Martha Milena SILVA CASTRO
Population-based research[a] has shown higher risk for depression and suicide in unemployed people[b]. Weich and Lewis[c] have found suicide risk those who have relatively lower income. Gunnel et al[d] also related admissions in psychiatry with socioeconomic deprivation. Although the aforementioned data are collective, these results correspond to a sum of isolated cases, without assessing social cohesion. These studies warn of a collective concern, however, the results do not allow understanding about the personal path towards suicide. To analyze this fact, it is necessary to explain how the individual decision to commit suicide is taken.
In health sciences, obsession with obtaining a result leads to seeing suicide as an outcome, equivalent to maximum failure, mortality. In a suicide, this particular death is worse because is the act of intentionally causing one’s own death. For this reason, the public health concern is to find health interventions that avoid this ‘bad outcome’. In addition, psychiatry aims to prevent deaths from mental illness; including biomedicine has developed drugs to prevent mood states or personality disorders that lead people to ‘lose their minds’. In this way, it is prevented that anyone makes suicide decision in a madness or melancholy. If someone has a suicidal ideation, probably could be diagnosed as mentally ill.
Immersed in the biomedical model, suicide simplification as an ‘outcome’ turns suicide into an indicator. Suicide is blurred as a social fact. Therefore, the understanding of this complex reality is lost. Public health is intended to establish a solution that works for everyone even though biomedicine has not stopped seeing suicide as an ‘outcome’ of an individual failure.
For this reason, I consider to understand suicide as a consequence of social exclusion and not as a cause of mortality, the simplicity of a life story of someone can be useful. I have looked for a story that describes the itinerary of a human being whose destiny is suicide. More than analyzing the act of suicide, I believe more important to analyze a trajectory that directs a human being to perform this act.
In this search, I found a straightforward story in a book called “Three Thousand Journeys to the South” (Tres mil viajes al Sur)[e]. Book author, Manuel Machuca, uses travel metaphors to describe women itineraries and life stories affected by social exclusion. I chose the first book story, Josefa’s story, because this itinerary leads to suicide explicitly. This story seems common, in which ending is glimpsed from the beginning of narrative. However, it is interesting how there is a detailed and relational description of social facts in this woman’s history. Each of the elements that the author reveals throughout the story gives meaning to her suicide. Josefa’s story does not fall into ‘fatality’ drama. On the contrary, the author presents with simplicity the logic of suicide, so elusive for health professionals or epidemiologists.
This story moves between ethnographic and biographical approach. Without revealing the limit between fiction and reality, Josefa introduces herself, tells her vision of the world and describes those around her. She also expresses her feelings for the places, including marked geographical symbols of her life. She explains her contradictions, her deep fears and argues, from her own logic, her life decisions. Sometimes the voices of other characters appear, mainly the voice of a teacher of her. While I was reading this story, it seemed that characters appeared as voices in her head, leading us to think that it was part of her ‘madness’. Nevertheless, progressively these voices reveal the cruelty of the subordination, incomprehension, uprooting and loneliness in life of this woman.
Everything seems to indicate that Josefa suffers a mental illness. Everything seems to indicate that the suicide was a failure of the medication that he took, of the health professionals who did not give him a good treatment, of the social services that did not help him to get a job, of the inequality, of the poverty, of marginality. However, this story locates suicide in the sphere of freedom. Why could not she break free from such a hard life? Why could not she free others from her burden? Why could not she exclude herself from society?
Certainly the story tells us how, little by little, Josefa «is no longer a social person». Le Breton[f] calls this as ‘the impersonal life’. This author explains when a person stops feeling in their place, abandons their domestic universe and prefers to be erased from social life. Still there without being. This person is led to a non-place, stripped of layers of identity, not to start living again, but to be erased with discretion. Following Le Breton»certain people who die had already disappeared a long time ago. Death was nothing more than a formality» (2016: 21). Josefa’s story speaks of her social disengagement, her ruptures, and her slow social death during her journey. For these reasons, suicide was a formality. But, although the ‘need for absence’ is an option in this society that pressures people to succeed and forces individuals to be creators of their own destiny, the keys to suicide are not only in the decision (or obligation) to become an ‘invisible’ person.
To understand suicide and social exclusion, it is essential to look for theoretical frameworks in the human sciences. Addressing social suicide[g], perspectives such as those raised by Durkheim[h] and Foucault[i] must be reviewed. Both authors[j] have determined the research in sociology, psychology and anthropology on this subject.
Durkheim points to suicide as a social fact[a]. Basically, the fundamental idea of suicide happens when solidarity has failed, both mechanical and organic solidarity. If society makes a person, society also eliminates a person; therefore it is a society that induces suicide.
Following the types of suicide according to Durkheim applied in Josefa’s story, perhaps because of my ignorance; I have not managed to fit in any type. I consider that Josefa’s suicide can be all types of suicides at the same time.
- Firstly, this suicide could be an altruistic suicide because the narrated situation presents a low influence of Josefa-self. When she feels unable to manage her children and her parents, it is an honorable feeling. She frees them and herself to obtain resources on her own to take care of others.
- Secondly, this suicide could be egoistic suicide because her social links are too weak to make sense of her life. She is a lost case for everyone, even for herself. The pressure and coercion of society to retain her in the social group is absent. Nobody depends on her. In addition, she believes that social services will take better care of her parents than she does by herself. She also knows her children no longer have anything to gain from her, she is free to carry out her will to not continue living.
- Thirdly, even for these reasons, Josefa’s suicide can also be an anomic suicide, because her bonds of coexistence are in a situation of disintegration or anomie[b]. She suffered exclusion when she was expelled from her neighborhood. She experienced the breakdown of her social network. This woman was a victim of marginalization in her own city. She was relegated to a new space, so that no one would «mix» with her cultural world. Various forms of poverty[k] claim their victims without mercy. Josefa’s isolation due to the inability of the social structure to provide her with what is necessary to achieve the goals imposed by society was very powerful. This social isolation manages to take away the meaning of his life.
- Finally, Josefa’s suicide could also be a fatalistic suicide because she was faced with too many social demands. The pressure of her failure has been so great that quitting living is the best decision she can make[l].
Foucault[m] analyzes Durkheim’s categories about the normal, the pathological and the abnormal to understand the place that the patient occupies in society. In that sense, explains the construction of the disease that shapes society. Foucault points out that the soul is the prison of the body. In the name of the soul, power constrains and produces individuals bound through a series of mechanisms of power. The power disputes in societies of normalization the life of each one of the individuals and of all as a whole. The fact of living is the object of permanent control and intervention of a set of knowledge and certain mechanisms of power. Life goes to the field of social intervention. As a consequence Foucault explains how biopolitics regulates the life of human beings. In this order of ideas, Foucault’s thought would indicate that the lack of social control would be the cause of Josefa’s suicide, to the extent that for Foucault the possibility of killing herself is a form of resistance, as a space of freedom not yet imprisoned by the power.
Suicide would be an abnormality of a part of the population that suffers social breakdown. This deviation, deciding to commit suicide, authorizes biopower and sustains mechanisms of power to regulate this malaise in society. For the others, Josefa was abnormal, she was sick, she was crazy. Although she was not confined in a jail, or in an asylum, she was confined in an excluded neighborhood. Foucault reflects that power relations are established through discrimination of ‘abnormal people’. In Josefa’s story, disciplinary society reproduces by micropowers that surround her.
In Josefa’s life, attempts are observed from education as an option for social inclusion. They are institutionalized ways of disciplining people who have the impulse to commit suicide. Because of the anomic pathology suffered by modern societies, the greater presence of institutions to support the poor will be justified sociologically. Likewise, the greater intervention and the greater invasion of life control of individuals is justified. With an apparent intention to conserve social inclusion through education, social actors do not recognize that there is no social cohesion in marginalized neighborhoods. The poor are qualified as abnormal, deviant, and ignorant. Education fails because it can not maintain a social network. In fact, institutions contribute to the marginalization and punishment of those who are different or unable to produce economic goods or services to society.
Following Foucault’s ideas, Josefa’s story can illustrate how failure is punished today. This story shows how isolation works as punishment. If someone refuses to move from home, to separate from their family, to submit to others, if the bodies are not manipulable, if women are not docile, the consequence is exclusion. Even in spite of their resistance, the biopower forces have reached where they should go. These forces have achieved that the speech of guilt has been internalized in her. Josefa and other excluded women become the greatest judges themselves. This is how paradoxically the inability to find value to life becomes the greatest act of freedom.
Biomedical discourses on mental illness as abnormal reproduce the relationships between power and daily life. They are a manifestation of biopolitics nowadays. Josefa’s story shows how exclusion is a consequence of controlling individuals. In addition, control goes beyond collective norms. The medicine uses drugs to control Josefa’s body. Supposedly, as a way to return her to normalcy. Why do not you commit suicide with pills instead of committing suicide when hit by a train? This is another question that has to do tryng to find a biomedical outcome. Biopower is exercised by health professionals. Why not ask about how and why the decision to die is made in this way. Is it not an act of resistance?
Machuca’s book reveals the effects of social exclusion on the life of a symbolic woman. A woman who represents how she can resist power through free decision to stop living. This is a story highlights harshness with which the forces of power hurt the vulnerable. Although, at the same time, each person shows if there is power, but, it is because in some measure there is freedom. In this way, this story opens the mind to look at suicide as a social failure not as an individual failure.
Understanding the paradoxes and social facts in Josefa’s history, through Machuca’s narrative description, exposes elements that question the profane reader and could help transform normalized and reduced look that we all have about social exclusion.
[a] Social facts consist of manners of acting, thinking and feeling external to the individual, which are invested with a coercive power by virtue of which they can exercise control over him”. Durkheim E. Luke S, ed. The Rules of Sociological Method and Selected Texts on Sociology and its Method. Halls W D. (translator). New York: Free Press; 1982 [1st pub. 1895].
[b] Anomie – A feeling of aimlessness or despair provoked by modern social life.
[a] Patel V. Cultural factors and international epidemiology: Depression and public health. British Medical Bulletin 2001; 57: 33-45.
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[d] Gunnell DJ, Peters TJ, Kammerling RM, Brooks J. Relation between parasuicide, suicide, psychiatric admissions, and socioeconomic deprivation. BMJ 1995; 311: 226–30.
[e] Machuca M. Tres mil viajes al sur. Sevilla: Ed. Anantes, 2015.
[f] Le Breton D. Desaparecer de sí. Una tentación contemporánea. Madrid: Ediciones Siruela; 2016.
[g] Wray M, Colen C, Pescosolido B. The Sociology of Suicide. Annual Review of Sociology 2011 37:1, 505-528.
[h] Durkheim E. Suicide: A study in sociology. New York: The Free Press; 1897/1951
[i] Foucault M. «Derecho de muerte y poder sobre la vida», en: Historia de la sexualidad I. La voluntad de saber, Madrid: Siglo XXI; 1989. pp 161-194.
[j] Romero MA, Gonnet JP. Un diálogo entre Durkheim y Foucault a propósito del suicidio. Revista mexicana de sociología. 2013; 75(4): 589-616.
[k] Paugam S. Las formas elementales de la pobreza. Madrid: Alianza; 2006.
[l] Besnard P. Anomia y fatalismo en la teoría durkheimiana de la regulación. : Reis: Revista española de investigaciones sociológicas. 1998; 81: 41-62. Available in: http://www.reis.cis.es/REIS/PDF/REIS_081_05.pdf
[m] Foucault M. Enfermedad mental y personalidad. Buenos Aires: Paidós; 2008