[author image=”http://hunzanews.com/wp-content/uploads/2016/04/10387246_906303432727378_7903601015314745572_n.jpg” ]Sabreena Baig student of BSN at Aga Khan University.[/author]
When a person starts thinking about his troubles only and forgets to count the blessings he has, then the idea of self termination arises… Suicide is the act of deliberately or intentionally taking one’s own life. (Center for Disease Control and Prevention, 2010). The alarming rise of suicide incidences is calling for an immediate action to be addressed. It has become a major public health problem in Pakistan, yet the official statistics and national rates are still unknown. The issue of suicide however, remains largely neglected in developing countries. In Pakistan, an Islamic country, suicide is understudied and under-researched: not even basic epidemiological data on national rates is available. According to CDC (2010) fact sheets report, males are more likely to commit suicide at a rate of five times than females whereas females are more likely to attempt suicide than males. Therefore, the purpose of this paper is to highlight the risk factors of attempting or committing suicide and suggest ways to deal with suicide, which has been neglected so far. This paper focuses on risk factors of suicide, overall health consequences, prevention and some recommendations for its control.
According to WHO, “One million people including 7,000 Pakistani commit suicide annually.” It is a matter of concern these days where our country is facing many challenges, where terrorism is at its peak, economic instability, especially poverty, has forced people to sell their children and body organs for their survival. Moreover, facilities like health, pre drinking water, sanitation, proper housing, education and others are lacking. This tremendous rise of suicide continues in different parts of the country. 23 people, including 10 females and 13 males, committed suicide in different parts of Gilgit-Baltistan during the year 2012, according to statistics shared by Mohammed Farooq, Chief Coordinator of International Human Rights Observer (IHRO), GB Chapter. Another case was reported by Pamir times that a sixteen years old girl has committed suicide by shooting herself in the Cheeta Colony area of Jutial, Gilgit. There are several methods to commit suicide such as hanging, strangulating, taking poison, jumping and gunshot. In Pakistan hanging, poisoning and firearms are common methods (Khan, 2007).
There are certain social and cultural factors that put a person at risk of attempting or committing suicide. Indeed, no one wishes to take his or her life by their own choice, they are compelled to end themselves forever. In countries like India, Pakistan, and Sri Lanka, where arranged marriages are common, the social and familial pressure on a woman to stay married even in abusive relationships appears to be one of the factors that increase the risk of suicide in women (Gururaj et al., 2004). An unmarried woman is least acceptable to the society and they feel insecure every now and then. In addition, those women who get married, when go to a new family are supposed to give dowry, the exchange of gifts before and after marriage in return. When the expectations of the bridegroom’s family are not met, young brides are harassed lifetime and these circumstances worsen the situation even more. As a result, women fail to cope up with their domestic problems, ending up with stress and depression which maximizes the risk of suicide. Furthermore, an unhappy marriage, financial problems, and having been beaten by a spouse seem to be the most frequently cited stressful events in our society. Two years back my neighbour committed suicide; even her 5 months old daughter could not stop her. The only reason was her husband, who was suspicious about her and used to beat her whenever he returned home from work.
Pakistan is a developing country, where many of the 170 million people earn less than two dollars a day, a little heave in the price of flour and edible oil can be devastating. Suicide in these countries is more likely to occur among individuals experiencing poverty, unemployment and debts. Other groups may include the younger generation who migrate from rural areas to cities and face problems to establish themselves. On the other hand, the older people who are left behind by their families for city life lack support system and are unable to meet their daily requirements. There are several cases where people commit suicide because of poverty, leaving behind their children. Majority of them try hard in search of job but they do not get way out of it. After failing to find a job, 23-year-old Arif Ghaffar jumped off Naghan Chowrangi Flyover, taking his life. There are more than a dozen of cases in Pakistan shown in the media where people are taking their lives because of unemployment and unfortunately majority of them go unreported. Muhammad Asif, 25, killed his wife and three minor children before hanging himself in Majeed Colony. He left a note saying poverty drove him to take his life. People do not have the right balance of opportunities, resources and hope, therefore they get hopeless.
Young adults having some mental illness such as depression, anxiety disorder, bipolar disorder or sleeplessness are at high risk for suicidal attempts. Among all these factors, depression is the foremost risk factor for suicidal ideation, suicidal attempts, and successful suicide (AACAP, 2001). Lots of young people even as young as 12, have attempted suicide because of academic pressures, relationship problems, identity problems, parental discord, use of drugs, and bullying. These factors could result from dissatisfaction from their life, low self-esteem and self-confidence. On the other hand, Children having authoritarian parents, less parental interaction, distorted family and overprotected parents result in low self-esteem and depression which eventually leads to suicidal ideation and suicidal attempts. After facing failure in grade 10 final exam, one of my friends jumped into the river. She had kept a note that she could not face her parents and relatives therefore, she is ending herself.
Experts believe that coverage of suicide by the media can also increase the risk of imitation by others. Extensive reporting and coverage of a teenage suicide by media increases the rate of suicidal attempts and completed suicide in youths within a 1 to 2 week period (Phillips, 1986). Another cause of attempting or committing suicide could be extensive physical illness. People suffering from physical illnesses are unable to afford their medical expenses and they do not want to be a burden on their families. Most of the times if patients are in severe and uncontrollable pain they prefer to die rather than spending their whole life in hospitals. Furthermore, poor prognosis of a disease can also put a patient at high risk of committing suicide. As a result, physical illnesses can lead to depression which can be devastating.
Although, suicide is a personal act but it affects the entire family and society as well. It has a great impact on person’s physical and psychological health. Those who attempt suicide and survive may have serious injuries like broken bones, brain damage, or organ failure. Also, people who survive often have depression and other mental health problems. Many times those people who survive in first attempt go for another attempt where they are successful enough to end their lives. In our culture it is usually observed that those individuals who attempt suicide are stigmatized and they are unable to cope up with the challenges of life. Symptoms of grief experience by suicide survivors include extreme feelings of isolation and emptiness, avoiding doing things, new or worsened sleeping problems, and having no interest in activities that the sufferer used to enjoy.
In addition, families may also feel ashamed and want to hide that their loved one’s death was a suicide. 24 year old female hanged herself in Gilgit, her family hid that it was a suicide. After three months of investigation it was revealed that she had committed suicide. Family and friends of people who commit suicide may feel shock, anger, guilt, and depression. The American Association of Suicidology explains that when a family member dies as a result of suicide, the suicide risks for other family members increase. The medical expenses and lost wages associated with suicide also take their toll on the community.
Nevertheless, Islam condemns suicide as an unforgivable sin; with those who take their own lives denied entry to heaven and Islam provides clear rulings against suicide. According to the Quran there is nothing more precious than life. A man or woman has no right to take his/her life. So in Surah Nisa the Quran says: “And do not kill yourselves (nor kill one another). Surely, Allah is Most Merciful to you”. Being an Islamic country the law in Pakistan considers suicide and attempted suicide to be criminal acts. In Muslim countries for example Kuwait, where committing suicide is strictly forbidden the total suicide rate is close to zero. (Bertolote & Fleischmann, 2012). For one reason or another suicidal rate in Pakistan tends to be higher. It is so unfortunate that Muslims have failed to portray the true picture of Islam and they are misinterpreting the principles of Quran and Sunnah. They are engaged in suicide bombing, killing innocent people and taking their own lives.
The rising incidence of suicide and attempting suicide which is prevalent in every age group, ethnicity and gender needs immediate attention. Interventions needs to be planned according to the risk factors and government should set a target to reduce suicide and attempted suicides. Almost 34% of Pakistani population suffers from common mental disorders and 90% cases of suicide are due to depression. (Khan, 2007). Suicidal ideation and suicidal attempt are very common among individuals who are suffering from mental illnesses such as bipolar disorder, schizophrenia and depression. It needs to be intervened at community level. For that suicide prevention and mental health should be integrated with primary health care system. Healthcare providers should be well trained so that they would be able to do proper screening of individuals who are prone to commit suicide.
Firstly, it is the government’s responsibility to make sure that primary health care system is affordable as well as available for every individual. The law enforcing agencies and other NGOs along with the government should be accountable. Poverty and unemployment can be eradicated with fair and honest developmental investments and through creating job opportunities. Strict rules should be made in order to eradicate domestic violence and women should be given equal rights. If these issues are catered at governmental level then the suicidal rates would definitely reduce. Similarly, other prevention strategies include public education by improving coping mechanisms, life skills and education programs. In addition, rendering community coordination and collaboration, suicide prevention centers, and hospital-based services would be also effective. While mental health professionals can play a vital role in this regard, each citizen, friend, parent, teacher and counselor should be aware of the warning signs that indicate a person is planning to attempt suicide.
Secondly, religious scholars can also play an important role in tackling such issues by raising awareness among the masses. The last prophet Muhammad (PBUH) said, “Do not wish for death, for the terror of the place whence one looks down is severe. It is part of a man’s happiness that his life should be long and Allah Who is Great and Glorious, should supply him with repentance” (Hadith –Qudsi). By teaching Islamic principles would actually help to cease this unforgiveable sin. Also, it is essential for the media to report suicide and condemn such acts and assist people in identifying healthy ways to deal with life’s problems. In addition, media should highlight those people who are vulnerable. In this way it can be useful to eliminate the stigma revolving around mental health by changing people’s thinking and attitudes.
Thirdly, the idea of suicide comes in a child’s mind when he or she has no one that intimate to share every possible thought. This causes isolation, then hopelessness, then depression and finally the idea of suicide. On the other hand, there are children and teenagers, who did not have mental illness, but died by suicide because of harmful experienced events, such as repeated trauma, abuse, neglect, and loss, or other significant stressors. Surprisingly, youth in foster care have higher possibility of suicidal behavior. It is very important for parents to know the warning signs and risk factors, which can help them, intervene and get the youth on track. If a child talks about craving to die or kill someone or looks for ways doing so, if he or she feels like having no reason to live, if a child feels like being a burden on other or thinks being trapped or if he or she has extreme mood swings, then it means that parents must enter the game of rescue. The best and simplest way to prevent a child from suicidal attempt is to talk to them and encourage them to talk with his/her parents. For this parents must be persistent and committed. In addition, constantly telling a child that his/her parents will always be there to listen whenever he or she is ready to talk.
Lastly, for adolescents at high risk, focusing more on skill training and social support would be effective in reducing risk factors (depression, hopelessness, stress, anxiety and anger) and enhancing protective factors (personal control, problem-solving skills, self-esteem and network support). Behavioral change and coping strategies in general school population would help to improve ego identity, and improved coping ability in children, thus reducing the tendency of suicide.
In summary, the suicidal rates in Pakistan are not as negligible as generally believed and due to unavailability of these studies, the prevalence is also less existing. There are certain risk factors such as poverty, unemployment, domestic violence and mental illnesses that compel people to commit this unforgivable sin. Living in an Islamic state it is the responsibility of the government, media, law enforcing agencies and every citizen to take measures in order to save the precious lives in the country.