Scott J. Fitzpatrick

Suicidology as a Social Practice

Suicide has long been the subject of philosophical, literary, theological and cultural–historical inquiry. But despite the diversity of disciplinary and methodological approaches that have been brought to bear in the study of suicide, we argue that the formal study of suicide, that is, suicidology, is characterized by intellectual, organizational and professional values that distinguish it from other ways of thinking and knowing. Further, we suggest that considering suicidology as a “social practice” offers ways to usefully conceptualize its epistemological, philosophical and practical norms. This study develops the idea of suicidology as a social practice and considers the implications for research, practice and public discourse.

Challenges to a more open discussion of suicide

Perspective discussions, group discussions and community discussions.3 It is important, therefore, to recognise th differences and the potentially different impacts and implications that these might have.3 Most of the research on discussion of suicide focuse individual-l vel interactions. For example, literature reviews conducted in New Zealand7 and Canada8 focu the question of whether asking about an individual’s The value and meaning of public discussion of suicide requires broader consideration

Religious Perspectives on Human Suffering: Implications for Medicine and Bioethics

The prevention and relief of suffering has long been a core medical concern. But while this is a laudable goal, some question whether medicine can, or should, aim for a world without pain, sadness, anxiety, despair or uncertainty. To explore these issues, we invited experts from six of the world’s major faith traditions to address the following question. Is there value in suffering? And is something lost in the prevention and/or relief of suffering? While each of the perspectives provided maintains that suffering should be alleviated and that medicine’s proper role is to prevent and relieve suffering by ethical means, it is also apparent that questions regarding the meaning and value of suffering are beyond the realm of medicine. These perspectives suggest that medicine and bioethics have much to gain from respectful consideration of religious discourse surrounding suffering.

Bereaved families and the coronial response to traumatic workplace fatalities: Organizational perspectives.

ABSTRACT Work remains a significant source of illness, injury, and death in developed countries. In Australia, for example, over 2,000 people die from work-related causes each year, with heavy social, economic, and personal costs (Safe Work Australia, 2013a). Most die as a result of work-related disease. However, many die from trauma. In 2012, 223 workers were fatally injured in Australia and in the United States the figure was 4,383 (Bureau of Labor Statistics, 2014; Safe Work Australia, 2013b). Apart from the immediate tragedy of each worker’s death, these deaths affect the victim’s immediate family, wider family, friends, and co-workers. It has been estimated that, on average, every death has an impact on at least 20 other people (Dyregrov, Nordanger, & Dyregrov, 2003), especially when the deceased had several families, which is an increasingly common phenomenon (OECD, 2014). Little is known, however, about how regulatory responses following a traumatic workplace fatality meet the needs of surviving families. With a focus on the coronial investigation, this article provides information about the regulatory responses to a traumatic workplace fatality and examines how various organizations involved in the coronial process following the death viewed its ability to accommodate the needs and wishes of surviving families.

Stories worth telling: moral experiences of suicidal behavior.

Moral constructions of suicide are deliberately avoided in contemporary suicidology, yet morality persists, little or imperfectly acknowledged, in its practices and in the policies, discourses, and instruments that it underpins. This study used narrative methodologies to examine the normative force of suicidology and its implications for persons who had engaged in an act of nonfatal suicidal behavior. I interviewed a convenience sample of twelve persons from two inner–urban community mental health centers who were receiving crisis and case management services after a recent act of nonfatal suicidal behavior. Interviews focused on events leading up to and after participants’ suicidal behavior; the responses their suicidal behavior generated in others, including family, friends, and the health professionals caring for them; and cultural views of suicide more broadly. Analysis of these interviews revealed that, although participants’ narratives were broadly consistent with a number of recognizable, canonical story formats common to our cultural repertoire of stories of suicide, they also revealed important tensions, divisions, conflicts, and challenges to contemporary suicidological discourse and practice. Despite evidence to suggest that biomedical understandings of suicide provided some therapeutic benefit to participants, they did not address important social and moral dimensions of human life or explore their connection to suicidal behavior—aspects of the suicidal event that were critical to its causation and to its retelling and “resolution.” The results of this study provide important insights into the moral features of suicidal behavior, the moral and ethical implications of suicide research, and the limitations of moral and ethical discourse in suicidology.

Investigation and prosecution following workplace fatalities: Responding to the needs of families:

Every year, there are over 200 traumatic deaths at work in Australia. A government safety inspector usually investigates each incident. The investigation may lead to prosecution of the employer or another party deemed to have breached relevant legislation. However, little systematic research has examined the needs and interests of grieving families in this process. Drawing on interviews with 48 representatives of institutions that deal with deaths at work (including regulators, unions, employers, police and coronial officers), this article examines how they view the problems and experiences of families. Notwithstanding some recent improvements, findings indicate ongoing shortcomings in meeting the needs of families regarding information provision, involvement and securing justice.

Ethical and political implications of the turn to stories in suicide prevention

The stories of suicide attempt survivors are gaining broader currency in suicide prevention where they have the potential to provide privileged insights into experiences of suicide, strengthen prevention and intervention measures, and reduce discrimination and stigmatization. Stories of suicide, however, have a double-edged power insofar as their benefits are counterweighted by a number of acknowledged harms. Drawing on the literatures and methods of narrative, and in particular, narrative approaches to bioethics, I contend that suicide prevention organizations make possible yet constrain the creation of personal stories of suicide, shaping the discursive meanings of public stories of suicide while setting limits on which stories are valued, legitimized, and rendered intelligible. Personal stories of suicide serve as important sites of meaning-making, power, and social identity, yet they also reproduce and normalize particular ways of thinking, acting, and communicating that reinforce the institutional logics of suicidology. These have ethical and political force as they help to frame the ways suicide is understood, the ways it is subjectively experienced, and the ways it is responded to.

Scientism as a Social Response to the Problem of Suicide

As one component of a broader social and normative response to the problem of suicide, scientism served to minimize sociopolitical and religious conflict around the issue. As such, it embodied, and continues to embody, a number of interests and values, as well as serving important social functions. It is thus comparable with other normative frameworks and can be appraised, from an ethical perspective, in light of these values, interests, and functions. This work examines the key values, interests, and functions of scientism in suicidology and argues that although scientism has had some social benefit, it primarily serves to maintain political and professional interests and has damaging implications for suicide research and prevention.

Re-Moralizing the Suicide Debate

Contemporary approaches to the study of suicide tend to examine suicide as a medical or public health problem rather than a moral problem, avoiding the kinds of judgements that have historically characterised discussions of the phenomenon. But morality entails more than judgement about action or behaviour, and our understanding of suicide can be enhanced by attending to its cultural, social, and linguistic connotations. In this work, I offer a theoretical reconstruction of suicide as a form of moral experience that delineates five distinct, yet interrelated domains of understanding: the temporal, the relational, the existential, the ontological, and the linguistic. Attention to each of these domains, I argue, not only enriches our understanding of the moral realm but also provides a heuristic for examining the moral traditions and practices that constitute contemporary understandings of suicide.

The effect of context in rural mental health care: Understanding integrated services in a small town

Abstract Unequal health care outcomes for those with mental illness mean that access to integrated models is critical to supporting good physical and mental health care. This is especially so in rural areas where geographic and structural issues constrain the provision of health services. Guided by a conceptual framework about rural and remote health, this study draws on interviews with health providers and other staff and examines the dynamics of integrated primary and community‐based specialist care for people with severe and persistent mental illnesses living in rural Australia. Findings show that the facilitation of sustainable linkages between general practice and community mental health requires the skilful exercise of power, knowledge, and resources by partners in order to address the social and structural factors that influence local health situations. These findings suggest that incremental processes of integration that are responsive to patients’ and stakeholders’ needs and that build on success and increased trust may be more effective than those imposed from the ‘top down’ that pay insufficient attention to local contexts. HighlightsEstablishing effective, sustainable integrated care is difficult.A novel and well‐established service in rural Australia is instructive.Creating responsive integrated care requires understanding local contexts and working collaboratively and incrementally.The skilful exercise of power, knowledge and resources are key to achieving intended outcomes.The paper contributes to the development of patient centred integrated care in rural communities.