Suicide – What it is & What it isn’t

Suicide, by definition, means self-inflicted death with explicit or implicit evidence that the person intended to die. It is one of the most complex human behaviours with biological, psychological, and social ramifications. It is mostly the result of an underlying mental illness, very commonly, depression, substance abuse and psychosis, and is amenable to psychiatric treatment.  Some plan for days, weeks, months or even years before ending their life while others take their life seemingly on an impulse without premeditation. A prior suicide attempt is the single most important risk factor for suicide in the general population.

Some figures & facts on suicide –

1. According to World Health Organization, 8,00,000 people die due to suicide every year, which means one person dies due to suicide every 40 seconds.
2. As per National Crime Records Bureau, the suicide rate for 2015 in India was 10.6 per 10,000 (equating to 1,33,623 deaths registered as suicides) as compared to global average of 11.6 per 10,000.
3. For every suicide there are many more people who attempt suicide. A ratio of 20:1 for attempted suicide: completed suicide has been recently suggested.
4. Approximately 90 percent of people who die by suicide seem to be having some mental disorder.
5. Ingestion of pesticide, hanging and firearms are the most common methods of suicide globally. In India, consumption of a poison, hanging, self-immolation, and drowning are the commonest modes.

Suicidal behaviour ranges from fatal acts (completed suicide),to highly lethal and failed suicide attempts (where high intention and planning are evident, and survival is fortuitous), to low-lethality attempts (usually impulsive attempts that are triggered by a social crisis, seem to be ambivalent and contain a strong element of an appeal for help). Whatever it is, an attempt to suicide should be taken seriously and immediate psychiatric help should be sought. Any individual having suicidal thoughts or any loved one vocalising wishes to die should be brought to clinical attention at an urgent basis.  

Multiple theories have been proposed to understand what pushes an individual to take such an extreme step. It is hypothesised that suicide happens as a complication of a psychiatric disorder rather than stress. Stress seem to precipitate or worsen the existing mental Illness which further triggers the suicidal behaviour in that individual. Other factors that play a role are pessimism, aggression, genetic factors, impulsivity, and childhood experiences.

As far as the biological theory of suicide is concerned, low levels of neurotransmitter serotonin have been implicated in suicidal behaviour. The most consistent post-mortem finding in the people who died by suicide is low level of serotonin in brain and spinal cord fluid.

Fortunately, most of the suicides are preventable, though some of them aren’t so predictable.  With the right support, medicines, and psychotherapy, we can avert a suicide in an individual.

Some myths about suicide –

1. People who commit suicide are weak.

Fact – No, they are not weak. Suicide is a convoluted human behaviour. Such a statement not only quashes the biological underpinnings of the phenomenon, but also attaches stigma and shame to it. NOT DONE at all!!! We can do better than this!

2. Suicide ends the suffering of an individual.

Fact – Well, we don’t really know how one feels after ending his life. But we surely know that people who are left behind end up feeling guilty and helpless. Survivors of suicide are also prone to suicide. They need psychological and social support. It is not worth saying that the suffering ends with the suicide.

3. People committing suicide are responsible for their actions, may be they deserved it.

Fact – No one deserves to commit suicide. It is sad how a mental illness pushes someone to take such an extreme step. Individuals cannot be held responsible for their mental illnesses. No one deserves to end their life. A person with mental illness deserves to be supported and treated. Suicide is preventable with proper treatment and a good support system!

So, the message is loud & clear for anyone who is battling suicidal thoughts –
Don’t hesitate to seek help!
You are not alone in this!
You are not a burden on anyone!
World needs you and is a better place with you in it!
The pain is not endless!
It is not you, but your illness which is making you think & feel like this!
The illness will go away with the right treatment!

And for the caregivers –

1. Mental disorders quietly erode an individual from within. They are not visible externally; at least they don’t manifest with eye catching symptoms. Sometimes suicide is the first noticeable manifestation of a mental disorder and it is too late.  Please seek help for your loved one at the very first suspicion of a psychological problem. It is always better to be cautious than to feel guilty later.
2. Please be kind and supportive to people with mental illnesses. An empathic non-judgmental approach would go a long run in letting them deal with their problems.
3. Blaming someone for their mental health problems and dealing with their problems yourself, without going to an expert is the last thing you would want to do. No one feels shy in seeking help from a cardiologist for a heart problem! One certainly wants to go to an oncologist for cancer treatment, so why not go to a psychiatrist when it is a mental health problem. Experts know how these problems can be tackled. Meet an expert and advice your loved one the same.

Suicide is preventable. Mental illnesses are treatable. Most of the people who wish to die want to end their agony more than their life. A compassionate, non-judgemental, supportive attitude towards the affected individual can not only prevent a suicide, but also ease out the distress and stigma associated with mental illnesses!

Wishing you the best of mental health today and always!

Dr Apala