‘We lost because of his drunkenness’: the social processes linking alcohol use to self-harm in the context of daily life stress in marriages and intimate relationships in rural Sri Lanka

Abstract

IntroductionHarmful alcohol use has been found to cause detriment to the consumers and those around them. Research carried out in Sri Lanka has described the socioeconomic consequences to families owing to alcohol consumption. However, the social processes around alcohol use and how it could result in behaviour such as self-harm was unclear. With an outset in daily life stressors in marriages and intimate relationships we explored alcohol use in families with a recent case of self-harm.MethodsQualitative data were collected for 11 months in 2014 and 2015 in the North Central and North Western provinces of Sri Lanka. Narrative life story interviews with 19 individuals who had self-harmed where alcohol was involved and 25 of their relatives were conducted. Ten focus group discussions were carried out in gender and age segregated groups. An inductive content analysis was carried out.ResultsParticipants experienced two types of daily life stressors: non-alcohol-related stressors, such as violence and financial difficulties, and alcohol-related stressors. The alcohol-related stressors aggravated the non-alcohol-related daily life stressors within marriages and intimate relationships, which resulted in conflict between partners and subsequent self-harm. Women were disproportionately influenced by daily life stressors and were challenged in their ability to live up to gendered norms of marriage. Further, women were left responsible for their own and their husband’s inappropriate behaviour. Self-harm appeared to be a possible avenue of expressing distress. Gendered alcohol and marriage norms provided men with acceptable excuses for their behaviour, whether it was alcohol consumption, conflicts or self-harm.ConclusionsThis study found that participants experienced both alcohol-related and non-alcohol-related daily life stressors. These two categories of daily life stressors, gender inequalities and alcohol norms should be considered when planning alcohol and self-harm prevention in this setting. Life situations also reflected larger community and structural issues.

Attempted suicide in Sri Lanka – An epidemiological study of household and community factors

“…The risk of attempted suicide is nearly double in women living in households with a household member who misuses alcohol after controlling for socio-economic variables. This is consistent with previous work from India which has indicated that increased levels of hazardous drinking in male household members increases the risk suicidal behaviour in co-habiting women ( Gupta et al, 2015 ), and research from Sri Lanka indicating husband/father alcohol misuse as a preceding factor for suicidal behaviour ( Gamburd, 2008 , Konradsen et al, 2006 , Marecek, 2006 ; Sørensen et al, 2017 ) Problematic alcohol use is often associated with intimate partner violence in Sri Lanka ( Abeyasinghe, 2002 , Gamburd, 2008 ). It may be that the increased risk of attempted suicide seen in women in households with problem alcohol use is due to these women experiencing such violence.…”

Respectability and rights. Sexual and reproductive health and rights of Sri Lankan women formerly involved in prostitution

“…Silence accompanied with the body language described above can, in the Sri Lankan context, be a way for women to live up to the gendered ideal of women silently 'bearing up under their problems'. This behaviour has been pointed out in other studies (Ruwanpura 2006;Sørensen et al 2017). It is also inherent in the norm of lajja-baya, which demonstrates that silence may be perceived as a way of positioning oneself as respectable.…”

A qualitative exploration of rural and semi-urban Sri Lankan men’s alcohol consumption

“…When carrying out formal observations to understand how, where and with whom alcohol was consumed, the first author was accompanied by a research assistant. Observations took place in villages at legal and illegal alcohol selling establishments and in households during interviews carried out for the purpose of another study (Sørensen et al, 2017 ). Observations were also made at social gatherings, such as funerals and weddings.…”

“…Despite these initiatives, alcohol consumption continues to have negative consequences for Sri Lankans, including in relation to poverty (Baklien & Samarasinghe, 2004 ), domestic violence (Subramaniam & Sivayogan, 2001 ), depression (Ariyasinghe, Abeysinghe, Siriwardhana, & Dassanayake, 2015 ), unintentional injuries in children (Punyadasa & Samarakkody, 2016 ), traffic accidents (Edirisinghe, Kitulwatte, & Senarathne, 2015 ) and self-harm (Pearson et al, 2014 ; Sørensen et al, 2017 ). The rate of cirrhosis is among the highest in the world (Abeyasinghe, 2011 ).…”