Since ancient times there has been a difference between suicide (an act of self-destruction) and self-immolation which, although self-destructive, has a sacrificial connotation. Self-immolation is associated with terrible physical pain (burning alive) and with the idea of courage. In modern times it has been used, among others, by Buddhist monks to protest against political oppression in the 1960s. It is, however, a new phenomenon in Arab Muslim societies.

As in many other religions, suicide is condemned by Islam. It is a sin which may be punished by burning in hell. The self-immolation of the young Tunisian Mohamed Bouazizi, a street vendor, expresses both the extreme hurt associated with the harassment and humiliation that was inflicted on him after his wares had been confiscated, and the fact that there were no other ways to be heard in a country where he knew no kind of political system other than dictatorship. This individual gesture had a catalyst effect, bringing together the voices of the voiceless and provoking an unprecedented movement of rebellion and protest in Tunisia which culminated with the departure of the head of state. His gesture is now being replicated, mostly by other young men in Arab countries.

Although these events clearly belong to the social and political sphere, they also raise important issues for psychiatrists and mental health professionals. First, these events highlight the social, political and cultural dimensions of suicide as a powerful collective idiom of distress. In the Tunisian case there is a shift from an individual sinful suicide to a sacrifice which evokes martyrdom. Fire symbolises purification and self-immolation may represent the collective desire for a transformation, a rebirth out of corruption. In recent decades, it is to be noted that martyrdom has become a common way to confront oppression, felt injustice and social suffering. Usually self-destruction was a way to destroy an enemy which was defined as external. In the present case, destruction is limited to the individual and the target of the protest is the national state. This may be an indication of a fracture in the ‘us and them’ polarisation, which has been put forward in the War on Terror and has not only characterised mounting international tensions but has facilitated the overall projection of suffering and oppression onto external enemies.

Second, in spite of the fact that the idiom of distress put forward by these Arab youth is radically different from the usual profile of youth suicide in Western countries, these events may also be an invitation to rethink the collective dimensions of youth suicide as a protest against society. Without minimising the role of psychopathology and interpersonal factors, it may be time to revisit the collective meaning associated by youth with the decision to exit a world in which they may feel they do not always have a voice.