Multidisciplinary approach to work-related suicides (Open Access)

Recently Denmark hosted the 19th European Symposium on Suicide and Suicidal Behaviour. Workplace suicide was on the agenda, and SafetyAtWorkBlog was able to pose some questions to a leader in suicide research, Professor Sarah Waters. Below is an illustrative extract:

“….If we reduce suicide to a mental health problem that is located in the mind, then there is no need to question the wider social structures and power relationships in which the individual is embedded. Suicide in my view is a political and a societal problem that is shaped by the wider social forces of which the individual forms part….”

SAWB: What is it like to attend a conference on a subject like suicide that continues to be stigmatised and most would describe as bleak? Do delegates achieve a sort of solidarity against the mainstream?

SW: It is a really exciting experience because you are amongst people who understand the fundamental importance of suicide as a major public health concern and as a subject of research. Suicide is one of the leading causes of premature death in the contemporary world. Suicide is also a subject that is at the very centre of the human condition. The French philosopher and writer Albert Camus famously said that to decide whether life is worth living or not is the fundamental question of philosophy and he noted in his book The Myth of Sisyphus that “there is only one truly serious philosophical problem and that is suicide”. For me, suicide and understanding why individuals choose to end their lives is a fascinating, complex and troubling subject of research. So, yes, it is great to be at a conference in which suicide is openly discussed and not subject to stigma or taboos and new knowledge is shared.
However, I think suicide has become a very mainstream subject in research nowadays and it is still characterised by quite narrow disciplinary boundaries. There were nearly 600 participants at the ESSSB conference coming from countries across the world, but the medical sciences still predominate – mainly psychiatry, psychology, but also epidemiology and public health. The conference was held in the beautiful Panam Building which houses the faculties of medical sciences and public health at the University of Copenhagen. All 23 keynote speakers at the conference came from the core disciplines of psychiatry, psychology, epidemiology and public health. Don’t get me wrong, this was a fabulous conference and there was some really interesting research shared, but, research on suicide is still a “one size fits all” in disciplinary terms and we need to bring in alternative and perspectives from history, sociology, the humanities and ethnography. Suicide is too important a subject to be dominated by one disciplinary focus.
I am a member of the Critical Suicides Network which brings together international researchers from a wide range of disciplines and aims precisely to broaden the study of suicide beyond its narrow disciplinary confines and consider how suicide is shaped by culture, social context, identity, gender, power and history. It is important not to reduce suicide to a matter of individual pathology and bring into focus the complex, multidimensional lived experiences and social circumstances of the person. More qualitative research that addresses the complexity of suicide experiences and contexts is needed. This complexity cannot be understood through quantitative studies alone.

SAWB: How hard is it to distil your research into a 15-minute slot in an international conference? Does the benefit of attending come from something other than your formal presentation?

SW: It is very difficult! Especially with a subject like suicide where you want to communicate the complexity and depth of a human situation, but you also want to communicate the key findings from your research. This creates a tension. The benefits for me are experienced outside of the conference room.
I have worked with researchers in the US, Hong Kong and Australia on work-related suicide for many many years. We have formed a community across time zones, shared ideas digitally and spoken to each other across computer screens. The ESSSB conference was the first time that I met these researchers in person and it was wonderful. We chatted over coffee, talked about new papers and what was going on. It was great to discover that they are such lovely and brilliant people in person.

SAWB: My contention has been that workplace suicide research, what there is, dismisses any suggestion that suicide can be a conscrious decision rather than a consequence of a mental illness. This dominant perspective in suicide prevention campaigns and strategies has impeded progress in addressing the causal, organisational factors, letting employers “off the hook”. Is this a valid argument?

SW: One of the problems with dominant disciplinary approaches is that they often overlook the question of agency – suicide is usually attributed to pathological or biological forces beyond the individual’s control. The individual becomes a passive victim of pathological forces. This strips the individual of any claim to meaning, intention or self-determination.
It also depoliticises suicide. If we reduce suicide to a mental health problem that is located in the mind, then there is no need to question the wider social structures and power relationships in which the individual is embedded. Suicide in my view is a political and a societal problem that is shaped by the wider social forces of which the individual forms part. The French sociologist Emile Durkheim made this argument in his 1897 book Le Suicide, but the medical sciences have since become the dominant perspective for explaining suicide.

SAWB: You have written that “recent suicides may represent a new and extreme form of protest”. Has this potential been realised? Has this type of protest continued in France or appeared in other countries?

SW: Tragically, there is evidence from across the world that suicide becomes an extreme form of protest when other collective means of communicating demands, such as trade unions are closed off. The wave of suicides in France in 2009 and 2010 had a strong protest dimension. Suicide notes were used to denounce company managers or to criticise the treatment used by welfare benefits offices. The suicidal individual often decides to take their own life in a public place – either in the workplace or somewhere that the suicide can be witnessed and seen by others. Suicide has been used since Antiquity as an act of self-sacrifice that serves to signal an injustice to society. The individual becomes a ‘martyr’ a word that is derived from the Greek word for witness. The verb martyrein is ‘to give testimony’. Suicides have been used as a mode of protest by hunger strikers in prisons and by asylum seekers.
In 2017, dozens of workers at the Foxconn factory in Wuhan, China, where strikes are prohibited and trade unions are restricted, threatened to jump off the roof of the building after bosses broke their promise to pay them a severance fee. This followed the wave of suicides at Foxconn in 2010 resulting in 14 deaths.

SAWB: What long-term effect has your analysis of the France Telecom suicides had on the recognition of some suicides as occupational incidents?

SW: The France Telecom criminal trial was made possible because of France’s specific legislative context and its relatively strong social protection for employees and in particular, the 2002 law on moral harassment. French law specifically refers to employers’ obligations to protect both physical and mental health. By way of comparison, there is no specific reference to mental health in UK legislation. Legal protection for employees’ mental health in the UK is weak.
France Telecom is a unique case because for the first time, criminal charges were brought against both the company as an organisation and individual executives. In a previous case in Japan, the company Dentsu was held liable for the suicide of an employee in July 2017, but no individual managers or executives were held responsible. In France, other large corporations have had rulings made against them in the courts in cases of employee suicide: Renault, La Poste, Lidl, Carrefour, Proservia have all been charged with gross negligence. Meanwhile hundreds of cases have cases have gone through the criminal courts and families have won compensation from companies.
The France Telecom case has had considerable impact in France itself. Companies are far more attentive to mental health and are wary of the legal repercussions of acting in a way that impinges on mental health. The French public health authorities have now set out a detailed definition of what constitutes a work-related suicide. Any suicide that takes place in the workplace is presumed to be work-related and subject automatically to an independent investigation by the health authorities. A suicide can also be considered as work-related if there is a material link to work in the form of a suicide note blaming work, a work uniform, weapon, work vehicle etc. In these cases, family members have to undertake litigation to demonstrate that the suicide is work-related drawing on this material evidence. Where a suicide is proven to be work-related, families are entitled to financial compensation from the company.
The France Telecom case has also had repercussions outside of France. This is a large global corporation and other companies are watching closely. I know from speaking to campaigners in other countries that the case is used as a warning message: this is coming and companies need to ensure that they are protecting their employees’ mental health.

SAWB: Neoliberalism is being blamed for many of the workplace injustices and exploitations. (A legitimate perspective IMO) However, many of the neoliberal policies expanded on the work and socioeconomic structures that already existed. A lot of debate about the future of work appears to be from recent experience but were “unsafe” work structures already in place and just made worse by neoliberalism?

SW: Work-related suicides have risen globally at a time of deteriorating working conditions linked to neoliberalism. There’s something about changing conditions of work over the past 20 to 30 years which is causing people trauma and placing unprecedented pressure on people’s mental health.
There has been a rise in precarious work, work has become more unstable and no longer provides people with security and a place in society. Work has become more intense, with long hours and tougher demands. Digital work means we’re constantly switched on, we’re expected to work all the time. So, there’s a whole series of complex factors, which have placed huge pressures on mental health, which explain why work-related suicides are on the rise and why they’re on the rise now, at this particular moment in time.
In France, which is the context I know best, there are few documented cases of work-related suicides prior to the 1990s and these were generally confined to the farming sector. Work-related suicides have been linked by French researchers to the rise of new neoliberal forms of management and work organisation.
However, it is difficult to say with certainty whether work-related suicide is a new phenomenon historically or whether its prevalence reflects a new awareness of work-related stress and an improved recording of suicides.
If you go back to the 19th century, Marx and Engels documented in detail the effects of factory work on all aspects of the daily life of the industrial working class, yet suicide is given barely any attention. It is absent from Marx’s three volumes of Capital. Work was a struggle for survival in the face of brutal conditions and death was the result of external forces and in particular factory conditions. Marx did write a brief article on suicide in 1846, yet he is concerned here with oppressive conditions within the bourgeois family and not working conditions in the factories

SAWB: If this is the case, what contained the workplace stressors last century, pre-neoliberalism? Was it trade unions or some other social factor such as the male-dominated workforce, the prominence of social protest over workplace activism on mental health?

SW: I believe work-related suicides are a response to economic conditions that make life unbearable for some people, but they also reflect a collapse of the means to express dissent in the face of these conditions. So, yes suicides partly reflect a decline of trade unionism and of collective channels to articulate protest in my view. Suicide is a desperate last resort by someone who feels powerless and disenfranchised, where violence that might otherwise be mediated by external collective structures, is internalised by the person.
The French film En guerre (At War, 2018), that was selected for the Cannes film festival, follows a group of workers engaged in a bitter struggle to save their jobs following the threatened closure of their factory employing 1,100 workers. They are led by a trade unionist Laurent who engages in an exhausting and heroic battle to prevent the closure and defend the workers facing unemployment. In the face of their failure to reverse this decision and a hostile media response, Laurent takes his own life at the end of the film. This act is presented as an expression of hopelessness and despair by a trade unionist who had remained faithful to his struggle to the bitter end but has now exhausted every possibility available to him. Like other recent French films depicting suicide, it is based closely on recent social events in France.

SAWB: Do workers and employers have a strong literacy on work stressors that can lead to suicide in this decade? If not, what impeded this literacy? Or were employers distracted by corporate wellness?

SW: I worked with trade unionists in France who were at the centre of the France Telecom suicide crisis. In the face of hostility from mainstream trade unions who were of the view that suicide was not a matter for unionism, they created a new syndicalist structure in 2007, the Observatory of Stress and Forced Mobility. It was this organisation that initiated legal proceedings against the company which resulted in the 2019 criminal trial.
Suicide is an expression of immense human suffering that isn’t necessarily linked to material or physical conditions in the workplace, but a more deeply-rooted sense of distress. Unions found it difficult to articulate this form of suffering because it is unseen and intangible. It is difficult to represent this within the conventional language and symbolism of trade-union militancy, which often draws on images of physical strength and masculinity. Some saw the suicides as an individual and medical problem that had nothing to do with union activism.


For those seeking more information on Professor Waters’ research, there are links to several articles in her profile, but the best value and insight may be found in her latest book – Suicide Voices – Labour Trauma in France

Kevin Jones

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