Suicide in response to changing societies

The "medical model" is an insufficient explanation for the high suicide rates, but it does not mean that suicide is a different phenomenon in China. A multidimensional model (Fig. 6) is proposed to appreciate better the complexity of the problem, which can be applied to other countries. As in Figure 6, suicide and suicide attempts are conceptualized as a continuum of behaviors. The suicide method may modify the boundaries (i.e., the availability and choice of a lethal method may expand the size of completed suicides and vice versa). The spectrum of behaviors is also under the influence of individual factors, such as psychiatric disorders and personality, and local factors, such as local cultural norms, resources, and familial problems. All of these factors are subject to the influence of greater social forces. For example, psychiatric disorder increases the risk of suicide but is shaped by global forces. In the case of China, the importing of Western values influences the way Chinese people present their idioms of distress. Chinese people who tend to somatize start to psychologize more, [figure: see text] which in turn affects the rates of depression and subsequently the risk of suicide. The various factors also interact with one another. The diagnosis of disruptive and antisocial disorder illustrates how local factors modulate that of the individual. In Diagnostic and Statistical Manual of Mental Disorders, conduct disorder is defined by a series of "socially unacceptable behaviors," including aggression, destruction of property, theft, and violation of rules. Because biologic validity is lacking, the diagnosis (an individual factor) may vary widely in different cultural settings (a local factor). In China, conformity, self-control, and discipline are emphasized; subthreshold cases in the West already may be unacceptable in the Chinese setting and be labeled "disruptive." On the other hand, the cultural emphasis on conformity in the upbringing may reduce the display of such behaviors and lead to a lower prevalence of disruptive and antisocial disorders in China. With globalization, however, the "Chinese" values are more closely identified with the global culture, and a rising trend of personality disorders has been witnessed. The media are some of the powerful agents in transmitting these forces. The medical model of explaining the phenomenon of suicide with psychiatric disorders is not entirely satisfactory. The association of a high suicide rate with a low prevalence of psychiatric disorders in China challenges this conventional view. Rather than refuting this conventional model, the dynamic interaction with local sociocultural factors and global forces is emphasized. Empirical evidence is lacking, however, and should be the focus for future suicide research.