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Biological, psychodynamic, socio-cultural and behavioural approaches to understanding the causes of suicide in Nigeria

  • Introduction

    This paper explores related literature (theories) and discusses suicide employing biological, psychodynamic and behavioural perspectives relevant  to the understanding of the underlying causes and course of the subject matter - suicide. Suicide, as discussed in the previous write up, is a critical condition that needs special attention; to enable effective intervention, there is need for profound insight and understanding of the problem - suicide especially in Nigeria. My previous write-up has imbibed in us the knowledge about the meaning, types, prevalence etc. of suicide. Here, we will look at the scope; examine a particular case study (ies). Also, as mentioned above, biological perspective, psychodynamic perspective, behavioural perspective, socio-cultural perspective and contemporary views of suicide will be discussed.

    Early views on suicide

    In the early 1900s Austrian psychoanalyst Freud developed a number of the primary psychological theories of suicide. He emphasized the role of hostility turned against the self. American psychiatrist Karl Menninger elaborated on Freud’s ideas. He suggested that every one suicide has three interrelated and unconscious dimensions: revenge/hate (a wish to kill), depression/hopelessness (a wish to die), and guilt (a wish to be killed). In Nigerian context, a huge number of youths experience societal problems including unhealthy family structures, abuses, incongruences, poverty etc., these result into depressive moods due to lack of stimulating environment that imbibes proper ego development. Therefore their executive control system is not effective to mediate conflicts between id and super ego which then effects guilt and other mental distress and or dysfunctions. Many Nigerians act impulsively after which they give a thought to their past actions which incite regrets and guilt.

    An American psychologist considered to be a pioneer within the modern study of suicide, Edwin Schneidman, has described several common characteristics of suicides. These include a sense of unbearable psychological distress, a sense of isolation from others, and the persistent perception that only death will mitigate or put a stop to the problems which one feels hopeless and helpless about. Particular cognitive theorists, whose interest is in how people perceive the world and process information, emphasize the role of rigid thinking pattern or tunnel vision ( such as "life is awful, death is that the sole alternative”) and lack of problem-solving skills; that is, the power to get solutions to problems. According to psychologists, many suicide attempts imply inner suffering and need  for help, an effort to reach out and receive attention. In Nigeria, attention and affections toward others are underrated. Nigerians have link attention to difficulties, people feel loved only when they demonstrate distressful behaviours or symptoms. Another case of receiving attention is when a person achieves a notable feat; people latter can be difficult to attain due to the many problems the country is faced with such as, unemployment, terrorist attacks, poverty and other psycho social problems.

    Aetiology of suicide

    We will explore psychological perspectives that best provide an explanation for suicide in Nigeria. Depression often precedes suicide. Depression is more onset of every other significant mental impairmentsymptoms of depression tend to overlap other symptoms such as addiction. This implies that people fall, victims of addiction and or suicide, while struggling to escape their depressive episodes (in a maladaptive way).

    Biological Model

    Genetic dispositions, hormonal imbalances, brain defects and dysfunctional neural activities incite mental and behavioural impairment. Genes thought to be associated with depression include those involved in the synthesis of serotonin from tryptophan (Gizatullin et al. 2006) and the transmission of serotonin at the synapse (Surtees et al. 2006).

    Biological mechanisms

    Both norepinephrine and serotonin have been implicated in the aetiology of depression. It was initially thought that low levels of either neurotransmitter impacted on mood. This simple model is now being challenged by recent data. It seems that mood is the result of an interaction between both serotonin and norepinephrine. For depression, it is possible that low serotonin levels disrupt activity within these systems, which results in depression. The major brain area involved in depression is the limbic system. This implies that our interaction with the world and how we channel and control these processes (memory, feelings etc) affect depressive moods which subsequently leads to suicide (Robin & Stephen, 2009).

    According to the psychobiological model, suicide and the associated mental dysfunctions occur when these processes are triggered by both social and psychological factors, the genetic factors, however, influence the degree of stress required from each domain before an episode of depression is triggered. Some people are genetically vulnerable / predisposed as a result of the inherited traits from their parents. This also explains; the less we make use of important areas of the brain (that are responsible for our consciousness through being mindful) the higher the reuptake of essential hormones associated with our cognitions and emotions. Overstimulation of the brain through the use of drugs or fixating thoughts on past and future strains brain areas that regulate our survival instincts; moods and mental wellbeing. This strain incites the reflexive act of committing suicide since the distorted thoughts have been associated with an impulse which automatically activates the sympathetic nervous system for immediate response. This implies that our genetic predispositions play a significant role in what parts of the brain are more stimulated because of how we process information or generally act and react to different stimuli.

    According to the evolutionary theory, suicide resulted from the unrelated traits transferred to us through survival (natural selection) from our ancestors, but that become maladaptive during this present existence. Randolph Nesse in his journal explained that cognitive vulnerabilities like depression resulted from the optimization of the trade-off these traits (Robin & Stephen, 2009).

    Socio-cultural factors

    A number of stressors that appear from and or through social interaction are shown to extend risk for depression. The prevalence rate of depression is comparatively high among the unemployed youths, poor, ethnic minorities and people with poor or no quality social or marital support (Jenkins et al. 1998). many of us experience a mixture of things (below their awareness) that make them particularly susceptible to depression which could lead on to suicide.

    Brown and Harris (1978), for instance , found that working-class women who had three or more young children lacked an in-depth confidante, had no outside employment, and whose father had died or divorced their mom while they were young, were more susceptible to depression than those with the other constellation of circumstances. this is often true as regards the situation in Nigeria, a number of the youths who reported mental distress came from broken or abusive homes. this suggests that it's not necessarily about the presence or absence of a prominent member of the family, it's more about getting social support and quality affections from loved ones.

    The kinds of problems that trigger attempted suicide vary consistent with age. Hawton’s (1997) summary of the info suggested that 72 per cent of adults who committed or attempted suicide had difficulties in interpersonal relationships, 26 per cent had employment problems, 26 per cent had difficulties with children, while 19 per cent had financial problems. against this, high levels of emotional liability and sexual problems may make some adolescents particularly susceptible to suicide.

    Remafedi et al. (1998), for instance , found that 28 per cent of homosexual or bisexual males but only 4 per cent of heterosexual male adolescents had ever considered or attempted suicide. For females, the corresponding figures were 21 and 15 per cent. Among older people, suicide may occur as a consequence of accelerating disability: 44 per cent of 1 sample of elderly people apparently committed suicide to stop being placed during a home (Loebel et al. 1991).

    Suicide among those that have recently been bereaved is additionally frequent. A recent phenomenon has been observed where people study effective means to terminate their own lives through the web . However, this is often not the basic problem and account for fewer deaths.

    Economically deprived individuals tend to experience more negative life-events than those that are better-off and should have fewer social and financial resources with which to affect them (House et al. 1991). many of us in the minority ethnic groups may need to deal with adverse economic circumstances. additionally , they'll need to deal with problems with prejudice and integration with the bulk population which will cause significant stress (Clarke 2000). More acute life stresses, like divorce or separation, can also trigger episodes of depression. Conversely, an honest social support network is often protective (Paykel 1994).

    There is variation in explanations of why more women report depression than men. It was initially dismissed as a reporting bias; there is significant evidence now that there are real gender differences in the prevalence of depression and suicides (Weich et al. 1998). Social explanations of these phenomena suggest that men are pressured by society to be a higher achiever in this society with limited opportunities to thrive without extra efforts. However, these men were not appropriately socialized; therefore, they hold on to wrong beliefs (that they are never to appear weak no matter what) and they lack adequate coping skills to deal with problems. On the other hand, women are raised up in a way that prepares them for challenges.

    In addition, Nigeria is “cultural,” norms, values and conventions are overemphasized, that it devalues individual uniqueness and abilities. This causes confusions and pains within individuals and impedes the quality of lives. Only the fortunate and daring ones get to survive the pitfalls in Nigeria, where the vague patterns of behaviours and ethics form the ways of life. There are always expected ways to behave which makes everyone like everyone else. This is harmful to the wellbeing of each individual.

    Some people in their bid to escape these pitfalls adopt unhealthy thought patterns and consequently develop mental disorder and could resort to suicide to end it all. Social media also contribute to how suicide act is more exposed and learned to escape problems since social media exist as solace to many youths. People who desire attention and recognition just as they admire on social media might choose suicide since that is the only affordable way to achieve their desires because the society is so critical of another way, which is most likely unconventional and unique. The pressures of the society, influences of others, limited opportunities and resources influence suicide in Nigeria according to this perspective.

    Related article: How locus of control and defence mechanisms impair our mental well-being and social functioning

    Psychodynamic explanations

    Freud ([1917; 1957) considered depression to be a similar process to grieving. During grieving, the individual regresses to the oral stage of development as a defence mechanism against overwhelming distress. This involves complete dependence on the loved one, as a consequence of which they merge their identity with them and symbolically regain the lost relationship. In addition, through a process known as introjection, they direct their feelings for the loved one into themselves. These feelings may include anger as a result of unresolved conflicts. This reaction is generally short-lived but can become pathological if the individual continues to introject their feelings in the long term, leading to self-hatred and depression. This explains that the world is a reflection of us. Whatever we think or feel of others are directly or indirectly directed back at us.

    Freud suggested that ‘normal’ depression results from an imagined or symbolic loss. Events are seen as somehow removing the love or esteem of important individuals, and the depressed person introjects their negative feelings towards the individual who is seen as rejecting them. Those most prone to depression are people who fail to effectively progress through the oral stage of development because they are either gratified too much or too little at the time. Such people remain dependent on others for love and approval through their lives and are susceptible to events that trigger anxieties or experiences of loss.

    All mothers need orientation as regards this because a number of them over or underfeed their children due to wrong beliefs they have imbibed. Some of these parents despise hearing the cries of their babies so whenever the child cries regardless of what could be the issue; they resolve the issue with feeding the child. This especially explains why many youths resort to taking drugs to deal with their depressive moods that could have resulted from a cause that needs to be looked into to really transform the painful feelings. This problem becomes aggravated that they feel nothing else but death could heal them. As explained above the attitude of parents towards children during oral stage predisposes them to attribute their pleasure to the external figure, whenever these figures are absent, they feel so empty or when something else hurts them they find a way to attribute to these figures and in turn feel the pains within, this is not a reality and thus it continues to aggravate the depressive conditions till they finally lose it and decide to terminate their lives.

    This is common to a typical Nigerian, where we form our identity from the external world. Deficiencies and rejections from these people or similar situations cause deep pains within us because we turn our anger towards them inwards. This implies that our innate activities (conflicts) are responsible for our mental distress.  Depression also arose because many Nigerians tend to adopt unhealthy defence mechanisms because the super ego is so strong while the ego has not fully developed. This means the anal and phallic stage was not readily successful. A number of youths cannot delay gratification (ego fails to mediate), to mitigate the conflicts they adopt defence mechanism e.g., using repression and denial excessively could result in unexplained anxieties, addiction etc.

    According to Freud (1920 & 1990), suicide represents a repressed wish to kill a lost love object and is an act of revenge. Hendin (1992) identified a number of other psychoanalytic processes that may lead to suicide, including ideas of effecting a rebirth or reunion with a lost object as well as self-punishment and atonement. Due to lack of ego development, and strong super ego development and ever vibrant Id, a number of youths are overwhelmed with guilt and confusion which propel them to atone and punish themselves in a maladaptive way, because they do not know about any other effective way or cannot delay gratification to employ another healthy way.

    Behavioural explanations

    Behavioural theories of suicide typically focus on operant conditioning and classical conditioning processes. Using Operant Conditioning, Lewinsohn et al. (1979), for example, suggested that suicide is the result of a low rate of positive social reinforcement. This leads to low mood and reductions in behaviour intended to gain social rewards. The individual withdraws from social contacts, an action that may actually result in short-term increases in social contact as they gain sympathy or attention as a result of their behaviour. This may establish a further reinforcement schedule, known as a secondary gain, in which the individual is rewarded for their depressive behaviours. This phase, however, is usually followed by a reduction in attention (further reducing the frequency of rewards available from the environment) and mood, this may lead them to look for alternative behaviour (suicide) to escape the negligence. For example, children who have learned to use cries and other ineffective ways to satisfy their desires as a child and adolescent are more predisposed to suicide when they encounter stressors that persist despite their cries, without being particularly proactive.

    In Nigeria, children are often punished without being provided with adequate alternative behaviours that can be reinforced to commend and increase the competence of the children. Children who seek independence and courage may be inhibited until he or she takes a drug which them compels relatives to let him or her be. An outspoken person in Nigeria is considered rude; such a person might experience aversive stimulus while being outspoken which then inhibits the behaviours to be replaced by depressive mood. The latter is wrongly defined as modest behaviour. Negative reinforcement and punishment bring about depressive moods, addiction and suicide.

    Classical conditioning explains how we easily associate stimulus around us with natural stimuli which consequently compel those (conditioned) stimuli to bring about conditioned response similar to the natural response. For example, someone who is feeling bad due to lack of preparation for a presentation may then attach those anxious feelings to the public. If this becomes habitually imbibed, then when we are in public we feel anxious. Or someone who has associated a particular set of thoughts to specific situations due to formation of schema may be compelled to automatically feel or behave in a certain way when present in a similar situation. Learned helplessness might set in. People who associate alcohol or other substances to pleasure will be motivated to take more of it.

    People who have associated their pleasure and identity to their partner might become so depressed when the person leaves their life. This might lead to suicide because they believe that there is no pleasure for them without the existence of the person in their lives. Many couples experience depression because they have attached their happiness with the other person, but in the end, they realize that their belief is not true and that the other person mirrors their innate dispositions and not necessarily their prince Charming that gives them nothing but joy. Some people have associated their good grades to their overall success which gives a profound feeling of happiness, so when they fail, they feel so depressed and suicidal. Some people appear seemingly happy, they have good career, marriage etc. but still feel depressed because they initially associated pleasure to particular things but in the end, the thing reveals its true nature and takes up its neutral state.

    This possibly explains the vague traditions passed across generations over time. Norms and values that worked for a group of people over a period have become associated with success. These values and norms have lost their authenticity and significance and need to be replaced but because the conditioning had occurred, it becomes difficult to change. Young generations are forced to imbibe it and struggle to integrate them to their individualities when the inconsistency and dissonance persist, then depressive moods set in. If despite this no solution surfaces (because depression is supposed to be signal for us to resolve particular imbalance within), drug abuse could follow and then probably suicide.

    There are other theories that are germane to the understanding of the underlying causes of suicide, which will be explained in subsequent articles to be posted here. Stay tuned! And thank you for reading.

    References

    Berman, Alan L. & Redmond, WA ( 2008) Suicide. Microsoft Encarta; Microsoft Corporation.

    Brown, G., & Harris T., (1978) Social origins of depression. Cambridge University Press.

    Freud, S. (1957) Revision of the theory of dreams. In: Strachy, J., Ed., The Standard Edition of the Works of Sigmund Freud. The Hogarth Press, London, 8

    Gizatullin, R., Ghazal Z., Erik G., Marie Å., & Rosario L. (2006) Tryptophan hydroxylase-1 gene variants associated with schizophrenia. Biological psychiatry 60 (6), 563-569.

    Hawton, K. (1997). Attempted suicide. In D. M. Clark & C. G. Fairburn (Eds.), Oxford medical publications. Science and practice of cognitive behaviour therapy (p. 285–312). Oxford University Press.

    Hendin, H., (1992). Suicide among homosexual youths. Amer. J. Psychiat 149;1416-1417.

    House, R., Jane M & Howell (1992) Personality and charismatic leadership. The Leadership Quarterly Volume 3, Issue 2, Summer 1992, Pages 81-108

    Lewinsohn, M, Gregory, N., Wesley, H., Mary, M., &  Lisa B., (1995). Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents: A randomized trial of a group cognitive intervention. Journal of the American Academy of Child & Adolescent Psychiatry 34 (3), 312-321, 1995

     Loeb, l J., Stephen R., Brandon S., & Donald T. (1991) Anticipation of nursing home placement may be a precipitant of suicide among the elderly. Journal of the American Geriatrics Society.

    Paykel, S. (1994). Psychological therapies. Acta Psychiatrica Scandinavica. Volume 89, Issues 383

    Remafedi, G. (1999) Suicide and sexual orientation: nearing the end of controversy? Archives of general psychiatry 56 (10), 885-886.

    Robin, S., & Stephen M. (2009) Abnormal psychology. United States of America

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