September 10, 2022
World Suicide Prevention Day
Ramesh* failed his SSLC exams. He was worried that his parents would be furious. He thought that his friends would make fun of him. His confidence hit rock bottom. The thought of giving supplementary exams gave him a heartache. He decided impulsively to end his life. He gulped phenyl from the bathroom to end it all! His throat burnt like fire! He could not swallow any more. He started screaming in pain. He was rushed to the hospital emergency. By God’s grace, his parents prayers and doctors efforts he was saved. But phenyl had totally scarred his food pipe and he had to be fed through a nasogastric tube for 3 months. When the psychiatrist counselled him, he regretted the attempt. He said he was sorry and would never do it again. He had not imagined the consequences of his action. He put himself through so much of unnecessary suffering.
Ramesh is not alone….
Around 703,000 people every year around the world, take their own life. For every suicide, there are around 20 other people like Ramesh making a suicide attempt and many more harbouring serious thoughts of suicide. Millions of people around such attempters and committers of suicide suffer intense sorrow or are otherwise profoundly impacted by the suicidal behaviour.
Every suicidal death is a public health concern. By raising awareness, reducing the stigma around suicide, and encouraging well-informed action, we can reduce instances of suicide around the world.
With this vision in mind, World Suicide Prevention Day was first observed in 2003 by the International Association for Suicide Prevention and World Health Organization. On 10th of September each year, world suicide prevention day is observed and people focus especially on this issue, try to reduce stigma and raise awareness, giving a singular message that suicide can be prevented.
“Creating hope through action” is the theme for the World Suicide Prevention Day this year. This theme is a reminder that there is an alternative to suicide and aims to inspire confidence and hope in all of us.
As a psychiatrist, I look at suicide as a bio psycho social problem. There are obviously biological reasons for suicide such as untreated or partially treated depression. Even an untreated medical illness like hypothyroidism can make a person depressed and suicidal.
There is a psychological aspect such as loss, deprivation, trauma or failure. Personality and negative thinking patterns also play a role.
Then there is this huge social issue -acceptability of the act, religious issues such as suicide being considered a sin in certain religions (may be protective) determines the overall burden of suicide and its impact. In today’s world where perfection and wealth is celebrated overtly, people have forgotten to appreciate being normal and average. They have stopped enjoying the mundane things in life which need to be celebrated as well. Over-Expectations bring disappointment.
What are the risk factors for suicide?
1. Untreated depression
2. Loss- loved person, job, financial setbacks, and reputation
3. Stressful relationship issue such as a break up
4. Previous history of suicide
5. Family history of suicide
6. Substance and drug abuse - many patients report that they were able to have the courage to harm themselves only when they were intoxicated. Probably the logical brain was deactivated due to being under influence of substance!!
7. Serious illness such as advanced cancer and chronic severe pain syndromes where patients lose hope often.
8. Personality- emotionally unstable borderline type
9. Copycat suicide and suicide after a famous celebrity dies of suicide.
What are the warning signs that a person is suicidal?
In case of a planned attempt, there could be several indicators. Some of my patients have suddenly written a will, given away their most loved belongings saying that they would not need them anymore. Others have written a suicide note. Some families have reported to me careful planning of act when no one is around and when they could not be saved. A mother committed suicide after the husband left for work and children to school. In a severely depressed individual if there is a sudden cheerful mood, it could be that the patient is suddenly happy as he is thinking that suicide will end his misery. Multiple means may be used to ascertain death. Some patients go on an accumulation spree of tablets from different pharmacies just to be able to swallow a large number of tablets. If a person who is depressed consistently tells you that he has no hopes for his future, you can be be almost certain he is harbouring a death wish or a suicidal idea!!
Impulsive attempts are more difficult to predict. But unstable personality, being under intoxication and previous such attempts will be helpful to warn of a suicidal attempt. Many a times it could be unsuccessful as it’s unplanned.
What to do once you suspect a loved one is suicidal?
Well don’t leave them alone. The suicidal impulse is not permanent. Help the person ride it through. Listen to what he or she has to say. Harness the protective influences such as impact of his loss on loved ones. One of my patients told me that when she thought about her children, she decided she would not deprive them of a mothers love. Distraction helps too. A change of place may change the mind-set. Also remove means of harm such as sharp objects, shawls which could aid in hanging and medications which may be overdosed. If it is not a family member, inform the family or guardian.
Get in touch with a psychiatrist and initiate therapy and medications. Trust me - suicide can be prevented!
How to behave with a person who has survived an attempted suicide?
Be supportive. Don’t stigmatise and isolate him. Encourage to take help to sort out mental health issues by consulting a qualified person, preferably a psychiatrist. I say this specifically because diagnosing a severe case of depression is done more correctly by a psychiatrist and also in severe cases medication is a must, along with therapy.
Suicide is a serious mental health emergency. A psychiatrist, psychologist and social worker will be required to help the patient along with support from family, friends and work colleagues.
A few years back I had counselled a young woman who was on the verge of attempting suicide after her boyfriend had left her for another girl. She was heartbroken and had lost trust and will to live. She was from a broken family and had lost her job recently. She had refused so many proposals thanks to her boyfriend who ditched her after making false promises and also making her part with some of her money. So many stressors all together! Recently I met her in a public place. She looked familiar. She thanked me for helping her change her mind away from committing suicide. She smiled and asked me, “Do you remember what exactly you told me doctor?” I replied earnestly that I had forgotten and apologised to her. She refreshed my memory and told me something which i thought I should share. She said doctor you told me then that “Is it justified that you take your life if someone lets you down? You have no right to take your life. God has given this life as a gift and only he can take it away. You have to fulfil your duties till you live. There is no point in even regretting over a useless person who didn’t deserve you in the first place. Let alone lose your precious life over him. Don’t be irrational. Focus your energy on what you can be today and how much you can achieve tomorrow. Your failed relationships and troubled family don’t define you- it’s what you have within you, that’s more vital. You have within you to overcome this hurdle, solve this problem and emerge victorious.”
She said that when a caring professional can have so much faith that I could overcome my problems, I thought I might as well try!!!
So let’s look at difficulties as problems that we can solve, and depression and mental disorders as illnesses that we should treat. Let’s keep the option of suicide out and lots of hope in. Let’s be non-stigmatising to those who survived attempted suicide and inclusive in helping them build a tomorrow full of hope and joy!!
Let’s say “No to Suicide”.