The Philosophical and Sociological exposition of Suicide in Lesotho

One of the philosophical problem is the phenomenon of suicide. In the Kingdom of Lesotho as many nations the nature of suicide can be understood from the philosophical and sociological lenses. Among the countries in the world with the highest suicide rate is Lesotho. How come? This research article delves into the complex relationship between individual agency and social factors in context of the existence of suicide in Lesotho, drawing upon philosophical and sociological approaches. The main philosophical and sociological positions of suicide in this paper are presented. A qualitative method has been applied in this paper, secondary data has been subscribed from electronic database from various reliable sources such as World Health Organization (WHO) reports, government and private documents related to suicide and mental affairs reports. A comparative analysis of philosophical and sociological perspectives, the article seeks to deepen our understanding of the factors contributing to suicidal behaviours and their implications for prevention and intervention strategies. This paper also discusses the richness of Durkheim’s insight on suicide and four etiological types of suicide. This paper concludes by putting forward that young people in Lesotho who have serious mental illnesses at an early age have a higher risk of suicide.


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his research article provides a comprehensive analysis of the philosophical and sociological perspectives on suicide.Drawing upon prominent philosophical and sociological theories, the study examines the multifaceted nature of suicide and explores how these 1 Suicide attempt is a non-fatal self-directed and potentially injurious behavior with an intent to die as a result of the behavior (Walling, 2021).

The Philosophical and Sociological exposition of Suicide in Lesotho
| 171 | perspectives contribute to our understanding of this complex phenomenon.By synthesizing key arguments and insights from both disciplines, this article aims to enhance our comprehension of suicide as a social and existential phenomenon.
The kingdom of Lesotho is a landlocked nation, entirely surrounded by The Republic of South Africa with a population of around 2 million people.In this country, the suicide rate is high.Suicide mortality rate (per 100.000 population) in Lesotho was reported at 72.4 % in 2019, according to the World Bank collection of development indicators, compiled from officially recognized sources (Economics 2023).It is becoming a growing concern and pressing issue around the world (Varzgani et al., 2021).Karakaya (2018) suicide has been debated in the philosophical field from antiquity to nowadays and different approaches to this phenomenon have been made Brás et al., (2023) asserted that it is a complex and multifaceted phenomenon, resulting from the interaction of several biopsychosocial factors.Mueller et al., (2021) maintained that these trends have been identified as a public health crisis in urgent need of new solutions and have spurred significant research efforts to improve our understanding of suicide and strategies to prevent it.Stanley et al., (2015) stated suicide among older adults has been an intractable clinical and epidemiological problem for decades, due in part to an incomplete understanding of the causes of suicide, as well as imprecision in the prediction and prevention of suicidal thoughts and behaviours in later life.Owing to poor suicide literacy, people are not aware of the consequences of the suicide stigma, which may affect individuals (Jahan et al., 2023).The classification of suicide deaths is a topic of ongoing discussion within the field of suicide research.Since it signifies a complex public health crisis, suicide is a subject of study across various disciplines including psychology, psychiatry, sociology and anthropology and philosophy (Khan and Mian, 2010;Edwards et al., 2022).Walling (2021) viewed Suicide as a death caused by self-directed injurious behaviour with an intent to die as a result of the behaviour.Moreover, suicide is the second most common cause of death for young people worldwide.

Research objectives and methodology
The present study adopted a qualitative method.Searching secondary data through electronic database such as annual review, web of science, PubMed, PsycINFO, Google Scholar, Zendy and Lesotho local newspapers.A researcher conducted a literature review focusing on the philosophical and sociological phenomenon of suicide, The Kingdom of Lesotho as a case study.The search for keywords such as "suicide", "Philosophical", "Sociological", "Durkheim's study of suicide" in the case of literature review.When the term "suicide" was searched on BioMed Central, 12.077 papers were found.

The nature of suicide
Suicide used to be called self-murder, felo de se.(Humphrey, 2018).From the historical perspective, attitudes towards suicide have closely mirrored the evolution of societies, particularly in society's attitude towards individual and personal rights (Khan and Mian, 2010).Walling, (2021) argued that a suicidal behaviour is episodic with short durations (several hours), and suicide attempts are often made in response to a rapid escalation in suicidal thoughts (Varzgani et al., 2021).Suicide behaviour is the result of the interaction between the individual's predisposing factors and precipitating factors.
Suicide remains an extremely complex phenomenon that includes the interactions of factors at different levels of analysis: the systemic level (access to suicide means such as post war firearms and ammunition), societal level (socio-economic determinants of mental health), community level (support from the community, family, and peer group) and individual level (sex, age, medical and biological determinants) (Pajić and Orešković, 2022).Durkheim theorized that modern societies could, in turn, generate two ideal-types of suicides: egoistic and anomic.Egoistic suicide, he posited, occurs when societies provide insufficient levels of integration, while anomic suicides occur when societies lack moral regulation (Mueller et al., 2017).Şeker (2019) stated that since suicide began to turn into a social problem, it has attracted the attention of social science.Numerous investigations into the causes of suicide, the elements that contribute to different types of suicides, and suggestions for the fight against suicide have all been conducted by various researchers.
It appears that religious affiliation is no longer a protective factor against suicide.What has changed?With a large Catholic population, the Kingdom of Lesotho is predominantly a Christian nation.(Gailienė, 2018).Morselli claimed that suicide was a social-physiological phenomenon and not pathologic because it is part of society from birth (Bak et al., 2019).Durkheim showed that suicide can be explained etiologically through social structures and their ramifications and that the structure of social relations are what bind and constrain the individual and protect them from suicide (Yüksek, 2021).

The philosophical debate of suicide from a historical perspective
Some philosophers approach suicide from a public health ethics perspective, debating the ethical implications of public policies and interventions regarding suicide prevention.Cooley (2007) mentioned that it has been argued that, on Kantian grounds, pedophiles, rapists and murderers are morally obligated to take their own lives prior to committing a violent action that will end their moral agency.Second, the agent must be in a situation in which he is forced to choose between either taking his physical or losing his moral life.Kant claims in Care for One's Life if it is a decision between moral and physical death, then physical death is to be preferred (Cooley, 2007).

Existentialist approaches
The major thinkers on freedom, authenticity, and existential misery, including Jean-Paul Sartre, Camus, Emmanuel Kant, and David Hume, as well as their contributions; an analysis of suicide as a reaction to the absurdity of life.Existentialism is a way of thinking about finding oneself and the significance of life through choice, decision, and moral obligation (Camus and Sartre's Views on Existentialism, 2021).Roberts and Lamont (2014) stated that Camus 3 situates the phenomena of suicide within the context of the uniquely human endeavour to make sense of the struggles and sorrows of life.On the other hand, Hendricks (2023) explored that existentialism emphasizes individual freedom, choice, and responsibility, and the search for meaning and purpose in a seemingly meaningless and absurd world.It contends that the individual is absolutely free, that objective ethical values are illusory, and that these realizations often engender feelings of despair, nausea, and anguish (Laskar, 2004).

Utilitarianism account of suicide
Utilitarian views hold that suicide would be morally forbidden if the suicide leads to greater suffering, such as the grieving of family and friends (Madray, 2017).Kant's position on suicide is much more complex than many realize as Cooley (2007) as stated.Kant argued that "There are duties which are far greater than life and which can often be fulfilled only 3 Albert Camus, the French-Algerian playwright, novelist and writer of philosophical essays, is generally acknowledged as being one of the most important cultural and intellectual figures of the twentieth century (Roberts and Lamont, 2014).by sacrificing life.The moral life is at an end if it is no longer in keeping with the dignity of humanity", (Cooley, 2007).According to him "suicide is in no circumstances permissible."The man who commits suicide "sinks lower than the beasts" (Edwards, 2007).In accordance to Kant, suicide is motivated by misfortune and founded on self-love (Ivic, 2007).Edwards (2007) on the other hand reveals that Kant maintains that man is God's property, and hence has no right to dispose of his own life.However, Kant also has a number of purely secular arguments, two of which deserve some discussion.According to the first of them, the suicide is abasing and degrading his humanity by treating himself as no more than a thing.Ivic (2007) revealed that Kant argued that suicide could be permitted by the rule of prudence, but on the other hand, it is strictly prohibited by the rule of morality.Ivic (2007) also emphasized that that according to Spinoza, an agent who commits a suicide is overcome by the external environment, which is operating contrary to the nature of an agent.A rational person would know that to have duties, one must be a moral agent or have the dignity of humanity; therefore, on the consistency grounds, no one could ever be morally required to act in such a way as to end her moral life (Cooley, 2007).In bioethics this means that we need to pay careful attention to the distinction between physical human life and moral life (Rabins, 2007).David Hume's (1711-1776) position on suicide includes the view that suicide is not only permissible for the individual but in some cases for their family and society as a whole (Kelly and Dale, 2011).Hume argued that morality of a particular conduct is not inherent in the conduct but rather, is ascribed to it by human beings (Oyebode, 1996).His analysis on suicide maintains that the act receives its meaning from the circumstances, characters and purpose of those committing it and also from the consequences of their act (Oyebode, 1996;Khan and Mian, 2010).Kelly and Dale (2011) claimed that John Stuart Mill, one of the most influential utilitarian philosophers of the 19th century, asserted that suicide prevention is never justified after an initial attempt has been made to find the cause.Madray (2017) postulated that utilitarian views hold that we have a moral duty to maximize happiness, and in the above cases an act of suicide will produce more happiness than if the individual were to remain alive.Agerbo et al., (2011) mentioned that works in the sociology of suicide focused on the analysis of long terms societal change, principally social integration.De Souza Minayo et al., (2006) revealed that the concept of suicide is presented as follows by Durkheim: Mueller et al., (2021) mentioned that sociological theories offer great promise for advancing our understanding of suicide and improving the efficacy of suicide prevention.

Durkheimian approach of suicide
Émile Durkheim, in his foundational classic Suicide, provides impressive guidance toward understanding why the end of the world goes hand-in hand with suicidal despair (Mueller et al., 2017).Gerardi (2020) mentioned that Durkheim's effort at understanding the problem of suicide can be found in the study of the Moral Collective character in both Traditional (Mechanical Solidarity) and Modern societies (Organic Solidarity).Mueller et al., (2021) posited that Durkheim's theory posits two core principles: the first one is that the structure of suicide rates is a positive function of the structure of a group or class of people's social relationships.Durkheim's effort at understanding the problem of suicide can be found in the study of the moral collective character in both traditional (Mechanical Solidarity) and modern societies (Organic Solidarity) (Gerardi, 2020).Mueller et al. (2021) argued that Durkheim articulated two continua and four types of suicide related to integration and regulation: egoistic/ altruistic suicides (too little ↔ too much integration) and anomic/fatalistic suicides (too little ↔ too much regulation).

Durkheim's typology of suicide
Gerardi (2020) mentioned the examination of the four types of suicide (altruistic, egoistic, anomic, and fatalistic) Durkheim argued that suicide in most cases is not a personal weakness, rather it is a concrete social problem based in levels of social integration Altruistic suicides are marked by cultural approval and benefit the social order (Stack, 2004), such suicides are committed by individuals having a peculiar type of personality and it is a form of sacrifice in which a person puts an end of his life by some heroic means in order to promote or further the interest of the cause or idea dear to him (Sharma, 2018).

Generally, Anomic, and Egoism can be found in an Organic Solidarity
Gerardi, (2020) mentioned the-application of sociological concepts to understand suicide as a social phenomenon.The first type of suicide according to Durkheim is egoistic suicide which we talk about when a human is not able to integrate him or herself into a society or a group (Bak et al., 2019).Yüksek (2021) claims that egoistic suicide occurs when an individual is strongly isolated from social circles and thus strongly unregulated by the norms and rules of society.Durkheim defined anomie as normlessness resulting from the absence of regulation and argued that anomic suicide "results from man's activities lacking regulation and his consequent sufferings" (Yüksek, 2021).In Figure 1, the global suicide rate is displayed first, followed by regional numbers and a table showing the distribution of the rate by nation, including both male and female representation.Lesotho has the highest suicide rate, followed by Esawtini, while Sao Tome has the lowest suicide rate.WHO (n.d.) while the link between suicide and mental disorders (in particular, depression and alcohol use disorders) is well established in high-income countries, many suicides happen impulsively in moments of crisis with a breakdown in the ability to deal with life stresses, such as financial problems, relationship break-up or chronic pain and illness.

Global context of suicide
In Africa, underinvestment by governments is the greatest challenge to adequate mental health service provision (WHO, 2022).Ignorance of man and society on suicide is a rooted cause for increasing the suicide numbers globally irrespective of gender, age and race (Aminur Rahman, 2022).However, Sussman, (2017) raised a point that the complexity of the issue arises from its various dimensions, which include legal, political and moral perspectives.
Suicidal ideation and attempted suicide are a huge problem in South Africa, especially in the rural areas (Shilubane et al., 2015).Suicidal ideation is the consideration of or desire to end one's own life.Suicidal ideation typically ranges from relatively passive ideation (e.g., wanting to be dead) to active ideation (e.g.wanting to kill oneself or thinking of a specific method on how to do it) (Cha et al., 2018).Suicidal thoughts and behaviours include suicidal ideation, suicide attempt, and suicide death.We begin by defining and describing each of these outcomes, and then summarize their known epidemiology, mechanisms, and related treatment.
In Australia, over 3.000 individuals die by suicide each year (Australian Bureau of Statistics, 2020) and every death has profound impacts on families, friends, and communities grappling with grief, loss, and trauma (Flego, et al., 2022).The suicide rate in India is 10.3.In the last three decades, the suicide rate has increased by 43% but the male female ratio has been stable at 1.4: 1. Majority (71%) of suicide in India are by persons below the age of 44 years which imposes a huge social, emotional and economic burden (Vijayakumar, 2010).In some countries the connection between religious affiliation and suicide rates remains constant, even for very long periods of time.For instance, in Switzerland Durkheim compared suicide rates between the Catholic and the Protestant cantons and found that the Protestant rates were higher than the Catholic ones (Gailienė, 2018).Flego et al., (2022) viewed that the guidelines encourage journalists to reduce the prominence of reports of suicide, use language that is not sensationalist, and refrain from providing detail about suicide methods.Teixeira (2023) in his research on suicide in Lithuania revealed that alcohol consumption is a prevalent factor in Lithuania's high suicide rate, which is consistent with patterns observed in other Eastern European countries.

General causes of suicide
Durkheim hypothesized that the main causes for human suicide are rooted in the levels of social integration (or "moral life" in society) (Gerardi, 2020).(Agerbo et al., 2011) postulated that the processes of secularization, urbanization, and industrialization were thought to promote a higher incidence of suicide through breaking down ties between the individual and the normative structures of family, religion, and agricultural work (Durkheim, 1897;Pope, 1975;Stack, 1982;Stack, 1993;Stack, 2000).Depression rates are one factor that holds serious importance, but other factors to take into consideration are academic, performance, physical condition, mental health and well-being, economic standing, financial struggles, workplace performance, and overall life satisfaction (WHO, 2023).Shilubane et al., (2015) claimed that they mentioned other factors that they thought could have contributed to the suicide of the learners, such as broken relationships, pregnancy, the use of drugs, young people not wanting to be reprimanded, a mother having a relationship with another man, child-headed households, the culture that prevented young people from discussing sexual issues with parents, evil spirits and black magic, family history of suicide, and HIV/AIDS.Hofmann and Wagner (2023) argued that a large body of research has identified wellknown symptoms of suicidal ideation and behaviour, which primarily include hopelessness, sadness, social withdrawal, and mood swings.
The act of suicide is a complex phenomenon and raises difficult ethical issues for individuals, healthcare providers, governments as well as the society at large (Khan and Mian, 2010).When dealing with the relation between religiosity and suicide Masaryk maintained the opinion that there was a higher number of suicides among Catholics than Lutherans (Bak et al., 2019).When a society is going through circumstances which sadden, perplex or irritate it, it exercises a pressure over its members, to make them bear witness, by significant acts, to their sorrow, perplexity or anger (Pope, 1975).Specifically, social integration is seen in relation to the effects which its relative absence causes, for example, suicide (Cresswell, 1972).

Challenges of suicide policy makers
Scarcity of resources means that policymakers often question whether benefits of interventions can be achieved at an acceptable cost.Specifically, we review how recent sociological theories of suicide have incorporated insights from social network theories, cultural sociology, sociology of emotions, and sociological social psychology to better theorize how the external social world matters to individual psychological pain and suffering (Mueller et al., 2021).We make the argument that death by suicide among humans is an exemplar of psychopathology and is due to a derangement of the self-sacrificial behavioural suite found among eusocial species (Joiner et al., 2016).Suicide, which is defined as the attempt of the human being against his life using his will, has been a subject of deep discussions of the philosophical field as an equivalent of the search for the meaning in the existential sense beyond just a sociological fact (Karakaya, 2018).Cooley (2007) argued that suicide based on free will's exercise is a contradiction and unable to be consistently willed.Masaryk understood suicides in relation to happiness and unhappiness in human life hence it is the result of losing one's purpose of life and is a manifestation of desperation (Bak et al., 2019).

The existence of suicide in Lesotho
The kingdom of Lesotho is traditionally a Catholic country and Christianity is a very important part of the cultural foundation of the country It has had to struggle since Independence in 1966 to maintain its sovereignty in the face of diverse political and economic adversities.It is a country near South Africa, has the highest suicide rate in the world at 87.48 suicides per 100.000people annually (Word Population Review, 2022;Government of Lesotho, 2012).Gailienė, (2018) argued that the part that the Roman Catholic Church played in debates regarding the acceptability and morality of suicidal behaviour was therefore very important.Boloetse (2021) stated that World Bank said in its latest report Titled Unlocking the Potential of Basotho Youth: Catalysing Youth Entrepreneurship and Employment, the report also states that: "Lesotho also has the highest female suicide rate in the world, at 24.4 per 100.000(compared to 17.8 for males)."

Suicide case studies in Lesotho
'Mapule Motsopa (2021) in her article titled "The slippery slope of suicide" stated a case that a 24 years old girl, got pregnant out of wedlock twice and attempted suicide twice.In all these instances, she was too afraid to discuss her problems with her parents.After years of suppressing her thoughts of suicide out of a fear of talking about her worries, she is currently receiving mental health care.
Lerotho Letsatsi (2019) in her article wrote that Police in Maseru are investigating a case of murder, attempted murder and suicide after a toddler and its mother dies last week after allegedly taking poison, while Police spokesman Senior Inspector Rankoane Motsoetla said the boy's 18-month-old sister died on arrival at hospital, while the mother's body was found near Durham Link in Maseru, the following day, June 9.Lerotho Letsatsi (2019) stated that senior Inspector Motsoetla appealed to couples to resolve differences amicably or seek arbitration instead of dragging children into their disputes.Motsoeli (2020) revealed that at the village called Hata-Butle, Roma residents on Friday woke up to the shocking sight of a lifeless body of a National University of Lesotho (NUL) student dangling from the rafters of a rented apartment.Next to it was a full-page handwritten suicide note.National representative president explained that on the bed was a suicide note where the deceased poured out his heart and explained why he had decided to take his life "because life was not worth living" (Motsoeli, 2020).Furthermore, he clarified that the cause of suicide had nothing to with a deceased academic performance but rather had to do with some other hardships that he was facing in life.Young people, particularly those in higher education, encounter many internal and external challenges, some of which lead to depression.

A case of suspected serial killer who killed himself
A suspected serial killer and traditional healer slit his stomach open when he realised that police had come to arrest him at his home in Ha Makhabane village in Nazareth (Nthatuoa Koeshe, 2017).Police Inspector Mpiti Mopeli confirmed that the man had run into his house and locked himself inside when he noticed a police vehicle approaching his home.
The disproportionate burden of household and care responsibilities that women continue to carry compared to men contributes to the financial disparities between the two sexes and is likely a significant source of distress for women leading to suicide (Boloetse, 2021).'Mapule Motsopa (2021) mentioned in her article a psychiatric mental health nurse at Mohlomi Mental Health Hospital, Kefuoe Ramone said causes of in Lesotho suicide or suicidal thoughts range from problems during child birth, teenage pregnancy, substance abuse, heredity, poverty, break-ups, divorce or body parts, crisis and toxic society.
'Mapule Motsopa (2021) revealed that Tlhokomelo e Nepahetseng Mental Health Association Representative named Lucy Makhalanyane stated that mental health is taken for granted in Lesotho as psycho education is still not readily available to many people."Mental illness victims don't have to be treated in a special facility unnecessarily, we need a holistic approach to health care".
The Director of Mental Health in the Ministry of Health, 'Moelo Ramahlele, said Lesotho is currently using the outdated 1964 laws on mental health.He further stated that "It is way outdated and doesn't work for Basotho anymore," She said through the World Health Organisation (WHO) funding 10 years ago, the ministry tried to amend the law but failed because authorities didn't give it the priority it deserved ('Mapule Motsopa, 2021).
Causes of suicide in Lesotho.Sharma (2018) in his book titled Criminology and Penology revealed that the major cause of suicide is dreadful diseases and this indicated that adequate facility for their treatment were not available.Poverty was another reason and dispute over property was a major factor.
Unemployment: Chan et al., (2007) in this research article on "Suicide and Unemployment: What are the Missing Links?" revealed that unemployment threatens psychological wellbeing in ways that induces stress, triggers mental health problems, and reduces self-esteem.In Lesotho, psychological instability that might result in suicide is significantly influenced by unemployment.O'Neill, (2024) shared some light that the unemployment rate in Lesotho decreased to 16.31 percent since the previous year.
Mental Health Issues: Mental health disorders, such as depression, anxiety, bipolar disorder, and substance abuse, are significant risk factors for suicide in Lesotho.Lack of access to mental health care can exacerbate these issues.
Traumatic Life Events: Traumatic experiences in people who are facing the various challenges in Lesotho, such as the loss of a loved one, divorce, or serious illness, can contribute to suicidal thoughts.
Social Isolation: Feelings of loneliness and social isolation can contribute to suicidal thoughts.This may be influenced by factors such as bullying, discrimination, or a lack of supportive social networks.

Prevention of suicide
WHO's live life approach recommends four cardinal interventions which have proven to be effective (WHO, 2023).The World Health Organization's suggested core pillars above align with the philosophical and sociological perspectives that this study attempts to address on the current complex public health issue in Lesotho.Osafo et al., (2020) revealed that in Africa training programs on suicide assessment and interventions for general practitioners or mental health professionals were very limited, available in just four countries.

Conclusion
Young people with early psychosis are at particularly high risk of suicide.However, there is evidence that early intervention can reduce this risk (Power et al., 2003).Mueller et al., (2017) revealed that research has shown that social relationships serve as important sources of biological, psychological, and social support, and reciprocal obligations that anchor individuals to something greater than themselves, thereby promoting mental health.There is an important need for improved access to care, treatment, and services for those diagnosed with severe and persistent mental health disorders (Shelile, n.d.).Community programs that promote a sense of usefulness, belonging and that contribute to preserve social integration should be encouraged (De Mendonça Lima et al., 2021).Gailienė (2018) illustrated that this overview clearly demonstrates that the relationship between religion and suicide seems to follow a different pattern in Lithuania in this particular moment in history than the previous research suggests.
Morselli proposed development of correct thoughts which will help us reach our goal in life and reconsolidation of moral character (Wray, Colen, Pescosolido, 2017). Masaryk, (2002) proposed a return to a religious life.Chan et al., (2007) suggested that suicide prevention for the unemployed could be done through mental health awareness programs; problem-solving skills training for attempters and males; and vocational training and job opportunities for discharged psychiatric patients and rehabilitees.This recommendation would also be beneficial given the suicide issue in the Kingdom of Lesotho.

Figure 2 .
Figure 2. Pillars of suicide prevention