Australian and New Zealand Journal of Psychiatry http://anp.sagepub.com/
Time for change: Homicide bombers, not suicide bombers Robert D Goldney Aust N Z J Psychiatry 2014 48: 579 originally published online 16 April 2014 DOI: 10.1177/0004867414532552 The online version of this article can be found at: http://anp.sagepub.com/content/48/6/579
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532552 research-article2014
ANP0010.1177/0004867414532552ANZJP CorrespondenceRD Goldney
Commentaries Australian & New Zealand Journal of Psychiatry 2014, Vol. 48(6) 579–584
Commentaries
© The Royal Australian and New Zealand College of Psychiatrists 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav anp.sagepub.com
Time for change: Homicide bombers, not suicide bombers Robert D Goldney Discipline of Psychiatry, University of Adelaide, Adelaide, Australia Corresponding author: Robert D Goldney, Discipline of Psychiatry, University of Adelaide, Adelaide, SA 5005, Australia. Email: [email protected] DOI: 10.1177/0004867414532552
The paper of Bou Khalil (2014) is an important reminder of the complexity of the issues involved in analysing and understanding what have been referred to as ‘suicide bombers’. This term has entered our lexicon on the obvious basis that although the prime aim may have been the killing of others, the individual perpetrator dies. Indeed, over the last three decades the media, the general public and sometimes the scientific community have uncritically used the words ‘suicide bomber’ to describe the deaths of those who kill others – sometimes a few, usually 10 to 20, or, in the case of 9/11, about 2000 – while at the same time killing themselves. Like many areas of human behaviour, these actions have been subjected to rigorous investigation in addition to that provided by Bou Khalil (2014), and it is timely to reflect on the findings. Detailed studies have generally shown that there is little in common with those who die by suicide, using ‘suicide’ in its historically clinically accepted sense.
For example, in an early review in 2007, Townsend concluded that available evidence demonstrated that so-called ‘suicide bombers’ had a range of characteristics which on close examination were not truly suicidal, and that attempting to find commonalities between them and those who died by suicide was likely to be an unhelpful path for any discipline wishing to further understand suicidal behaviour (Townsend, 2007). Furthermore, in 2009, Post and his colleagues referred to the ‘normality’ and absence of individual psychopathology of suicide bombers (Post et al., 2009). Other researchers have reported similar findings, although it is fair to acknowledge that Merari (2010) has expressed contrary views which have stimulated spirited and at times acrimonious debate (Brym and Araj, 2012), and there is the recent polemical work of the English literature graduate Lankford (2013), which has urged for these persons to be considered as mentally unwell. From the point of view of experienced clinical psychiatrists, the usual feelings of hopelessness and unbearable psychic pain, along with selfabsorption and restriction of options in those who are suicidal, are the antithesis of terrorist acts, and mental disorders do not appear to be a prominent feature. In fact, suicidal intent is usually specifically denied by ‘suicide bombers’, as it is proscribed by most religions, including Islam and Christianity. Indeed, Islam condemns suicide as a major sin with committers denied entry to heaven, and, as it is implied that the act of a ‘suicide bomber’ results in a shorter path to
heaven, this would not be achieved if suicide intent was present. Is this focus on the words used simply an academic distraction, or could it be important? It is pertinent to recall the saying that ‘the pen is mightier than the sword’, attributed to Cardinal Richelieu by Edward Bulwer-Lytton in his 1839 play, which has entered our everyday language. My colleagues, fellow psychiatrist Murad Khan of the Aga Khan University and sociologist Riaz Hassan of Flinders University, who has collated the largest database in the world of such acts (Hassan, 2010), and I are mindful of that saying and believe that the words do matter. We discussed this in more detail in the Asian Journal of Social Science (Khan et al., 2010). It has long been recognized that inappropriate publicity promotes further suicide, and Littman (1985) noted that the more there is any reporting of suicide, the more there is a tendency for it to be normalized as an understandable and reasonable option. That being so, repeated use of the term ‘suicide bomber’ runs the risk of normalizing such behaviour, simply because of the frequent use of these words. A logical extension of Bou Khalil’s paper is to address the issue of terminology again. Although the word ‘homicide’ is not entirely accurate because of the political/military context in which these deaths occur, it is more appropriate than the continued use of the word ‘suicide’. Furthermore, it has the potential to modify this behaviour. Thus, whereas suicide is often portrayed as being altruistic in these
Australian & New Zealand Journal of Psychiatry, 48(6)
Downloaded from anp.sagepub.com at UNIV OF IDAHO LIBRARY on August 24, 2014
580 circumstances, there is nothing glamorous or idealistic about homicide. Clearly there is no simple answer to what has occurred increasingly over the last decades. However, by the use of the words ‘homicide bomber’ a gradual change in the worldwide interpretation and acceptability of these acts may occur. Representatives of the scientific community and the media are urged to consider this change. Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
The links between early childhood trauma and major mental illness: Psychiatry’s response? Joan Haliburn1,2,3 1Private
Practice, Drummoyne, Australia Sydney Health Services, Mental Health Sciences Centre, Cumberland Hospital, Parramatta, Australia 3Division of Psychological Medicine, University of Sydney, Sydney, Australia 2Western
Corresponding author: Joan Haliburn, Complex Trauma Unit, Mental Health Sciences Building, Cumberland Hospital, 5 Fleet Street, Parramatta, NSW 2150, Australia. Email: [email protected] DOI: 10.1177/0004867414527178
Approximately two-thirds of both inpatients and outpatients in the mental health system report a history of childhood sexual and/or physical abuse. Middleton et al. (2014) cite in their most timely and important paper the Adverse Childhood Experiences (ACEs) Studies of 1998 and 2010, which demonstrate links between childhood trauma and mental illness, and call for more research in this area. Numerous studies since the early 1990s, including those in Australia
ANZJP Correspondence Declaration of interest
Bou Khalil R (2014) To be or not to let others be: Is it relevant to the mental health field? Australian and New Zealand Journal of Psychiatry 48: 505–506. Brym RJ and Araj B (2012) Suicidality and suicide bombing revisited: A rejoinder to Merari. Studies in Conflict and Terrorism 35: 733–739.
Hassan R (2010) Life as a Weapon: The Global Rise of Suicide Bombing. London and New York: Routledge. Khan M, Goldney R and Hassan R (2010) Homicide bombers: Life as a weapon. Asian Journal of Social Science 38: 479–482. Lankford A (2013) The Myth of Martyrdom. New York: Palgrave Macmillan. Littman SK (1985) Suicide epidemics and newspaper reporting. Suicide & Life Threatening Behavior 13: 43–50. Merari A (2010) Driven to Death. Oxford: Oxford University Press. Post JM, Ali F, Henderson SW, et al. (2009) The psychology of suicide terrorism. Psychiatry 72: 13–31. Townsend E (2007) Suicide terrorists: Are they suicidal? Suicide & Life Threatening Behavior 37: 35–49.
(Mullen et al., 1993), have highlighted these links and also the effect on response to pharmacotherapy of early childhood trauma. These findings unfortunately have not been translated to any meaningful research. Childhood adversities (CAs) are common. In a national survey among 13 to 17-year-old US adolescents with anxiety, mood, behavioural and substance-use disorders, CAs were found to be highly co-occurring and strongly associated with the onset of psychiatric disorders. Though the data cannot distinguish between the possibilities that CAs are causal risk factors rather than risk markers, the implications for mitigating the harmful effects of childhood adversity and for improving mental health outcome cannot be overstated (McLaughlin et al., 2012). Sexual abuse during childhood is surprisingly common, with estimates in the general population ranging from 15% to 38% (Bachmann et al., 1988). Some responses, such as suicidal behaviour, are not only life-threatening but have multigenerational repercussions (i.e. the transmission of mood disorders and suicidal behaviour to their offspring) (Brent et al., 2004). Childhood adversities are among the most consistently documented risk factors for psychiatric disorders and an association between child sexual abuse
(CSA) and increased rates of mental health problems in adulthood is now well established on the basis of a range of methodologically robust studies (Mullen et al., 1993). Child sexual abuse involving penetration is a risk factor for developing psychotic and schizophrenic syndromes; irrespective of whether this statistical association reflects any causal link, it does identify an at-risk population in need of ongoing support and treatment (Cutajar et al., 2010). Epidemiological studies indicate that children exposed to early adverse experiences are at increased risk for depression, anxiety disorders or both (Heim and Nemeroff, 2001) and that depressed people respond differently to pharmacotherapy, whether they have experienced childhood trauma or not (Nemeroff et al., 2003). Despite this, only a few randomized controlled trials have examined the effect of childhood trauma on response to treatment for depression. The current state of knowledge about the consequences for mental health of early trauma (i.e. sexual, physical, emotional abuse and neglect) is too compelling for psychiatry to ignore. The high degree of heterogeneity in the therapeutic response to antidepressant medications among patients with major depression is
The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper. See Viewpoint by Bou Khalil, 2014, 48(6): 505–506.
References
Australian & New Zealand Journal of Psychiatry, 48(6) Downloaded from anp.sagepub.com at UNIV OF IDAHO LIBRARY on August 24, 2014
Time for change: Homicide bombers, not suicide bombers Robert D Goldney Aust N Z J Psychiatry 2014 48: 579 originally published online 16 April 2014 DOI: 10.1177/0004867414532552 The online version of this article can be found at: http://anp.sagepub.com/content/48/6/579
Published by: http://www.sagepublications.com
On behalf of:
The Royal Australian and New Zealand College of Psychiatrists
Additional services and information for Australian and New Zealand Journal of Psychiatry can be found at: Email Alerts: http://anp.sagepub.com/cgi/alerts Subscriptions: http://anp.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
>> Version of Record - May 29, 2014 OnlineFirst Version of Record - Apr 16, 2014 What is This?
Downloaded from anp.sagepub.com at UNIV OF IDAHO LIBRARY on August 24, 2014
532552 research-article2014
ANP0010.1177/0004867414532552ANZJP CorrespondenceRD Goldney
Commentaries Australian & New Zealand Journal of Psychiatry 2014, Vol. 48(6) 579–584
Commentaries
© The Royal Australian and New Zealand College of Psychiatrists 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav anp.sagepub.com
Time for change: Homicide bombers, not suicide bombers Robert D Goldney Discipline of Psychiatry, University of Adelaide, Adelaide, Australia Corresponding author: Robert D Goldney, Discipline of Psychiatry, University of Adelaide, Adelaide, SA 5005, Australia. Email: [email protected] DOI: 10.1177/0004867414532552
The paper of Bou Khalil (2014) is an important reminder of the complexity of the issues involved in analysing and understanding what have been referred to as ‘suicide bombers’. This term has entered our lexicon on the obvious basis that although the prime aim may have been the killing of others, the individual perpetrator dies. Indeed, over the last three decades the media, the general public and sometimes the scientific community have uncritically used the words ‘suicide bomber’ to describe the deaths of those who kill others – sometimes a few, usually 10 to 20, or, in the case of 9/11, about 2000 – while at the same time killing themselves. Like many areas of human behaviour, these actions have been subjected to rigorous investigation in addition to that provided by Bou Khalil (2014), and it is timely to reflect on the findings. Detailed studies have generally shown that there is little in common with those who die by suicide, using ‘suicide’ in its historically clinically accepted sense.
For example, in an early review in 2007, Townsend concluded that available evidence demonstrated that so-called ‘suicide bombers’ had a range of characteristics which on close examination were not truly suicidal, and that attempting to find commonalities between them and those who died by suicide was likely to be an unhelpful path for any discipline wishing to further understand suicidal behaviour (Townsend, 2007). Furthermore, in 2009, Post and his colleagues referred to the ‘normality’ and absence of individual psychopathology of suicide bombers (Post et al., 2009). Other researchers have reported similar findings, although it is fair to acknowledge that Merari (2010) has expressed contrary views which have stimulated spirited and at times acrimonious debate (Brym and Araj, 2012), and there is the recent polemical work of the English literature graduate Lankford (2013), which has urged for these persons to be considered as mentally unwell. From the point of view of experienced clinical psychiatrists, the usual feelings of hopelessness and unbearable psychic pain, along with selfabsorption and restriction of options in those who are suicidal, are the antithesis of terrorist acts, and mental disorders do not appear to be a prominent feature. In fact, suicidal intent is usually specifically denied by ‘suicide bombers’, as it is proscribed by most religions, including Islam and Christianity. Indeed, Islam condemns suicide as a major sin with committers denied entry to heaven, and, as it is implied that the act of a ‘suicide bomber’ results in a shorter path to
heaven, this would not be achieved if suicide intent was present. Is this focus on the words used simply an academic distraction, or could it be important? It is pertinent to recall the saying that ‘the pen is mightier than the sword’, attributed to Cardinal Richelieu by Edward Bulwer-Lytton in his 1839 play, which has entered our everyday language. My colleagues, fellow psychiatrist Murad Khan of the Aga Khan University and sociologist Riaz Hassan of Flinders University, who has collated the largest database in the world of such acts (Hassan, 2010), and I are mindful of that saying and believe that the words do matter. We discussed this in more detail in the Asian Journal of Social Science (Khan et al., 2010). It has long been recognized that inappropriate publicity promotes further suicide, and Littman (1985) noted that the more there is any reporting of suicide, the more there is a tendency for it to be normalized as an understandable and reasonable option. That being so, repeated use of the term ‘suicide bomber’ runs the risk of normalizing such behaviour, simply because of the frequent use of these words. A logical extension of Bou Khalil’s paper is to address the issue of terminology again. Although the word ‘homicide’ is not entirely accurate because of the political/military context in which these deaths occur, it is more appropriate than the continued use of the word ‘suicide’. Furthermore, it has the potential to modify this behaviour. Thus, whereas suicide is often portrayed as being altruistic in these
Australian & New Zealand Journal of Psychiatry, 48(6)
Downloaded from anp.sagepub.com at UNIV OF IDAHO LIBRARY on August 24, 2014
580 circumstances, there is nothing glamorous or idealistic about homicide. Clearly there is no simple answer to what has occurred increasingly over the last decades. However, by the use of the words ‘homicide bomber’ a gradual change in the worldwide interpretation and acceptability of these acts may occur. Representatives of the scientific community and the media are urged to consider this change. Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
The links between early childhood trauma and major mental illness: Psychiatry’s response? Joan Haliburn1,2,3 1Private
Practice, Drummoyne, Australia Sydney Health Services, Mental Health Sciences Centre, Cumberland Hospital, Parramatta, Australia 3Division of Psychological Medicine, University of Sydney, Sydney, Australia 2Western
Corresponding author: Joan Haliburn, Complex Trauma Unit, Mental Health Sciences Building, Cumberland Hospital, 5 Fleet Street, Parramatta, NSW 2150, Australia. Email: [email protected] DOI: 10.1177/0004867414527178
Approximately two-thirds of both inpatients and outpatients in the mental health system report a history of childhood sexual and/or physical abuse. Middleton et al. (2014) cite in their most timely and important paper the Adverse Childhood Experiences (ACEs) Studies of 1998 and 2010, which demonstrate links between childhood trauma and mental illness, and call for more research in this area. Numerous studies since the early 1990s, including those in Australia
ANZJP Correspondence Declaration of interest
Bou Khalil R (2014) To be or not to let others be: Is it relevant to the mental health field? Australian and New Zealand Journal of Psychiatry 48: 505–506. Brym RJ and Araj B (2012) Suicidality and suicide bombing revisited: A rejoinder to Merari. Studies in Conflict and Terrorism 35: 733–739.
Hassan R (2010) Life as a Weapon: The Global Rise of Suicide Bombing. London and New York: Routledge. Khan M, Goldney R and Hassan R (2010) Homicide bombers: Life as a weapon. Asian Journal of Social Science 38: 479–482. Lankford A (2013) The Myth of Martyrdom. New York: Palgrave Macmillan. Littman SK (1985) Suicide epidemics and newspaper reporting. Suicide & Life Threatening Behavior 13: 43–50. Merari A (2010) Driven to Death. Oxford: Oxford University Press. Post JM, Ali F, Henderson SW, et al. (2009) The psychology of suicide terrorism. Psychiatry 72: 13–31. Townsend E (2007) Suicide terrorists: Are they suicidal? Suicide & Life Threatening Behavior 37: 35–49.
(Mullen et al., 1993), have highlighted these links and also the effect on response to pharmacotherapy of early childhood trauma. These findings unfortunately have not been translated to any meaningful research. Childhood adversities (CAs) are common. In a national survey among 13 to 17-year-old US adolescents with anxiety, mood, behavioural and substance-use disorders, CAs were found to be highly co-occurring and strongly associated with the onset of psychiatric disorders. Though the data cannot distinguish between the possibilities that CAs are causal risk factors rather than risk markers, the implications for mitigating the harmful effects of childhood adversity and for improving mental health outcome cannot be overstated (McLaughlin et al., 2012). Sexual abuse during childhood is surprisingly common, with estimates in the general population ranging from 15% to 38% (Bachmann et al., 1988). Some responses, such as suicidal behaviour, are not only life-threatening but have multigenerational repercussions (i.e. the transmission of mood disorders and suicidal behaviour to their offspring) (Brent et al., 2004). Childhood adversities are among the most consistently documented risk factors for psychiatric disorders and an association between child sexual abuse
(CSA) and increased rates of mental health problems in adulthood is now well established on the basis of a range of methodologically robust studies (Mullen et al., 1993). Child sexual abuse involving penetration is a risk factor for developing psychotic and schizophrenic syndromes; irrespective of whether this statistical association reflects any causal link, it does identify an at-risk population in need of ongoing support and treatment (Cutajar et al., 2010). Epidemiological studies indicate that children exposed to early adverse experiences are at increased risk for depression, anxiety disorders or both (Heim and Nemeroff, 2001) and that depressed people respond differently to pharmacotherapy, whether they have experienced childhood trauma or not (Nemeroff et al., 2003). Despite this, only a few randomized controlled trials have examined the effect of childhood trauma on response to treatment for depression. The current state of knowledge about the consequences for mental health of early trauma (i.e. sexual, physical, emotional abuse and neglect) is too compelling for psychiatry to ignore. The high degree of heterogeneity in the therapeutic response to antidepressant medications among patients with major depression is
The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper. See Viewpoint by Bou Khalil, 2014, 48(6): 505–506.
References
Australian & New Zealand Journal of Psychiatry, 48(6) Downloaded from anp.sagepub.com at UNIV OF IDAHO LIBRARY on August 24, 2014
