Let’s talk suicide

In the early 1990s you didn’t talk about HIV/Aids in public.

It was, so it was thought, God’s way of punishing promiscuity, so who were you to comment on His way of restoring order in a wayward world?

Now the disease is viewed as a public health problem and we are all talking about it.

But there is another killer we are tight-lipped about. Suicide is its name and, just because you self-annihilate, it doesn’t mean it is less of a causal agent when it comes to death.

In fact, doctors are all agreed that, like many diseases, this is a growing global health problem.

According to The World Health Organisation (WHO), about a million people die annually worldwide from suicide.

The same number dies of malaria, making suicide among the top 20 leading causes of death globally. Every 40 seconds, a person is dying of suicide.

The laws of Kenya lump suicide together with murder under ‘offenses connected with murder and suicides’.

In the penal code, chapter 63 says that: “Any person who attempts to kill himself is guilty of a misdemeanour”.

Sadly, the only updated source of data on suicide is the Kenya Annual Crime Report for the year 2010. Under the category Homicide Crimes, suicide is listed alongside murder, manslaughter, infanticide and others.

And it is here that we discover that, in 2009, 265 Kenyans committed suicide compared to 162 in 2010, which fortunately shows a downward trend.

Because of the stigma associated with suicide, it is very likely that many more people took their lives but were not reported.

Twenty-five years ago, a study by the Kenyatta National Hospital reported that 3.4 per cent of patients that had been referred to its psychiatric clinic had attempted suicide.

Prof David Ndetei published a paper in 2010 from a study conducted in government hospitals in Kenya, which reported that one in every 10 patients had suicidal symptoms.

Again, the data was for specific groups, which, depending on illness, may feel more hopelessness than healthy ones.

However, a glance at media reports on suicide last month alone suggests that it is not such a hidden problem.

In Naivasha, six people died of suicide within four days. In the same month, a 13-year-old school boy committed suicide in Meru.

But media reports over-simplify the cause of a suicide. Remember the Arsenal fan who was reported as having committed suicide in May 2009 because his team lost to Manchester United?

And the girl who committed suicide because her parents did not allow her to attend a concert by dancehall reggae star Shaggy?

Those two reports created the impression that people who take their lives are rather foolish attention seekers.

However, evidence from across the world has shown that people rarely commit suicide because of a single development.

In Kenya, suicide and attempted suicide are treated as crimes. Often, suicide is viewed as a sign of weakness, rational choice, symptom of an illness, or the result of spirit possession.

A cause for worry is that suicide survivors who have to live with this stigma often attempt to kill themselves again.

The stigma is so entrenched that some churches will refuse to perform a funeral service for people who ended their own lives.

Relatives are not only weighed down by grief but also by guilt, wondering whether they could have done something to avert the suicide.

Family and friends of those who attempt or complete a suicide are devastated.

A case in point is Marko Cheseto’s. Early this year, a Kenyan student William Ritekwiang committed suicide in Alaska leaving his close friend, Marko Cheseto, severely affected.

So depressed was Cheseto that he wandered from his college room in Alaska and apparently got lost. When he was finally found two days later on November 9, he was so frost-bitten that his legs had to be amputated.

He called it a ‘personal crisis’ and felt the need to apologise to Kenyans, fearing that many would not be able to understand his emotional situation.

We took a while to talk about HIV/Aids but we need not take too long to talk about depression, hopelessness, loneliness and despair — which are the triggers of suicide — how to identify a colleague, close friend or relative in need and how to avert a suicide by helping them get the help they need.

“Suicidal people suffer in silence because of the stigma attached to the act, but they need to know that having such feelings does not make them any lesser human beings,” says Dr Lincoln Khasakhala, a psychologist at the African Mental Health Foundation.

And Dr Matthew Nock of the Department of Psychology at Harvard University adds that nine per cent of all people have serious suicidal thoughts at some point in their lives, and about three per cent actually make a suicide attempt.

A medical problem that kills a minimum of 162 people a year in Kenya may not appear to be serious, but when the problem is 100 per cent preventable, then that is 162 deaths too many.

We can take lessons from other countries with much higher suicide rates and which have set up prevention interventions.

This is a matter of great importance in Asian countries which have much less taboo attached to the topic.

In 2002 alone, about 331,000 people committed suicide in the Western Pacific region, comprising 38 per cent of the world’s total suicides and necessitating prevention interventions.

A meeting held in Manila in August 2005 bore two quotes from the WHO regional director Dr Shigeru Omi which provide a powerful description of suicide.

“Suicidal people are not weak, they are not crazy. Suicide is not a scandal. Suicide is not a personal failure. It is a tragedy of the family, the community, and the society at large,” he said.

“I asked a group of experts that included anthropologists, psychiatrists, sociologists and epidemiologists for their opinion.

“Of course, there were many factors and slightly different perceptions each expert mentioned to me.

“But there was one common denominator. They were unanimous in concluding that everything boils down to one thing — a lack of connectedness.

“And this lack of connectedness permeates modern life, impacting society at three distinct levels; the family, the community and the work place.” Dr Omi added.

Although there are seven billion of us on the planet, human beings have never been so lonely. Perhaps it is worse to feel alone in a crowd.

Urbanisation, mental illness, high divorce rates, the loss of extended family ties, extreme inequality and poverty as well as an increased emphasis on individual success all push people down a lonely path.

Other risk factors include experience of sexual or interpersonal violence. People who suffer social exclusion, for example, those released from prison, homosexuals and lesbians, and alcohol and drug abusers are known to have an increased risk of suicide.

Researchers have attempted to find neat predictors of people who move from thoughts of the act to suicide attempts, but a comprehensive list is hard to come by, especially across different regions of the world.

However, being female, young, less educated, unmarried and having a mental disorder were risk factors consistently found in those that attempt suicide.

WHO data for 2000 shows that suicide rates for the young are rather high across the world.

Although attempted suicides are high among women, data from the WHO collected from 1950 to 2000 shows that more men die of suicide-related causes than women.

Theories abound as to why women die less often from suicide yet they attempt more of it.

One explanation is that men choose more lethal methods. It is also reasoned that men abuse alcohol and drugs more than women which may aggravate their mental states.

High self-esteem and factors that build on social connectedness, especially with family and friends, being in a stable relationship and religious or spiritual commitment are all protective factors against suicide.

Early identification and treatment of mental disorders, especially depression plays a great role in prevention. Untreated depression is one of the strongest predictors of suicide.

Yet, according to Prof Ndetei’s study, about 42 per cent of depression patients in government hospitals did not receive any treatment while in hospital.

Although health workers may fail to notice the signs of depression, even if they did, the likelihood that a mental health practitioner would be on hand to treat them is very low, especially in rural parts of Kenya.

“Most mental health practitioners in Kenya are based in Nairobi. If a patient has to travel to (the city) for treatment, it becomes prohibitively expensive,” says Dr Khasakhala.

The WHO estimates that for every suicide death, there are at least 15 suicide attempts. So the 2010 estimate from Kenyan crime records of 162 complete suicides translates to 2,430 attempted suicides. Hundreds of these people are paraded in courts and handed severe jail sentences.

“Criminalising suicide may be one of the reasons that suicidal people do not speak out.

“When police are called in cases of attempted suicide, they should not put the person in custody but in a mental health hospital,” says Dr Khasakhala.

On November 7, a Nyeri court jailed John Wachira for three years for attempted suicide. Only John knows what drove him to such despair. Is a jail sentence in the best interest of John and those around him?