Wednesday, December 12, 2007

Mortal Thoughts: Suicide

Suicide is a taboo; it is a subject that most of us avoid discussing although some humans and even some animals are known to end their lives for no apparent reason. Instead of brushing the subject aside and ignoring it, it is time we gave it a close look. By understanding it we might save lives, writes Kuldip Dhiman

IF you have finally made the drastic decision of ending your life, your reasons must be serious indeed. Your family life is in a mess, your career has come to an end, you have lost in love, you are in a very embarrassing situation like an unwanted pregnancy before marriage, or blackmail. And you now see only one way out of your present situation.

But in life, we often tend to take the easy option, and that's quiet natural for humans, so if you think suicide is the easy way out, fine, go ahead, but what if there is an easier way out?


One thing is for sure, you are not mentally ill or insane, because then you perhaps wouldn't be reading this. The majority of individuals who commit suicide do not have a diagnosable mental illness. They are people just like you and I who at a particular time are feeling isolated, desperately unhappy and alone.

Suicidal thoughts and actions may be the result of life's stresses and losses that the individual feels they just can't cope with.

In your case, no doubt something very serious has happened, but the chances are that you won't actually kill yourself, because most of us harbour suicidal thoughts. Sigmund Freud called it the secret death wish. He believed that all of us are born with "Eros", the life instinct which refers to joy, happiness, and "Thanatos", the death instinct which refers to sadism, aggression, and even self-destruction. Before Freud, Durkheim, in his 'manifesto' of 1895 Suicide put forward the hypothesis that, when social conditions fail to provide people with the necessary social goals and or rules at the appropriate levels of intensity their socio-psychological health is impaired, and the most vulnerable among them commit suicide.

But is there any point in telling you all this if you have already decided to commit suicide. Of course, it is quite likely that you did not make this decision all of a sudden. Your suicidal thoughts might have grown over the years as you grappled with the problems of life. Contrary to the popular opinion, whoever made this world, did not make it for us to lead a comfortable existence. Our problems begin right at the moment of our birth and continue to torment us until our last breath. Yet, most of us get along with life and even love it, while only a few of us decide to end it. Why?

Mortal thoughts, which most of us have, progress to fatal thoughts somewhat like this: In the beginning we just have a passive suicidal wish— we say things like, "O! I wish I were dead." As life progresses it might become an active wish. We begin to say things like, "I wish I were somehow killed". At this stage we knowingly or unknowingly put ourselves in dangerous situations such as walking into traffic, we repeatedly hurt ourselves accidentally, or we might take up dangerous pastimes such as rock climbing, motor racing sky diving, and so on. Now the ideator, that is the person who is having ideas about suicide, is under more risk but the situation can still be saved. If we do not turn back, then our passive suicidal wish has a great chance of becoming suicidal wish and we start saying things like, "I wish I could kill myself". And finally this might leads to a suicidal intent: "One day I am going to kill myself." The good news is that most of us do not make it to this stage, but if we have reached this stage then matters must be taken seriously.

What drives people to suicide

When misery and pain exceed the ability to bear it, an attempt to end one's life might follow. It is a time when you feel you have reached a dead end; you feel there are no options left; there is no way out of your suffering. In the vast majority of cases the ideator would choose differently if they were not in great distress and were able to evaluate their options objectively. But these unfortunate people are unable to think rationally as they could be suffering from a number of conditions, such as depression, stress, or a prolonged illness. But although most of us are in such situations in our lives, not all of us commit suicide. The answer to this is that most of us have this tremendous ability to survive, to find solutions, and society has developed ways and means to deal with hard times.

The stress or trauma generated by a given event will vary from person to person depending on their background and how they were taught to deal with that particular stressor. Some people are more or less vulnerable to particular stressful events, and some people may find certain events stressful which others would see as a positive experience. The presence of multiple risk factors does not necessarily imply that a person will become suicidal.

Depression: The No 1 killer

Depression illnesses are total-body illnesses that affect a person's thoughts, feelings, behaviour and physical health and appearance, and affect all areas of a person's life such as home, work, social life and so on. Depression could last for months and even years. What actually causes depression is a much debated topic, and there are different views on the subject. We might consider some recent views. The cognitive-behavioural view says that a person becomes depressed when they believe that they no longer have any control over the reinforcers in their lives, and second when they believe that they themselves are responsible for this situation.

The biological view has two strands: the genetic and the biochemical. The genetic view suggests that some people have a predisposition towards depression. In the biochemical view, the evidence suggests that the neurotransmitters serotonin and norepinephrine may be the cause of depression. A word of caution: genetics is a much misunderstood science. Most of us are under the impression that if there is a gene in us that let's say leads one to commit murder, then one day we will commit a murder. This view is totally wrong. All that genetics says is that in certain circumstances, we are susceptible to committing murder, but we may never commit a murder in spite of the presence of that gene. Such a situation may never arise, and even if it did, our upbringing and our values might prevent us from doing the act. Similarly, if there is a gene for depression in our body that we might have inherited from our parents, it does not necessarily follow that we will end up being depressed.

Warning signals

Depression can cause thoughts of hopelessness and helplessness, and if it is left untreated for a long time it might then lead to a suicidal intent. But as depression is a taboo subject, most of us never admit we are victims of it, as a result mild depression could become chronic and fatal. Most people are very good at hiding depression or disguising it. However, it is possible to detect it and even prevent it although the ideator may not know that they have a treatable illness.

Drug abuse and alcohol

Depression coupled with drug abuse or alcohol could prove to be very dangerous. Most people take to drugs or alcohol in order to escape depression, but this does not help. Actually it becomes a vicious cycle: you are depressed, you take a drug. The drug might elevate you so long as its effect lasts, but after it you are more depressed than before. Now you take the drug again in a bigger dose, and this is followed by a bigger depression, and this goes on ad infinitum.

Prevention is the key

You can survive suicidal feelings by either finding a way to reduce your pain, or by finding a way to increase your coping resources.

The other way to avoid reaching a suicidal condition is by not getting it into it at all. Persons having high-stress jobs such as army intelligence, might do well by curbing the tendency to accept free gifts from strangers, and by living within their means. If you are in business or politics, it would be better to keep away from the underworld. If you live beyond your means, the chances of your taking huge loans or accepting bribe are more. Do not invest all your life's savings in a venture that promises a quick buck.

Parents could refrain from making careless remarks to adolescents, and especially to the girl child. It is not uncommon in India to remind the girl that again and again that she is a burden on the family. If you have school-going children be very careful on the day the results are announced. Don't threaten the child that if they do badly in the exam, the consequences would be dire. It is often the fear of punishment and the humiliation that might follow that makes students take the extreme step. We should avoid making careless and rude remarks to our relations or friends at home and at work. Imagine your day beginning with your parents or your spouse saying something nasty to you, and when you reach office your colleagues are equally rude to you, and this goes on day after day.

Unmarried girls in love are at high risk on the suicide chart. Don't trust your romantic instincts too much. First of all, avoid an unwanted pregnancy before marriage as it is still not acceptable in our society, but if you have become pregnant, do something before it is too late. Don't use your pregnancy as a lever to force the man in your life to marry you. It is pointless in the long run. When love is lost, the feeling is terrible, and you think you will never recover from the shock, but the fact is most of us do recover, and often wonder why we were so blind in love.

Our reasons for disappointment with our life could be many, such as no job satisfaction, setback to our career, death of a loved one, failure in love, an accident that has left us handicapped, or loneliness and old age. In most cases crisis could be avoided by finding a purpose in life. Religious activity, social work, philanthropic work, or an engaging hobby might well avert a suicidal action.

How to help someone who is suicidal

It is quite possible that you are not suicidal yourself, but you suspect someone you know is. Could they be helped? Sure, but this is a very tricky job to do. It would depend how close you are to the person. If you are very close, then perhaps you could ask a direct question, "Are you thinking of suicide?" If you are not very close to a person but yet care about them, then the approach has to be more subtle and indirect as the ideator is not likely to accept that fact that he or she has suicidal thoughts. Listen actively to what the person is saying to you. Remain calm and do not judge what you are being told. Do not advise the person not to feel the way they are, and don't tell them they are wrong. Reassure the person that there is help for their problems and reassure them that they are not "bad" or "stupid" because they are thinking about suicide. Help the person break down their problems into more manageable pieces. It is easier to deal with one problem at a time. Emphasise that there are ways other than suicide to solve problems.

You could encourage them to take help anonymously from various agencies that counsel people round the clock. Advise the person to speak to other close family members or friends. Do not promise them anything you can't do or you will lose their trust forever. Suggest that the person see a doctor for a complete physical check-up. Although there are many things that family and friends can do to help, there may be underlying medical problems that require professional intervention. The doctor can also refer patients to a psychiatrist, if necessary. Seeing a psychiatrist does not mean you are mad.

Coming back to the easy way out mentioned in the beginning. They say better the devil you know than the one you don't. No doubt life is bad, full of misery and hardships, but at least we know how bad it is. There is no guarantee that by ending your life your problems will end because we don't know what happens after death. It is quite possible that after death we go to a better place full of bliss, but it is equally possible that we go to a place that is worse than we are in, and there is also this possibility that everything ends when we die. So is the chance worth taking? Isn't it better to come to terms with the situation and turn our miserable life into a wonderful one.



DR Jack Kevorkian has become infamous for advocating planned death for terminally ill patients. He has been dubbed Dr Death by the media, thus giving the impression that he is a blood-thirsty mass murderer. Though he has assisted about 130 people to end their lives, it would be wrong to bracket him with criminals. We must try to understand what the controversial doctor and the others who have similar views are trying to say.

All he says is that when a person is so ill that nothing can help reduce their suffering, assisted suicide should be allowed. This sounds terrible, but the same was the case with abortion until yesterday.

In his 1991 book, Prescription: Medicide, Kevorkian, described an encounter that served as an awakening for him: "The patient was a helplessly immobile woman of middle age, her entire body jaundiced to an intense yellow-brown, skin stretched paper-thin over a fluid-filled abdomen swollen to four or five times normal size. The rest of her was an emaciated skeleton: sagging, discolored skin covered her bones like a cheap, wrinkled frock. . . . The poor wretch stared up at me with yellow eyeballs sunken in their atrophic sockets. . . it seemed as though she was pleading for help and death at the same time. Out of sheer empathy alone I could have helped her die with satisfaction. From that moment on, I was sure that doctor-assisted euthanasia and suicide are and always were ethical, no matter what anyone says or thinks."

Dr Kevorkian then went on to invent the "Thanaton" a Greek word that means "death machine". He experimented with many methods of killing people and in the end concluded that lethal injection was probably the most tolerable method on a subjective level. He wrote that it was time "for a society obsessed with planned birth to consider diverting some of its attention and energy from an overriding concern with longevity of life at all costs to the snowballing need for a rational stance on planned death".

Dr Kevorkian provoked the authorities to arrest him as he wanted his message to reach the masses. He is in prison these days for helping a man suffering from ALS to die, and for giving a lethal injection to Thomas York, the tape of which was shown live on TV. This forced the police to arrest him. He is by no means alone in this campaign for what is called voluntary euthanasia.



No comments: