Burns
Volume 35, Issue 1 , Pages 154-155, February 2009

Classic philosophy lessons and preventing self-inflicted burns: A call for action

Department of Anesthesiology, Critical Care and Pain Management, Kermanshah University of Medical Sciences, 6718818838, Iran

Department of Public Health Sciences, Division of Social Medicine, Karolinska Institute, Stockholm, Sweden

Department of Psychology, University of Alabama at Birmingham, USA

Tehran Institute of Psychiatry and Mental Health Research Centre, Division of community psychiatry, Iran University of Medical Sciences, Iran

Department of Anesthesiology, Critical Care and Pain Management, Kermanshah University of Medical Sciences, Iran

Article Outline

 

In Iran, suicide ranks as the fifth-leading cause of years of life lost (YLL) through premature death. Suicide by self-burning (self-immolation) is the third leading cause of YLL among women, after disasters and breast cancer [1], [2].

Self-immolation is rare in high-income countries, but is reported more frequently in low- and middle-income countries such as Iran, India, and Sri Lanka [2], [3].

In this letter, we’d like to outline why culture-based opinion and evidence is important to the field, but must be considered in conjunction with theoretically driven, empirical data that cross cultures. To do so, we invoke the thoughts of two classic philosophers, one Eastern (Rumi) and the other Western (John Stuart Mill).

There are many opinions about the root causes of self-immolation. Recently, it has been suggested that the ‘dowry’ system is a major contributory factor for suicides and parasuicides among young, married women in India [4]. Others have suggested the roots of self-immolation in particular regions might include contamination with natural sour gas containing hydrogen sulfide [5]; the influence of Ancient Greeks [6], religious influences [7], sanguine marriages [8], or the traditional style of Kurdish women's clothing [9].

These reports are valuable, but must be qualified since they are based largely on the opinions and impressions of the authors rather than standard evidence-based empirical study. Some of these wise arguments about self-immolation, we believe, are reminiscent of John Godfrey Saxe's (b. 1816, d. 1887) satirical poem, “The Blind Men and the Elephant” (1851), which retells the classic fable often attributed to Mualana Jalaladdin Muhammad Balkhi, or Rumi, a well-known thirteen-century Persian mystic and philosopher [10], [11].

In the fable, a Sultan pitches his camp upon the plain where, to prove his splendor, rank, and state, he keeps an elephant. The townspeople, curious to learn more about the creature, send six learned blind delegates to investigate the beast. Each feels only a part of the elephant, and each concludes that the elephant must be like the part he touched. That is, one blind man felt only the elephant's side and concluded the animal was like a wall. A second felt only the tusk and reported the beast was like a spear. Others felt the elephant's trunk and reported a snake; the leg and reported a tree; the ear and reported a fan; and the tail and reported a rope. Each blind man was convinced that he was correct and persisted in his views. In fact, each was correct in reporting his own sensation, but failed to grasp the full picture of what the beast was like. This fable can be analogized to our current-day controversy over the nature of self-inflected burns.

We must open our eyes to the reality of self-immolation patients, and gather the holistic information about their particular culture backgrounds, opinions, and behaviors. Clearly we must learn about the individual parts of the elephant—those local cultural factors that may contribute to self-immolation in a particular area. At the same time, however, we must also consider the full beast, and work to understand broad human conditions that might influence self-immolation risk across cultures. Strong empirical science will accomplish that goal.

The thoughts of the English philosopher John Stuart Mill illuminate this issue. In his 1883 book Essentials of Logic (p. 219), Mill wrote, “If an instance in which the phenomenon under investigation occurs, and an instance in which it does not occur, have every circumstance in common save one, that one occurring only in the former; the circumstance in which alone the two instances differ is the effect”.

Without a doubt, we must continue scientific investigation into broad factors that are related to risk for self-immolation not just locally but cross-culturally. Case-control, longitudinal, and cohort studies are sparse but desperately needed; our extensive literature review discovers only two case-control self-immolation studies, both from Western cultures (even though self-immolation is far more common in low- and middle-income countries) [12], [13]. Studies that cross cultures are also urgently needed.

At the same time, we recognize the value of tradition and culture, and argue they must not be ignored. Factors for self-immolation are likely to vary across cultures and nations, and only culturally sensitive research will discover factors such as the methods of marriage and the traditional style of clothing, which have developed over thousands of years and are likely to influence human behavior in so many ways including suicide risk. With these goals in mind, science can continue to work toward preventing self-immolation in all cultures of the world.

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Conflict of interest statement 

None.

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References 

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  10. The Poems of John Godfrey Saxe. Complete edition. Boston: James R. Osgood and Company; 1873, p. 77–8.
  11. The Masnavi: book two, translated by Jawid Mojaddedi. Oxford World's Classics Series. Oxford University Press; 2007.
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PII: S0305-4179(08)00170-8

doi:10.1016/j.burns.2008.05.022

Burns
Volume 35, Issue 1 , Pages 154-155, February 2009

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