I got a frantic call from a student on the tele-helpline I operate to de-stress the stressed students during their exam time. He sounded very desperate and very scared. He told me that he had failed in his XthBoard exam and was very scared his parents would beat him—so he said, he was standing in the middle of a railway track waiting for the train to come and run over him—he was attempting suicide! I had a tough time trying to dissuade him. He agreed to walk away from the railway track after I had managed to contact his father and made him talk to his son imploring him to come back home and promising not to reprimand or beat him. My immediate remedial intervention in this emergency and empathetic talk managed to save his life.
The World Suicide Prevention Day (WSPD), marked a few days ago on September 10, is organised by the International Association for Suicide Prevention (IASP). World Health Organisation (WHO) is the co-sponsor of the day. The purpose of this day is to raise awareness around the globe that suicide can be prevented. Working Together To Prevent Suicide was the theme for this year’s WSPD.
Suicide is defined as ‘intentionally taking one’s own life’ and comes from the Latin word suicidium, which literally means to kill oneself. Suicide is considered a criminal offence in some locations, a religious taboo in some, and, in some cases, an act of honour (eg suicide bombings). Close to 8,00,000 people die due to suicide every year, which is one person every 40 seconds somewhere in the world. Suicide is a global phenomenon and research has shown that for each adult who died of suicide there may have been more than 20 others attempting suicide somewhere.
Suicide may occur throughout the lifespan of a person and is the second leading cause of death among 15-29 year old youth globally. It is very important for us to understand why a person attempts or plans to end his or her life. What goes on in his mind, why does he not find life worth living? The answers are many and we have to try and go to the root cause of the problem to be able to help the person. It may be someone with depression or other mental disorders. Depression is a major cause of suicides today. Someone who is sad or has lost interest in his daily activities or is feeling helpless, hopeless or listless for a long duration of time - sometimes more than two weeks- is a high risk person when it comes to depression.
Other mental disorders also play an important role in the increased risk of suicide in people. It is estimated that 90 per cent of individuals who commit suicide suffer from some type of psychiatric disorder.
These mental disorders with the prevalence of increased suicide risk include major depressive disorder, bipolar disorder, schizophrenia, personality disorders, post traumatic stress disorder and eating disorders. People suffering from major depressive disorder and bipolar disorder are at the highest risk of suicide. Many times, psychiatric factors and substance abuse co-exist. Other risk factors for suicide include genetics, substance abuse, family and social situations.
Access to weapons and other methods of suicide also increase the risk of suicide in many cases. For example, rates of suicide in homes which have with guns are greater than in homes without them. Those who may have suffered an emotional breakdown like the loss of a loved one or a relationship failure,people who are socially isolated or have a chronic or painful illness, or those who have witnessed abuse or post traumatic stress disorders are also the high risk people vulnerable to suicide. We should be ready to help them come out of their emotional turmoil. Sometimes suicides are impulsive and people react on the spur of the moment when they are not able to cope with the situation,like relationship break downs or a financial crisis.
The good part of this discussion is that we have to realise that suicides are preventable and by talking to someone who we feel is suicidal we not only reduce his anxiety by the catharsis he undergoes, but we also help the person because he feels he is being understood. Our empathy helps him a lot. The take home message is that it is absolutely okay to talk of suicide.
Suicide rates are also high in people who feel discriminated like the refugees and migrants, indigenous people, lesbian, gay, bisexual, transgender, intersex (LGBTI) persons, and prisoners. Genetics is also thought to play an important role in suicide – a family history of suicide indicates an increased risk of suicide among other family members– accounting for up to 55 per cent cases of suicidal behaviour. Similarly, exposure to suicide (eg watching a family member commit suicide or finding their body) is also indicative of an increased risk of suicidal behavior.
Family and socio-economic problems are also contributing factors to increased suicide risk. Unemployment, homelessness, poverty, childhood sexual abuse, social isolation, loss of a loved one and other life stresses can all increase the likelihood of suicide. Sexual abuse alone is thought to contribute to 20 per cent of the overall risk of suicide.
Males are four times more likely than females to commit suicide though many more females are likely to have thoughts of suicide.Females are four times more likely than men to attempt suicide.
A previous suicide attempt is a very important indication that someone may contemplate suicide in the future. Sometimes some people start giving us very significant hints about intentions of suicide. Some may talk about feeling hopeless or having no purpose in life and feel trapped .They may say things like ‘being a burden to others’. They may increase their intake of alcohol or drugs; some may be agitated very restless and may have sleeping problems.They either sleep too much or too little. Some may exhibit extreme mood swings
Protective factors are important characteristics which can make a person more resilient to problems. Such people are less likely to adopt suicidal behaviour. Effective clinical care for mental, physical and substance use disorders along with restricted access to lethal means of suicide also help. Strong connections to family and community support,cultural and religious beliefs that discourage suicide and support self-preservation too help prevent suicide.
Suicide prevention and treatment focuses on the underlying causes in addition to prevention of suicidal thoughts and acts. If there is a mental disorder, a treatment plan to treat this condition is started first.
One of the most common suicide prevention techniques is psychotherapy – also known as talk therapy – in the form of Cognitive Behavioral Therapy (CBT) or Dialectical Behavior Therapy (DBT).This helps us go to the root cause of the problem the person has and also empowers him to find ways to cope with the problem and find rational solutions to it.
Increased awareness among doctors is also a prevention technique. Research indicates that many individuals who have completed suicide or attempted suicide did seek medical attention in the year prior; however, warning signs may have been missed. Increased education and awareness among medical professionals and the public might decrease suicide rates in the future. The person who commits suicide dies once- those who are left behind die a thousand deaths trying to relive those terrible moments and ask why.
(The author is a neuro-psychologist, CBSE designated counselor and director of Pari Foundation)A