East Asian Arch Psychiatry 2013;23:134

BOOK REVIEW

This is a relatively short text filled with powerful epistemological (belief-dependent) arguments on the meaning of suicide beyond a conventional medical model. Written by scholars with outstanding backgrounds in social psychiatry, sociology and anthropology, this book is richly informed socio-culturally. Wisely, it builds the scaffolds of theories on suicide and evidence from field studies that are open to ongoing communications with the conventional biological and medical sources. This book is a rare representative of its genre and definitely enlightening for all clinicians and researchers with an enthusiastic quest for better understanding and clinical practice in suicide prevention.

In the era in which disease models are dominated by biological psychiatry, it aptly addresses the chiasma between depth psycho-cultural issues and neuroscience. Thus, the first chapter is devoted to a discussion of “Why culture is important even in biological research” with witty examples cited across genetics, neuroimaging, epigenetics, and psychopharmacology. “Biology is not culture free.” (Chen et al, 2007) “…there are environmental influences on gene expression…the key process that determines the functional operation of genes. Some genetic effects are contingent on an interaction with specific environmental influences so that any understanding of the causal pathway must incorporate identification of the mechanisms underlying the interplay, along the pathway from thought processes to behavior.” (Rutter, 2006). “Change the context and you change the brain’s response” (Restak, 2006). “Transcultural neuroimaging has shown that cultural background influences neural activity.” (Stompe, 2009). The opening chapter concludes with a solidly grounded assertion for a paradigm shift in suicide research to move the field forward. In so doing, it advocates a multidisciplinary collaborative approach cutting across biological, social, and psychological risk factors.

The book is organised into 3 sections. The first is named The Issues, and covers: (i) Suicide research and prevention: the importance of culture in “biological times”; (ii) Culture, cultural meaning(s), and suicide; (iii) The cultural meaning of suicide: what does this mean?; and (iv) Culture and suicide. Without going into “data” (public health figures or in-depth ethnographic field studies), this section defines the depth and perspectives of the subject matter along the watershed of contemporary medical / biological models and cultural perspectives. The middle section constitutes the main bulk of the book written by 4 experts on 4 well-chosen topics ranging from a broad spectrum to focused field studies. They include: (i) Cultural meaning(s) of suicide: a cross-cultural study; (ii) Cross- cultural research on suicidality: an example and a critique; (iii) Sati (which means widow suicide); and (iv) Cultural ambivalence and suicide rates in South Korea. Despite the depths of the selected cultural arenas, the authors maintain an open-mindedness, and succinctly and critically highlight the methodological issues in cultural research. These include sampling, respondents’ biases in cultural contexts, and the validity of cross-cultural measures of psychological and behavioural phenomena.

This thought-provoking book is one of the best resources for any stakeholder interested in the field of suicide research and intervention at any stage of their career. Anyone on the look-out for a refreshing yet embracing view on the intriguing complex phenomena of suicide in mankind will be rewarded by reading this treatise.

Sandra Chan, MRCPsych, FHKAM (Psychiatry), FHKCPsych (email: schan@cuhk.edu.hk)
Department of Psychiatry
The Chinese University of Hong Kong
Hong Kong SAR, China