Above photo: CIAT – CC BY-SA 2.0.
And The Shame Of Shrinks.
Roland Chrisjohn, lead author of Dying to Please You: Indigenous Suicide in Contemporary Canada, more effectively than anyone I know, confronts this tragic denial by mental health professionals: through their medicalizing and diseasing of sociopolitically-fueled suicidality, they are enabling suffering and increasing suicide. Chrisjohn is Onyota’a:ka of the Haudenausaunee, has a doctorate in psychology, and is currently an associate professor in the Department of Native Studies at St. Thomas University in Canada (Dying to Please You coauthors are Shaunessy M. McKay and Andrea Odessa Smith).
Chrisjohn—to make it as easy as possible for all but completely obtuse shrinks to “get it”— documents that during the years of the intensive removal of German Jews to concentration camps, their suicide rate was at least 50 times higher than for non-Jewish Germans; and he then reminds mental health professionals: “Not one social scientific study was designed or conducted to establish why the Jews were behaving in such a fashion, nor was there any apparent urge to uncover the ‘inner dynamics’ of Jewish suicide.”
Caustically but correctly, Chrisjohn points out that “the ‘proper treatment’ for the ‘Jewish Suicide Problem’ wasn’t to send cheerleaders into what remained of their communities; it was the elimination of the system of unspeakable cruelty that destroyed their lives.” Instead of increasing access to mental health treatment, he reminds us that a very different treatment was required: “It was, in fact, Zhukov and Patton, and the forces they led, that ended the oppression that ended the storm of suicide that engulfed the Jews.”
Thus for Chrisjohn, simple logic should inform us that “the ‘proper treatment’ for the ‘Indian Suicide Problem’ isn’t to send cheerleaders into our communities; it is the elimination of the system that is destroying our lives.” This analysis of indigenous suicide in Canada in Dying to Please You applies to other oppressed peoples.
Farmer Suicides in India
In the current issue of the journal Ethical Human Psychology and Psychiatry is the article “Farmers’ Protests, Death by Suicides, and Mental Health Systems in India: Critical Questions.” It is authored by psychologist Sudarshan Kottai, who grew up in rural India in an agriculture-based family and currently teaches at Christ University, Bangalore, India. Kottai, like Chrisjohn, is outraged by how the majority of mental health professionals address suicide of his people: “Yet, the mainstream mental health discourses shut its eyes and ears toward the larger sociopolitical upstream factors that affect farmers’ plight, including suicide, reducing them merely as a mental health issue to be treated through counselling and psychopharmaceuticals.”
Before returning to Kottai’s analysis, first a little background about the staggering number of suicides by farmers in India. In 2014, P Sainath reported (BBC), “A total of 296,438 farmers have killed themselves in India since 1995.” And in 2021, Salimah Shivji reported (CBC), “an average of 28 suicides in India’s farming community every day.”
The cause of this suicide epidemic of farmers in India is despair over their livelihoods—crippling debt and bankruptcy that have been caused by governmental policies. Shivji explains that in the mid-1960s, the Indian government introduced subsidies to encourage farmers to grow high-yielding rice and wheat varieties to move the country into becoming self-sufficient in those grains. However, this ultimately resulted in problems for famers, as she notes, “All those water-intensive paddy fields led to the depletion of the area’s groundwater. Many farmers poured money into digging deeper wells and into pesticides to protect their crops, but their costs spiralled, leading to crushing debt for many.”
Shivji quotes Vikas Rawal, an economics professor specializing in agrarian distress at New Delhi’s Jawaharlal Nehru University. Rawal reports that 90 percent of India’s farmers can’t cover the basic costs of fertilizer, seeds, pesticide and other equipment, but they have few options and so descend deeper into debt. The majority of India’s farmers work tiny plots of land, and Rawal explains that their cost of production has gone up, but they have been made to compete with the world. Rawal concludes, “That has squeezed incomes of farmers so much that basically they’re being forced to . . . suicide.”
Sudarshan Kottai, in his Ethical Human Psychology and Psychiatry article, observes that even though it is now commonly known that the suffering of Indian farmers has been caused by sociopolitical factors “including the role of the state in promoting agrocapitalism,” mental health professionals “almost always frame it as a mental health problem to be addressed by increasing access to psychopharmaceuticals.”
To counter this framing, Kottai’s goal is to highlight the relationship between the neoliberal state and farmers’ distress: “Government policies that seek to integrate domestic agriculture into global markets have resulted in commercialization of agriculture based on neoliberal ideology leading to loss of traditional modes of agriculture, increased cost of farming, dependence on high interest informal credit and increased susceptibility to international market fluctuations.” Quoting from “Voices of Farmer-Widows Amid the Agrarian Crisis in India” (in Women’s Studies in Communication) that analyzed farmers suicides in Maharashtra, India, Kottai reports that these widows “locate the suicides of their husbands in irrecoverable debt.”
Kottai is exasperated by his fellow mental health professionals, noting, “Farmers are labelled, responsibilized for their ‘depression’ and ‘anxiety’ exhorting them to change and adapt to unjust statutes instituted by the state.” The farmer who is distressed on account of debts and anti-farmer agricultural policies is diagnosed with depression “without delving into the toxic and chronic stress that the farmer encounters daily.” For Kottai, “Treating the farmer with individual counseling, psychotherapies, and medicine amounts to individualization, psychocentrism, biological reductionism, and medicalization of a complex sociopolitical problem.”
Mainstream mental health professionals enable oppressive structures that are responsible for causing distress. Kottai observes, “Here the clinician, in the name of treatment, commits double violence—misrecognizing the cause of suffering and individually ‘treating’ the poor farmer for a political problem that requires systemic solutions. Consequently, the brain of the ‘maladjusted farmer’ becomes the site for intervention at the expense of the pathological structures and unjust policies. The farmers’ agency to act against state oppression gets buried as they perceive themselves to be the source of their distress.”
What Can Professionals Do?
By explaining to mental health professionals and the general public that the root cause of suicide among their people is a sociopolitical one and not a brain disease, Roland Chrisjohn and Sudarshan Kottai do their part to foment rebellion against the sociopolitical status quo rather than—as most professionals do—enable it. There are other things professionals can do to help.
Kottai offers Rachel Morley as one model. Morley, a clinical psychologist and a psychosocial practitioner for the British Red Cross, is the author or the 2015 article “Witnessing Injustice: Therapeutic Responsibilities” (in the Journal of Critical Psychology, Counseling and Psychotherapy). For Morley, when working with victims of social and political violence, therapeutic responsibilities include “bearing witness” to stories of injustice. Morley tells mental health professionals that it is their ethical and therapeutic responsibility to speak the unspeakable: “Therapists are in a privileged position as witnesses to their client’s testimonies of human rights abuses. By acting as secondary witnesses we are helping someone to be the primary witness of what has happened to them, to locate their experiences within an autobiographical narrative of their lives and to see their response and resistance as well as the trauma they have been subject to. . . .The responsibilities placed on witnesses are to listen properly, to respond ethically by recognising the humanity of the teller, acknowledging the justice of the claim and helping to find communal forms of acknowledgement and redress.”
When thinking about suicide epidemics in populations subject to excruciating oppression, it is important to keep the concentration camp example in mind. Auschwitz survivor Viktor Frankl reported in his Man’s Search for Meaning, “The thought of suicide was entertained by nearly everyone, if only for a brief time.” It is normal for people facing excruciating oppression to consider suicide.
Unfortunately, mental health professionals can make acting on suicidal thoughts more likely. Some individuals don’t act on their suicidal thoughts because they are inhibited from acting by some reason—for example, concern of its effect on surviving friends and family members; however, medical treatments can be disinhibiting. Specifically, while alcohol is commonly known to serve as “liquid courage,” other psychotropic drugs—including psychiatric medications such as antidepressants—can also increase suicidality and disinhibit one to act on suicidal thoughts. One of the greatest failures of contemporary mental health professionals—especially true for psychiatrists who routinely see their patients every two or three months for a ten-minute “medication management”—is simply to not know their patients; and so these professionals are incapable of making an informed judgement as to whether a psychotropic drug may help take the edge off of excruciating pain or, instead, will be disinhibiting—and increase the likelihood that suicidal thoughts become suicidal actions.
Consider this. If you were suicidal because of horrific sociopolitical oppression (such as experienced by German Jews, indigenous North Americans, and Indian farmers), would you rather be labeled as mentally ill and treated as such, or instead be seen as an unlucky victim of sociopolitical oppression and be provided with a survival guide? One such survival guide is The Survivor: An Anatomy of Life in the Death Camps, authored by Terrence Des Pres. The Survivorexamines memoirs and accounts of Nazi concentration camp and Soviet Gulag survivors, both the famous (Viktor Frankl, Primo Levi, Elie Wiesel, Bruno Bettelheim, and Aleksandr Solzhenitsyn) and the non-famous.
Survivors, Des Pres reports, acknowledged that perhaps the most important factor in their surviving was simply good luck, but also helpful in surviving extreme degradation and humiliation were strategies that allowed them not be overwhelmed by these pains. Such strategies—quite different than today’s standard mental health “treatments”—included: (1) a journalistic detachment so as to bear witness as both an obligation to those who didn’t survive and a vehicle for future justice; (2) discovering one’s purpose for survival; (3) a dark sense of humor that does not deny the pains of injustice, humiliation, and degradation but flips them to absurdity and laughter; (3) collective resistance, cooperation, and altruism with one’s fellow prisoners which allowed for some sense of dignity and freedom from complete self-focus on one’s own suffering; and (4) temporary respites from hellish existence by focusing on the beauties of nature outside the death camp such as a tree in the distance or a sunset.
Finally, for young mental health professionals who aspire not to be used to enable oppression, some words that energized me early in my career were from the historian Howard Zinn (in his chapter “The Coming Revolt of the Guards” in A People’s History of the United States): “In a highly developed society, the Establishment cannot survive without the obedience and loyalty of millions of people who are given small rewards to keep the system going: the soldiers and police, teachers and ministers, administrators and social workers, technicians and production workers, doctors, lawyers. . . . They become the guards of the system, buffers between the upper and lower classes. If they stop obeying, the system falls.”