What sent shockwaves amongst people all over the world recently was a whole host of celebrities committing suicide. Kate Spade, Anthony Bourdain and very recently back home Bhaiyyu Maharaj. In the past we have often seen people who have it all end their precious lives. They rule the world in their own right with their confidence, grit, humour and charming personalities and end their lives leaving people who follow them shell shocked. Take Robin Williams for example. Who would’ve imagined the protagonist of ‘Dead Poet’s Society’ would end his life? He definitely looked like a man with much vigour. Behind the veiled stardom, he suffered. As did the others. Kurt Cobain, Marilyn Monroe, Alexander McQueen are other such examples of people who had it all going for themselves. Then why would they ever end their lives? This question sure has crossed all our minds when we heard of the shocking news break out.
“Perception,” explains Dr Samir Parikh who is an eminent psychiatrist and the director of department of mental health and behavioral sciences at Fortis Healthcare. “Perception is the crux. We feel they have it all and have everything going because that is what these celebrities showed us always. We never knew what they suffered deep within them. Only the near and dear ones could’ve known what demons they battled with,” continues Dr Parikh.
According Dr Parikh’s extensive research on the subject, suicide is the 8th highest killer in the world and 90% of those who commit suicide have an undiagnosed, untreated or partially treated psychiatric condition at the root cause.
So, what causes a human being to come to this tipping point where he or she feels the need to end their lives? “There are proximal and distal factors at play. Proximal refers to some recent developments and distal refers to long term issues. Long term issues lead to vulnerabilities that makes you come to this point when you take the final plunge. There is a sense of hopelessness that causes a person to end his life,” explains Dr Parikh.
Organizations, families, friends, support circles, suicide helplines, government agencies can help. If you identify any near or dear one even thinking or getting a suicidal thought, reach out to a professional or a helpline and seek help. Dr Parikh says that 18% of people who die of suicide have had a previous failed attempt.
This data in itself should send out alarm bells to most!
A patient on condition of anonymity revealed, “I have cried wolf many times. I don’t really know if I will ever commit suicide in reality but I do raise an alarm bell every now and then. I have been clinically depressed for a while and I feel like no one understands what I suffer on an everyday basis. Even waking up in the morning and going to work feels like a huge task. I’m irritable, I feel hopeless and my family says get married and they give me all sorts of random solutions.” Now will a person like this ever commit suicide? Dr Parikh says you can’t rule out the possibility. “A wolf’s cry too is a cry of anguish, of wanting attention and must be attended to,” he recommends.
According to a collection of reports, around 300 million people worldwide experience depression and have had suicidal thoughts at some point when they are depressed. Depression is mainly a chemical imbalance in the brain. Like any other part of the body that malfunctions, the brain too can malfunction.
For a hormonal imbalance you have endocrinologists, for a malfunctioning of the heart, you visit a cardiologist, similarly for a chemical imbalance in the brain that leads to depression you have psychiatrists, neurologists and counsellors.
Visit one or take your near and dear one to a specialist before it’s too late.
Dr Sonia Lal, a board certified neurologist specializing in headache medicine and vascular neurology explains, “Many times people suffer from depression for a long time and don’t get help maybe for reasons like society since it is considered a taboo. Sometimes, they just don’t know why they are depressed."
"People need to understand that depression is an illness like any other chemical imbalance in the body. Here we are dealing with a chemical imbalance in the brain. So, in reality one doesn’t have to have a reason to feel depressed. But when someone has symptoms of feeling low and sad for unclear reasons, they should get help. Always. At that point, friends and family's support apart from medications are key in helping the person come out from that state. Also like any other illness, treatment is long term. Sometimes when medicines are stopped abruptly, it can push someone into a severe bout. Suicidal thoughts can be seen in severe depression but it has been seen that sometimes one starts believing that the only way they can feel better is to die. Data shows that the people who have a history of self harm, an acute stressful event and a feeling of intense hopelessness can also gravitate towards trying to commit suicide,” observes Dr Sonia.
Another perspective on this comes from Varkha Chulani, a clinical psychologist, psychotherapist and enablement expert. This is how she explains it: “People end their lives for different reasons. It’s not a one size fits all kind of scenario. There are deeply personal things which not too many people are aware of which leads the person to despair and unfortunately to end their lives. It is too superficial to say that he was ‘depressed’ and that’s why he ended it. All depressed people do not end their lives. And all people who end their lives need not be depressed. There is an ‘impulsive’ suicide where a person has suddenly panicked and unfortunately felt that there is no ‘hope’ and ends his life. Then there can be someone who can’t ‘bear’ the pain of his thoughts or condition and decides that enough is enough.
Then there is a despairing person who believes that nothing will ever change and life is ‘hopeless’ and decides it’s better to die than live. So, you and I may see people as having it all - fame, money, power, the works and yet find them self-destroying. Why? Because all of the above are not conditions for contentment. A quiet despair envelopes the ‘successful’. They are more anxious, more insecure because they now don’t want to lose what they have. And if somehow they feel ‘threatened’ that it’s all going to be taken away, they may believe that they won’t be able to live, and believe it’s better to end their existence.”
We will address the treatment and media reportage and responsibility part of it too. But let’s first understand the why’s and how's of it all.
Dr Samir Parikh explains that suicide helplines come in handy when the urge is impulsive in nature. “But when it’s obvious that a patient has suicidal tendencies we usually use 'suicide counters' that prevent them. The best counters are religion, showing them responsibility and the impact their death would have on their immediate family and changing their perception about their own life and showing them the brighter side of why they should live. Of course, medications are prescribed to balance the chemicals in the brain too,” he adds.
An interesting observation comes from a cardiologist who specializes in interventional cardiovascular and peripheral procedures - Dr Sameer Gupta. He explains how patients with heart diseases are at an increased risk of committing suicides. “With a pre-existing mental illness, this risk is greatly increased. According to studies, the risk of suicide is three times higher in the ensuing month of a heart attack. Hence, it is important to identify and treat mental illness in the nick of time,” asserts Dr Gupta.
Dr Samir Parikh emphasis that the paucity of experts in comparison to the population numbers that we have, needs a re-look. This to be able to create avenues for training more individuals to be able to diagnose and manage some basic mental health related conditions. He asserts that training general practitioners to anganwadi workers, social workers, NGO volunteers, nurses and other allied professionals is going to be a key step in moving towards preventing suicides. An effective method would also be engaging in public-private-partnerships in key areas pertaining to mental health to increase outreach and have cost-effective models in place.
Dr Parikh goes on to show how the role of media is crucial and just cannot be ignored. “When reporting a story on suicides, cut the sensationalism out. Add a suicide helpline number. Treat your story such that you highlight the consequence of suicides. Mention support tips. This will have a huge impact on society at large,” he insists.
The ‘Werther Effect’ and ‘Papageno Effect’ must be understood.
Very interestingly Dr Parikh explains what this is. “The spike of emulation suicides after a suicide is widely publicized and sensationalized by the media is called the 'Werther Effect'. This historically gets the term from the novel ‘The Sorrows of Young Werther’ who, at the end of the novel ends his own life. Hence the term is called Werther Effect. Today media channels need to stop sensationalizing suicides. In fact, they should create a ‘Papageno Effect.’ This term essentially means the effect media can have by presenting non-suicide alternatives to problems. It is named after the character ‘Papageno’ from ‘The Magic Flute’ where he was contemplating suicide until the other characters showed him different ways to resolve his issues.
“What I am trying to say is that we can save lives through media too if the reporting leads to a Papageno Effect!” feels Dr Parikh.
Even celebrities who speak up about these issues leads patients to get the confidence to speak up. “One such example was actor Deepika Padukone opening up about her battle with depression that had a massive impact on people speaking up. Keep the politics aside and PM Modi’s fitness video is a great move. When a Virat Kohli or Deepika Padukone or PM Modi speak up and these messages go viral, they have an impact. We regularly use social media to reach out to the millennial population and it is a must. “Asking for help by a patient is a sign of confidence. We encourage it. And families and support systems too should encourage patients who are suffering from mental illness to reach out for professional help,” adds Dr Parikh.
Doctors across the board feel decriminalizing suicide is a giant leap. Dr Parikh though makes a case for suicide prevention policy and hopes the government looks at it seriously soon enough.
Dr Sapna Bangar, psychiatrist at Mpower says that the first step towards preventing someone from ending their own life is recognizing the warning signs such as change in behavior, being preoccupied with death and dying, seeking means of committing suicide, making a will, giving away prized possessions and saying goodbye, being hopeless (there is no way out), self-loathing (people will be better off without me), withdrawing from others, a sudden sense of calm after being severely distressed for a long period of time.
Listening without judgement becomes inevitable and hence reaching out to professionals is non-negotiable. This is a sentiment across all doctors who were spoken to during the course of writing this article.
Dr Bangar’s quick tips to readers who may know of someone with suicidal tendencies:
- Listen without judgement and offer support (I am here for you)
- Give them hope (We can get through this, depression is treatable and curable)
- Help them with a safety plan - contact their loved ones for support, talk to friends, emergency contacts, helplines
- Remove access to means of suicide – lock away knives and unprescribed medication
- Encourage them to seek professional help
-Encourage positive lifestyle changes such as a healthy diet, plenty of sleep and getting out in the sun or into nature for at least 30 minutes each day. Exercise is also extremely important as it releases endorphins, relieves stress, and promotes emotional well-being.
SOME HANDY SUICIDE HELPLINE NUMBERS
If you or any of your near or dear ones may have suicidal thoughts, do call up the following numbers and get immediate help:
Fortis Helpline: +91 8376804102
AASRA: 022 2754 6669
Vandrevala Foundation Helpline – 1860 266 2345
MPower Helpline: 022 23828133/ 022 2385628
iCall Helpline: 022-25521111
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