Aisha Gill is a criminology lecturer at the University of Surrey, Roehampton, and management committee member at Newham Asian Women's Project in London, which supports women and children experiencing domestic violence. Her teaching and research interests include violent crime and gender inequality, youth crime, violence against women and social justice.

Drawing on a study of 20 Asian women living in London,(1) this article looks at three women's stories to provide a qualitative analysis of Asian female suicide attempters' insight into the dynamics of suicide attempts, and the implications for prevention and intervention.

The three women attempted suicide primarily to take control of a violent relationship and to escape an intolerable situation. Further research - specifically into contributory socio-cultural factors - is needed to establish why Asian women turn to suicide as a way out.

These cases bring to light the many ways in which women become isolated, trapped and depressed as a result of domestic violence. Shame about violence, fear and a loss of sense of self all contributed to the attempted suicides and thoughts of suicide.

Although suicide rates around the world are about three times higher for men than women, there is mounting evidence that in the Indian subcontinent suicide is far more common among young women than men. The same seems to be true of the diasporic communities in the UK. (2),(3).

There are, however, few theories to explain why this is so. Theorists such as sociologist Emile Durkheim propose that suicide is related directly to the larger social context. In other words, a society's attitude towards suicide can and will affect suicidal behaviour. A society that views suicide positively (encouraging or approving of it as an honourable way to resolve problems, for example) may foster a negative, destructive attitude within its citizens.

In some Asian cultures, suicide may be viewed as a better alternative to remaining alive if it protects the family from shame, exposure or embarrassment.(4) Similarly, some religions may allow for passive euthanasia or physician-assisted suicide, depending on circumstances.

A society that simply ignores the incidence of suicide may inadvertently undermine the value of life for some populations. On the other hand, a society whose religious dogma or laws prohibit suicide may be seen by its citizens as unsympathetic to the human experience, or insensitive to the values of minority groups in a multicultural and pluralistic society.

The attitude of any given society towards suicide can affect not only the culture as a whole, but also the behaviour of individuals within that culture.

Daljit* suffered physical and emotional abuse from her partner and described the emotional abuse as more crippling than the physical abuse. She felt lost as a result of violence, and this led her to a point where she wanted to die. Remaining in an abusive relationship was a way for her to die - something she could not do to herself. Nevertheless, she eventually considered actively ending her life.

"I think that there was a part of me that wanted to die but I was too scared to do it myself," she says. "When he hit me I realised that I had lost a loving feeling inside. I felt I brought shame upon myself and started to lose my confidence. He made me feel no good, so I thought about killing myself and started to lose my grip on reality. I would sit in the dark after he'd hit me and think about it."

For Shirin*, loss of self occurred as a result of the emotional trauma of enduring almost daily violence from her husband. "It was like living in a war zone. You just didn't know when he was going to throw a bomb at you. It got to the point where I could not speak. I was too frightened. He turned the whole family against me by saying I was going mad and had no respect for him."

Shirin attempted suicide to deal with the crisis. "I needed to find a way out. I was going crazy, isolated from everything. I didn't want to exist anymore. I wanted to die. It was taking control of my body, which was being abused by others. It had got to a point where I was nothing, I gave him everything and I was nothing."

Shirin had hoped her marriage would improve but the violence ground her down into a state of depression in which she felt helpless. The suicide attempt offered her a solution. "I was trying to find a way out," she says.

For Priya*, all major decisions affecting her life were made by those above her in the family's hierarchy - older brothers, elders and even her own sisters and mother.

"I tried to commit suicide when my father [sexually] abused me," she says. "He was an educated man, you know. We had a comfortable life and all of us enjoyed a good education. But I guess that it had a lot to do with image. It was the most important thing to my father. Where was his honour image when he abused me? How could he do that to me? Why? I didn't know how to deal with it, so I just buried it! There was no one I could talk to. In my heart, I just felt so alone. I was ashamed."

Paternal incest was incomprehensible to Priya's mother, so Priya could never disclose the abuse to her. Priya grew up in a "typical" Asian family, with its concern for social image and the external presentation of the self.(5) Priya's mother either denied or reconstructed her daughter's activities to maintain her public presentation of the "good daughter".

Many researchers have documented the relationship between domestic violence, its psychological effects and its tendency to inspire thoughts of suicide.

Hoff writes:"The association between violence from one's spouse, low self-esteem, and suicidal tendencies is very strong, especially when compared to the women's pre-battering life phase."(6)

Bhugra suggests that suicide attempts are usually non-habitual and carried out at the height of a crisis.(7)

In the present study, Daljit, Priya and Shirin attempted to take their lives as an escape from domestic violence, usually in the form of emotional, physical or sexual abuse. When family and friends discovered the attempts, the women encountered hostility in some cases, and further violence after recovery.

Vulnerability to suicidal behaviour increases with social isolation, alienation, cultural incompatibility and lack of a supportive community, as well as family pressure to conform to old or "traditional" cultural values.

Further sources of conflict may derive from the incongruity between the cultural belief that the family should provide support and intimacy, and the reality of the Asian family's status within society, where they are often oppressed as well as being racially segregated and the subjects of discrimination.

Diekstra and Garnefski argue that the significance of the Asian family unit in the development of suicidal behaviour needs greater emphasis.(8) They found that the primary causes of attempted suicide were family-based:conflict with spouses, parents and parents-in-law.

Interpersonal disputes (particularly over marriage and lifestyles), the pressures of economic competition and the loss of self-esteem associated with failure, and the anxiety attached to nonconformist behaviour have all been cited as causes of self-harm among young people.(9),(10),(11).

These pressures are intensified in young Asian women, who have to cope with rigidly defined roles imposed by the community. Submission and deference to males and elders, arranged and forced marriages, the financial pressures imposed by dowries and the marital and family conflicts that ensue have all also been cited as contributory factors to self-harm in young Asian women. Self-harm in this context, therefore, serves as a form of problem-solving in the face of threatening social forces and expectations.

Key recommendations have been advanced for immediate action by all agencies involved with the prevention of suicide among young Asian women.

• Promote awareness that suicide and self-harm in ethnic minority communities is a major, but largely preventable, public health problem.
• Develop and implement strategies to reduce the stigma associated with mental illness, substance abuse and suicidal behaviour, and promote opportunities for seeking help.
• Institute training for all health, mental health, substance abuse and human service professionals (including teachers, social workers and health professionals) for suicide risk assessment and recognition, treatment, management and aftercare interventions.
• Develop and implement safe, effective programmes in educational settings for young people that address adolescent distress, provide crisis intervention and incorporate peer support.

It is important that agencies, particularly social services, provide appropriate conditions in which young Asian women can report their suicidal vulnerabilities in a safe and confidential space without fear of being misunderstood.

This, however, requires significant investment in suicide prevention measures across the health care services to deliver comprehensive and socially appropriate care packages targeting risk behaviour and social exclusion.

*Names have been changed

Abstract

This piece provides a qualitative analysis of Asian female suicide attempters, an insight into the dynamics of suicide attempts and the implications for prevention and intervention. Asian women who have failed one or more suicide attempts have participated in this study, sharing their stories and motivations.

References

(1) A Gill, Challenging Silence: A Study of Domestic Violence Against South Asian Women Living in East London, PhD thesis, University of Essex, 2002

(2) J Merrill and J Owens, "Ethnic differences in self-poisoning: A comparison of Asian and white groups," British Journal of Psychiatry, Vol 148, 708-712, 1986

(3) D Bhugra and M Desai, "Attempted suicide in south Asian women", Advances in Psychiatric Treatment, Vol 8, 418-423, 2002

(4) A Gill, "Voicing the silent fear: South Asian women and domestic violence", Howard Journal of Criminal Justice (forthcoming), 2004

(5) E Goffman, The Presentation of Self in Everyday Life, Doubleday, 1959

(6) A Hoff, "Human abuse and nursing's responses", in P Holden (ed), Anthropology and Nursing, Routledge 1990

(7) D Bhugra, "Attempted suicide in west London", Psychological Medicine, 29 (5), 1131-1139, 1999

(8) R Diekstra and N Garnefski, "On the nature, magnitude and causality of suicidal behaviours: An international perspective, suicide and life-threatening behaviour", Vol 25(1), 36-57, 1995

(9) J Merrill and J Owens, as above

(10) Bhugra, 1999, as above

(11) S Raleigh "Suicide patterns and trends in people of Indian subcontinent and Caribbean origin in England and Wales", Ethnicity and Health, Vol 1(1), 55-63, 1996.

Contact the Author

E-mail a.gill@roehampton.ac.uk