Suicide at a distance

1 Pesticide suicide in India

To introduce our case, the ingestion of pesticide is said to account for approximately 30 percent of the world’s total suicides, most of which occur in the Global South (Gunnell et al., 2007). Despite continued efforts to apprehend the issue, it remains poorly understood as to why over 250,000 people each year self-destructively swallow pesticides (Gunnell et al., 2007). In India, pesticide ingestion is the most popular method of suicide, and researchers from the medical sciences contend that pesticide ingestion is a characteristically ‘rural’ suicide method: a problem of easy access to pesticide (Patel et al., 2012). Social scientists on the other hand have constructed farmers’ suicides as a self-evident product of India’s ‘agrarian crisis’ (Jeromi, 2007; Jodhka, 2001; Kennedy and King, 2014). At first glance these disciplinary understandings of suicide appear fundamentally different. However, when considering the materialities of suicide performed through the literature, these understandings are linked through their fundamental concern with access and, more fundamentally, through distance. To be explicit: the medical sciences present suicide as a problem of easy access to a highly toxic material, while the social sciences present suicide as a problem of inaccess to resources. Access is central.

Specifically, our review examines how ‘access’ works as a framing. We place a particular focus on the medical sciences, as their framing of suicide points to the importance of materiality in suicide methods, making it a particularly productive site for geographical analysis. Taking from Donaldson et al. (2013), we understand framing as the knowledge-practices that create boundaries around relations in order to delineate problems and their matching solutions – exploring both what is made to inhabit the frame as well as what ‘overflows’ its boundaries. Most importantly, the access framing is transferred and translated across time and space, scaled up and down, whilst always maintaining its logical consistency; in Latourian terms (1986), access is an immutable mobile. The mobility of access affords aggregated knowledge the capacity to be inscribed on distant bodies through interventions. This use of distance to both explain and solve suicide emerges from a notion of distance as a territorial separation between points on a two-dimensional plane. Whilst we are critical of understandings of space as a surface on which the social unfolds, we are cautious in our awareness that we too are in the business of making abstractions. Our critique is not of access as an idea per se but the self-perpetuating ways through which access is known and made to work.

Our paper is structured as follows: we begin our review of the literature (Part II) by building an understanding of the contributions from the medical sciences, followed by a review of the key themes identified in the social sciences. It is in this part that we explore how knowledge of suicide is disciplined to (re)produce the access framing. Part III discusses the mobility of knowledge; focusing our critique, it challenges the access framing, exposing logical leaps and unjustified conclusions. Drawing from Li (2007), we also highlight the methods through which suicide is rendered ‘technical’ for intervention. In Part IV we offer a methodological way forward for potential geographies of suicide, exploring the materialities of self-destruction through the literature. Finally, in Part V we situate the knowledge, demonstrating how the conditions of knowledge production shape the literature on suicide. We discuss how emergent interventions loop back and reinforce knowledge in a co-productive manner (Jasanoff, 2004). Our avowedly partial account demands we stay with ‘the trouble’ (Haraway, 2010); ultimately, our contribution is to reassert the incoherences of suicide.

2 Assembling distance

The paucity of geographic research on suicide requires that we outline our methodological approach before proceeding with the review. Drawing from science and technology studies (STS) (Mol, 2002; Law, 2002), and the assemblage work undertaken by Li (2007, 2014), we use assemblage to apprehend the heterogeneous array of relations and actors involved in both suicide and the knowledge produced to make sense of it. We take this position because of the critical need to understand suicide as part of a ‘messy’ world (Law, 2004), inclusive of the material and the discursive – a perspective overlooked in the reviewed literature.

A material imagination is invoked to situate the largely placeless and transcendent understandings of suicide. We draw from STS as a way of exploring what pesticide does, the assemblages in which it is entangled, and the prosaic relations of pesticide with those who use it to end their lives. Taking from Callon (2004), we argue that pesticide ‘matters’ because it forges links between different actors and provokes the emergence of new technologies such as pesticide storage facilities (see Part V). Our materiality places an emphasis on the ontological multiplicities of pesticide (Law, 2002; Mol, 2002) – pesticide can be, at once, an agricultural tool and an occupational hazard and a method of suicide. In the (re)contextualization of pesticide suicides in Part IV, we also think through geographical writing that tells ‘commodity stories’ (Bakker and Bridge, 2006), juxtaposing different elements of pesticide sale and distribution by ‘following’ (Cook, 2004) pesticide throughout the literature. Ultimately, pesticide in this paper functions as a productive sense-making tool for approaching the incoherences inherent to suicide.

Our concern with materiality in making sense of suicide also extends our conceptual work into new territory. Distance emerged as a fundamental factor both in the process of reviewing the literature and through our interrogation of the conditions under which the research from the medical sciences is produced. Three key interrelated enactments of distance surfaced through this sense-making: the first is epistemological distance, produced through the abstraction of suicide from its inherent uncertainty; the second is the literature’s use of access – underpinned by distance – as an explanation and solution for suicide; and the third distance is proximate corporate engagement with knowledge and governance what we term distancing-through-engagement. This corporate distancing reflects Law and Hetherington’s (2000) analysis of knowing and acting at a distance as performative. Differently articulated by Ibert (2010), distance is at once a practice and an effect. Fundamentally, these relational productions of distance constitute connections. This contravenes the commonsense notion of distance as a territorial separation. Our paper broadly contributes to geographic scholarship working to liberate distance from constraints of territory and physicality (Law and Hetherington, 2000; Amin and Cohendet, 2005; Ibert, 2010), opting for what we hope is a more radically relational perspective.

1 Medical sciences and ‘suicide by pesticide ingestion’

Amongst the medical sciences, easy access to pesticide is presented as the central risk factor for ‘rural’ suicide (Chowdhury et al., 2010; Gunnell et al., 2007; Patel et al., 2012; Vijayakumar and Babu, 2009). Chowdhury and colleagues (2007: S388) are representative of this assumption, declaring, ‘easy availability of pesticides is one of the most important variables in the pesticide-suicide scenario’. The ‘problem’ of pesticide access is directed toward the suicides of farmers and workers in agrarian settings. However, despite the widespread discussion of this risk factor, the relationship between access and suicide has not been explored empirically. A recent study of pesticide use amongst farmers in West Bengal (Banerjee et al., 2013) has attempted to contribute empirically, examining the correlation between ‘unsafe’ pesticide practices and rates of pesticide suicide. This correlative relationship is also explored by Vijayakumar et al. (2013) in a pilot suicide intervention which regulated farmers’ access to pesticide through the installation of a centralized storage facility (discussed in Part V). Despite their attempts to offer stronger evidence for the connection between access and suicide, these studies did not make any empirical contributions to understanding the spaces in which suicides occur. In this way, the problem of access emerged from assumptions concerning the linearity of distance and space.

Working in concert with assumptions of easy access to pesticide in rural households, farmers’ pesticide suicides in India are also characterized as ‘impulsive’, particularly because there is no ‘evidence’ of suicide planning (Alex et al., 2007; Gunnell and Eddleston, 2003; Mishara, 2007). This argument is part of a ‘developing countries’ generalization common in the literature. In his review of pesticide suicides in ‘Asia’, Mishara (2007: 13), for example, states ‘pesticide suicides are mostly impulsive acts undertaken during stressful life events (often family quarrels) and they are committed mostly by persons who do not have a mental illness’. Similarly broad claims are made by Alex et al. (2007: 274), who argue that ‘many people in the low-and-middle-income counties who die by suicide do not have severe mental illness’. Disagreeing while replicating the tendency towards abstract generalizations, these kinds of broad conclusions about suicide in the ‘developing world’ have been disputed by epidemiologists who argue that suicide planning may be internal, or less explicit, particularly amongst women (Chen et al., 2012). There is also a substantial volume of literature from the medical sciences that relies on impulsiveness in an implicit manner (for example, see Vijayakumar et al., 2005; Gunnell et al., 2007). By recommending that farmers’ access to pesticide should be restricted to curb rates of suicide, a more implicit framing is endorsed, in which suicides are essentially acts of convenience and impulsiveness.

The classification of suicides using demographics is integral to the identification of risk and sites for intervention. Rurality is isolated as a fundamental risk factor in meta-analyses that aggregate data to national (Patel et al., 2012), regional (Chen et al., 2012), and global (Gunnell et al., 2007) scales, and in case studies that examine clinical records in individual hospitals (Basha et al., 2010; Gannur et al., 2008). The making of rural suicide performs two exclusionary functions – the first is the erasure of female farmers’ suicides, and the second is the dismissal of suicides among urban populations. This gendered production of ‘farmers’ suicides’ can be partially understood as the result of researchers’ use of data from India’s National Crime Records Bureau; despite their pivotal role in agriculture, females are excluded as farmers because they are rarely entitled to be landholders (Kennedy and King, 2014). Urban suicides are also dismissed in the production of pesticide suicide as a rural phenomenon. The difference in numbers between rural and urban suicides in some reports is minimal, troubling the relevance of the access framing. A forensic study of organophosphorous poisonings in Ahmedabad indicates that 47.7 percent of deaths were ‘urban’ (Zariwala et al., 2011). Similarly, a hospital study of deaths in the state of Punjab reports that urban populations constituted 45.5 percent of deaths (Singh et al., 2013). ¹

Occupational categories in pesticide suicide statistics have recently been unsettled, highlighting the erasure of difference and the problems that emerge with generalization (Kennedy and King, 2014). In their analysis of a national survey of suicide published in The Lancet (Patel et al., 2012), sociologists Kennedy and King (2014) point to the merging of labourers and landholders into a single category – smoothing over the diversity of livelihoods and excluding migrant labourers. Kennedy and King (2014) argue that farming practices make a difference in suicide rates, with their results suggesting that farmers engaging in cash-cropping are at greater risk of suicide. This runs contrary to a long-standing narrative in regional studies of pesticide suicides, in which victims are assumed to be ‘subsistence farmers’ (Eddleston, 2000) or isolated ‘Asian smallholders’ (Gunnell et al., 2007). It is integral to emphasise that this construction of occupations is not merely discursive, it fundamentally shapes how suicide is understood as a problem – and therefore shapes the imaginable solutions.

2 Social sciences and ‘farmer suicide’

The social sciences identify farmers’ suicides in India as a symptom of farmers’ growing debt and the associated ‘agrarian crisis’ (Kennedy and King, 2014; Mohanty, 2013; Sidhu and Jaijee, 2011; Sridhar, 2006b; Jodhka, 2001). Contributions from social scientists to understanding the use of pesticide for suicide, however, pale in comparison to their counterparts in the medical sciences, both in the number of publications and the depth to which the suicide method is explored. This relative contribution is reflected in the small space we afford the social science literature in this part of our review. Despite the lack of research directly addressing the use of pesticide for suicide, the social sciences offer critical insights on broader pesticide use and distribution. The key social science literature that addresses the suicide method emerges predominantly from sociology (Mohanty, 2013; Kennedy and King, 2014), and economics (Sarma, 2004; Sridhar, 2006), with notable contributions from anthropology (Münster, 2012; Parry, 2012) and development studies (Gruére and Sengupta, 2011). While the farmer suicide literature has been reviewed by Kennedy and King (2014), our review offers a new perspective by thinking relationally about distance and the material.

The social and medical science literatures speak to each other on a number of rare but important occasions. Mishra’s (2006) economic examination of farmers’ suicides in Maharashtra reports that 79 percent of suicides were from pesticide ingestion. The author draws on Gunnell and Eddleston’s (2003) epidemiological study of pesticide suicide in ‘Asia’ to make sense of the results, concluding that the overwhelming majority of farmers used pesticide to kill themselves ‘because of the easy accessibility in farming households’ (Mishra, 2006: 1541). In practice, this is the use of generalized knowledge to make highly located conclusions. Gruére and Sengupta’s (2011) response to India’s genetically-engineered cotton and farmer suicide controversy also draws on Gunnell and Eddleston (2003) to scale-up their findings – in this case, using pesticide ingestion in one state to draw conclusions about suicide throughout ‘rural’ Asia. This scaling and transportation of knowledge is a significant concern. How this is enacted will be explored in Part III.

1 The co-production of suicide

Access to pesticide is a problem co-produced by the medical sciences; that is, this interpretation of suicide relates directly to the choices of how the phenomenon is studied and understood (Jasanoff, 2004). The pervasiveness of access is, in part, the product of existing knowledge – there is an established consensus in psychiatry that restricting access to suicide methods is an effective approach to curbing rates of suicide (Florentine and Crane, 2010; Yip et al., 2012). Ostensibly certain of the capacity for this consensus to travel, researchers in the medical sciences rely on inference to conclude that access to pesticide is a problem that needs to be solved. We do not deny that the presence of toxic materials in the home is a factor that can shape a suicide, but this framing is supported in the literature by its obviousness. For example, in a longitudinal study of farmers’ pesticide use in West Bengal, Banerjee et al. (2013) attempt to paint a comprehensive picture of pesticide use and abuse. The researchers undertook a study that interviewed farmer households about spaces of pesticide storage. The findings are compared with annual suicide rates instead of, perhaps, examining where suicide victims normally store their pesticide. The access framing fails when explored critically: what of the knives or ropes in these homes? Surely there are other means of suicide that are less painful and more accessible. Despite the proximity of alternatives, people are using pesticide to kill themselves, begging the question of why? ²

The co-productive nature of knowledge is not only relevant to the medical sciences. Equally, it applies to the social sciences, where economists have framed suicide as a largely economic issue. The key difference between the literatures, however, is that the economic framing is supported by research on the livelihoods of farmers and the economies in which they are situated, whereas access to pesticide is a framing imported from understandings of suicide from ‘western’ case studies, such as changes to paracetamol packaging in Britain (Eddleston, 2000) and gun control in Australia (Chen et al., 2012). This transportability of knowledge is enabled by the common language through which those researching suicide communicate, and the development of universal risk factors (Latour, 1986).

Understanding risk factors as universal allows knowledge for suicide interventions implemented in London to be transferred to suicide interventions in agrarian settings in India. This is logical in a context built on placeless transcendent claims. In this way paracetamol, guns, and pesticide are made interchangeable. Such attempts to smooth out complexity and strip research of its context, particularly its spatial dimensions, require geographical involvement. More urgently, the resulting geographic perspective must recognize that unsituated research is driving the development of interventions that have material, emplaced, and embodied consequences. The medical sciences do not offer any empirically based insights into why so many people in India use pesticide to kill themselves and why containing access to pesticide would be a productive intervention. This logical leap and the uncritical use of distance to intervene in matters of life and death is cause for geographers to contribute to knowledge of pesticide suicide.

How might this paradox of knowing self-destruction be avoided? Daniel Münster’s (2012) ethnography of farmers’ suicides suggests that working with incoherence and questioning taken-for-granted knowledge is a productive point of entry. In troubling the category of ‘farmers’ suicides’, the anthropologist offers an insightful analysis, highlighting the processes through which ‘farmers’ suicides’ become a reified object, appropriated by a range of actors for broader political gains. Münster (2012: 205) tells us, however, that ‘farmers’ suicides constitute a complex phenomenon, not easy to come to terms with as an object of study’. It is in this space that geography has the capacity and opportunity to contribute: a materialist reading highlights that pesticide is a fundamental actor throughout the literature – even if its presence is relegated to footnotes (for example, see Münster, 2012: 195).

1 Pesticide for sale

The practices of pesticide sale and distribution in India are largely unregulated (Chowdhury et al., 2007). This environment facilitates ‘aggressive’ approaches to sell pesticide, genetically-engineered seeds, and fertilizers to farmers who ‘buy into rhetoric’ from local and multinational corporations with vast networks that extend into villages (Iyer, 2009; Chowdhury et al., 2007). There is concern that farmers’ (presumed) limited understanding of new technologies is exploited; pesticide shop owners are argued to be the only source of knowledge and advice for farmers (Chowdhury et al., 2007; Iyer, 2009). Vijayakumar and Babu (2009) detail the role of the ‘all-in-one dealer’ in cash crop agriculture: this dealer supplies pesticide on credit, with high rates of interest, while at the same time procuring farmers’ produce at low prices. Pesticide dealers have prospered through the inflation of agricultural inputs (Padhi, 2009; Sridhar, 2006).

The benefits of pesticide use to distributors also extend into informal economies, where a market for ‘spurious’ or ‘adulterated’ pesticides has flourished (Sridhar, 2006; Mishra, 2006). Unregistered retail outlets and grocery stores offer wide access to pesticides and inputs (Chowdhury et al., 2005). These commodities are at once ‘fake’ and ‘real’; spurious seeds bought by farmers attempting to cut costs have purportedly played a pivotal role in the controversial crop failures of Bt cotton and the suicides with which they are associated (Gruére and Sengupta, 2011). The success of the informal pesticide market is arguably driven by the high prices of ‘real’ pesticide; wholesale prices of pesticides increased by 90 percent from 1991 to 1996, with similarly sharp increases to costs of fertilizer, seeds, and diesel (Iyer, 2009). Yet prices for crops, particularly cotton, remain below costs of production (Iyer, 2009).

2 Nonhuman resistance

The intensive use of pesticides and fertilizers has also contributed to severe consequences for soil fertility and dramatic increases in pest resistance (Jeromi, 2007; Iyer, 2009). For example, soils have become depleted ‘beyond redemption’ in Wayanad after years of ‘overuse’ to maintain cash-crop profitability (Münster, 2012). New diseases have emerged in this tired agrarian environment, with the capacity to rapidly destroy entire plantations. Farmers have responded to destructive diseases with even more lethal pesticides, often banned products such as Carbofuran and DDT (Münster, 2012). Targeted ‘pests’ such as the bollworm have responded to the intensive use of pesticide and developed resistance to their toxic assailants (Assadi, 2006; Iyer, 2009). This greater resistance leads to increased pesticide use and, in turn, to greater costs of cultivation for farmers (Iyer, 2009). As a result, farmers are purportedly applying double the recommended levels of pesticides on crops; in the case of Bt cotton cultivation in Andhra Pradesh, the targeted bollworm has returned in force, infesting crops with a devastating impact on yields (Gruére and Sengupta, 2011).

3 Pesticide with/in the body

Farmers’ ingestion of pesticide, and the corporeal and clinical processes that follow, are no less messy and tragic than the economies through which the commodity flows. Attentiveness to the process of death is essential in a material reading of the literature. The visceral details of suicide are important. They matter when pesticide suicides are considered to be characteristically ‘impulsive’ (Mishara, 2007; Alex et al., 2007), and farmers are argued to be ignorant of the outcomes of ingesting this toxic material (Chowdhury et al., 2007; Banerjee et al., 2013; Eddleston, 2000). This is not a quick nor an easy death. Clinicians and researchers in forensic medicine are all-too-familiar with the toxic liveliness of pesticide; it can take up to three days for an agrochemical ‘agent’ (Kanchan et al., 2010) to produce death with/in the human body (Veeresh and Chidananda, 2013). A forensic study detailing the time of death indicates that over one-quarter of pesticide ingestion patients are still alive 24 hours after ingestion (Basha et al., 2010). After swallowing a mouthful of organophosphorous compounds – the most common pesticide for suicide (Veeresh and Chidananda, 2013) – the range of symptoms include nausea, sweating, vomiting, slurred speech, abdominal pain, diarrhoea, palpitation, and convulsion (Gannur et al., 2008). Treating patients who have ingested pesticide proves consistently difficult for clinicians; uncertainty over the types of pesticide consumed places patients at greater risk through the administration of treatments that may trigger further harm or, alternatively, provide little benefit and ‘waste’ scarce medical resources (Veeresh and Chidananda, 2013).

Farmers’ corporeal relations with pesticide are not only acute and deliberate; chronic exposure to pesticide through application has repercussions for the health of farmers and the villages in which they live. In the Sundarban region of West Bengal, 67 percent of farmers have experienced a range of impacts on their health from working with pesticide (Chowdhury et al., 2007). This study reports that farmers take limited precautionary measures when applying pesticide, and that only 29.7 percent of farmers had knowledge about pesticide’s toxicity to the human body (Chowdhury et al., 2007). Farmers in the south of the subcontinent in Kerala have similarly suffered from chronic pesticide exposure, with increased incidences of cancer (Münster, 2012). Recognising only the knowledge produced by ‘experts’, researchers claim that farmers' ignorance is central to dangerous and counterproductive pesticide practices (Chowdhury et al., 2007; Gruére and Sengupta, 2011; Mohanty, 2013). Illegible directives on pesticide packaging, in addition to the absence of advice on health risks from pesticide sellers (Chowdhury et al., 2007), are argued to have fostered an environment where pesticide application is a lethal activity.

4 Meaning in the method?

In the process of juxtaposing the method of suicide against everyday practices, we could not help but consider whether there is a meaning in the method, whether the choice to ingest pesticide is an act of communication, and if this question of ‘meaning’ is useful in understanding suicide in India. In their discussion of material cultures, Bakker and Bridge (2006: 12) highlight that ‘meanings are seen to emerge from the interaction of objects with social processes’. Considering pesticide accounts for the majority of suicides amongst farmers in India, could the ingestion of pesticide have a meaning beyond the expression that life is not worth living (Camus, 2000 [1942])?

Münster’s (2012: 198) ethnography of suicides in Kerala explores the communicative aspect of farmers’ self-destruction, describing farmers’ suicides as ‘acts that intend to do more than just end a life: they convey a message of despair and protest and, therefore, a political message’. For Münster, these suicides are ‘political’ as farmers know that their suicide is contributing to a broader discursive field. However, the author does not include the methods of suicide in his analysis. Pesticide is a highly profitable commodity – the extent of this profit will be discussed in Part V. It is tempting to attach symbolic meaning to pesticide suicide, creating a narrative to frame our paper. We choose to stop short of doing so, acknowledging that these juxtaposed elements remain separate in their coherence, and preferring to leave this question to be explored in future research. We continue our exploration of materiality in Part V, but re-orient our analysis to the practices that have contributed to the dominance of access in the medical sciences. If all knowledge is indeed made somewhere by someone (Haraway, 1988), which actors are involved in the production of access and what is at stake?