Devika BrendonSuicide Awareness
The high prevalence of suicide and attempted suicide in Sri Lanka.
There is an epidemic of suicide around the world, and the age group identified as most at risk is the 15-29 demographic. In Sri Lanka, one person in 40 seeks suicide as a solution to their life challenges each year. This translates to 8 to 10 people a day. Globally, this number rises to 800,000 people a year. This does not include the attempts that go unreported. The leading cause of death is traffic accidents, but suicide is a close second. There has been a marked drop in fatalities, despite an increase in attempts, due to successful intervention and better access to health care and transport to medical facilities.
This article explores the high prevalence of suicide and attempted suicide in Sri Lanka.
Causal factors
In Sri Lanka, people who don’t want to live their current lives are often accused of seeking attention, for even expressing their suicidal thoughts. Psychologists and other counsellors have identified certain risk factors that operate in people’s lives which are each individually significant, but are potentially deadly in combination. These include relationship risk factors, including divorce, abuse (physical and emotional), chronic illness, sudden death, breaches of duty of care, and relationship breakup. Bullying, shaming, being targeted and trolled online are all increasingly normalised features of contemporary life which can cause discomfort to turn into despair.
Genetic factors, environmental, education, financial status, disability, desensitised and competitive culture, the idea that any vulnerability will be used against you, being made to feel like a burden: this generation faces new challenges, due to technology and social media, entering a world in which they are relatively inexperienced, and feel unsupported.
Community values which contribute
Community risk factors include the ongoing traumatic consequences of war, relocation, the high occurrence of natural disasters, debt, the endemic lack of insurance, workplace expectations, gender-based harassment and violence, the erasure of diversity in sexual orientation and gender identification, the stresses of unemployment or employment that does not match the person’s goals or skill sets and offer no pathway to professional development.
The feelings involved
In the interactive discussion, participants commented that they also felt socially and personally restricted in their individual choice and expression; specifically referring to the high degree of conformity required of them from a young age, which made them feel forced to comply with social stereotypes that they felt were outdated. Restriction of expression and distrust of emotional vulnerability and mockery of sincerity, openness and enthusiasm all contribute to people suppressing natural feelings in everyday life.
Health system risk factors: The sense of safety and support in the community is often compromised by direct experiences with health care workers, who work in understaffed environments, under a great deal of pressure. Sufferers experience being ignored, belittled, and even berated by hospital staff, who scolds them before offering any assistance or treatment.
‘You could have died and saved us the trouble of trying to look after you’.
This is a direct quote which was witnessed by a clinical psychologist who was in attendance.
The psychologist also commented on the lack of respect shown by healthcare workers, particularly to those in this situation.
The Danger Signs
The deficit in the support and caring attention currently on offer can be remedied by greater awareness on the part of the greater community. This would require a greater deal of awareness on the part of the general community of the danger signs and vulnerabilities shown by the people we interact with in our daily lives, both professionally and personally.
The inadequacy regarding adequate availability of specialised support enables people in the ordinary community to act as mediators between a suffering individual and the help that they need. Many people feel disqualified from intervening or offering help because they are not professionally trained. However, if they are observant and are willing to alleviate the suffering of others, they can learn certain techniques of listening which can materially assist friends and colleagues who may be in need of intervention and finding it can be difficult to articulate their needs (due to fear of exposure or shaming). Religious judgment is also a strong cultural shaming mechanism, used insensitively.
A Cry For Help
The suicidal condition is portrayed with insensitivity, shallowness and a tendency to sensationalise: as a sign of weakness and frailty in the media and (frequently) in popular culture. There is a conversation protocol that can be adapted for use in situations where people you know are displaying signs of distress or emotional disconnect. This involves prompts and cues which act as a gentle, but forceful, guidance and indication to the sufferer, and open up a pathway which will enable them to explore their options. This directly challenges the state of helplessness in which they feel they have no choices.
What an untrained person can do to recognise and intervene in a situation of distress:
There are simple rules that can guide you to an effective outcome. Listen to them:
Be present
Asking will open up space for them to talk
Give them space to get more support and make suggestions themselves. They may be feeling broken and frail, weak and powerless. Focus on their resilience and survivalism.
Do not make assumptions e.g.that they are ‘being manipulative’.
Do not overwhelm them with suggestions
Do not leave them alone or make them feel alone; follow up with specific times where you can be available to assist them/provide companionship/solace.
Do not offer any support you cannot give. Be accountable. Be clear.
One person in 40 commits suicide, but there are those who are ‘unsuccessful.’ The way suicide is talked about is often misleading. It is seen as an achievement, an option, an action. And sometimes is presented as a positive action. It is important, as an intervenor, to see it as an action which has a negative intention underlying it, which is to annihilate the living self.
Understanding the context in terms of cultural attitudes operating on the sufferer is crucial. Shame/blame/despair going unheard are often the triggers. (NOT a cry for attention).
‘Suicide first aid’ is a term used in emergency management.
First responder information – intervenors need not necessarily be qualified but must be aware. Personal biases and cultural sensitivity should be taken into account; withholding of judgment is crucial in positive management of people with suicidal ideation. Awareness of the limitations of media representations of vulnerable people is necessary.
Accessing a belief that suicide is NOT ‘inevitable’ is a must.
Suicide is defined as a permanent solution to a temporary problem. Help the sufferer see their problems as not permanent, even if they are chronic problems Try to turn what is seen as a disaster into something that is less intense and overwhelming: something situational, that can be remedied and solved.
There is an underlying condition which makes people more likely to seek suicide as an exit from a life which they perceive to be unbearable.
When this underlying condition is seen, a suicide attempt on the part of a vulnerable person can be seen as an emergence of unseen issues and thus an opportunity to deal with them.
The desire for suicide is the symptom of a real problem, and it is difficult to identify what exactly the problem is at first. It manifests as a web in which the vulnerable person is enmeshed.
The primary question for those who wish to help themselves and others is: how to detach the person from the issues surrounding them, and help them deal on a practical level with each at a time, until their context is clarified, and the core issues identified.
How to help
Look, Listen, Link – techniques to calm and connect with people who are in distress. Asking the following questions will open up a space for talking:
Can we talk about it?
Would that be okay with you?
How could I support you?
Is there anything we can do together?
What would you like to do?
Have you…
Have you been thinking of other ways of dealing with this or of other possibilities, maybe?
It must be very difficult.
Would talking about it make you feel better?
Call me up anytime and I will get back to you ASAP. These are the best times to contact me.
Do NOT promise anything you can’t follow through on, because this inconsistency erodes the trust of a person in distress.
The difference between suicidal thoughts and suicidal action is the difference between a sigh that life is difficult and a scream of annihilation.
