Health, Mental Health, Social Science, Top Stories

Suicide Prevention and the Social Science Cargo Cult

When white people began visiting the islands of the Pacific Ocean, the native peoples, fascinated by the abundance of good things coming to them, assiduously observed the visitors’ behaviour. They concluded that the great birds in the sky, filled with packing cases bearing the inscription “cargo,” were gifts from the gods. So, they began to imitate the newcomers, building runways in the middle of the jungle, lighting fires based on the pattern of airport landing lights, and constructing small control towers out of wood and bamboo. Then they awaited the benevolence of the gods, but the gods were not compliant. The planes did not land on their runways, despite the enormous effort they had put into building them and the meticulousness with which they copied the buildings and equipment of the white people. Even today, this cargo cult persists in some corners of Oceania.

In a speech delivered at a degree ceremony at the California Institute of Technology, Richard Feynman, a noted physicist and Nobel Prize winner in 1974, compared the social sciences to the cargo cult. Representatives of the social sciences, he argued, imitate the behaviour of other sciences but to no effect. Feynman did not end with this comparison, but added examples from the fields of rehabilitation, psychotherapy, and parapsychology. He stated that despite the enormous effort invested in researching and perfecting teaching methods, students’ results are worse every year. The same goes for criminality and the other problems which the social sciences attempt to resolve. Was Feynman right?

The bustle of adherents to the cargo cult

In many fields, great effort has produced paltry results and sometimes even worsened the prevailing state of affairs. In December 2020, a comprehensive meta-analysis was published covering 50 years of research into the efficacy of various interventions aimed at preventing suicide and self-harm. A research team, led by Kathryn Fox from the University of Denver and Xieyining Huang from Florida State University, analysed 1,125 of the most methodologically correct research carried out in the last half-century. Inter alia, the research considered emergency intervention, psychodynamic psychotherapy, peer support, social care, drug therapy, hospitalisation, external methods of control, cognitive and behavioural approaches, dialectical and behavioural psychotherapy, as well as other psychotherapeutic methods. The results were depressing. The efficacy of all methods examined was found to be very low, effects do not last long after intervention, and there is no real difference between the various methods. But most striking is the discovery that, despite the nearly exponential growth in the amount of research into these methods, their effectiveness today is as low as it was 50 years ago. Within the diversity of approaches, no indicators were discovered which would have a crucial influence on the effectiveness of intervention.

According to the WHO, from the 1960s to 2012—a period during which the methods of helping those who wish to kill themselves did not improve—the number of suicides per 100,000 of the population rose by 60 percent. Today, about 1.5 percent of the population die by their own hand. Suicide is one of the most frequent causes of death among young people, and is responsible for about 20 percent of all deaths among teenagers. For every successful suicide there are between 10 and 40 unsuccessful attempts. In the United States alone, the costs of suicide are estimated to be $94 billion annually. Additionally, about 5.5 percent of all adults practice systematic self-harm, and among adolescents this figure reaches 17.2 percent. Is the effort invested in half-a-century’s research and improvement of methods in helping potential suicides really all that different from the bustle of the cargo cult followers who were unable to lead the planes to their runways?

This meta-analysis is not the only study of its kind showing the powerlessness of the social sciences in relation to the problem of suicide. In 2017, a research team led by Joseph Franklin from Harvard University published the results of another meta-analysis, which showed that 50 years of research into the predictors of suicide allow us to predict whether a specific patient is likely to kill themselves with a reliability of a coin toss.

In light of the above, both the researchers and the practitioners who employ these methods when working with patients often state that without their efforts suicide indicators might be even higher, and that their low level of effectiveness is better than nothing. However, if short-term, simple intervention methods are just as effective as long-term, complex, and expensive alternatives (for example, psychodynamic therapy), then nothing justifies the use of the latter apart from the economic interest of those intervening.

Effective intervention

Additionally, other data indicate that the number of suicides can be adjusted by methods other than social or psychological. Until now, the most successful method of suicide prevention has been various kinds of restriction on means and opportunity. About a third of all suicides worldwide are committed using poisonous pesticides. During the 1980s and 1990s, Sri Lanka had the highest suicide rate in the world. When the UN began to limit easy access to pesticides, there was a 70 percent fall in the overall number of suicides. A similar decline took place in Bangladesh following the introduction of regulations to limit access to poisonous pesticides, and a ban of the sale of weed-killers frequently used in South Korea as a poison led to an immediate reduction of this type of suicide and of suicides in general. Similar measures have been successfully introduced in China and Nepal. Of course, it is impossible to entirely exclude other factors affecting the drop in suicide rates, but the effects of restrictions do appear to support their efficacy, nonetheless.

Restricting access to firearms, poisonous medicines, intoxicating substances such as alcohol, and other means has also reduced the overall number of suicides. In east Asia during the 1990s, a popular method of committing suicide was to burn charcoal in a closed space in order to generate a fatal concentration of carbon monoxide. So supermarkets removed charcoal from the open access shelves, and customers had to ask the salesperson if they wanted to purchase it. An immediate decrease in the number of suicides followed, at least among those using that method.

Even simple deterrents such as barriers on bridges and metro and railway platforms have an effect on the suicide rate. Analysis of potential suicide cases in hospitals showed that the number of successful attempts can be easily limited by restricting access to places from which they could jump to their deaths or hang themselves. And although the determined suicide will always find a substitute, restricting options is nevertheless probably still the most effective known method for controlling the numbers of those who are eventually successful.

Between Werther and Papageno

Media coverage of suicides also provides some shocking pointers. The suicide of a well-known person is often followed by a wave of imitators who take their lives in the same way. This phenomenon is known as the Werther effect, or “copycat” suicides. The discovery of this effect led to an international agreement restricting the public reporting of suicides, drawn up by international organizations responsible for health and the media. The leading schools of journalism respect the recommendations of Reportingonsuicide.org, which are so simple they can be abbreviated to just one sentence “The less about suicide the better.”

However, wrapping suicide in media taboo is a superficial half-measure, not least because the existence of a Werther effect has not been decisively established. Some researchers, such as James Hittner, have cast doubt on the theory, pointing out that the increase in suicide should be analyzed in relation to the so-called expected value, which depends on many different factors, such as the prevailing economic conditions, and even the season of the year, temperature, or level of air pollution. So if a celebrity commits suicide at the beginning of an economic crisis or at a gloomy time of year, the increase in the number of suicides following their death can only be partially attributed to media coverage. Repeated analyses of cases of the Werther effect identified in the literature show that suicides depend only to a small degree on media publicity. Moreover, researchers point to the fairly obvious fact that mental problems are the primary cause of attempted suicide. The fact that a famous person dies in this way may accelerate the decision, but not necessarily their total number of events, so the Werther effect may only be a disruption of the frequency of suicides committed. Over a longer period of time, a year for example, their number will be relatively constant and match the number of people experiencing mental problems which are conducive to self-destruction.

Sometimes an opposite effect occurs, and the number of suicides decreases as a result of media reporting. Such was the case with the suicide of Kurt Cobain, which analyses found was not followed by the Werther effect, and which appeared to deter many from following in Cobain’s footsteps. This finding was confirmed by an analysis conducted by Steven Stack from the Center for Suicide Research at Wayne State University. Stories containing negative descriptions of suicides were 99 percent less effective in spreading suicidal contagion than other media reports. This little-known reverse effect was named after one of the main characters in Mozart’s The Magic Flute. Papageno wants to commit suicide after the loss of his true love, but he is dissuaded by a conversation with three young men who show him an alternative way of resolving the situation. Showing the act of suicide from a suitable perspective may help to prevent it.

A team of Austrian and German psychologists, psychiatrists, and communication specialists conducted a comprehensive analysis of almost 500 press reports about suicides. They examined which suicides produced the Werther effect and the Papageno effect, respectively, and published their findings in the British Journal of Psychiatry in 2018. An increase in suicide rates is predicted by the repeated publication of reports about suicide itself and the repetition of myths related to it, in particular the idealization of acts of self-destruction. Publications analysing individual suicidal thoughts unaccompanied by suicidal behaviours were negatively correlated with an increase in the indicators. Media reports showing people in crisis situations who adopted strategies other than suicide to cope with adverse circumstances had a similar impact. Interestingly, articles containing the objective opinions of experts and epidemiological facts related to this phenomenon increased the likelihood of suicide. So, media coverage of suicide can help diminish the chances of imitation, but there is a dearth of information in the research about how to accomplish this. The Papageno effect is not even mentioned in the web pages of reportingonsuicide.org.

Conclusion

Social science can be a valuable means of understanding the world and improving human well-being when it is rigorously and practically applied. This approach requires falsifying hypotheses, continuous improving the methods used, and abandoning those that proved to be ineffective as a result of research. The ritualistic approach, on the other hand, misleads because it is based on empirically unconfirmed assumptions, often adopted long ago, and the developed methods are cultivated regardless of the results they bring.

Why, then, when looking for methods to prevent suicide do we rely on approaches to social science which cultivate ritualistic methods rather than practical ones? Even today these rituals are stubbornly repeated, even though they have not yet persuaded any planes to land with their longed-for cargo. Instead, they have brought respect and recognition, and consolidated the social position of their priests. Don’t the priests of the social sciences obtain similar benefits? Hasn’t copious research showing our powerlessness borne fruit in publications, academic titles, grants, and social recognition?

During the Second World War, at times of very poor visibility, pilots sometimes mistook the flaming runways of the islanders for their own airfields and attempted to land there. Most often such attempts ended tragically, but for the islanders it was a sign from the gods that their efforts had been recognised. Of course, it brought them a pile of scrap instead of the expected riches, but it strengthened the conviction that their efforts were worthwhile. And so they persisted, just as we persist with so many ineffective practices that have arisen in the sphere of the social sciences, frequently mistaking chance and coincidence for truth.

 

Tomasz Witkowski is a psychologist, skeptic, and science writer. Among the books he has published are Psychology Gone Wrong, Psychology Led Astray, and Shaping Psychology. He blogs at https://forbiddenpsychology.wordpress.com.

Photo by Modestas Urbonas on Unsplash