The ‘cultural turn’ in some parts of suicide studies has long roots (Douglas 1967), and has recently begun to proliferate (Lester et al. 2013). Particularly within sociology, anthropology, and—more recently—critical suicide studies, culture has been and is taken seriously—understood to be deeply implicated in producing suicide, its meanings, and related knowledge practices (Fitzpatrick, Hooker and Kerridge 2015). There is wider recognition that ‘culture’ is of importance in understanding and responding to suicide and there are signs that more diverse disciplinary approaches to studying suicide through a ‘cultural’ lens are gaining traction (Mueller et al. 2021; Wolsko, Marino and Keys 2020; Abrutyn and Mueller 2021; Stamenkovic 2014). The recent paper by Hazan and Romberg (2022) offers a timely opportunity for reflection, neatly summarising important tensions in the study of both suicide and culture, and setting out ongoing challenges for those of us working in this ‘messy’ space … [please read below the rest of the article].

Image credit: Evan Lavine via Flickr / Creative Commons

Suicide Cultures—Parallel Histories, Mutual Goals

Drawing on work that they have cultivated over several years, Hazan and Romberg articulate in their paper the notion of ‘suicide cultures’ in order to highlight ‘temporal, agentive, performative, and social justice questions of suicide and culture’ (2022, 1). As we are currently working on a research project which shares the same name (Suicide Cultures: Reimagining Suicide Research, 2020-2025, Wellcome Trust), we have something of a stake in how ‘suicide cultures’ might be understood and made use of as a productive notion, and the potentials it may hold for ‘reimagining’ the scope and aims of suicide research.

In our own work, the phrase ‘suicide cultures’ is designed to signal a desire to do sociological research on suicide differently. Amy Chandler, who developed and leads the project (building on an earlier study, also entitled Suicide Cultures, 2018-2020), had grown frustrated with several absences and limitations in suicidology. Firstly, the relative absence of sociological contributions, and the tendency of any such contributions to stick closely to the functionalist imaginary of Durkheim (Wray, Colen, and Pescosolido 2011), with alternative, more interpretive paradigms, left relatively unused (see Timmermans 2005; Fincham et al. 2011 for notable exceptions). Secondly, the related absence and indeed dismissal of qualitative methodologies, as charted over many years by Heidi Hjelmeland and Birthe Knizek (2016, 2011, 2010). In response to these absences, ‘suicide cultures’ reflected an interest in understanding suicide as a diverse, meaningful, dynamic, and embodied cultural practice, in contrast to the suicide that is imagined in much mainstream suicidology; which Ian Marsh (2010) has characterised as reflecting a ‘compulsory ontology of pathology’ (18)—universal, unchanging, monolithic.

Amy was inspired by calls “for more expansive and creative thinking” (White, 2020, 79) in suicide research from those aligned with ‘critical suicide studies’ (White et al. 2016; White 2020), as well as by innovative, interpretive sociologies of suicide being developed in parallel (Mueller et al. 2021; Abrutyn, Mueller and Osborne 2020; Abrutyn and Mueller 2021, 2018; Fincham et al. 2011; Scourfield et al. 2012). As such, Suicide Cultures: Reimagining Suicide Research, was envisioned as a transformative call to action. The research project aims to demonstrate what alternative sociologies, interdisciplinary social scientific collaboration, and qualitative, creative methodologies can offer to understanding and responding to suicide.

Core to our project is a concern with ‘culture’ and what it can offer to the study of suicide, if treated with care. In the remainder of this paper, we offer an engagement with and extension of some of the concerns and possibilities sketched out by Hazan and Romberg (2022). While there are many overlaps between our approaches, we point to some important differences that are worth highlighting for the purposes of further deepening our understanding of culture in suicidology.

The Challenges and Limits of ‘Culture’

Hazan and Romberg (2022) crystallise long-standing concerns with the way in which ‘culture’ has been operationalised within research in general, and suicide studies in particular. They rightly note that the concept of culture has been inappropriately understood as fixed and measurable. This approach to understanding culture has been especially problematic for the way in which suicides among ‘minority’ groups are framed; resulting, for instance, in the ‘problem’ of suicide being located in the ‘culture’ of a specific ethnic group, or tied to their alleged ‘inability’ to ‘assimilate’ into the dominant culture (Yue 2021). As Hazan and Romberg note, such conceptualisations of culture as simultaneously ‘fixed’ (and pathogenic) and in need of improvement via assimilation to a ‘dominant’ (and also assumed to be ‘fixed’ culture) are reductionist and inaccurate.

A related limitation of such understandings of culture is that they imagine complex processes as ‘variables’ rather than as deeply embedded in the production of other factors, also operationalised as variables, such as gender, class, ethnicity (Hazan and Romberg 2022, 5). This is an issue that Brossard and Chandler (2022) explore in a recent book, highlighting this as a broad and problematic feature of many attempts to grapple with ‘culture’ and ‘mental health’, especially where concepts such as ethnicity/race, indigeneity and nativity are conflated, or used interchangeably (Brown et al. 2013).

Together, these interventions underline the need for sociology—and other social sciences—to approach culture in relation to suicide specifically, and mental health in general, more critically, and more carefully. It is not enough to identify apparent ‘cultural differences’ between groups. Rather, culture must be approached as dynamic, fluid, and multifaceted; a set of practices and meanings, not bounded by group or location—but porous. Culture is also temporally situated and thus changeable (Anderson, 2019; Geertz, 2000). Further, individuals are not bound by a singular culture, cultures intersect—making defining and attending to any one ‘culture’ a challenging prospect, and one we face continually in our own engagement with the relationship between ‘cultures’ and suicide in Scotland.

Given this more dynamic and relational understanding of culture, it is important that researchers also acknowledge their own role in contributing to and eliciting particular cultural formations from the fields in which they move. Generating data about culture is a process of co-creation with our participants who, like the researcher, are situated beings talking from a particular stand-point within the shifting cultural milieu of their time (Jaworski 2021; Clifford and Marcus 1986). This observation offers further support to the critique developed by Hazan and Romberg, deeply problematizing attempts to study culture as observable, extractable, identifiable and measurable.

Our own engagement with ‘suicide cultures’ also seeks to situate and understand ideas about ‘cultural difference’ as a continuation of colonial difference, produced in order to construct ‘uncivilised’ populations and legitimise their colonisation. Reckoning with the coloniality of suicide prevention and research is a necessary and vital part of any engagement with ‘suicide cultures’ (White 2020; Ansloos 2018; Ansloos and Peltier 2021; Cardon 2021). This is because, despite the formal end of the economic and political policies of colonisation, the logic of coloniality endures (Maldonado-Torres 2007), and has deep roots in many of our disciplinary knowledge practices (Bhambra and Holmwood 2021). It therefore provides vital context for understanding suicides today (X and Polanco 2021), and especially for ongoing engagement with ‘cultural’ understandings or explanations.

The Possibilities of ‘Culture’

Hazan and Romberg develop a strong case for the importance of ‘culture’ in understanding suicide. However, in their suggestions about how we might best operationalise such an engagement, it appears that our approaches diverge somewhat. In our own work with ‘suicide cultures’ we draw from accounts of individuals and within communities, as well as considering broader policy, politics, and popular discourses; we engage a simultaneous concern with materiality and embodiment; and we seek to contend with accounts, embodied experience and the structural conditions in which these play out. These movements build upon and expand sociologist C Wright Mills’ classic articulations of the power of the ‘sociological imagination’ to understand relationships between ‘private troubles’ and ‘public issues’ (Mills 1959). In contrast, Hazan and Romberg appear to propose a study of culture that centres on discourse alone. We suggest that such an approach would limit the possibilities for engagement with culture, and the ways in which culture is material, agentic, pliable—in short, how culture plays out among individuals and communities, how it shapes embodied experience and practice.

Attending to the ways in which cultures of suicide may be mediated by and through materiality and affect is a key concern for us. Drawing on feminist science studies, and recent work in cultural geography, we suggest that engaging culture in the study of suicide necessitates attending to the ways in which selfhood and identity can be understood as distributed and processual, pieced together across material and non-material things (Haraway 1988). For geographers, attending to culture involves focusing increasingly on relationality and the impact of different spaces, places, and times on language and action—expressions of culture’—while not forgetting the individual, embodied, material nature of these expressions as well. Scholars such as Anderson indicate that culture can be seen as created through and embedded in materiality, with materiality envisioned as always entangled with meaning (Barad 2007; Anderson 2019). Anderson argues that cultural representations are just one part of a ‘relational configuration’, highlighting the importance of considering what a representation does—its impact—as opposed to the (potentially more static) ‘system it expresses’ (1122). These approaches intersect with new materialist approaches, particularly those used in feminist, anti-racist and queer studies, offering a more active (agential) view of matter, whilst maintaining an equally important emphasis on identity, power, oppression and resistance (Feely 2016). Such interventions again lead us to emphasise the vital role of qualitative, collaborative and ethnographic engagements with ‘suicide cultures’—alongside a consideration of the role of (public) discourse.

Measuring ‘Culture’ and ‘Suicide’

Perhaps one of the most provocative claims Hazan and Romberg make in their paper concerns the methodologies that should be used in order to engage meaningfully and appropriately with ‘suicide cultures’. Hazan and Romberg claim that in order to properly study ‘suicide cultures’ ‘drastic conceptual and methodological shifts’ (12) are required, including accepting the ‘un-quantifiability’ of culture itself, moving away from ‘measuring’ suicidal acts and instead ‘accounting’ for them (9).

While we are broadly in agreement with the characterisation of ‘culture’ as lacking in coherence and fixity, we would question whether this necessarily entails the rather oppositional position this argument sets up. Certainly, we agree that measuring and quantifying cultural understandings or practices relating to suicide may be difficult and necessarily incomplete, however this could imply that quantitative approaches have no place in suicide research. While our own work unashamedly prioritises and centres qualitative approaches, we would suggest this characterisation of a quantitative/qualitative divide is both unhelpful and unrealistic. Even in the most careful qualitative research, forms of quantification can be found (Barbour 2008); and there may yet be some benefits to examining the production of some quantifiable differences which have relevance or resonance to making sense of ‘suicide cultures’.

For instance, in our own work in Scotland, we are exploring how individuals affected by suicide (via an attempt, a loss, or their professional involvement) make sense of suicide. We are concerned with suicide as an embodied, affective, spatial, social and cultural practice. This includes considering methods of suicide as a visceral ‘sign’ of the diverse and patterned ways that suicide can be read as an embodied practice. Our starting point for this inquiry lies in quantitative data, and our qualitative analysis of accounts and meanings, local social and cultural practices relating to suicides, and the environmental or material spaces where suicides take place, will continue to speak with and be informed by available quantitative data, whilst recognising its limitations.

In Scotland, quantitative data indicates that men are more likely to die by suicide via hanging; but that the number of women using hanging as a method of suicide has increased in recent years. This is just one instance where qualitative approaches to researching suicide may offer significant advances on the much ‘thinner’ attempts to imagine why methods of suicide vary by sex/gender (Stack and Wasserman 2009; Kposowa and McElvain 2006). However, importantly, both qualitative and quantitative methods are required to inquire into these issues. Indeed, as Hazan and Romberg note (11), ‘statistical reporting of suicides … may influence the ways in which suicide is deployed, interpreted, and sensed’. Quantitative methods, then, are implicated in the way suicide is constructed and narrativised, and can provide us with a base to guide our qualitative questioning and analysis.

A related example lies in the role of suicide statistics and the identification, production, or erasure of ‘high risk groups’. For example, elsewhere Emily Yue has argued that in the UK, national suicide data produces suicidal populations, rather than objectively reflecting the reality of suicide in the UK. Since the data is based on census categories, people who are excluded from the UK census categories are also erased from national suicide research and prevention, and from public discourse (Yue 2021). This observation raises concerns about Hazan and Romberg’s proposal to focus a study of ‘suicide cultures’ on ‘non-reactive data composed of readily available representations of suicide available in the public sphere’ in order to ‘unravel local social meanings and dramas of suicide’ (12). Critical qualitative researchers, and critical suicidologists, have each underlined the situated and partial nature of representations and ‘knowledge’ about suicide. Yue’s work demonstrates how statistics form a vital, if contested, part of producing such representations of suicide (see also Marzetti et al. 2022). Crucially, we would question whether statistics or any other representation of suicide could be understood as ‘non-reactive’.

Critically Engaging the ‘Cultural Turn’ in Suicide Studies

Epistemology lies at the heart of recent debates regarding qualitative methods and the ‘cultural turn’ in suicide studies (Hjelmeland and Knizek 2016; Hjelmeland et al. 2012; Bantjes and Swartz 2019, 2017). Bantjes and Swartz have questioned whether the ‘assumption’ about the relevance of culture to understanding suicide is valid in suicide prevention research. Relatedly, they question whether interview-studies exploring cultural meanings of suicide or suicide prevention offer ‘better’ insights than biomedical or quantitative studies. Bantjes and Swartz’ critique is itself questionable (Hjelmeland and Knizek 2019), including their suggestion that much qualitative research addressing suicide is ‘at best descriptive’ (2017, 517). That said, their intervention does speak to broader arguments within critical suicide studies regarding whether suicide research should necessarily focus narrowly on a ‘prevention’ agenda (Tack 2019; Baril 2020).

Indeed, others have noted how such a foci can contribute to an understanding of suicide that focuses on prevention of particular acts, rather than addressing the broader contexts (including cultures) which may produce the conditions for suicide (Marzetti et al. 2022; Ansloos and Peltier 2021; Fitzpatrick 2020, 2018). Further, we would suggest that inquiring into suicide using qualitative methods via longer-term, less directive, engagements may offer a far more fruitful route to exploring the ‘contingent’ (Hazan and Romberg 2022, 12) ways in which cultural contexts may shape understandings and practices of suicide.

As noted above, Hazan and Romberg suggest an exemplar approach to studying ‘suicide cultures’ is via engagement with ‘representations of suicide available in the public sphere […without] the need of eliciting ‘opinions’ about suicide in experimental settings’ (12)’, an approach they develop in their (2021) monograph Suicide Social Dramas: Life-Giving Moral Breakdowns in the Israeli Public Sphere. However, between both of these approaches, we suggest there are important limitations and potential losses. Focusing in a limited way on what people ‘say’ about ‘suicide prevention’ (as per Bantjes and Swartz’s characterisation of qualitative research on suicide) or focusing solely on public or media representations about suicide (as per Hazan and Romberg’s proposal), each miss out vital aspects of the complex ways in which suicide is made sense of by diverse individuals within communities. There is an expansive ‘middle ground’ between examining public and popular discourse about suicide and gathering opinions about suicide in experimental settings. Alongside these, we suggest the vital need for embedded ethnographic and qualitative interview-based approaches to exploring ‘suicide cultures’ in order to inquire into the embodied and affective ways that suicide manifests in different groups and areas (Abrutyn and Mueller 2018; Widger 2014; Chua 2014). Such approaches offer ways through which ‘what people say’, ‘what people do’, ‘how suicide is represented’ and the structural conditions and statistical shape of suicide can be creatively and carefully examined.

Ethnography is a fundamentally interpretive method that aims to account for multiple experiential modalities within its inquiry (Clifford and Marcus,1986). Researchers’ ability to trace how culture and suicide interact is inherently co-constructive, developed through our engagement with individuals and communities. There are no people, including ethnographers, who are not culturally situated. Examining how we create data about suicide in collaboration with our participants can move beyond the discursive approach conceptualised by Hazan and Romberg to attend to sensory, embodied, and affective cultural experiences as they relate to suicide. The mixed qualitative methods approach of the Suicide Cultures project provides routes through which researchers can work with participants and community members to critically explore how ‘public understandings’ of suicide play out in more intimate, embodied, mediated settings. Examples of this can be seen in both our own ongoing fieldwork in Scotland (Chandler 2021, 2019; Chandler and Simopoulou 2021) and, for instance, Abrutyn, Mueller and colleagues’ extended ethnographic study of youth suicides in a US community (Miklin et al. 2019; Abrutyn, Mueller and Osborne 2020; Abrutyn and Mueller 2018).

Future Directions for the ‘Suicide Cultures’

Hazan and Romberg’s welcome paper sets out in detail some of the limitations in how ‘culture’ has been enrolled in studies of suicide, as well as proposing promising ways forward. In our response, we have sought to extend some of these insights, and argued for a more expansive and methodologically flexible approach to engaging with ‘suicide cultures’. Suicide is, undoubtedly, complex, but there are—as both Hazan and Romberg, and this reply demonstrate—a wealth of theoretical and methodological resources through which the broader social sciences can contribute to understanding and responding to suicide. There are also, as we have sought to show here, a growing number of scholars, across sociology, critical suicide studies, anthropology and elsewhere who are engaged in this work. We thank Hazan and Romberg for prompting this reflection on this emerging field of scholarship, and look forward to seeing where this work can take us.

Acknowledgements

All authors are funded by the Wellcome Trust, Reference: 219842-Z-19-Z.

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Categories: Critical Replies

Tags: Amy Chandler, Emily Yue, Joe Anderson, Rebecca Helman, Sarah Huque, suicide, suicide cultures, suicidology