If you are unable to solve a problem and overcome a tense situation even after 48 hours, then you should not hesitate to seek help. In most cases, sharing feelings with close ones is better than formal therapy. Cases of suicide are more in urban areas compared to rural parts as the support system is stronger in the latter, and suicides are much higher where male chauvinism is high, says Dr Ajit V Bhide, well-known consultant psychiatrist and former president, Indian Psychiatric Society. In conversation with TNSE to mark World Suicide Prevention Day on Sunday, Dr Bhide says therapy as a procedure is expensive and the government should invest significantly in making therapists accessible across the country to prevent suicides. Excerpts:
What is the reason for the increase in suicide cases?
When a society does not have a clear set of values and it keeps changing, it leads to moral corruption causing unrest in a person’s soul and mind. It creates a massive disequilibrium driving people to desperate acts. Idealism and devotion to work have largely eroded among people, especially in the last 50 years. We live in a society where dissonance is not allowed, causing unrest among people more than earlier.
Would you call suicide a desperate act?
In most cases yes. Enough research is available to suggest that people who have survived a suicide attempt are likely to have said, “I wish I did not do that” or “I wish I knew there was a way out”. People suffer from distress, followed by helplessness and hopelessness. A person’s ability to take drastic measures like attempting suicide becomes much higher.
Are some people more prone to committing suicide? How does one build resilience?
Depression is an illness of emotions. People more prone to suicide go through multiple emotions — sadness, anger or irritation. People having a clear history of depression, family loading of depression or are genetically determined are forerunners of suicide. Resilience comes from an early stage and can be strengthened over time.
What is the psyche of celebrities dying by suicide?
Celebrities live a glamorous life. Showbiz is all about attention. If they do not gain success on multiple occasions, they tend to get disappointed.
How does lack of parental support and communication trigger suicidal tendencies?
Parental and peer pressure pushes people into careers and even marriages. Often the pressure of pursuing a particular career by parents pains the children and drives people wanting to take their lives.
What are the early symptoms of depression among children that parents can look out for?
Tendency of complete withdrawal from social interactions, lack of interest in regular activities, feeling forced to stay at home, irregular sleep, loss of appetite, even excessive rebelliousness can be indicators in certain cases.
How prevalent is mobile addiction among children? Is that also the cause?
Suicides among children have increased. Internet-enabled devices are responsible for making children very rigid. It is a sign of emotional immaturity. Even the addiction to pornography is linked to internet addiction, which is very high now. Though it is not an accurate indicator for suicidal behaviour, it is a measure that compromises people in life.
What role does ‘nature vs nurture ‘play?
With major depressive illness, genetic contribution is about 80% and environmental contribution is about 20%. However, with impulsive suicide, genetic contribution is only 5-10%. Most commonly we imitate the behaviour of our parents or people around us. Being surrounded by a toxic environment at home makes a person more prone to poor mental health. The Nature vs Nurture controversy will not be resolved in our lifetime, but both contribute to people’s suicidal tendencies.
Isn’t suicide among small school-going children a cause of concern?
It is very uncommon to see small children committing suicide. The youngest case in my professional career at NIMHANS was an 8-year-old who attempted suicide because she was denied a visit to the circus at her convenience. It is a well- known phenomenon among youngsters hitting puberty as they are extremely vulnerable at the time.
What advice can you give to parents?
Give enough time to your child. Provide them with the right strokes and advice but don’t overdo it. Correct them in private rather than making an issue of the mistake.
How should schools address these issues?
Schools must look after the academic development of children and ensure fairness while dealing with them. Teachers should not be very harsh and abusive. Schools must have an infrastructure to provide counselling to students. Beyond schools, the support system at home is much more responsible for counselling students. Cold wars at home, domestic violence and constant bickering among parents harms the child much more. Familial factors contribute more to suicides among children than school factors.
Do joint families have a positive impact, compared to nuclear families?
The joint family is a ‘lost paradise’ now. They significantly contribute in providing an alternate social and emotional support when parents are not available. Nuclear families can also imbibe that and not transfer their personal pressures on to the child.
What is the importance of gatekeepers in preventing suicide?
Gatekeepers are the ones who are trained to pick up signs of suicide early and disallow the individual from taking the extreme step. The concept of gatekeepers was first written about in the 1980s, but it got attention much later and has now become an important facet.
What about suicide pacts and some influenced by cults?
One is romantic lovers (married and unmarried) committing suicide as they do not have the approval of their parents. Postpartum depression is three times more than the normal depression where she (the young mother) kills the child first and then commits suicide. This is preventable. The other is the case where the man of the house who is in an economic crisis, kills the children, his wife and then commits suicide. There are also cases where the whole family travels to a faraway place from their native and commits suicide. This is known but is not common. Many die in a mass murder-suicide by consuming poison-laced drinks at the order of a cult. This is horrible and the cults engaging in these kinds of acts are well-known. We cannot deny that cults can lead to many positive actions, but it is difficult to monitor all the cults. Charismatic cult leaders who do not have a strong personal structure are the ones who are likely to lead people astray.
Is suicide indicative of a lack of self-love?
While external validation has its place, it should not overwhelmingly define our success. Insufficient self-love and self-respect often indicate that a person has relied on external validation throughout their life. The constant need for validation can increase when we are used to receiving praise for the smallest achievements. When this validation is lacking, it can lead to a sense of desperation and potentially risky behaviour.
What about the lack of agencies or people to express one’s problems?
Life was much simpler earlier. Our pleasures were simpler and reaching out to people for help was much easier earlier. It is a common phenomenon now that an individual might have nearly 2,000 friends on social media but not even one with whom he or she can share and confide and take the help from. We live in a terribly lonely world where many do not even know their neighbours.
Is the suicide rate higher in urban or rural areas?
Suicides are more of an urban phenomenon. In rural areas, there are many absorbing mechanisms available. Chronic mental illnesses, for instance, are accepted much better in rural India than in urban parts.
Suicides among men and women… How do they compare?
Both men and women tend to attempt suicide equally. However, ‘completed suicides’ are more common among men, and ‘attempts to suicide’ are more among women. It is not corroborated by research, but we can say that women tend to survive suicide attempts. Violent deaths like jumping off heights, gunshots and drowning are common in men; consuming phenol, insecticides or other poisonous substances present at home and overdosing on prescribed medication are common in women. Suicides are higher in states where male chauvinism is high and the women give up and commit suicide. Also, education is not a guaranteed method of preventing suicide.
What is your opinion on decriminalising suicides?
There is a separate law which makes suicide act a crime. There is a mental health act which went beyond its purview and said suicide should not be a crime, we gladly accepted that. However, suicide is a crime that has not been undone yet.
How should media report suicide cases?
Irresponsible reporting is rampant. Media, at times, constructs narratives around incidents like suicide which often discourage people from taking legal action due to constant media attention.
Should everyone undergo therapy?
Some form of introspection and sharing of things among our close ones can help better than regular, formal therapy. We require skilled counsellors and therapists. Therapy, as a procedure, is an expensive one hence the government has to invest significantly in making therapists accessible across the country. Additionally, therapists themselves may need support to manage the stress inherent in their profession.
Are enough psychiatrists available?
We do not need as many psychiatrists as we have. But we need more psychologists and counsellors. Sometimes, effective counselling and understanding the root cause of a problem becomes more necessary than solely relying on prescriptions.
Which city records the maximum number of suicides?
In areas with robust reporting systems, there tends to be a higher volume of data. Additionally, cities with larger in-transit populations, particularly major metropolitan areas, tend to experience higher cases. In some instances, individuals may choose to end their lives in a metro city to keep it from being discovered in their hometown. Kerala and Kolkata have notably high suicide rates.
Suicides are reported much more among the middle class. Do you think the lower class has some coping mechanism to deal with it?
Suicide rates are not lower in any particular social segment. Both the upper and lower strata of society often conceal such incidents more effectively. In certain cases, suicides are disguised as natural causes, such as heart attacks. In contrast, the middle class tends to be more vocal and is inclined to report such occurrences.
In recent times, people provide hints about their intentions to attempt suicide and even livestream suicides on social media...
Erring on the side of caution is preferable to downplaying such situations. While some instances may be attempts to gain attention, they should never be dismissed lightly.
What role does belief in afterlife play in suicides?
While it is a contributing factor, the overwhelming hardships in one’s present life often drive someone to give up on life.
What about the family they leave behind?
A complex mix of emotions is involved, but guilt often dominates when family members think they couldn’t provide the necessary help. This emotional mix may also include anger and sadness. It’s essential to highlight the availability of self-help groups where suicide survivors can seek support.
Do you feel mental health should be part of the curriculum in schools?
Yes, it should be introduced from high school. Before that, students are too young to be exposed to these topics. Teachers should also possess a sensitivity towards children and awareness of learning disorders.
What about ‘body-shaming’?
Body-shaming is often exaggerated. While certain comments on appearance can be distasteful, young individuals need to distinguish between genuine concern and hurtful remarks.
Many individuals, particularly those new to their professions, frequently express being overly stressed and feeling trapped with no way out. How can one effectively address this situation?
This often indicates a lack of resilience and patience. As economic demands grow, stress can escalate. Individuals should cultivate hobbies and find ways to disengage from stressors in these circumstances.
How do you cope with stress?
Theatre used to be my passion, and I also like writing and gardening. Nurturing creativity is truly essential to keep ourselves motivated and fulfilled.