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Making sense of suicide-Maitri Chand
-The Hindu


Suicide has been part of everyday conversation in many living rooms, but there is little understanding of why it happens

Everyone has opinions on why people they have never met, and do not know, kill themselves. I hear people say things like "what a cowardly thing to do," or "he was weak". The words are redolent of casual judgment, perhaps born out of familiarity and even fear: the thoughts that lead some people to die aren't unknown to most of us.

For weeks now, suicide has been part of everyday conversation in many living rooms: the tragic death of Sunanda Pushkar has disappeared from headlines, only to be replaced by the loved character actor, Philip Hoffman.

It isn't generally understood just how common stories like these actually are. In India, 10.3 of every 1,00,000 people take their own lives each year, the respected medical journal, The Lancet, estimated in 2012. To give a sense of scale, that means suicide is roughly three times as common as murder.

What pushes people to take such an extreme step? The story isn't about moral fibre or character. Instead, it involves biology, genetics, problem-solving skills, coping mechanisms, and family dynamics.

Factors influencing suicide

Philosophers and psychologists have struggled, just like everyone else, to make sense of suicide. In the 19th century, French sociologist Émile Durkheim first examined the cultural and social factors which influenced suicide. He came up with three categories. The first was egoistic, which applied to anyone who was socially isolated. The second was altruistic, the result of a person being too integrated into a social group, like soldiers who sacrificed their lives in battle. The third condition was anomic, the consequence of a drastic disruption to the life of a well-integrated person.

Contemporary social scientists believe a person's suicidal fantasies, whether revenge, power, escaping pain, rescue, reunion with the dead, or sacrifice, tell us a lot about what they believe will happen if and when they commit suicide. These fantasies are a result of biological, genetic and social factors, which interact with the cultural environment we live in.

At the biological level, we know serotonin - a neurotransmitter, or chemical that transmits signals from neuron to neuron inside our brain - plays a key role in the suicide story.

The genetic and biological causes of suicide are illustrated by studies of specific populations, namely twins adoptions. Studies of suicidal behaviours among twin siblings brought to light a high probability that a co-twin of a person who had committed suicide had either completed suicide or had attempted suicide several times.

Not just genetic destiny

It would be simplistic, though, to represent suicide as genetic destiny. From a welter of studies, we know that factors that increase a person's vulnerability include gender, age, marital status, physical health and mental illness.

By and large, what we do know in terms of the risk factors involved is from people who attempted suicide but did not complete it. In India as well as the U.S., men are noted for more suicide completions and women for non-fatal attempts. Suicide is more common among adolescents and young adults (between the ages of 15-29) and the elderly (according to data from the U.S.). Married individuals (in the U.S.) are less likely to kill themselves than their single counterparts.

From a psycho-social perspective, family histories of substance abuse, suicidal behaviours and mental illness leave their mark on the coping mechanisms considered viable by an individual.

Also, development of effective communication skills, how to handle happiness, worries, sorrow, successes, failures, and how to connect emotionally with others are all impacted by what we see in our family-of-origin.

Physical illness - immobility, disfigurement, and chronic pain - are also factors associated with suicide. Living with constant discomfort and pain contributes to the lack of our mental and emotional stability and well-being. Wishing to end the misery at this point begins to look like a real option.

Finally, there are significant correlations between mental illnesses -mood disorders, certain personality disorders, and schizophrenias- and suicide.

What families can do

Families rarely discuss thoughts of suicide, even of suffering, honestly with one another - especially when the issues involve one of the great stigmas in our society, mental illness. People fear being judged as weak, inadequate or flawed. Much prejudice is directed toward a person who is unable to "control their moods," "cheer himself/herself up," or "just can't snap out of it." The awkwardness we feel is about our own inability to provide an appropriate response when faced with another's vulnerability and naked pain.

There are things all of us can do if someone does open up about feeling suicidal, or if you think they might be. First, manage your own anxiety about the conversation, by focussing on the person and what they have shared with you. Convey your empathy, let them know that you're sorry they're suffering, and that you're there for them.

Most importantly, ask them if they have spoken to a therapist, counsellor or trained professional-and if not, ask them if they'd like to contact one.

Ever since antiquity, humans have responded to suicide with moral condemnation. From the story of the philosopher, Socrates, we know this is a supremely useless response. Socrates condemned suicide, asserting that "man, who is one of god's possessions, should not kill himself." Yet, he committed suicide himself, drinking poison after being sentenced to death by the state. He rationalised his choice thus: suicide was legitimate when "god sends some compulsion upon him, as he sends compulsion on us at present."

That compulsion Socrates felt wasn't either godsent or divine. Each of us can help ensure its outcome isn't inevitable.

(Dr. Maitri Chand is a New Delhi-based therapist.)