Finally, some of the barriers to a full understanding of social and cultural forces on suicide are described. Next, it explores the roles of the individual, of geographical location, of society, and of historical perspective on the social factors that impact the risk of suicide. This chapter describes a framework for thinking about the continuum of cultural influences on suicide. They shape risk and protective factors as well as the availability and types of treatment that might intervene to lessen suicide. Cultural variables have a far-ranging impact on suicide. This has important implications for treating individuals belonging to different racial, ethnic and cultural groups in the United States, as discussed in detail in the Surgeon General's Report, Mental Health: Culture, Race, and Ethnicity (US DHHS, 2001). Culture influences the way in which we define and experience mental health and mental illness, our ability to access care and the nature of the care we seek, the quality of the interaction between provider and patient in the health care system, and our response to intervention and treatment.

Society and culture play an enormous role in dictating how people respond to and view mental health and suicide. As such, understanding suicide and attempting risk prevention requires an understanding of how suicide varies with these forces and how it relates to individual, group and contextual experiences. Suicide is not everywhere linked with pathology but represents a culturally recognized solution to certain situations. At both the individual and population levels, the suicide rate has long been understood to correlate with cultural, social, political, and economic forces (Giddens, 1964). Suicide carries a social and moral meaning in all societies. If I cannot have both, I would rather take dutifulness than life. Life is what I want dutifulness is also what I want.

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