The Discovery of Suicide in Eastern and Southern Africa

Abstract

Historically African societies have been assumed to have low suicide rates, though there is little conclusive evidence to support this assertion and it is informed by dubious colonial assumptions about the nature of African subjectivity. In particular, longitudinal evidence is lacking. In recent years suicide has begun to attract the attention of psychiatry professionals in Eastern and Southern Africa and of the media. It is now widely argued that suicide rates are increasing, and in some places concern around suicide has taken the appearance of a ‘moral panic’. Suicide is invested with a variety of meanings across the two regions. The results of a small-scale study of attitudes to suicide in Malawi are reported.

Keywords:

• suicide
• Africa
• depressive illness
• African psychiatry
• Malawi

Acknowledgements

Research for this article was supported by the Arts and Humanities Council of the United Kingdom (AHRC) and forms part of a larger study on ‘Death in Africa: a History c1800 to Present’. I am extremely grateful to the AHRC for their support and to the Leverhulme Trust, which generously funded research leave through a Major Research Fellowship. I am very grateful to a number of people who have discussed suicide with me and have aided me in my research. These include David Ndetei, Felix Kauye, Harris Chilale, Eugene Kinyanda, Andrew Fearnley, Julie Livingston, Rene Collignon and the volunteers at Samaritans (Nairobi) and Connie Smith. I am particularly indebted to Mathero Nkhalamba of the Department of Psychology, Chancellor College, University of Malawi who oversaw the small-scale study of suicide in Malawi, and to Pearson Mphangwe and Chikondi Lipato who carried out the interviews. Permission to carry out research in Malawi was granted by the National Research Council through the Centre of Social Research, University of Malawi (permit number CSR/07/10/08). I would like to thank the University of Malawi for its continued support to my research over the last 30 years.

Notes

I have not conducted a systematic survey of press coverage of suicide, so this observation needs to be treated with some caution. But cases of suicide are regularly covered in the newspapers of the region, along with discussions of its causes and consequences. This concern may also be reflected in other media, but I have not studied these in any detail.

There is a very large literature on ‘cross-cultural’ psychiatry and within this a literature on the diagnosis of depressive illness (Prince 1967; Patel, Mutambwira and Nhiwatiwa 1995; Watters 2010). My own understanding of this complex issue is dependent on conversations with a range of African psychiatry professionals over many years. Most recently I have benefitted in particular from the insights of Professor David Ndetei.

For a discussion of the wider phenomenon of what he calls the ‘globalization of the mind’ see Watters (2010).

Moreau worked for the colonial agricultural service at its research unit at Amani, Tanzania, but is best known for his extensive work on African ornithology (Jacobs 2006).

Livingtson (2009) quotes these figures (a male suicide rate of 23 per 100,000 in 2000), which are said to be drawn from a report produced at the University of Botswana. She also provides anecdotal evidence for this increase. However, she does acknowledge that she has been unable to identify the original report from which these figures are drawn.

For a systematic and critical examination of the media reports see Exner and Thurston (2009) and Odireleng (2009).

Though Livingston does not cite the work of Baudelot and Establet (2008), her findings for Botswana accord well with their understanding of suicide in rapidly modernising societies.

New Vision 31 August 2007.

See www.who.int/mental-health/prevention/suicide/suicideprevent/en/ The only mainland sub-Saharan African country for which the WHO publishes suicide statistics is Zimbabwe, quoting a (1990) rate of 10.6 per 100,000 for males and 5.2 for females. For a review of the (very limited) data on current suicide rates on the African continent see Schlebusch (2005).

New Vision 31 August 2007.

‘Teen’ suicide, or more accurately the suicides of young people under the age of 25 years, appears to be a concern across the region, but is particularly remarked on in South Africa where, by some accounts, it is the second most common cause of death for 15 to 24 year olds (Smit 2010; Schlebusch 2005).

This view was very evident in interviews I conducted with Samaritans volunteers in Nairobi in December 2008.

Overall, suicide rates for South Africa for the period 1979 to 1981 were estimated at 8.4 per 100,000 for men and 2.2 for women, rising to an estimated 24.6 per 100,000 for men and 6.9 for women in 2000. For an analysis of the South African statistics see Burrows (2005) and Schlebusch (2005).

This mode of analysis is in part a very rational response to the very high rates of violent death of various kinds in South Africa, but it is also facilitated by the collection of national-level statistics through the National Injury Mortality Surveillance System, which includes suicide deaths. On the uses of this data see Burrows et al. (2003). These questions are not confined to the modern South African case. See for example Susan Morrissey's discussion of alcoholism and suicide in later 19^th-century Russia (Morrissey 2005).

The Pietermaritzburg Suicidology Project, which produces much of the research on suicide in South Africa, was established by clinical psychologists in 1983.

I had intended to carry out more of this field research myself, but a family illness and death necessitated my return to the United Kingdom.

At the time when I carried out this research Dr Felix Kauye (the country's only resident psychiatrist) was seeking to raise funds for a nationwide survey of suicide. At the St John of God centre in Mzuzu (a pioneering teaching and community mental health institution) clinical psychologists shared the view that suicide, particularly that related to serious psychiatric illness, was increasing and was under-reported.

Pesticide poisoning appears to have taken over from hanging as the primary mode of suicide in Malawi. The increasing use of pesticides in suicide is a much wider phenomenon in Africa and other parts of the world and has given rise to debates about access to these substances and regulation. It has recently been suggested that organophosphate insecticide exposure may itself contribute to depression and suicide, thus complicating the analysis of the relationship between suicide and pesticide availability (London et al. 2005).

They were asked to include, as far as was possible, a notional ‘cross section’ of the community in terms of age and gender.

Predictably this view was emphasised in my interviews with police officers and magistrates.