BIGGER PICTURE: Suicide now prevalent but still given little attention

Suicide is becoming prevalent in recent years but unfortunately, it is still not given the much-needed attention it richly deserves.

“Suicide is a form of murder – premeditated murder,” explained Susanna Kaysen in Girl, Interrupted. “It isn’t something you do the first time you think of doing it. It takes getting used to. And you need the means, the opportunity, the motive. A successful suicide demands good organization and a cool head, both of which are usually incompatible with the suicidal state of mind.”

A few years back, a 17-year-old leaped to death from a seventh-floor of a school building. “The administration and studentry are so shocked about the unfortunate incident that claimed the life of our student, who committed suicide by jumping out of the window,” said the official school statement.

A flashback. Before the incident, the student reportedly “displayed erratic behavior while attending her class.” She even tried to climb out of the classroom’s window. Fortunately, the teacher was able to restrain the student.

The teacher called the guidance counsellor who then fetched the student and brought her to the counselling office. He contacted the mother of the student. While waiting, he asked some questions.

From their conversation, he learned that “she has been physically, verbally and psychologically abused by her parents at home.” However, the student did not elaborate when asked why.

The counsellor also learned that she tried to commit suicide several times already. At one time, she ingested a dozen packs of monosodium glutamate. On another occasion, she gulped a dozen antibiotics and analgesics.

Then the mother arrived. “When the student sensed that her mother was around, she asked to go to the comfort room,” the official statement said. “Escorted by a female guidance counselor to the women’s comfort room, the student quickly went inside the cubicle and locked herself up. And things quickly happened in seconds as she slipped out of the cubicle’s window.”

In 2014, the Geneva-based World Health Organization (WHO) issued Preventing Suicide: A Global Imperative, its first report on suicide as a public health issue. Suicide takes places as often as every 40 seconds, the report said.

According to the said report, close to 800,000 people around the world die each year due to suicide. “For every suicide, there are many more people who attempt suicide every year,” the United Nations health agency deplores.

In the Philippines, an earlier WHO report said, the suicide rate (per 100,000 population) was 2.5 for men and 1.7 for women. This fact may be appalling for Filipinos but the numbers are way too small compared to those in Western countries.

In fact, the Philippines has one of the world’s lowest suicide rates. The 2000 Philippine Health Statistics from the Department of Health (DOH) showed only 1.8 per 100,000 people to have inflicted harm on themselves. In comparison, European countries had the highest figures which ranged from 30 to 42 per 100,000 people.

Let’s take a closer look at the study conducted by Maria Theresa Redaniel, May Antonnette Lebanan-Dalida, and David Gunnell, authors of “Suicide in the Philippines: time trend analysis (1974-2005) and literature review.”

In their study, the researchers found out that incidence of suicide in the Philippines among males increased from 0.23 to 3.59 per 100,000 between 1984 and 2005. Similarly, rates rose from 0.12 to 1.09 per 100,000 in females. Among females, suicide rates were highest among the age bracket of 15- to 24-year-olds; while in males, rates were similar in all age groups throughout the study period.

While suicide rates are low in the country, there is an increase of suicide incidence among adolescents and young adults. Citing a report from the National Poison Management and Control Center (NPMCC) of the Philippine General Hospital, Senator Joel Villanueva pointed out during a Senate hearing some years back that 46% of the total suicide cases recorded since 2010 were from the young people.

Studies showed suicide is the second leading a cause of death among young people aged 15-29 years, after road injury. Among teenagers aged 15-19, suicide is the second leading cause of death among girls (after maternal conditions) and the third leading cause of death in boys (after road injury and interpersonal violence).

Dr. Dinah Nadera, a psychologist of the University of the Philippines’ Open University told the Philippine Daily Inquirer that based on studies made on 300 cases from hospitals and police reports in 2008 and 2009, suicides happened between 8:01 in the morning and noon on weekdays, “when other people were not around in their homes.” Least suicides occurred between 12:01 and 4 a.m.

Unknowingly, there may be more Filipinos who commit suicide than what is being recorded. “Certainly, the actual rate in the Philippines is probably higher, with many doctors agreeing not to report deaths as suicides because of the stigma. But even if we could get the true figure, it would probably still be relatively low,” Dr. Michael Tan wrote in his Philippine Daily Inquirer column.

Suicide, the process of purposely ending one’s own life, has always been viewed negatively in most culture. But not in Asia, where 60% of all the suicide deaths in the world are reported from. In fact, two of the countries with relatively huge suicide rates are Japan and South Korea, which have a very high level of competition that starts right from childhood.

“Although some attempted or completed suicides come as a shock even to family and friends, clear warnings are given in most cases,” says The Merck Manual of Medical Information. “Any suicide threat or suicide attempt is a plea for help and must be taken seriously. If the threat or attempt is ignored, a life may be lost.”

For health purposes, the Merck manual calls it as “suicidal behavior.” It says: “Suicidal behavior is an all-too-common health problem. Although most suicidal behavior does not result in death, 10% of people who try to kill themselves using a potentially fatal means do die from their actions.”

According to the Merck manual, suicidal behavior is an unmistakable signal that a person has feelings of desperation and hopelessness. Among those with high-risk factors for suicide are males, having painful or disabling illness, living alone, having debt or living in poverty, under bereavement, experiencing humiliation or disgrace, and depressed.

Other high-risk factors: persistence of sadness even when other symptoms of depression are getting better, history of drug or alcohol abuse, history of prior suicide attempts, family history of suicide, family violence (including physical or sexual abuse), suicidal preoccupation and talk, and well-defined plans for suicide.

“Suicidal behavior includes attempted suicide, suicide gestures, and completed suicide,” the Merck manual states. “An attempted suicide is suicidal action that is not fatal. If an attempted suicide involves a suicidal action unlike to have any potential of being fatal, it is called a suicide gesture. A person taking such an action (for example, ingesting six acetaminophen tablets) may be making a plea for help or attention without having any intention of actually ending his life. A completed suicide is a suicidal action that results in death.”

Some studies have shown that practicing members of most religious groups are less likely to commit suicide. Such people are generally supported by their beliefs and are provided with close social bonds protecting against acts of self-destruction.

“But religious affiliation and strong religious beliefs do not necessarily prevent individual impetuous, unpremeditated suicidal acts during times of frustration, anger, and despair, especially when accompanied by delusions of guilt and unworthiness,” one study noted.

According to studies, one out of four people who complete suicide left suicide notes. These notes often refer to personal relationships and events that will follow the person’s death. Notes left by older people often express concern for those left behind, whereas those of younger people may express anger or vindictiveness.

The choice of method often is influenced by cultural factors and availability and may or may not reflect the seriousness of intent. “Some methods (for example, jumping from a tall building) make survival virtually impossible, whereas other methods (for example, overdosing on drugs) make rescue possible,” the Merck manual notes. “However, even if a person uses a method that proves not to be fatal, the intent may have been just as serious as that of a person whose method was fatal.”

Drug overdose and self-poisoning are two of the most common methods used in suicide attempts. Violent methods, such as gunshots and hanging, are uncommon among attempted suicides because they usually result in death. Of completed suicides, a gunshot is the method most frequently used by males. Females are more likely to use non-violent methods, such as poisoning, drug overdose, or drowning.

In the Philippines, a study showed that the methods of committing suicide included shooting oneself, 40%; hanging, 30%; poisoning, 16.7%; and jumping from high places, 13.3%. In 73% of the reported cases, suicide was committed in their own homes.

Brian Mishara, of the International Association for Suicide Prevention, said more people kill themselves each year than are killed in all wars, terrorist acts, and homicides. “Yet, we give a large attention every time there is a death by homicide and very little attention to the million lives lost worldwide to suicide,” he deplored.

“Every death (caused by suicide) is a tragedy for family, friends and colleagues,” pointed out Dr. Tedros Adhanom Ghebreyesus, WHO director general.

Most people don’t talk about suicide because of the stigma attached to it. “Stigma, particularly surrounding mental disorders and suicide, means many people thinking of taking their own life or who have attempted suicide are not seeking help and are therefore not getting the help they need,” the WHO explains. “The prevention of suicide has not been adequately addressed due to a lack of awareness of suicide as a major public health problem and the taboo in many societies to openly discuss it.”

There are several reasons why a person commits suicide. As stated earlier, there are those who are planning to do it and give some hints. Such was the case of the 26-year-old Nestor. He jumped off from the fifth floor of a shopping mall. Before he took his own life, he posted on his Facebook wall that he was going to do it.

“I decided to go hindi dahil sa kasalanan ko ngaun… dahil matagal ko na tong plano, sana pala ginawa ko na noon di na sana ako naka gawa pa ng ibang kasalanan at makapanakit ng damdamin ng ibang tao,” he wrote in his status. (“I decided to go not because of the mistake I did now… I had planned this before, if I had done it before I would have done other mistakes that would hurt the feelings of others.”)

A lady friend advised him not to do something drastic but he replied: “Dili ni sya dautan teh mao jud ni sya akong disisyon (This is not wrong, sister, this is really my decision).”

Suicide is for real and it is unfathomable why people try to cut their lives. “It’s difficult to understand how a person could not give value to a survival instinct, which is to stay alive from a standpoint of a non-suicidal person,” wrote Dr. Gia B. Sison, a practicing medical doctor who specializes in occupational medicine and a strong mental health advocate.

But those who want to commit suicide actually fight. “Killing oneself is, anyway, a misnomer,” said Sally Brampton, author of Shoot the Damn Dog: A Memoir of Depression. “We don’t kill ourselves. We are simply defeated by the long, hard struggle to stay alive.

“When somebody dies after a long illness, people are apt to say, with a note of approval. ‘He fought so hard.’ And they are inclined to think, about a suicide, that no fight was involved, that somebody simply gave up. This is quite wrong.”

Experts urge everyone to save those who want to cut their lives. “We can all help to make a difference in the lives of those around us who might be struggling with thoughts of suicide,” urges the Baton Rouge Behavioral Hospital in its website. “It can be as simple as reaching out to someone who you know is having a rough time, or keeping your eyes open for somebody who is struggling and taking a moment to talk with them. These simple acts of kindness can sometimes be the key to helping someone open up and seek support for their issues.”

For its part, the health department has issued an administrative order stipulating guidelines for the ethical and responsible reporting of suicide in the news and broadcast media, and portrayal in films, stage, and television.

“It is important that those at risk are not exposed to articles or movies that encourage or give instructions on suicide,” pointed out Dr. Maria Rosario Singh-Vergeire, DOH undersecretary.

Curtailing suicide is not a job for health department only but for everyone. As WHO puts it: “Suicide is a complex issue and therefore suicide prevention efforts require coordination and collaboration among multiple sectors of society, including the health sector and other sectors such as education, labor, agriculture, business, justice, law, defense, politics, and the media.”

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