Suicide

What is suicide?
People think that death due to suicide is a rare event.  Actually, it is not; it ranks ten among the leading causes of death in most countries. Suicide is generally described as the act of purposefully ending one’s life. Opinion about suicide differs from culture to culture and from country to country. Some religions like Christianity and Islam consider suicide a sin. Some states brand suicide attempt as a crime punishable by law. But in several other cultures, it is approved as a sacred religious act. Some Jain saints in India voluntarily end their life and the act is considered sacred. Jains ending their life out of starvation is not considered as suicide but an culturally accepted act. Japanese engage in hara-kiri when a person has had a serious failure in life or has been dishonored. Several people kill themselves when someone whom they adored (king, queen, leader, hero or heroine) dies. Nowadays, several individuals (terrorists) are trained to kill themselves as suicide bombers. There are people who undertake a hunger strike unto death. Some psychologists and psychiatrists consider suicide as a mental disorder; several people are found to kill themselves within a week after their discharge from a mental hospital.

 You may wonder why some people kill themselves when all of us want to live. Freud was of the opinion that there is an innate biological tendency driving all of us to death. He proposed that there are two groups of instincts: life instincts (Eros) and death instinct (Thanatos), and believed that there is an inborn desire to end life along with the desire to live. For him, life was an intertwining of living and dying, creation and destruction; no construction is possible without destruction. In fact, Freud once wrote that “the goal of all life is death.” After all, all men are mortal; every person will eventually die. Freud asserted that every person has a wish, usually unconsciously, to die. Hence, he thought that suicide is an expression of Thanatos. Death wish (self-destruction) turned outside becomes aggression. Freud’s assumption of a death wish is based upon the constancy principle as formulated by psychophysicist G. T. Fechner. The constancy principle asserts that all living processes tend to return to the stability of the inorganic world; back to the soil. Life is thus a round about way to death. Disturbed, out of its stable existence, organic matter strives to return to a quiescent state of inorganic matter. Thus,  the death wish in humans may be a psychological representation of the constancy principle. Some people try to reach the original state of inorganic matter rather soon through suicide.

After Freud, neo-Freudian Erich Fromm postulated two types of personalities: biophilous (those who are in love with life) and necrophilous (those who are attracted to death); but, he did not call them instincts. There appears to be a parallel between Freud and Fromm, but actually it is not a parallel. For Freud both life and death instincts were inherent in the biology of humans, whereas for Fromm, life was the only primary potentiality. Death is merely secondary and only enters the picture when the life forces are frustrated. These are theoretical propositions about living and dying. But, the facts about suicide defy the theoretical explanations. Let us examine some of the facts about the incidence, causes, risks, and prevention of suicide. 
 
Incidence of suicide
It is reported that every year one million people commit suicide all over the world. Every ten minutes, there is a suicide somewhere in the world. Nearly 500,000 Americans are reported to attempt suicide each year—almost one per minute. More than 31,000 commit suicide every year in the US. Suicide is the third leading cause of death after accidents and homicides among people 15 to 24 years of age. A national survey (1999) showed that about 10 percent of college students had seriously thought of killing themselves during the preceding year.  In a representative US sample of 15 to 54-year-olds, nearly one in twenty reported making a prior suicidal attempt. The same may apply to other countries as well.  Women are about 3 times as likely to attempt suicide as men. But, about four times more men than women complete suicide. Many women attempt to kill themselves, but more men than women actually do it. 

In the US, the highest rate of completed suicide is in the elderly group (aged 65 and over). A high proportion of them were divorced or widowed, or suffered from chronic illness. It is the 8th leading cause of death in men and 16th in women; it is the 3rd cause among youth (18 to 24). Recently, there has been a phenomenal increase in the rate of suicide among the youth. During 1950-1990, there has been a 300 % increase among those between 15 and 19. Experts agree that the number of actual suicides is at least two to four times higher than the number officially reported because many self-inflicted deaths are attributed in official records to other, more “respectable” causes. Half a million people attempt suicide and nearly 3% of Americans have made a suicide attempt at some time in their lives. 

Possible causes of suicide
Causes of suicide are multifaceted, more complex, and they may be real or imagined. Generally, a person intending to commit suicide is experiencing immense, unendurable, psychological pain. He or she thinks that suicide is the best way to stop the awareness of painful existence; there is a desire to end consciousness. If he or she can reduce the pain in whatever way possible, even just a little, it will go a long way in preventing suicidal thoughts.

One of the major causes of suicide is trouble in the family. Suicide is more frequent (3 to 4 times higher) among single, separated, or divorced than among married people living together. It is found to be more frequent among the unemployed and among those from low income group. Surprisingly, it is reported that more people end their life during spring! In women, suicide is generally triggered by failure in love, whereas among men career failure is the main cause. 

What are the motives for suicide? Researchers have found two: (1) Some people use suicide as a solution to their problems; they want to put a full stop to their emotional distress by killing themselves; some others attempt suicide thinking that they are a burden to the people around them. (2) Some others use the threat of suicide to gain some benefit.  

People whose psychological needs are frustrated are more likely to attempt suicide. The inner life of the suicidal person is desperately in need of something; it may be the need for security, achievement, trust, love, or friendship. The helper must find out what exactly is his or her need and help the person to find a way out of the problem.

All people have problems and they are in search of solutions. But some people think that death is the only solution to the problem. It is these people who choose suicide. They do not think that there are alternate ways of solving their problem. They think dying is the only solution. There is some kind of constriction of options in their mind. Such people must be convinced that there are several routes to their goal and alternate solutions to their problems.

Suicidal thoughts
People who attempt suicide report the following feelings and thoughts:

• Helplessness and hopelessness; negative expectations,
• A sense of helplessness and a belief that no one can help him or her,
• Ambivalence; love-hate relationships with people,
• He or she “wants and does not want to die” simultaneously; the person wants to kill oneself and at the same time is crying for help,
• Departure; avoidance; wanting to escape, run away from everything,
• Lifelong coping pattern: “cut and run” approach to problems. They walk away from home, marriage, and quit the job.
• Sexual abuse, rape, loss of honor, privilege, freedom,
• Break up of a romantic relationship or loss of a loved one. Most attempts occur in the context of interpersonal discord or other severe life stress.

Warning signals

• Verbal comments: Statements such as “I wish I would never have been born” and “you will be sorry when I am gone” should be taken as seriously as the direct threat “I am going to kill myself.”
• Behavior changes: These include a wide range of activities such as giving away valuable possessions, talking about life-threatening risks and having frequent accidents, complaints of boredom and loneliness, marked increase in agitation and irritability, getting into trouble with police, depression, changes in appetite and sleep habits, inability to concentrate, and withdrawal from friends and from favorite activities
• Situational factors: These include inability to communicate with family members and friends, problems at school or workplace, end of a love relationship, and recent involvement with drugs or alcohol. All these increases the situational risk for suicide.

Communication of intent, signs and symptoms
Generally, 80% of people give clues to members of family or friends their intention to die. These intentions can be inferred from their words and actions. Those who intend to commit suicide try to set their things in order, write a will, meet friends, and relatives, write to their loved ones, visit their place of birth, go to temples and religious centers. There is a sudden change in mood. They may try to purchase drugs (sleeping pills) and instruments (gun, rope, and knife). 

Risk factors

• One or more previous suicide attempts,
• Having psychiatric illness, especially mood disorders or alcoholism,
• Drug and alcohol abuse,
• Among the elderly, illness, anxiety, social isolation, and depression are major risk factors.

Mental disorder and suicide
Suicide is not a mental disorder in itself. But it is closely linked to some psychiatric conditions. Approximately 90 percent of people who either attempted or successfully completed suicide had some psychiatric problems at the time. The risk of suicide is found to be a significant factor in all types of depression and bipolar disorders. Although people commit suicide for reasons other than depression, estimates are that about 40 to 60 percent of those who complete the act do so during a depressive episode or in the recovery phase. Paradoxically, the act often occurs at a point when the person appears to be emerging from the deepest phase of the depressive attack. The lifting of depression may provide the energy needed to complete the suicidal act. Depressed people are 59 times more likely to commit suicide than non-depressed people.

Adolescent suicide
Suicide in schools among adolescents is becoming more rampant nowadays. It may be due to pressure from parents to get good grades in schools or college, failure in examination and the consequent humiliation, sexual abuse, and ragging. Nowadays, ragging is driving youth to end their life. Among children, bullying and being bullied is a major cause of suicide. Suicidal act, when it occurs in schools, may take on certain glamour among some other students who see it as an exciting and glamorous way of dealing with their problems. 

Effect of suicide on survivors
The loss of a family member or close friend is a painful event, but it can be more painful when the death is caused by suicide. After suicide, survivors are left to deal with some very complex feelings and are typically at greater risk for physical and mental health problems than are those bereaved in a non-suicidal fashion. Many survivors of a loved one’s suicide blame themselves for not doing enough to prevent the tragedy and display exaggerated bereavement reactions. In cases, where people have left a suicide note naming some persons as causes of their suicide, the condition of survivors becomes more serious. These people experience severe guilt and often they may commit suicide. Survivors need professional help. The fact that someone close chose suicide as a solution to the problem may legitimize it as choice course. Many survivors may have to deal with a social stigma attached to them because someone in their family committed suicide. 

Preventive measures
Often suicide can be prevented if surrounding loved ones know what to look for.  Suicide is no a bizarre or incomprehensible act of self-destruction. It has a method; suicidal people have a style of thinking that brings them to the conclusion that death is the only answer to their problem. Suicide can be prevented if one knows how and when to intervene. When you have information about why some people would choose to end their life, you can help them to try a different approach to try to get what they want.

Steps to prevent suicide

• Heightened awareness (by professionals) of the roles of depression, alcoholism, and other factors play in suicidal risk.
• Early treatment of the psychological problems that underlie suicide attempts.
• Careful questioning about suicidal intention.
• Hospitalization of individuals who are known to have formulated a plan to kill themselves.
• Removal of all access to firearms whenever the slightest hint of suicide is detected.
• Restricted access to high-risk individuals to drugs that can be lethal in high doses. 
• Follow up of high-risk individuals after treatment.
• Providing “suicide helpline” to listen to the troubled people and counsel them against the extreme step of going to a place “without a return ticket.”
• Apprising them of the innumerable alternative solutions to their problems.
• Informing them of the pleasures of living.
• Convincing them about the impact of their suicide on people who are depending on them.

Suicide postvention in schools 
Postvention refers to efforts to help those who knew the person who died. In order to help the survivors and to prevent future suicides, programs involving professionals, school faculty, and students can be very effective. Postvention programme has three basic principles.

1. Nothing should be done to glamorize or dramatize a suicide.
2. Doing nothing can be as dangerous as doing too much.
3. The students cannot be helped until the faculty is helped.

The postvention team usually meets first with school administrators, then with the faculty, and finally with all the members of the student group. During the meeting, all participants have a chance to challenge their own feelings of guilt or self-blame by learning something about the dynamics of adolescent suicide. They also have an opportunity to express the varying emotions that are typical after a suicide – shock, guilt, anger, and anxiety 

Research on suicide
It is unfortunate that nobody takes serious note of suicide. Bengaluru is often called the suicide city of India. What are we doing about it? Pretty little; neither the society, nor the government bothers about the increasing number of suicides. Every city and every community should set up suicide help centers, where troubled people can talk about their problems and explore the possibility of find a solution. 

Funds must be made available to study the causes and prevention of suicide. Researchers must meet the people who attempted suicide, talk to members of the victim’s family to understand the mental makeup and patterns of behavior of those who are suicide prone. Researchers have been working to understand people who commit (or try to commit) suicide in order to learn why they do it and at what point it might have been prevented. These findings are based on information left behind (suicide notes) by those who have been successful at committing suicide, on interviews with those who unsuccessfully attempted suicide, and on interviews with the survivors. 

Appendix - 1
Student suicide in the Indian metros

Student suicides increased by 26% from 2006 to 2010, with metros Chennai, Delhi, and Mumbai having most victims, in that order. And this is just the official data. While 5,857 student suicides were reported in 2006, the figure jumped to 7,379 in 2010, according to data released by the National Crime Records Bureau. In other words, 20 students killed themselves everyday in 2010, something both academicians and mental health professionals blame on a flawed education system where performance pressure ranks above all else.

For the first time in the past five years, Maharashtra recorded the largest number of students killing themselves, followed by West Bengal. Over the past decade or so, the two states have only interchanged positions in the top. Delhi as a city alone accounted for 133 deaths in 2010, while as a state, it accounted for 166 deaths. The examination system and the selection process for institutions of higher education weigh heavily on young people.

Appendix - 2
Box – Suicide Statistics in India

Reported causes of suicide in India 
    Harassment for dowry,
    Farmers’ inability to pay the debts,
    Failure in love,
    Forbidding youngsters to marry persons of their choice,
    Failing in examination,
    Missing a rank or promotion in office.

Appendix - 3
Editorial in Deccan Herald on farmers’ suicide, 31-10-2011

The intensity of the agrarian crisis and the abject failure, rather the reluctance of successive governments to address it, has been laid bare by the quarter million farmers’ suicides between 1995 and 2010. According to National Crime Records bureau figures, around 15, 964 farmers committed suicide in 2010 bringing the total number since 1995 to 256,913.  Although the number of farmers in the country has decreased significantly in this period – rural distress has forced millions out of agriculture, the number of farmers taking their lives has grown. And five states – Maharashtra, Karnataka, Andhra Pradesh, Madhya Pradesh and Chhattisgarh – account for two-thirds of farmers’ suicides. Significantly, three of these states – Maharashtra, Karnataka and Andhra – are among those that adopted economic reforms most enthusiastically.

Clearly there is a link between economic liberalization and farmers’ suicides. Mounting debts and inability to pay back the interest, let alone the loan appears to be driving an ever increasing number of farmers to suicide. In 2008, the Center announced a loan waiver amid much fanfare. While this provided some relief and stemmed the tide of suicide, its impact has been limited. This is because the Government waived off bank loans only. Indebtedness to money lenders, which is far more exploitative, was not touched. What drives farmers to seek debt in the first place was not addressed. Thus the upward spiral in farmers’ suicides has continued. 

The Government has refused to accept that it is the crushing impact of commercialization of agriculture, the corporatization of seed and fertilizer production and the privatization of water, and the withdrawal of subsidies to poor farmers that have unleashed an agrarian crisis in India. Farmers have been encouraged to grow cash crops but these are vulnerable to volatile global prices. Unless the Government steps in and addresses aggressively the entire gamut of reasons underlying farmers’ despair, suicide will be the only way for farmers to avoid the consequences of not paying up loans. To pay off loans, farmers are selling their carts, their cows, even their children. When all else fails, they swallow the pesticide that they, ironically, bought by raising a loan. The suffering does not end with the death of the hapless farmer. His widow and children are left to face the loan sharks. They turn to more loans to pay off debts and the cycle of violence turns into a spiral. This spiral of violence must be broken and immediately. 

Appendix -4
Number and rate of suicides for formers and rest of population in the major form crisis states in 2011

Source: 1)     Accidental deaths and suicides in India 2011
             2)     Census of India 2001 and 2011
             3)     Nagaraj K. Farmers suicides in India: Magnitudes, Trends 
                and Patterns. wwwmacroscan.com (March 2008)
Reported in The Hindu – Saturday, May 18, 2013