There is a significant increase in the suicide rates during the exam and results season, particularly among youngsters. Suicide help-lines, counselling centres, hospitals and mental health clinics fall short in their efforts to attend to all these distress calls. But what compels people to take their own lives? Why do they take such an extreme step?
Suicide on the surface
Technically, suicide means intentional killing of oneself or performing an act destructive to one’s own interests. Suicides are classified as attempted and completed suicides. They are attempted in a premeditated planned manner or in an impulsive manner.
Often, premeditated suicides are attempted by individuals who are in a state of depression or despair. For such suicide attempters and victims, it is not so much the thought of death that drives them towards the decision, but an unbearable state of agony, helplessness and hopelessness, where they feel death is the only choice left.
When the suicide is attempted on an impulse, the attempters try to end their lives with a low intentionality for dying. Such persons often have underlying personality disorders, which push them towards taking such a drastic step. Suicide, in such cases, although looks like an act of despair, may have hidden motives of gaining attention or desired object.
The deep end
The power of the mind to infuse the will to live even in the most agonising of circumstances is extinguished when it is in the grasp of a devil, called depression. Depression, the common cold in psychiatry, is one of the leading causes of suicides. It can be severe and persistent enough to drive a person to end her own life.
In psychiatric literature, we have three terms to describe the mental state of a depressed person thinking about death and suicide—death wishes, suicidal ideation and suicidal attempts.
Death wishes refer to wishing to be dead in some way, not necessarily by planning to kill self. Such thoughts may be in the form of “I wish I would be dead” or “I wish I would get killed in an accident”. Death wishes can be experienced by people when they are moderately frustrated or mildly depressed, but when such thoughts become frequent or chronic, they lead to suicidal thoughts.
Suicidal thoughts are thoughts about killing self. For instance, “I feel like killing myself” or “I’d rather kill myself than live this miserable life”. Suicidal thoughts, when frequent, precipitate actual suicidal ideation, or the serious intention to attempt suicide. The intentionality to die may vary from one attempter to another. Some may plan to attempt in such a way that there might be chances of getting rescued.
The intention to die is low in such cases, and suicide is looked upon as a way of getting help/attention from others in some way. On the other hand are attempters, who may be severely depressed and their intentionality of death may be high. In such cases, suicide seems to be the only solution.
The terrible triangle
In psychotherapeutic literature, the trio of hopelessness, helplessness and worthlessness is what defines the depressive triangle, with the deadliest of emotions being hopelessness. The trio corresponds to negative thoughts and feelings about the self [worthlessness], world [helplessness] and future [hopelessness] and these three are considered to be the cognitive markers of severe depression.
Research has identified several risk factors of suicide. Studies suggest [based on All-India surveys] that suicide is more common among employed individuals than among unemployed individuals.
The following categories were found to be at a high risk of attempting suicide:
- Individuals with a mental health problem like depression, mood disorder, psychosis
- Individuals with substance-dependence [alcohol/drugs]
- Men below 25 years of age who are in depression
- Medical professionals
- Professionals in service in private sectors
- Individuals with nil, primary or matriculate education
- Married and unmarried individuals with relationship problems
- Divorced/separated individuals
- Individuals experiencing illnesses or family problems
- Early career professionals/ medical students.
Family members/ colleagues/ friends can often sense that something is wrong, as depressed individuals usually display some classic warning signs.
- Talking about death
- Severe depressive symptoms: persistent sadness, crying spells, loss of pleasure in activities
- Refusing to eat
- Not taking care of self
- Not interacting with others
- Feeling helpless about one’s problems; feeling despair and agony about one’s life
- Feeling hopeless; being extremely pessimistic; saying “Nothing will work” or “Things will never improve” or “The future looks bleak and dark without any ray of hope”.
Suicide not only takes a loved one away, it leaves its survivors and/or their families in a deep state of shock and stigma. And although suicidal individuals may be identified in advance, such individuals need to undergo long-term counselling and psychotherapy to help them deal with the problem that is at the root of their depression or impulsivity in their personality.
Suicide prevention is a complex process, which cannot be done by a professional alone; family, friends and significant others too play an important role in helping those who see themselves between the devil and the deep blue sea.