented 17% of all autopsies, that men were far more likely to commit suicide than women, and that the most common mode of suicide was chemical poisoning using agricultural pesticide. Though the mortuary records were found to be useful for some purposes, only 5% of them recorded the circumstances surrounding the cases or the „reasons‟ given for an individual‟s suicide. There was, however, a striking seasonality to the suicide cases reaching the mortuaries. In 2001, 2002 and 2003 (but not, apparently in 2000) around thirty-three percent of cases occurred in January and February. The authors speculated that this might be explained by three factors. Firstly this period follows the celebrations of Christmas and New Year, secondly, this it the time of year when parents are faced with paying annual school fees, and thirdly, that this is 13 a time of seasonal food shortage. Strikingly the authors failed to mention that though food shortages are indeed common in January and February, the years surveyed were far from „normal‟ years. They were in fact years of very serious and sustained food shortage in Malawi, when seasonal shortfall turned into famine for some groups. (ref Devereux etc). Useful as this study is, it also has severe limitations, as the authors themselves acknowledge. In 2008 I discussed with Mathero Nkhalamba of the Department of Psychology at Chancellor College, University of Malawi, the possibility of carrying out a small piece of research on suicide in Malawi. I had hoped to carry out this work myself, but my mother was ill and I needed to return home, so my own interviews were confined to a handful with magistrates and policemen. Ms Nkhalamba asked her final year students to submit essays on the subject and then she selected two students, Mr Pearson Mphangwe and Ms Chikond Lipato to carry out research in their home areas during the vacation. I briefed the students on a couple of occasions and Ms Nkahlamba supervised their work when I had returned to the UK. Malawi may be a small country but it is overrun with social researchers from overseas (often forming part of very large and well-funded research teams), most of whom are studying aspects of the country‟s HIV/AIDS epidemic or its endemic problems of poverty. The demand for „research‟ on the part of NGOs, aid agencies and visiting academics is such that social science students at University (and their teachers) are frequently used as „data collectors‟. This has clear financial benefits but also sometimes gives rise to a degree of resentment amongst local researchers who rarely get to set the agenda. It also has consequences for how students perceive „research‟. „Research‟, by and large, is conceptualised as something which is oriented towards solving a „development‟-related problem and which must be carried out following a „scientific‟ methodology. This perception does not stop with the researchers. Many Malawian communities have been subject to waves of „research‟ over decades – the latest, HIV/AIDS related wave being only the most recent – and they too have clear ideas about the nature and purposes of „research‟. Given this background, it is perhaps not surprising that one of the striking aspects of the interviews conducted by the students was the framing of suicide within a 14 discourse of development which sometimes included a notion of a „progressive‟ approach to psychological issues. I have worked in Malawi, and with Chancellor College, on and off for thirty years, but my new work on suicide made me uncomfortably aware that I was now just one of that army of foreign researchers asking yet more questions about death. One very positive consequence of their university research training was that both Pearson and Chikondi were scrupulous in documenting the context of their interviews and both produced interesting personal reflections of their work as it proceeded. No-one finds talking about suicide easy, particularly if they have experience of suicides within their circles of family or friends. Most people agreed to be interviewed, but both Pearson and Chikondi indicated that the end result of their work (twenty-two neatly recorded and translated interviews) give a somewhat false impression of the research which had, in fact, been difficult and quite trying. In practice many people were reluctant and sometimes frightened to engage in a conversation on this subject (though this I imagine would be much the same wherever one was carrying out this kind of research). Most people who agreed to a conversation held the view that suicide was on the increase in their communities and that this was a problem. It was a problem because it was bad for the development of the country; it was a problem because it left yet more children parentless, and (for some) it was a problem because it was an indication of wider social problems. Older informants in particular felt that younger people were committing suicide at a higher rate than in the past because they are “failing to withstand life‟s problems” and some went on to remark that the younger generation had lost their fear of death. Many people felt that one of the causes of what they perceived as an increase in suicide was the wide availability of pesticides which makes suicide „easier‟. xlviiAll but three respondents were members of Christian churches and reported that suicide was condemned by the church and that suicides were almost always denied Christian funeral rites. The two Muslim respondents articulated very explicitly a view of suicide as a form of martyrdom. Older informants recalled that in the past the bodies of suicides had been greatly feared, and had been subject to special rites designed to prevent the spirit of the suicide from returning. Almost all the respondents, 15 young and old, when asked to make word associations with suicide, came up with „witchcraft‟ or „magic‟, but most also argued that nowadays people were much less inclined to blame the surviving family members of causing suicides through witchcraft. Most said that they welcomed the intervention of the police and the performance of post mortems, since these established the „true‟ cause of death and therefore put an end to such speculations (an argument that was, predictably, emphasised in my own interviews with police and magistrates). A „developmental‟ narrative was evident in these answers in two ways. Suicide was „bad‟ for „development‟, but with „development‟ communities deal with suicide in more „rational‟ ways. When asked how suicides were viewed within their communities, many emphasised the role of compassion and understanding, particularly in relation to certain circumstances. The idea of „counselling‟ is widespread in Malawi as a result of interventions associated with HIV/AIDS an also with various human rights campaigns. In relation to the suicides of HIV/AIDS patients (and also of some other cases) informants stressed the need for counselling and compassion to prevent suicides. But clearly not all suicides are the same. Malawian respondents echoed arguments in the academic literature on suicide in distinguishing different kinds of suicide. Pearson Mphangwe listed a set of case studies that had been mentioned in his interviews that seemed to him to represent distinct categories of suicides eliciting different responses.: Mrs D‟s grandparents had been married for many years but they had a rocky marriage and argued frequently. One day Mrs D‟s grandfather came home in a bad mood and refused to eat the food she had cooked. An argument ensued in the course of which Mrs D‟s grandfather struck his wife on the head with a pestle. She died almost immediately. Mrs D‟s grandfather took a rope and hanged himself in the kitchen the same day. No-one could understand what had made the man so angry. The incident was reported to the chief and to the elders of the Roman Catholic church, who arranged a funeral. 16 Mr G. knew a young man who had fallen in love with a girl and wanted to marry her. The girl‟s parents agreed to the marriage but his own parents refused and would not move from their decision. The young man killed himself. The whole village blamed the parents. They felt sad and deeply ashamed. The young man was a member of the CCAP (Presbyterian Church). Since the church regards suicide as a sin, there was no church funeral. Mrs M said that people sometimes committed suicide as a result of the infidelity of their spouses. She gave as an example a man she knew who heard frequent rumours that his wife was committing adultery with her cousin. He grew “tired of hearing this painful story” and killed himself by ingesting a pesticide. The woman was „chased‟ from the village by the man‟s relatives. Ms Y told the story of the loss of a school friend. The girl had been becoming noticeably thinner over a period of time. Without telling her family she took herself for an HIV test. It was positive. She told her friend that she had seen the suffering of people with AIDS and she thought of killing herself. One day she did not return from school and her body was eventually found in a well. She had left a short note in which she said she was “tired” of living with HIV/AIDS : “let me go and rest”. Everyone in the village was shocked and deeply saddened. Mr S once worked with a man who had what appeared to be the good fortune to having two of his children selected in the same year to go to secondary school. But instead of feeling happy he “just stayed quiet as if he had not heard anything good.” Worried about how he would pay for this he attempted to secure a loan from his employer, but was refused. The next day he was found hanged from a tree. People were surprised and confused, but then they found a note that the man had left which explained his despair at not being able to afford the secondary school fees. Mr C knew a family in which there were two teenage boys and a girl. The girl had been brewing beer to earn money. Her younger brother was unhappy 17 about this and quarrelled with her and beat her up. On seeing this the elder brother attacked him, hitting him so hard that he eventually killed him. Realising what he had done he felt guilty and also fearful of being arrested. He ran into the bush and hanged himself. The family was distraught. They had lost two boys at once. In my analysis of inquest cases from the 1940s and 1950s many of the same issues arise. xlviiiMen often killed themselves after they felt dishonoured in some way, or ashamed at having killed or injured a close relative. Some killed themselves out of despair at their extreme poverty or their incapacitation from long-term illness or disability (reminding us that this kind of despair did not begin with HIV/AIDS). Some suicides were recognised by family and community to have been caused by serious mental illness which caused individuals to act as id driven by an external force. Both men and women were driven to suicide by infertility or loss of children, though sometimes these cases were further complicated by suspicions of witchcraft. This could work in different ways. Convinced that they were bewitched, and that there was no escape from their misfortune, people sometimes ended their lives. But being accused of witchcraft drove others to suicide. Marital disagreements featured prominently in the inquests as precipitating suicide. Thwarted love appears to have caused some young men to commit suicide. The loss of a loved one (spouse, child, care-giver) was also a common precipitating factor. The pressures and demands of the cash economy featured prominently in the conversations that Chikondi and Pearson held with informants. They felt that younger people in particular were influenced by new media to aspire to life- styles and possessions they could not afford. No doubt this pressure (or at least the perception of it) has greatly increased in recent decades, but it was also evident to some degree in the 1940s and 1950s amongst educated men who had fallen into debt. Suicide notes also featured in a small number of these earlier cases. As noted for other periods of history, literacy makes it possible for individuals to influence (or at least to attempt to influence) the interpretation of their suicidal actions, though whether this results in the decline of interpretations involving supernatural forces is a much more complicated question. In her reflections on the research Chikondi remarked 18 that “Most Malawians associate suicide with witchcraft. They believe that no person in his or her sanity would commit suicide unless under a magical spell.” But she went on to add that “in our communities suicide is considered either as shameful or unfortunate depending on the reasons why it was committed.” Chikondi‟s summary of her fellow Malawians‟ views are not at all unlike my own when faced with real cases of people I have known, rather than with anonymised statistics. At one level it is easy to explain individual suicides by reference to what we know of the circumstances of the individual‟s life – depressive illness, unbearable losses, shame and dishonour, fear, or a terrible sense of failure (and the inquest system encourages this kind of psychological post-mortem). While Malawians might be less inclined than myself to resort to medical categorisations, and perhaps more inclined to emphasise dishonour as a motivating force, these differences are ones of degree. But beyond this very human desire to understand what motivates a suicide there often lingers a residual sense of the enormity of the act, and a feeling that finally the person was „moved‟ by something beyond their control. ------------------------------------------------------------------------------------------------------ The comparative history of suicide tells us that suicide rates and attitudes to suicide vary significantly between different societies, but can also change over time. Whether societies in Eastern and Southern Africa are experiencing a significant change in either rates or attitudes to suicide is, frankly, extremely difficult to ascertain given the absence of longitudinal data. However, we can say two things with reasonable certainty. Firstly, the perception that historically suicide rates in Africa were extremely low is just that – a perception – and one heavily influenced by a history of racial thinking on the „African mind‟. Secondly, the current interest in suicide in Eastern and Southern Africa may turn out to be a reflection of real rising suicide rates. We cannot know this for certain until more research has been conducted and 19 more reliable data collected. Whether rates are rising or not, the „discovery‟ of suicide in Africa is part of a larger, and anxious, public discourse on the nature of subjecthood in rapidly changing circumstances. In some parts of the region, this discourse is influenced, not only by medical models of suicide and its causation, but also by a new psychological language of the self in relation to the stresses and disappointments of a modern economy. These ideas do not replace, but interact with pre-existing views of the forces, apparently beyond their control, which drive individuals to take their own lives. i This project is generously supported by the AHRC. Equally importantly, it has been very generously supported by colleagues in Malawi, most particularly by Mathero Nkhlambo of the Department of Psychology, Chancellor College, University of Malawi, and by her (former) students, Pearson Mphangwe and Chikondi Lipato. I have also benefited from discussions with Dr Felix Kauye, Mr Harris Chilale, Professor David Ndetiei and the volunteers at Samaritans, Kenya. Dr Eugene Kinyanda kindly shared an unpublished paper with me. Dr Julie Livingston stimulated my thinking and shared her work from Botswana. ii R.E. Moreau, “Suicide by „Breaking the Cooking Pot‟”, Tanzania Notes and Records, (1942) 12: 49-50. Moreau worked for the colonial agricultural service at its research unit at Amani, Tanzania, but is best known for his extensive work on African ornithology. See Nancy Jacobs, „The Intimate Politics of Ornithology in Colonial Africa‟, Comparative Studies in Society and History (2006), 48:654-603. iii For an illuminating discussion of this see Tim Kelsall, „Rituals of Verification: Indigenous and Imported Accountability in Northern Tanzania‟, Africa (2003), 73: 174-201. iv Moreau, „Suicide‟, p.49. 20 v John T. Maltsberger and Mark J. Goldblatt (eds), Essential Papers on Suicide, (New York, 1996). vi Todd May, Death, (Stocksfield, 2009). vii In his monumental study of suicide in Europe in the Middle Ages, Alexander Murray discusses African beliefs about suicide in a section on pollution: Alexander Murray, Suicide in the Middle Ages. Vol 11: The Curse of Self-Murder (Oxford, 2000). African practices are also mentioned briefly by Michael Macdonald and Terence Murphy, Sleepless Souls :Suicide in Early Modern England (Oxford, 1990), 44-46. There is, however, a growing literature on suicide and slavery in the Atlantic world: Louis A. Perez, To Die in Cuba: Suicide and Society (Chapel Hill, 2005); William D. Piersen, „White Cannibals, Black Martyrs: Fear, Depression and Religious Faith as Causes of Suicide among New Slaves‟, Journal of Negro History (1977), 62:147-159. viii Of course, this multi-layered quality of explanation is hardly unique to the phenomenon of suicide and has been addressed at length in the wider historical and anthropological literature on witchcraft: Kelsall, „Rituals‟. ix This section is summarised from a longer discussion in Megan Vaughan, „Suicide in Late Colonial Africa: evidence of inquests from Nyasaland‟ , American Historical Review (in press), April 2010. x Megan Vaughan, Curing Their Ills: Colonial Power and African Illness (Cambridge and Stanford, 1991) Chapter ; Sloan Mahone , „East African Psychiatry and the Practical Problems of Empire‟, in Sloan Mahone and Megan Vaughan (eds), Psychiatry and Empire (Basingstoke, 2007), 41-67; Jock McCulloch, Colonial Psychiatry and the ‘African Mind’ (Cambridge,1995). xi The most famous proponent of these views was J.C. Carothers who argued that Africans were essentially tribal people, with collective identities, who had not yet evolved a clear sense of the individual and of individual responsibility. Carothers was employed by the late colonial administration in Kenya in the „re-education‟ of Mau Mau detainees: Vaughan, Curing Their Ills; Mahone, „East African Psychiatry‟. xii M.J. Field, Search for Security: an Ethno-Psychiatric Study of Ghana (London, 1960). xiii In 1957 the anthropologist, Jack Goody, had published a critique of this interpretation: „Anomie in Ashanti‟, Africa (1957), 27:356-363. xiv Raymond Prince, „Changing Patterns of Depressive Syndromes in Africa: is it fact or diagnostic fashion?‟, Canadian Journal of African Studies (1967)1 : p190. xv Vikram Patel, Jane Mutambwira, and Sekai Nhiwatiwa, „Stressed, depressed or bewitched? A perspective on mental health, culture and religion‟, Development in Practice, (1995), 5 :216-224. xvi Gordon Parker, „Is depression over-diagnosed?‟, British Medical Journal (2007), 335:328; D. Healy, The anti-depressant era (Cambridge, Mass. 1999). xvii Henri Collomb et Rene Collignon, „Les Conduites Suicidaires en Afrique‟, Psychopathologie Africaine (1974), X, 55-113. xviii Tolani Asuni, „Suicide trends in Western Nigeria‟, British Medical Journal (1962) xix On the importance of ideas of honour in African history see John Iliffe, Honour in African History (Cambridge, 2005) which contains numerous references to suicide and codes of honour. On politically motivated suicide see also Olufunke Adeboye, „„Iku Ya J‟esin‟: Politically Motivated Suicide, Social Honor and Chieftaincy Politics in Early Colonial Ibadan‟, Canadian Journal of African Studies (2007), 14:189-225. Questions of shame, honour and fate also feature prominently in interpretations of 21 suicide in Chinua Achebe‟s novel, Things Fall Apart (New York, 1959): Alan R. Friesen, „‟Okonkwo‟s Suicide as an Affirmative Act: Do Things Really Fall Apart?‟, Postcolonial Text, (2006), 2 (http://postcolonial.org/index.php/pct/article/view/453/354). xx M.D.W. Jeffreys, „Samsonic Suicide or suicide revenge among Africans‟, African Studies (1952), 11: 118-122. „Magical thinking‟ in relation to suicide is hardly uniqie to African societies, however. Many psychoanalytic accounts of suicide draw attention to its fantastical elements: Emile A. Gutheil, „Dream and Suicide‟, in Maltsberger and Goldblatt (eds), Essential Papers, 118-131; Viggo W. Jensen and Thomas A. Petty, „The Fantasy of Being Rescued in Suicide‟ in Maltsberger and Goldblatt (eds), Essential Papers, 113-142. xxi Paul Bohannan (ed) African Homicide and Suicide (Princeton, 1960). xxii A.F. Henry and J.F. Short Jnr. Suicide and Homicide: some economic, sociological and psychological aspects of aggression (Glencoe Ill. 1954). xxiii Some of these rites bear an uncanny resemblance to those described for pre- Christian Europe, including burial at crossroads. xxiv J.S. La Fontaine, „Person and Individual: some anthropological reflections‟ in Michael Carrithers, Steven Collins and Steven Lukes (eds), The Category of the Person: anthropology, philosophy, history (Cambridge, 1985), 123-141; Michael Jackson and Ivan Karp (eds), Personhood and Agency: the experience of self and other in African cultures (Washington D.C., 1990); Paul Riesman, „The Person and the Life-Cycle in African Social Life and Thought‟, African Studies Review (1986), 29:71-138. xxv Perez, To Die in Cuba; Morrissey, Suicide and the Body Politic; Minois, History of Suicide. xxvi New Vision (Kampala), 31 August 2007 (posted on the web 3 September 2007). I have been unable to access the original report and so cannot verify the figures here. xxvii www.who.int/mental-health/prevention/suicide/suicideprevent/en/ The only mainland sub-Saharan African country for which the W.H.O. publishes statistics on suicide is Zimbabwe, quoting a (1990) rate of 10.6 per 100,000 for males and 5.2 for females. For a review of the (very limited) data on current suicide rates in Africa see Lourens Schlebusch, Suicidal Behaviour in South Africa (Scottsville, 2005), pp 38-39. xxviii Under-reporting is mentioned in the press coverage on Uganda and is raised as an issue by professionals working all over this part of Africa. xxix New Vision, 31 August 2007. xxx Juliet Lukwago, „Lwango Warns on Suicide‟, New Vision, 29 October 2007 (posted on the web 30 October 2007). xxxi Julie Livingston, „Suicide and the Unbearable Disappointments of Life in Contemporary Botswana‟, paper presented at „Death in African History: an Interdisciplinary Connference‟, 5-6 May 2007, CRASSH, University of Cambridge. I am very grateful to Dr Livingston for her insights into the subject. xxxii Francis Tayanjah-Phiri, „Love drives two men into suicide‟, The Daily Times, 1 July 2008 (posted on the web). xxxiii John Iliffe, The African AIDS Epidemic: a History (Oxford, 2006), pp 84-85; Schlebusch, Suicidal Behaviour, pp 112-120. xxxiv New Era (Windhoek, Namibia), 16 May 2008 (posted on the web 16 May 2008) reported that Namibia had the sixth highest suicide rate in the world. High suicide rates are also reported for Rwanda in the aftermath of the 1994 genocide. 22 xxxv Schlebusch, Suicidal Behaviour; Eugene Kinyanda et al. „Suicide in urban Kampala, Uganda: a preliminary exploration‟ ; Charles Dzamalala, Danny A. Milner and N. George Liomba, „Suicide in Blantyre, Malawi (2000-2003)‟, Journal of Clinical Forensic Medicine, (2006), 13: 65-69. xxxvi Dr Eugene Kinyanda (Makerere University, Uganda) and his colleagues have recently (March 2008) established an African Network for the Study and Prevention of Suicide and Suicidal Behaviors and in Malawi, Dr Felix Kauye and his colleagues at the Zomba Mental Hospital are launching a nationwide research project on the incidence of suicide. xxxvii Eugene Kinyanda and Seggane Musisi, „Suicide in urban Kampala, Uganda: a preliminary exploration.‟ (Unpublished paper); E. Kinyanda, H. Hjelmeland, and S Musisi, „Deliberate self-harm as seen in Kampala, Uganda: a case control study‟, Social Psychiatry and Psychiatric Epidemiology, 39 (2004), 318-325; E. Kinyanda, H. Hjelmeland and S. Musisi, „Negative life events asoociated with deliberate self- harm in an African population in Uganda‟, Crisis, 26(2005), 4-11; David M Ndetei, Lincoln I. Khasakala, Victoria Mutiso and Anne W Mbwayo, „Suicidality and depression among adult patients admitted in general medical facilities in Kenya‟, Annals of General Psychiatry, 9, 7, (2010); David M Ndetei et al., „A cross-sectional study of co-occurring suicidal and psychiatric symptoms in inpatients in Mathari Psychiatric Hospital, Nairobi, Kenya.‟, Journal of Clinical Psychology, 11, 3 (2009), 110-114; D. Kebede, T. Ketsela, „Suicide in Ethiopian adolescents in Addis Ababa high schools‟, Ethiopian Medical Journal, 31 (1993), 83-90; E. Ovuga and J. Boardman, „Suicide prevention in Uganda‟, in D.Wasserman and C. Wasserman eds, The Oxford Textbook of Suicidology and Suicide Prevention, A Global Perspective, (Oxford 2009), 759-764. xxxviii On the nature and reliability of South African data see Stephanie Burrows, „Suicide mortality in the South African context: exploring the role of social status and environmental circumstances‟, Doctoral dissertation, Karolinska Institute, Sweden, December 2005. On the history of suicide in South Africa: Kerry Ward, „Defining and Defiling the Criminal Body at the Cape of Good Hope, c 1652-1795‟ in Steven Pierce and Anapama Rao (eds), Discipline and the Other Body: Correction, Corporeality, Colonialism (Durham NC, 2006): 36-59; Julie Parle, States of Mind: Searching for Mental Health in Natal and Zululand, 1868-1918 (Scottsville, 2007), Chapter 5; Fatima Meer, Race and Suicide in South Africa (London, 1976). Meer employed an unusually rich archive of inquest records for her sociological analysis of suicide in apartheid South Africa. xxxix The highest figures quoted seem to be for the Umtata region of Transkei, where Meel reported rates of 38.6 per 100,000 in 2000 :B.L. Meel, „ A study on the incidence of suicide by hanging in the sub-region of Transkei, South Africa‟, Journal of Clinical and Forensic Medicine (2003), 10: 153-157. xl Overall, suicide rates for South Africa in the period 1979-1981 were estimated at 8.4 per 100,000 for men and 2.2 for women, rising to an estimated 24.6 per 100,000 and 6.9 per 100,000 by 2000. See Burrows, „Suicide Mortality‟ and Schlebusch, Suicidal Behaviour for an analysis of the South African statistics. xli Andrew Fearnley, „Race and the Intellectualizing of Suicide in the American Human Sciences, c.1950-c.1975‟.Central to the „discovery‟ and analysis of suicide in the African-American population of the United States was Herbert Hendin‟s complex work, Black Suicide (New York, 1969). 23 xlii This mode of analysis is no doubt in part a very rational response to the very high rates of violent death of various kinds in South Africa, and is facilitated by the collection of national level statistics through the National Injury Mortality Surveillance System, which includes suicide deaths. On the uses of this data see Burrows, „Suicide Mortality‟; Stephanie Burrows, M.Vaez, A.Butchart and L.Laflamme, „The share of suicide in injury deaths in the South African context: sociodemographic distribution‟, Public Health (2003), 117 (1), 3-10. These questions are not, of course, confined to the modern South African case. See, for example, Susan Morrissey‟s discussion of alcoholism and suicide in later nineteenth century Russia: „Drinking to Death: Suicide, Vodka and Religious Burial in Russia‟, Past and Present (2005), 186:117-146; Morrissey, Suicide and the Body Politic, p.24. xliii Fearnley, „Race and the Intellectualizing of Sucide‟. xliv Morrissey, Suicide and the Body Politic, Introduction; Watt (ed), From Sin to Insanity; Lisa Lieberman, Leaving You: the Cultural Meaning of Suicide (Chicago, 2003); Thomas Szasz, Fatal Freedom: the Ethics and Politics of Suicide (Westport, 1991); Al Alvarez, The Savage God: a Study of Suicide (London, 1971); George Howe Colt, The Enigma of Suicide (New York, 1991). xlv See Vaughan, „Suicide in Late Colonial Africa‟, AHR. xlvi Charles P. Dzamalala, Danny A. Milner, N. George Liomba, „Suicide in Blantyre, Malawi (2000-2003)‟, Journal of Clinical Forensic Medicine, 13 (2006), 65-69. xlvii This accords with the views of suicide researchers in the region and was one of the findings of the Blantyre study cited above. xlviii Vaughan, „Suicide in late colonial Africa‟, AHR.
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