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The ontology of suicide prevention and suicide in the ontological world of

Chinese people: A discussion on the effectiveness of modern suicide
intervention in China

Article · June 2019

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The ontology of suicide prevention and suicide in the ontological world

of Chinese people
A discussion on the effectiveness of modern suicide intervention in China

Summary
In spite of the recent decrease in suicide rates in the People’s Republic of China (PRC)
(Zhang et al. 2014b), suicide remains to be one of the five top causes of death in that country
(Weiyuan 2009). China also used to be one of few countries having higher suicide rates in females
than in males (Weiyuan 2009; Zhang 2014a; Zhang et al. 2014b). Previous attempts (Yang et al.
2005; Weiyuan 2009; Zhang et al. 2004; Zhang 2014a) have been made by multiple researchers to
interpret the high suicide rates and the unusual demography of suicide committers in China, with
the concepts of religious notions (e.g. reincarnation) and the social, family structure induced by the
traditional systems of normality (e.g. Confucianism).
This essay firstly argues that (1) modern suicide prevention is in fact a product of Western
historical and religious perspectives on suicide, which can be categorised either as Catholic-style
condemnation or Protestant-style decriminalisation (Georges Minois 1999). Secondly, it argues that
(2) the indigenous perspectives on suicide among Chinese people is shaped by a different collection
of concepts and notions from which that has produced suicide prevention (Weiyuan 2009; Zhang et
al. 2004). Finally, this essay concludes that (3) the theoretical basis of suicide intervention
employed by most relevant institutions in China is not aligned with the indigenous notions and
proposes a discussion on the improvement to suicide prevention methods, that makes the latter
address the ontological reasons of Chinese people for committing suicide.

Keywords suicide, suicide prevention, public health policy, China, ontological turn, semiotic
anthropology, historical anthropology


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1 Background: Suicide in China
From 2002 to 2005, the People’s Republic of China (PRC) saw a decrease in suicide rates,

from 15.68 per 100,000 people in 2002 to 11.50 per 100,000 people in 2005 (Zhang et al. 2014b, p.

562, 563). Before 2006, China used to be one of few countries having higher suicide rates in

females than in males (Zhang et al. 2014b, p. 562), and after that year, China has gradually been

having same numbers of male suicide committers as female committers (p. 564). The other

characteristic of China in term of suicide lies with ‘the absence of mental illness’ (Yang et al. 2005,

p.387). In many other countries than China, 90% of suicide cases are causally related to the mental

illness that the committers had at the time of death, whereas in China, 37% of committers had died

without any ‘diagnosable’ mental disorders (Yang et al. 2005, p.387; Zhang et al. 2011, p. 244).

In spite of the recent drop, suicide remains to be one of the five top causes of death in China

(Weiyuan 2009, p. 888; Zhang et al. 2011, p. 244) and the top cause of death of people between 15

and 34 years old in that country (Zhang et al. 2011, p. 244). The annual number of suicide

incidences in China, which is approximately 200,000, constitutes around one quarter of the total

number of incidences each year in the world (Weiyuan 2009, p. 888; Zhang et al. 2014b, p. 560).

Previous attempts (Yang et al. 2005; Weiyuan 2009; Zhang et al. 2004; Zhang 2014a) have been

made by multiple researchers to interpret the high suicide rates and especially the unusual

demography of suicide committers in China. Traditional and contemporarily prevalent systems of

concepts and notions occupy centre stages in many of these researches. The social and family roles

played by different genders induced by traditional Chinese systems of notions, especially

Confucianism, are often attributed to the unusual gender ratio of suicide committers in China

(Weiyuan 2009; Zhang 2014a). Traditional religious notions involving reincarnation are also

blamed for increasing the likelihood of suicide committing (Zhang et al. 2004).

This essay omits the argument about whether Confucianism is a religion, which has puzzled

some researchers (e.g. Zhang 2014a). This article also does not denounce any indigenous or
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prevalent notions as ‘superstition’ or ‘risk factors of suicide’ (Zhang et al. 2004, p. 435, 436).

Instead, this article utilises an anthropological and historical enquiry, in order to interpret the

concepts of suicide, death and afterlife in the ontological world of those Chinese people who still

uphold the traditional or indigenous systems of concepts and notions. Additionally, this essay

considers ‘culture’ to be dynamic and mutable and entertains the role of cultural transformation in

decreasing the suicide rates in China.

1.1 Dimensions of suicide

In a cross-cultural discussion on topics related to suicide, it is inevitable to firstly define the

meaning of the term suicide and the dimensions of it. Georges Minois (1999) uses the term

voluntary death as a synonym of suicide. Doris G. Bargen (2006) intends to provide an

interculturally agreeable definition of suicide by quoting and translating Heribert Aigner, which is

‘the specific action of a human being that aims at ending his or her life prematurely or allowing it to

end prematurely’ (p.14). The core consequence of suicide, according to the definition given by

Bargen (2006, p. 14), is a life ending prematurely. However, this definition contains two

dimensions: ‘ending life’ and ‘allowing [life] to end’ (Bargen 2006, p. 14). These two dimensions

are different not only methodologically, but they are often prompted by different reasons and

interpreted differently in different eras, populations and contexts (Bargen 2006, p. 14).

In medieval Europe, innocent and ‘glorious’ suicide was a ‘privilege’ of the aristocrats, but

the suicide of peasants was considered as a detestable and condemnable action out of ‘egotism and

cowardice’ (Georges Minois 1999, p. 7-10, 16). The aristocrats who committed self-sacrifice,

namely ‘indirect suicide’, were believed to have fulfilled their social responsibilities, but the

peasants who did alike were believed to have deserted them (Georges Minois 1999, p. 16). In Japan,

at least up until the end of the Meiji era in the 1910s, the ‘ritual suicide’ of a servant after the death

of his master, known locally as junshi, was still preformed, as manifested in the self-

disembowelment (seppuku) of General Nogi Maresuke on the same day as the funeral of Emperor

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Meiji (Bargen 2006, p. 1). As a criminalised symbol of loyalty, the ‘self-inflicted human sacrifice’

of Nogi both shocked and puzzled the then progressively Westernised Japanese people and the

Westerners increasingly involved in Japan affairs (Bargen 2006, p. 1-3, 14). In some even more

‘foreign’ cases, death by ‘black magic’ or ‘voodoo’, namely ‘“voodoo” death’, among indigenous

people in South America, the Caribbean, Africa, Australia and the Pacific Islands, after breaking

certain taboos, was seen by Walter Bradford Cannon (2002) as a combination of two symptoms

prompted by emotion fear, which are a collection of fatal biomedical conditions and voluntary

death by refusing to eat and drink (p. 1593, 1595, 1596).

The next chapter uncovers how the perspectives on suicide in the West eventually gave birth

to modern suicide prevention as a public health policy. Afterwards, I explore the reasons for suicide

among Chinese populations, which maintain a nevertheless high rate of suicide in that nation.

Finally, I discuss the effectiveness of modern suicide intervention in China.

2 Suicide prevention: From religion to policy

Men once were we, that now are rooted here.
Thy hand might well have spar'd us, had we been
The souls of serpents.
— Dante Alighieri (2004)

Nothing, I am afraid, symbolises the detestation of suicide committers among late medieval

Europeans more than the verses by Dante Alighieri (2004) quoted above. In his poetry, the souls of

the men who killed themselves had become trees, passively enduring and constantly lamenting the

eternal predicament in the afterlife (Dante Alighieri 2004). However, not all people who committed

what we now call ‘suicide’ were interpreted by medieval Europeans in such detestable fashion, and

the discrimination between suicide in different contexts and populations is deeply embedded in

Hellenistic philosophy and Christianity (Georges Minois 1999, p. 16, 24-28, 45, 46).


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2.1 Hellenistic philosophy, Christianity, and suicide
In 1897, Émile Durkheim discovered that suicide rates were lower in Catholics than in

Protestants in the population he studied (Panczak et al. 2013, p. 213). A more recent research

(Panczak et al. 2013) conducted in Switzerland also revealed similar results. In addition to the

social integration theory used by Durkheim to explain such findings (Panczak et al. 2013, p. 213),

the research by Panczak et al. (2013) suggests the possible effects of particular religious principles

on suicide. Namely, since the modern Catholic Church does not condemn those who committed

suicide out of mental disorders but does condemn those who did so because of terminal diseases

(e.g. cancer), ‘the protective effect’ of Catholicity is weak in the population suffering from mental

disorders but strong among cancer patients (Panczak et al. 2013, p. 213, 219). Therefore, the

attitude towards suicide is not determined by a solitary factor, nor does it remain immutable and

rigid over time and space. However, what factors have shaped the notion that suicide is an issue in

modern public health? And, what are the major turning points in the evolution of the notions behind

suicide prevention?

The first persistently influential notion that discriminate between suicide incidences in

different contexts was created by Plato (Georges Minois 1999, p. 45, 46). In Platonism, people are

assigned to their roles and destinies by ‘the divinity’ or, in other terms, supernatural agents

(Georges Minois 1999, p. 45). Plato also recognised that the fate of people can be determined by

worldly agents, such as ‘the State’, possibly inspired by the forced suicide of Socrates (Georges

Minois 1999, p. 45). In his opinion, suicide induced by any of these two agents is not to be

condemned (Georges Minois 1999, p. 45).

The Platonic notion of agency was then carried into the era of Christianity. By modern

definition, the death of Jesus Christ was a case of suicide, that Jesus allowed his life ‘to end

prematurely’ by travelling to Jerusalem near Passover, a gravely dangerous combination of place

and time for him, and not defending himself whilst being tried (Georges Minois 1999, p. 24; Bargen

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2006, p. 14). ‘Suicide’ in similar manners was committed repeatedly by early Christians, and so

long as death being aligned with the presumed plan of God, it would be celebrated as

‘martyrdom’ (Georges Minois 1999, p. 25). To the other extreme, any self-inflicted death out of

personal, ungodly reasons would be discouraged or dishonoured, symbolised by the death of Judas

Iscariot (Georges Minois 1999, p. 25, 26).

In the Middle Ages, the categorisation of suicide, the condemnation and punishment of

people who had committed certain categories of suicide and the theological basis of suicide

condemnation were relatively developed (Georges Minois 1999, p. 9-12, 16-18). As mentioned in

the last chapter, suicide committed by different ranks of people was interpreted differentially based

on the roles once played by the committer in a society as well as the role of suicide in the fulfilment

or abandonment of responsibilities (Georges Minois 1999, p. 16). Methodologically, the aristocrats

would have the ‘opportunities’ to have themselves killed in battles, hunts and jousts, as self-

sacrifice or fulfilment of their social responsibilities, whereas the commoners could only kill

themselves by drowning or hanging to abandon their miserable lives and responsibilities (Georges

Minois 1999, p. 10, 11, 16). Generally speaking, ‘diabolic temptation’ and madness were two

common reasons for suicide in commoners as believed by medieval Europeans, and torturing the

corpse and confiscating the properties of the person who had committed suicide were two typical

forms of punishment (Georges Minois 1999, p. 9). In one of the earliest examples in year 1257, the

corpse of a man was sentenced to torture after he presumably threw himself into the Seine (Georges

Minois 1999, p. 7). In another example in 1278, the heirs of Philippe Testard, after the latter stabbed

himself to death, used ‘insanity’ as an excuse for avoidance of the confiscation of his properties

(Georges Minois 1999, p. 7, 8). There is, however, no historical account that can be found proving

the bodies of noble people who killed themselves would be sentenced to such punishment (Georges

Minois 1999, p. 15, 16).

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 One of the major turning points in Western attitude towards suicide was the Protestant

Reformation (Georges Minois 1999, p. 72-74). Protestant reformers, like Martin Luther, began to

remove the criminal significance of suicide. This is to say that, instead of individual egotism,

cowardice and weakness towards ‘diabolic temptation’ (Georges Minois 1999, p. 9, 16), the cause

of suicide was believed, by Martin Luther, to be the objective existence of diabolic possession

without the subjective initiative of the committers, and a person who committed suicide would be a

‘victim of an assassination committed by Satan’ (p. 72). Among Anglicans and Puritans in England,

suicide was interpreted in a similar fashion, either as diabolic possession or as divine punishment

for previous wrongdoing (Georges Minois 1999, p. 73). Even though the image of suicide

committers had transformed from active criminals to passive victims in Protestantism, suicide was

nonetheless ‘diabolized’ and hardly gained any positive meanings (Georges Minois 1999, p. 72, 73).

Later history of Europe has seen Catholic-style condemnation and Protestant-style decriminalisation

jointly shaping the Western attitude towards suicide.

2.2 The Enlightenment, French Revolution, and governmentality

Indicated by the coinage of term suicide in English and its equivalents in other European

languages, the debate over suicide had begun to increase in frequency since the seventeenth century

(Georges Minois 1999, p. 181, 210). In spite of the increased number of debates, public opinion was

still filled with the condemnation of suicide, that suicide was considered to be an unjust means to

defy the life and fate assigned to an individual by supernatural or worldly agents, namely God or

society (Georges Minois 1999, p. 211, 212). Some defiant thinkers, including Montesquieu, had

connected suicide with individual liberty to withdraw from the contract with a society or return life

to God (Georges Minois 1999, p. 228). In either ideology, suicide was interpreted by Europeans in

the Age of Enlightenment based on the relationship between individuals and the external, supreme

agents that determine the fate and responsibilities of individuals.

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 The liberty of people to withdraw themselves from worldly duties was once again revoked

during the French Revolution, and this time, suicide was more of a crime against governments than

a sin against deities (Georges Minois 1999, p. 302-304). The life of each individual was directly

governed by the revolutionary governments as assets. Ending it without permission from the

governments was considered to be desertion or violation of social contract (Georges Minois 1999,

p. 302-304). From the nineteenth century onward, as the revolutionary passion cooled down in

Western Europe, the decriminalisation of suicide had been revived (Georges Minois 1999, p.

321-323). Instead of diabolic possession, suicide committers were seen as being ‘possessed’ by

social issues and individual emotions, by sociologists and neurologists in nineteenth- and twentieth-

century Europe, including Émile Durkheim, Maurice Halbwachs and Sigmund Freud (Georges

Minois 1999, p. 321, 322). Thus, suicide had gradually become a medical condition and health issue

to be dealt with by public health enquiries and policies (Panczak et al. 2013; Knox 2014; Zhang et

al. 2014b; Tempier 2016).

The texts above display that throughout the history of Europe and Western world, lives and

destinies of individuals are always determined by certain supreme agents outside and above

individuals themselves, be they gods, the Christian God, governments or societies. Life is the only

channel through which one can fulfil or abandon the responsibilities assigned to him by a supreme

agent. According to Georges Minois (1999), the notion that ‘life at any cost is preferable to death’ is

still ‘tacitly’ agreeable in Western societies (p. 328). Now, let us break the shackles of Western

civilisation and explore the meanings of life, death and suicide in another world, the ontological

world of Chinese people.


!8
3 The Chinese solution
one – to cry; two – to scream; and three – to hang herself
— Chinese proverb about the
‘three solutions to women’s problems’
(Weiyuan 2009, p. 889)

‘To be, or not to be’ is a question raised in year 1600 in England, and yet it is probably not a

personal question of Hamlet the character, or of William Shakespeare the playwright, but an

immortal and omnipresent question of human beings of all ages and regions (Georges Minois 1999,

p. 86-88). Meng Ke (2008), otherwise known as Mencius, a Confucian scholar living in the fourth

to third centuries BC in China, had also given his answers. Much similar to Western perspectives,

life is more desirable than death in his opinion, but there are or should be something more desirable

than life that can only be achieved by losing it (Ke 2008). What missing in the idea of Meng Ke

(2008), however, is an agent that assigns people into their destinies and responsibilities. According

to him, the choice between life and death is to be made entirely by a person him/herself, like

making a choice between different food to eat, and people of all classes, even ‘beggars’, may have

their values to defend or to die for (Ke 2008).

The lack of supernatural agents is a noticeable feature of Confucianism (Zhang 2014a, p.

147). Apart from the absence of spiritual condemnation of suicide, the Chinese system of beliefs is

also weak in divine supervision (Fong 2001, p. 112, 113). Instead of an omniscient, omnipresent

agent that oversees the behaviours of believers, Confucianism stresses the measurement of personal

reputation, locally known as lien or mianzi (literally ‘face’), basing on the behaviours and

conditions that can be observed by other people (Zhang et al. 2004, p. 435; Li, Hatzidimitriadou &

Psoinos 2014, p. 74). As a result, contrary to medieval Europeans who considered suicide among

commoners to be detestable occurrence only to be committed in privacy (Georges Minois 1999, p.

16), Chinese people from the first century BC to the nineteenth century AD, aristocrats and

!9
commoners, men and women alike, had been writing poems before committing suicide in order to

signify their self-inflicted death (Fong 2001, p. 111-113).

However, most of those historical suicide incidences signified by poetry were nonetheless

induced by the code of loyalty (mostly in men) or chastity (mostly in women) (Fong 2001, p. 111,

112). The article so far does not interpret why still more contemporary Chinese people would kill

themselves impulsively out of personal reasons, as previously discovered in multiple studies (Yang

et al. 2005; Weiyuan 2009; Zhang et al. 2004; Zhang et al. 2010; Zhang et al. 2011). The answer lies

with the meaning of death and afterlife in the minds of Chinese people.

3.1 Chinese people and their death

Enquiry into death can be one of the most enthralling anthropological enquiries (Kan 1992,

p. 283). A number of ethnographic researches in the death rites in China can help us to construct an

interpretation of the Chinese notions of death and afterlife (Kan 1992, p. 288-293).

The first thing noticed by the researchers in this area is that there seems to be no clear

boundary between life and death in the Chinese system of notions (Kan 1992, p. 288, 289). The

social significance of a deceased individual is substantially consistent with which before death (Kan

1992, p. 288), and a deceased ancestor would continually impact on the fortune, health and

reproductivity of living descendants, depending on the level of worship (Kan 1992, p. 288, 289).

Secondly, the concept of afterlife in Chinese conceptual system is centred on ‘reincarnation’

not ‘salvation’ (Kan 1992, p. 291). In such system, instead of being reborn in another world, such as

Heaven or Hell, a deceased person may return to this world and start a new life, especially when

that person does not stay with the ancestors in the afterlife (Kan 1992, p. 291; Zhang et al. 2004, p.

435, 436). Additionally, the afterlife may be different between Chinese men and women, that men

are more likely to stay in the afterlife and maintain their worldly statuses, and women are more

likely to be reincarnated as different beings (Kan 1992, p. 291). Therefore, death, especially for

women, is a point on a circle instead of an end of a line, in the belief system of Chinese people. This

!10
offers an interpretation of the cause of the aforementioned high suicide rates in Chinese women

(Zhang et al. 2014b).

Thirdly, the spiritual beliefs of Chinese people are not regulated by any unitary institute,

with a lack of ‘state church’ or ‘state religion’ (Kan 1992, p. 289). Previous ‘“anti-superstition”

campaigns’ initiated by the communist government of PRC have also been ineffective (Kan 1992, p.

292). Chinese people are consequently free to interpret their beliefs and the recipients of their

worship, such as their deceased ancestors, in a great variety (Kan 1992, p. 289, 291).

To conclude, Chinese attitudes towards suicide and Chinese concepts of death and afterlife

are incommensurable with which behind modern suicide prevention as a public health policy,

described in Chapter 2. In the ontological world of those Chinese people who still uphold the

indigenous system of concepts and notions, suicide is a matter of personal choice, essentially

without any negative significance (Ke 2008; Fong 2001). Death can be a temporary section in the

cycle of reincarnation or an extension of life, and both suicide and death can be interpreted

variously by each individual in the system (Kan 1992). Consequently, absence of mental disorders

and impulsivity have become two common features of Chinese suicide committers (Yang et al.

2005; Weiyuan 2009; Zhang et al. 2004; Zhang et al. 2010; Zhang et al. 2011), because

subconsciously, a number of Chinese people may embrace death and inflict which upon themselves

without serious spiritual or worldly consequences. Furthermore, suicide can be casually mentioned

by Chinese people as ‘a solution’ to worldly problems, as manifested in the proverb quoted at the

beginning of this chapter (Zhang et al. 2004, p. 435, 436; Weiyuan 2009, p. 889).


!11
4 Conclusion: Suicide prevention and China
This essay compares the factors that have shaped modern suicide prevention as a public

policy with the indigenous Chinese perspectives on suicide. In the West, the lives and destinies of

people have always been governed by supreme agents outside and above the individuals. Suicide

defies the supremacy of such agents and is to be prevented. The indigenous system of concepts and

notions of Chinese people lacks such agency, and decisions about suicide can be made impulsively

and randomly, thus maintaining relatively high suicide rates in China. Nevertheless, the recent effort

at the development of suicide prevention and the cultural transformation in China prompted by the

alteration in social and family structures have induced the aforementioned decrease in suicide rates

and change in the demography of Chinese suicide committers (Zhang et al. 2014b).

Surveys and studies of the suicide rates in China have started to be conducted since 1990

(Zhang et al. 2014b, p. 560). In 2002, Beijing Suicide Research and Prevention Center (BSRPC)

was founded as a department of Beijing Hui Long Guan Hospital (Beijing Suicide Research and

Prevention Center [BSRPC] 2015). According to Chinese media (中国新闻 [zhong-guo-xin-wen]

2014), the first 24-hour suicide prevention hotline was established in 2012 in Shanghai, by an

expert psychologist. Evidently, the theoretical basis of contemporary suicide prevention is

pathological, if not epidemiological, and psychological, which is not aligned with the indigenous

notions of Chinese people, as mentioned in Chapter 3. In the case of BSRPC, an institution

dedicated to suicide prevention in China is established and assessed, according to ‘international

standards’ (BSRPC n.d.).

4.1 Discussion: the future of suicide prevention in China

In spite of the inconsistency with indigenous notions, based on reported narratives, Chinese

people have shown a certain level of comprehension of suicide prevention (中国新闻 2014).

Meanwhile, the indigenous system of notions and concepts has begun to be denounced in Chinese

populations as ‘superstition,’ that religiosity is seen as deviation (Zhang et al. 2004, p. 435, 436).
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This could be the outcome of governmental campaigns designed to destroy these indigenous beliefs

over decades or more likely, a result of socio-economic development that prompts a transformation

of the contexts in which indigenous Chinese values have originally developed (Kan 1992, p. 292;

Zhang et al. 2014b, p. 566, 567). Either way, along with the decrease in suicide rates, the bias

against indigenous values has also been introduced into Chinese societies, and the impulsivity

induced by ontological factors continues to be a characteristic of Chinese suicide committers (Yang

et al. 2005; Weiyuan 2009; Zhang et al. 2004; Zhang et al. 2010; Zhang et al. 2011).

Up to now, researches in the suicide rates in China are predominantly quantitative (e.g. Yang

et al. 2005; Zhang et al. 2004; Zhang et al. 2010; Zhang et al. 2011; Zhang 2014a; Zhang et al.

2014b). Few qualitative studies are only on a small scale (e.g. Weiyuan 2009). I would like to

propose a discussion among indigenous Chinese on the improvement to suicide prevention

methods, making the latter address the ontological reasons of Chinese people for committing

suicide, before more in-depth ethnographic studies can be conducted.


!13
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