SUICIDE

INTRODUCTION

Suicide – defined as an act with a fatal outcome that is deliberately initiated and performed by

the person in the knowledge or expectation of its fatal outcome.

It’s a complex phenomenon

Insurmountable disparity between expectations and outcomes, real or imagined – tremendous

pressure on mind, blinding its logic, forcing it a conclusion of escape

• Derived from Latin word

• sui = oneself, cidium = a killing

• Primary emergency for mental health professional

Suicide has nowadays become an extremely important social issue in every contemporary

society. A large amount of sociologist has tried to identify the true reason that lead people

towards committing suicide. The modern suicidal tendencies have a set of reasons that influence

its increase or decrease. The main priority of the sociologists is to define these reasons in order to

prevent the performance of such behavior. One of the widest spread theories concerning the

suicide matter is the Durkheim’s theory which primarily studies the influence the society over

the suicidal tendencies. The main social aspect that Durkheim reveals in his studies is the social

integration of each person so that the high level of social integration prevents the person from

committing suicide and the small level of integration implies the predispose to suicidal behavior.

Durkheim primarily studies the effect of social integration thought the religious communities.

According to his studies, the decrease of the suicidal risk within the society is conditioned by the

support the religious communities provide and the prohibition of suicidal behavior as the

religious law. There is a wide range of opinions on the issue of suicide and most of the scientists

either support Durkheim and add more inflective variables to his studies or argue his results,

providing contradicting evidence. Nevertheless all of them try to find the “key” to eliminate or at

leas decrease the suicide risk. The analysis of the next three articles represents three different

points of view on suicidal behavior in terms of Durkheim’s theory.

HISTORICAL PERSPECTIVE

• In ancient Athens, a person who committed suicide without the approval of the state was

denied the honours of a normal burial

• In ancient Greece & Rome suicide was deemed to be an acceptable method to deal with

military defeat

RELIGIOUS CONTEXT, AND SUICIDE

ISLAM: Suicide is PROHIBITED

CHRISTIANITY: Suicide is considered a sin

In 19th-century in Europe the act of Suicide shifted from being viewed as caused by sin to being

caused by insanity.

Hinduism:

When Lord Sri Ram died, there was an epidemic of suicide in his kingdom, Ayodhya

The Bhagavad Gita - condemns Suicide

Upanishads, the Holy Scriptures - condemn suicide

‘he who takes his own life will enter the sunless areas covered by impenetrable darkness after death’

Vedas - permit suicide for religious reasons

consider that the best sacrifice was that of one's own life - ‘sallekhana’

Sati, where a woman immolated herself on the pyre of her husband rather than live the life of a widow

SOCIOLOGICAL FACTORS

Durkheim’s Theory: Emile Durkheim ( French Sociologist )

• Egoistic - This type of suicide occurs when the degree of social integration is low

• Altruistic - degree of social integration too high

• Anomic – Integration into society is disturbed

• Fatalistic – Luck & Slavery!!! – EXCESSIVE REGULATIONS

PSYCHOLOGICAL FACTORS

Freud’s theory: “ Mourning and Melancholia”

Menninger’s theory: suicide as inverted homicide

Genetic factors

Molecular biology – polymorphism in TPH gene (tryptophan hydroxylase enzyme)

RISK FACTORS

Gender differences- Men 4 times > Women

Exceptions – India and China , ratio is 1.3:1 (Kaplan & Sadock’s Synopsis of Psychiatry (10th

edition)

Age- Increase with age

men peak age- after 45 years

women – 55years (Ibid)

Race- Two out of every three suicides are White males (Ibid)

Religion- Degree of orthodoxy and integration (Community Mental Health in India; B. Chavan,

Nithin Gupt)

Marital status- Lessens the risk (Ibid)

Occupation- Higher social status greater the risk unemployed > employed (Ibid)

Physician suicides - physicians particularly females are at greater risk (Ibid)

Mental illness- 90- 95% have a diagnosed mental disorder

Psychiatric patients-

Depressive Disorder- 80%

Alcohol Related Disorders – 4-60%

Schizophrenic Disorder- 3-10%

Personality Disorder- 5-44%

Organic Mental Disorder- 2-7% (Dr. Suhasini K. 2014)

GLOBAL SCENERIO

More than 8,00,000 people die by suicide per

year

Estimated annual mortality is 14·5 deaths per

1,00,000 people (Mental health: New

understanding, new hope by WHO, 2001)

Around one person every 40 seconds (Ibid)

75% of suicides occur in low- and middle-

income countries (Dhaka Tribune)

Suicide worldwide was estimated to represent

1.8% of the total global burden of disease in

1998

By 2020 - projected to be 2.4% (Mental health: New understanding, new hope by WHO, 2001)

Tenth leading cause of death worldwide (Google.com)

It is the second leading cause of death in 15-29 year-olds globally (Ibid)

Suicide belt – (25 per 100,000) Scandinavia, Switzerland, Germany, Austria, eastern European

countries (Belarus, Estonia, Lithuania, and the Russian Federation) and Japan (New Oxford

Textbook of Psychiatry, 2001)

Prime suicide site of the world – Golden Gate Bridge in San Francisco (Dr. Suhasni K, 2014)

Japan- reported to have highest number of cases (New Oxford Textbook of Psychiatry, 2001)

75% of suicide occur in low and middle-income countries. (Dhaka Tribune 10 SEP 2014)

In wealthier countries, three times as many men die by suicide than women. Men aged 50 years

and over are particularly vulnerable. (Dhaka Tribune 10 SEP 2014)

SUICIDE IN BANGLADESH

10,000 people commit suicide every year (Statistics of the Police Headquarters.)

73,389 people committed suicide in seven years from 2002 to 2009.

31,857 hanged themselves & 41,532 had swallowed poison. (The Daily Star 28.04.2012)

258 people--180 women and 78 men--killed themselves in eight months from January 2011 to

August 2011. (Bangladesh Manabadhikar Bastabayan Sangstha)

40 girls committed suicide from 2006 to 2010 because of stalking. (Jatiya Mahila Ainjibi

Samity)

4,747 women and girls killed themselves from 2001 to 2010 due to family violence. (Ibid)

– Hidan Mehjabin, a seventh grade student of Viqarunnisa Noon School, killed

herself on October 9, 2011 having failed to endure the agony caused by the

separation of her parents. (The Daily Star 28.04.2012)

– Sultana Akhter, 24, a resident of Kandapara village in Dharmapasha upazila of

Sunamganj district, committed suicide following torture by her husband over

dowry on October 13, 2011 (The Daily Star 28.04.2012)

Dr. Mohammad Jahangirul Alam, a physician at Bangabandhu Sheikh Mujib Medical University

(BSMMU), says the most common underlying disorder is-

Depression and 30-70 percent of suicide victims suffer from major depression or bipolar

(manicdepressive) disorder.

According to the latest WHO data published in may 2014 –

Suicide Deaths in Bangladesh reached 10,167 or 1.40% of total deaths.

The age adjusted Death Rate is 7.63 per 100,000 of population

Rank of Bangladesh in suicide is #97 in the world.

COMMON METHODS OF SUICIDE

• Pesticide poisoning (30%)

• Hanging

• Exsanguinations

• Suffocation

• Drowning

• Firearms

• Drug overdose

• Fatal injuries

WARNING SIGNS

• Trouble coping with recent losses, death, divorce, moving, break-ups, etc.

• Feelings of hopelessness and despair

• Making final arrangements: writing a will or eulogy, or taking care of details (i.e. closing

a bank account).

SIGNS / INVITATIONS TO TALK

1. Stressful events especially with feelings of loss Including

2. Money Worries

3. End Of Relationship

4. Move / Any Loss Of Social Support

5. Bereavement

6. Unemployment

7. Any Major Change E.G.

8. School / Work Etc.

THOUGHTS

1. “Everyone will be better off without me”

2. “I won’t be needing these things anymore”

3. “I wish I was dead”

4. “I can’t do anything right”

5. “All my problems will end soon”

6. “I can’t think straight anymore”

7. “No one can help me now”

8. “I can’t take it anymore”

9. “Now I know what they were going through”

PROTECTIVE FACTORS

• Strong connections to family and community support

• Skills in problem solving, conflict resolution, and non-violent handling of disputes

• Personal, social, cultural and religious beliefs that discourage suicide and support self-

preservation

• Restricted access to means of suicide

• Seeking help and easy access to quality care for mental and physical illnesses

• Evidence from Australia, Canada, Japan, New Zealand, the United States and a number

of European countries revealed that limiting access to these means of committing suicide

can prevent such deaths.

• Currently, only 28 countries are known to have national suicide prevention strategies.

• Another key to reducing deaths by suicide is a commitment by national governments to

establish and implement a coordinated plan of action.

CONCLUSION

Suicide is not a solution rather a problem. It is nothing but the ultimate outcome of frustration.

Depressed people must be helped by them who are surrounded to them because, Suicide is

preventable.

REFERENCES

1. Kaplan & Sadock’s Synopsis of Psychiatry (10th edition)

2. New Oxford Textbook of Psychiatry ; Michael Gelder, Nancy Andreasen (2nd edition)

3. Community Mental Health in India; B. Chavan, Nithin Gupta

4. Essentials of Psychiatry; Jerald Kay, Allan Tasman

5. A hand book on Suicide Prevention Strategies, KRISIS

6. World Health Organization. World Health Report 2001. Mental health: New

understanding, new hope. Geneva

7. S.Manoranjitham;Towards a National Strategy to Reduce Suicide in India; The National

Medical Journal of India vol. 18, no. 3, 2005

8. Aaron R, Joseph A, Abraham S, Muliyil J, George K, Prasad ; Suicides in young people

in rural southern India Lancet; 2004;363:1117–18

9. http://archive.dhakatribune.com/crime/2014/sep/10/28-people-commit-suicide-

veryday#sthash.hmX72mEE.dpuf