Dr Pooja Mohanty
We hang on to our dear lives, that which can slip on anytime until we lose our soul to a deep sea of emptiness, darkness and despondency? We do not talk about it often, as the trouble with this word �suicide� is that we don�t know what to say, and no one knows how to react. However as it happens, we tend to jump on to speculations and judgements of why, when and how not realising that the mind that choose to give up, also gave up on �help� and �hope� from his closed ones.
Suicide is among the top leading causes of death globally for all ages. The World Health Organisation estimates the annual global suicide rate is about 16 per 10,000 people, or almost 1 million people die every year. 95-100 people commit suicide in India every day. This is a pertinent story about a horrifying disease that is slowly and silently engulfing and consuming us. That is depression leading to suicides. India has to wake up and realize this is as serious as cancer and more funding and awareness has to be raised. Life pressures, isolation, parent�s unmet expectations, vulnerability to stress, existential crisis, and lack of coping skills with life�s numerous problems leads adolescents to choose the extreme escape.
For us as people, the grim situation always demands a story and the strong intent that stimulated the act. So what could be the motive- escape, relief, guilt, seek help or attention, to show love, or get their way out. Do they understand the permanence of the act, this always remains unanswered? Suicide is often mentioned as permanent solution to a temporary problem which drives us urgently to understand the complex phenomenon, so as to be able to disapprove it as a resolution to any crisis. Suicides are largely preventable with timely evidence based and often low cost interventions.
According to the data, during the last three months of lockdown during the pandemic, 80 people killed themselves due to loneliness and fear of being tested positive for the virus. There have been a staggering number of suicides, caused by fear of infection, loneliness, lack of freedom of movement, and alcohol withdrawal. A large number of migrant laborers stuck in quarantine facilities, walking to reach home, away from family, died by suicide, fearing infection, and sometimes even the stigma attached to the disease.
Theoretically, suicide has been a subject of concern by most of the social scientific disciplines, although none of these explanations in isolation can be considered conclusive. No one explanation is enough to explain the cause and effect of the phenomenon. The difficulty of studying it is on one side, it is ubiquitous and multi contextual, on the other, it is strictly individualistic and personal. The complexity of studying causes of suicide gets amplified when it is confusing to be treated either as a mental illness with depression, drugs, alcohol use and other mental disorders or as an effect of faulty circumstantial factors like dysfunctional families.
Philosophical theorists question the purpose of life, while physiology explains a disturbance in Hypothalamo-Pitutary Axis and reduction of serotonergic (5-HTergic) system responsible for it. Psycho analytics attack on guilt and repression, sociologists insist on social causes and call it a social fact and psychologists confess cognitive errors and negative schemas like negative views about self, world and future responsible for the same.
Suicide is generally a consequence of gamut of emotional and psychological pain, perturbation and pressures. The decision to quit is made out of desperation, hopelessness, isolation and loneliness. The unbearable pain converts to perturbation and becomes pressures sometimes as much excruciating and agonizing release of which only results in giving up and ending self. That is why we experience calmness and contentment in a victim during his last few days or hours of life. �The thought of suicide is a great consolation: by means of it one gets through many a dark nights� as told by Friedrich Nietzsche.
Mental health professionals and counsellors believe spreading awareness and knowledge through prevention focussed strategy can be single best way to prevent suicides. Stress is inevitable, but the response towards it can be influenced by dissemination of knowledge. There are suicide prevention programs extended by many organisations which help to dispel myth and increase knowledge about risk factors, protective factors, warning signs, promote case findings, provide people with information about mental health resources, encourage the vulnerable to seek help, promote interpersonal life skills and social competency among students.
There is a need to involve self to influence the other, the individual, family, community, schools, and relationships in order to promote resilient protective factors and reduce risk factors. This is known as gatekeeper training. Gatekeepers could be teachers, parents, peer groups, friends who could help strengthening social support and connectedness and keep a check on risk factors like vulnerability towards negativity and access to lethal means. They can identify warning signs like behavioral and emotional cues like talking or joking about suicide/death repeatedly and sudden mood changes or outbursts.
Long term therapies like psychoanalysis, cognitive-behavior/dialectic therapies and interpersonal family therapies help in identification of guilt through free associations, negative schemas and irrational thoughts through thought monitoring. No suicide contracts are signed and role conflicts and communication difficulties are identified for families to focus on inclusion and reorganize.
To extract delight out of distress, desires out of doubt, hopes out of sorrows, merry out of misery requires patience and persistence, and the good news is that we all have it in us. Most people talk about their intent and desperation. For the love of people everywhere, let�s listen their stories, make eye contact, convey empathy, be kind, hold their hands, hug them a little and encourage help. Connecting whichever way possible during this lockdown and keeping our safety intact, let�s check on friends on the doors, those who are struggling with depression. Learn about resources in your area and refer them. We may not argue with them, act shocked, try to fix their problems or promise any confidentiality but we can be calm, non judgemental, empathetic, kind and offer hope. After all one human connection can make all the difference. Preserving life in the face of death and seeking permanence in the midst of perdition are the workings of will to assert existence.
(Dr Pooja Mohanty, Psychotherapist, at XLRI- Xavier Institute of Management, Jamshedpur.�She is certified Practitioner in Suicide Prevention and Mindfulness Stress Based Reduction. She has recently done a fellow teachers training on Mindfulness Cognitive Behaviour Therapy from Oxford University, UK. She has written books on the prevention of suicide and has journal papers to her credits.)