Sir, - I would like to comment on a number of issues raised by John Waters in his article in Opinion July 2 2001column of July 2nd ("Reasons for male suicide all too clear"). One thing that is all too evident is that the reason for the increase in male suicides is anything but clear.
Most developed countries have seen a dramatic increase in young male suicides over the past 25 years and Ireland is no exception. This increase is extremely disturbing - all the more so because of the lack of any clear reasons. One factor, however, has been well established. Virtually all suicides occur in people who are emotionally distressed.
Psychological autopsies go further in establishing that the majority of people who kill themselves have a psychiatric disorder of one sort or another. There is a particular relationship between suicide and depressive illness. John Waters is perfectly correct in saying that suicide is not just a topic for psychiatrists, but psychiatrists do have special knowledge in this area, and special responsibility also.
While people may become "depressed" for many reasons, there is a definite entity of clinical depression. This condition is recognised in the degree and in the duration of its symptoms. Psychiatrists fully recognise that life stresses of various sorts can trigger this disorder. Treatment involves therapies which take on board individual vulnerabilities and life problems. Biological factors, however, are always important in clinical depression and for this reason medication is of proven value.
There is little evidence to suggest that depression is "a sane response to the external reality of the sufferer's life". In addition, it is anything but a "refuge". Many depressive illnesses occur with no obvious trigger in people who are otherwise emotionally stable. There is abundant evidence for genetic vulnerability and characteristic life course in the expression of these disorders. The major mood disorders can be very disabling conditions. Their early diagnosis and effective treatment, which frequently involves medication, are critical in reducing the high suicide rates associated with these conditions.
Discussions on suicide have emphasised factors positively associated with suicide. Protective factors have largely been neglected. John Waters rightly emphasises these in his comments on the special problems society poses for young men.
He may well be correct in implying that attention to these problems may be of most importance in turning back the epidemic of young male suicides. Recognised protective factors relate to a cluster of beliefs and values - having a sense of self-worth, close family and community ties, religious belief, and a sense of the inherent value of life.
Ireland has changed in many ways. With increasing prosperity, priorities have changed, and success is all too often judged in purely economic terms. Young people are increasingly autonomous, but perhaps with this goes increasing isolation.
What can be done? Psychiatric services need to be radically improved so that high-quality services are both readily available and easily accessible. The public, particularly the young, need greater awareness and understanding of emotional problems and how to respond to them. There must be recognition in political and public life of the importance of fostering a society that encourages and supports community integration and family life. The communal "hug" enabled by such a society may well be part of the answer. - Yours, etc.,
John Owens, Consultant Psychiatrist, St Davnet's Hospital, Monaghan. (On behalf of the Irish Psychiatric Association.)