【英语中国】富士康与中国的自杀谜题

Michael R. Phillips

The recent string of suicides among young workers at the Foxconn company in Shenzhen, China, has been variously interpreted as an indictment on exploitative factory owners; a commentary on the problems of China's rapid social change; or a consequence of newly aggressive media hyping tragedy and spurring copycats. None of these explanations capture the essence of this phenomenon.

The Foxconn suicides certainly seem to call out for some special explanation. Ten workers have taken their own lives so far this year and two others have tried. Some observers suggest it is a 'suicide cluster,' which occurs when there are significantly more suicides in a community over a specified time than would be normally expected. While such clusters are uncommon in China, reports from other countries have identified suicide clusters in schools, military units and other closed communities similar to the 'company town' environment at Foxconn. Most common in adolescents and young adults, there is always a contagion element to clusters because the individuals know each other or have been exposed to prior suicides by personal communication, the media or the Internet.

Given that 300,000 people work at the affected factory, it is not yet certain whether this string of suicides rises to the formal statistical definition of a cluster, but the intense press attention has certainly promoted the perception of an abnormal increase in suicides. The fear is that in this highly charged emotional atmosphere, continued media coverage will encourage more suicides.

The most common narrative in reports about Foxconn is that these suicides are the result of the break-neck speed of social change in China. The intense competition for financial success, the breakdown of traditional family structures, the weak coping skills of children from one-child families, the massive rural-to-urban migration and other aspects of China's modernization are, according to this narrative, believed to have caused a corresponding rise in psychological stress, mental illness and suicides.

The facts do not support these assumptions. With the possible exception of increasing rates of substance abuse (particularly alcohol abuse), there is little evidence to confirm a rapid rise in rates of common mental illnesses, and there is strong evidence of a dramatic drop in suicide rates over the last 20 years, perhaps by as much as 50%. The psychological stresses experienced by individuals have certainly changed as the country has become more mobile and more competitive. But these stressors may be less severe than those experienced in pre-reform China, which had high levels of rural poverty, restricted social mobility and rigid family relationships.

Another important part of the story is that China's overall suicide rate, despite its recent decline, still is somewhat higher than that reported in most high-income countries. Suicide is the second most common cause of death among China's youth and young adults after traffic accidents, compared to third in the United States, after traffic accidents and homicide.

Both the pattern and characteristics of suicide in China are substantially different from the West, and there is considerable debate about the reasons for these differences. In China rural rates are double urban rates and female rates are similar to male rates, but in Western countries urban and rural rates are roughly similar and male rates are two-fold to four-fold higher than female rates. Another major difference is that only 65% of people who die by suicide in China have a mental illness, compared to 90% to 95% in high-income countries.

Depression and other mental disorders are still major risk factors for suicide in China. But the relative importance of chronic and acute psychosocial stresses (particularly family conflicts), impulsive personality traits, and poor conflict-resolution skills may be greater in China than elsewhere. Pesticide ingestion is the method employed in about 65% of suicides and about 27% of attempted suicides; thus impulsive suicidal behavior following interpersonal conflicts in persons who do not have an underlying mental disorder may be more likely to result in death in China than in countries where less lethal methods such as ingestion of sleeping pills are more commonly employed by suicide attempters.

China has yet to develop a national strategy to tackle suicide as a public-health problem. Starting in the early 1990s there has been an increasing awareness of the issue on the part of policy makers. But local, institution-specific suicide preventive efforts have not yet been integrated into comprehensive national or regional plans. One of the most surprising aspects of the Foxconn story is the degree of access given to the press and the forthrightness of government officials in trying to address the problem, something we wouldn't have seen 15 years ago. The new transparency hopefully will stimulate a greater emphasis on the conditions of factory workers more generally, although the increased press coverage runs the risk of encouraging more suicides.

The public outcry about Foxconn should also spark a recommitment to developing a comprehensive, multisectoral approach to suicide prevention. As a first step, renewed public-health efforts to restrict access to means (particularly pesticides), to expand social support networks for persons at high risk of suicide, and to conduct publicity campaigns to decrease the stigma associated with seeking help for psychological problems would help sustain the downward trend in suicide rates.

The best response to the Foxconn suicides would be to first conduct a careful study of precisely what happened. This would include determining the relative importance of work environment, contagion from media reports, other social stresses and underlying psychological problems in driving each of the victims to take his or her life. Only then can the company determine what steps, if any, it needs to take to avoid this in the future. That information will also be crucial to public-health authorities in better understanding China's broader suicide problem and crafting effective community-based solutions. The worst thing to do now -- for policy makers, factory owners or journalists -- would be to settle for facile explanations of what has caused this complex tragedy to unfold.

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Dr. Phillips is director of the Shanghai Suicide Research and Prevention Center at the Shanghai Mental Health Center and professor of psychiatry and global health at Emory University in Atlanta.

Michael R. Phillips

针对近期中国深圳富士康公司发生的一连串年轻工人自杀事件出现了各种各样的解释：有人称这是对剥削阶级工厂老板的控诉；有人说这说明中国社会的快速变革带来了问题；亦有人称这是近期媒体对悲剧事件进行大规模宣传引发工人效仿造成的结果。但这些解释均未透过现象抓住问题的本质。

相关报导事实情况并不支持这些假设。可能除了酗酒或滥用药物的比例有所上升，没有证据证明普通精神疾病的患病率快速增长，而且有确凿证据表明过去20年间自杀率大幅下降，降幅或许高达50%。随着国家的流动性更大，竞争更为激烈，个人的心理压力肯定会有所改变。但这些紧张性刺激的剧烈程度或许还低于中国改革前。当时，农村贫困人口比例很高，社会流动性受限，家庭关系僵化。

尽管近年已经下降，但中国的总体自杀率仍高于大多数高收入国家。这是另一个重要方面。自杀是导致中国青少年死亡的第二常见原因，仅次于交通事故，而自杀因素在美国排名第三，位居交通事故和谋杀之后。

中国自杀事件的模式和特点均与西方有很大的不同，关于存在这些差异的原因有相当多的争论。在中国，农村的自杀率是城市的两倍，女性和男性的自杀率相似；而在西方国家，城乡自杀率大体相同，而男性自杀率则比女性高了两倍到四倍。另外一个主要不同点是，中国自杀身亡的人中只有65%患有精神疾病，而高收入国家中的这一比例是90%至95%。

在中国，抑郁症和其他精神疾病仍是自杀的主要风险因素。不过，相比其他国家，长期和短期的社会心理压力（特别是家庭矛盾）、冲动的个性、较差的矛盾解决能力在中国的相对作用可能更大。有约65%的自杀身亡者和约27%的自杀未遂者是通过服用杀虫剂自杀的。在中国，没有精神疾病的人在人际关系出现矛盾后做出的冲动性自杀行为致死的可能性比其他国家更高。在其他国家，企图自杀的人更常见的方法是服用安眠药等致命性不那么强的方法。

中国尚未制定一种国家战略来应对自杀这个公共卫生问题。从90年代初开始，决策人士就越来越意识到这个问题。不过，地方性、机构性的自杀预防工作尚未整合成全面的国家或地区性的计划。富士康事件最让人吃惊的一点是，媒体被允许对这一事件进行广泛地了解报导，政府官员在努力解决问题方面态度直率，而15年前我们是看不到这类情况的。我们希望，新的透明性将促进对工人普遍条件的更大重视，尽管媒体的大量报导可能会有鼓励更多自杀事件的风险。

公众对富士康事件的不满应该还会激发在制定综合性、多领域自杀预防机制的重新投入。首先，重新投入限制自杀手段的公共卫生工作（特别是杀虫剂）、扩大对高危群体的社会支持体系、展开宣传活动以减轻在精神问题上寻求帮助所带来的羞耻感，这些都将帮助保持自杀率的下滑趋势。

应对富士康事件的最好方法是，首先对事件进行详细调查。这将包括确定工作环境、媒体报导的影响、其他社会压力和潜在的精神问题在促使各个自杀者自杀中的相对作用。只有到了那个时候，富士康才能确定是否需要采取行动以及采取什么行动来避免未来发生更多的自杀事件。这类信息还将对公共卫生部门更好地了解中国更广泛的自杀问题、制定有效的社区解决方案至关重要。决策人士、厂主和记者们现在最不该做的是，满足于对这一复杂悲剧成因的表面解释。

（编者按：本文作者费立鹏(Michael R. Phillips)现为上海市精神卫生中心心理危机研究与干预中心主任，美国埃默理大学(Emory University)精神病学及全球卫生教授。）

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