Suicide: In pursuit of meaning

IT is now obvious that even successful, rich and famous people with the world at their feet, may die suddenly from suicide. How can this be? We are now inundated by reports of suicide deaths involving secondary school children, undergraduates, adults, rich as well as poor individuals from all walks of life. What exactly is happening here?

How and what could be the state of mind of an individual, that will lead them to the conclusion that death is a better and preferred solution than to continue living? Surely, it must be the result of a mental illness or demonic possession? How does this come about? Why has it become such a big problem? What are the risk factors and what can we do about it? Surely, these are signs of the end time?

What are the facts?

The World Health Organisation (WHO) estimates that one suicide death occurs every 40 seconds (one million deaths every year). The numbers of those who attempt suicide is estimated at 20 times the number of suicide deaths. Indeed, for all causes of violent deaths, more people die from suicide (57 per cent) than from the combined total deaths accruable from wars, conflicts and homicides (totaling 43 per cent) every year.

Unfortunately, about three quarters of all suicides occur in low and middle income countries such as in Asia and Africa. In Nigeria, we do not have reliable statistics but our suicide rates are equally high. From clinical experience, we know that suicides in Nigeria cuts across socio-economic class, level of education or background. Indeed, a large study of adolescent suicidal behaviour in Nigeria, conducted 10 years ago with 1500 students revealed that one in five had thought about suicide in the past one year; while one in 10 had actually taken some steps to actualise it, but did not follow through. So, it is not exactly a new problem.

What are the causes?

Suicide is a multifactorial event that does not have a straightforward cause. Rather, multiple factors may act in tandem to result in the eventual act of suicide. Thus, it is best to refer to them as risk factors. These factors may be individual, socio-cultural or situational factors.

Individual risk factors include presence of mental illness especially mood disorders such as depression, personality disorders and substance use disorders. Chemicals in our brain are responsible for all the functions that it performs – intelligence, memory, judgement, thinking, mood or happiness, behaviour etc.

The chemicals responsible for our state of happiness or sadness (feel-good chemicals) may be especially low at some point in our life, that results in such a person feeling very sad and miserable. When this situation persists for some time, such an individual may become clinically depressed and will require treatment and professional help to recover – including use of medications that restore the balance of these brain chemicals.

Other individual risk factors include impulsivity – as some individuals just carry out suicidal behaviour on a whim. Thus, individuals with poor impulse control are at greater risk. Acute emotional distress, chronic pain or medical illness such as a diagnosis of cancer, family history of suicidal behaviour, use of psychoactive substances, social isolation and lack of social support, and loneliness are other examples of individual risk factors.

Socio-cultural risk factors include labelling of certain events/occurrences as so shameful and embarrassing, or stigmatised as to make death a preferable option than facing up to the anticipated societal humiliation and social pressure. In some cultures, it is seen as a dignified way to handle a shameful situation.

Situational risk factors are those that are more likely to trigger impulsive individuals to consider suicide and act on their whim without much ado. They include things like financial loss and ruin, emotional or relationship break-ups including divorce, stressful live events, access to means, celebrity or wide media coverage of a recent suicide leading to copy-cat imitations or “Werther effect” e.t.c.

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What type of thoughts lead to suicide?

Several people wake up every day, go through the motions, show up at work, talk to colleagues, relate with family at home, but feel empty inside. They have no emotional attachment or intimacy with any one. They thus feel isolated, detached – as if life is just passing them by, while they remain at the periphery.

It may then occur to them that they have no value or worth, leading to feelings of extreme loneliness, hopelessness, and overwhelming despair that their life has no meaning, or that they are failures. They may experience severe sadness, intense emotional pain and anguish, such that the thought of seeking an escape route begins to look attractive.

To sleep peacefully and never wake up again, to just disappear…after all, they will hardly be missed and the world (or their family) may even be better off without them. And the stage becomes set, for suicidal behaviour.

 To be continued next week