An unhelpful dissection?

This two-hour long (no interval) play, written by Alice Birch and directed by Katie Mitchell, is about three generations of women: mother (Carol), daughter (Anna) and granddaughter (Bonnie). Their stories are presented simultaneously, making them at times difficult to follow (your seat number largely determines which story you follow more closely), but it becomes immediately clear that this play is about suicide, and more specifically women's/mothers' suicide.

I was pleased that Alice Birch decided to use her brilliant artistic skills to 'talk about' suicide. Suicide has been defined as a national crisis, yet it remains largely neglected by the public, media, services and funding bodies. People who, like myself, specialise in suicide research and suicide prevention are often frustrated about how little is available to people at risk for suicide and their 'carers'. Doing research in this area is also a struggle: suicide-specific funding is rarely available and, when it is, may be limited to a narrow range of perspectives and interventions. 

My own experience on a theatre stage as a young woman made me really appreciate the amazing craft of what Birch and Mitchell achieved, as well as the performance mastery of the actors. The use of slow movements in between scenes, coupled with loud and evocative sounds, contributed to create a very dramatic experience (perhaps too dramatic for some, like my seat neighbour who cried for most of the time and the couple sitting in front of me who left after 20 minutes in a visibly shocked state). Yet, as much as I was pleased by the choice of topic and the theatrical qualities of the play, as a clinical psychologist who volunteers for Maytree suicide respite centre in London, and someone who has been personally touched by suicide, I was disappointed, perhaps even outraged, by its content. 

In an online interview Birch mentions that she 'went to speak to one academic who runs this suicide studies thing at Oxford University'. Hearing that, one is left wondering whether, if suicide is 'the only one really serious philosophical problem' as claimed by Camus, talking to one academic expert when writing a play on such a complex multi-layered, stigmatised and misunderstood issue is perhaps just too little. And if one academic it has to be, why not choose a woman and/or someone expert in women's suicide and gendered aspects of suicide? One such might have been Professor Silvia Sara Canetto (Colorado State University) with whom I had the honour to watch the play, together with Dr Bridget Escolme, from the School of English and Drama at Queen Mary University of London. 

Bridget and I have been working together on an MSc in Creative Arts and Mental Health at QMUL, a course I currently co-lead, which has a particular emphasis on the representation of 'madness' and mental health experiences in theatre and performance. After viewing Anatomy of a Suicide, I shared with Bridget my uneasiness with the way all three women in the play were represented. They were mad, unstable, extremely emotional and mean, as they made the lives of people around them miserable. As we chatted about the representation of women and womanhood in 19th- and early 20th-century theatre, I felt even more uncomfortable. Is not now, the 21st century, time to stop propagating an image of women as weak, crazy and unbalanced? What is the underlying message that this play suggests? What is particularly problematic to me with this play is that the message given to the public is not only that suicide is possibly hereditary and (genetically?) transmitted, a hypothesis for which there is no sound scientific evidence; but also that women who are suicidal are mad (perhaps even 'bad'), they have some dramatic personal struggle, and are fundamentally unable to live and cope with their traumatic experiences. By contrast, the men in the play are stable, caring, loving and present, and eventually mistreated by the women. (This representation contrasting the evidence that domestic/family violence and abuse against women and girls, usually at the hands of males, is one of the key predictors of suicidal behaviour: see Colucci & Heredia Montesinos, 2013; Colucci & Hassan, 2014. This is also the subject of my current film-documentary). In the play Carol treats her husband John very poorly, Anna has basically destroyed John's (her father's) life and drugged and had sex with the 15-year-old brother of his (male caring and calm) friend, a junior doctor; and Bonnie is mean to basically every person in her life.

In English-language countries, including the UK, the dominant 'cultural script' of a suicidal woman is very different to the dominant script for a suicidal man. As Silvia Sara Canetto put it in our post-play discussion, male suicides are typically interpreted as the result of social and economic ills. This was certainly the case in another play I watched a few months back at the National Theatre called The Suicide. So, when a man wants to kill himself, it is basically because he is victim of some social injustice, discrimination or other life circumstances out of his control like unemployment, poverty and racism. But a woman who is suicidal is typically presented as just unable to 'pull herself together', having 'lost her mind' and with 'something wrong with her', concepts overwhelmingly present in The Anatomy of a Suicide. Too many women who have tried or contemplated suicide have heard such views way too often. 

Other words we also hear often in this play are 'I'm sorry' and 'No'. The former, repeated several times by all three women, suggests an internalisation of the cultural script about them (as the guilty one, the one to blame, the one who has got something wrong with them). The latter is about their repeated rejection of attempts to help them. This suggests, first of all, that people at risk of suicide have people around them who care for them and are there to help. And while this is true for some of them, it is definitely not so for many of the people I have encountered in my 20+ years experience in this field, across several countries. Secondly, it potentially justifies the use of compulsory/involuntary treatment. In two scenes, both Carol in the 1970s and Anna in the 2000s receive electro-convulsive treatment to attempt to 'cure' their suicidality. ECT is an extremely invasive treatment that is usually seen, or should be seen, as the last resort to deal with severe mental illness, and it was unfortunate that Birch decided to portray only this as a potential treatment for suicidality. I could not avoid thinking about the impact that seeing a young woman in convulsions on a hospital bed as result of ECT might have on a member of the public who is suicidal and considering seeking help – a high chance given that suicide is the leading cause of death of British men under 50 years of age and on the rise also among English women.

Leaving the theatre, I felt that an interested but uninformed member of audience would exit with confirmation of their cultural scripts of woman and womanhood, and for a suicidal woman as someone troubled and troublesome. They would also have acquired the unfounded knowledge that suicide is transmissible and, as such, inevitable unless hard measures are taken, such as sterilisation. 

'Suicide is not inevitable. Suicide can be prevented.' This is a slogan that we repeat daily. But suicide can only be prevented if we understand and counteract the individual as well as socio-cultural-political forces that determine an individual's 'choice' to take their own lives… whether a man or a woman. This play had all the potential to provide a social analysis of suicide and contribute to stimulating the public to be part of that discussion and do their part to save lives. Instead, although very well crafted, it perpetuated unhelpful views.

I do hope to see more plays on suicide. I strongly believe in the power of arts and theatre to challenge the status quo of stigmatising social representations and improve a fundamentally inadequate mental health system. But I also hope future playwrights will do a bit more reading before writing, and consult with some of the thousands of people who are touched by the painful experience of suicide on a personal and/or professional level. 

- Reviewed by Dr Erminia Colucci, who is at Queen Mary University of London.

Find much more about suicide in our archive, along with information and support.

Further reading

Canetto, S.S. (1992-1993). She died for love and he for glory: Gender myths of suicidal behavior. Omega--Journal of Death and Dying, 26, 1-17.

Canetto, S.S.  (1997). Gender and suicidal behavior: Theories and evidence.  In R. W. Maris, M.M. Silverman & S.S. Canetto (Eds.), Review of suicidology  (pp. 138-167).  New York: Guilford.

Canetto, S.S. (2008). Women and suicidal behavior: A cultural analysis. American Journal of Orthopsychiatry, 78, 259-266. http://dx.doi.org/10.1037/a0013973

Colucci, E. (2013). Culture, cultural meaning(s), and suicide. In Colucci, E. & Lester, D., Eds (2013), Suicide and Culture: Understanding the context, 25-46. U.S.:Hogrefe Publishing http://www.hogrefe.com/program/suicide-and-culture.html

Colucci, E., & Heredia Montesinos, A. (2013). Violence against women and suicide in the context of migration. Suicidology Online 4, 81-91

Colucci, E. & Bhui, K. (Eds.), (2015). Special issue: Arts, media and cultural mental health, World Cultural Psychiatry Research Review, September/December http://www.wcprr.org/volumes/volume-10-number-34/

Colucci, E. & Hassan, G. (2014). Domestic violence in low-middle income countries: Consequences and prevention. Current Opinions in Psychiatry, 27:5, 350-357.

Wang, W. D. & Colucci, E. (2017). Should compulsory admission be part of suicide prevention strategies? Bristish Journal of Psychiatry Bullettin, 41(2) http://pb.rcpsych.org/content/pbrcpsych/early/2017/04/10/pb.bp.116.055699.full.pdf