[> -*Research ReportSuicide and Attempted SuicideAmong the SfaonaIt has long been apparent that suicide andattempted suicide are relatively rare in ShonaSociety. It has also been noticed that the usualmethod was by hanging, and that other methodssuch as mutilation were seldom encountered,Rittey and Castle (1972) have analysed theAttorney-General's figures for such deathsamongst Africans and Europeans in Rhodesiaby standardising the rates instead of using cruderates which are usually quoted in this connec-tion. They showed clearly that the rate inAfricans was significantly lower than in Euro-peans. These figures, however, do not tell uswhere the deaths occurred or the reason forthem.The Shona people constitute the largest ethnicgroup of Rhodesia and number about fourmillion. About one million are working in urbanand periurban areas, whilst the rest live in theirtraditional tribal lands under their chiefs, re-latively untouched by the Western world. Eachtribesman is entitled to a sufficient share of theland which may not be alienated. Although theeconomy may not be strictly subsistent, it isfairly traditional: consequently there is relative-ly little material differentiation but a great dealof mutual dependence. Marriage tends to bea very stable institution, and the large size offamilies reinforces a sense of interdependence.This feeling is further strengthened by the patri-lineal structure of Shona society in which mostmales of a tribal grouping are felt to be thedescendents of the original ancestor.This link with ancestors is doubly strong, evenwith those Shona who adhere to Christianity,for protection from the casualties of life is ex-pected from the ancestral spirits (vadzimu).Indeed in the eyes of the Shona no one shoulddie; life is everlasting provided a person doesnot lose the protection of his vadzimu. Exceptperhaps in the aged, death is said to be due tothe loss of protection of these spirits or to thespells of a witch. Suicide is felt to be a mostunnatural death and the Shona explain its rareoccurrence as due to an angry spirit (ngozi) ofa person who was murdered who visits theguilty family in search of revenge, causing onedeath after another until the family agrees tocompensate the bereaved one.It long appeared that among the Bantu-speaking peoples of Africa suicide andattempted suicide were rarer than in westernsociety; but it was only in 1937 that Laubscherdocumented this fact. He circularised magis-trates in the tribal territories in the EasternGape to ascertain the number of cases of suicidereported to their officials during a two-yearperiod. In an area with a population of 868 944there were 14 cases of suicide and fourattempted suicides in two years, giving a rateof less than 1 per 100 000. Laubscher was sostruck by its rarity that he concluded there hadto be some serious psychic despondence beforesuch an act was committed.Similarly Dembowitz (1954) found that thesuicide rate was low among mentally disorderedpeople from West Africa, as did Asuni (1962and 1967) in Nigeria. Asuni's first study wasbased on coroners' reports over a four yearperiod (1957-60) in the Western region of73Nigeria. He divided his cases into two groups,those in the 15-19 years age-group and thosefrom 50 years onwards. Most of them wereof the traditional faith but a few were Muslimor Christian. There were far more male thanfemale cases, and hanging was the most com-mon mode of suicide, accounting for about fiftyper cent of the total cases. The incidence ofsuicide in his series was less than one in 100 000.His second study was on attempted suicide.Over a period of a month he collected 29 casesout of a population of 393 800. Eighteen of themwere male and eleven female. He commentedon the rarity of attempted suicide in this society.No less than thirteen of the subjects had somemental disorder, seven of whom had depressionor schizophrenia. The methods used were in-teresting: 16 slashed their bodies, 10 took drugs,1 tried to hang and 1 to drown.METHODSIt was decided three years ago to study thesubject of suicide and attempted suicide amongRhodesian Africans by interviewing the friendsand relations of all suicides brought to HarareHospital for treatment or autopsy. Also inter-viewed were those patients who had been ad-mitted for attempted suicide, as well as theirrelatives and close friends who appeared withthem. As far as is known, this approach hasnot been tried before. Harare Hospital is in afortunate position in this regard as it is theonly one in which autopsies are performed fora large area of Mashonaland and anyone whohas attempted to kill himself is brought in to'outpatients' for emergency treatment. It is truethat not every person who has attempted suicideis brought in, but generally such cases are rushedto this central hospital. In addition to the assist-ance from the families concerned, valuable in-formation was obtained from the Africanpolicemen who brought them to hospital. Thesemen invariably went out of their way to checkinformation or follow up points that neededto be clarified.This investigation began in July 1970, andalthough it is still continuing, all the cases thatappeared to the end of June 1972, are sur-veyed in this research report. At the same time,the superintendent of the European Hospital inSalisbury supplied the figures and details ofcases of attempted suicide brought to the Casu-alty Department there in order to evaluate anydifference in frequency over the same periodbetween the two races.RESULTSSuicides (mainly urban)For the period July 1970, to the end ofJune 1972, forty-four cases of suicide weredealt with at the mortuary at Harare Hospital.Thirty-nine of these were male (88 per cent)and five female. Thirty-six of these cases (82 percent) were connected with an urban or Euro-pean environment, having lived either in atownship or close by on a European farm; andonly eight came from more traditional environ-ments in Tribal Trust Lands. However, onlyone of the forty-four was an educated person,and all the others were more traditional inoutlook despite the fact that most of themlived in an urban area or in close contact withone.In analysing these cases, no particularseasonal variation is noticeable. The mostcommon means of suicide was hanging (38, i.e.,86 per cent) ; 2 jumped from heights, 1 wasrun over by a train, 1 died by fire, 1 by drown-ing and 1 was gassed. In thirteen of the cases,it was not possible to find a cause; in each ofthese, the individual was reported as beingnormal and the relations and friends knew ofno factor that seemed to be responsible. Thefollowing table records the possible reasons forthe suicides:Table ICAUSATIVE FACTORS IN FORTY-FOURSUICIDES IN SALISBURY AND REGIONReason NumberWife/husband difficulties 4Boy/girl troubles 1Debt (gambling) 6Fear of consequences of some action (e.g.,police arrest) 4Physical illness 3Possible physical illness 1Mental illness 5Possible mental illness 2Witchcraft accusation 2Drink 1Possibly drink 1Tired of life "' 1No apparent reason 13TOTAL 44For the thirty-six cases connected with anurban or peri-urban environment, it is possibleto analyse ages accurately. The great majoritywere between 20 and 50 years of age. Theyoungest case was sixteen years of age, andthere were three over seventy who were res-74pectively ill, bereaved and tired of living. Innone of these cases was there evidence ofprevious attempts:liable IIAGE OF THIRTY-SIX SUICIDES IN SALISBURYURBAN OR PERIURBAN AREAYears of Age Number0- 9 010-19 220-29 830-39 1440-49 .650-59 260-69 170-79 280 and over 1Of these cases, five were foreign Africans, threefrom Malawi and two from Mozambique.Suicides in Tribal Trust LandsDuring this period attention was also givento the number of deaths in Tribal Trust Lands,where the people live with what can be re-garded as a largely traditional outlook. Figureswere obtained from the districts of Katarere,Wedza and Cinarnora.At Katarere in the North Inyanga area nearthe Mogambique border, with a population ofabout 40 000 people, there appeared to havebeen four suicides between the years 1968 and1972 (three men and one woman). The cruderate was 2,5 deaths per 100 000.The information from Wedza was more de-tailed. Between 1964 and 1971, in an area witha population of 45 000, eleven suicides wererecorded (crude rate 3,49 per 100 000). Ofthese cases, seven were male and four female.Nine hanged themselves and two died by fire.Six of the suicides occurred in the cold monthsof the year and three in the warm weather. Theages of the males ranged from 16 to 60 yearsand in the females from 28 to 50 years. Thealleged reasons for suicide are as follows:Table IIISUICIDES IN WEDZA (1964-1971)Domestic disputes 4Mental illness 2Possible depression 1Physical illness 1Accusations of adultery 1No apparent reason 2TOTAL 11At Cinhamora, about 30 miles from Salis-bury, with a population of 19 000, six cases ofsuicide were reported to the chief Š threemale and three female (crude rate 5,26). Thefollowing table gives details about these sixcases (1966-1972) :Table IVSUICIDES IN CINHAMORASex Age Method ReasonMale 44 Hanging Said he was falsely ac-cused of hiding thenames of people whohad burnt the Chief'shouseMale 18 Hanging Eloped with a girl andhis family would notallow him to live withher in his areaFemale 38 Hanging Scolded by her husbandFemale 16 Hanging Not allowed to marryher loverMale 32 Hanging Embezzlement of moneyat Post OfficeMale 51 Hanging After murdering his twowivesComparison of Suicide RatesThe crude suicide rate in Salisbury with anAfrican population of approximately 320 000and 36 cases in two years was 5,6 per 100 000,whereas that in the three Tribal Trust Lands(with a total population of 105 000) was 3,4.It would thus appear that, allowing for thedifficulties in comparing the urban and rural-populations, there is no significant increasestatistically in the suicide rate in the urbanareas.Attempted Suicide in the Salisbury AreaThirty-five people were examined in theperiod in which this study was undertaken.Twenty-nine were female and six male. Thirtycame from an urban environment and five froma traditional or rural one. They appeared to beof a younger age group than those whosucceeded in committing suicide. Thirty-five(66 per cent) were below 30 years of age incontrast to 15 (34 per cent) out of 44 suicides.Table VATTEMPTED SUICIDES IN SALISBURY AREA(July 1970-June 1972)Number whoMethod employed itTablets 6Swallowed noxious agent (dettol, javel,needle, glass, caustic soda 19Hanging 6Cut throat 2Set on fire 1Jumping from height , 175Thirteen of this series had a fairly good edu-cation. Polygamous marriages had a bearingon three of the attempted suicides. One, anursing sister, attempted to end her life whenher husband took another wife. Another wo-man, a second wife, attempted suicide becauseshe was jealous of the first wife. A husbandtried to take his life when he found his secondwife in bed with another man. Infidelity or asexual reason was responsible for 16 out of the35 attempts, and fourteen of them were single.Drink might have been a factor in one case ofattempted suicide, but in this instance there wasalso argument over the bride-price.Attempted Suicide in Rural AreasAttempted suicide appears to be very rarein traditional areas; and this Is confirmed byvarious sources of information Š the medicalprofession, missionary bodies, and Africansworking at the Chiefs court (dare). In theseareas, only one case was traced.Table VTATTEMPTED SUICIDES IN RURAL AREASSources ofInformationDr. MacintoshDr. Brien andSister DoloresChiefs DareAreaWedzaKatererePeriod1964-71Number0CinhamoraTOTAL1968-721966-721Comparison of Attempted Suicide RatesIn the Salisbury urban and periurban areasthere were thirty cases of attempted suicide,if one excludes the five brought into Hararefrom the countryside. The crude rate, there-fore, was 4,7 per 100 000. This shows how verymuch greater was the occurrence of attemptedsuicide in the urban areas.For comparative purposes the figures forattempted suicides amongst Europeans, werealso obtained. As the Salisbury Central Hospi-tal is the only centre catering for such emer-gencies its figures provide a good idea of theextent of its occurrence in European society.The European population of Greater Salisburyis 105 000 as compared with 320 000 Africans.In the year 1970 the number of patients ad-mitted to the Outpatients Department, having,attempted suicide was 59 (40 female and 19male). Tablets were taken (mostly barbitu-rates, tranquillizers or aspirins) by 49; of theremainder, 3 attempted suicide by gunshot, 4by slashed wrists, 1 by stab wounds of abdo-men and 2 by carbon monoxide (B. Laidler,Personal Communication, Salisbury CentralHospital). This represents an attempted suiciderate of about 56 per 100 000 for Europeans, andis to be compared with the African rate inSalisbury of 4,7 per 100 000.DISCUSSIONThe traditional Shona are aware of the occur-rence of suicide and attempted suicide. InShona mythology we learn the story of Van-yamita, the great tribal spirit of the people ofthe Mangwende Tribal Trust Land. Untoldyears ago, when she was alive on this earth,she married but bore no children. She pinedfor some of her own. Her husband's otherwives were more fortunate and Vanyamitagave their children the loving care of a mother.She grew very fond of them and they of heruntil their own mothers became jealous of thelove they bore her and they were removed fromall contact with her. One day Vanyamita andthe children disappeared. People hunted forthem until eventually they were drawn to alarge pool of water, on the surface of whichfloated the bodies of Vanyamita and the twolittle girls, whose hands were still clasped inhers. Today the clansmen of Mangwende stillgo to the pool of Vanyamita every year to prayto their guardian spirit.Nevertheless in the traditional background ofthe Shona, suicide and attempted suicide areuncommon. The more traditional the people,the more attached they are to their ancestors,the greater are the bonds between them andtheir living families and the less these tra-gedies occur. When the senior tribal mediumat Katarere was asked about the occurrence ofthe occasional suicide in his area, he repliedthat in former days it was very rare but nowa-days, because people are unable to move fromone piece of land to another when the first hasbeen worked out, the problems arising fromland shortage may, on occasions, result in sui-cide amongst the Shona.The other explanation for suicide, mentionedearlier, that it is due to an aggrieved spirit orngozi is still universally believed in traditionalsociety, although when Shona put an end totheir lives, the same factors exist that are foundin Western Society. For, living in tribal con-ditions is not necessarily free of want or anxiety,and rural people are as liable to have argu-76Ł* 4ments and disappointments as those who live ina western environment or influence. Hence theappearance in the Tables as causes of suicide, ofillness (especially mental), acute anxiety dueto loss of wealth or debt, upsets between a maleand a female, quarrels, old age and wearinessof life. In fact no real difference in causationbetween the two races can be seen, and it isinteresting to note that more males than fe-males commit suicide in Shona society as inwestern society. It can be argued that in thetribal lands, weapons and instruments of deathare less available than in the towns, wheredrugs, carbon monoxide and weapons are morehandy than in isolated places. This may wellbe a factor; yet sharp instruments, like knives,are procurable and fire, pools of water andheights from which to jump are not rare.This study shows that the risk of suicide ofthe urban Shona is not significantly differentfrom the rural Shona living in a, more tradition-al background. This does not mean that thenumbers will not grow, for, just as happenedwith the American Negro, one can expect farmore cases as the links with their traditionalbackground lessen and disappear. At the pres-ent time almost all the Shona in the Salisburyurban area have close links with the tribalareas and there is a constant to and fro move-ment between the urban and rural areas.The causes of suicide amongst Africantownsmen are much the same as in townselsewhere in the world, except that very fewhave previously attempted to take their lives.Again a few seem to have had mental disorderslike depression. In the European, alcoholismfigures fairly predominantly but in the Shonait does not appear to be important.The large number of cases (1.3) in whomthere appeared to be no reason for the takingof life is of interest. The relations and friendswere surprised at what had happened; no onesuspected that anything was wrong, even upto the last time they saw them. There is noobvious explanation for this, but Carothers(1948) refers to the episodes of attemptedsuicide as a cultural factor which he terms'frenzied anxiety', in which those attemptingsuicide are of quiet disposition and their aggres-sion is turned inwards. Perhaps this state maydevelop suddenly in one living in a new environ-ment, different to the one he knew.Lambo f 1962) speaks of a 'malignant anxi-ety' which appears to be very similar to the'frenzied' one of Carothers. However, in thecases in which the cause of suicide was notknown, there was no account of a precedingstate of frenzy or acute mental confusion. Butthis acute disturbance in which an individualmay run amok is well known, and there is onrecord a case of attempted suicide in a youngman who believed he was possessed by hisancestral spirit (Gelfand, 1971),The obvious increase in the number ofattempted suicides in the towns, compared tothe number in rural and traditional areas ofRhodesia, shows that the urban pattern isassuming a similar picture to that in Westernsociety in which younger persons, usually fe-male, involved in some of the acute problemsto which people of this age are exposed, tryto take their lives. Disappointments in love,arguments between husband and wife, mainlyover fidelity and relative matters, seem to bethe most pressing of these problems. Attemptsor repeated attempts by those suffering from amental aberration are apparently rare. Themarked difference in the two series is neverthe-less surprising. In suicides the cases are mostlymale and of an older age group, whereasattempted suicide occurred mainly in a youngergroup, mostly in females. Except for a fewwho resort to the rope, it seems likely that mostof the attempted suicides do not really wantto die.In traditional Shona society living in its ownhomelands, we find a very integrated society inwhich the group is united by a common pur-pose. If the members of a community arestrongly bound to it and therefore to each other,the integration is deep. But if an individual isinadequately associated with the others, in tak-ing part in the institution, he is said by Durk-heim to be in a position of anomy (lawlessness)and if such a person takes his life, this is whatDurkheim refers to as anotnic suicide. PerhapsDurkheim's law of suicide might be quotedhere: 'Suicide varies inversely with the degreeof integration of the original groups of whichthe individual forms a part'. Therefore wemight well explain the rise in attemptedsuicides in Shona society by the growth ofwestern environment, pressures, especially in-dividualism, the introduction of a new economywith which the African must comply, and theloss of their association with a stable integratedgroup of people. The more this process pro-gresses, the more attempts at suicide can be77expected. Even in the present situation inRhodesia, suicide and attempted suicide aremuch less in the African than in the whiteman, but the more complete the break withthe traditional background, the more of thesetragedies are likely to occur.SUMMARY.1. Although suicide is significantly less amongthe Shona-speaking people than in Euro-pean society, no significant difference in thesuicide rate between the Shona living in theSalisbury urban and periurban area andthose in three selected Tribal Trust Landswas found.2. The number of cases of attempted suicidewas far more common in Salisbury than inthe selected Tribal Trust Lands.3. The frequency of attempted suicide amongthe European population of Salisbury wassignificantly greater than among that of theShona.4. Reasons for these differences are discussed.REFERENCESASUNI, T. 1962 Suicide in Western Nigeria. Brit. Med. ]., (ii), 1091-7.1967 Attempted Suicide in Western Nigeria. West. Afr. Med. J., 16, (N.S.), 51-4.BOHANNAN, P. 1960 African Homicide and Suicide. Princeton (N.J.), Princeton University Press.CAROTHERS. J. C. 1948 Frenzied Anxiety. /. Merit. ScL, 93, 548-97.DEMBOVITZ.' N, 1945 Psychiatry amongst West African Troops. /. Roy. Army Med. Corps., 84, 70-4.DURKHEIM, E. 1952 Suicide: a Study in Sociology. London, Routledge & Kegan Paul, p. 209.GELFAND, M. 1969 The Shona Mother and Child. NADA, 10, 76-80.1971 An Attempt at Suicide. C. Afr. J. Med., 17, 57-8.LAMBO, T. A. 1962 Malignant Anxiety. A Syndrome Associated with Criminal Conduct in Africans. /.Ment. ScL, 108, 256-63.LAUBSCHER, B. J. F. 1937 Sex, Custom and Psychopathology. London, Routledge & Kegan Paul.RITTEY, D. A. W. and CASTLE, W. M, 1972 Suicides in Rhodesia. C. Afr. J. Med. 18, 97-100.University of RhodesiaM. GELFAND4 A.78