One case of a suicide a day was declared in Tunisia in 2015, a total of 365. Worse still, this sad record is almost double what was reported before the revolution. Kairouan, Gafsa and Bizerte were the three main regions involved. The age group that is the most affected is 20-39 years. Hanging is at the forefront of the means chosen (58.63%), followed by self-immolation (15.89%).
Why? How do we tackle this dire problem? Leaders interviewed experts.
Mohamed Bouazizi, by Carlos Latuff, December 2010
The founding act of the Tunisian revolution was a suicide. The immolation that Mohamed Bouazizi inflicted on himself inspired others, who also recognised the impossibility of living that the young street vendor experienced. Because since 2011, immolations as acts of political protest coupled to a resignation to death, have been occurring in quick succession, each seeming to give impetus to the next. This particular form of suicide, spectacular, public, and profoundly political, should not however overshadow "ordinary" suicides which are isolated from the public space. More "trivial" by their recurrence and therefore repetitiveness, suicide by hanging or poisoning is stealing the lives of more and more of the Tunisian youth.
A social fact
The conclusion is compelling: suicide, whether "successful" or only attempted, is a scourge that weighs on the Tunisian social climate and continues to spread like wildfire five years after the revolution. "Suicide is a social fact", insists the sociologist Mohamed Kerrou, citing Emile Durkheim. He immediately cuts short explanations that are too psychologising, which fail to take into account the social environment, an environment which is not chosen, but is imposed upon people. If he also warns against deterministic interpretations considering suicide as an uncontrollable social phenomenon, Kerrou questions the role played by society in the production of so many suicides. Excluded from society, they are "protesters" whose expression leads to a "reactional suicide". Bouazizi's case is also "anomic" in that it reflects the inability of society, which has become deregulated and deregulating, to equip people with the power to limit their individual desires.
Is it therefore a phenomenon that is crystallising in a new way around, notably, failures of the revolution in matters of social justice? It is feared, because "we are seeing more and more immolations occurring following conflicts between the suicide victim and representatives of public authority, like the suicide of Bouazizi", explains Fatma Charfi, President of the Technical Committee of the fight against suicide. But for Kerrou, immolation, the "political act par excellence, is only political when it is publicised". And it is only publicised when it is spectacularly staged. Immolation also happens to be, according to Amen Allah Messadi, professor of intensive care, the most unbearable physical pain that a human can experience. A one man show that is both spectacular and painful, then. How did we get to this point?
A chilling reality
National statistics on suicide in 2015, obtained from nine forensic services in Tunisia, show that 365 people have ended their days in the country, bringing the suicide death rate (or "incidence of suicide") to 3.27/100,000 inhabitants. Suicide also seems to be a phenomenon that particularly affects young people (it mainly concerns those aged 20 to 39 years) and males. Men are indeed almost three times more likely than women to kill themselves (4.75/100,000 against 1.8/100,000 in 2015). According to official figures established before the revolution, the annual incidence of suicide averaged around 1.8/100,000 inhabitants, against 3.15/100,000 on average since the revolution. A significant increase, but one that should be relativised because of the taboo that surrounds communication about suicide before the revolution: although the number of suicides is actually on the rise, the figures for the period before 2011 are, according to some experts, underestimated.
This phenomenon of under reporting finds its origin in a cultural predisposition to see suicide as a major taboo, which continues to prevail in some parts of the country and which could explain the disparity of incidences between different regions. A situation that prevents us from drawing clear conclusions about regional characteristics (socio-economic development, relationship of residents to representatives of power, social climate) which may contribute to the production of suicidogenic living conditions. In 2015, Kairouan, Gafsa and Bizerte were the three main regions affected by the phenomenon, far ahead of southern Tunisia which has been sparsely represented (see figure).
Suicide method: Hanging, Immolation, Drowning, Throwing self in front of a moving object, Fall from a height, defenestration, Stabbing, Fire arm, Medical intoxication, Ingestion of organophosphate pesticides, Poisoning, Ingestion of chloralose, Medical intoxication and fire arm, Ingestion of pesticides and drowning.
The phenomenon of self-immolation
The suicidal use many methods to put an end to their lives, but two techniques appear to be preferred over the others. Hanging moved up to first position (58.7% of suicides used this method), and immolation accounted for 15.89% of suicides registered in 2015. A new phenomenon, before the revolution suicide by immolation was the fourth most common method, coming after hanging, drowning and the ingestion of toxic substances.
After Bouazizi, it became increasingly widespread (attempted suicide by immolation is on average 20 times more common than before the revolution) and this spectacular method with a sacrificial tinge would seem to shed light on the development of social perceptions of suicide in Tunisia.
"Yesterday strictly confined to the domestic space, suicide today tends to be used as a desperate cry for help," says Mehdi Ben Khelil, University Hospital assistant in forensic medecine. A cry for help that would fit moreover an approach promoting externalisation and sharing of individual suffering with the community.
For in fact, besides the resurgence of immolations, there has been an increase in suicides in symbolic public places (often in front of municipalities, police stations, etc.) is also regrettable, demonstrating an endemic conflict that has taken root between the representatives of authority and those who are excluded from society. Moreover, while most suicidal people are single, we are witnessing an increase in suicides by married people, often because of the pressure that financial difficulties inflict on their household. Not surprisingly, it is the unemployed and the working class who are most likely to commit suicide, accounting for over 80% of cases.
Suicide rates per 100,000 population according to the regions
When they are stated, the reasons for suicide often involve mental illness, financial problems, or persistent marital or family conflicts. Back-histories in psychological instability are worth inquiring about. Because according to Mehdi Ben Khelil, if there is an increase in suicides by patients with mental illnesses, however it is not yet possible to know if this reality evokes a greater propensity to suicide on the part of the population, or if the families of the suicide are starting to abandon the taboos surrounding mental disorders, which are highly stigmatised in Tunisia. The phenomenon of under-reporting suicide motives might be on its way to dying out.
But it could also be a "decompensation" of mental illness, a kind of accelerating movement bringing them to end their suffering. One possibility that would be in line with another alarming reality revealed by the figures of recent years: the increasing use very grim means of suicide, in particular by stabbing. In sum, suicides in Tunisia are not only more numerous, they are also more violent, more "public" and increasingly committed by unstable people.
Beware of the Werther effect
It is also known as "mimetic suicide". This is a sociological trend demonstrated in 1974 by USAmerican sociologist David P. Phillips that the excessive media coverage of suicide, especially if carried out by a celebrity and its treatment in positive terms can set in motion a dynamic of suicide epidemics. Even if the Werther effect only concerns the part of the population already predisposed to suicide, the Technical Committee against suicide warns against the damage that could be caused by clumsy, simplistic and sensational reporting of cases of suicide.
With one voice, Fatma Charfi, Ourida Boussada, teacher in communication, and Mehdi Ben Khelil all call for the establishment of a media coverage charter that would reinforce professional ethics in the treatment of such cases. The challenge is all the greater since they think it is necessary to turn the media into a weapon against suicide, contributing to its prevention rather than its spread. According to many experts, the peak of suicides among teenagers that was observed in late 2014 was no stranger to "excessive" media treatment, during prime time.
A need for re-enchantment?
The social anthropologist Meryem Sellami was able to talk with teenagers who had survived suicide attempts, thanks to work with the child psychiatry department of Razi Hospital in Tunis. The cases that she took on seem to converge with the argument raised by Kerrou, that we must not disassociate the phenomenon of suicide from the postmodern environment in which it is currently thriving. This is primarily defined by the industrialisation and secularisation of existence, which together can bring about a "disenchantment" that brings with it suicidal tendencies, or in any case risk behaviours.
For Meryem Sellami, "adolescents' suicide attempts are attempts to live where the desire to die is not stronger than the desire to live" and a way to express through their body "a temporary inability to exist". She cites as evidence the surprising fact, that teens always reflect upon the post-suicide attempt scenario before actually attempting suicide, "which is not the case in adults", she recalls. According to the social anthropologist, teenage suicide attempts are often a way to "have a break" during which the body cleanses itself of their pain. It is a "reversible death, without a corpse" that they would like to experience as a break from an existence which is too monotone or, conversely, too melancholy.
But it is the need for a ceremonial and religious acting out of a return to life, which pushes them to the suicidal act. The researcher explains that the exorcism and prayer ceremonies (hizb latif) organised by the families "to thank God" are very effective symbolically. "They comfort the girl through the intervention of a man, a father substitute, as an imam chanting verses from the Koran and prayers that are especially dedicated to her. There is something like a remedy, a re-sacralisation of the self that can be affected through these liturgies", Meryem remarks. When the father joins the recitation, a physical contact with his daughter is recreated, bringing her to life.
What food for thought does this give us?
In addition to "re-enchantment", we need to take radical political measures against unemployment, a determining factor in the suicide of adults. More broadly, associations in the fight against suicide stressed the urgent need to bring peace to social climates, prevalent in some circles, districts or trades, which are sometimes very violent. Others point to the use of increasingly uninhibited and standardised drugs, persistent fatalistic tendencies, widespread violence and crime as factors in the increase in suicides, etc.
But the situation cannot be healed solely by taking into consideration economic factors. An appreciation of artistic ideals, a cultural revaluing of society around common ideals, and social integration for everybody are all measures to be taken immediately to limit the damage of what Durkheim called "anomic suicide".
What is the Technical Committee against suicide?
It is an agency of the Ministry of Health, which was launched in February 2015 to implement a prevention programme against suicide and epidemiological surveillance of suicidal tendencies in order to better understand the population at risk. They are also about to set up a national register of suicide and suicide attempts. A report on suicides in 2015 which the Committee contributed to producing has already been published on the website of the Ministry of Health (www.santetunisie.rns.tn
) and is the first detailed epidemiological document on suicide.
►On this topics, you can read (if you know Italian, an English version is still missing)
Annamaria Rivera, Il fuoco della rivolta. Torce umane dal Maghreb all'Europa (The fire of revolt: Human Torches from Maghreb to Europe)
A sharp socio-anthropological analysis of the phenomenon of public protest suicides by fire, from Tunisia to Israel through Europe.