When thinking of some of the most extreme things that can happen to “life”, one often thinks of death. Even though it is an important aspect of life, we refrain from talking about it. The fact is that one cannot fully live life without considering the possibility of death. However, talking about death, how and in what conditions one wants to die, and the different possibilities of death are seen as “morbid thoughts”.
When talking about death, suicide is considered to be one of the most “extreme” forms of death. Such an act of “taking away” one’s own life is more often than not condemned by the larger culture. There is also a kind of silence that surrounds this issue. If we are to truly consider numbers and statistics to estimate the importance of this issue; suicide is the second leading cause of death across the world. As per WHO reports (2014), India was placed at the top with the maximum number of suicides in the world. It has also been estimated that the highest incidents of suicides occur in the age group of 15 to 29 years – considered to be the prime of youth! Most of these occur in low and middle income countries.
The aim of this article is to talk about and discuss issues related to it. In “talking about suicide”, the purpose is to remove the taboo surrounding this issue, and to begin considering it as a serious health concern.
To believe or not to believe…
The first step in talking about suicides is to bust the myths surrounding suicide. Because suicide is not often discussed or talked about, there is a tendency to make assumptions about what it entails.
“People who talk about suicide, do not actually mean to do it. They are just trying to scare everyone around them”
|People who talk about committing suicide, do so, because they are experiencing homelessness, anxiety and depression and may actually act upon it. This is their way of communicating distress.|
|“Most suicides happen suddenly, without a warning”
|People who wish to commit suicide, also communicate their intent to do so. Warning signs can be noticed, if we look out for them.|
|“Someone who is suicidal is committed to die”||People who wish to commit suicide may be ambivalent about living or dying.|
|“Once someone is suicidal, they always remain suicidal”.||Such a state is temporary in nature and dependent on how one thinks and feels.|
|“Only people with mental disorders are suicidal”||Suicidal behaviour can stem from extreme stress in the environment – family conflict, financial issues etc. and is not necessarily related to a mental disorder|
|“Talking about suicide may actually put this idea in their head… and may be seen as encouragement for them to actually commit suicide”||People who have suicidal thoughts often do not know whom to speak to, considering the widespread stigma around the issue. Instead of covering the issue with a blanket, it is important to openly speak about it and lend support to those who need help.|
What leads people to feel suicidal?
The next logical question to ask is – why do people feel suicidal. Such a question is not only complex and multidimensional but also difficult to answer; it can be answered from different perspectives. A person from a medical background would consider this an abnormality and an imbalance in the functioning of the brain. For example, a doctor would say that suicidal thoughts originate from the malfunctioning of certain parts of the brain. However according to other perspectives, suicide occurs because of a number of environmental factors acting as stressors in a person’s life. Some examples of these stressors could include – poverty, unemployment, break up of a relationship, examination stress, death of a loved one, pre-existing mental health problem (such as depression or bipolar mood) etc. Suicidal thoughts occur when the individual experiences an extreme sense of helplessness and hopelessness in life; such that, committing suicide seems to be the only option left for them. There are also pre-existing conditions like a traumatic childhood which may make the person more vulnerable than others to commit suicide.
You may also wonder that we all experience stressors in life; these could be daily stressors or more intense and abrupt stressors. No one’s life is without problems… then why is it that everyone does not feel suicidal?! An important point to consider here, is the fact that each one has a tolerance level for stressors – and can “cope” with it. However, when the stressors in life exceed a person’s coping ability or “tolerance level”, thoughts of suicide may occur. It is important to consider that suicidal thoughts occur as an interaction of the biological and environmental factors. It is also difficult to say that “this is THE reason” why he/she feels suicidal. There is no direct cause-effect relationship when talking about suicide. There could be multiple causes.
As mentioned earlier there are some factors that may increase or decrease the risk of committing suicide. Factors that may increase a person’s risk for suicide include:
- Current ideation, intent, plan, access to means
- Previous suicide attempt or attempts
- Alcohol / Substance abuse
- Current or previous history of psychiatric diagnosis
- Impulsivity and poor self control
- Hopelessness – presence, duration, severity
- Recent losses – physical, financial, personal
- Recent discharge from an inpatient psychiatric unit
- Family history of suicide
- History of abuse (physical, sexual or emotional)
- Co-morbid health problems, especially a newly diagnosed problem or worsening symptoms
- Age, gender, race (elderly or young adult, unmarried, white, male, living alone)
- Same- sex sexual orientation
Factors that may decrease the risk for suicide are also called protective factors. These include:
- Positive social support
- Sense of responsibility to family
- Children in the home, pregnancy
- Life satisfaction
- Reality testing ability
- Positive coping skills
- Positive problem-solving skills
- Positive therapeutic relationship
Watch out for signs!
One of the most important factors in preventing suicide is to identify the signs at the earliest.
The first three and the most obvious signs are:
- Threatening to hurt or kill self
- Looking for ways to kill self; seeking access to pills, weapons or other means
- Talking or writing about death, dying or suicide
The other signs which may be communicated are:
- Rage, anger, seeking revenge
- Acting reckless or engaging in risky activities, seemingly without thinking
- Feeling trapped – like there’s no way out
- Increasing alcohol or drug abuse
- Withdrawing from friends, family or society
- Anxiety, agitation, unable to sleep or sleeping all the time
- Dramatic changes in mood
- No reason for living, no sense of purpose in life
You may hear them say things like:
- Life isn’t worth living
- My family (or friends or girlfriend/boyfriend) would be better off without me
- Next time I’ll take enough pills to do the job right
- Take my prized collection or valuables — I don’t need this stuff anymore
- Don’t worry, I won’t be around to deal with that
- You’ll be sorry when I’m gone
- I won’t be in your way much longer
- I just can’t deal with everything — life’s too hard
- I won’t be a burden much longer
- Nobody understands me — nobody feels the way I do
- There’s nothing I can do to make it better
- I’d be better off dead
- I feel like there is no way out
- You’d be better off without me
What can YOU do?
Considering that it is a fact that people are likely to attempt suicide if they talk about it, the following things can be done to prevent them from committing suicide.
- Be aware – learn the risk factors and warning signs for suicide and where to get help
- Be direct – talk openly and matter-of-factly about suicide, what you have observed, and what your concerns are regarding his/her well-being. Don’t worry, you are not “putting” thoughts of suicide in their head by talking about it.
- Be willing to listen – allow expression of feelings, accept the feelings, and be patient
- Be non-judgmental – don’t debate whether suicide is right or wrong or whether the person’s feelings are good or bad; don’t give a lecture on the value of life
- Be available – show interest, understanding, and support
- Don’t dare him/her to engage in suicidal behaviors.
- Don’t act shocked at their behaviour or what they express to you.
- Don’t ask “why” – it is simply irrelevant!
- Don’t swear to keep their secret. This is a dangerous promise to keep. Tell them that you will report to others if there is harm to self and others.
- Offer hope that alternatives are available – but don’t offer reassurances or false hope that everything will be alright in the future.
- Take action – remove lethal means of self-harm such as pills, ropes, firearms, and alcohol or other drugs
- Get help from others with more experience and expertise
- Be actively involved in encouraging the person to see a mental health professional as soon as possible and ensure that an appointment is made.
Most importantly be comfortable talking about suicide. If you are not comfortable, you may not be willing to listen to their narratives about ending their lives. Hence, you may miss an opportunity to help them by filtering out this information.
It is important to also note that we can do a LOT, to prevent a crisis situation. You can offer support… Suicide is a crucial matter of life and death. You do not want to lose a life, just because you are not comfortable with talking about it.
(Sadhvi Krishnamoorthy is a Researcher with QualityRights Gujarat, Centre for Mental Health Law and Policy, Indian Law Society, Pune. QualityRights Gujarat Project (QRG) is an innovative intervention to improve public mental health services in Gujarat, India, by reorienting services from a purely medical approach to a holistic, comprehensive and participatory approach that values and emphasizes empowerment, autonomy, recovery and an integration into the family and community.)