Suicide

[Saima]

Alwaez Rai Abu Ali
Waez # 819
Date: November 5, 2004
Place: Austin, TX

Towards the end of the waez, he lists 10 Gunah-e-Kabirah which will follow one to the grave. They are as follows:

1. Breaking Bayat to the Imam-e-Zamaan
2. Hurting your parents
3. Testifying a false witness (lying as a witness)
4. Breaking another's trust
5. Rape
6. Cheating a widow or an orphan
7. Hurting a learned man (teacher, scholar)
8. Accusation to destroy one's reputation
9. Hurting your children (i.e. spends money on gambles instead of providing for children)
10. Suicide (the punishment lasts for 5,000 years)

[Mehreen1221]

[cough] [cough]...I wonder if there's anything else left here that I can consider of as a 'sin'...
anyways...he didn't mention the 'punishment' for suicide...? could it be jail time for 5000 years?

[shiraz.virani]

4:29 (Y. Ali) O ye who believe! Eat not up your property among yourselves in vanities: But let there be amongst you Traffic and trade by mutual good-will: Nor kill (or destroy) yourselves: for verily Allah hath been to you Most Merciful!

it is said in one of the hadiths that if a person commits suicide by hanging/stabbing/drinking poison etc etc he will receive the same punishment in hell i.e stabbing himself/choking or drinking poison forever in hell

it might be that the waizeen was pointing @ above , 5000 years of same punishement in hell = 18,25,000 days

[hussainkhan55]

A person who takes away his life by hanging does not attain salvation and angel procures his soul and it (soul) remains at the vicinity of point where death has taken place.

[kmaherali]

Can We Stop Suicides?

It’s been way too long since there was a new class of drugs to treat depression. Ketamine might be the solution.

Excerpt:

The suicide rate has been rising in the United States since the beginning of the century, and is now the 10th leading cause of death, according to the Centers for Disease Control and Prevention. It’s often called a public health crisis. And yet no new classes of drugs have been developed to treat depression (and by extension suicidality) in about 30 years, since the advent of selective serotonin reuptake inhibitors like Prozac.

The trend most likely has social causes — lack of access to mental health care, economic stress, loneliness and despair, the opioid epidemic, and the unique difficulties facing small-town America. These are serious problems that need long-term solutions. But in the meantime, the field of psychiatry desperately needs new treatment options for patients who show up with a stomach full of pills.

Now, scientists think that they may have found one — an old anesthetic called ketamine that, at low doses, can halt suicidal thoughts almost immediately.

More...
https://www.nytimes.com/2018/11/30/opin ... 3053091202

[swamidada_1]

Newser - Current News - Breaking Stories

20 Students Commit Suicide After Faulty Exam Results
Errors will be rectified, but too late for some in India's Telangana state

By Arden Dier, Newser Staff
Posted May 2, 2019 7:51 AM CDT

(NEWSER) – Since April 18, student suicides have been a daily occurrence in India's Telangana state. On that day came results of a state examination taken by almost 1 million 12th graders, per Fox News, and nearly 350,000 failed—supposedly. An independent panel has since found the software developed by outside firm Globarena, commissioned by the state Board of Intermediate Education to process exam results, was faulty. Many students said they sat for the exam on which most university admissions are based but were marked absent, received zero marks in sections they'd completed, or otherwise failed as a result of incorrect marks, per CNN. After failing zoology, a 17-year-old girl set herself on fire in Narayanpet district on Saturday, reports the Khaleej Times. She's one of more than 20 to die by suicide since April 18, per the Telegraph.

"People should not resort to such kind of extreme steps," says a senior police official, noting exam errors "can be checked and rectified." But he adds getting the message out is difficult since "all these people are spread over a large area." Telangana's Chief Minister K. Chandrashekhar Rao has ordered that all failures be reexamined. One student who failed a subject reportedly received 93% after such a review, per the Telegraph. Yet the outlet points to larger issues: a booming population, the highest unemployment rates in 45 years, and university acceptance rates below that of Harvard. CNN likewise highlights intense pressure on Indian students, noting parents climbed school buildings to pass cheat sheets to 10th graders in Bihar state in 2015.

[kmaherali]

What Lies in Suicide’s Wake

Along with everything else, I wasn’t prepared for the stigma of becoming a widow this way.

When I lost my husband in 2008, I learned that the shocking cause of his death wasn’t as rare as I had thought. More than 45,000 Americans died last year from suicide, in a staggering but seemingly silent epidemic. All this week mental health professionals are sounding the alarm about this crisis, drawing attention to the warning signs that someone you love may be at risk.

I missed those signs until it was too late. Once he was gone, my life was unimaginably altered, both by his deadly decision and the stigma it left in its wake.

More...

https://www.nytimes.com/2019/09/12/opin ... 3053090914

[swamidada_2]

OCTOBER 17, 2019, 1:14 PM ET

‘She Died In My Arms’ : Teen Takes Own Life 2 Years After Being Sex Trafficked, Family Says

“The family deserves justice and peace of mind that her death is not in vain,” Letty Serrano's godmother said.

BY JILL SEDERSTROM

A HOUSTON TEENAGER TOOK HER OWN LIFE Saturday morning, two years after family says she was drugged and sold to sex traffickers.

“She died in my arms,” her father, Mariano Serrano, told local station KTBC of his 15-year-old daughter’s tragic death.

Letty Serrano barricaded herself in the bathroom Saturday morning as her desperate father tried to reach her, but he would be too late.

The teen’s death is a tragic end for a girl who was once described by her godmother as a “good student” who got good grades until her family said she caught the attention of a sex trafficker.

“She was the perfect target for them,” Cynthia Rivera told the station, saying the teen had also been “kind of a loner” and had been struggling after the death of her brother when she was targeted by the man.

Her family said when the teen was just 13 years old, she was drugged and sold to sex traffickers, local ABC affiliate KTRK reports.

Her family searched for the teen for days. Eventually, they found her, but the girl who returned home was never the same as the one who had vanished.

“We got her back damaged,” Rivera said.

The man who her family believes took her was arrested — but later released just a short time later, KTBC reports.

Her family believes Serrano was torn between the man who trafficked her and her family — even running away again on two different occasions to be with him.

“She wanted to be with him,” Mariano Serrano told KTBC. “But, she also didn’t want to hurt her family.”

Letty's family is now hoping to raise awareness about the devastating cost of sex trafficking and seek justice for the teen.

“I want to see him in court,” Mariano Serrano told the station. “I want to tell him it’s his fault my daughter is dead.”

Houston Police Commander Jim Dale said he plans to look into re-opening the case.

“She was a victim and somehow her cries fell through the cracks and I think that’s why it’s so imperative that we get the schools involved,” he told KTBC of efforts to increase education about sex trafficking dangers in local schools.

https://www.oxygen.com/crime-news/letty ... amily-says

[kmaherali]

The Crisis in Youth Suicide

Too often, suicide attempts and deaths by suicide, especially among the young, become family secrets that are not investigated and dealt with in ways that might protect others from a similar fate.

The death of a child is most parents’ worst nightmare, one made even worse when it is self-inflicted. This very tragedy has become increasingly common among young people in recent years. And adults — parents, teachers, clinicians and politicians — should be asking why and what they can do to prevent it.

In October, the Centers for Disease Control and Prevention reported that after a stable period from 2000 to 2007, the rate of suicide among those aged 10 to 24 increased dramatically — by 56 percent — between 2007 and 2017, making suicide the second leading cause of death in this age group, following accidents like car crashes.

“We’re in the middle of a full-blown mental health crisis for adolescents and young adults,” said Jean M. Twenge, research psychologist at San Diego State University and author of the book “iGen,” about mental health trends among those born since 1995. “The evidence is strong and consistent both for symptoms and behavior.”

Along with suicides, since 2011, there’s been nearly a 400 percent increase nationally in suicide attempts by self-poisoning among young people. “Suicide attempts by the young have quadrupled over six years, and that is likely an undercount,” said Henry A. Spiller, director of the Central Ohio Poison Center, who called the trend “devastating.” “These are just the ones that show up in the E.R.”

Had any other fatal or potentially fatal condition leapfrogged like this, the resulting alarm would surely have initiated a frantic search for its cause and cure. But too often suicide attempts and deaths by suicide, especially among the young, become family secrets that are not investigated and dealt with in ways that might protect others from a similar fate.

“We’re at a point now where this issue really can’t be ignored,” said John P. Ackerman, clinical psychologist and coordinator of suicide prevention at Nationwide Children’s Hospital in Columbus, Ohio. “We invest heavily in crisis care, which is the most expensive and least effective means of preventing suicide.”

He proposed instead that more time and money be spent “on identifying kids who are most vulnerable, helping them respond effectively to stress, and teaching them what they can do in a crisis. And we need to start early, in the elementary grades. We haven’t even begun to use the resources that we know work. We have to be proactive.”

More...

https://www.nytimes.com/2019/12/02/well ... 0920191203

[charlie]

DAWN.COM

Why are more Pakistanis taking their own lives?
Rising number of traditionally under-reported suicide cases indicates hidden mental health epidemic remains unaddressed.
Tanzeel Hassan
Updated May 13, 2019
Although figures for suicide and suicide attempts are notoriously sketchy in the country, doctors agree that they are seeing an increase in the number of such cases.

What they indicate, however, is that aside from increasing stressors, there is a mental health emergency that remains unaddressed.

Draped in a red plaid scarf worn loosely around her head, 21-year-old Aasia* has just been shifted to the ward after five days in intensive care. Her skin looks pale and her legs are flexed.

Even at 21, Aasia seems to have carried the weight of the world on her tender shoulders. And perhaps, this burden was all too much for her to bear: Aasia is in hospital after ingesting rat poison in an attempt to end her life.

Standing beside her is an elderly man, her father, while her mother is sitting on a vacant bed next to her. “Aasia doesn’t have any mental health issues,” her father avows.

The family has been lodged at the National Poison Control Centre (NPCC) at the Jinnah Postgraduate Medical and Dental Centre (JPMC) in Karachi ever since Aasia was brought in.

The father simply doesn’t understand how matters came to such a head. Being the only daughter remaining in the house after the marriage of her six elder sisters, he claims she is loved unconditionally.

“She tried to end her life because her mother had taken her to task for cooking the food too spicy,” he narrates. “She was making mistakes for the past few days while preparing meals for the family and was being criticised over that.”

Little did the parents know the toll such taunts were taking on Aasia. Fed up with the bickering, Aasia consumed poison. It took the family three hours to take Aasia to the NPCC, but luckily, they reached in time.

The increasing number of suicide cases reported indicates is that there is a mental health emergency that remains unaddressed.

On the extreme right to Aasia lies another young woman named Khizra* who attempted suicide by consuming insecticide. The 20-year-old was admitted to the hospital a few hours ago and is now stable after receiving the treatment.

A small quarrel with her younger brother over ironing of clothes had made her feel worthless and convinced her to take her own life.

Khizra ran and consumed insecticide soon after the quarrel was over, giving no time to the family to comprehend the situation. Her mother laments that children don’t think about their parents when they resort to such extreme decisions.

Aasia and Khizra are only two of the patients admitted at Ward 5 of JPMC.

There are many other patients of both genders who have either intentionally ingested poison or are victims of venomous insect bites or stings.

Dr Muhammad Junaid Mahboob, resident doctor at the NPCC, tells Eos that approximately 15-20 patients are admitted daily at the NPCC, many of whom consume poison deliberately in order to kill themselves.

The number of patients brought in is surprisingly higher on weekends.

While 98 percent of the patients of intentional poisoning survive, Dr Mahboob states that the survival chances depend on the type of poison, the amount taken, and the time it takes to reach the hospital.

While poisoning is one of the three leading modes of suicide in Pakistan besides hanging and firearms, Dr Mahboob specifies insecticide and rat poison as the most-opted poisonous substances by people who attempt suicide. The other less-reported poisonous substances are phenyl and acids.

Explaining the reasons of poisoning, he says, the most common problems reported by patients are loneliness, family quarrels, domestic violence, and interpersonal relationship issues.

The NPCC, established in 1989 with the help of the World Health Organisation (WHO), treats patients of intentional and accidental poisoning.

As routine practice, doctors at the centre recommend all suicide survivors to see a psychiatrist at Ward 20, Department of Psychiatry and Behavioural Science, when they are being discharged.

Despite doctors’ recommendation and the psychiatry ward being only a few metres away from the NPCC, Dr Mahboob believes that not many patients see a psychiatrist because they never accept they need professional help.

“[Underlying] causes when left untreated increases the vulnerability to suicide risk after attempted suicide,” he says.

“Within the first six to 12 months following a suicide attempt, people are at increased risk of another attempt,” corroborates Dr Murad Moosa Khan, president of the International Association for Suicide Prevention (IASP) and professor at the Department of Psychiatry, Aga Khan University.

“Since these people have already experienced death closely, they are not afraid of dying anymore,” he elaborates. “This persuades them to attempt suicide more aggressively.”

Trust and betrayal
Most loved ones respond to suicide as something out of the blue.

In reality, those thinking about suicide have been doing so for long. And in many cases, it’s a pressure cooker inside those people’s minds — in terms of helplessness and feeling overwhelmed — that has exploded and manifested as suicide or suicide ideation.

That said, there is no single cause for suicide, states the American Foundation for Suicide Prevention.

It occurs when stressors and health issues converge to create an experience of hopelessness and despair.

Millions of women in Pakistan, for example, are constantly being told, by their spouses, by in-laws, and even by parents, that they are good-for-nothing; they are neither beautiful nor intelligent so much so that it kills their self-esteem and they gradually start doubting themselves.

“This is called conditioning,” explains Adeel Hijazi Chaudhry, CEO of psychiatric helpline Talk2Me.

“We receive numerous calls from women plagued by self-doubt asking us whether they are really not good enough.”

Such situations tend to hurt a person’s ego.

If loved ones are questioning their existence, who does one find love and validation from?

Such existential questions can, and often do, lead to an abyss, out of which there is no return.

“More than the chemical changes in the brain, suicide is linked with the thoughts running in the brain. When a person is unable to find solutions to the problems and has lost the ability to control their thoughts, they resort to suicide,” says Dr Khan.

More than 90 percent of people who die by suicide have some form of mental illness at the time of their death.

Dr Iqbal Afridi, dean of JPMC’s Psychiatry and Behavioural Sciences department, argues that depression is one of the leading risk factors of suicide but other medical conditions, such as bipolar disorder and schizophrenia, can also contribute to it.

Dr Khan implies that any change in behaviour or the presence of a new behaviour is a warning sign that should never be ignored.

For instance, if a person stops receiving calls, starts avoiding people or going to gatherings, he should be reached out to understand what triggered this change.

Warning signs indicate a person is in crises and needs immediate attention, whereas risk factors suggest someone is at increased risk of suicide, but not necessarily in crisis.

Risk factors classified by the American Foundation for Suicide Prevention into health, environmental and historical factors, are conditions that increase the chances of a person attempting suicide.

Establishing and identifying risk factors can improve the prevention and treatment of suicidal thoughts and behaviours.

“According to a conservative estimate, nearly 15-20 percent adults and 10 percent children in Pakistan have some form of mental disorders. Some studies quote an even alarming number of 34 percent,” says Dr Khan.

The most common mental illnesses are depression and anxiety, but they either remain undiagnosed or untreated, and therefore, increase the risk for suicide.

The uncertainty of numbers
The WHO estimates that nearly 800,000 people die by suicide every year, making it a global phenomenon.

Suicide, an act of killing oneself voluntarily and intentionally, is quite prevalent in low- and middle-income countries and is the second leading cause of death among young people (15-29 years of age).

Although Pakistan is said to have lower suicide rates than other countries, the absence of official statistics makes these rates hard to determine.

Suicide rates are described as the number of self-initiated, intentional deaths.

Accurate collection of data on suicide is affected by a number of reasons, including whether a suicide is reported in the first place, how a person’s intention of killing himself or herself is determined, who is responsible for completing the death certificate, whether a forensic investigation is carried out, and the confidentiality of the cause of death.

Existing data [for official purposes] relies on reported cases.

It follows, then, that existing data relies largely on reported cases, the number of unreported cases goes misrepresented and is not part of the official count.

For each adult who dies by suicide, there may be 25 others attempting suicide, and 100 others struggling with suicidal ideation.

“There are indications that for each adult who died by suicide there may have been 25 others attempting suicide and 100 others with suicide ideation,” says Dr Afridi.

If ever there was any doubt about the growing scale of this phenomenon in Pakistan, the numbers show it is slowly becoming an epidemic.

“More than 13,000 people died by suicide in Pakistan since 2012, according to a WHO report on suicide prevention,” states Dr Khan. “These are the latest statistics we know,” he adds.

Data generated by the Human Rights Commission of Pakistan (HRCP), an independent non-government organisation, also presents a grim picture.

Based on the monitoring of leading newspapers and reports from volunteers, the HRCP estimates that more than 3,500 cases of suicide and attempted suicide were reported in 2017, over 2,300 cases were registered in 2016, while more than 1,900 cases were recorded in 2015.

The WHO has also researched the extent of known suicide, suicide attempts and self-harm cases (reported to hospitals) and declared reported cases to be only the tip of the iceberg.

The organisation claims that a majority of cases remain “hidden” under the surface and are never reported to healthcare services.

The crude suicide rate in Pakistan, according to WHO Global Health Estimates 2016, was 2.9 per 100,000 population in 2015 and 2016.

Although the WHO Global Health Estimates provides a comprehensive assessment of mortality for countries, these figures underestimate the actual magnitude of the issue, taking the legal, sociocultural and religious stigma, and poor reporting of cases in consideration.

An associated matter in the Pakistani context is the issue of death certificates.

Since a death certificate is mandatory to make funeral arrangements in urban areas, suicide cases are often reported to police and hospitals, but many family members don’t opt for autopsy or forensic investigation due to religious and legal issues, hence the manner of death remains unknown, says Dr Khan.

While in rural areas, where a death certificate is not a requirement for burial, he suspects that many suicide cases are hushed up.

“Ending the stigma associated with suicide, making forensic investigation compulsory to determine the manner of death and decriminalizing suicide and suicide bid can improve the reporting of such cases,” proposes Dr Khan.

He adds that Pakistan is among the few countries of the world where attempting suicide is a criminal offence with an imprisonment of up to one year or with fine or with both, according to Section 325 of the Pakistan Penal Code.

The legal status of suicide in a country has a massive impact on the reporting of such cases.

Although decriminalizing suicide and suicide attempt may not lead to its prevention, it can improve the reporting and access to medical treatment.

dawn.com/news/1281826

[kmaherali]

America’s suicide rate has increased for 13 years in a row

Those living in rural and less-populated areas have been hit especially hard

IN 2010 AMERICA’S Department of Health and Human Services set a goal of reducing the country’s suicide rate from 12.1 to 10.2 per 100,000 population by 2020. Instead of falling, however, the rate has climbed. On January 30th the Centres for Disease Control and Prevention (CDC), a federal government agency, reported that more than 48,000 Americans had taken their own lives in 2018, equivalent to 14.2 deaths per 100,000 population. This makes suicide the tenth-biggest cause of death in the United States—deadlier than traffic accidents and homicide.

A recent paper by researchers at Ohio State University and West Virginia University tries to understand why such tragedies occur more frequently in some parts of the country than others. Using county-level CDC data on the nearly half a million 25- to 64-year-old Americans who committed suicide between 1999 and 2016, the authors found that isolation may be an important factor. In 2016 the suicide rate was 25% higher in rural and less-populated counties (those with fewer than 50,000 people) than in more populous ones (with at least 1m). Fifteen years ago, it was only 10% higher.

Several other characteristics go hand in hand with high suicide rates. Deprivation—as measured by low levels of education, employment and income, and high levels of poverty—correlates with more suicides. So does loneliness, which the authors estimate by using the share of households with single or unmarried residents, or residents who have been living in the area for less than a year. Places with fewer opportunities for social interaction (parks, museums, stadiums and the like) tend to have more suicides, too.

Easy access to guns also seems to boost the risk of self-harm. Using a database of firearm-sellers from Infogroup, a data provider, the authors found that the presence of a nearby gun shop was associated with significantly higher suicide rates. American health officials may never find a complete solution to the country’s suicide crisis. Making guns less easily accessible might be a start.

Chart at:

https://www.economist.com/graphic-detai ... a/391324/n

[swamidada]

Home / India News / Nearly 7 die by suicide in Delhi every day: NCRB
Nearly 7 die by suicide in Delhi every day: NCRB
The absolute number of suicides stayed constant – 2,526 in each year, with “family problems” remaining the number one cause. Family problems relate to quarrels in families, relatives not doing well in their lives, etc.
INDIA Updated: Sep 11, 2020 02:06 IST
Shiv Sunny

In comparison, suicides due to illnesses of all kinds – such as mental, critical and prolonged physical illness.-- dipped by 48%, from 218 to 130.
In comparison, suicides due to illnesses of all kinds – such as mental, critical and prolonged physical illness.-- dipped by 48%, from 218 to 130

New Delhi: The number of people who died by suicide in Delhi because of mental illness rose by more than two-and-a-half times in 2019 compared to the previous year, although overall suicides because of various health reasons dipped significantly, according to data released by the National Crime Records Bureau (NCRB).

The absolute number of suicides stayed constant – 2,526 in each year, with “family problems” remaining the number one cause. Family problems relate to quarrels in families, relatives not doing well in their lives, etc.

The data does not capture the number of suicide attempts. Nearly seven people died by suicide every day on average, much more than the fatalities in road accidents, which left four persons dead every day in 2019.

This is the latest data available for suicides in the Capital; Delhi Police doesn’t share suicide statistics.

Mental illness was attributed as the reason for 47 suicides in Delhi last year, a 161% jump from 18 such deaths in the year before that. The number of women in both years remained constant at six, while the number of men who died by suicide because of mental illness rose from 12 to 41.

In comparison, suicides due to illnesses of all kinds – such as mental, critical and prolonged physical illness.-- dipped by 48%, from 218 to 130.

In 469 (18.5%) of all 2,526 suicides, the NCRB couldn’t ascertain the cause.

Psychologists could not point to any specific reason behind the trend, even as they contended that NCRB may not have been able to capture the exact data. “If a person did not seek medical treatment for his or her mental illness despite suffering from it, it is not going to be counted as that,” said psychiatrist Samir Parikh, who is the director of Fortis National Mental Health Programme.

Unemployment and education

Unemployment was a factor that led to more suicides in 2019 than the previous year. At least 118 people died by suicide on turning jobless, a 20% jump from 98 such deaths in 2018. Also, the number of suicides by jobless people rose from 611 in 2018 to 677 in 2019.

Overall, a vast majority of people who died received only a basic education and earned little money, showed the data.

Over 80% of the suicides were by people who had studied only up to Class 12, and more than 61% were people who earned less than Rs1 lakh annually. Nearly 10% of all suicides were by daily wager labourers.

Rajat Mitra, a clinical psychologist, attributed the relation between poor financial/educational backgrounds and suicides to a sense of “despondency and gloom”. “This class of people tend to feel a sense of hopelessness and lack of options in their lives. It hurts their self-esteem and leaves them with suicidal tendencies,” said Mitra.

He said that a possible solution to this problem was to cultivate the culture of entrepreneurship among such people. “They need to be able to pick up skills to earn a livelihood and the government needs to step forward to encourage them to start their own venture,” said Mitra.

Relationship issues

Relationship issues -- be it marriage, family, love affairs or relationships outside marriage -- were the reason for 1,007 dying by suicide, nearly 40% of all suicides. However, suicides related to marriages dipped from 233 to 123.

But there were more in the list who recently lost their partners – either due to death or separation. Thirty widows and widowers died by suicide in 2019, up from 10 in the year before that; and the number of people who were recently separated from their partners went up from 31 to 93 in the corresponding period.

Hanging was the method used in three out of every four suicides, followed by poison in 6.76% of the cases. Mitra said that most people don’t realise that hanging or even other suicide methods often do not kill people and instead leave them with other injuries, which sometimes last a lifetime.

A study by the American Association of Suicidology showed that only one in every 25 suicide attempts in the US ended in death.

Until July 2018, suicide was criminalised under the Indian Penal Code (IPC), Section 309, and made punishable with a year in jail, or a fine or both. But the Mental Healthcare Act of2017(which came into force from 2018) restricted its application and said that unless proved otherwise, a person who attempts suicide is to be presumed to be under severe stress.

A senior Delhi Police officer said that the IPC Section 309 was now pressed in rare cases. “If an apprehended suspect, for example, tries to bang his head against the wall with an intention of getting away, we book them under this section,” said the officer who didn’t want to be identified.

Eish Singhal, the Delhi Police spokesperson, said that the process followed now is to carry out an inquest proceeding after a suicide to ascertain if it was due to pressure or harassment by anyone. “We look for suicide notes, for statements of relatives of the victims, and to understand if someone had abetted the suicide,” said Singhal.

Fear worse this year

While the data for this year is not still available, there have been a number of instances when people have died by suicide either after getting infected by Covid-19 or due to financial impact of the pandemic.

Mitra feared that suicide figures this year could be significantly higher than in previous years. “People have lost their jobs and their businesses have taken a hit, but right now they are living off their savings. Once they begin getting a sense of the loss and their savings start drying up, the situation could get bad,” said Mitra.

He said that such affected people need to acknowledge the loss, look for entrepreneurship opportunities and realise that they can always bounce back. “They must take inspiration from the times of the partition when so many people lost everything, but built up as entrepreneurs to recover,” said Mitra.

Parikh said India needs a suicide prevention policy and more and more suicide helplines. “In the long run, we need to impart life skills in schools so that people can cope with such situations,” he said.

https://www.hindustantimes.com/india-ne ... 4RPfL.html

[swamidada]

BBC
What's behind suicides by thousands of Indian housewives?
Geeta Pandey - BBC News, Delhi
Wed, December 15, 2021, 6:05 PM

Why do thousands of Indian housewives kill themselves every year?

According to the recently released data by the government's National Crime Records Bureau (NCRB), 22,372 housewives took their own lives last year - that's an average of 61 suicides every day or one every 25 minutes.

Housewives accounted for 14.6% of the total 153,052 recorded suicides in India in 2020 and more than 50% of the total number of women who killed themselves.

And last year was not an exception. Since 1997 when the NCRB started compiling suicide data based on occupation, more than 20,000 housewives have been killing themselves every year. In 2009, their numbers rose to 25,092.

Reports always blame such suicides on "family problems" or "marriage related issues". But what really does drive thousands of women to take their lives?

Mental health experts says a major reason is rampant domestic violence - 30% of all women told a recent government survey that they had faced spousal violence - and the daily drudgery that can make marriages oppressive and matrimonial homes suffocating.

"Women are really resilient, but there's a limit to tolerance," says Dr Usha Verma Srivastava, a clinical psychologist in the northern city of Varanasi.

"Most girls are married off as soon as they turn 18 - the legal age for marriage. She becomes a wife and a daughter-in-law and spends her entire day at home, cooking and cleaning and doing household chores. All sorts of restrictions are placed on her, she has little personal freedom and rarely has access to any money of her own.

"Her education and dreams no longer matter and her ambition begins to extinguish slowly, and despair and disappointment set in and the mere existence become torture."

India women walk to a river to do laundry
Housework in India is almost always a woman's responsibility
In older women, says Dr Verma Srivastava, the reasons for suicide are different.

"Many face the empty nest syndrome after the children have grown up and left home and many suffer from peri-menopausal symptoms which can cause depression and crying spells."

But suicides, she says, are easily preventable and that "if you stop someone for a second, chances are they would stop".

That's because, as psychiatrist Soumitra Pathare explains, many Indian suicides are impulsive. "Man comes home, beats up wife, and she kills herself."

Independent research, he says, shows that one-third of Indian women who take their lives have a history of suffering domestic violence. But domestic violence is not even mentioned in the NCRB data as a cause.

Does India really have more women than men?

'Prime minister, please make men share housework!'

Chaitali Sinha, a psychologist with Bangalore-based mental health app Wysa, says "a lot of women who remain in active domestic violence situations retain their sanity only because of the informal support they receive".

Ms Sinha, who earlier worked for three years in a government psychiatric hospital in Mumbai, counselling survivors of attempted suicide, says she found that women formed little support groups while travelling in local trains or with neighbours while buying vegetables.

"They had no other avenue to express themselves and sometimes their sanity depended on this conversation they could have with just one person," she says, adding that the pandemic and the lockdown worsened their situation.

"Housewives had a safe space after the menfolk would leave for work, but that disappeared during the pandemic. In situations of domestic violence, it also meant they were often trapped with their abusers. It further restricted their movement and their ability to do things that brought them joy or solace. So anger, hurt and sadness builds over time and suicide becomes their last resort."

India reports the highest numbers of suicides globally: Indian men make up a quarter of global suicides, while Indian women make up 36% of all global suicides in the 15 to 39 years age group.

But Dr Pathare, who has researched mental disorders and suicide prevention, says India's official numbers are a huge underestimate and do not convey the true scale of the problem.

Women in India
Women have few avenues to express their emotions
"If you look at the Million Death Study [which monitored nearly 14 million people in 2.4 million households between 1998-2014] or the Lancet study, suicides in India are under-reported by between 30% and 100%."

Suicide, he says, "is still not talked about openly in polite company - there's shame and stigma attached to it and many families try to conceal it. In rural India, there's no requirement for autopsies and the rich are known to lean upon the local police to show a suicide as accidental death. And police entries are not verified."

At a time when India is developing a national suicide prevention strategy, Dr Pathare says the priority must be to fix the quality of data.

The Indian kitchen serving an unpalatable truth

"If you look at the numbers of attempted suicides in India, they are laughably low. Anywhere in the world, they are generally four to 20 times [the number] of actual suicides. So, if India recorded 150,000 suicides last year, the attempted suicides would have been between 600,000 and six million."

This, Dr Pathare says, is the first at-risk population that should be targeted for any suicide prevention intervention, but we are hobbled by poor data, he says, with consequences worldwide.

"The United Nations target is to cut down suicides globally by a third by 2030, but in the past year, ours have increased by 10% compared to the previous year. And reducing it remains a pipe dream."

https://currently.att.yahoo.com/news/wh ... 03757.html

[swamidada]

Muslims face a suicide crisis in America. The taboo of talking about it must end.
Rania Awaad and Taimur Kouser
Sun, January 2, 2022, 5:01 AM
If you or someone you know is having serious thoughts of suicide, please call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

Sana was gripped with fear. Her mind raced as she debated whether Allah would forgive her for being so ungrateful. She became certain that her newborn and toddler would be better off without her, a mother who couldn’t bond with her children.

The thoughts surprised her. Sana considered herself religious and was aware that suicide is forbidden in Islam. But it seemed like the only solution.

Her characteristically joyful personality had given way to uncontrollable feelings of guilt, despair and hypocrisy. Here she was, a lawyer and teacher of the Islamic sciences, considering suicide.

Seeking help from friends was futile, as they told her what she already felt — she was suffering from weak iman (faith). They encouraged her to read more of the Qur’an and pray to restore her faith and gratitude.

On the day Sana had planned to die by suicide, a concerned friend called to check-in. She had just completed a suicide response training developed by the Stanford Muslim Mental Health & Islamic Psychology Lab and offered by Maristan, a community partner with the lab.

Several recent tragedies were the catalyst for Maristan to launch its 500 Imam Campaign with a goal to train at least 500 Muslim leaders across the country in 2022 in suicide prevention, intervention and post intervention. Maristan’s five-year goal is to train leaders in all 3,000 mosques across the U.S.
Several recent tragedies were the catalyst for Maristan to launch its 500 Imam Campaign with a goal to train at least 500 Muslim leaders across the country in 2022 in suicide prevention, intervention and post intervention. Maristan’s five-year goal is to train leaders in all 3,000 mosques across the U.S.
Sana’s friend recognized red flags that she had learned about, explained to Sana that her symptoms were the result of postpartum depression, and insisted that she take her to an emergency room for a psychiatric evaluation.

Learning about her symptoms and that they were unrelated to her level of education or religiosity helped to comfort Sana and ultimately saved her life.

Mental illness is still highly stigmatized around the world, but its stigma in Muslim communities is especially strong. Instead of seeing mental health challenges as medical problems requiring (in part) medical solutions, many Muslims view such challenges as purely spiritual ones that can be prayed away or addressed with similar spiritual solutions.

Suicide, in particular, is a taboo within a taboo not only because of its connection to a mental health vocabulary, but also because it is morally forbidden in Islam.

A combination of Qur’anic verses and Hadith (narrations of the Prophet Muhammad, peace be upon him) underscore God’s explicit prohibition of killing oneself, emphasizing the special status that He has given to each human life and reminding Muslims about the nature of trials in this life and the need and goodness of patiently enduring them.

But moral prohibitions alone do not afford Muslims blanket immunity from suffering suicidal thoughts or dying by suicide. Research shows that a significant number of Muslims attempt and die by suicide each year, despite the fact that reported rates of Muslim deaths by suicide are low.

There also may be a good reason to believe that the rates are actually much higher than reported. In addition to its social stigma, suicide is criminalized in many Muslim-majority countries, which may yield underreporting or misclassification of deaths by suicide as “accidental deaths.”

American Muslims at higher risk
In the United States, our recent study published in JAMA Psychiatry — through a partnership among our StanfordMMHIP Lab, the Institute of Social Policy and Understanding, and the Institute of Muslim Mental Health — showed that American Muslims are twice as likely as any other religious group to report previous suicide attempts.

As noted in the Economist, it is hard to imagine that this is not linked to the high rates of Islamophobia and anti-Muslim sentiment that defined post-9/11 experiences for most American Muslims. But there’s more too.

Mental health is not only stigmatized and culturally and religiously congruent resources not easily accessible, but American Muslims also suffer from unique stressors in their daily lives that hurt their mental well-being.

For example, our study showed that experiencing discrimination — especially the combination of Islamophobic and gender-based discrimination — increased suicide attempts by 180%. And gay and bisexual Muslims were eight times as likely to report attempting suicide.

Cultural assimilation also plays a major role. U.S.-born Muslims were much more likely to attempt suicide than their immigrant-born predecessors.

Ultimately, the study underscores that there is a growing suicide crisis afflicting the American Muslim community.

Over the past several years, our StanfordMMHIP Lab has been contacted by numerous Muslim communities in the United States and abroad following deaths by suicide. It became clear to us that we needed to develop custom-tailored resources for Muslim communities to help them navigate the impact of suicide on their communities.

By April, when two brothers killed themselves and their family members in a murder-suicide in the Allen, Texas, Muslim community, we had completed the first draft of a suicide prevention, intervention and post-intervention manual that integrates the latest evidence-based scientific research on suicide along with Islamic ethics and moral teachings.

Within 24 hours of the Allen tragedy, our team had hosted multiple virtual training sessions for Muslim leaders in the Dallas area, including training specific to Imams, other religious leaders and mental health professionals.

We also published a widely circulated article on the do’s and don’ts of suicide response for Muslims who were reeling after the brothers’ graphic suicide note had gone viral. Our goal was to prevent a suicide contagion in U.S. Muslim communities.

Addressing suicide has been a major gap in Muslim communities worldwide, but we are finally beginning to take meaningful steps to combat the troubling anecdotal, clinical and research findings that show an increase in suicidal ideation and deaths by suicide.

The StanfordMMHIP Lab recently received a John Templeton Foundation Grant to study Islamic-inspired character virtues that may serve as unique resiliency and protective factors against suicide, representing a significant stride in Muslim mental health research.

Suicide prevention training is available
Several recent tragedies were the catalyst for Maristan to launch its 500 Imam Campaign with a goal to train at least 500 Muslim leaders across the country in 2022 in suicide prevention, intervention and post-intervention. Maristan’s five-year goal is to train leaders in all 3,000 mosques across the U.S.

Muslim communities seem finally to be waking up to the reality of mental illness and the acute need to address it through collaborations among mental health professionals and community and religious leaders.

But there is still much work to do. Effective suicide prevention in Muslim communities requires more information, more commitment and more communication. It requires the entire community to engage. It requires a solution that is medical and spiritual, and one that meets each community where it is at and uses tools from varying traditions to engage the problem effectively.

We need more research to document the extent of the problem, more resources to provide care based in the Islamic tradition, more communication about the importance of mental health care, more recognition of unique stressors, and more leadership to responsibly guide communities to a healthier future.

Yet, there is reason for hope. At Maristan's first in-person suicide prevention training in September, an Imam was the first person to arrive. And he sat in the front row. A few years ago, he had brushed off the need to talk about mental health, despite our efforts to seek his support.

Dr. Rania Awaad is an associate professor in the Department of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine. Taimur Kouser is a Masters in Bioethics & Science Policy student at Duke University.

You can read diverse opinions from our Board of Contributors and other writers on the Opinion front page, on Twitter @usatodayopinion and in our daily Opinion newsletter. To respond to a column, submit a comment to [email protected].

This article originally appeared on USA TODAY: American Muslims must break taboo of confronting suicide

https://currently.att.yahoo.com/news/mu ... 59976.html

[kmaherali]

Provisional data from the Centers for Disease Control and Prevention show that deaths by suicide were up last year — but not for all groups.

The estimated number of suicide deaths in the United States rose to nearly 50,000 in 2022, according to provisional data released on Thursday from the Centers for Disease Control and Prevention. The total would be an increase of approximately 2.6 percent since 2021.

The C.D.C. estimates the overall number of deaths to be 49,449 but has not yet calculated the suicide rates for 2022. Given that the U.S. population grew by about 0.4 percent in 2022, a 2.6 percent increase in deaths indicates that suicide rates are continuing to rise, although not universally among all groups.

Suicide deaths have fluctuated somewhat over the years and declined in 2019 and 2020. But the overall suicide rate, or the number of suicides per 100,000 people, has increased by about 35 percent over the last two decades. People 65 and older had the highest increase in the number of deaths by suicide in 2022 among the various age groups.

Experts say ready access to guns contributes to the issue. Suicides attributed to firearm injuries have been rising since 2006. In 2022, nearly 27,000 people died by gun-related suicide, surpassing earlier records and accounting for more than half of all suicide deaths.

Mike Anestis, the executive director of the New Jersey Gun Violence Research Center, attributes the increase partly to an “unprecedented surge” in firearm sales in 2020. That year, the Federal Bureau of Investigation processed a record of about 39.7 million firearm background checks.

In a paper published in JAMA Psychiatry, Dr. Anestis and his colleagues found that those who purchased a firearm for the first time during the surge were at a higher risk of having experienced suicidal thoughts.

“If firearms are more likely to be in homes where suicidal thoughts recur, then as the years go by you’re more likely to have that sort of confluence of wanting to die and having ready access to — by far — the most lethal method for suicide,” Dr. Anestis said.

Other research suggests that factors like economic uncertainty, substance use, social isolation, difficulty accessing mental health care or stigma around seeking help can also be risk factors for suicide.

“Suicide is complex and is rarely caused by a single issue,” Robin Lee of the National Center for Injury Prevention and Control said in an email. “Additionally, we know from prior research that suicide rates may be stable or decline initially during a national disaster (such as the Covid-19 pandemic), only to rise afterward as longer-term consequences unfold for individuals, families and communities.”

The C.D.C. data also included positive developments: The number of suicide deaths fell by around 8 percent among people 10-24 years old and by about 6 percent for American Indian and Alaska Native people.

“I’m hoping what this means is that the work that we’ve all been putting into decreasing youth suicides is really paying off,” said Dr. Laura Erickson-Schroth, the chief medical officer of the Jed Foundation, a suicide prevention organization that aims to protect the emotional health of teenagers and young adults. “People are coming together from all different areas to support youth mental health.”

Even so, the decrease does not discount the fact that some people in these groups are still struggling with mental health.

From March 2021 to March 2022, for example, a study in JAMA Psychiatry reported a 22 percent increase in teenage girls who visited emergency rooms with a mental health emergency compared with a similar period of time prepandemic. The rise was associated with an increase in suicidal and self-harming behavior.

A KFF analysis of census data found that half of adults ages 18 to 24 reported anxiety and depression symptoms in 2023, compared with about a third of adults overall.

Studies have found that about two-thirds of people with suicidal ideation never make a suicide attempt, and 7 percent of those with suicidal ideation will attempt suicide during the subsequent two years.

The 988 Suicide and Crisis Lifeline, a national network with more than 200 call centers, has undergone a revamp in the past year, including expanded access to counselors, an L.G.B.T.Q. “subnetwork” for those under the age of 25 and Spanish text and chat options. The free service is available at all hours for anyone who needs mental health or substance abuse support, including concerned family members.

If you are having thoughts of suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline or go to SpeakingOfSuicide.com/resources for a list of additional resources. Go here for resources outside the United States.

https://www.nytimes.com/2023/08/11/well ... 778d3e6de3

[swamidada]

THARPARKAR’S SUICIDE CRISIS

After Chitral, Sindh’s Tharparkar district has the highest prevalence of suicide in the country, going by just the reported cases.
Matee-ur-Rehman Published September 10, 2023 Updated about 23 hours ago

Seventy-year-old Sarang Meghwar sweats excessively in the stifling heat of Mithi, Tharparkar. The deep creases across his forehead betray his age, and he appears to be more bones than man. But his disposition is the result of years of troubles and torment. Meghwar has lost three of his children to suicide.

“My eldest son, Ishaan, was free-spirited,” he tells me in Dhatki, one of the native languages of Tharparkar. “He used to escape from home and travel to strange places. He would frequently disappear for months at a time, without any explanation, and then return inexplicably.”

One day, instead of Ishaan, the police turned up at Meghwar’s doorstep, to inform him that his 27-year-old son had hanged himself.

A few years later, when Meghwar’s 16-year-old daughter Gita was not allowed to pursue a relationship with a boy she liked and was instead, out of social obligation, married off to a man she had no interest in, she chose to kill herself.

After Chitral, Sindh’s Tharparkar district has the highest prevalence of suicide in the country, going by just the reported cases. What underlying factors make this such a widespread phenomenon in this region and why is it not being addressed?

Chaandni, Meghwar’s 24-year-old eldest daughter, was married off after she finished her Intermediate exams. She faced intense domestic abuse and violence at the hands of her in-laws and was on the brink of starvation, because her in-laws said she could not eat more than one meal a day.

Meghwar decided to intervene and was on his way to bring his daughter back home when he got the news that Chaandni had also committed suicide.

Unfortunately, almost every hamlet and town in Tharparkar is ripe with such tales. The reality is that Tharparkar usually only garners the attention of Pakistan’s mainstream media when it is hit by a crippling drought or when yet another person in the district commits suicide.

Over the last three years, there has been a drastic surge in the cases of suicide in Tharparkar. According to the SSP office in Tharparkar, there were 129 suicides in the region in 2022, an increase from the 121 in 2021. After Chitral, Tharparkar has the highest suicide rate in Pakistan.

Once a remote region tucked away from the rest of the country, Tharparkar became interconnected due to a 3,000 kilometre-long network of roads which were constructed during Gen Pervez Musharraf’s era, effectively linking Mithi to Diplo, Nagarparkar and Chhachhro.

The construction of these roadways allowed locals access to the outside world and, vice versa, enabled businessmen, mining outfits and the media to venture into the region. This development, however, came at a cost and challenged local traditions which had been in place for ages.

SOCIAL NORMS

Tharparkar has the highest Hindu population in Pakistan and, as per the 2017 census, Hindus make up more than 43% of the district’s population. This has led to an establishment of certain traditions centred around Hindu customs and practices in the region.

According to social activist and educationist Partab Shivani, inter-caste marriages are strictly prohibited in traditional Hindu societies. Although this is not an official tenet of Hinduism, it has been practised and enforced by many Hindu pundits or clerics since the mid-19th century. It is often ensured that the man and woman being wed have had no family connection for the past 10 generations.

This norm only further compounds a long list of misfortunes Tharparkar’s young people are battling. According to police reports, four couples, aged between 15-30 years, have committed joint suicides in Tharparkar since 2021. Since these couples belonged to the same community, there was no chance of their marriages being approved by their elders.

Due to this rigid adherence to established norms, the concept of love marriage is essentially taboo in Tharparkar, which in turn often leads to unhappy marriages. For instance, last year in Mithi, a woman committed suicide after being married to a man she simply had no interest in.

Referred to as the baddho system locally, exchange marriages (also called vatta-sattas) occur very frequently in many rural communities across Tharparkar. However, such arrangements can regularly lead to the development of problematic dynamics due to the nature of these interlinked relationships.

In many instances, these complicated ties often result in women becoming victims of domestic violence. Shivani explains, “It is expected that if my brother-in-law is physically abusive towards my sister, ie his wife, I should reciprocate that sentiment by beating his sister, ie my wife.”

As a result, such exchange marriages can sometimes trap women in a cycle of violence and enforced ‘accountability’. Women who feel they can’t find a way out of this abuse choose to kill themselves as opposed to spending the rest of their lives as pawns through which family scales are balanced and revenge exacted.

In 2022, 70 females and 59 males reportedly committed suicide in Tharparkar. The cause of suicide for most of the women was simply listed as ‘domestic affairs’ in the official records, but locals know that this term implies domestic violence.

Apart from attending to their domestic responsibilities, women in the region also have to collect firewood, walk long distances to get water and help the males in harvesting cotton, which in turn adds to their stress, since they know that a failure to comply will lead to violence.

Over the last three years, there has been a drastic surge in the cases of suicide in Tharparkar. According to the SSP office in Tharparkar, there were 129 suicides in the region in 2022, an increase from the 121 in 2021. After Chitral, Tharparkar has the highest suicide rate in Pakistan.

But these rigid customs and norms are not only limited to incidents involving marriage. For instance, a particularly tragic story which was relayed to me during my travels through Tharparkar was that of Shivam and Ved, two first cousins who had been inseparable since their childhood.

They wore the same clothes, ate the same food and grew up spending most of their time together. When they became teenagers, their families became suspicious of their intimacy and forced them apart. In retaliation, one day the boys wore matching new clothes, went to the bazaar to eat their favourite mithai, took selfies together, and then hanged themselves.

Furthermore, strict adherence to the caste system also robs many residents of Tharparkar of any hope of upward social mobility, thus trapping them in the system’s unbending structure. The Dalit caste, also known as the ‘untouchables’, lie on the lowest rung of the Jati caste system in Hinduism and are treated as such. Hence, it is no coincidence that the Dalit Kolhi, Bheel and Meghwar communities have the highest incidences of suicide in Tharparkar.

However, many villages in Nagarparkar lie at the opposite end of the rigid social norms spectrum. Nagarparkar, which is one of Tharparkar’s tehsils, lies near the Pakistan-India border. The villages scattered throughout Nagarparkar are largely secluded and inaccessible through roads. Due to this isolation, there is rampant frustration in the area, arising from unemployment and idleness.

According to Krishan Sharma, a social worker based in Tharparkar, these factors have led to a strong culture of drugs and alcoholism in some quarters of Nagarparkar, and the locals here brew their own moonshine, locally called tharra, in their homes. When Sharma went to villages in Nagarparkar to examine kids for malnutrition, most of the mothers accompanying their children were drunk.

The complete breakdown of any societal constructs in Nagarparkar and the lack of adequate healthcare or educational provisions has led to a constant barrage of suicide cases here — each driven by a set of complex underlying factors, which are incredibly hard to address. For instance, just a few years ago, a 14-year-old Hindu boy in Nagarparkar burnt himself alive in the hope of attaining mukti [liberation after death].

Some micro-financing banks and local money-lenders [banyas] in the region offer minor loans to the locals in order to support their farming since the livelihood of communities in Tharparkar depends upon agriculture. Micro-financing institutions such as the Khushhali bank, Akhuwat Foundation and the Thardeep Rural Development Programme also operate in Tharparkar.

They loan money in small amounts, helping alleviate any temporary financial difficulties farmers might have. While the banks demand their money back in full, the local moneylenders demand the return of their loans in percentage increments. This proves distressing for the debtors.

Since the literacy rate in Tharparkar district is only 38 percent, according to the Sindh District Report 2017-18, most farmers are completely oblivious as to how they should go about paying back their loans and whether or not they should trust their local moneylenders.

In some cases, if a farmer has borrowed a sum of money from a bank and is unable to pay it back, he will borrow money from the local banya, who will accept the farmer’s cultivated land and cattle as mortgage. After successfully paying the loan on time, the bank will offer the debtor a bigger loan next time.

However, this can lead to the farmer being stuck in a vicious cycle of loan-taking. The main assets of these farmers are their cattle, so when rainfall is scarce or a drought occurs and crop production decreases, their cattle is often seized. Eventually, the moneylender has to be paid back and, if the farmer is unable to do so and has already lost all his assets, he may choose to commit suicide.

Oftentimes in such a scenario, the lenders gather outside the debtor’s chaunra [straw-roofed mud house] and start seizing whatever he owns, thus attracting a crowd of onlookers in the process. The shame, stigma and financial constraints which arise due to a failure to pay back these loans have caused many farmers to commit suicide.

This is exactly what happened a few years ago in a widely reported incident, when a young farmer from Mitha Tar was unable to pay back a loan. As the collectors protested in front of the boy’s chaunra and demanded that he repay the loan fees — all while neighbours and strangers alike looked on — the young man chose to kill himself instead of being forced to endure the humiliation of facing members of his community and the lenders in such a manner.

Apart from their household responsibilities, women in Tharparkar also have to collect wood for fires, walk long distances to get water and help in harvesting cotton | White Star

PLAGUED BY POVERTY

Social worker Ali Akbar Rahimoo says that notions of integrity, honesty and community are very important in Tharparkar’s social fabric — often to an extreme extent. For instance, a person would rather die from starvation than use illicit means to obtain money, which perhaps explains why Tharparkar has a negligible crime rate.

Rahimoo recalls that, in 2003, a man hanged himself from a neem tree because he had not eaten anything for three days. “People here would rather kill themselves than be perceived as a burden or engage in criminal activities to survive,” Rahimoo says.

Since 87 percent of people are below the poverty line in Tharparkar, according to the United Nations Development Programme (UNDP) Multidimensional Poverty Index, suicide becomes a recourse for many who are unable to provide for themselves and their families.

Nawal, a carpet weaver from the remote village of Chhachhro in Tharparkar, killed himself and his four sons due to the extreme financial difficulties the family was facing. His cousin Tarachand tells me that Nawal refused to accept either sympathy or money from any of his relatives or friends. Instead, he pushed his sons into a well and then jumped in himself.

Similarly, a 50-year-old Kolhi woman living in Dileep Nagar Mithi says that her son, Gordhan, committed suicide after his wife’s death, who got electrocuted while she was breastfeeding their two-month-old son. Bogged down by grief and the inability to support all of his children, Gordhan killed himself.

THE COST OF MODERNITY

Many of the underlying issues which have been highlighted thus far are also present in remote villages in rural Punjab and several areas of Balochistan. Yet these areas do not have the staggering suicide rate that Tharparkar does. So what’s the reason for the difference?

Social workers and intellectuals in Tharparkar argue that the most pressing reason for the region’s high suicide rate has been the advent of the Thar coal mining project, and the sudden arrival of ‘modernity’ that followed suit. Due to this, parts of Tharparkar went from deeply regressive areas to mechanised hubs almost overnight.

The French sociologist Emile Durkheim posits that a sense of anomie arises when a social system disintegrates and newer, stranger values or norms make their way into a society. In many ways, the Thar coal mining

project challenged the traditional value system of the Thari people. Due to the rapid development of infrastructure to facilitate the coal mining, this once quiet, traditional society was forced to contend with an influx of outsiders — irrevocably damaging the region’s social fabric in the process.

Mithi is the capital of Tharparkar district and it has undergone partial urbanisation in the wake of this project, due to which its residents have access to roads, phones, the internet, and television networks. As per the Pakistan Bureau of Statistics, 93 percent of Tharis now have access to mobile internet, but this connectivity is coming at a cost.

The hunger to own the latest gadgets, which are advertised to the Thari youth as something to aspire to, is fuelling a deep sense of insecurity which did not exist till a few years ago. Many youngsters who are unable to attain these objects or lifestyle contemplate suicide because they consider themselves to be somehow ‘lacking’ in a world which is rapidly advancing.

Sharma adds that it has also been increasingly observed that social media platforms in Tharparkar are filled with uncensored images of suicide victims and harrowing details regarding these incidents. The concept of suicide is now not only readily spread online in Thar but also normalised in the process by exposing people to its prevalence.

Earlier, in areas like Tharparkar, each village had a leader called a mukhiya [chief] who managed the general grievances of the residents. If a village housed five communities and an issue or a dispute arose, the chief would attempt to resolve the grievance of the respective community. However, now with the arrival of technology, mobile phones and internet in the region, many Tharis believe that there is a severe communication gap between all members of any given household and community.

Sharma argues that he has seen this decay of interpersonal relationships in Tharparkar first-hand. He posits that the cherished concept of sharing problems with siblings, parents or elders has now eroded away, and the strength of emotional ties has become extinct here. As a result, an entire generation of Tharis have now grown up with no anchorage to their communities or their elders, which has only further exacerbated their sense of unease and loneliness. This, coupled with the poverty already plaguing the land, makes for a deadly combination.

Due to these factors and the commonplace nature of suicide in the region, it is evident that the idea of killing oneself is treated with a degree of callousness and irreverence by many of the locals. During my journey through Tharparkar, I overheard the bus driver relaying a personal dilemma over the phone. At the end of the conversation he calmly and nonchalantly said in Sindhi, “Maan phahoo khae wathaan? [So, should I just commit suicide?]”

APATHY OF THE AUTHORITIES

The reason why it is so difficult to address this rising suicide rate is because there are no official statistics regarding suicide in Pakistan. As a result, it’s extremely difficult to try to get a sense of which localities need the most help. However, there are some basic requirements that the government must ensure are met if the state wishes to bring down the suicide rate in Tharparkar.

For instance, although the Sindh Mental Health Authority was established in 2017, currently there is only one psychiatrist in all of Tharparkar, and he sits in Mithi. That’s one psychiatrist for nearly 20,000 square kilometres.

According to Rahimoo, 80-90 percent cases of suicide occur in villages far removed from Mithi, and these people have no access to any mental health services. Moreover, the fees involved, the cost of medication and the social stigma of seeking help for one’s mental health further decreases the likelihood that people in Thar will seek out help, even if they are having suicidal thoughts.

As Rahimoo puts it, “Here in Tharparkar, a person will first go to a maulvi for healing, then he will go to the shrines, and then, right at the end, he will think about going to a doctor.”

Dr Karim Ahmed Khawaja, Chairman of the Sindh Mental Health Authority, says that, “Initially the district police was not cooperating with us with regards to the collection of data on suicides in the region. Only after we put in a word with their senior officers did the local police start cooperating with us.”

The lack of seriousness exhibited by the local authorities demonstrates why most suicide cases are so egregiously mishandled by the police in Tharparkar. There is a serious inconsistency in police records when it comes to instances of suicide.

According to police reports in Tharparkar, 120 suicides from 2021 to 2023 have been placed under the category of ‘mental disease’. When this term is used in official records, it means that there is no need for any police investigation, nor is the case forwarded to the courts.

The police do not investigate the suicide case if they receive a statement from the family of the victim saying that the deceased was mentally disturbed, so the case is inevitably shut. The family is not even required to present a medical certificate to substantiate their claim. This is further complicated by the fact that, if a parent kills their own children before committing suicide, police records simply report all the deaths as suicide.

NO END IN SIGHT

Therefore, because the data collected by local authorities is largely unreliable, cases are underreported and mismanaged or the causes of suicide misattributed, our understanding of the prevalence of this phenomenon in Tharparkar is greatly hindered. Furthermore, politicians who belong to different constituencies of Tharparkar seem unbothered about addressing this issue. I approached multiple local politicians to discuss Tharparkar’s high suicide rate but did not receive a single reply.

As per the district police data, there have been 75 incidents of suicide this year in Tharparkar, up until August 2023. This figure already is equal to 60 percent of the suicide incidents that took place in the whole of 2022. Each year the numbers rise, and these figures do not even take into account all the cases which go unreported.

On a superficial level, the hospitality of the Thari people, their brotherhood and simplicity paints a romantic image of Tharparkar. But in reality, the people of Tharparkar are suffering. Their anguish is a result of years of state neglect and the persistent indifference of the authorities.

The writer is currently pursuing a degree at the Department of Social Sciences and Liberal Arts (SSLA) at the Institute of Business Administration (IBA).
He can be reached at [email protected]

Published in Dawn, EOS, September 10th, 2023

[kmaherali]

After years of pressure from victims’ families, the installation of $217 million in steel netting is almost complete.


A fence at the base of the Golden Gate Bridge is a makeshift memorial for those who have died there. An estimated 2,000 people have jumped to their death since the bridge opened in 1937.

It was May 27, 1937, the opening day for a stunning new suspension bridge across a gap in the California coastline known as the Golden Gate. Before cars were allowed on the crossing, an estimated 200,000 people celebrated between the bridge’s four-foot-high rails, more than 200 feet above the water.

Doris Madden, 11, was there with her parents. It was one of her favorite days of her childhood, a story she told until the end of her life.

About 78 years later, in 2015, Madden’s 15-year-old grandson, Jesse Madden-Fong, was dropped off at his high school in San Francisco.

Jesse did not go to class. An hour later, he was on the Golden Gate Bridge, walking alone. The family was told that Jesse had shrugged off his backpack and went over the rail. He left no explanation, no clues, for why he had jumped.

Jesse’s mother confirmed her son’s identity with the coroner through the boy’s new corduroy pants. An urn of Jesse’s ashes sits on the mantel of his family’s San Francisco home.

“My mother loved the bridge,” said Pat Madden, Jesse’s mother and Doris’s daughter. “I’m really glad she passed away two years before Jesse.”

His was one of 33 confirmed suicides from the bridge that year, a typical number.

For nearly 87 years, it was so easy.

Image
A woman in a black shirt and jeans, sitting on the ground and looking directly at the camera.

Pat Madden.

Image
A boy wearing glasses waves at the camera.

Jesse Madden-Fong.

‘It’s About Damn Time’

The Golden Gate Bridge is a rare blend of form and function, a massive structure that somehow adds to nature’s beauty instead of detracting from it.

It stands as one of the world’s engineering marvels and a symbol of Depression-era American muscle. It tickles with its delicate, sweeping lines and harp-string vertical cables, playing hide-and-seek with the ever-shifting light and fog.

Connecting a sophisticated city and an untamed beyond, it is less a gate than an aperture. Everyone views something different through it.

Some see endless possibilities. Some just see the end.

About 2,000 people are known to have died by jumping off the bridge. The count has never been precise, and the true tally is certainly higher, perhaps substantially so, since not all jumps are witnessed and not all bodies are found. At least three cases included a homicide; parents have tossed children over the rail and then jumped in after them.

Such tragedies, officials hope, are mostly in the past. Workers are nearly finished installing 3 ½ miles of stainless steel nets — creating what officials call a “suicide deterrent system” — strung on both sides of the bridge, end to end.

Construction cost $217 million and the system has taken longer to build than the bridge itself did.

The nets are nearly invisible from a distance, blending into the steelwork. They cannot be seen from the 40 million vehicles that cross the bridge each year.

But they are visible to anyone standing at the rail. They hang about 20 feet down and stretch about 20 feet out. They are stitched between 369 new struts, 50 feet apart, painted International Orange like the rest of the bridge.

These are not the soft, springy nets of a circus act. They are taut, marine-grade stainless steel nets meant to withstand the Golden Gate’s combination of rain, wind, salt and fog.

ImageA stretch of steel netting around the red structure of the Golden Gate Bridge.

Installed 20 feet below the sidewalk, more than three miles of stainless steel nets have been strung to deter people from jumping — and to catch those who still do.

“We want the message to be that it’s going to hurt, and also jumping off the bridge is illegal,” Denis Mulligan, the general manager of the organization that oversees the bridge, said.

The nets have already shown themselves to be a deterrent, but not a perfect solution.

Several people have jumped into them. Some have been rescued from there, but “a handful” had “jumped into the net and then jumped to their death,” Mulligan said.

He declined to say how many. It will take a year or two of data to fully understand the system’s effectiveness, he said.

In the decade beginning in 2011, bridge officials said, there were 335 confirmed suicides, or an average of 33.5 per year. In 2022, as the first nets were being strung, there were 22. Through October this year, as more nets have been added, there were 13.

“If we save 30 lives a year, and not 31, it’s worth it for those 30 people who we saved,” Mulligan said. “And that’s every year. To greatly reduce the number of people dying in the community is a worthy goal. And to achieve that is success.”

Image
Looking down on a detail of the steel netting. The water can be seen below.

The four-millimeter stainless steel nets are designed to withstand the harsh elements.

Image
Looking up at the bridge from underneath it.

Stretched between new steel struts, the nets line both sides, below public sidewalks.

The completion of the system, and the focused two-decade drive to get it done after decades of failed campaigns, has produced a range of emotions.

“It’s satisfying,” said Manuel Gamboa, who has been a persistent proponent of the nets since his 18-year-old son Kyle drove 100 miles to the bridge one school morning in 2013, stopped his truck in the middle of the bridge, turned on the flashers and leaped over the rail.

“Part of me is just exhausted that it took this long,” said Paul Muller, president and co-founder the Bridge Rail Foundation, a nonprofit founded in 2006 with a mission of ending suicides at the bridge.

“I’m glad I’m still alive to see it,” said Dr. Mel Blaustein, a San Francisco psychiatrist who helped push the mission to build a barrier 20 years ago, when he was in his 60s.

“I’m excited — it will be a good tool to have,” said Lt. Michael Bailey of the Bridge Patrol, which uses surveillance to spot potential jumpers, intervening close to 200 times per year, officials said.

“It’s about damn time,” said Ken Holmes, the former coroner in Marin County, across the bridge from San Francisco, whose office was responsible for examining the recovered bodies of jumpers.

“I am relieved,” said Pat Madden, the mother of Jesse. “You just want to spare other people from what you’re going through.”

A Low Railing

The first confirmed suicide from the Golden Gate Bridge happened about 10 weeks after its opening. Harold Wobber, a 47-year-old World War I veteran, reportedly said, “This is as far as I go,” and jumped.

More followed — dozens a year, hundreds a decade. The unique majesty that draws tourists from all over the world made the bridge a premier destination for death.

“There’s a certain magnetic appeal around a suicide site that draws other desperate souls to it,” said John Bateson, a longtime director of a Bay Area suicide prevention center and the author of “The Final Leap,” a 2012 book about suicides at the Golden Gate Bridge. “And the Golden Gate Bridge exerts a larger magnetic pull than anywhere else because of its natural beauty, because of its tragic history.”

Studies have shown that many people will drive across other bridges, like the San Francisco-Oakland Bay Bridge, to jump from the Golden Gate — but not the reverse.

Among other reasons that someone looking to jump might choose the bridge is a near guarantee of death (about 1 in 50 have survived) and a belief that loved ones will be spared the horror of discovering the body.

But there was always something more practical: The railing is just four feet high.

Almost anyone could get over it, whether after long consideration or in a moment of impulse. Some run and hurdle the rail. Others swing a leg up and over it. One elderly man brought a step stool.

“Fundamental to suicide prevention is restricting easy access to lethal means,” said Muller, the Bridge Rail Foundation co-founder. “And the Golden Gate Bridge has provided easy access.”

Image
A man and woman walking on the pedestrian path of the bridge.

The bridge’s sidewalks have long been closed to pedestrians at night, so most jumps have happened during the day and are often witnessed by drivers, pedestrians and boaters.

Bridge lore has it that the original design called for the railing to be 5 ½ feet tall, but it was lowered either by the chief engineer, Joseph Strauss, (a short man whose statue stands near the Golden Gate Bridge Welcome Center and gift shop) or the architect Irving Morrow, whose credited contributions include many of the bridge’s hallmarks, such as its paint color and Art Deco flourishes.

Mulligan, the bridge general manager who spent a decade as its top engineer, said that he had never discovered such plans. But the California Highway Patrol first asked for a higher railing in 1939 to deter jumpers.

That it took so much time and heartache to seriously address the issue is a source of great debate and consternation.

Bureaucratic Indifference

Those in charge of most famous tall structures, from the Eiffel Tower to the Empire State Building, moved quickly to keep people from jumping from them, often after a few deaths. In New York in 2021, access to the Vessel, a 150-foot sculpture composed of spiraling stairs, was shut down after three suicides within one year. It reopened and closed again after a fourth later that year.

Not at the Golden Gate Bridge. Jumping off the bridge was always an option, even a dark joke.

“I grew up in San Francisco,” Mulligan said. “I grew up hearing people say, ‘Well, why don’t you just go jump off the bridge?’ That was what people said. They obviously didn’t understand suicide or mental health.”

Such nonchalance was reflected in the 19-member board of directors for the Golden Gate Bridge, Highway and Transportation District, which oversees the operation of the bridge and a regional bus and ferry system.

“One of the directors actually told me that the solution would be building a diving board on the bridge — to show the callousness I’ve seen people have,” said Dr. Blaustein, a former president of the Northern California Psychiatric Society and longtime medical director of a psychiatric unit a few miles from the bridge.

For decades, decision makers ducked behind concerns over aesthetics, costs and effectiveness.

Image
Waves crash ashore in the foreground. The bridge is in the background.

The middle of the bridge is about 220 feet above the water. The fall takes four seconds, and only about 1 out of 50 have survived.

Clouding serious consideration were long-held misperceptions about suicide — mainly, that people prevented from jumping from the bridge would simply take their lives a different way.

A 1978 study by Richard Seiden, at the University of California, Berkeley, tracked 515 people who, between 1937 and 1971, had gone to the bridge intending to jump and had been persuaded not to. It found that 94 percent were still alive or had died of natural causes.

“Suicidal behavior is crisis-oriented and acute in nature,” Seiden concluded.

The Bridge Patrol is on the front lines of those crises. Created as an antiterrorism force after the Sept. 11 attacks, officers spend much of their energy preventing suicides. Using surveillance and roving patrols, and often assisted by ironworkers, painters and others doing work on the bridge, they try to spot the potential jumpers among millions of bridge visitors every year.

A planned jump is stopped every other day, on average, bridge officials said.

Image
A man with GGB on the back of his uniform watches two screens showing views of the bridge traffic and sidewalks. Next to him is another man in uniform watching a different screen.
A large part of the Bridge Patrol’s role is to intervene in possible suicide attempts through surveillance and patrols. Such interventions happen every other day, on average, officials said. But not everyone can be stopped.

Lieutenant Bailey, a 14-year patrol veteran, does not count the lives he saves, because then he would have to count the jumps he witnessed and could not stop.

“It’s hard not to let it affect you,” he said. “We’re all humans out here, with normal feelings like anybody else.”

Holmes, the Marin County coroner, never knew the victims. He just examined the bodies.

He had worked for the county since 1975, but never appreciated the death toll from the bridge until the early 1990s, when the U.S. Coast Guard moved operations to Marin County from the San Francisco side of the strait. That meant that his office became responsible for examining the bodies of jumpers, mostly retrieved by the Coast Guard.

Holmes knew that a four-second fall is not a peaceful way to die. It shatters bones and rips apart organs. Those who somehow survive the impact usually drown.

It was not the bodies that moved him.

“It was the enormity of the numbers — oh, my God,” said Holmes, now retired. “It’s not one every few months or anything like that. It was two or three every single month. One year we had 44 — 44! Even my investigators at the time were saying, ‘Did you have any idea?’ And of course I didn’t.”

Holmes compiled statistics specifically for Golden Gate jumpers, something not done before. Over 15 years, he found that three-quarters of them were men. The average age was under 40. About 85 percent lived in the Bay Area, and more than 7 percent were from out of state. The most common occupation was student, followed by teacher.

Holmes began appearing regularly at bridge-district board meetings to plead that something be done, joining a small, shifting carousel of researchers, psychiatrists and grieving families.

A Movement Takes Shape

True momentum for the effort came in the early 2000s. A 2003 New Yorker story by Tad Friend, titled “Jumpers,” cast a bright light on the bridge’s dark history. The San Francisco Chronicle followed in 2005 with an unblinking, weeklong series called “Lethal Beauty.”

There were documentaries, including “The Bridge” in 2006, that controversially showed people plummeting into the water.

That same year, a man named David Hull turned his grief into a mission, cofounding the Bridge Rail Foundation. Hull’s 26-year-old daughter had driven two hours from Santa Cruz to jump from the bridge.

The Bridge Rail Foundation organized other families in a common effort. It wrote op-eds and monthly newsletters. It made short films to spread on social media. It created a traveling exhibit of hundreds of shoes worn by the jumpers, including World War I-era boots to represent Wobber, who died by the bridge’s first known suicide.

Image
Five workers construct the netting high above the water.

Adding the nets has taken seven years, three years longer than it took to build the bridge.

Image
The bridge is barely visible through the fog.

Part of the appeal of nets is that they do not change the aesthetic appeal of the bridge.

Mostly, the group focused not on cold data, but on the warmth of humanity and empathy.

“In the beginning, researchers felt that empirical evidence was strong enough that, naturally, it’s going to convince anybody to erect a barrier,” said Bateson, the author. “And, in fact, the emotion was missing from those early arguments.”

Growing numbers of families joined the fight. They crowded meetings. They held photographs of their lost loved ones. They carried the little bag of belongings returned by the coroner — phones, wallets and notes that had been discovered in pockets, left on the rail, found in abandoned cars.

In 2005, finally moved, the bridge board agreed to build a barrier if the money came from outside sources. So began the slow churn of American bureaucracy.

There were environmental studies and engineering tests to ensure that the bridge could withstand any structural changes.

After all the talk of raising the rails, along came an idea borrowed from a successful suicide prevention system at a tall cathedral in Bern, Switzerland.

The nets were a compromise. The Bridge Rail Foundation was so named because it envisioned a higher rail. But to appease opponents who thought that high rails or fencing would mar the bridge’s iconic look or block the views for everyone else, nets became the chosen prevention method in 2008.

Then began years of political wrangling for money. By 2014, with an estimated cost of $76 million for the project, money was committed. There was a call for construction bids. Estimates came in much higher than expected and soon rose again, toward $200 million.

Hopes ebbed and flowed. More families joined the push. More money was found.

“Every month it was delayed, more people were lost,” Madden said.

Manuel and Kymberlyrenee Gamboa showed up to nearly every bridge district meeting for 10 years, driving the same 100-mile route to the bridge that their son had traveled, to plead for faster action.

“I said, ‘I’m going to be here at every meeting until something is done,’” Manuel Gamboa said. “‘It’s not your fault that he chose this bridge. But it is your fault that you don’t have something in place to try to prevent these people from coming here.’”

The nets were expected to take four years to complete. It will be nearly seven. The bridge district is embroiled in legal squabbles with the contractor.

But they are nearly finished, and emotions are mixed. Exhaustion. Satisfaction. Peace.

“On the one hand, it’s been 20 years for me,” said Muller, the Bridge Rail Foundation president. “On the other hand, it’s been 87. Which is staggering.”

True costs are impossible to calculate, even beyond the 2,000 or more who have died. Left behind are family members and friends, all the bridge patrollers, the accidental witnesses, the emergency medical workers, the body retrievers, the coroners.

How many have been forever changed by suicides on the Golden Gate Bridge?

Pat Madden is just one. Her mother loved the bridge. Not only did 11-year-old Doris attend the opening in 1937, but 61-year-old Doris was there for the massive pedestrian celebration of the bridge’s 50th anniversary, in 1987.

Image
The bridge at sunset.

The Golden Gate Bridge is a globally famous symbol of San Francisco and California. Not everyone sees beauty in it.

Madden thought she loved the bridge, too. But since Jesse’s death, she has avoided crossing it or going places in the city where she knows it might come into view.

“I remember when my husband and I went to back-to-school night early in Jesse’s freshman year,” she said. “I remember being in his English classroom, and it was evening and the bridge was lit up. And I said to my husband, ‘Look, what a beautiful view the students have.’”

She paused.

“It was in full view for Jesse that whole year,” she said.

Jesse, like so many others, was drawn to the bridge. There was nothing between life and death but a four-foot rail.

If you are having thoughts of suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline or go to SpeakingOfSuicide.com/resources for a list of additional resources.

https://www.nytimes.com/2023/11/05/us/g ... -nets.html

[swamidada]

Understanding suicide
Zafar Mirza Published November 17, 2023
The writer is a former SAPM on health, professor of health systems at Shifa Tameer-i-Millat University, WHO adviser on UHC, and member of the Pakistan Mental Health Coalition.

“No one commits suicide because they want to die”… “Because they want to stop the pain”.
Tiffanie DeBartolo

WHILE late Asim Jamil’s tragic suicide is fresh in minds, it is important to talk about the phenomenon by way of demystifying and destigmatising it.

I know three people in my life who took their own lives. One had been visibly in a low mood for some time before he hanged himself. Another, an adolescent, had a fight at home on some sticky matter and in the evening his body was found on a nearby railway track.

The third one was burnt in his house; there is speculation that the arson was deliberate, as he was living alone following a separation. Now that I have sat down to write on the subject, the faces of all three dear ones are coming to my mind, two cheerful, one sad. May Allah bless them all.

Suicide, “the deliberate act of killing oneself”, indeed can happen as a premeditated act or on an impulse. It can happen due to a stressful life situation or because of mental illness.

Sometimes people kill themselves when they reach a dead end in a crisis situation, e.g. Hitler, and sometimes it runs in the family, for example, the famous writer Earnest Hemingway had seven members over four generations who took their own lives. There are also instances of mass suicides. Suicide, hence, is a diverse phenomenon in terms of its occurrence, reasons and methods.

Mental disorders and suicide are closely related. Systematic reviews inform that up to 70 to 80 per cent of suicide deaths are attributed to a mental or substance use disorder. Relative risk of suicide in people with depressive disorders is highest followed by bipolar disorder and schizophrenia.

Psychological autopsy studies have shown that 40pc of suicides in China, 35pc in India, and 37pc in Sri Lanka are linked with the diagnosis of depression. However, an important study published from Pakistan in 2008 by Murad Moosa Khan et al found even stronger association between mental disorders, especially depression and suicide.

Of the 100 suicides the team studied, 96 were established as having psychiatric disorder through psychological autopsy and 79 out of these had depression as a principal diagnosis.

The most common methods of suicide were hanging, followed by poisoning. Firearms were used in 15pc of these suicides. And only three of these 96 victims were undergoing treatment, one from a psychiatrist and two from family physicians. These numbers speak for themselves and reflect the mental health care situation in the country.

Regardless of the causation, the incidence of suicide is increasing the world over. Globally, around 800,000 people take their own lives every year. Seventy-seven per cent of these suicides take place in low- and middle-income countries.

Globally, among young people between 15 and 29 years, suicide is now the fourth leading cause of death, according to WHO. Of all suicide deaths, 58pc occur between the ages of 15-49.

There is a generally accepted rule of thumb that for every suicide there are 10 unsuccessful suicidal attempts and for every such attempt there are 100 people who harbour suicidal thoughts.

According to the estimate of Mental, Neuro­logical and Substance Use Disorders, Burden of Disease study in Pakistan in 2019, there are 9.77 suicides per 100,000 population, which comes to around 20,000 suicides per year in the country. Going by the above, there would be 200,000 attempts and two million people with ideas of suicide.

These are high numbers. In the WHO Eastern Mediterranean Region, among 22 member states, Pakistan has the third highest rate of annual suicides after Djibouti and Somalia.

Lately, there have been reports about high rate of suicides from northern areas, especially in Gilgit-Baltistan and especially among young women. Some researchers have been probing the causes but until now there is no conclusive inference.

More women are educated than men in the main cities and nearby areas in GB, there are limited job opportunities and there are strong local traditions for not allowing young people to exercise their life choices. These and others may be the causes, and it may be simply that suicides are being reported more in the media from these areas because similar causes are not less prevalent in many other areas of Pakistan.

Until this point in the article, I have avoided using the word ‘commit’ with ‘suicide’ as ‘commit’ connotes a crime or a sin. There is a history of how suicide has been considered a crime in different countries. This was the case in Britain until 1961. P

akistan continued with it until Section 325 of the Pakistan Penal Code, a law from 1860 and a colonial legacy, was repealed in May 2022 by the Senate and in October 2022 by the National Assembly. It was a result of a successful national advocacy and lobbying campaign, ‘Mujrim Naheen Mareez’ launched by Taskeen Health Initiative, a Karachi-based not-for-profit working on increasing mental health awareness, providing free-of-cost mental health support and advocating for mental health policy change in Pakistan. Taskeen is also an active part of Pakistan Mental Health Coalition, an alliance of more than 100 members and organisations working to promote mental health.

Under Section 325, suicide was an offence. A person attempting suicide could be imprisoned for up to one year and could also be fined. The state could take over the assets of those that committed suicide. This would result in non-reporting, stigmatising and lack of treatment. The law has changed now and needs to be fully implemented.

Patients with mental disorders, with previous suicidal attempts and suicidal ideation need special attention. Suicide prevention is critical and complicated and professional help must be sought at the right time.

Suicide is also a taboo. Enlightened religious scholars especially need to play an important role in destigmatising suicide as more than 90pc of people taking their own lives are actually suffering from mental illnesses. They are patients, not sinners.

The writer is a former SAPM on health, professor of health systems at Shifa Tameer-i-Millat University, WHO adviser on UHC, and member of the Pakistan Mental Health Coalition.

Published in Dawn, November 17th, 2023
https://www.dawn.com/news/1790055

[kmaherali]

How Do You Serve a Friend in Despair?

My friendship with Peter Marks was created around play. Starting at age 11, we played basketball, softball, capture the flag, rugby. We teased each other, pulled pranks, made fun of each other’s dance moves and pretty much everything else. We could turn eating a burger into a form of play, with elaborate smacking of lips and operatic exclamations about the excellence of the cheese. We kept it up for five decades.

My wife has a phrase that got Pete just right — a rare combo of normal and extraordinary: masculine in the way you’re supposed to be masculine, with great strength and great gentleness. A father in the way you’re supposed to be a father, with great devotion, fun and pride. A husband the way you are supposed to be a husband, going home at night grateful because the person in the whole world you want to talk with the most is going to be sitting right there across the dinner table.

Over the years, Pete and I often spoke about the stresses he was enduring over the management of his medical practice, but I didn’t see the depths of what he was going through until we spent a weekend with him in the spring of 2019. My wife noticed a change immediately. A light had gone out; there was an uncharacteristic flatness in his voice and a stillness in his eyes. One bright June afternoon, he pulled us aside and told us he wasn’t himself. He was doing what he loved most — playing basketball, swimming in the lake — but he couldn’t enjoy anything. He was worried for his family and himself and asked for our continued friendship and support. It was the first time I had seen such pain in him — what turned out to be severe depression. I was confronted with a question for which I had no preparation: How do you serve a friend who is hit with this illness?

I tried the best I could, but Pete succumbed to suicide last April. This article flows from what I learned from those agonizing three years and that senseless tragedy. It reflects a hard education with no panaceas.

First, I need to tell you more about Pete. We met as kids at Incarnation Camp in Connecticut. We were campers and counselors together for a decade and remained close for life. At camp, Pete was handsome, strong, athletic and kind. There was an exuberant goofballism about him.

I remember once, in a fit of high silliness, he started skipping around the dining hall, singing, and leaping higher and higher with each skip. He tried to skip right out of the room, but there was a doorframe, probably about seven feet tall, and Pete slammed into the top of the frame and fell flat on his back. The rest of us, being 16-year-old junior counselors, found this utterly hilarious. Pete, also being 16, found this utterly hilarious, too. I remember him lying there in a fit of giggles, with a doorframe-shaped bruise forming on his brow.

One summer, Pete and I led a team of 12- and 13-year-olds in a softball game against a team of 14- and 15-year-olds. Our team miraculously won. In the celebration afterward, Pete, the boys and I piled on one another on the mound in a great wriggling heap of disproportionate ecstasy. We hugged and screamed and high-fived. I think our celebration lasted longer than the game — a volcano-like pile of male self-approval that is lodged in my memory as one of life’s moments of pure joy.

As the years went by, Pete did well in college, joined the Navy, went to medical school and became an eye surgeon. On evenings before surgery, Pete took great care of himself, didn’t stay out, made sure he had enough sleep to do the job that he loved. On evenings after surgery, he’d call his patients to see how they were feeling. His wife, Jen, a dear friend who was also at camp with us, used to linger around just to hear the gentleness of his tone on those calls, the reassuring kindness of his manner.

He seemed, outwardly, like the person in my circle least likely to be afflicted by a devastating depression, with a cheerful disposition, a happy marriage, a rewarding career and two truly wonderful sons, Owen and James. But he was carrying more childhood trauma than I knew, and depression eventually overwhelmed him.

At first, I did not understand the seriousness of the situation. That’s partly temperamental. Some people catastrophize and imagine the worst. I tend to bright-icize and assume that everything will work out. But it’s also partly because I didn’t realize that depression had created another Pete. I had very definite ideas in my head about who Pete was, and depression was not part of how I understood my friend.

Over the next months, severe depression was revealed to me as an unimagined abyss. I learned that those of us lucky enough never to have experienced serious depression cannot understand what it is like just by extrapolating from our own periods of sadness. As the philosophers Cecily Whiteley and Jonathan Birch have written, it is not just sorrow; it is a state of consciousness that distorts perceptions of time, space and self.

The journalist Sally Brampton called depression a landscape that “is cold and black and empty. It is more terrifying and more horrible than anywhere I have ever been, even in my nightmares.”

The novelist William Styron wrote brilliantly about his own depression in “Darkness Visible.” He wrote that “the madness of depression is, generally speaking, the antithesis of violence. It is a storm indeed, but a storm of murk. Soon evident are the slowed-down responses, near paralysis, psychic energy throttled back close to zero.” He continued: “I experienced a curious inner convulsion that I can describe only as despair beyond despair. It came out of the cold night; I did not think such anguish possible.”

During the Covid pandemic, Pete and I spoke by phone. In the beginning, I made the mistake of trying to advise him about how he could lift his depression. He had earlier gone to Vietnam to perform eye surgeries for those who were too poor to afford them. I told him he should do that again, since he found it so tremendously rewarding. I did not realize it was energy and desire that he lacked, not ideas about things to do. It’s only later that I read that when you give a depressed person advice on how to get better, there’s a good chance all you are doing is telling the person that you just don’t get it.

I tried to remind Pete of all the wonderful blessings he enjoyed, what psychologists call “positive reframing.” I’ve since read that this might make sufferers feel even worse about themselves for not being able to enjoy all the things that are palpably enjoyable.

I learned, very gradually, that a friend’s job in these circumstances is not to cheer the person up. It’s to acknowledge the reality of the situation; it’s to hear, respect and love the person; it’s to show that you haven’t given up on him or her, that you haven’t walked away.

Time and again Pete would talk about his great fear that he would someday lose his skill as a surgeon, that he would cease to be a healer, that he would lose his identity and self.

As Pete spoke of his illness, it sometimes seemed as if there were two of him. There was the one enveloped in pain and the other one who was observing himself and could not understand what was happening. That second self was the Pete I spoke to for those three years. He was analyzing the anguish. He was trying to figure it out. He was going to the best doctors. They were trying one approach after another. The cloud would not lift.

I am told that one of the brutalities of the illness is the impossibility of articulating exactly what the pain consists of. Pete would give me the general truth, “Depression sucks.” But he tried not to burden me with the full horrors of what he was going through. There was a lot he didn’t tell me, at least until the end, or not at all.

I never told him this, but there were moments during that hard plague year of 2020 that I feared that my own mind was slipping. Cheerfulness is my normal default state, but that year my moods could be dark and troubled. When your oldest friend is battling his demons, it’s natural to wonder about your own.

While I’ve devoted my life to words, I increasingly felt the futility of words to help Pete in any meaningful way. The feeling of impotence was existential.

After a while, I just tried to be normal. I just tried to be the easygoing friend who I always had been to him and he had been to me. I hoped this would slightly ease his sense of isolation. Intellectually, Pete knew that his wife and boys lavishly loved him, that his friends loved him, but he still felt locked inside the lacerating self-obsession that was part of the illness.

Perhaps the most useful thing I did was send him a video. My friend Mike Gerson, a Washington Post columnist, had been hospitalized with depression in early 2019. He had delivered a beautiful sermon at the Washington National Cathedral about his experience before he died of complications of cancer last November. Depression, he said, was a “malfunction of the instrument we use to determine reality.” Then he talked about the lying voices that had taken up residence in his mind, spewing out their vicious clichés: You are a burden to your friends, you have no future, no one would miss you.

ImageIn a sepia-tinted photo, David stands closely to Pete. Both wear suits and ties, and smile thinly.

David and Pete grew older together, but not old.Credit...Photo illustration by Thomas Sauvin; photograph via the Marks family

That resonated with Pete and gave him a sense of validation. He, too, would describe the obsessive-compulsive voices that would attack him from inside his own head. Mike also talked about the fog eventually thinning, at the glimpse of beauty or of love, and reminded Pete that “there is something better on the far side of despair.”

Still the clouds refused to lift. Jen had some wise words when I asked her what she learned being around him during those years. “I was very aware this was not the real Pete,” she said. “I tried not to take his periods of negativity and withdrawal personally.”

I wish I had bombarded Pete with more small touches. Just small emails to let him know how much he was on my mind. Writing about his own depression in The Atlantic last year, Jeffrey Ruoff mentioned that his brother sent him over 700 postcards over the years, from all 50 states, Central America, Canada and Asia. Those kinds of touches say: I’m with you. No response necessary.

“There are moments in our lives,” Honore de Balzac wrote, “when the sense that our friend is near is all that we can bear. Our wounds smart under the consoling words that only reveal the depths of pain.”

The years went by and medications and treatment programs continued to fail. Pete and Jen began to realize how little the medical community knows about what will work. They also began to realize that mental health care is shockingly siloed. Pete saw outstanding doctors who devoted themselves to him, but they work only within their specific treatment silo. When one treatment didn’t work, Pete would get shuttled off to some other silo to begin again. Jen recently emailed me that when she had a cancer recurrence, in the middle of Pete’s depression, she had a “tumor board” — three different cancer experts (a surgeon, an oncologist and a radiation oncologist) — who coordinated her care.

“In our experience, there is none of this in mental health,” she wrote me. In many places, there is no one looking at the whole picture and the whole patient. “If one more mental health professional tells me ‘Everyone did their best,’ I will scream,” Jen wrote. “If this is our best, it is not nearly good enough.”

Pete developed theories to explain why this had happened to him. He pointed to a series of traumas and neglect he had suffered at home as a child — events he had vaguely referred to during our friendship but had never gone into in detail with me until his final years.

He thought part of his illness was just straight biology. Think of it like brain cancer, he’d say. A random physical disease. I agree with some of that, but I’m also haunted by the large number of medications doctors put him on. He always seemed to be getting on one or getting off another as he ran through various treatment regimens. His path through the mental health care system was filled with a scattershot array of treatments and crushing disappointments.

Pete and his family joined us for Thanksgiving in 2021. By this point I was just trying to be as I always had been toward him, in hopes that he might be able to be as he always had been toward me. We all played basketball and board games and enjoyed the weekend. I felt some hope. But Pete appears in one of the photos that were taken that weekend, sitting on the couch, still-faced, enveloped in shadow. One afternoon, he asked my wife to pray over him in the kitchen, plaintively, grasping for hope.

The experts say if you know someone who is depressed, it’s OK to ask explicitly about suicide. The experts emphasize that you’re not going to be putting the thought into the person’s head. Very often it’s already on her or his mind. And if it is, the person should be getting professional help.

When Pete and I gestured toward the subject of suicide, we just talked about what a magnificent family he had, how much they all loved one another. Like Jen, I tried to tell him that this darkness would lift, though as the years went by and the therapies failed, his faith in this deliverance waned.

Pete was always the braver of the two of us. He was the one who would go cliff diving or jump over bonfires without fear. And he was never more courageous than over his last three years. He fought this malady with astonishing courage and steadfastness against a foe that would bring anybody to his knees. He fought it minute by minute, day by day — over a thousand days. He was driven by his selfless love for his family, which he cherished most in the world.

We had dinner a few days before he died. Jen and I tried to keep the conversation bouncing along. But, apparently, their car ride home was heart-rending. “How can I not be able to talk to my oldest friend?” Pete asked. “Brooksie can talk to people. I can’t.”

I don’t know what he was thinking on his final day, but I have read that depression makes it hard to imagine a time when things will ever be better. I have no evidence for this, but knowing Pete as I did, I strongly believe that he erroneously convinced himself that he was doing this to help his family and ease the hardship his illness had caused them. Living now in the wreckage, I can tell you that if you ever find yourself having that thought, it is completely wrong.

Depression can be bitterly ridiculous. Pete died a few weeks before his younger son’s college graduation, enmeshed by loving relationships and friendships.

It’s ridiculous that we still know so little about the illness and how to treat it. I find it unfathomable that it’s been well over a century since Sigmund Freud started writing about psychology. We’ve had generations of scholars and scientists working in this field, and yet suicide rates in 2020 were 30 percent higher than they were in 2000 and one in five American adults experiences mental illness each year. We need much more research funding to figure this out.

If I’m ever in a similar situation again, I’ll know that you don’t have to try to coax somebody out of depression. It’s enough to show that you are trying to understand what this troubled soul is enduring. It’s enough to create an atmosphere in which the sufferer can share her experience. It’s enough to offer him or her the comfort of being seen.

My friend Nat Eddy, who also accompanied Pete through those final years, wrote to me recently: “Do whatever it is you do to give the wives and children a break — an hour or two when they don’t have to worry that the worst will happen (and pray that it doesn’t happen on your watch, because that isn’t a given). Do whatever it is you do so you can look at yourself in the mirror. True friendship offers deep satisfactions, but it also imposes vulnerabilities and obligations, and to pretend it doesn’t is to devalue friendship.”

I feel sorrow that I didn’t know enough to do this more effectively with Pete. I might have kept him company more soothingly. I might have made him better understand what he meant to me. But I do not feel guilt.

Pete had teams of experts walking with him through this. He had his wonderful wife and kids, who accompanied him lovingly and steadfastly every day.

I’ve talked to Jen about this. Pete used to say he found talking to Jen more helpful than talking to any of the experts. So there is no reason for any of us to feel like failures because we could not alter what happened. Every case of depression is unique, and every case is to be fought with as much love and endurance and knowledge as can be mustered. But in this particular case, the beast was bigger than Pete; it was bigger than us.

I feel like I’ve read a lot about the grieving process for family members but not so much about what grieving is like when your friends die. Death and I were too well acquainted last year. I lost three good friends — Pete, Mike Gerson and my longtime “NewsHour” partner, Mark Shields. I’ve been surprised by how profound and lasting the inner aches have been.

Pete’s death has been a cause of great disorientation. He’d been a presence for practically my whole life, and now the steady friendship I took for granted is gone. It’s as if I went to Montana and suddenly the mountains had disappeared.

One great source of comfort has been the chance to glimpse, from time to time, how heroically Pete’s boys, Owen and James, have handled this loss. In their own grief, they have rallied forcefully and lovingly around their mother. Two months after Pete’s passing, my eldest son married. To my great astonishment and gratitude, Jen and the boys were able to make the trip to attend. At the reception, the boys gently coaxed their mother to join us on the dance floor. It felt appropriate since this is what we did at camp; dancing skeined through the decades of our lives. I have a sharp memory of those two fine young men dancing that evening, and a million memories of the parents who raised them so well.

If you are having thoughts of suicide, call or text 988 to reach the National Suicide Prevention Lifeline or go to SpeakingOfSuicide.com/resources for a list of additional resources

https://www.nytimes.com/2023/02/09/opin ... 778d3e6de3