The biopsychosocial model is currently the foremost comprehensive and influential approach to explaining psychological disorders, especially as it applies to the Nigeria context. Having explained suicide from a cognitive perspective, behavioural perspective, biological perspective, now let’s look at it from another popular perspective because none of these previous perspectives is enough to profoundly explain the causes of suicide or why it is currently a dire issue. The diathesis-stress model puts all factors in various perspectives into consideration to enrich our knowledge about suicide, which is vital to facilitating effective interventions. This model is therefore prominent partly because it encompasses numerous critical causal factors, including biological imbalances, genetically inherited characteristics, brain damage, psychological traits, socioculturally influenced learning experiences, stressful life events, and a lot more which includes traumatic experiences.
But it is not strange for us to wonder how all these factors actually interact to trigger the disorder. Most researchers who study psychopathology believe that inherited characteristics, biological processes, learning experiences, and sociocultural forces combine to initiate a predisposition or diathesis for psychological disorders. Whether or not an individual eventually develops symptoms of a disorder, they say, depends on the nature and amount of stress the person encounters (Turner & Lloyd, 2004; U.S. Surgeon General, 1999). However, the level of stress experienced depends mainly on the perception of the stressed individual and their reactions toward such stress. This implies that suicide results from the interaction between stress faced by an individual and their relevant past experiences (usually traumatic and the psychological constructs of the individual) including specific biological predispositions such as having a neurotic personality, being sensitive etc.
For example, a suicide survival who reported that he just could not deal/cope with life anymore and believed his death would end all of his sufferings. Such person may have inherited a biological tendency toward depression or may have experienced faulty learning process that formed his unhealthy personality which then influenced his distorted cognition towards specific stressful situations and consequently he or she created the fallacy ( false belief ) that nothing else could alter the situation. This may not necessarily be the reality but because he or she had not performed the right actions (focus inward) to alter his or her distorted thoughts which will consequently alleviate the symptoms. But these predispositions might not result in suicide unless the person is faced with a severe financial crisis or suffers the loss of a loved one or just be a victim of unfavourable economic status. This person, however, reported domestic abuse, issues with police and school problems which kept on aggravating the problems. With this, we should understand that there is a tendency for suicide.
If major stressors don’t occur, or if the person, including all other people, has good stress-coping skills, suicidal thought may never appear or may be relatively mild. In Nigeria only few people are aware of this reality, stresses and other problems are often attributed to a cause that appears to be beyond them, so they saw no reason to learn and actively employ these coping skills to improve their wellbeing.
So according to the diathesis-stress explanation of psychological disorder, biological, psychological, and sociocultural factors can predispose us toward disorder; (in this context the disorder we are considering is suicide), but it takes a certain amount of stress to actually trigger it. For those with a strong diathesis, relatively mild stress might be enough to create a problem. Those whose predisposition is weaker might not show signs of suicide until stress becomes extreme or prolonged.
Another way to think about the notion of diathesis-stress is in terms of risk: The more risk factors for a disorder a person has-whether in form of genetic tendencies, personality traits (peculiar to Nigerians), cultural traditions (such as in case of Nigeria where individualism is ignored which could incite incongruence, faulty socialization etc), or stressful life events (including verbal, emotional abuses etc. and pressures)-the more likely it is that the person will display symptoms of suicidal intent or suicidal attempt in response to those occurrences that incite overwhelming emotions within them.
It is obvious that in Nigeria, a large percentage gets to go through a stressful experience such as unemployment, domestic abuse, sexual abuse, break up of a long term relationship, poverty, etc., as referenced in previous write-ups about suicide.) Looking at the reported cases of suicide, many of these cases are associated with break ups, unemployment, failure in school, limited school admissions. Some of these cases do not come with an explanation as to why they committed suicide. One thing is certain these people subsequently get depressed as a result of direct exposure to these aforementioned serious stressors.
We might be tempted to say that socio-economic challenges, unemployment, abuses, poverty, breakups etc. led to the depression, but these stressors were not the only force in play here. Many people experience these stressors without becoming depressed; this tells us that a breakup will cause depression only if other factors are present, and this is the perspective of the current model being discussed.
What are those other factors? Part of the answer lies in a person’s biology, or childhood experiences, (as mentioned above
that make up a person’s personality because; some people have a genetic tendency toward depression or personality disorders which is often associated with suicidal cases. Some are vulnerable to depression and other mental disorders due to the disposition formed as a result of stimulation from the environment right from childhood. This tendency remains unexpressed (and so the person suffers no depression) until the person experiences a particularly stressful event. Then, when that stressful event takes place, the combination of the event plus the biological tendency or personality disposition will likely lead to feeling so empty or depressed to the point of considering to end one’s life.
This suggests that we need a two-part theory of suicide, and the same is true for virtually every other form of psychopathology as well. This two-part conception is referred to as a diathesis-stress model (Bleuler, 1930; Meehl, 1962;), with one set of factors (the diathesis) creating a predisposition for the disorder, such as genetic dispositions, childhood experiences (that resulted from inefficient training and learning process), parenting style etc. that form a typical unhealthy Nigerian’s personality, and a different set of factors (the stress) such as unemployment, poverty, exam failure etc. providing the trigger that turns the potential into the actual disorder (suicidal ideation/intent or suicidal attempt). Notice that, by this model, neither the diathesis nor the stress by itself causes the disorder; instead, the disorder emerges only if both are present.
The youths who feel hopeless, use drugs or who finally think about committing suicide have developed certain innate dispositions (often neurotic and makes them less capable of overcoming challenges) over time due to childhood experiences and as they interact with their environment, which can incite serious mental and behavioural impairment symptoms if they experience stressful event. According to Damilola (2018), over 60% of youths is predisposed to PTSD and exhibit symptoms of personality disorders due to problems in Nigeria and the upbringing each child experienced. How vulnerable people determine the intensity level of stress required to activate mental problems such as committing suicide. This vulnerability is the accumulation and interaction between genetic factors and learning processes a person experiences
In addition, the search to tie social factors, emotional causes, innate dispositions and physiological composition to suicide may also be influenced by Walter Cannon’s observation in 1932 that emotion is accompanied by physiological changes (Kimball, 1981). Cannon’s research demonstrated that emotions can cause physiological changes that are capable of causing ailment including mental distress and a case as hideous as suicide. From this finding, Helen Flanders Dunbar (1943) developed the notion that habitual responses such as anxiety, irritability, compulsive acts etc. which people exhibit as part of their personalities, relate to the specific deficit. In other words, Dunbar hypothesized a relationship between personality type and diseases. A little later, Franz Alexander (1950), a one-time follower of Freud, began to see emotional conflicts as a precursor to certain ailments.
These views led others to see a range of specific ailments as “psychosomatic.” These ailments included such disorders as peptic ulcer, rheumatoid arthritis, hypertension, asthma, hyperthyroidism, and ulcerative colitis. This belief diverged from the biomedical view, which concentrates on the body and ignores the mind. However, the widespread belief in the separation of mind and body; a belief that originated with Descartes (Papas et al., 2004) led many laypeople to look at these psychosomatic disorders as not being “real” but merely “all in the head.” Thus, psychosomatic medicine exerted a mixed impact on the acceptance of psychology within medicine; it benefited by connecting emotional and physical conditions, but it may have harmed by belittling the psychological components of illness. Psychosomatic medicine, however, laid the foundation for the transition to the biopsychosocial model of health and disease (Novack et al., 2007). This model is synonymous to diathesis-stress model that provides us with the understanding that the prevalent suicide rate has psychological, biological and social implications.
References
Bleuler, E. (1930) The Physiogenic and Psychogenic in Schizophrenic. Amer J. Psychiat, 10: 208-211
Cannon, W.B. (1932) The Wisdom of the Body. New York: Norton.
Jane, O., (2007) Health Psychology (Fourth Ed.). United States of America.
Meehl, P. (1962) Schixota is, Schizotypy, Schizophrenia, Amer. Psychologist, 17:827.
Turner R. & Lloyd D. (2004). Stress burden and the lifetime incidence of psychiatric disorder in young adults: racial and ethnic contrasts. PubMed, 61(5):481-8.
