Aboriginal, Maori and Inuit youth suicide: avenues to alleviation?

Tatz, Colin

Abstract: As a society, we react badly to suicide, especially by the young. We seek understanding of why youth do it, and we are determined on prevention. To date we have looked mainly to the Western medical/mental health model, one which approaches the treatment and prevention of suicide as if this behaviour was solely a "mental illness'. But this particular model has failed to alleviate, let alone prevent, escalating rates of youth suicide among Aborigines, Maori and Inuit in Australia, New Zealand and the Canadian territory of Nunavut, respectively. An alternative approach is to look at external social, political and cultural factors, such as 'Westernisation', the legacies of colonialism, chronic unemployment, and the impoverishment of body and soul; and at internal factors such as parenting problems, sexual abuse, alcohol and drug overuse, grief cycles, an absence of mentors, illiteracy and deafness. To generate discussion about the need for the separation of this growing problem from the mainstream medical approach to suicide, a case is made for the development of entirely different pathways to suicide alleviation (a less ambitious and less grandiose aim than prevention) in these three societies.

Understanding suicide

A considerable part of my professional life has been devoted to comparative studies: in race politics and later in genocide studies. Comparison does not always bring understanding. However, looking at similarities and differences can help us to learn and to distil some general principles, always with the aim of improving or, idealistically, of ameliorating or preventing racist or genocidal behaviour. Nevertheless, I am much less certain about the value of comparison in suicide studies. As James Hillman (1997:49) argued, to compare is to move sideways--it deflects from the path towards understanding, and decorates rather than illuminates the heart of the matter.

In order to pursue alleviation of an ever-growing crisis, we need an understanding of Aboriginal suicide, to find what Hillman (1997) called 'the soul of the suicide'. That goal is a long way off. Some explanation--by way of social, medical and biological science--may be possible, but explanation is not understanding. The psychotherapist may arrive at understanding in an intimate session with a voluntary client. But in all other contexts we are left with a mishmash of explanations and 'solutions': a welter of statistics, a battery of research methods, a catalogue of convoluted and often contradictory theories, a series of speculations, longer and longer lists of 'at-risk' factors, and theses on therapies. In the end, despite these endeavours and the claims on their behalf, we are confronted by higher and higher suicide rates among the young.

The late Joseph Zubin, a noted American psychopathologist and authority on the aetiology of schizophrenia, once said that in most behaviour disorders we have at least part of the process at hand for examination (Tatz 2001:95). But 'in suicide all we usually have is the end result, arrived at by a variety of paths'. 'Unravelling the causes after the fact', he declared, 'is well nigh impossible'. In the vast majority of cases we don't know why people commit suicide. We may hope we know, and so believe we have the correct pathways to prevention, but in the end we simply don't know.

Aboriginal, Maori and Inuit youth suicide rates are escalating despite a great deal of research and development within the mental health/depression framework. I suggest a philosophy more suited to what I contend are patterns different from those in mainstream society. There is need to embrace a wider perspective, to escape from a straitjacket approach of what is so assertively deemed 'best possible practice' and/or 'only possible practice'. After all, practice in suicidology is not science but conjecture. After a decade of working in this field, my aim is to encourage some fresh thinking by professionals and bureaucrats working to alleviate this sad problem.

Suicide and incarceration

My 1994 study of the relationship between sport and delinquency in 80 Australian Aboriginal (1) communities led me to realise that there was much more Aboriginal suicide outside prison or police custody than was occurring inside (Tatz 1994:25-6). This was contrary to the general intellectual conceptualisation and political ambience of the time, namely, that a Royal Commission into Aboriginal Deaths in Custody was essential in order to (1) investigate 'assisted' deaths by police or prison staff, and (2) end the wholesale incarceration of once nomadic hunter-gatherers for whom confinement was so severe that suicide was their only way out (Reser 1989). There were 109 deaths in custody in the nine years from 1981 to 1989 (RCIADIC 1991). The royal commission's finding was suicide--not homicide. Surprising to me at that time was the realisation that suicide in custody was the tip of a much larger iceberg, and that suicide and attempted suicide (commonly called 'parasuicide' in the literature) were widespread in Aboriginal communities. In some 30 years of fieldwork, to that point in time, I had not encountered the phenomenon.

The data

In 1996, I began a three-year study of suicide in 55 Aboriginal communities in New South Wales (NSW) and the Australian Capital Territory (ACT). As a component of the research, I visited New Zealand (NZ) for several weeks, and later spent time in Nunavut in May-June 2003, participating in the Canadian Association for Suicide Prevention (CASP) conference in the Nunavut capital, Iqaluit.

During this extensive fieldwork, I adopted an essentially anthropological approach (Tatz 2001:41-56). The statistical and coronial reports in the State Coroner's head office in Sydney rarely contain the full police files and the witness depositions for each case of suicide (or unexplained death). To obtain a fuller, more reliable and 'explanatory' picture, I went to the local sources, the local police and their records, depositions in the local coroner's files, to the Aboriginal residents and office-bearers in corporations, and to the affected and bereaved families. Unfortunately, an enduring problem in the records of officialdom is the defining of individuals as Aboriginal or Maori; this isn't a problem in Nunavut, a vast area but an ethnically encapsulated community.

Given the extent of misreporting, non-reporting, of coronial reluctance to find suicide, and a coronial propensity to overlook such deaths as drug overdoses and single-car accidents, the suicide figures for Australia generally are probably twice the rates found by coroners. This should be borne in mind when viewing the data on rates of suicide, always measured by the number of deaths per 100 000 of the population:

* NSW/ACT: for the period 1996-98, 128 deaths per 100 000 for the age bracket 15-24 (Tatz 2001: 79-93).

* Nunavut: for 1998, 79 deaths per 100 000 overall, but an astonishing 207 per 100 000 for the 15-29 age group (Isaacs et al. 1998:4-5).

* Nunavut: for 2003, 128 deaths per 100 000 for the Inuit overall (Neily 2003).

* New Zealand: for 1995, 35 deaths per 100 000 for Maori males and 6.6 for Maori females in the 15-24 age group (Skegg et al. 1995:453-9).

Noteworthy is the comment from Tim Neily (2003), the Senior Coroner for Nunavut, that there were 110 suicides between 1 April 1999, the date of Nunavut's grant of self-government and territory status, and 4 June 2003, a remarkably high figure in a total population of 26 000 people. Skegg et al. (1995) noted that Maori rates of suicide are escalating annually.

The non-indigenous rates for the 15-24 age group in the 1995-2003 period are instructive (Isaacs et al. 1998:2; Tatz 2001:21):

* Australia: 26.6 deaths per 100 000.

* New Zealand: 44.1 per 100 000.

* Canada: 13 deaths per 100 000.

In sum, Aboriginal rates are three times the Australian norm, Inuit rates are almost ten times the national Canadian figure, and Maori rates--which were traditionally much lower--are now almost equal to the abnormally high New Zealand male rates of suicide.

For all three societies, there were few data available on those under 14 years of age. Despite the increase in the younger-age suicides, the under-14 rate is almost never included in the statistics, for reasons no one explains. New South Wales had an 'unofficial' Aboriginal child rate of 15 per 100000; Canada as a whole had a rate of 1.3, with the Canadian province of Manitoba experiencing a 'high' of 5.25 per 100 000 (Tatz 2001:86). Suicide is occurring at ever-younger ages in these societies. My youngest 'case' in western New South Wales involved an 8-year-old girl; following discussion with an Aunty (Elder), it became clear that here was a case of an intentional hanging. Most children of that age, at least in relatively peaceful democratic societies, do not comprehend death, let alone self-death.

The puzzle

Why were these rates so high everywhere when, on the face of things, life seemed better all round? Land claims were settled or being settled, discriminatory laws had been abolished, human rights protocols were in place, government interference was less or lessening, better housing was available, musical, sporting and artistic achievements were recognised. In New Zealand, a fresh and positive interpretation of the 1840 Treaty of Waitangi and the newly established Waitangi Tribunal had led to reasonable reparation and restoration of Maori control of property and places. Nunavut became a self-governing territory of Canada on 1 April 1999, a remarkable land settlement which gave an area one-fifth the size of Canada to 26 000 people. While Australia is light years behind in its settlement and recognition of Aborigines as a first-nation people, successful and often substantial land claims should have led to a sense of ownership, of landfulness, and of restored confidence.

In my long involvement in Aboriginal affairs, especially in the Northern Territory, Queensland and Victoria, suicide had not been an issue until the early 1980s. It was never mentioned by Aborigines, anthropologists (inter alia Ronald and Catherine Berndt, Donald Thomson, Ken Maddock, Mervyn Meggitt, Diane Barwick, Marie Reay), linguists (like Beulah Lowe, Judith Stokes), government officials, missionaries, magistrates, pastoralists, or police. Between the 1960s and 1980s, none of Kidson and Jones (1968), Cawte et al. (1968) or Eastwell (1988) could find any significant cases of Aboriginal suicide. Lester Hiatt, who has worked at Maningrida (in the Liverpool River region of Arnhem Land) for more than 40 years, cannot recall a single case of, or reference to, suicide before mid-1988 (pers. comm.). The linguist, Colin Yallop, has told me that no Aboriginal language or dialect has a noun corresponding to suicide (pers. comm.), and Vivien Johnson confirms that she had not seen any representation of suicide, or self-destruction, in Aboriginal art before 1960, even 1970 (pers. comm.). In 1982, Christine Stafford's research revealed that in NSW prisons between 1971 and 1982 there was only one Aboriginal suicide and five parasuicides; in Queensland for that period, the figures were nine suicides and eight parasuicides; in the Northern Territory, there were five completed suicides in custody in the decade (McIlvanie [Stafford] 1982).

This point needs repetition and recognition: there was no concept of suicide in Australian Aboriginal cultures and there were virtually no known Aboriginal suicides before 1960, perhaps even 1970, whether in or out of custody. That seems to me to be incontrovertible, despite some speculative theories that Pacific Islanders practised suicide and that Aborigines may well have had contact with those Islander cultural practices. Maori have a notion of suicide (whakamomori) as acceptable behaviour in certain circumstances but, equally, there are circumstances where it is, if not taboo, then unacceptable. The Inuit have a tradition of 'sacrificial suicide', or survival strategy: for example, an older woman may tell a camping and hunting party enduring bad weather to go ahead while she, and they, know that she is sacrificing herself for the survival of the group. But that is the only traditional example of suicide. Apart from a rash of suicides in the seventeenth century, suicide among the Inuit was not a major problem before 1960. From a base of almost zero suicide some 40 years ago, the rates in these three societies have become cosmic, among the highest in the world. The data demand an explanation, something more precise and convincing than late-onset 'depression'.

Explanations?

The Canadian report on youth suicide--Acting on what we know (AOWWK 2002)--is commendable. Its explanations could well cover many, if not most, of the Aboriginal and Maori situations, namely, colonisation and its aftermath, the introduction of some devastating social habits (tobacco, alcohol and gambling), forced assimilation policies and practices, residential schools (and the more serious practice of forcible child-removal in Australia), (2) oil and gas exploration, mining, the establishment of Distant Early Warning systems in Arctic sites during the Cold War, poverty, tribal destruction, racism, and bureaucratic controls (Memmott et al. 2001:13; Tatz 2003:67-106).

Despite these insights, the Canadian conviction is writ clear: while saying that they aren't certain about causality, they believe implicitly that suicide is a mental disorder and therefore that treatment/ prevention lies exclusively in the mental health, medical/psychiatric domain.

Comparing New Zealand, Nunavut and New South Wales

In New Zealand, there is a professional (and lay) tension between those involved closely with Maori communities and those whose studies focus on mainstream suicide. The latter, especially the Canterbury Suicide Project, tend to emphasise 'the current psychiatric morbidity' of suicides and para-suicides. Some researchers have gone so far as to say that 90-94% of all suicides are the result of mental illness (e.g. Neame 1997). Maori psychiatrists and health workers fully recognise te taha wairua, the spiritual quality that is the most basic and essential requirement for health; they also recognise that when whakama--an illness of the spiritual dimension--goes untreated, it can lead to breakdown, to what Western medicine diagnoses as 'psychiatric disorder' but which Maori know and perceive to be mate Maori, Maori sickness.

Among Inuit, health and wellbeing are contingent on family and kinship relationships and activities, as well as on talking and communication. A third and essential ingredient of wellness is to be found in two letters of the alphabet, IQ, not the IQ that has been so signally abused and misused for a century in race politics, but IQ standing for Inuit Qaujimajatuqangit, that is, traditional knowledge, including hunting, camping, tool- and clothes-making, in short, their cosmology and belief system. There are no general, let alone specific, words for mental health or mental illness in the Inuktitut language.

In both New Zealand and Nunavut, serious attention is being paid to internal indigenous systems and values by researchers, perhaps less out of a genuine knowledge or belief in them but more out of recognition that Eurocentric, monocultural approaches have achieved little of significance.

In contrast, Australian 'suicidologists' too often show an inadequate understanding of Aboriginal culture, cultural documents, or internal lifestyles (as opposed to outward appearances--in art, music--as measured by Western standards). Suicidology is essentially a non-Aboriginal domain which, like so much else in Aboriginal life, including wellbeing, we insist must be acknowledged and accepted by Aborigines if they are to make any 'progress'. It is not surprising that one of the reputable students of Aboriginal suicide, Robert Goldney, a professor of psychiatry, is convinced of the pervasiveness of mental illness as a factor in Aboriginal suicide. For him, and for so many of his colleagues, all suicides and parasuicides are managed under the umbrella of the mental health model, a model created by, and for, essentially non-Aboriginal, urban, middle-class societies, one which emphasises counselling, therapy, medication and, if need be, institutionalisation.

Apart from the important work of Ernest Hunter and Joe Reser (Hunter et al. 1999), only two 'radicals' in Australian psychiatric/psychological practice have come to the fore in recognising the importance of Aboriginal cultural factors--not as a cause or a factor in suicide but as part of a 'cure'. Dr Russell D'Souza, from Victoria, has developed what he calls 'Spiritually Augmented Cognitive Behaviour Therapy', harnessing his patients' spiritual beliefs, prayers and practices into a medicalised therapy. Working in Broken Hill, this Indian-born practitioner has become aware that 'ignoring the spirits of forefathers and spirits of the earth' has left conventional depression therapy going nowhere. However, he remains embedded in the causation of suicide as 'depression and demoralisation'. George Halasz, a Melbourne-based child and adolescent psychiatrist, and the child of an Auschwitz survivor and of the Hungarian revolution in 1956, has much in common with Hillman. For him, 'the core issue is the status of the soul' (Halasz 2003).

Flaws

There are serious and obvious flaws in the biomedical, biochemical and genetic approach. These are highlighted below:

* As demonstrated, there was almost no Australian Aboriginal suicide before 1960. There was very little in Nunavut before that date. The 1970s and 1980s saw the start of high Inuit figures, with 79-88 deaths per 100 000 in the period 1993-97 (Isaacs et al. 1998; Kral 2003). Maori rates of suicide were well below the national figures, at least until the 1990s. Were these 'suicide genes' or 'biochemical markers' dormant till then? Did something awaken them? Australian Aborigines are not, and have not been, of 'full blood' since white settlement in 1788 (or since a relationship began with the Macassans from Asia, perhaps as early as 1650). They are, therefore, no longer a 'pure race', if ever there were such a thing. Because all peoples have always been and are of mixed 'race' and lineage, one must ask the unanswerable question: whose genes and whose biochemistry are we talking about? How does one isolate and fractionalise the biochemistry of the 'Aboriginal' part of a person of mixed descent who identifies (and lives) as Aboriginal? Robert Parker (Parker & Ben-Tovim 2002:404-10) has provided evidence for substantial rates of depression among Aborigines in the Top End of the Northern Territory. My reporting on Aboriginal suicide here is confined to New South Wales, a place where there are no 'traditional' Aboriginal people and where there is no relative isolation from mainstream society (as in Bathurst, Melville, Milingimbi, Croker, Goulburn, Elcho and Groote islands in the Northern Territory).

* Assuming, even for the sake of argument, that suicide is a result of a disease or a mental disorder, it is improbable that one single gene will produce that 'abnormality'. Single-gene abnormalities are rare; one such is Huntington's chorea. Schizophrenia or bipolar disorders, for example, are the result (possibly) of a number of genes interacting with (probably) an unknown number of non-genetic, that is, environmental, cultural and social, factors.

* There was no evidence, from family witnesses or general practitioners or hospital depositions, of mental illness in the 43 suicides I examined in New South Wales over a 30-month period (1996-98). Neily (2003), in probably the best postmortem (social and physical) profiling available worldwide, found no depression in any of the 110 Inuit deaths from suicide between April 1999 and June 2003. Isaacs et al. (1998:8) reported on distressed or unusual Inuit behaviour 24 hours prior to their suicide. Some 40% (n=78) were reported as having 'emotionally distressed' symptoms. However, to be distressed doesn't mean one is clinically depressed. Anthropologist Hugh Brody, a major authority on Inuit life, insists that there is no depression among Inuit people, and that 'deep insecurities, chronic anxiety and depression are not to be found among the [Inuit] hunter-gatherers I have known' (Brody 2001a: 194-5). He contends that in their most adaptable language, one given to high specificity and preciseness, there are no Inuktituk words for depression (Brody 2001b). However, the Nunavut Kamatsiaqtut Help Line (NKHL), a crisis phone-line system for people in need, does make brief mention of 'winter depression' among youth in Baffin Island communities who use this phone service (Tan et al. 2004). New Zealand studies generally do not indicate whether or not their samples include Maori or, if they do, whether or not there is anything Maori-specific about causality or 'Maori-depression'.

What is mental illness?

The AOWWK (2002) report identifies the following as general suicide at-risk factors: being male, previous suicide attempt, victim of violence, perpetrator of violence, user of alcohol, user of marijuana, school problems, mood disorder (major depression), social isolation, and poverty and unemployment. The report then adds special circumstances pertaining to the Inuit, namely, economic marginalisation, rapid culture change and cultural discontinuity, forced assimilation, forced relocation, and residential school experience.

Accordingly, if AOWWK is correct, only three of these 15 factors might come within the frame of mental illness: acts of violence (to self and others), substance abuse, and depression. The remaining factors at work are cultural, that is, social and political.

Is mental illness what is defined by the bible of the American Psychiatric Association, the Diagnostic & statistical manual for mental disorders? (3) At present, DSM-IV-TR lists over 50 major categories of mental disorder, many with new names for new syndromes. A Mathematical Deficit Syndrome is a definable disorder, meaning that you can't do maths, you think about it and feel bad about it (DSM-IV-TR 2000:53). Likewise, you apparently have a mental disorder if you smoke, drink a bit too much, ingest caffeine (2000:231), have an aggressive nature, exhibit antisocial tendencies (2000:740), have an erectile problem (2000:545), a male orgasmic disorder (2000:369), or exhibit hypochondria (2000:504). It would seem that any form of 'feeling bad' could be a litmus of a definable disorder. (Some critics consider these 'syndromes' as controversial; be that as it may, they stand quite clearly on the DSM pages as disorders.)

We need to consider an existential problem posed by the labelling of 'disorder'. If practically everything in life is disorder, we are all disordered. If everything is disorder, then evil, immorality, crime, hate, war--in fact, most of the behaviours admonished in the Ten Commandments--are disorders warranting treatment and medication. Ultimately, mental disorder, as a label, has come to mean that almost no one is responsible, before tribunals or courts of law, for his or her own actions. As disordered persons, the accused are ill and therefore know not what they do, or are so impaired as not to know the difference between right and wrong, or they are 'ill enough' to warrant mitigation and the minimum of sentences. The currency and frequency of this defence is not confined to the fiction of television dramas: it is a commonplace in real courts, criminal and civil, in sports tribunals, and in school classrooms. Thomas Szasz is a dreaded name in American psychiatry for, among hundreds of works, his 'The myth of mental illness' (1960), his book on The manufacture of madness (1970), and his 'Self-ownership or suicide prevention?' (2004). With Szasz, I would contend that DSM-IV-TR has, indeed, elements of its own (self-created) madness within it.

Depression and suicide

Depression is thought to occur in 10-15% of any population. So, among 26 000 Inuit in Nunavut today, between 2600 and 3900 might be likely to suffer from depression. But, as Brody has attested (2001a,b), there isn't any; but if there is, there isn't enough to have elicited any papers that specifically consider the incidence of depression and other illnesses among the Inuit and their connection, if any, to suicidal behaviour. Among the present 280 million Americans, between 28 and 42 million would suffer the condition. The Australian Commonwealth Health Department has stated that in any one year approximately 6% of Australians, or 1 200 000 people, will experience a depressive illness (NAPD 2000:3). Yet, even if these endemic or pandemic figures were true, only tiny fractions of those numbers of people attempt, or commit, suicide. In short, considerable numbers of people around the globe fall within the definition of 'depressed', yet never attempt the deed. So what is the precise marker, what is the pinpointable 'malignancy', that says either that those who do commit suicide have an especial form of depression, or that those in whom we can locate a specific kind of depression will commit suicide?

Depression is thought to be a result of chemical imbalance in the brain, with stress contributing to a change in brain function. Dorothy Rowe (2004), a noted but controversial Australian-British psychologist, insists that it is absurd to talk of depression as a chemical imbalance in the brain, because we don't know 'what a chemically balanced brain is'. The prevailing discourse is that the answer to depression lies in counselling and drugs. Symptoms of depression include irritability, feelings of guilt or helplessness, feelings of anxiety, inability to concentrate, reduced appetite, loss of interest in appearance, loss of interest in favourite activities, difficulty in sleeping, difficulty in getting up, constant feelings of tiredness, thoughts of suicide, changes in weight, and physical symptoms, like headache or backache.

During the process of writing this article, I have endured some ten of these symptoms. Having most of them should leave me in no doubt about my 'condition': a choice between 'psychosocial depression', as in sadness or disappointment, or 'clinical depression', as in biological disturbance or chemical imbalance (NAPD 2000:3). But how likely am I to suicide? What makes us leap so speedily, so quantumly, from symptoms of dispiritedness, dejection, dullness of things around us--in short, plain gloom--to DSM-IV-TR clinically diagnosed 'depression'? Are the standardised psychiatric diagnostic interviews with the 'patients', their relatives and friends, their medical attendants, infallible measuring instruments? What has happened to the English language that we have been able to turn all, or most, feelings of being miserable, unhappy, dejected and dispirited into clinical illness? Are stressors some abnormal, alien facts of life?

Suicidal factors

My contention, as well as that of the Canadian researchers cited earlier, is that the major factors in indigenous suicide are social, political, economic, sociohistorical, sociopolitical and geographic: racism, legal and bureaucratic control, reservation life, deculturation, poor education, poor nutrition, together, I believe, with medical-physical (not medical-mental) ill-health. Deafness, due to chronic otitis media, is prevalent and pervasive among Maori and Aboriginal children. Illiteracy rates are high, even among children of literate parents. We need urgent investigation of correlations between suicides and these two conditions, especially since so many of the Maori at-risk suicides who have been in custody (some 20%) have been seriously deaf (Tatz 2001:111, 182).

The fault of AOWWK, and of so many other reports, is that all of these factors are neatly funnelled into a catch-all container called depression or mental unwellness, both requiring counselling and/or medication, regimens that too often purport treatment of the 'illness' as well as elimination of its causation. No pill, no Prozac or Zoloft, has ever cured the legacies of racist colonialism, nor will it--unless we detach all the 'at-riskers' from their emotions and permanently zombify the populations concerned.

Different kinds of suicide

Medication cannot assist every form of would-be suicide. There is a need to distinguish different kinds of suicide, an effort rarely made by those who perceive (and treat) the act within the medical model. However crude the classifications that follow, they do indicate a wide spectrum of 'ideation', each of which may well need a different approach. There can be no 'scientific' classification of suicides, just as there can't be a 'science of suicide', a judgement that Professor Robert Goldney, a passionate advocate of biochemical and genetic research in this field, conceded when he appeared as an expert witness in the Moran v Moran case (Waldren 2001:199ff).

The political suicide has many facets: from Japanese kamikaze pilots to Palestinian bombers, on the one hand, to the many Jews who committed suicide between the two world wars rather than surrender their fates to the Nazis, to Aboriginal youths who insist they will 'neck' themselves on arrest in order to 'see' the police officer in trouble with the royal commission or some other dire tribunal.

The respect suicide is all too common in Aboriginal communities: the younger, usually male sibling, a 'nobody', an under-achiever in all forms of social or sporting competition, who asserts that one day all around him will have to accord him respect--at his funeral. And, of course, they do.

The empowerment suicide is the one who rarely experiences autonomy, self-fulfilment or personal sovereignty over his or her physical, material or internal life. To take one's own life is the ultimate empowerment, what Hillman (1997:196-7) so aptly and poignantly called 'a small seed of selfhood', what Szasz (2004) would insist is 'self-ownership'.

The lost suicides, so common among Aboriginal and Maori communities, experience a sense that there is a 'hole' in their lives but do not know what it is. They suffer the label 'Aborigine', yet they cannot comprehend what it is in 'Aborigine' that causes such antagonism and contempt. As Dr Erahana Ryan, the only female Maori psychiatrist, states, there is only 'the stress of loss of who they are' (pers. comm.).

The appealing suicide is a result of a person having 'reached the end of his tether', feeling unable to achieve a single social aim unaided by others. In this sense, it is a cry of pain, or a cry for help, and an attempt to shift some of his or her obligations, such as dependants or parents, onto others. He or she engages in violence towards others, and finally towards sell as a desperate means of regaining the support of family or kin (Marx 1976:2-3).

The grieving suicide is almost inevitable in communities where there is at least one funeral a week, if not two or three, where there are no longer ritualised, traditional, mortuary and mourning rites, where the boozy Irish wake is now the norm, and where grief counselling doesn't exist. Many Aboriginal youth who have attempted suicide have expressed (to me and others) a desire to commune, by self-death, with a dead brother, a cousin, a sister.

The neglect suicide and the sub-intentional suicide result from the person 'forgetting' to take insulin or other medication, or from running red lights, or from cliff-climbing at midnight while drunk, or 'train-surfing' while sober. These are the people who deny any intent but who in fact promote self-destruction through their actions.

The focal suicide believes that part of the body is the cause of anguish, hence there is a focus on an arm, a leg, genitals, and with an ensuing mutilation of serious, often fatal, proportions.

The rational suicide is a form of 'auto-euthanasia', where the person's plight is, or appears to be, irremediable. This is an intellectual decision to self-destruct; it is what the philosopher David Hume, way back in the eighteenth century, would have called a 'logical and reasonable action'.

Existential suicide, following Albert Camus' writings, is ending the burden of hypocrisy, of the meaninglessness of life, of the ennui and lack of motivation to continue to exist. This category seems to me to have the most relevance to Aboriginal and Maori communities. I have insufficient knowledge of Inuit circumstances to make a judgement, but I do have difficulty accepting the belief, expressed to me by many Inuit parents, that most of the spate of hangings since 1999 were caused by heartbreak at failed love relationships. Kral (2003) reported that 'romantic relationship' problems, alone, counted as the precipitating event 68% of the time in reports on suicides prepared by the Deputy Chief Coroner for the two communities in his study. Has all the intensive holistic research into Inuit suicide produced a finding as simple, and as singular, as the seemingly banal and mundane answer of 'romantic relationships'? Surely there is a deeper set of 'ideational' factors preceding the 'precipitating' trigger? Kral's private answer to me was, yes, of course there is.

The chronic suicide is the masking of an orientation towards death by an excessive use of alcohol and/or drugs. Chronic suicide may well be the most lingering form of suicide, a matter worth addressing in the context of Aboriginal and Inuit petrol- or glue-sniffers. More seriously, one has to ask whether this 'method' is not, in the longer run, a form of mass suicide. In 2003, an Aboriginal elder declared, in the context of a search for new pathways in Aboriginal mental health, that 'most Aborigines feel bad most of the time--that's why we drink and drug so much' (NACCHO 2003:1).

Most of these forms embody neither badness, madness nor illness. They certainly involve sadness. That their worlds are in disorder is certain--but social disorder is not synonymous with mental disorder, DSM-IV-TR notwithstanding.

Methods of suicide

The hallmark of Aboriginal, Maori and Inuit suicide is hanging, that is, asphyxiation by tying a cord or rope around the neck. In my Australian study, 38 of the 43 suicides were male and 5 female: hanging was the method in about 58% of the cases; firearms, 16%; drowning, 9%; jumping, 7%; and overdoses, carbon monoxide and trains, 2% each.

Kral (2003:23) reports that hanging is much more prevalent in eastern Canada, especially in Nunavut, while the Dene people in the west of the Northwest Territories tend to use firearms. In Nunavut, of the 110 suicides between April 1999 and June 2003, 93 were male and 17 were female: 74 males used hanging, 18 used firearms, and 1 used a knife; 15 females used hanging, and 2 used firearms. Hanging thus accounts for 80% of Inuit deaths. Interestingly, this is in a society where every household would have a minimum of three to four guns, used for hunting prey for food.

Similarly, hanging is by far the most commonly used method among Maori (Tatz 2001). These are often public or semi-public hangings, in a sense confrontational, as in making a political statement.

In all three societies, suicide by hanging has become patterned, institutionalised and ritualised--and while 'hanging' is becoming more common among non-Aboriginal suicides, there is simply nothing like this pattern in mainstream societies.

Answers?

My first and foremost assertion about the ineffective medical or public health model for dealing with suicide has received support from, of all places, modern Ireland. It is the contention of Smyth et al. (2003:7) that Irish youth suicide, now higher than elsewhere in the European Union, is essentially about changes in the social lives of the young, and that cultural factors are infinitely more involved than medical or psychological problems. They quote David Hume's 1783 essay on suicide:

 To take one's own life was not to express a selfish
 disregard for oneself, one's society or even God. Rather,
 it was a logical and reasonable action to rid oneself of
 life if existence has become an unbearable burden.

The level of suicides in the three communities under discussion in this article cries out that we are confronted by a major societal problem, rather than a series of individual problems with individual psyches.

There can be no progress towards alleviation unless the indigenous peoples concerned are involved as co-researchers and co-workers in this growing phenomenon of youth suicide. I stress the word alleviation rather than prevention. (The latter term both implies and insists that suicide can be cured or prevented. I wish it were so, but since we haven't been able to mitigate, dilute or even alleviate this growing problem, prevention is a pretentious term.) 'Cultural factors' are not just another item in a long list of 'at-risk' items in the lexicon of suicidology. The ugliest, most demeaning, and unscientific of all the 'at-risk' factors is the personification of the very existence of people themselves as a 'suicide risk'. You don't suicide, as several texts and reports assert, because you are Inuit, Aboriginal or Maori. Canada has conceded a co-relationship in many things, from land grants to suicide problems, one in which each value system is seen (in theory, at least) as a full partner at arriving at decisions or procedures. Likewise, New Zealand scholars are being pushed to recognise Maori perspectives on suicide and on the role of mate Maori. But, as in so many fields of endeavour, Australia runs a distant and regrettable last in finding respect for Aborigines, let alone for their internal medical and pharmaceutical systems, or for their viewpoints in general. We talk about it often enough--in government policy workshops, in academic seminars and classrooms, in newspaper features and editorials--but we do precious little in the way of genuine cooperative decision making, let alone in cooperative implementation.

The 2003 NACCHO discussion paper, A way through?, contests the value and validity of the 'dominant epidemiological discourse'. It insists on defining the issues from 'Aboriginal community perspectives' and demands that 'measurement' of health have a more rigorous framework 'whereby the term "holistic" becomes one of considerable substance'. It praises the Aboriginal initiatives these past 15 years in retrieving 'ownership' of their health. It is an impressive analysis, yet one that is marred, in my view, by remaining wedded to some sort of instrument of measurement. Instruments can measure cholesterol, liver function, pathology, and diabetic glucose levels: they cannot and do not 'cure', or even alleviate, the illnesses or their causes. Having come so far down the track, why does NACCHO still look to medical/psychological/sociological measuring rods?

The medicalised, mental illness approach is essentially an urban-based, urban-responsive, essentially non-Aboriginal, middle-class value. It is based on the right to be happy, the right not to suffer, not to feel pain or undue grief. Happiness is an artifice of Madison Avenue, of Hollywood, an artificial creation of twentieth-century popular culture emanating from the advertising and cinematic industries, respectively. Viktor Frankl (1984) observed a much more realistic existentialism: simply, that to live is to suffer, a far cry, indeed, from the happiness versus unhappiness philosophy that runs so strongly through the National Action Plan on Depression.

There is a need to take stock, to review what has been learned over the past 50 years by way of understanding. There is a need to review, intensely and continentally, what works and what doesn't. What may apply in Yirrkala or Yarrabah may not necessarily work in Coifs Harbour. What is cross-cultural in one part of Aboriginal Australia isn't necessarily cross-cultural in another. What may work in individual therapy or counselling may not work in groups, in what we so loosely and glibly call 'communities'. This is a term whose very usage indicates a communitas, groups in a voluntary association, with a common tribal or linguistic membership and fellowship, a common historical, or political, or cultural heritage, communalistic in their membership, integrated and socially coherent. There is hardly a community in Aboriginal Australia that has the luxury of such homogeneity, yet we persist in pursuing 'community-wide' therapies and strategies, seemingly in the hope that what may work for one will work for all members in that geographic space. Where, indeed, is the research that correlates depression, other 'mental illness' and suicide with birth and residence in truly 'home country', as in Bathurst Island perhaps, and 'country' that was manifestly an artifice, as in Palm Island or Woorabinda?

Researchers in this, and akin fields, seem over-inclined to judge knowledge only by its recentness. A glance at any 'self-respecting' bibliography shows a tendency to concentrate solely on the 1990s, and the pieces that look 'scientific'. Soon the 1990s will become passe. If we want 'holism', we have to have history, social and political history, not simply the present and the immediate future. There is much of value written on Aboriginal health and ill-health, from wider perspectives, health seen in interdisciplinary and integrative perspectives. One example must suffice here: Aboriginal homicide rates. The Memmott (et al. 2001) study of 'Violence in Indigenous communities' describes the 'body of available literature' in an opening paragraph (2001:7), the oldest of which is an item from 1988. The report begins with statements that the 'incidence of violence is disproportionately high', 'rates are increasing' and 'types of violence are worsening' in some communities (2001:39-40). Homicide rates are alarmingly and disproportionately high. The point I make here is that these rates and types were simply not present in remote communities 40 years ago--when Aboriginal serious offences were almost 50% lower than non-Aboriginal rates (Tatz 1963, 1964). Some cosmic changes have occurred in the homicide, serious assault, rape, incest, child molestation patterns, and more so in suicide, since the 1960s. Suicide is but one facet of increased Aboriginal violence. For those who espouse the mental health model, there is an onus to show just what it is in their 'wellness'/'illness' approach that explains, and can treat, these violent manifestations, and not just suicide as a quite separate and singular behaviour. Someone has to show just what the 'new' precipitating and predisposing factors are so that better diagnoses can be made. Bureaucratic controls and colonial attitudes didn't start 40 years ago, and 'bad feelings' didn't begin for Aborigines in the 1980s and 1990s.

We need a new approach, a new mindset. Australian Aboriginal, Inuit, Maori, Samoan, Fijian, Guatemalan, Iroquois, Cree, Dene, Navajo suicide is different. It has, I contend, different causes and manifestations, and it needs different responses and alleviations. One essential answer lies in helping people find purpose in life, which was Frankl's contribution to survival--even in a Nazi death camp. Purposefulness means helping youth engage--in religion, or political life, or political strife, or in legal issues, land issues, activism, or in sport, art, music-in seeking to pit their wills and their skills against others involved in the same or similar enterprise (which is, in effect, Max Weber's famous definition of power). Alienation, in a political sense, and the struggle of one's will over and against the opposition, is a better spur to keeping oneself alive than ennui.

The time has also come for polite 'political' action, as in the case of the 2003 CASP conference. In a most friendly fashion, Inuit health workers, bureaucrats and elders prevailed upon the CASP president to move the biennial suicide prevention conference from the usual big-city hotel velvet rooms to distant Iqaluit, over 2000 frozen kilometres north of Toronto. Six hundred delegates were present and the Inuit effectively 'hijacked' the agenda to focus on polar suicide. The elders of the Australian counterpart, and of the Twenty-eighth International Congress on Law and Mental Health, held at the Sydney Wentworth in 2003,4 haven't as yet managed anything better than short side-sessions, or poorly attended sessions in some windowless, backroom seminar cubicles--as if reluctant to make too many concessions to their agenda, which remains firmly and wholly mainstream.

ACKNOWLEDGMENTS

An earlier version of this article was presented to the Twenty-eighth International Congress on Law and Mental Health, Sydney, on 3 October 2003. My thanks to Lynley Wallis, Sandra Tatz and Michael Kral for their comments, criticisms and suggestions on this revision.

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Colin Tatz

AIATSIS, Canberra

NOTES

(1.) Australian Aborigines are the only colonised minority not to have been accorded the right to name themselves. Thus, those who were there from the beginning were dubbed 'aborigines'. From the 1960s to the mid-1990s, a victory of sorts was achieved when self-adopted terms became commonplace: Koori for the people in Victoria and New South Wales, Yolgnu in the Northern Territory, Murri in Queensland, and Nunga and Nyungar in Western and South Australia. In the 1970s, the people of the Torres Strait Islands were accorded a separate status and ethnicity. In 2000, the South Sea Island population of Queensland was formally recognised as a distinct people. However, the shorthand, chic term 'indigenous'--at first an academic usage, but now a widespread term in bureaucracies and in the media--is the vogue word, one subsuming differing peoples, with different historical experiences, under one convenient rubric. Herein I use the not altogether satisfactory forms of Aboriginal/Aborigines and Islanders, where appropriate.

(2.) Unlike the practices of Canada and New Zealand, which removed children to boarding schools for lengthy but finite periods, Australian practice was to remove children forever from their environment and culture.

(3.) Commonly known by the shorthand term 'DSM-IV'; DSM-IV-TR 2000 is the fourth revised edition.

(4.) A much abbreviated version of this article was presented to that conference on 3 October 2003.

Colin Tatz is Adjunct Professor of Politics at Macquarie University, Visiting Professor of Political Science at the Australian National University, and Visiting Research Fellow at AIATSIS.

3/23 Shirley Rd, Wollstonecraft 2065 <ctatz@laurel.ocs.mq.edu.au>

AIATSIS, Canberra <colin.tatz@aiatsis.gov.au>