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Socioeconomic inequalities of suicide: Sociological and psychological intersections:

01 Feb 2020-European Journal of Social Theory (SAGE PublicationsSage UK: London, England)-Vol. 23, Iss: 1, pp 33-51
TL;DR: Suicide research is complex; yet suicide research is dominated by ‘psy’ disciplines which can falter when seeking to explain social patterning of suicide rates, and how this relates to individual actions as discussed by the authors.
Abstract: Suicide is complex; yet suicide research is dominated by ‘psy’ disciplines which can falter when seeking to explain social patterning of suicide rates, and how this relates to individual actions. T...

Summary (2 min read)

Introduction

  • Edinburgh Research Explorer Socioeconomic inequalities of suicide Citation for published version: Chandler, A 2019, 'Socioeconomic inequalities of suicide: Sociological and psychological intersections', European Journal of Social Theory.
  • The contributions of sociology and psychology to the study of suicide are less easily understood as oppositional, or binary, though this is often how they are described.
  • By focusing on psychological and sociological attempts to understand the relationship between socioeconomic inequalities and suicide, I demonstrate some of the significant promise of more ambitious interdisciplinary endeavours.

Cumulative disadvantage

  • The theme of cumulative disadvantage featured in both the psychological literature reviewed by Kirtley and O’Connor, and in the qualitative research.
  • Thus, ACEs were framed as doubly contributing (though not neatly) to suicide risk in adulthood, both through independent correlation of ACEs with suicide attempts, and through increasing the chance of living with socioeconomic disadvantage as an adult, which is also independently correlated with suicide.
  • Curiously, two of the sociologically informed qualitative studies displayed a tendency to draw on qualitative data in order to quantify the impact of such experiences (Huey et al., 2014; Stack & Wasserman, 2007).
  • This resulted in analyses which ultimately stopped short of explaining how and why such accumulations of disadvantage result in greater chances of self-harm and suicide in a given context.
  • The disjuncture between qualitative findings within a particular population (men leaving prison) and quantitative studies of risk factors in more general populations indicates both the need for, and the challenge of doing suicide research which moves between the specific and the general.

Emotions and inequalities

  • The role of emotions in mediating or shaping the relationship between socioeconomic disadvantage, self-harm, and suicide was another clear intersection between the two chapters.
  • The psychological literature reviewed by Kirtley and O’Connor highlighted the role of specific emotions or feeling-states, namely: defeat, entrapment, humiliation and shame, though they were forced to extrapolate findings somewhat, since they were unable to identify psychological studies which addressed these factors in relation to socioeconomic disadvantage.
  • Perhaps unsurprisingly, the way in which emotions emerged in these papers diverged significantly from the quantitative studies, though there were also important divergences among the qualitative studies.
  • This highlights a rather obvious distinction between the data generated by quantitative and qualitative work.
  • Fullagar argues that “individualizing discourses of neoliberalism are implicated in perpetuating shame” (p. 300), as well as in encouraging youth experiencing suicidal thoughts to feel personally responsible (and thus doubly shamed) for their emotions (see also McDermott & Roen, 2016).

The relevance of shame

  • The qualitative review identified two emotions as important in both researchers’ analysis of suicide and self-harm in the context of socioeconomic context, and in the accounts of participants: anger, and shame.
  • Indeed, Scheff has made some initial suggestions regarding this.
  • Scheff draws here on Marx’s notion of false class consciousness, proposing that attending to emotion can help explain why members of subordinate classes tolerate their oppression (1990 p. 120-1).
  • In contrast, McDermott and Roen (2016) have drawn on alternative literatures (e.g. Ahmed, 2014; Sedgwick, 2003) to theorise the embodied, affective experiences of shame and selfharm among young, queer youth from lower socioeconomic backgrounds.
  • Their analysis somewhat contradicts Scheff’s claim that shame is ‘ubiquitous and hidden’, highlighting the ways that shame is unequally distributed, or perhaps more pointedly, how resources through which shame might be resisted are unequally distributed.

Agency and the status of accounts

  • The themes addressed thus far are each liable to result in structurally oriented accounts of the role of socioeconomic disadvantage, which tend to minimise the agency of the person self- harming or dying by suicide.
  • Within suicidology, psychiatrists and psychologists alike have noted that motives – and methods – for self-harm may change over time, be multiple and contradictory, or reflect deep ambivalence about life or death (Arensman & Keeley, 2012; De Leo, 2011; Kapur et al., 2013).
  • A more recent paper, by Byng and colleagues (2015) significantly pushes forward a sociological agenda in interpreting accounts of suicide and self-harm, drawing on Emirbayer and Mische’s (1998) comprehensive examination of sociological approaches to the concept of agency.
  • A key divergence between psychological and sociological approaches with regard to the role of life histories and their impact on current reasoning, reflection and agency, lies in the different lenses applied.
  • The intersections noted above point to fertile starting points for such collaborative efforts.

Notes

  • Defining suicide and self-harm is challenging and contested.
  • While individual accounts of self-harm (particularly selfcutting) often frame this as the ‘opposite of suicide’, there are – arguable, contested – relationships between self-harming practices which do and do not result in death.
  • With suicide the account is rendered void by the existence of a dead body – but see Jaworski 2014 for an account which troubles this connection.
  • I use the term here because Byng et al.
  • This point was raised by colleagues at the Critical Suicidology 2.0 conference, Canterbury Christ Church University June 2017.

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Edinburgh Research Explorer
Socioeconomic inequalities of suicide
Citation for published version:
Chandler, A 2019, 'Socioeconomic inequalities of suicide: Sociological and psychological intersections',
European Journal of Social Theory. https://doi.org/10.1177/1368431018804154
Digital Object Identifier (DOI):
10.1177/1368431018804154
Link:
Link to publication record in Edinburgh Research Explorer
Document Version:
Peer reviewed version
Published In:
European Journal of Social Theory
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Download date: 10. Aug. 2022

1
Socioeconomic inequalities of suicide: sociological and
psychological intersections
The study of suicide entails consideration of several enduring debates within social theory.
Even aside from the problem of defining suicide (and alongside it, self-harm)
1
(Atkinson,
1978; Chandler et al., 2016); considering suicide requires reflection on the role and nature of
individual agency and social structure; of rationality, reason and their potential opposites
irrationality, perhaps madness. Other dualisms are enrolled in debates about suicide: nature
and culture, the biological and the social (Giddens, 1965). The contributions of sociology and
psychology to the study of suicide are less easily understood as oppositional, or binary,
though this is often how they are described. Durkheim famously used his study of suicide to
demonstrate the importance of sociological theory and method in understanding a practice
that was otherwise understood as depending “on individual factors, thus belonging to
psychology alone” (1951: p. 46). In this paper I chart some of the ways in which sociological
and psychological work on understanding suicide diverges, but also key ways in which it
intersects. I will argue that research and theory in each discipline necessarily borrows from
the other. As such, considering sociological and psychological suicide research in tandem
rather unsettles disciplinary boundaries, even as those working in each of these fields often
seek to affirm them.
By way of a case study, I draw on a report which I contributed to, commissioned and
published by Samaritans (a UK based charity which runs a helpline, and is engaged in suicide
prevention), which sought to highlight and understand socioeconomic inequalities in suicide
in the UK (Samaritans, 2017). The report incorporated chapters written by academics
working in economics, geography, social policy, health psychology and sociology. Each
sought to enrol their disciplinary expertise in understanding and responding to socioeconomic
inequalities in suicide. Contrasting the contributions from health psychology (Kirtley &
O'Connor, 2017) and sociology (Chandler, 2017) facilitates an examination of some
similarities, differences and intersections between and within the disciplines. I highlight two
common features: firstly, quantitative methods are privileged in each discipline, restricting
the ability of either to theorise the relationship between the statistical ‘shape’ of suicide –
whether in terms of population-based rates, or aggregate risk factors and individual

2
experience (Hjelmeland & Knizek, 2010). Secondly, I suggest that, again in each discipline,
emotions or feelings such as shame tend to be conceptualised in potentially limiting ways:
superficially described, or reduced to quantitative measures which are connected only loosely
to social and cultural contexts, rather than theorising these as deeply intertwined (Burkitt,
2014).
The curious position of sociology in suicide research
Emile Durkheim’s Le Suicide (1952) has a particular status within sociology for
demonstrating the relevance of sociological methods and theory in understanding a
phenomenon that had been viewed as individual and psychological (Fincham et al., 2011;
Fitzpatrick et al., 2015; Marsh, 2010). However, as Bryant and Garnham (2015) note, it is
perhaps surprising given this early and prominent sociological intervention that contemporary
approaches to understanding suicide tend to be overwhelmingly individualistic. Sociological
research addressing suicide in the late 20
th
and early 21
st
centuries remains a curiously niche
endeavour (Abrutyn & Mueller, 2014: p. 347; Recker & Moore, 2016; Scourfield et al.,
2012). A review of publications in mainstream sociology journals in the US found that only
3% addressed suicide (Wray et al., 2011). Conversely, within suicidology journals an
ostensibly multidisciplinary field psychiatric and psychological research dominates,
quantitative approaches are privileged, and sociological work is in a clear minority (Abrutyn
& Mueller, 2014; Hjelmeland, 2015; Hjelmeland & Knizek, 2016; Marsh, 2010).
Where sociology does address suicide, there is a great tendency to draw on Durkheim, despite
a number of serious critiques being levelled at his theories in the 20
th
Century (Douglas,
1967; Stack, 1982). This close affinity with Durkheimian sociology may explain in part the
propensity towards the development of functionalist models, and reliance on quantitative
methods (Gove, 1972; Stack & Wasserman, 2009). Recent work by Abrutyn and Mueller
(2014; 2016), and Braswell and Kushner (2012), is notable in attempting to build creatively
on Durkheim’s work; with Abrutyn and Mueller in particular advocating for the relevance of
Durkheim’s typology to researching the ‘socioemotional foundations’ of suicide. However,
their ‘microsociological view’ retains the functionalist spirit of Durkheim’s original typology,
arguing for an extension and elaboration of Durkheim’s original insights. Further, while
Abrutyn and Mueller have begun to incorporate interpretive approaches in more recent work
(Mueller & Abrutyn, 2016), at times they maintain a cautious distance from qualitative
empirical research referring, for instance, to the “shaky” nature of qualitative data (Abrutyn

3
& Mueller, 2014, p. 332), whilst nonetheless acknowledging the need for qualitative suicide
research (p. 345).
As sociologists working on suicide readily acknowledge (Abrutyn, 2017), the study of suicide
in the late 20
th
and early 21
st
centuries is overwhelmingly dominated by ‘psy’ sciences and by
biology seeking answers to suicidal ‘impulses’ and ‘risk profiles’ in genetics, epigenetics,
hormones, neurochemicals and synapses (Hjelmeland & Knizek, 2016). This biological
tendency is undoubtedly related to the dominance of psychiatry within the multidisciplinary
field of suicidology (Marsh, 2010), and to the concomitant valorisation of biological,
neurobiological, and genetic research in psychiatry (Insel, 2014; Pickersgill et al., 2013;
Rose, 2013). However, as Pickersgill (2011) has noted in relation to psychiatry and
personality disorder, psychiatric understandings and responses to distress may incorporate
‘surprising commitments’ to the social and the psychological. In this paper, I seek to excavate
and critique similarly ‘surprising’ commitments in both sociological and psychological work
addressing suicide and socioeconomic inequalities.
Suicide and self-harm are acts which directly engage the social, psychological and biological,
unsettling attempts to demarcate distinctions between these (Fitzpatrick et al., 2015).
However, despite this, much suicide research continues to operate in disciplinary silos. By
focusing on psychological and sociological attempts to understand the relationship between
socioeconomic inequalities and suicide, I demonstrate some of the significant promise of
more ambitious interdisciplinary endeavours. As such drawing on Fitzgerald et al.’s recent
call for a ‘revitalization’ of sociology, I argue that a similar ‘revitalization’ of suicidology is
required one which enrols psychology, sociology and other disciplines in working together
to understand the ‘mutual entanglements’ of bodies, minds, cognitions, emotions, social and
cultural contexts, in which suicides take place, are experienced, understood and given
meaning (Fitzgerald et al., 2016). My arguments can be situated within the emergent field of
‘critical suicide studies’ which works towards complexity, creativity and nuance in suicide
research (White et al., 2016).
Socioeconomic contexts of suicide and self-harm
Although there are debates around measurement, in the UK people living in areas of
socioeconomic deprivation, who are themselves relatively socioeconomically deprived, are at
higher risk of death by suicide, and higher risk of hospitalisation following self-harm, than
those living in more affluent circumstances (Mok et al., 2012; Platt, 2011; Platt et al., 2005).

4
Historically, rates of suicide have fluctuated, and following Durkheim’s original arguments
in many cases these can be associated at least superficially with changing economic
circumstances (Baudelot & Establet, 2008). While Durkheim originally argued that suicides
were concentrated among the more affluent, with poverty a ‘protective factor’, Baudelot and
Establet note that the evidence for this is far from clear (2008, p. 141). In part, this relates to
the limited nature of available historical data. What data is available appears to suggest
higher rates of suicide amongst both the very poor and the very affluent. However, in the
latter half of the 20
th
century, this has shifted: “Suicide no longer haunts the more affluent
section of society, and is now concentrated amongst the poorest and the most fragile”
(Baudelot and Establet 2008 p. 147). Epidemiological studies of suicide in the UK suggest
that higher rates of suicide among poorer groups can be related to unemployment, job
insecurity, housing insecurity, debt, and the impact these experiences have on mental health
and substance use (Coope et al., 2014; Gunnell et al., 2003; Haw et al., 2015).
The picture is similar, though perhaps more contested, with self-harm
2
. Measuring rates of
self-harm is challenging, as most acts of self-harm are not clinically treated, and one of the
more prevalent self-harming practices (self-cutting) is generally viewed as ‘hidden’
(Chandler, 2018). Nevertheless, data has been collected in some UK hospitals for several
decades, providing longitudinal data regarding rates of hospital treated self-harm (Geulayov
et al., 2016). Such cases are usually overdoses (70-80%), though include other acts such as
self-cutting, burning, jumping from heights, and hanging. As with suicide, rates of hospital
treated self-harm are higher in poorer areas, and rose following the 2008 recession (ibid). A
review of data regarding General Practice presentations found a similar pattern, with rates of
recorded self-harm higher among patients presenting to practices in areas of deprivation (Carr
et al., 2016).
Despite the frequent identification of socioeconomic contexts as ‘risk factor’ in suicides,
mainstream suicide research and prevention efforts have tended not to engage with this (Platt,
2011). Further, in much sociological work, there is a similar perhaps more curious
disengagement from investigating the role of socioeconomic contexts in suicidal practices.
For instance, Wray et al’s (2011) review of studies of suicide in US sociology journals
addresses socioeconomic context or markers only briefly, factors that are ‘controlled’ for in
studies of race and suicide. Stack’s comprehensive, two-part review (Stack, 2000a; Stack,
2000b) of sociological research on suicide includes a section on ‘economic approaches’ to
understanding suicide. Stack includes a number of interesting suggestions regarding how

Citations
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01 Jan 2020
TL;DR: In this paper, the integrated motivational-volitional (IMV) model of suicidal behavior is proposed to predict suicidal ideation and the transition from suicide ideation to suicidal behavior.
Abstract: Suicide is a major public health concern accounting for 800 000 deaths globally each year. Although there have been many advances in understanding suicide risk in recent decades, our ability to predict suicide is no better now than it was 50 years ago. There are many potential explanations for this lack of progress, but the absence, until recently, of comprehensive theoretical models that predict the emergence of suicidal ideation distinct from the transition between suicidal ideation and suicide attempts/suicide is key to this lack of progress. The current article presents the integrated motivational–volitional (IMV) model of suicidal behaviour, one such theoretical model. We propose that defeat and entrapment drive the emergence of suicidal ideation and that a group of factors, entitled volitional moderators (VMs), govern the transition from suicidal ideation to suicidal behaviour. According to the IMV model, VMs include access to the means of suicide, exposure to suicidal behaviour, capability for suicide (fearlessness about death and increased physical pain tolerance), planning, impulsivity, mental imagery and past suicidal behaviour. In this article, we describe the theoretical origins of the IMV model, the key premises underpinning the model, empirical tests of the model and future research directions. This article is part of the theme issue ‘Evolutionary thanatology: impacts of the dead on the living in humans and other animals'.

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TL;DR: In this paper, the authors argue that critical phenomenology, informed by critical race and intersectional scholarship, offers a useful lens through which to consider suicide and self-harm among men.
Abstract: In this article I argue that critical phenomenology, informed by critical race and intersectional scholarship, offers a useful lens through which to consider suicide and self-harm among men. To ill...

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Cites background from "Socioeconomic inequalities of suici..."

  • ...In the UK, the US and other minority world contexts, male suicide rates are between three and five times higher than women’s (Payne, Swami, & Stanistreet, 2008), a topic which has garnered significant concern, framed in some cases as a ‘crisis’ (Jordan & Chandler, 2019)....

    [...]

  • ...However, gendered understandings of suicide and self-harm are intriguingly resilient (Jordan & Chandler, 2019; Scourfield, 2005)....

    [...]

  • ...Existing sociological research addressing suicide among men is characterised by a concern with the impact of hegemonic masculinity (Abrutyn & Mueller, 2018; Cleary, 2012; Fincham et al., 2011; Garcia, 2016; Reeves & Stuckler, 2016)....

    [...]

  • ...Most research addressing suicide – including within sociology – has employed quantitative methods, quite far removed from what might be understood as the ‘lived experience’ of suicide/self-harm (Abrutyn & Mueller, 2014; Chandler, 2019; Wray, Colen, & Pescosolido, 2011)....

    [...]

  • ...Despite a long history within sociology, the study of suicide and self-harm remains a relatively marginal activity among sociologists, and in the allegedly interdisciplinary field of suicidology (Chandler, 2019)....

    [...]

Journal ArticleDOI
TL;DR: The temporal increases in incidence rates of self-harm among adolescents observed in some Western European countries experiencing major economic recession were not observed in Denmark, suggesting restricted sales of analgesics, access to dedicated suicide prevention clinics, higher levels of social spending and a stronger welfare system may have protected potentially vulnerable adolescents.
Abstract: Studies conducted in the UK and in Ireland have reported increased rates of self-harm in adolescent females from around the time of the 2008 economic recession and through periods of subsequent national austerity programme implementation. It is not known if incidence rates have increased similarly in other Western European countries during this period. Data from interlinked national administrative registers were extracted for individuals born in Denmark during 1981–2006. We estimated gender- and age-specific incidence rates (IRs) per 10,000 person-years at risk for hospital-treated non-fatal self-harm during 2000–2016 at ages 10–19 years. Incidence of self-harm peaked in 2007 (IR 25.1) and then decreased consistently year on year to 13.8 in 2016. This pattern was found in all age groups, in both males and females and in each parental income tertile. During the last 6 years of the observation period, 2011–2016, girls aged 13–16 had the highest incidence rates whereas, among boys, incidence was highest among 17–19 year olds throughout. The temporal increases in incidence rates of self-harm among adolescents observed in some Western European countries experiencing major economic recession were not observed in Denmark. Restrictions to sales of analgesics, access to dedicated suicide prevention clinics, higher levels of social spending and a stronger welfare system may have protected potentially vulnerable adolescents from the increases seen in other countries. A better understanding of the specific mechanisms behind the temporal patterns in self-harm incidence in Denmark is needed to help inform suicide prevention in other nations.

20 citations

References
More filters
Journal ArticleDOI
TL;DR: An issue concerning the criteria for tic disorders is highlighted, and how this might affect classification of dyskinesias in psychotic spectrum disorders.
Abstract: Given the recent attention to movement abnormalities in psychosis spectrum disorders (e.g., prodromal/high-risk syndromes, schizophrenia) (Mittal et al., 2008; Pappa and Dazzan, 2009), and an ongoing discussion pertaining to revisions of the Diagnostic and Statistical Manuel of Mental Disorders (DSM) for the upcoming 5th edition, we would like to take this opportunity to highlight an issue concerning the criteria for tic disorders, and how this might affect classification of dyskinesias in psychotic spectrum disorders. Rapid, non-rhythmic, abnormal movements can appear in psychosis spectrum disorders, as well as in a host of commonly co-occurring conditions, including Tourette’s Syndrome and Transient Tic Disorder (Kerbeshian et al., 2009). Confusion can arise when it becomes necessary to determine whether an observed movement (e.g., a sudden head jerk) represents a spontaneous dyskinesia (i.e., spontaneous transient chorea, athetosis, dystonia, ballismus involving muscle groups of the arms, legs, trunk, face, and/or neck) or a tic (i.e., stereotypic or patterned movements defined by the relationship to voluntary movement, acute and chronic time course, and sensory urges). Indeed, dyskinetic movements such as dystonia (i.e., sustained muscle contractions, usually producing twisting and repetitive movements or abnormal postures or positions) closely resemble tics in a patterned appearance, and may only be visually discernable by attending to timing differences (Gilbert, 2006). When turning to the current DSM-IV TR for clarification, the description reads: “Tic Disorders must be distinguished from other types of abnormal movements that may accompany general medical conditions (e.g., Huntington’s disease, stroke, Lesch-Nyhan syndrome, Wilson’s disease, Sydenham’s chorea, multiple sclerosis, postviral encephalitis, head injury) and from abnormal movements that are due to the direct effects of a substance (e.g., a neuroleptic medication)”. However, as it is written, it is unclear if psychosis falls under one such exclusionary medical disorder. The “direct effects of a substance” criteria, referencing neuroleptic medications, further contributes to the uncertainty around this issue. As a result, ruling-out or differentiating tics in psychosis spectrum disorders is at best, a murky endeavor. Historically, the advent of antipsychotic medication in the 1950s has contributed to the confusion about movement signs in psychiatric populations. Because neuroleptic medications produce characteristic movement disorder in some patients (i.e. extrapyramidal side effects), drug-induced movement disturbances have been the focus of research attention in psychotic disorders. However, accumulating data have documented that spontaneous dyskinesias, including choreoathetodic movements, can occur in medication naive adults with schizophrenia spectrum disorders (Pappa and Dazzan, 2009), as well as healthy first-degree relatives of chronically ill schizophrenia patients (McCreadie et al., 2003). Taken together, this suggests that movement abnormalities may reflect pathogenic processes underlying some psychotic disorders (Mittal et al., 2008; Pappa and Dazzan, 2009). More specifically, because spontaneous hyperkinetic movements are believed to reflect abnormal striatal dopamine activity (DeLong and Wichmann, 2007), and dysfunction in this same circuit is also proposed to contribute to psychosis, it is possible that spontaneous dyskinesias serve as an outward manifestation of circuit dysfunction underlying some schizophrenia-spectrum symptoms (Walker, 1994). Further, because these movements precede the clinical onset of psychotic symptoms, sometimes occurring in early childhood (Walker, 1994), and may steadily increase during adolescence among populations at high-risk for schizophrenia (Mittal et al., 2008), observable dyskinesias could reflect a susceptibility that later interacts with environmental and neurodevelopmental factors, in the genesis of psychosis. In adolescents who meet criteria for a prodromal syndrome (i.e., the period preceding formal onset of psychotic disorders characterized by subtle attenuated positive symptoms coupled with a decline in functioning), there is sometimes a history of childhood conditions which are also characterized by suppressible tics or tic like movements (Niendam et al., 2009). On the other hand, differentiating between tics and dyskinesias has also complicated research on childhood disorders such as Tourette syndrome (Kompoliti and Goetz, 1998; Gilbert, 2006). We propose consideration of more explicit and operationalized criteria for differentiating tics and dyskinesias, based on empirically derived understanding of neural mechanisms. Further, revisions of the DSM should allow for the possibility that movement abnormalities might reflect neuropathologic processes underlying the etiology of psychosis for a subgroup of patients. Psychotic disorders might also be included among the medical disorders that are considered a rule-out for tics. Related to this, the reliability of movement assessment needs to be improved, and this may require more training for mental health professionals in movement symptoms. Although standardized assessment of movement and neurological abnormalities is common in research settings, it has been proposed that an examination of neuromotor signs should figure in the assessment of any patient, and be as much a part of the patient assessment as the mental state examination (Picchioni and Dazzan, 2009). To this end it is important for researchers and clinicians to be aware of differentiating characteristics for these two classes of abnormal movement. For example, tics tend to be more complex than myoclonic twitches, and less flowing than choreoathetodic movements (Kompoliti and Goetz, 1998). Patients with tics often describe a sensory premonition or urge to perform a tic, and the ability to postpone tics at the cost of rising inner tension (Gilbert, 2006). For example, one study showed that patients with tic disorders could accurately distinguish tics from other movement abnormalities based on the subjective experience of some voluntary control of tics (Lang, 1991). Another differentiating factor derives from the relationship of the movement in question to other voluntary movements. Tics in one body area rarely occur during purposeful and voluntary movements in that same body area whereas dyskinesia are often exacerbated by voluntary movement (Gilbert, 2006). Finally, it is noteworthy that tics wax and wane in frequency and intensity and migrate in location over time, often becoming more complex and peaking between the ages of 9 and 14 years (Gilbert, 2006). In the case of dyskinesias among youth at-risk for psychosis, there is evidence that the movements tend to increase in severity and frequency as the individual approaches the mean age of conversion to schizophrenia spectrum disorders (Mittal et al., 2008). As revisions to the DSM are currently underway in preparation for the new edition (DSM V), we encourage greater attention to the important, though often subtle, distinctions among subtypes of movement abnormalities and their association with psychiatric syndromes.

67,017 citations


"Socioeconomic inequalities of suici..." refers background in this paper

  • ...This issue has recently been played out in discussions regarding the DSM-5 (American Psychiatric Association, 2013) and the inclusion of proposed new diagnoses: Suicidal Behaviour Disorder, and Non-Suicidal Self-Injury (Chandler, 2016)....

    [...]

Book
01 Jan 1897
TL;DR: The suicide is one of the least understandable of human behaviours as discussed by the authors, and suicide makes an immense contribution to our understanding to what must surely be the most understandable of acts in human life.
Abstract: There would be no need for sociology if everyone understood the social frameworks within which we operate. That we do have a connection to the larger picture is largely thanks to the pioneering thinker Emile Durkheim. He recognized that, if anything can explain how we as individuals relate to society, then it is suicide: Why does it happen? What goes wrong? Why is it more common in some places than others? In seeking answers to these questions, Durkheim wrote a work that has fascinated, challenged and informed its readers for over a hundred years. Far-sighted and trail-blazing in its conclusions, Suicide makes an immense contribution to our understanding to what must surely be one of the least understandable of acts. A brilliant study, it is regarded as one of the most important books Durkheim ever wrote.

5,336 citations

Book
01 Jan 2004
TL;DR: In this paper, Ahmed considers how emotions keep us invested in relationships of power, and also shows how this use of emotion could be crucial to feminist and queer political movements Debates on international terrorism, asylum and migration, as well as reconciliation and reparation are explored through topical case studies.
Abstract: This is a bold take on the crucial role of emotion in politics Emotions work to define who we are as well as shape what we do and this is no more powerfully at play than in the world of politics Ahmed considers how emotions keep us invested in relationships of power, and also shows how this use of emotion could be crucial to feminist and queer political movements Debates on international terrorism, asylum and migration, as well as reconciliation and reparation are explored through topical case studies In this textbook the difficult issues are confronted head on New for this edition: a substantial 15,000-word Afterword on 'Emotions and Their Objects' which provides an original contribution to the burgeoning field of affect studies; a revised Bibliography; and updated throughout

5,021 citations


"Socioeconomic inequalities of suici..." refers background in this paper

  • ...In contrast, McDermott and Roen (2016) have drawn on alternative literatures (e.g. Ahmed, 2014; Sedgwick, 2003) to theorize the embodied, affective experiences of grounds....

    [...]

Journal ArticleDOI
TL;DR: In this paper, the authors conceptualize agency as a temporally embedded process of social engagement, informed by the past (in its "iterational" or habitual aspect) but also oriented toward the future (as a projective capacity to imagine alternative possibilities) and toward the present, as a practical-evaluative capacity to contextualize past habits and future projects within the contingencies of the moment.
Abstract: This article aims (1) to analytically disaggregate agency into its several component elements (though these are interrelated empirically), (2) to demonstrate the ways in which these agentic dimensions interpenetrate with forms of structure, and (3) to point out the implications of such a conception of agency for empirical research. The authors conceptualize agency as a temporally embedded process of social engagement, informed by the past (in its “iterational” or habitual aspect) but also oriented toward the future (as a “projective” capacity to imagine alternative possibilities) and toward the present (as a “practical‐evaluative” capacity to contextualize past habits and future projects within the contingencies of the moment).

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"Socioeconomic inequalities of suici..." refers background in this paper

  • ...…understood as ‘one of life’s ultimate acts’ (2015: 937).3 Sociological theory and research continue to grapple with the concept of agency (Burkitt, 2016; Emirbayer and Mische, 1998; McNay, 2008), and reflection on the position of qualitative accounts of suicide and self-harm within suicidology…...

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  • ...…engage in repeated acts of self-harm, and who describe ‘chaotic’ lives in which they feel powerless, categorizing these as embodying ‘restricted agency’, which is primarily iterative (following Emirbayer and Mische, 1998) or akin to Margaret Archer’s ‘fractured reflexives’ (Byng et al., 2015: 948)....

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2,342 citations


"Socioeconomic inequalities of suici..." refers background in this paper

  • ...Sociologically, the status of accounts have long been an issue of importance (Mills, 1940; Scott and Lyman, 1968), and these theoretical and methodological discussions are directly relevant to understanding debates about motives, and the status of accounts about self-harm and suicide (Fincham et…...

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  • ...Sociologically, the status of accounts have long been an issue of importance (Mills, 1940; Scott and Lyman, 1968), and these theoretical and methodological discussions are directly relevant to understanding debates about motives, and the status of accounts about self-harm and suicide (Fincham et al....

    [...]

Frequently Asked Questions (13)
Q1. What are the main themes of the qualitative studies reviewed?

The qualitative studies reviewed also pointed to the importance of attending to early experiences of difficulty – particularly trauma (e.g. childhood sexual, physical or emotional abuse or neglect) and bereavement or loss. 

Socioeconomic disadvantage either accumulates in a person’s life ‘resulting’ in suicide or self-harm; or else it contributes to emotional responses, which similarly ‘result’ in suicide or self-harm. 

Their findings point to an important role for emotions and feelings – for affective evaluations of the self, and how these relate to social contexts. 

As such, the concept of agency has clearrelevance to psychological models of suicidal behaviour (such as O’Connor’s IMV) which engage directly with the role of individual choice and the ability to reflect, and the psychological factors which might mediate this. 

Agency and the ascription of motivation are central to long-standing deliberations regarding the definition of self-harm and suicide (Chaney, 2017; Jaworski, 2014; Millard, 2015). 

while they also frame shame (and self-harm) as hidden and secret, they suggest that when shame becomes visible – when it is acknowledged – it can be felt more intensely. 

Attending to qualitative accounts of self-harm and suicide, and examining how these might contribute to an understanding of the relationship between suicide and socioeconomic inequalities, necessitates a critical examination of agency, and with this, the status of accounts about self-harm and suicide. 

The themes addressed thus far are each liable to result in structurally oriented accounts of the role of socioeconomic disadvantage, which tend to minimise the agency of the person self-harming or dying by suicide. 

This argument underlines the relevance of theoretically informed analyses which draw on both sociological and psychological traditions, in order to inform policy and practice in suicide prevention. 

A further criticism which has been levelled at psychological models of suicide, which draw largely on quantitative evidence, is their linearity, and what Hjelmeland & Knizek refer to as “cause and effect thinking” (2016). 

A significant aspect of Byng et al’s analysis is the role of mastery, and their enrolment of both sociological and psychological theory in seeking to understand the variations between participants reported histories of suicidal thoughts, self-harm, and adversity. 

they note the potential role of stigma for those living with socioeconomic disadvantage, also highlighting evidence that feelings of low self-worth endured even when personal finances improved. 

Like Fullagar (2003), McDermott and Roen note the importance of wider social and cultural contexts in shaping experiences of shame, and in understanding how such affective feelings might relate to self-harm. 

Trending Questions (1)
Are there theories of social and economic inequality as a complex syste,m?

The paper does not explicitly discuss theories of social and economic inequality as a complex system.