The “WHYs” of life have always been the hardest to answer – You know ‘why’? The one question everyone has asked without exception, that they ache to have answered more than any other, is simply: why? Why did their friend, child, parent, spouse, or sibling take their own life? Even when a note explaining the reasons is found, lingering questions usually remain: yes, they felt enough despair to want to die, but why did they feel that? A person’s suicide often takes the people it leaves behind by surprise (only accentuating survivor’s guilt for failing to see it coming).
Suicide in Pakistan has been a long-term social issue and is a common cause of unnatural death. Incidents of suicide are often reported in the press and newspapers throughout the country as well as by several non-governmental organizations.
However, diagnosing and covering suicide cases has generally been difficult in the local culture due to a number of social stigmas and legal issues that bind the problem; given that suicide is prohibited in Islam, there are various obstacles which come along in openly discussing the phenomenon in Pakistan, a predominantly Muslim country.
Suicidal death tolls and attempts have increased marvelously over the years and have therefore served as the foremost reason behind deaths especially amid youth and teens.
Suicide is considered a criminal offence, with punitive laws imposed in place for attempted suicide. National suicide statistics are not compiled on a formal level nor officially reported to the World Health Organization, thus leaving any obtained data to be neglected and under reported. While suicide patterns have traditionally been low, there has been a slow but steep increase in the past few years.
One analysis of suicide reports, based over a period of two years, showed over 300 suicidal deaths in Pakistan from 35 different cities.
The findings showed that men outnumber women by 2:1 and that the majority of men who commit suicide tend to be unmarried; the trend for women, however, is the opposite.
Research also indicated that the majority of subjects were under the age of 30 and that “domestic problems” are the main reason stated for suicide. These include unemployment, health issues, poverty, homelessness, family disputes, depression and a range of social pressures. Hanging, use of insecticides and firearms are the most common methods for carrying out suicide in Pakistan.
People who’ve survived suicide attempts have reported wanting not so much to die as to stop living, a strange dichotomy but a valid one nevertheless. If some in-between state existed, some other alternative to death, I suspect many suicidal people would take it. For the sake of all those reading this who might have been left behind by someone’s suicide, I wanted to describe how I was trained to think about the reasons people kill themselves. They’re not as intuitive as most think.
In general, people try to kill themselves for six reasons:
- They’re depressed. This is without question the most common reason people commit suicide. Severe depressionis always accompanied by a pervasive sense of suffering as well as the belief that escape from it is hopeless. The pain of existence often becomes too much for severely depressed people to bear. The state of depression warps their thinking, allowing ideas like “Everyone would all be better off without me” to make rational sense.
They shouldn’t be blamed for falling prey to such distorted thoughts any more than a heart patient should be blamed for experiencing chest pain: it’s simply the nature of their disease. Because depression, as we all know, is almost always treatable, we should all seek to recognize its presence in our close friends and loved ones.
Often people suffer with it silently, planning suicide without anyone ever knowing. Despite making both parties uncomfortable, inquiring directly about suicidal thoughts in my experience almost always yields an honest response. If you suspect someone might be depressed, don’t allow your tendency to deny the possibility of suicidal ideation prevent you from asking about it.
- They’re psychotic. Malevolent inner voices often command self-destruction for unintelligible reasons. Psychosisis much harder to mask than depression and is arguably even more tragic. The worldwide incidence of schizophrenia is 1% and often strikes otherwise healthy, high-performing individuals, whose lives, though manageable with medication, never fulfill their original promise.
Schizophrenics are just as likely to talk freely about the voices commanding them to kill themselves as not, and also, in my experience, give honest answers about thoughts of suicide when asked directly. Psychosis, too, is treatable, and usually must be treated for a schizophrenic to be able to function at all. Untreated or poorly treated psychosis almost always requires hospital admission to a locked ward until the voices lose their commanding power.
- They’re impulsive. Often related to drugs and alcohol, some people become maudlin and impulsively attempt to end their own lives. Once sobered and calmed, these people usually feel emphatically ashamed.
The remorse is often genuine, but whether or not they’ll ever attempt suicide again is unpredictable. They may try it again the very next time they become drunk or high, or never again in their lifetime. Hospital admission is therefore not usually indicated.
Substance abuse and the underlying reasons for it are generally a greater concern in these people and should be addressed as aggressively as possible.
- They’re crying out for help, and don’t know how else to get it. These people don’t usually want to die but do want to alert those around them that something is seriously wrong. They often don’t believe they will die, frequently choosing methods they don’t think can kill them in order to strike out at someone who’s hurt them, but they are sometimes tragically misinformed.
The prototypical example of this is a young teenage girl suffering genuine angst because of a relationship, either with a friend, boyfriend, or parent, who swallows a bottle of Tylenol, not realizing that in high enough doses Tylenol causes irreversible liver damage.
- They have a philosophical desire to die. The decision to commit suicide for some is based on a reasoned decision, often motivated by the presence of a painful terminal illness from which little to no hope of reprieve exists. These people aren’t depressed, psychotic, maudlin, or crying out for help. They’re trying to take control of their destiny and alleviate their own suffering, which usually can only be done in death.
They often look at their choice to commit suicide as a way to shorten a dying that will happen regardless. In my personal view, if such people are evaluated by a qualified professional who can reliably exclude the other possibilities for why suicide is desired, these people should be allowed to die at their own hands.
- They’ve made a mistake. This is a recent, tragic phenomenon in which typically young people flirtwith oxygen deprivation for the high it brings and simply go too far. The only defense against this, it seems to me, is education.
The wounds suicide leaves in the lives of those left behind by it are often deep and long lasting. The apparent senselessness of suicide often fuels the most significant pain.
Thinking we all deal better with tragedy when we understand its underpinnings, I’ve offered the preceding paragraphs in hopes that anyone reading this who’s been left behind by a suicide might be able to more easily find a way to move on, to relinquish their guilt and anger, and find closure.
Despite the abrupt way you may have been left, guilt and anger don’t have to be the only two emotions you’re doomed to feel about the one who left you.
- Suicide is intentionally acting to end one’s life.
- Suicide attempts may be planned out or impulsive.
- Murder-suicide involves a person killing someone else, then himself or herself. This is a very dramatic, but fortunately rare, event.
- Suicide by cop involves a person trying to provoke police officers to kill him or herself.
- Self-mutilation is deliberate self-harm without an intent to end one’s life. Self-mutilation is associated with an increased risk of suicide.
- Most individuals who commit suicide have a mental illness such as depression, bipolar disorder, or schizophrenia.
- Decreased serotonin activity in the brain is associated with suicide risk.
- People who feel hopeless, helpless, or isolated are more likely to consider or attempt suicide.
- People who have serious losses — deaths of close people, loss of jobs, a move — are more at risk for suicide.
- Every 40 seconds, somewhere in the world, someone ends their life.
- In the U.S., about 100 people die every day of suicide.
- Young people and older adults are more likely to commit suicide.
- Guns are the most common method for completed suicide. Poisoning or overdose and asphyxiation/hanging are the next most common methods.
- People who have experienced bullying, physical abuse, or sexual trauma are more at risk for considering, attempting, or completing suicide.
- Treatment of mental-health conditions can reduce the risk of suicide and improve quality of life.
This question is complex and difficult to answer — our best information comes from people who have survived suicide attempts or by trying to understand what people who killed themselves may have in common.
Alternately, some people leave a suicide note that may give some insight into their state of mind. Many people who attempted suicide indicate that they don’t necessarily want to die but more often want to end their pain– emotional or physical.
Suicide Risk Factors:
Even though suicide is a relatively common cause of deaths, it is extremely difficult to predict. People who attempt or commit suicide come from every race, country, age group, and other demographic.
There are many factors that are common among people who died by suicide, but most other people with these same factors still do not attempt suicide.
For example, even though most people who commit suicide have some mental disorder, such as depression, most people who have depression do not commit suicide. Even so, we can still learn about suicide, and hopefully do better at preventing suicides, by understanding risk factors.
Globally, societal and cultural factors also affect suicide risks. Communities with limited access to health care or that discourage help-seeking behavior place people at higher risk.
Countries involved in war or other violent conflicts, as well as natural disasters, also tend to have higher suicide rates. Ethnic groups who are facing significant discrimination, particularly with displacement or immigration, are also at risk.
Certain demographic factors are associated with an increased suicide risk, and since they can’t be changed, they are sometimes called non-modifiable risk factors. These include male gender, Caucasian ethnicity, age (under 25 or over 65), and relationship status (divorced, widowed, and single).
Certain professions, such as physicians and dentists, may be more at risk for suicide. It is not clear if this is due to job stresses, knowledge of and access to lethal means, or other factors. Unemployment or recent job loss may also increase the risk of suicide attempts. Importantly, individuals with limited social supports are a higher risk of attempting suicide.
Individuals with a family history of completed suicide are at higher risk of suicide themselves. This may be related to hereditary (genetic) factors but may also be due to the trauma and distress of losing a family member in this way. Lastly, one of the strongest predictors of future suicide attempts is past suicide attempts.
Social factors, including current or past discrimination, abuse, or trauma also predispose people to suicidal acts. People who have been subject to bullying are more likely to consider or attempt suicide. This is true both for young people currently being bullied, as well as adults who were bullied when younger.
It is likely that more recent tactics, such as cyberbullying, would have the same impact. A similar pattern is seen for those who have been sexually abused or assaulted, both women and men. For adults sexually abused as children, suicide attempts were two to four times more likely in women and four to 11 times more likely in men, compared to those not abused.
People who identify as lesbian, gay, bisexual, or transgender (LGBT) also seem to have higher rates of suicide. People exposed to combat, either civilians or military personnel, have an increased risk of suicide as well.
Although these stressors are very different, they likely have a similar impact on people; people can feel isolated and helpless in controlling or escaping these situations, and they may also feel more socially isolated and unable to reach out for help.
Treatments for Suicidal Thoughts or Behaviors:
There are no treatments that specifically stop suicidal thoughts. However, for each individual, identifying and treating any mental illness, and dealing with any stressors can reduce the risk of suicide.
Some treatments for mental illness, including major depression and bipolar disorder, have been shown to reduce suicide risk.
Medications cannot completely eliminate the suicidal aspect cultivated within a being, yet, it can normalize the victim to a certain extent.
In contrast, there are certain anti-depressants that subdue the suicidal attempts. However, there are many who contradict this belief as it is believed that certain anti-depressants actually foster suicidal attempts within human mind.
Nonetheless, it is always advisable to consult a doctor or a psychiatrist in grave cases.
Moreover, a psychotherapy that includes a talk session can also be a relief for the victim. It is always advisable to seek help via counselling.
Helping Someone with Suicidal Thoughts:
- Take statements about suicide, wanting to die or disappear, or even not wanting to live, seriously — even if they are made in a joking manner. Don’t be afraid to talk to someone about suicidal thinking; talking about it does not lead to suicide. Discussing these thoughts is the first step in getting help, treatment, or safety planning.
- Help them to get help. Encourage or even go with them to get help. Call a hotline, clinic, or mental-health clinic.
- Remove risky items from their possession or home. It is particularly important to remove any firearms. The majority of suicide deaths used a gun, and most (90%) of suicide attempts with a gun are lethal. Other risky items may include razors, knives, and sharp objects. Prescription and over-the-counter medications should be secured.
- Avoid alcohol or other drugs; these can increase impulsive actions and suicidal thoughts. Alcohol is a “depressant” because it can make depression worse on its own. Almost one-quarter of suicide victims had alcohol in their system at their deaths.
- Practice methods to “slow down.” If people can distract themselves, even for a short time, the worst suicidal thoughts may pass. This could involve anything from meditation, deep breathing, listening to music, going for a walk, or being with a pet. With a partner, friend, or family member, talking or even just being there may help.
- If someone is still feeling suicidal, it may be helpful to stay with them or to help find others to stay nearby. This type of support or suicide watch can help keep someone safe until they can get help.
- If these strategies are not working, get help now. Go to a mental-health center, an emergency room, or even call 911. Suicide hotlines may also be able to connect you to local help.
- Remember, get help — it can get better.
How to Cope with the Loss of a Loved One to Suicide:
- Find a support group, such as a survivors of suicide (SOS) group. It helps to know you are not alone.
- Grief is very different for everyone. Don’t feel like you have to be on someone’s schedule or timeline. It might take longer than you (or others) think it will.
- Get help for yourself, particularly if you have symptoms of depression or suicidal thoughts.