A Cry for Help
If you wait for a train at any station by the Yamanote line in Tokyo, you will notice a bright blue LED lights suspended at the end of the platforms of the Japan East Railway stations. Given the slick design and futuristic feel, most of us will probably assume that it is some sort of high tech purpose lamp. In reality, that was not the case. The special designed blue LED lights were installed in hope to reduce the regular occurrence of suicides which beside human loss, delays thousands of commuters who depend on the nation’s punctual trains and subways. Some psychological experts believe that blue light have a soothing and calming effect, which in this case will hopefully deter the suicidal thoughts from people’s mind. Although there is no conclusive study to support that, the willingness of the railway company to invest around 15 million yen on such project depicts how desperate Japan is in curbing the spiralling rate of suicide.
Unfortunately, Japan is not alone. Welcome to the new global epidemic.
Many countries around the globe are reporting worrisome trend of suicide cases. In Malaysia the ratio of suicides from 2007 to 2010 was 1.3 for every 100,000 people, which is far lower than the global average of 16 for every 100,000 people. However this might be just a tip of the iceberg for the suicide cases in Malaysia are believe to be under-reported with statistics contributed only from post-mortems. The previous Health Minister Datuk Seri Liow Tiong Lai claimed that the suicide rate is on the rise. Data from the Malaysian National Health Morbidity Survey III (NHMS III) showed that 6.4% Malaysian adults had suicidal ideas, which represent 1 million of Malaysian 29.24 million populations. Even more disturbing, the majority of the 1,156 people who committed suicide over the three-year period aged between 24 and 44, the most productive age group. An understanding of suicide is necessary to stop this tragic self-destructive trend.
Rationalising the Irrational
Although suicide victim may leave behind note explaining their decision, there will always be questions lingering behind. The loved one will usually feel more victimized than that of the suicide victim himself. Questions will always remain for nothing can justify the pang of loss and the wound felt by those who are left behind. Some consider suicide as an act of selfishness, yet some consider it rational. The real question that should be asked is why do they want to stop living instead of why do they want to kill themselves. Because nobody can rationalise the irrational thought of wanting to be dead.
Thus, wanting to stop living and wanting to die are two different things. There are nobody in their right state of mind will want to kill themselves. However, they are some like those who have suicidal thoughts find life to be so unbearable to live for that death seems to be the only way out. Such people consider suicide as a solution instead of a dead end. Suicide victim who are clinically depressed and psychotic views the entire world as disturbed and distressed, so there is nowhere to escape. And it is this fact that makes suicide so seductive, because it seems to offer the one available escape option. This sort of victim when treated effectively by psychotherapy can be saved from that one fatal decision.
The Anatomy of Suicide
On the other hand, a mentally healthy victim will need a more rationalise excuse to commit suicide. However, many suicide victims mistake their emotional eruption as a rational decision and regret it later. Only 10% of the people who attempt suicide will go on to complete and die by suicide. Though there is consistent evidence suggesting that genetic factors play an important role in the predisposition to suicide and suicidal behaviors, the real fuel that drive a victim to act upon his thoughts are undeniabely from his surroundings. Provocation by stressful life events may lead to suicidal thoughts, which combined with impulsive behaviour, can lead to suicide.
According to data compiled from the National Institute for Occupational Safety and Health of America, high-skill and high-stakes occupations have elevated suicide rates with physicians sadly on the top of the list, with 476 suicides recorded among 16,887 doctors from 1984 to 1998. It is then followed by dentist, veterinarians, finance workers, urban planners, real estate seller, lawyers and pharmacist with only few manual labour jobs in between. In Japan, unemployment following its recession in early 2009 contributed to 57 per cent of its suicides. Yet, those who are employed suffered from the increasing pressure of retaining jobs which can lead to fatigue from work and work-related depression. Out of 2,207 work-related suicides in 2007, the most common reason was overwork. However, we should not overlook suicide cases among youth in school and college. South Korea which rank second behind Greenland in suicide, has reported that the most common cause in youth suicide is pressure-related to the College Scholastic Ability Test.
Preventing The Preventable
Hence it is clearly shown that suicidal people come from all walks of life that it is no longer strange to see someone who seems to have it commit suicide. Early intervention to people who spoke of suicide is necessary despite how superficially happy they try to make others believe. Do not belittle, stigmatise and ridiculed their suicidal thoughts by thinking that they will never have the gut to do it. Besides that, bear in mind that people who are suicidal have ambivalent feelings. Their mind is divided; either to kill themselves or to cling on the reason to live. They needed to be convinced that the issue for which they had decided to die for was something that could be overcome and not worth dying for. Do not say “Don’t kill yourself” but instead we need to highlight the reasons for them to continue living. In fact, persuading someone to abandon the idea of suicide may already make the suicidal people feel they’re still wanted.
For most of us who are future medical personnel, we will, by one way or another encounter suicidal people, either as a patient or our own colleague. If the suicidal person tries to reach out for help, listen and allow them to express their feelings, and accept what they share without judgment. Arguing with them about suicide’s rightness or wrongness will not win their hearts. Moreover the greatest hurdle in preventing suicide is the reluctance of victims to share their problems for fear of being stigmatised. Hence, the moment someone decided to confide their suicidal thoughts to you should has been seen as an opportunity to reach out and help out.
Even though suicide is a combination of genetic vulnerability, psychological makeup, and social network of the person concerned, early intervention may help suicidal patient from choosing the wrong path. If only we care enough to listen.
Ummu Helma binti Hasan
Third Year, Cairo University Faculty of Medicine
Unit Karya PCK 2013/2014
*Written in conjunction with this year’s World Suicide Prevention Day on September 10 with the theme of ‘Stigma: A Major Barrier for Suicide Prevention’.