Suicide & mental health

By Zubeida Mustafa
Source: Dawn

THE Pakistan Association for Mental Health will be looking into various aspects of the problem of suicide when it observes mental health day belatedly on Sunday. PAMH has been working for decades to create awareness about mental health and has managed to educate the public somewhat about the common disorders such as depression, schizophrenia, and personality problems.

But suicide per se has not received the attention it should have, given its growing prevalence. Informed public awareness of this issue is negligible.

It is strange that the dramatic increase in the incidence of suicides in Pakistan has not alerted policymakers to address this problem concertedly. The Lawyers for Human Rights and Legal Aid, an NGO working in this field that has set up a helpline, has reported that suicide led to 3,123 deaths in Pakistan in 2003. Experts estimate that for every suicide there are another 20 or so cases of attempted suicides that fail. This is a worldwide trend and WHO reported that one million people killed themselves in the year 2000, which is more than those who lost their lives on account of war or homicide. Worse still, this trend is on the rise. Take the case of Sindh. In 1985, 105 suicide cases were recorded here. In 2003, this figure had shot up to 1,588.

The lack of understanding of this phenomenon is quite shocking. Conventional wisdom in our society holds that the appalling conditions prevailing in the country resulting in joblessness, lack of security, poverty, economic inequities and discordant interpersonal relations lead to despair and a sense of hopelessness that cause people to take their life. But this is true to an extent only. Science has now proved conclusively that suicidal tendencies in an individual are a direct result of the chemical make-up of his brain and his inability to cope with the tension — real or imagined — he is faced with.

Psychiatrists attribute suicide to mental illnesses such as depression, schizophrenia, bipolar disorder, substance abuse and postpartum depression. Since these are all treatable/manageable, it is a pity that they should lead to suicide. But as Prof Haroon Ahmed, president of the PAMH, points out a difficult social, family and economic micro-environment can act as a trigger for a person who is vulnerable. But simply providing a severely suicidal person employment may not really be enough to preempt his suicide, just as every person who loses his job does not go and kill himself. True, it is not coincidental that the suicide rate has increased as the conditions in the country have deteriorated. This trend indicates the rise in trigger factors. Ideally, transforming Pakistan into a Utopia should decrease the stress the citizens face in their daily living. But that would be like waiting for Godot. Moreover, even in perfect conditions the clinically ill who are predisposed towards suicide would still take their own life. Hence the more pragmatic approach is to identify the people at risk and reinforce their coping mechanism.

It is this basic fact that needs to be understood by people so that they learn to recognise suicidal tendencies and are not afraid to seek medical help. While creating this awareness it is also important that a concerted effort is made to reduce the stigma that is attached to mental illness. The first step would be to change social attitudes because mental health professionals operate in a socio-cultural milieu and need the community’s cooperation and understanding to provide the mentally ill the socio-medical support they need.

Suicide, however, poses more complex problems than other disorders. For instance, the stigma is not just social. It is also religious. This complicates matters for para suicide cases where the patient survives and needs additional support and treatment. Condemning him as a sinner will detract from the support that is essential in testing times — suicide is a desperate cry for help. More problematic is the legal aspect. Under the Lunacy Act of 1912 suicide/attempted suicide was treated as a crime. Mercifully, the Mental Health Ordinance, 2001, (MHO) did away with this ridiculous approach to suicide. But with the MHO still awaiting implementation it is not at all clear what the legal position on suicide is at present in Pakistan.

With society’s perception of suicide as a mental health problem still so ambiguous, we are now faced with the new phenomenon of suicide bombers. Given the fact that suicide has never been glorified in our part of the world, as it was for example in Japan where it was considered honourable to kill oneself to atone for one’s shame, suicide bombing has not been upheld as an act of heroism. It falls in a different category altogether. The act of the suicide bomber is not directed against himself alone. He destroys himself with the aim of inflicting maximum damage on others he perceives as his enemies.

A glance at the history of suicide bombings makes it clear that this was first used as a strategic weapon to attack the enemy in times of war. Starting with the Knights Templars in the Crusades of the 12th century, more recently Japanese Kamikaze pilots attacked American naval ships in the Second World War. Even closer in time have been the Tamil Tigers in Sri Lanka and the Palestinians attacking Israelis in desperation. The suicidal attacks launched by Al Qaeda are the latest in the series.

But suicide bombings are now moving away from an act born from despair and hopelessness as the Palestinians’ suicide attacks symbolised. The suicide bombings we witness in Iraq, Afghanistan and Pakistan today are more in the nature of acts of vengeance and hatred than anything else. Crazed by these negative emotions, the suicide attackers are willing to go to the extent of killing themselves — along with others.

How would one describe those who turn to extreme religiosity and freely resort to violence of the most brutal kind? It is said that the suicide bombers have been heavily indoctrinated and brainwashed into believing that their act of self-destruction is a noble one that will win them martyrdom and paradise. But one cannot overlook the possibility of socially and emotionally maladjusted individuals seeking group identity in extremist organisations. Mental health professionals should study this phenomenon from a scientific point of view and also seek to identify the factors that result in extremism of a mindless kind.