This article was originally published on the news and analysis outlet Toward Freedom.
In the critically acclaimed film The Lives of Others, the formerly show-cased writer, Georg Drayman, risks his future and reputation by penning an article exposing the shocking rates of suicide within the German Democratic Republic. Having been previously known for his loyalty to the “actually existing socialism” of the GDR and his personal friendship with the Honecker family, Drayman’s transformation from cultural icon to political dissident is intertwined not only with the recent suicide of his friend, Albert Jerska, but a refusal to compromise with a political system contemptuous of the humanistic values it claims to uphold.
In unforgettable prose, Drayman blasts the government’s callous re-definition of suicide as “self-murder.” Suicide, for Drayman, has “nothing to do with murder” as it “knows no bloodlust, no heated passion” but “only death, the death of all hope.” The death of hope for many of the GDR’s citizens, in his view, had become a political inconvenience for the ruling order.
There’s a risk, however, when dealing with fiction set in the former eastern bloc. In an epoch marked by post-modernism and the triumph of neo-liberal economic practice, productions such as The Lives of Others can be too easily interpreted as a blanket moral endorsement of the present-day status quo. Twenty six years after the fall of the Berlin Wall, however, we find that the triumph of west over east has not led to a society free of the “death of hope” that led poor Jerska to his end – far from it.
A study recently published in the Lancet Psychiatry claims that of the hundreds of thousands of people across the globe who end their lives each year, around forty five thousand per annum between 2000-2011 have done so out of desperation at ongoing unemployment. In an analysis of previously compiled data from the International Monetary Fund (IMF) and World Health Organisation (WHO), researchers claimed suicides had increased in frequency over the past decade by twenty to thirty percent, with one in five self-inflicted deaths now attributed to unemployment.
The Lancet calculated from data obtained from 2009 that there had been a spike of nearly five thousand suicides directly linked to the financial crash of 2008.
Earlier projections by WHO in 2004 held that such fatalities may peak at over a million per annum by 2020, with Eastern Europe coming in for special mention as a focal point. While older individuals were initially thought to be more vulnerable, a corresponding rise in self-inflicted deaths among the young has been noted. In fact, as early as the year 2000, WHO held that suicide ranked as one of the three main causes of death among those aged fifteen to thirty five.
“Our findings reveal that the suicide rate increases six months before a rise in unemployment,” said Dr Carlos Nordt of the University of Zurich Psychiatric Hospital, in an interview with The Guardian. “What is more, our data suggests that not all job losses necessarily have an equal impact, as the effect on suicide risk appears to be stronger in countries where being out of work is uncommon.”
Yet this is not a new trend. According to a study carried out in 2003 at the Wellington School of Medicine, unemployment was alleged to be “associated with a twofold to threefold increased relative risk of death by suicide.” The reasons cited as to why this may be the case were numerous, although underpinning health issues actively contributing to individual unemployment appeared to play a role. Mental illness was found to comprise one of several “risk factors” that may arise from or precede unemployment, with the more expected financial difficulties brought on from being out of work linked to suicide occurrence.
Statistics subsequently alluded to an informal relationship between unemployment levels and suicide rates. According to the above study, unemployment in New Zealand jumped from a meagre four percent of the population in 1987 to a startling 10.7 percent in 1991. The numbers of New Zealanders making the decision to take their own lives was found to be markedly high compared to other advanced economies around this time, with insecure or sporadic employment being cited as a prime factor in the development of psychological disorders themselves linked to suicide.
Some years earlier and on the other side of the Pacific, the United States suffered from a wave of suicides, which, according to the aforementioned Lancet study, were thought to stem from the escalating unemployment experienced during the early years of President Reagan’s tenure. By 1982 US unemployment stood at 10.8 percent of the population, then the “highest level since the Great Depression” according to a paper by American academics Steve Stack and Ain Haas.
Stack and Haas had made an authoritative study of this episode of American history, which had been published way back in 1984 in the journal Sociological Focus. In what is now well established, the two authors link unemployment to the degradation of mental health, claiming that “periods of high unemployment will increase problems such as suicide” in addition to deaths from alcoholism, heart attack and homicide.
More recent findings by WHO link mental health problems such as depression and schizophrenia in predisposing a sufferer to suicidal tendencies. The fact that those unfortunate enough to endure such maladies are also more likely to experience unemployment compounds the link between suicide and a lack of work. Such a relationship, however, is rendered more complex when one factors in issues involving access to mental health treatment. Indeed, WHO admits certain issues relating to a lack of development in mental health care in various countries, problems which are exacerbated when coupled with issues relating to unemployment, financial loss, and the resulting inaccessibility of health care.
A British government study in 2004 found that those experiencing unemployment were markedly more likely to develop psychological disorders. What’s more, the unemployed were alleged to be prone to avoid seeking assistance from qualified care practitioners, potentially due to factors relating to social isolation and, particularly in this case, financial burdens. Shocking levels of discrimination towards the mentally ill, from employment opportunities to every-day interactions in public, also play a role not only in why suffers attempt to avoid exposure but may also resort to self-harm.
The problem seems particularly entrenched in Britain. According to the Mental Health Foundation (MHF) the UK has the highest rate of “self-harm” (not necessarily outright suicide) in all of Europe, with some four hundred out of every one hundred thousand citizens engaging in such behaviour.
Unsurprisingly, the group also found that “unemployment and poverty are all linked to mental ill health,” claiming that of those patients consulted during research, nine out of ten suffered some form of discrimination in their lives. As a whole the mentally ill were found to be “the least likely of any group with a long-term health condition” to enjoy ongoing employment, decent housing and stable personal relationships.
In an article for Toward Freedomlast summer, it was revealed that, in addition to being at greater risk for mental health afflictions, the life expectancy of a homeless Briton stood out at a miserable 47 years. The rest of the population, on average, lived a hearty 77 years.
A report published by the National Health Service and the charity group St. Mungo’s Broadway further clarified matters. They revealed that members of the UK homeless population were nine times more likely than other citizens to take their own lives.
Elsewhere, a lack of mental health access in the “developing world” is playing a major role in the proliferation of psychological maladies linked with suicide. According to an article in The Guardian back in 2010, mental health charities often struggle to raise funds for their work in the global south in face of government indifference and donor apathy.
Why might this be the case? The author, Andrew Chambers, points to problems with development strategy and the “market-driven nature of aid”. In his view “mental health is an invisible problem in international development” because “allocation of funds is strongly correlated with a project’s marketability to the general public.”
Chambers cites the experience of WHO workers in Zambia, claiming that many sufferers of mental health issues attempt to avoid treatment due to negative stigmas. “What treatment is delivered,” writes Chambers, “tends to rely on traditional healers who often interpret mental illness in terms of possession or curse.”
In 2007, a report filed by IRIN Humanitarian News and Analysis linked Zambian rates of mental illness and suicide to economic factors, particularly joblessness. Out of a population of some ten million, sixty eight percent lived on less than a dollar a day, with a meagre four hundred thousand formal jobs keeping a stuttering economy afloat.
“Mental health problems are on the increase among the population,” said Nora Mweemba, a local WHO officer, in an interview with IRIN. “[This is] mostly because of the socio-economic difficulties that exist in this country – HIV/AIDS, poverty, joblessness – they all precipitate mental problems.”
Mweemba subsequently argued that many mental health sufferers refuse to admit to their predicament, believing it to be “some form of punishment” outside of their control.
The Times of Zambia claimed that, as recently as 2014, cases of suicide have risen directly due to “negative social” and “economic” factors exacerbated by “unresolved psycho-social problems.”
This appears to be compounding problems relating to poverty overall, as sufferers, unwilling or unable to obtain treatment, become dependent on family members for material support which, potentially, can exacerbate the feelings of depression associated with suicidal tendencies. In his article for The Guardian, Chambers presents an alarming situation, where, despite the evident deficit in mental heal provision “half of all countries in the world have no more than one psychiatrist per 100,000 people and a third of all countries have no mental health programmes at all.”
This opens up broader questions in regards to global development, particularly in relation as to how wealthy nations approach their obligations to less empowered governments. According to a 2005 research paper “Achieving the Millennium Development Goals: Does Mental Health Play a Role?” by J. J. Miranda and V. Patel, “mental illness is closely associated with social determinants, notably poverty and gender disadvantage, and with poor physical health, including having HIV/ AIDS and poor maternal and child health.”
Miranda and Patel argue that a lack of focus on mental health on the part of the now outgoing Millennium Development Goals (MDGs) was a mistake. Indeed, the authors bemoan the fact that “mental health remains a largely ignored issue in global health, and its complete absence from the MDGs reinforces the position that mental health has little role to play in major development-related health agendas.”
Their report goes on to highlight the impact poor mental health can play in eroding economic security and also educational opportunities. Both maladies appear to feed off the other, with the mentally ill sinking further into poverty “because of both increased costs of health care—often being sought through private providers—and lost employment opportunities.”
At the same time, the traditionally poor suffer increased likelihood of psychological trauma due to the stress of their predicament. According to the author’s findings “virtually all population-based studies of the risk factors for mental disorders, particularly depressive and anxiety disorders, consistently show that poor and marginalized people are at greater risk of suffering.”
An unsettling facet to such revelations is the preponderance of poverty, psychological trauma and subsequent suicide in the female population. Globally speaking women tend to shoulder a higher than average burden when it comes to economic deprivation. Back in 1997, the United Nations reported that some 70 percent of those living in poverty were women. In 2013 the Food and Agriculture Organisation of the UN (FAO) published a report citing that, of the “millions” living in “food insecurity” women once again endure a sizeable degree of privation due to restricted access to education, employment opportunities and financial services.
This problem is only further compounded when one considers women’s access to mental health services, given that, according to Miranda and Patel, some 10 to 30 percent of mothers in the developing world will or do suffer from depression. This issue turns from lamentable to tragic when the authors reveal that “suicide is now a leading cause of death in young women in the world’s two most populous countries, India and China.”
Alleviating the problem of suicide globally ties in with objectives towards satisfying certain economic norms ensuring a decent life for the population. Links between poverty, psychological trauma and, ultimately, the “death of all hope” cited by the fictional Georg Drayman, seem clear enough. But perhaps also is the solution.
Both WHO and the authors of the Lancet Psychology study point towards the importance of adequate care in evaluating those most at risk of taking their own lives. Yet there are broader methods available that are conducive to the wellbeing of the population, starting from a recognition that human rights are not merely limited to free speech but also constitute guarantees towards economic sustainability. The International Covenant on Economic, Social and Cultural Rights, itself enshrining everything from “the right to work” to “fair wages” and a “decent living” to, under Article Twelve, “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health” is a case in point.
These rights are not abstractions, nor are the people behind the statistics that show us that, to again quote Georg Drayman, the “death of all hope” for hundreds of thousands each year is not an accident of fate, but directly linked to the political and economic reality we live in.
Daniel Read is a UK based journalist. He has a BA in journalism and an MA in human rights, and is currently finishing an MSc in global politics at the University of Southampton. Follow him at his blog uncommonsense.me and on Twitter at @DanielTRead