To be or not to be

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By 2017-03-19

By Sanuj Hathurusinghe
Ceylon Today Features

Although there are traits of some animals exhibiting self destructive behaviour, humans are the only known animals who use weapons or go through elaborate plans to end their own lives. In the olden days, it sometimes may have been considered an act of courage to end life on one's own terms, evident by the historic accounts we hear about valiant kings, soldiers and Samurais who took their own lives in the battlefield but today, suicide is regarded as a grave public health problem.

Danger of suicide
According to the World Health Organization (WHO), suicide represents almost half of all violent deaths, worldwide. Every year, 800,000 suicide fatalities are reported and the number is expected to rise up to 1.5 million by the year 2020. Worldwide, more people die from suicide than from all homicides and wars combined and suicide is the second leading cause of death among 15 to 29-year-olds.

75% of global suicides occur in low and middle income countries such as Sri Lanka. According to police reports, there have been 3,058 reports of suicide cases in Sri Lanka in the year 2015, a large majority of them being male. Compared to the records a year before, a slight decrease is apparent but no solace should be found based in the decrease because suicide is considered a largely preventable public health problem in comparison with other causes of global decease.

What is suicidology?
A growing number of suicide cases worldwide have made knowing about suicides a timely necessity. A particular discipline called suicidology was derived, first in the mid 19 century, in order to understand more about suicidal behaviour and its causes. Senior lecturer at University of Ruhuna and consultant psychiatrist at Teaching Hospital, Karapitiya, Dr. Harshini Rajapakse elucidated to Ceylon Today about Suicidology in detail.

"Suicidology is the scientific study of suicidal behaviour and suicide prevention which involves a wide range of behavioural sciences related specialties such as anthropology, psychology and sociology" explained Dr. Rajapakse. "The study of factors leading to suicide and factors important in suicide prevention involves multiple disciplines of study. It cannot be handed over to one discipline. For example it cannot be handled by psychiatrists alone as there are many who will attempt suicide without a mental health illness. A separate study called Suicidology evolved due to the need to bring all disciplines of study together" added Dr Rajapakse.

Is suicide a mental illness?
Having a separate multi-disciplined study makes suicide appear as a mental illness but is that really the case? When asked whether all suicides are a result of mental illnesses, Dr. Rajapakse responded that it is not always the case.

Ceylon Today reached psychotherapist and Certified Clinical Hypnotherapist, Dr. Romesh Jayasinghe who had the following to add regarding the matter. "About 80% of all suicides can be caused due to some mental disorder like clinical depression, bipolar disorder, schizophrenia, and some personality and substance abuse disorders. These disorders can lead into suicidal behaviour if gone untreated"

What causes suicide and why suicide?
While there is a clear link between suicide and mental disorders, it can also happen impulsively in moments of crisis, breakdown or stress. Poverty, financial difficulty, unemployment, exam failure, relationship breakdown, sexual harassment, rape, chronic pain, illness, and other forms of family disputes lead to suicidal episodes. According to 2015 police reports, the most number of suicides were committed due to harassment by the husband and family disputes.

Suicide is a form of escape mechanism. All the reasons mentioned above put pressure on a person and create psychological or emotional pain. In coping with this pain, people tend to escape reality through various means such as drinking, gambling, drug abuse and binge-eating. Contemplating suicide also is a common coping mechanism. These methods do seem to have a temporary relief effect on psychological pain. Even the great German philosopher Friedrich Nietzsche once said "The thought of suicide is a great consolation; by means of it, one gets through many a dark night."

But the relief is short-lived and the troubled will over-abuse their escape mechanisms in hopes of prolonged solace until they reach a breaking point. "Every individual has a breaking point. Once the unbearable psychological pain reaches this point, rational thinking escapes from the mind and they think suicide is the best solution available for them" remarked Dr. Jayasinghe.

Identifying a suicidal
The news of a suicide death always comes as a shock. Relatives and close friends of the diseased could often be heard saying "If only we knew beforehand." A lay person who is not familiar with Suicidology might not be able to read the subtle indications suicidal persons give away but the chances are, in most suicide cases, the person shows certain behavioural patterns such as:
n A noticeable change in normal or routine behaviour
n Lack of interest in pleasurable activities
n Sleep disturbance/Insomnia
n Social isolation and wanting to be alienated
n Excessive consumption of alcohol
n Loss of interest in food and personal hygiene
n Self-destructive behaviour
n Refusing to study or work
n Mentioning suicide
"If one shows multiple signs of the above mentioned, the chances are he or she might be suicidal" said Dr. Jayasinghe. A lay person might not be in the best of positions to help out a suicidal person as the matter needs to be taken care of patiently, methodically and diplomatically but what could be done is informing the family, talk the person into counselling or to go to a psychiatrist or at the least, to a normal physician.

Suicidological approach
According to Dr. Rajapakse, medical treatment for suicidal behaviour is prescribed only if the patient has a psychiatric illness."Treatment is only if they have a psychiatric illness such as depression and schizophrenia. Problem solving skills can be taught if they have poor coping skills. If there are other issues such as physical or sexual abuse or alcohol dependence, they can be referred to a service or an organization which helps with that particular issue" said Dr. Rajapakse.

According to Dr. Jayasinghe, first on the agenda in treating a suicidal person is stress release and relaxation exercises. Then comes discussing alternatives with rational thinking and calming down of the patient. Different forms of therapy, even hypnotherapy, could be prescribed according to the patient. Closely monitoring a suicidal even after the initial threat is gone (postvention) is vital especially in patients who have attempted suicide as they are more likely to try again within the first year after the attempt.

Organizations such as Sumithrayo with trained volunteers and skilled professionals at their disposal island wide, has shared a fair amount of the burden of preventing suicides in Sri Lanka. Suba, a volunteer at Sumithrayo opened up to Ceylon Today about how they deal with suicidal persons.

"Initially, we listen to them. Then we ask what led them to this point, what is happening in their lives and so on. We try our best to help the caller to come over and have a one-on-one conversation if possible. We give them the opportunity to come out and reveal their plan. Some people actually say what they have planed. The revelation itself helps them to realize the whole picture"
"There is no guarantee but we do feel it if we have done a good job by the tone of the caller. In a nutshell, we listen to everything callers have to get off their chests. We don't advise or put guilt. We sometimes suggest and discuss actions with the callers if he or she is supportive but we never try to force our opinions on them" said Suba.

The stigma of suicide
Suicide carries a social and cultural blemish in Sri Lankan society. It is considered a taboo. No one likes to talk about it and it is considered a foolish option for the weak. But according to latest police data, the number of men who have committed suicide is almost four times higher than women. Shaming or guilt-tripping people, especially men, to not commit suicide has evidently backfired gravely as the numbers suggest higher suicide rate among males.

"We have an unhealthy level of competition in our society. The stereotypical view in our culture and society is that a man has to be successful. Men are supposed to be the bread winners of the family and are also considered as a symbol of strength. When men are unable to satisfy these expectations and think they are weak, they tend to bottle up these feelings not letting them out due to the stereotypes built around them which could eventually lead into suicidal behaviour" explained Dr. Jayasinghe.

Suicide should be talked about more
According to police data of 2015, almost 58% of reported suicide cases have been committed by people who had studied only up to grade eight or lower. Education might not be the only parametre but it certainly does play a big part in suicides. The least that could be done in preventing suicides among the lesser-educated is to create awareness about suicide. "More public awareness has to be made and the media has to be involved. They could do documentaries and hold discussions about suicide prevention. Suicide self-help groups and suicide survivor groups have proven helpful in other countries and could be introduced to Sri Lanka as well" mentioned Dr. Jayasinghe.

The media could also have a negative effect on suicide. According to Dr. Rajapakse, reporting a suicide or portraying one in a movie in meticulous details could result in copycat suicides. Sometimes media reports suicides with graphic content which put relatives and close mourners at unease and sometimes the media portrays the one who committed suicide as a hero."Common reasons should be addressed but going into details is not good. Sensitivity is needed when reporting a suicide without glorifying the act or making it gossip" said Dr. Rajapakse.

Sri Lanka, once a country with the highest suicide rate in the world, has come down to fifth on the list according to 2014 WHO reports. Receding numbers certainly is a plus but there is much more to be done, should be done and could be done, most important of all being providing hope and assurance when a suicidal thinks all hope is lost.

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