Humans have attempted and successfully committed suicide since time immemorial. The reasons for killing or harming oneself vary with cultures and societies and in urban or rural settings.In ancient European cultures, suicide was common, with women using hanging and men using various tools for deliberate self-harm. Ancient Hindu texts allowed individuals to kill themselves, although in later Upanishadic periods suicide was generally condemned, but it was acceptable for holy men, especially if they had reached the stage in their life where they had gained insight into life's problems. Suicide was permitted on religious grounds, as death was seen as the beginning of another life. Somasundaram et al (1989) report that the great 11th-century Tamil classic Purananuruan anthology includes references to self-immolation by a widow on the death of her husband. There is also mention of suicide by starvation or fasting. These authors conclude that, irrespective of race, religion, culture and location of the civilisation, there was almost identical motivation for suicidal behaviour.Parasuicide, attempted suicide or deliberate selfharm may be suicidal gestures, manipulative attempts to seek help or unsuccessful attempts to die. Generally, the act is non-habitual and may be influenced by single or multiple crises.In this paper we illustrate epidemiological findings on attempted suicide in South Asian people in their countries of origin and in the UK and compare social and cultural factors across the two settings. The Indian subcontinentMost reported data have been collected from general hospitals. One of the key problems in identifying rates of attempted suicide is that of defining the act. A second problem is that, where suicide is legally proscribed, individuals or their families give different reasons for the action to hide the problems rather than admit to suicidal thoughts or acts.In Madurai in South India, the number of patients presenting with attempted suicide trebled between 1974 and 1978. Of the 114 suicide attempts studied in 1965, 65 were by men and this male dominance persisted in data collected 2 years later. The dominant feelings of those attempting suicide (attempters) were depression, anger, spite, jealousy and a desire for attention. When those who repeated a suicide attempt (repeaters) were studied 10 years later, 19 out of 35 were male. The clinician described 20 as 'hysterical' with inadequate or immature personalities, eight had schizophrenia, three were dependent on drugs, two had a stammer, one had epilepsy and one had a toxic psychosis. The absence of depression was striking (Venkoba Rao & Chinnian, 1972).When differentiating between suicide and attempted suicide on the basis of psychological factors, Venkoba Rao (1992) cautions that suicide does not result from a single cause. He suggests that attempted suicide should be linked with personality disorders and argues that social isolation contributes to increased rates of suicide and attempted suicide.Quarrels with in-laws and problems in interpersonal ...

Acculturation as a process, during which cultural identity is challenged, plays an important role in the psychological wellbeing of minority ethnic groups. This paper introduces the Asian Cultural Identity Schedule, and demonstrates its use in an investigation of acculturation and deliberate self‐harm. The Asian Cultural Identity Schedule (ACIS) consists of 106 questions, from which 12 scores represent acculturation on specific domains. The schedule was used as an interview in two research studies of deliberate self‐harm among Asian adolescents and Asian women. Asian adolescents (N = 22), their parents (N = 22) and a sample of Asian women (N = 54) were interviewed. A half of the subjects in each of these three groups were cases; the rest were controls. The acculturation items are compared among each of three groups of cases and controls, and then between subgroups. The results showed that adolescents were less traditional than their parents on the following items: language, leisure, decision making, food shopping and living with a white person. In the absence of any discordance among control group adolescents and their parents, there are less traditional attitudes to work and marriage held by adolescents who attempted deliberate self‐harm in comparison to their parents. Adolescents who attempt deliberate self‐harm show as untraditional aspirations as their parents, and as control group adolescents. The parents of control group adolescents are more traditional, reflecting a protective effective of traditionalism. Women who attempted deliberate self‐harm show less traditional attitudes to social contact and aspirations than control women. In comparison with control parents, women who attempt self‐harm have less traditional attitudes to food shopping, work and living with a white person, whilst showing more traditional attitudes to religion. It may be concluded that acculturation on specific domains is associated with deliberate self‐harm. Copyright © 1999 Whurr Publishers Ltd.

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In the mid-1980s, the anesthesia departments at hospitals affiliated with Harvard Medical School were faced with a challenge: mounting medical malpractice costs. Malpractice insurance was provided by the Controlled Risk Insurance Company (CRICO), a patient safety and medical malpractice insurance company owned by and providing service to the Harvard medical community. CRICO spearheaded an effort to reduce these costs and ultimately found a way to decrease the risks associated with anesthesia. Here, we chronicle events that led to the dramatic changes in medical practice that resulted from the activities of a small group of concerned anesthesiologists at Harvard-affiliated hospitals. We place these events in a historical perspective and explore how other specialties followed this example, and end with current strategies that minimize the risk associated with anesthesia. We conducted interviews with principals who formulated original standards of patient monitoring. In addition, we consulted documents in the public domain and primary source material. Efforts of these pioneers resulted in the establishment of the seminal Harvard-based anesthesia monitoring standards for minimal monitoring. What followed was an unprecedented transformation of the entire field. After the implementation of these standards at Harvard-affiliated hospitals, the American Society of Anesthesiologists (ASA) adopted “Standards for Basic Anesthetic Monitoring” for use during the administration of all anesthetics in the United States. Other nations have since adopted similar guidelines and these practices have resulted in significant improvements in patient safety. Currently, we estimate mortality due to anesthesia in healthy patients to be 1:400,000—perhaps as much as 10 times lower since the early 1980s. What began as an attempt to lower medical malpractice costs in a group of university hospitals became a worldwide effort that resulted in improvements in patient safety. Other specialties have adopted similar measures. Currently, an attitude and appreciation of safety are exemplified by several practices that include among others—the adherence to these patient safety guidelines, simulator training, the promulgation of standards and guidelines by ASA, and the use of a safety checklist before induction of anesthesia.