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Selection of Person of the Year from Public Health Perspective:
Promotion of Mass Clusters of Copycat Self-immolation
Mehran Zarghami, MD(cid:149)*
___________________________________________________________________________________________
Suicide is a complex phenomenon with multiple diverse causes. It is obvious that if the media give rewards
to the suicides directly or indirectly, they will have more copycat effect. It seems that political means in the
mainstream media, particularly in the Western world overshadow public health- especially mental health- issues.
#_>
Selection of a Tunisian fruit vendor who set himself on fire in a public square as the person of the year by Time
Magazine is a good example in this domain. Mass clusters of copycat altruistic self-burning promotion in the
Middle East and North Africa obviously demonstrate the importance of the dilemma and its relevance in terms of
public health, and the need to develop efficacious interruptive strategies able to prevent people from committing
a dramatic fatal act.
Declaration of Interest: None.
Citation: Zarghami M. Selection of Person of the Year from Public Health Perspective: Promotion of Mass
Clusters of Copycat Self-immolation. Iran J Psychiatry Behav Sci 2011; 6(1): 1-11.
S uicide has been defined as a fatal act However, there are controversies on underlying
which is deliberately performed by a relations in Durkheim's work. For example,
person in the expectation of its fatal Berk believes that psychological and
outcome (1) This is a complex phenomenon individual variables as non-social cause of
with multiple and diverse causes (2-4) Several suicide, overlooks social forces (8).
suicide preventive strategies are based on Documented evidence suggests that one of
medical, ecological and sociological conceptual the underlying causes of suicide may be a
models (5). The sociological model goes back maladaptive by-product of generally adaptive
to Durkheim(cid:146)s classic categorization of suicides social learning principles (4, 11).
as anomic, altruistic, egoistic and fatalistic (6). Some people imitate another suicide that
#_>
Despite its limitations, Durkheim's practice they know about either from local knowledge,
has influenced proponents of control theory (7). having a close relationship or from the media.
Durkheim has explained suic#id_e> sociologically Following Goethe's novel (cid:147)Die Leiden des
within a holistic perspective instead of jungen Werthers (cid:147)(The Sorrows of Young
particular i#n_d>ividual explanation. He has Werther) in 1774- #_in> which many men
emphasized at variation among social replicated the act of the hero (shooting
environments in the incidence of suicide #(_8,> 9). himself) - (12) the effect of this knowledge is
Altruistic suicide in his viewpoint occurs called (cid:147)Werther effect(cid:148) (13). This process is
in #h_i>ghly integrated societies, where the called (cid:147)suicide contagion(cid:148) (14), and this kind
society's needs are seen as more important of suicide is known as (cid:147)copycat suicide(cid:148) (15,
than individual(cid:146)s needs, and the individuals 16). It seems that some myths (i.e. wrong
kill themselves on behalf of the society (10). judgments concerning suicide that are culturally
confirmed and do not have any scientific
basis) (17) may be expanded through media.
Authors' affiliations: * Psychiatry and Behavioral Sciences Research
Some copycat suicides spread through
Center and Department of Psychiatry, Mazandaran University of
Medical Sciences, Mazandaran, Sari, Iran clusters of people (e.g. schools, communities,
(cid:149)Corresponding author: Mehran Zarghami MD, Professor of nations and regions). These are called (cid:147)suicide
Psychiatry, Zare Hospital, Taravat St., Neka Road, Mazandaran, Sari,
Iran clusters(cid:148) (14, 15). Two common patterns of
Tel : +98 151 32 85569
suicide clusters have been documented (4, 18)
Fax : +98 151 32 85109
E-mail: [email protected]
1
Iran J Psychiatry Behav Sci, Volume 6, Number 1, Spring and Summer 2012
Person of the Year and Public Health
Copycat cluster suicides which occur in both suicides between 1967 and 2009 (25). This
the same time and the same space are called fact has been confirmed after controls for
(cid:147)point clusters(cid:148) and those which occur in the confounding variables (such as unemployment
same time but not the same space are called `trends, season, holiday and day of the week
(cid:147)mass clusters(cid:148) (18). Point effects) in large scale
clusters have been attributed investigations (25).
to social learning within local According to the (cid:147)laws of
groups (19), and mass clusters (cid:149) Bouazizi’s deliberate self- imitation(cid:148) mass clusters of
immolation that was rewarded in
have been attributed to prestige suicide result from two social
numerous ways and was covered
and similarity bias (11) and learning biases: prestige bias,
extensively by the media, acted a
the mass media (20, 21). where people prefer to copy
catalyst for Tunisian Revolution
Recently, Rezaeian has #_> the behavior of high-status
and triggered protests in several
discussed the unique pattern of other North A#f_r>ica and Arab and/or reputable models (4,
suicide cluster and introduced countries. Meanwhile, several men 27), and similarity bias, where
a novel type of categorization. did the copycat suicide and emulated people prefer to copy the
He states that the dilemma Bouazizi’s self-burning. behavior of models that
with the previous categorization resemble to them in ethnic
is that the important role of characteristics (4, 11, 28). In
place or space is overlooked in a mass cluster. other words, some people believe that similar
In other words, under such situations, the cluster people face similar challenges and same
finally encompasses a wider geographical stressors, and so may have suitable solutions to
area which is covered by the media (22). such challenges (4, 25, 28). These are called
Many researches have cited the mass (cid:147)vertical(cid:148) and (cid:147)horizontal(cid:148) identification
media (newspapers, magazines, television, respectively (25, 26, 29).
radio etc.) as a trigger of mass clusters of This is an important fact that vertical and
suicide (20, 21, 23). The internet and satellite horizontal identification may occur together,
television have increased the global range of and both celebrity and no celebrity publicized
the mass media in recent years (4). Mass suicides are often associated with increases in
clusters are typically related to high-profile the copycat suicides (25, 30, 31).
celebrity suicides that are broadcasted in the It should be emphasized that the immediate
public mass media (4, 23, 24). In other words, rise in suicide rate is not caused by already-
widely publicized celebrity suicides are more vulnerable people committing suicide earlier
likely to precipitate a copycat suicide (23,25,26). than they otherwise would have. Because
Examples of celebrities whose information evidence shows that suicide rates do not drop
had been publicized and disseminated via some time after the publicized suicide (4, 24).
mass media and have inspired suicide clusters Also besides the characteristics of the stories
include Ruan Lingyu, the Japanese musicians and the audience, it has been documented
#_>
Yukiko Okada and Hide and Marilyn that, the greater the coverage of a suicide by
#_> #_> #_>
Monroe, whose suicides was followed by an the media (such as the number of networks or
increase of 200 more suicides than average newspapers carrying the story of suicide, the
for one month (14, 15). priority of newspaper pages and the column
It seems that a copycat suicide may have inches, seconds of radio and TV news etc.),
anomic, altruistic, egoistic or fatalistic nature, the greater the Werther(cid:146)s effect (25).
and the nature of the first (original) suicide On the other hand, people and groups with
may not be necessarily the same as the copycat pre-existing protective factors against suicide
ones. For instance an anomic or egoistic will be less predisposed to Werther effects,
suicide may be imitated altruistically, vice and people with some risk factors are more
versa. vulnerable (25).
At least 120 scientific studies were published Media representations of suicide are a
on the possible association between media basic component of social learning processes,
descriptions of suicide and actual copycat and may have positive and negative effects to
Iran J Psychiatry Behav Sci, Volume 6, Number 1, Spring and Summer 2012 2
Zarghami M
their audience (23, 25, 32-35). Positive definitions English means sacrifice oneself, without any
of suicide encourage a copycat effect, and reference to burning (42).
negative definitions minimize the odds of this Self-immolation has been practiced for
effect. However, media coverage usually has many centuries, especially in India. This
#_>
more positive and/or neutral approach (25). phenomenon is admitted by some principles
Positive approach to suicide of Mahayana Hinduism and
#_> #_>
includes individual and social Buddhism for various
rationalizations, giving attention reasons, including
and rewards, focusing on the (cid:149) Despite the very strong renouncement, Sati, devotion,
condemnation of suicide by Islam, it #_>
positive aspects of victim(cid:146)s life and political protest. Some
seems that we are now seeing a
and glorification of deceased warrior cultures, such as in
trend: Triggering the protests by
person (25). the Rajputs and Charans, also
self-immolations in some Islamic
Negative approach to prac#ti_c>ed self-imm#_o>lation (42).
countries.
suicide includes emphasizing Western media gave a
that suicide is wrong, valueless, strong association between
and even foolish; focusing on "self-immolation" and fire, and
victim(cid:146)s injury and deformity/disfigurement; introduced this word to a wide English-
arguingalternativesolutions, and discouragement speaking audience after coverage of Buddhist
of suicide by shaming the victims (36). monks setting fire on themselves in protest of
Emphasizing on negative definitions of the South Vietnamese regime in 1963 (42).
#_>
suicide in suicide stories is 99% less likely In modern times, (cid:147)self-immolation(cid:148), (cid:147)self-
than their counterparts to report a copycat burning(cid:148) or (cid:147)Bonzo(cid:148) has become a type of
effect (37). Well-known dishonored figures radical political protest (42).
that have negative prestige (e.g. War spies) Self-immolations are often newsworthy,
and non-celebrities, both of whom lack because of their public, dramatic, and political
reputations, have non-significant or smaller nature. They attract attention and become
effects on suicide rates (4, 23, 26). aggrandized as martyrdom, because of the
#_>
Using scan statistic methods and agent- perception of great discomfort. They may be
based simulations to clarify the social learning perceived as a type of altruistic suicides for
processes underlying point and mass clusters the collective effects (42).
found that point clusters are generated by Instances of deliberate self-burnings had
social learning between neighboring agents. been reported for centuries in Vietnam,
This effect was sometimes mimicked by a including multiple cases during the 1920s and
phenomenon called (cid:147)homophily(cid:148), which means 1930s. Also this practice had been recorded in
that people prefer assorting with similar 1948 in Harbin (China) when a monk
#_>
others. Mass clusters are formed by one-to- immolated in protest against the communists
many transmissions by the mass media, of Mao Zedong (43, 44). Another case had
#_>
perhaps due to copying prestigious celebrities been seen in 1950 in North Vietnam (44).
(prestige bias) and/or only copying similar A number copycat self-immolations
models (similarity bias), where social learning occurred by Buddhist monks who burned
was weak (4). themselves in protest of the persecution of
Media-publicized suicides have resulted to Buddhists by South Vietnam's Roman
#_>
increased suicide rates in many countries, Catholic government. The most famous of
including Austria (38), Japan (39), Germany (40), them was a Vietnamese Buddhist monk
and Taiwan (41). named Th(cid:237)ch Quảng Đức, who burned
#_>
himself to death at a busy Saigon road
#_>
Deliberate Self-Immolation intersection in 1963. His heart which had
Deliberate self-immolation is the most been remained intact (44-46) was considered to
dramatic, violent and often the most difficult be holy and placed in a glass chalice and was
to understand method of suicide. interpreted as a symbol of compassion,
The word self-immolation in Latin-based amplifying the impact of his death on the
3 Iran J Psychiatry Behav Sci, Volume 6, Number 1, Spring and Summer 2012
Person of the Year and Public Health
psyche of the world public (44, 47). He was "Basboosa," (55, 56), who set himself on fire
called a (cid:147)martyr(cid:148) and Photos of his self- on December 17, 2010 (42) in protest of the
burning were quickly circulated widely and mortification that he reported was inflicted on
were featured on the front pages of him by municipal officials (15, 56). The
newspapers worldwide. Malcolm Browne (the Tunisians(cid:146) anger aggravated and their
#_>
photographer) won a Pulitzer revolution precipitated
#_>
Prize, and another similar following Bouazizi's suicide,
photo won the World Press leading then President Zine
(cid:149) Bouazizi’s action that was
#_> #_>
Photo of the Year in 1963 (48). resonated across the region and El Abidine Ben Ali to step
Five more copycat self- sparked a wave of copycat self- down on 14 January 2011,
immolations occurred after Đức immolations, is currently ongoing in after 23 years in power (56).
by Buddhist monks until late the North Africa and Middle East, Several reward systems
October 1963 as the protests with many self-immolations in were activated after Bouazizi's
#_>
escalated in Vietnam (46). Algeria, Egypt, Saudi Arabia, suicide. More than 5,000
#_>
Mauritania, Syria, and Ethiopia, 13
A famous self-immolation persons participated in the
#_> #_>
of them occurred within 13 days
event took place in Tianmen several funeral processions
shortly after Bouazizi(cid:146)s suicide. Also
Square in China, in which five (57). Public media services
the wave of copycat self-immolations
#_>
members of Falun Gong, a such as YouTube and Face
reached Europe in a few months.
#_>
prohibited movement, set book marked images of riots
themselves on fire to protest and commemorations (58).
the unfair treatment of their spiritual band by Many people in the North Africa and Middle
the Chinese government in 2001 (49, 50). East honored Bouazizi as a hero (59, 60).
The video of the incident was broadcasted (51) Mohamed Bouazizi was considered as "a
and received prominent international news symbol for eternity" (56, 61) and a "hero for
coverage (49). Tunisians and the Arab world as a whole" (59)
As mentioned above, it has been by Tunisian film directors, and assumed a
documented that self-immolations have led to martyr by the Progressive Democratic Party
#_>
numerous copycat suicides. Almost 100 self- (PDP) of Tunisia (62). The mayor of Paris
#_>
immolations have been presented by the New named a square in Paris as a tribute to honor
#_>
York Times and The Times between 1963 and Bouazizi (63), and the main square in
#_>
1971 (44, 52), most of them happened in the Tunis was renamed as (cid:147)Bouazizi Square(cid:148)
#_>
United States protesting the Vietnam War and posthumously (64). Bouazizi was awarded
#_>
Asia. Đức’s act was followed by American Sakharov Prize as "one of five representatives
#_>
citizens in protests against the Vietnam War, of the Arab people" in 2011 (65). The new
#_>
and by other monks for other reasons (44, 46). Tunisian government respected him with a
Also this practice occurred in the Soviet bloc postal stamp (56). Some Arab commentators
#_>
by Czech student Jan Palach in 1968. Non- called those men and Bouazizi as "heroic
#_>
political self-immolations also became more martyrs" (66) and their comment were
prevalent in these years. In addition, more illustrated by the media broadly. At this time,
than 1,584 deliberate self-immolations have the Time magazine named Bouazizi as person
been occurred in 2000 and 2001 in India (42, #o_f >the year 2011 (67, 68).
53). A critical high wave has been reported in Bouazizi's deliberate self-immolation that
this country protesting the Reservation in was rewarded in numerous ways and was
1990 (54). covered extensively by the media, acted a
Also self-immolation was the selected way catalyst for Tunisian Revolution and triggered
of Tibetans to protest Chinese rule in early protests in #s_e>veral other North Africa and
2011. Sixteen copycat self-immolations have #A_r>ab countries. Meanwhile, several men did
been recorded in this region since 2011 (42). the copycat suicide and emulated Bouazizi's
The most resent famous case of self- self-burning (42).
immolation was a Tunisian street vendor Since the Holly Qur(cid:146)an says, (cid:147)Do not
named Mohamed Bouazizi (locally known as expose yourselves to ruin through you own
#_>
Iran J Psychiatry Behav Sci, Volume 6, Number 1, Spring and Summer 2012 4
Zarghami M
hands(cid:148) (69), and violence against oneself is them, many people believe that action is
prohibited by the (cid:147)Hadith(cid:148) (70), suicide is appropriate for them as well (15).
forbidden and considered as a sin by most Sensationalizing and romanticizing the
interpretations of these facts and Bouazizi's reports especially about reputations, magnifying
self-immolation resulted controversy among the deceased, suggesting that there is an
some Muslims. While al-Azhar, epidemic, simplifying the
#_>
the most prestigious religious reasons, and publishing the
institution in North Africa means of suicides in public
and Sunni Arab Middle East (cid:149) From a public health perspective, media all lead to increases
count#r_ie>s issued a directive suicide prevention within in the suicide rate (15).
psychosocial approach is one of the
stating "suicide violates Islam Getting a lot of attention,
most important issues. Several
even when it is carried out as a sympathy, and concern to
descriptions and proposals promise
social or political protest," some the deceased person that
programs for the prevention of
protesters speak sympathetically suicide behaviors, i.e. establishment he/she had never got in life,
of self-immolators (66). of regulations, guidelines and will propagandize suicide
Despite the very strong safeguards regarding the news as a glamorous ending.
condemnation of suicide by casting of suicides in the media to Scientific studies have
Islam, it seems that we are now restrict the glorification and shown that real stories are
dissemination of suicides.
seeing a trend: Triggering the more likely to uncover a
protests by self-immolations in copycat effect than fictional
some Islamic countries (71). stories; and televised stories
Bouazizi's action that was resonated across are less likely to report a Werther effect than
the region and sparked a wave of copycat newspapers(cid:146) statements. Another possible
self-immolations, is currently ongoing in the factor is its disappointing effect. Vulnerable
North Africa and Middle East, with many people may feel that "If they couldn't cut it,
self-immolations in Algeria, Egypt, Saudi neither can I" (81).
#_> #_>
Arabia, Mauritania, Syria, and Ethiopia (42, Furthermore, suicidal media content may
#_> #_>
56, 72-74), 13 of them occurred within 13 days have an (cid:147)indirect Werther effect(cid:148); i.e. impact
shortly after Bouazizi(cid:146)s suicide (75). Also the on others which, in turn, can influence one
wave of copycat self-immolations reached person·s own future (15, 82).
Europe in a few months (56). Social proof model is an alternative
app#r_o>ach to clarify Wherther effect (83). In
Media impact this model, people imitate those who seem
The events have shared the extensive similar demographically, despite or even
use of social media (76, 77), considering a because of societal disapproval (15).
#_>
terrifying, serious way that immediately
attracts attention, disgust, but also sympathy Preventive Mission
(77). It is obvious that if the media give From a public health perspective, suicide
rewards to the suicides directly or indirectly, prevention within psychosocial approach is
they will have more Werther copycat effect one of the most important issues. Several
(15). In addition to rewards, also criticizing descriptions and proposals promise programs
copycat suicides and hearing about them in for the prevention of suicide behaviors (15),
the media seems to give permission to those i.e. establishment of regulations, guidelines
who are vulnerable (15, 78). and safeguards regarding the news casting
According to Werther effect, the majority of suicides in the media to restrict the
of the suicides will occur in the same or a glorification and dissemination of suicides (4,
similar way as the one publicized. People who 20, 21).
are more similar to the person in the These guidelines should focus on both
publicized suicide are more likely to commit the audience characteristics and the story
suicide (12, 15, 79, 80). Especially if the publicized characteristics in mapping media effects (25).
suicide is of someone in a similar situation as The popular media should limit graphic and
5 Iran J Psychiatry Behav Sci, Volume 6, Number 1, Spring and Summer 2012
Person of the Year and Public Health
unnecessary depictions and minimize the and others confirmed directions for coverage
unnecessary coverage of suicides to reduce of any suicide: Using extreme limitations in
suicide rates. covering these deaths - limit the number of
Health care professionals should treat stories, do not romanticize the death, and keep
properly with the facts and information about the word "suicide" out of the headline (86).
suicides, especially regarding authority figures Some countries have national journalism
and famous people. codes to discourage suicide reports (15). For
Journalists have an important role in example a strict rule in Norway states that
deglamorizing information, illustrations and "Suicide and attempted suicide should in
interpretations about suicide in the journals, general never be given any mention", or a
newspapers, TV and radio. more moderate one which mentions that "In
Some organizations have produced cases of suicide, publishing or broadcasting
guidelines for the reporting of suicide since information in an exaggerated way that goes
the mid 1990(cid:146)s. World Health Organization beyond normal dimensions of reporting with
(WHO) has issued booklets in Preventing the purpose of influencing readers or
Suicide. A resource series are addressed to spectators should not occur". In Turkey films,
specific professional and social groups visual images and pictures depicting suicide
including general physicians, media cases should not be made public (87). Some
professionals, teachers, primary health care other countries do not have national codes but
workers, prison officers, survivors, do have in-house similar guidelines. For
counselors, at work, and first line responders example in the United States of America there
#_>
(84). Also Int(cid:146)l Association for Suicide are no industry wide standards or there exists
Prevention has issued a Resource for Media voluntary industry codes in some newspapers
Professionals in this domain (25). or journals which are very generic or there are
no industry wide standards in others. In
The WHO Media Guidelines include: Ireland regulations were introduced on the
(cid:149) 1. Take the opportunity to educate the reporting of suicides recently which attempt
public about suicide to eliminate any positive connotations the act
(cid:149) 2. Avoid language that sensationalizes or might have (for example using the term
normalizes suicide, or presents it as a "completed suicide" instead of "successful
solution to problems suicide" when describing a suicide attempt
(cid:149) 3. Avoid prominent placement & undue which resulted in a death) (15). In Canada,
repetition of stories about suicide reporting of the details of suicide is
(cid:149) 4. Avoid explicit description of the method discouraged (88). To my knowledge, there are
used in a completed or attempted suicide no national journalism codes regarding
(cid:149) 5. Avoid providing detailed information suicide reports in Iran.
about the site of a completed or attempted Australia is one of the few countries where
suicide is interested to teach journalism students
(cid:149) 6. Word headlines carefully about reporting suicide related issues. Media
#_>
(cid:149) 7. Exercise caution in using photographs or Wise is a media ethics charity that provides
film footage training for journalists on this subject (15).
(cid:149) 8. Take particular care in reporting celebrity In Ireland a media monitoring program
suicides named (cid:147)Headline(cid:148), has provided a National
#_>
(cid:149) 9. Show due consideration for people bereaved Strategy for action on Suicide Prevention.
by suicide This program also serves the public to
(cid:149) 10. Provide information on where to seek become involved in monitoring the Irish
help media on issues related to suicide (15).
(cid:149) 11. Recognize that media professionals
themselves may be affected by stories Does the Media Follow the Guidelines?
about suicide (85). Although regulations, guidelines and
Mesoudi advices media to follow WHO, safeguards have been established and
Iran J Psychiatry Behav Sci, Volume 6, Number 1, Spring and Summer 2012 6
Zarghami M
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