As Mental Health Professional,who has been reading the various cases of suicide and attempted suicide, i was urged to put out my two bit for the benefit of all those who care to read and know.
This is not a Bible.
It is neither a textbook of Psychology.
It is simply put an attempt in bringing out the seriousness of the issue and providing people with an opportunity to know better than they previously did.
It is an attempt in helping people to understand others or try to understand other fellow human beings .
It is an attempt for those who read to share who others and society at large that Suicide is not an Act of Crime or intention to Commit a Crime.
Suicide is a Serious Mental Health Issue that needs to be addressed
with T.L.C.---> Tender Loving Care.
SUICIDE WARNING -- Depression carries a high risk of suicide. Anybody who expresses suicidal thoughts or intentions should be taken very seriously.
The best way to minimize the risk of suicide is to know the risk factors and to recognize the warning signs of suicide.
Take these signs seriously. Know how to respond to them. It could save someone's life.
Suicide in simple terms is, “The action of killing oneself intentionally”-
Suicide is the process of purposely ending one's own life.
The way societies view suicide varies widely according to culture and religion. For example, many Western cultures, as well as mainstream Judaism, Islam, and Christianity tend to view killing oneself as quite negative.
One myth about suicide that may be the result of this view is considering suicide to always be the result of a mental illness.
Some societies also treat a suicide attempt as if it were a crime.
In India , “Suicide is treated as a crime”.
In some countries like Japan; however, suicides are sometimes seen as understandable or even honourable in certain circumstances, such as in protest to persecution (for example, hunger strike), as part of battle or resistance (for example, suicide pilots of World War II; suicide bombers) or as a way of preserving the honour of a dishonoured person (for example, killing oneself to preserve the honour or safety of family members).
Are There Warning Signs of Suicide?
A Suicidal Always Talks / Calls. [
It maybe a Subtle Call / Talk. Avoid Ignoring it or Taking / Treating It Lightly]
Warning signs that someone may be thinking about or planning to commit suicide include:-
Always talking or thinking about death
Clinical depression -- deep sadness, loss of interest, trouble sleeping and eating -- that gets worse
Having a "death wish," tempting fate by taking risks that could lead to death, such as driving fast or running red lights
Losing interest in things one used to care about
Making comments about being hopeless, helpless, or worthless.
Putting affairs in order, tying up loose ends, changing a will
Saying things like "it would be better if I wasn't here" or "I want out"
Sudden, unexpected switch from being very sad to being very calm or appearing to be happy
Talking about suicide or killing one's self.
Visiting or calling people to say goodbye.
Be especially concerned if a person is exhibiting any of these warning signs and has attempted suicide in the past , between 20% and 50% of people who commit suicide have had a previous attempt
What Should I Do if Someone I Know Shows Warning Signs of Suicide?
First, if someone you know appears to be depressed and is contemplating suicide, take that person seriously.
Listen to what he or she is saying.
Take the initiative to ask that person what he or she is planning.
But don't attempt to argue him or her out of committing suicide.
Rather, let the person know that you care and understand and are listening.
Avoid statements like: "You have so much to live for."
If someone you know appears to be depressed and talks about suicide, makes a suicidal gesture, or attempts suicide, take it as a serious emergency.
Listen to the person, but don't try to argue with him or her. Seek immediate help from a health care professional.
Depressed people are often suicidal. It is a key symptom of the disease.
Some studies show that the neurotransmitter serotonin plays a central role in the neurobiology of suicide. Researchers have found lower levels of serotonin in the brainstem and cerebrospinal fluid of suicidal individuals.
In addition, suicidal behavior may sometimes runs in families.
Remember, any talk of suicide is always an emergency.
Have the person talk with a health care professional immediately.
Where Can I Get Help for Suicide and Depression?
Encourage a suicidal or depressed person to seek the help of a mental health professional. Because the person feel so hopeless that they may not think it's possible to be helped, you'll probably have to be persistent and go with that person.
If your loved one appears to be in imminent danger of committing suicide, do not leave him or her alone.
Remove any weapons or drugs he or she could use.
Accompany him or her to the nearest medical emergency facility.
During treatment, be supportive.
Help the person remember to take antidepressants or other prescribed medications and to continue any other therapy that's been prescribed.
What are the effects of suicide?
The effects of suicidal behaviour or completed suicide on friends and family members are often devastating. Individuals who lose a loved one to suicide (suicide survivors) are more at risk for becoming preoccupied with the reason for the suicide while wanting to deny or hide the cause of death, wondering if they could have prevented it, feeling blamed for the problems that preceded the suicide, feeling rejected by their loved one, and stigmatized by others. Survivors may experience a great range of conflicting emotions about the deceased, feeling everything from intense emotional pain and sadness about the loss, helpless to prevent it, longing for the person they lost, and anger at the deceased for taking their own life to relief if the suicide took place after years of physical or mental illness in their loved one. This is quite understandable given that the person they are grieving is at the same time the victim and the perpetrator of the fatal act.
Individuals left behind by the suicide of a loved one tend to experience complicated grief in reaction to that loss. Symptoms of grief that may be experienced by suicide survivors include intense emotion and longings for the deceased, severely intrusive thoughts about the lost loved one, extreme feelings of isolation and emptiness, avoiding doing things that bring back memories of the departed, new or worsened sleeping problems, and having no interest in activities that the sufferer used to enjoy.
What are some possible causes of suicide?
Although the reasons why people commit suicide are multifaceted and complex, life circumstances that may immediately precede someone committing suicide include the time period of at least a week after discharge from a psychiatric hospital or a sudden change in how the person appears to feel (for example, much worse or much better). Examples of possible triggers (precipitants) for suicide are real or imagined losses, like the breakup of a romantic relationship, moving, loss (especially if by suicide) of a friend, loss of freedom, or loss of other privileges.
In most countries, women continue to attempt suicide more often, but men tend to complete suicide more often. Although the frequency of suicides for young adults has been increasing in recent years, elderly males continue to have the highest suicide rate. Other risk factors for taking one's life include single marital status, unemployment, low income, mental illness, a history of being physically or sexually abused, a personal history of suicidal thoughts, threats or behaviors, or a family history of attempting suicide.
Data regarding mental illnesses as risk factors indicate that depression, manic depression, schizophrenia, substance abuse, eating disorders, and severe anxiety increase the probability of suicide attempts and completions.
Nine out of 10 people who commit suicide have a diagnosable mental-health problem and up to three out of four individuals who take their own life had a physical illness when they committed suicide.
Behaviors that tend to be linked with suicide attempts and completions include violence against others and self-mutilation, like slitting one's wrists or other body parts, or burning oneself.
Risk factors for adults who commit murder-suicide include male gender, older caregiver, access to firearms, separation or divorce, depression, and substance abuse.
In children and adolescents, bullying and being bullied seem to be associated with an increased risk of suicidal behaviors.
Specifically regarding male teens who ultimately commit murder-suicide by school shootings, being bullied may play a significant role in putting them at risk for this outcome.
Another risk factor which renders children and teens more at risk for suicide compared to adults is that of having someone they know commit suicide, which is called contagion or cluster formation.
Generally, the absence of mental illness and substance abuse, as well as the presence of a strong social support system, decrease the likelihood that a person will kill him- or herself.
Having children who are younger than 18 years of age also tends to be a protective factor against mothers committing suicide
Celebrity Deaths May Trigger Suicide;- Big-time celebrities affect our lives in intimate ways. Today, through television and the Internet, the lives of luminaries like Leno and Letterman, Cher and Madonna, can become interwoven with our own. And if a celebrity who matters to us suddenly dies, we care.
A Celebrity’s death adds to existing feelings of sadness and distress in some people. For them, this public tragedy was a final, private burden that pushed some of them over the edge.
Psychologists recognize this; "We know there is a 'contagion factor' in suicide," "We know when a teenager commits suicide, there's increased danger someone else in the same school may also commit suicide.
Most often, suicide is an impulsive act. In the case of Princess Diana's death, there may have been people who already felt suicidal. When they heard the news, it heightened their own preoccupation with death."
Closer home in India, in some of the southern states; a death of a celebrity either political or a cine star has also taken in its train the lives of some common people who indulged in suicide and thus taking their own lives.
Not just the loss of a celebrity, but the loss of a friend or family member may also plunge someone into a painful re-examination of their life. Even a holiday or birthday can do it, These are times when people reflect on their lives and ask whether they've gotten where they wanted to.
A person who is feeling depressed should seek care.
"If you feel down in the dumps -- not just for one day but for many days -- this should be viewed as a medical symptom, like a cough,
"See your doctor, and request a complete physical exam. Keep in mind that depression may be a sign of physical illness. A health care professional should review all your medications, since some medications may lead to depression."
In addition to your primary care physician, advice from a mental health professional can be very helpful.
However, if & when someone is really feeling suicidal, waiting for a professional appointment, even just for a day or two, may feel like a very long time, or may be just too late. In that Situation, Reach out to Someone -- a friend or family member -- for help.
"Suicide is very much an impulse of the moment, so anything you can do to create some postponement, some thinking process, will be helpful,"
"What will work can vary from person to person, but anything that puts some pause between initial impulse and the action is a good idea.
If you feel you are in real danger of harming yourself, go to a hospital emergency room."
What are the signs and symptoms for suicide?
Warning signs that an individual is imminently planning to kill themselves may include;
the person making a will,
getting his or her affairs in order,
suddenly visiting friends or family members (one last time),
buying instruments of suicide like a gun, hose, rope, pills or other forms of medications,
a sudden and significant decline or improvement in mood,
or writing a suicide note.
Contrary to popular belief, many people who complete suicide do not tell their therapist or any other mental-health professional they plan to kill themselves in the months before they do so.
If they communicate their plan to anyone, it is more likely to be someone with whom they are personally close, like a friend or family member.
Individuals who take their lives tend to suffer from severe anxiety or depression, symptoms of which may include moderate alcohol abuse, insomnia, severe agitation, loss of interest in activities they used to enjoy (anhedonia), hopelessnessof situuations, and persistent thoughts about the possibility of something bad happening.
As suicidal behaviors are often quite impulsive, removing guns, medications, knives, and other instruments people often use to kill themselves from the immediate environment can allow the individual time to think more clearly and perhaps choose a more rational way of coping with their pain.
Thoughts & Behaviour Assessment
The risk assessment for suicidal thoughts and behaviors performed by mental-health professionals often involves an evaluation of the presence, severity, and duration of suicidal feelings in the individuals they treat as part of a comprehensive evaluation of the person's mental health.
Therefore, in addition to asking questions about family mental-health history and about the symptoms of a variety of emotional problems (for example, anxiety, depression, mood swings, bizarre thoughts, substance abuse, eating disorders, and any history of being traumatized), practitioners will frequently ask the people they evaluate about any past or present suicidal thoughts, dreams, intent, and plans.
If the individual has ever attempted suicide, information about the circumstances surrounding the attempt, as well as the level of dangerousness of the method and the outcome of the attempt, can and may be explored. Any other history of violent behavior might be evaluated.
The person's current circumstances, like recent stressors (for example, end of a relationship, family problems), sources of support, and accessibility of weapons are often probed.
What treatment the person may be receiving and how he or she has responded to treatment recently and in the past, are other issues mental-health professionals tend to explore during an evaluation.
How can people cope with suicidal thoughts?
In the effort to cope with suicidal thoughts, silence is the worst enemy.
Suggestions for helping people survive suicidal thinking includes:-
Engaging the help of a doctor or other health professional, a spiritual advisor, or,
by immediately calling a suicide hotline ,or,
going to the closest emergency room or mental-health crisis center.
In order to prevent acting on thoughts of suicide, it is often suggested that individuals who have experienced suicidal thinking keep a written or mental list of people to call in the event that suicidal thoughts come back.
Other strategies include;
having someone hold all medications to prevent overdose,
Removing knives, guns, and other weapons from the home,
Scheduling stress-relieving activities every day,
Getting together with others to prevent isolation,
Writing down feelings, Including positive ones, and
Avoiding the use of alcohol or other drugs.
How can people cope with the suicide of a loved one?
Grief that is associated with the death of a loved one from suicide presents intense and unique challenges. In addition to the already significant pain endured by anyone who loses a loved one, suicide survivors may feel guilty about having not been able to prevent their loved one from killing themselves and the myriad conflicting emotions already discussed.
Friends and family may be more likely to experience regret about whatever conflicts or other problems they had in their relationship with the deceased, and they may even feel guilty about living while their loved one is not.
Therefore, individuals who lose a loved one from suicide are more at risk for becoming preoccupied with the reason for the suicide while perhaps wanting to deny or hide the cause of death, wondering if they could have prevented it, feeling blamed for the problems that preceded the suicide, feeling rejected by their loved one and stigmatized by others.
Some self-help techniques for coping with the suicide of a loved one include avoiding isolation by staying involved with others, sharing the experience by joining a support group or keeping a journal, thinking of ways to handle it when other life experiences trigger painful memories about the loss, understanding that getting better involves feeling better some days and worse on other days, resisting pressure to get over the loss, and the suicide survivor's doing what is right for them in their efforts to recover.
Many people, particularly parents of children who commit suicide, take some comfort in being able to use this terrible experience as a way to establish a memorial to their loved one. That can take the form of everything from planting a tree or painting a mural in honor of the departed to establishing a scholarship fund in their loved one's name to teaching others about surviving child suicide.
Generally, coping tips for grieving a death through suicide are nearly as different and numerous as there are bereaved individuals. The bereaved person's caring for him- or herself through continuing nutritious and regular eating habits and getting extra, although not excessive, rest can help strengthen their ability to endure this very difficult event.
To help children and adolescents cope emotionally with the suicide of a friend or family member, it is important to ensure they receive consistent caretaking and frequent interaction with supportive adults.
All children and teens can benefit from being reassured they did not cause their loved one to kill themselves, going a long way toward lessening the developmentally appropriate tendency children and adolescents have for blaming themselves and any angry feelings they may have harbored against their lost loved one for the suicide.
For school-aged and older children, appropriate participation in school, social, and extracurricular activities is necessary to a successful resolution of grief.
For adolescents, maintaining positive relationships with peers becomes important in helping teens figure out how to deal with a loved one's suicide.
Depending on the adolescent, they even may find interactions with peers and family more helpful than formal sources of support like their school counselor.
What is the treatment for suicidal thoughts and behaviors?
Those who treat people who attempt suicide tend to adapt immediate treatment to the person's individual needs.
Those who have a responsive and intact family, good friendships, generally good social supports, and who have a history of being hopeful and have a desire to resolve conflicts may need only a brief crisis-oriented intervention.
However, those who have made previous suicide attempts, have shown a high degree of intent to kill themselves, seem to be suffering from either severe depression or other mental illness, are abusing alcohol or other drugs, have trouble controlling their impulses, or have families who are unwilling to commit to counseling are at higher risk and may need psychiatric hospitalization and long-term outpatient mental-health services.
Suicide-prevention measures that are put in place following a psychiatric hospitalization usually involve mental-health professionals trying to implement a comprehensive outpatient treatment plan prior to the individual being discharged.
This is all the more important since many people fail to comply with outpatient therapy after leaving the hospital.
It is often recommended that all firearms and other weapons be removed from the home, because the individual may still find access to guns and other dangerous objects stored in their home, even if locked.
It is further often recommended that sharp objects and potentially lethal medications be locked up as a result of the attempt.
Vigorous treatment of the underlying psychiatric disorder is important in decreasing short-term and long-term risk.
Contracting with the person against suicide has not been shown to be especially effective in preventing suicidal behavior, but the technique may still be helpful in assessing risk, since refusal to agree to refrain from harming oneself or to fail to agree to tell a specified person may indicate an intent to harm oneself.
Contracting might also help the individual identify sources of support he or she can call upon in the event that suicidal thoughts recur.
Talk therapy that focuses on helping the person understand how their thoughts and behaviors affect each other (cognitive behavioral therapy) has been found to be an effective treatment for many people who struggle with thoughts of harming themselves.
School intervention programs in which teens are given support and educated about the risk factors, symptoms, and ways to manage suicidal thoughts in themselves and how to engage adults when they or a peer expresses suicidal thinking have been found to decrease the number of times adolescents report attempting suicide.
I have consciously avoided going into citing medications for the same as that is beyond the scope and purview of this note.
The Indian Scenario:-
Four of India's southern states — Tamil Nadu, Andhra Pradesh, Karnakata and Kerala — that together constitute 22% of the country's population recorded 42% of suicide deaths in men and 40% of self-inflicted fatalities in women in 2010.
Maharashtra and West Bengal together accounted for an additional 15% of suicide deaths.
Delhi recorded the lowest suicide rate in the country. In absolute numbers, the most suicide deaths in individuals, aged 15 years or older, were in AP (28,000), Tamil Nadu (24,000) and Maharashtra (19,000).
The first national study of deaths in India, published in the British Medical journal The Lancet, says that suicide has become the second-leading cause of death among the young in India.
Methods of Suicide
A study of the methods of suicide reveals that individuals choose from a variety of acts to end their lives.
The choice of a method for suicide or attempted suicide is related to the person's culture and tradition, and depends upon the intent, seriousness, situation (time and presence of family members), motive and availability of means.
A distinct difference is noticed;
Self-poisoning with a variety of substances ranging from pesticides to commonly available household products is the commonest method, also show a high incidence of self-poisoning.
Hanging is the other frequently adopted method,
Self-burning (immolation) is a method commonly adopted.
Jumping off high rises is yet another form.
Jumping off bridges near sea fronts or across rivers is another way of committing suicide..
This pattern in the methods of committing suicide is also likely to change over a period of time depending on the availability of methods to people, indicating the need for constant surveillance.
Urban/rural differences
An increase in the number of suicides has been noticed in urban areas, suggesting that it may be linked to urbanization, industrialization, migration and changing socioeconomic patterns. Though detailed urban/rural comparisons are not available, in India, nearly 50-60% of suicides still occur in rural areas. This variation may not reflect the exact picture of urban / rural differences due to differential reporting in rural vs urban areas. Many factors, such as societal and family pressures, limited access to health care, and education and employment determinants, may play a role in these variations.
Age variations
There is also a distinct difference in the occurrence of suicides among various age groups.
In India, the highest rates of suicide (30-60%) are seen between 15-29 years, followed by 30-44 years. Of the total deaths by suicide in individuals aged 15 years or older, about 40% suicide deaths in men and about 56% in women occurred in individuals aged 15-29 years.
Suicide deaths occurred at younger ages in women (average age 25 years) than in men (average age 34 years).
Educated persons were at greater risk of completing a suicide.
This indicates, suicide is on the increase among the youth, leading to loss of lives in the most productive years.
Gender differences
It seems that a greater number of men committed suicide though an almost equal ratio of 1.2:1 exists in India, for men and women, respectively.
Attempted suicides
Attempted suicides are on the increase in the country. The magnitude of attempted suicides (parasuicides) is not clearly known for no single reporting agency compiles this type of data.
For every completed suicide, nearly 10-20 persons attempt suicide.
Nearly 10-30% of registrations in hospital emergency departments are due to attempted suicides. Patients who attempt suicide are provided care in government or private health care institutions. Many cases exist where families hush-up and conceal such cases or attempts on account of the social stigma involved.
Data on attempted suicide may be underreported because attempting suicide is a crime in many countries, and this information may be suppressed by families or health care providers at the request of the person's family.
Some studies report the presence of suicidal thoughts among 5-10% of the population in India.
Suicidal thoughts are higher among women in the reproductive age group, according to a recent study in Bangalore.
Such thoughts are related to age, gender, situation and ongoing crises in different walks of life.
Those living in socially underprivileged environments and suffering from mental health problems, such as depression and alcohol abuse, are more prone to such thoughts.
During the economic crisis, it was found that 58% of respondents reported suicidal thoughts.
Clear differences exist in the nature, pattern and intent of attempted suicides and completed suicides, though they are events or steps of the same process.
Stressors are frequently immediate family and interpersonal conflicts Stressors are generally varied and include terminal illness and socioeconomic factors.
Professor Vikram Patel of the London School of Hygiene and Tropical Medicine in his studies told TOI that;
1.87 lakh people committed suicide in India in 2010.
Overall, more Indian men commit suicide than women, but the male to female ratio for suicides is smaller in India than in many Western countries, in particular among youth.
Studies have suggested that social factors such as violence and depression are key determinants of suicide in women."
Prof Patel pointed out to lack of national strategy for suicide prevention in India.
He said, "Suicides can be prevented through interventions like banning the most toxic pesticides and teaching rural communities on safe storage of pesticides.
India should also start mental health promotion for young people through schools and colleges and introduce crisis counseling services and services for treatment of depression and alcohol addiction."
"Compared to most other countries, suicide rates are especially high in young adults and, in particular, young women for whom suicide rates in India are four to six times higher than in developed countries.
The suicide rates vary 10-fold between states with the highest rates in the southern states of India,"
Suicide deaths among men were almost 11-times higher in Maharashtra as compared to Delhi. When it came to women, it was four times higher in Maharashtra than Delhi.
"The large variations we observed between states clearly point to the role of as yet poorly understood social factors in influencing the risk of suicide in India.
We recorded a reduced risk of suicide versus other causes of death in women who were widowed, divorced or separated, compared with married women and men," Prof Patel said.
The study says, suicide claims twice as many lives in India as HIV-AIDS and almost as many as maternal deaths in young women.
Suicide kills nearly as many Indian men aged 15-29 as transportation accidents.
Studies have shown that the most common contributors to suicide are a combination of social problems, such as interpersonal and family problems and financial difficulties, and pre-existing mental illness.
"The large variations we observed between states clearly point to the role of as yet poorly understood social factors in influencing the risk of suicide in India.
We recorded a reduced risk of suicide versus other causes of death in women who were widowed, divorced or separated, compared with married women and men," Prof Patel said.
The study says, suicide claims twice as many lives in India as HIV-AIDS and almost as many as maternal deaths in young women.
Suicide kills nearly as many Indian men aged 15-29 as transportation accidents.
Studies have shown that the most common contributors to suicide are a combination of social problems, such as interpersonal and family problems and financial difficulties, and pre-existing mental illness.
My interactions with some acquaintances reveals the following;
**Some of this material below has appeared in the various media.
* Failure in Love is another cause for committing suicide by teenagers and amongst youth.
But at first we must understand what Love is . Love means your wishes of best life for your partner . If he or she thinks that he or she will be happy with another person , you must admit and respect it , as you respect your love . " Failure does not mean God has abandoned you , it does mean God has better plan for You " Love means sacrifices if you think only of yourself , then you only love yourself . " If you like the Tajmahal it does not mean it should in your garden . We all live in the same world , and if you truly love someone he or she may live at another place , but your heart always feel connected . Do not think of your loss or gain all the time , try to share or give someone what you can , at least a smile or you time.
When cinema came to India, devotional laden music scores used to be the rule, until the early 1990s, and they depicted love between man and woman in its chaste form which did not hurt Indian cultural values. The case of separation between lovers yearning for reunion. Or just frolicking, flirting in good taste. Today all these values of chastity, waiting for reunion, etc, are questioned and efforts are made also to use through films and T.V. serials that suicide and murder as almost vital elements.
With better social commitment to help people mould good taste through the media, it is not difficult to reverse the trend of their largely corruptive influence on young men and women both educated and uneduated.
Parents should be more affectionate to the children , they must not always worry or be obsessed about the future of their children .
If children get love and comfortable peaceful childhood then they can face any problem positively in future . If the children are used to prayer than they can also feel how grateful is God to give us an opportunity to live in this beautiful world . The beauty of the panaromic nature in all her splendour and majesty is here alongwith the whole world for you .
Avoid thinking only about your position in the society or bank balance .
You can be the happiest person in the world if you just share and learn to share in an atmosphere and environment of give and take of your thoughts & feelings with your friends or dear ones besides listening to their problems also .
Thank GOD for being blessed with what you have.
Avoid lamenting always for what you do not have.
People can opt to learn Yoga / Sudarshan Kriya / Deep Breathing Exercises.
Best,
Prasad.
