Slugger O'Toole

Conversation, politics and stray insights

“We seem to have adjusted to peace by means of mass medication…”

Wed 25 July 2012, 12:55pm

Some contrasting reports to note on health and well-being in Northern Ireland.  We knew in February this year that “the people of Northern Ireland are the happiest in the United Kingdom”.  That’s by their own subjective assessment, of course.  And a more detailed breakdown of the data suggests you might feel even happier living in some areas of Scotland.  As long as you’re employed, older, and in good health…

Of more significance is the study by Professor Mike Tomlinson- “War, peace and suicide: The case of Northern Ireland“.

As the BBC report notes

The study found the highest suicide rate among men aged 35-44. Previously, younger men were believed most at risk.

Professor Mike Tomlinson said health staff may have put an over-emphasis on treating people in younger age groups.

This would have meant a failure to focus on those who experienced the worst of the violence, he said.

The professor said Northern Ireland’s suicide prevention strategy had so far made little impact on the upward trend.

The Irish Times report has some of the telling detail

Prof Mike Tomlinson said suicide prevention strategies in Northern Ireland are failing to combat the rise, and said they could be targeting the wrong age groups.

“The rise in suicide rates in the decade from 1998 to 2008 coincide with the move from conflict to peace in Northern Ireland,” he said.

“The transition to peace means that cultures of externalised aggression are no longer socially approved or politically acceptable. Violence and aggression have become more internalised instead.

“We seem to have adjusted to peace by means of mass medication with anti-depressants, alcohol and non-prescription drugs, the consumption of which has risen dramatically in the period of peace.” [added emphasis]

His research, which examined death registration data over the last 40 years, found that the highest suicide rate is for men aged 35-44 (41 per 100,000 by 2010), followed closely by the 25-34 and 45-54 age groups.

The findings showed that children who grew up in the worst years of violence between 1969 and 1977-78 are the group which now has the highest suicide rates and the most rapidly increasing rates of all age groups. [added emphasis]

Suicide rates for men went from 13 per 100,000 of the population in 1997 to 24 per 100,000 by 2008, while in women the increase was from a rate of 3.9 to 7.3 over the same period.

The Irish Times also notes that Londonderry has the highest level of hospital presentations resulting from self-harming in nine cities across the UK and Ireland, “with 611 per 100,000 of the population in 2009, while Dublin had a rate of 352 presentations in the same year”.

The final quote in the Irish Times report is also worth highlighting

Professor Tomlinson said: “During the 1970s and 1980s, the suicide rate rose steadily up to a rate of 10 per 100,000, low by international standards.

“It then fell slightly over a ten year period. The puzzle is, why have we seen such a dramatic increase in the rate since 1998?

“What this research reveals for the first time is that the age groups with the highest suicide rates are the cohort who were children during the worst years of violence.

“Those born and growing up in the conflict experienced no other social context until the late 1990s. There are clear indications from the research that this cohort not only has the highest suicide rate but also the most rapidly increasing rate when compared with other age groups.” [added emphasis]

And from the study’s abstract

Contrary to Durkheim, the recent rise in suicide involves a complex of social and psychological factors. These include the growth in social isolation, poor mental health arising from the experience of conflict, and the greater political stability of the past decade. The transition to peace means that externalized aggression is no longer socially approved. It becomes internalized instead.

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Comments (34)

  1. Mister_Joe (profile) says:

    Interestingly, I recall that when the No-Go areas were first set up back in the late 60s, a report some months later said that the number of people from those areas visiting doctors because of depression had fallen considerably. It was speculated that people had more important things to worry about than their mental health.

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  2. Mick Fealty (profile) says:

    This last would seem to cover that:

    “The transition to peace means that externalized aggression is no longer socially approved. It becomes internalized instead.”

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  3. Mister_Joe (profile) says:

    Could be, Mick, but if my memory serves, the reported fall was among women, mainly mothers, and their immediate concerns were more mundane such as “where are I going to get milk for the baby?” or about defence rather than aggression “Is someone going to come and burn my house down?”

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  4. articles (profile) says:

    Not only the increased rate but the sheer number of suicides is appalling:

    In 2011, 289 deaths were registered as suicides (source: Northern Ireland Statistics and Research Agency).

    During the period 1999 to 2009, a total of 2,258 deaths were registered as suicide (source: Northern Ireland Statistics and Research Agency).

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  5. I dont know if “happiness” can be objectively judged.
    A lot of people might look (objectively) at me and say Im pretty miserable…..but actually I am (subjectively) rather happy.
    My own recollection of living in a no-go area was that while life was depressing for people and people were clearly unhappy about that ..the levels of violence were such that people did not think about suicide…..in part because we all knew the effects of grief.
    Id be reluctant to compare 2012 with 1972 because our society had a well-intentioned habit of under-reporting suicide. Scandanavians being more honest.

    But certainly there is an “age factor”. I tend to think of 30-40 as being a good time. I was a man with a young family and a decent career. While 40-50 was comparatively responsible visiting an elderly mother and aunt in two nursing homes is no picnic.
    I tend to look on my life now as happy. Married kids. Retired. Grandchildren. Mortgage paid off.
    We outlive our fears.
    And that high suicide rate might reflect the age in our lives when we have most fears.
    Of course it is still possible that there is under-reporting of suicide or assisted death (to use that euphensm) in the age groups over 75….we have not yet got round to being hones about that.
    Being over 75 brings a whole new set of fears.

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  6. andnowwhat (profile) black spot says:

    I saw that those in Scotland’s far off isles were the happiest of all and why wouldn’t they be. A while before I met, my good lady lived on the Isle of Lewis and loved it, a beautiful clean place where people freely communicated and helped eachother.

    And there, IMHO, is the answer, it’s no mystery and most of us can remember when we all had that.

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  7. Mister_Joe (profile) says:

    I think that living in a community where all people have around the same amount of “stuff”, including food etc makes you relatively happy. I had a very happy childhood growing up in a cluster of 40 houses at the very edge of town. We were poor but so were almost all of our neighbours.

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  8. Pete Baker (profile) says:

    Guys

    Focus on the significant point being made here.

    The overall rate of suicide in NI has almost doubled from 8.6 per 100,000 in 1998 to 16 per 100,000 in 2010.

    And, even more significantly, as the Irish Times report states

    His research, which examined death registration data over the last 40 years, found that the highest suicide rate is for men aged 35-44 (41 per 100,000 by 2010), followed closely by the 25-34 and 45-54 age groups.

    The findings showed that children who grew up in the worst years of violence between 1969 and 1977-78 are the group which now has the highest suicide rates and the most rapidly increasing rates of all age groups. [added emphasis]

    Suicide rates for men went from 13 per 100,000 of the population in 1997 to 24 per 100,000 by 2008, while in women the increase was from a rate of 3.9 to 7.3 over the same period.

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  9. Mister_Joe (profile) says:

    Fair enough, Pete, but what can we say? I would be interested in knowing how this compares to the rest of the UK but I don’t know if the report details that and a subscription is required to read it all.

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  10. Jack2 (profile) says:

    Overall UK statistics 2006 – 2010 from the ONS:

    In 2010 there were 5,608 suicides in people aged 15 years and over in the UK, 67 fewer than the 5,675 recorded in 2009

    There were 4,231 suicides among men in 2010 (17.0 per 100,000 population)
    In women there were 1,377 suicides in 2010 (5.3 per 100,000 population)

    In 2010 suicide rates were highest in those aged 45–74 at 17.7 per 100,000 for men and 6.0 per 100,000 for women

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  11. BluesJazz (profile) black spot says:

    The rates for suicide are still a tiny proportion of the population. And a still tinier fraction of those who die by obesity or smoking.
    Diabetes is a huge killer among middle aged people, even in India, massively swamping the suicide factor. Add in smoking, and you’ve really got an epidemic.
    We may have reached the top of the bell curve in terms of life expectancy. For REAL Life expectancy, without infirmity, dementia, Alzheimers etc, we passed that point on the curve a decade ago. The long slow entropic downward curve is the future. At least it’s not raining.

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  12. Mister_Joe (profile) says:

    It’s not the same, BJ. I doubt that many suicides are impulsive events but come at the end of periods of extreme depression and feelings of hopelessness. If we can help prevent it, we should, like with any illness

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  13. BluesJazz (profile) black spot says:

    Sure Mister Joe
    But we can try and prevent the mass killers.
    Some of us will know of a prominent academic (sociologist) at QUB whose specialist subject was suicide.
    He succumbed to it himself.
    I agree with you but it’s not always a preventable illness.
    The person concerned argued -academically- that it was a rational decision, for some at least.
    Who are we to judge?

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  14. Mister_Joe (profile) says:

    Blues Jazz,

    Agree that it is a rational decision for some. I’ll do it myself if I’m at the end of life and can’t stand any associated pain or total degradation of quality of life.

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  15. Pete Baker (profile) says:

    And back to the actual topic…

    The doubling of the rate of suicide between 1998 and 2010.

    And the particular increase among “children who grew up in the worst years of violence between 1969 and 1977-78.”

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  16. Mister_Joe (profile) says:

    Pete,

    Jack2 gave some UK figures (thanks Jack) but they don’t allow a comparison. Can you enlighten us more? Are the authorities failing these people by not providing accepted standards of support?

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  17. wee buns (profile) says:

    The world’s highest record of post traumatic stress disorder is here according to an international report that includes Isreal and Lebanon.

    “International research shows that recovery from PTSD is unlikely if sufferers do not have access to trauma focussed-treatment,”

    I’d imagine ‘untreated’ PTSD often leads to suicide.

    http://www.bbc.co.uk/news/uk-northern-ireland-16028713

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  18. Mister_Joe (profile) says:

    Yes, wee buns. The General Patton “treatment” just doesn’t work.

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  19. wee buns (profile) says:

    Suicide – the new ‘acceptable level of violence’.

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  20. Pete Baker (profile) says:

    There is no indication that this is a result of untreated PTSD.

    Joe

    If you doubt the statistics then do the homework. All I can say is that it seems that elsewhere in the UK 1998 was regarded as a high ‘blip’ for suicides followed by a steady reduction in the numbers until another increase, on the previous year, in 2010.

    But that’s beside the point compared to the rates we have here.

    And the particular increase among “children who grew up in the worst years of violence between 1969 and 1977-78.”

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  21. wee buns (profile) says:

    For a bit of perspective on numbers – (emphasis is mine).

    ”Northern Ireland has lived in a situation of persistent civil unrest and political violence since the late 1960s. Over 3,600 deaths, mostly young male adults, have meant that over 7,000
    parents have lost a child, over 14,000 grandparents have lost a grandchild, and an estimated 3,000
    people have lost a spouse, on the whole, about 115,000 people have lost a close relative

    In addition, over 40,000 people have suffered injuries, thus
    issues related to trauma, victimhood, and therapeutic interventions are very much at the forefront of debate.
    In the 1970s, psychiatrists argued that people affected by community violence generally
    reacted with astonishing resilience to the continuing violence
    Overall, data collected during this period showed a relatively low impact of trauma on psychological health.
    For instance, there was no increase in psychiatric patient numbers and family doctors dealt with minor symptoms. It was generally concluded that the majority of people dealt
    effectively with community violence and trauma either through denial or intra-community support

    http://www.eric.ed.gov/PDFS/EJ803996.pdf

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  22. The Lodger (profile) black spot says:

    “The doubling of the rate of suicide between 1998 and 2010.

    And the particular increase among “children who grew up in the worst years of violence between 1969 and 1977-78.” ”

    Pete,

    All we can do with these statistics is make a number of assumptions. If we knew how many of the people in these age groups had served in the security forces or had been members of terrorist organisations then we could consider a number of related factors.

    1. Survivor guilt.

    2. Guilt at having murdered people.

    3. Depression resulting from feeling that the individual ‘sacrifice’ was all for nothing.

    4. Depression resulting from having the individual’s main aims in life removed post ceasefire.

    5. An addiction to alcohol resulting from some or all of the above.

    Etc, etc.

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  23. Toastedpuffin (profile) says:

    “I saw that those in Scotland’s far off isles were the happiest of all and why wouldn’t they be.”

    The prevalence of alcohol abuse perhaps?

    I’d like to see the full paper on this topic. There are a number of things that don’t seem to make any sense: for example, if I’m reading it right those born in 1978 are part of this phenomenon, yet wouldn’t have experienced the worst years of the troubles.

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  24. Pete Baker (profile) says:

    Lodger

    “All we can do with these statistics is make a number of assumptions.”

    The point being made is a more general one than that you seem tempted to go for.

    His research, which examined death registration data over the last 40 years, found that the highest suicide rate is for men aged 35-44 (41 per 100,000 by 2010), followed closely by the 25-34 and 45-54 age groups.

    The findings showed that children who grew up in the worst years of violence between 1969 and 1977-78 are the group which now has the highest suicide rates and the most rapidly increasing rates of all age groups. [added emphasis]

    Suicide rates for men went from 13 per 100,000 of the population in 1997 to 24 per 100,000 by 2008, while in women the increase was from a rate of 3.9 to 7.3 over the same period.

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  25. Mister_Joe (profile) says:

    I’d love to see a graphical trend to see if the rate is still increasing at this rapid rate.
    It really is a scary thing to see all these lives being thrown away, presumably because of desperation, whatever the reason.

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  26. Pete Baker (profile) says:

    From the study’s abstract [linked in original post]

    …the recent rise in suicide involves a complex of social and psychological factors. These include the growth in social isolation, poor mental health arising from the experience of conflict, and the greater political stability of the past decade. The transition to peace means that externalized aggression is no longer socially approved. It becomes internalized instead.

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  27. Mister_Joe (profile) says:

    The “growth in social isolation” factor puzzles me since we keet being told that the rise of “social media” has meant greater connectedness. Wish I could afford a subscription to read the whole report.

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  28. Pete Baker (profile) says:

    “The “growth in social isolation” factor puzzles me since we keet being told that the rise of “social media” has meant greater connectedness.”

    Don’t believe the hype.

    It’s not that difficult to understand.

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  29. Mister_Joe (profile) says:

    Pete,

    Don’t forget I no longer live over there. I only know my own extended family and they are well connected and, mental illness in them, though not totally absent, is very rare.
    I do not understand.

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  30. Pete Baker (profile) says:

    Joe

    Your comment that “we [keep] being told that the rise of “social media” has meant greater connectedness” has nothing to do with the actual topic.

    Hence, don’t believe the hype.

    It’s not that difficult to understand.

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  31. wee buns (profile) says:

    Communities used to be very close knit because they needed to be, whereas now they don’t need to be anymore, so people are cast adrift from each other – as they are in most ‘normal’ western societies – but worse because it was a relatively sudden shift from neighborly reliance to a shopping center culture.

    The discrepancy between male & female stats exists everywhere as women generally tend to form better support structures between themselves.

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  32. FuturePhysicist (profile) says:

    We’re adjusting to economic deprivation and loss … not peace. … by medication

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  33. Toastedpuffin (profile) says:

    FuturePhysicist:

    Definitely that’s suggested by a breakdown of suicides by constituency, but that was the case during the troubles as well.

    Interestingly, Bosnia appears to have seen a similar post-peace rise in suicide rate:

    “There were 11 suicides per 100,000 people before the 1992-95 Bosnian war. Now, more than seven years after the conflict ended, the rate has risen to 20 suicides per 100,000 people”

    http://www.balkanpeace.org/index.php?index=article&articleid=11787

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  34. The Lodger (profile) black spot says:

    http://eamonnmallie.com/2012/07/suicide-and-the-past/

    “The Queen’s University academic established that many of those who killed themselves, predominantly male, had been at the ‘coal face’ of the Troubles.

    Suicide did not respect class or creed. Mr Tomlinson points out that many of those who died as a result of ‘self inflicted death’ came from the security services, the paramilitaries and the ranks of people grieving etc.”

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