BackStep away from that edge
Actor Robin Williams' suicide last week shook us all. How can you read the signs and prevent people from taking this extreme step?
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Kevin Hines leapt from the Golden Gate Bridge in California in 2000 at the age of 19. He survived.
Before jumping he stood on the bridge for 40 minutes. Later, in an interview to a news channel, Hines said he realized he had made a mistake the very moment he jumped. That mistake broke his body, but not his spirit. He seized his second chance at life, becoming a mental health advocate and speaker. The home page of his website, Kevinhinesstory.com, says: “Life is the single best gift we have ever been given…or will ever be given." Today, he travels globally to teach others the importance of preventing suicide and last year published his memoir, Cracked ... Not Broken: Surviving And Thriving After A Suicide Attempt.
Another Golden Gate Bridge survivor, Kenneth Baldwin, jumped off the bridge in 1985, when he was 28. He was depressed that he was not doing well professionally. He survived too, and said in an interview to a magazine soon after: “I remember my hands leaving the railing, the sensation of falling. I instantly realized I had made a mistake. I can’t tell you how frightening that was. I didn’t want to die."
“Suicide is almost always a decision made out of a feeling of hopelessness, worthlessness and the resulting helplessness that leads to depression," says Samir Parikh, director, mental health and behavioural sciences, Fortis Healthcare, New Delhi. “Depression is often at the root and if caught and treated in time can avert a lot many tragedies," adds Sameer Malhotra, department of mental health and behavioural sciences, Max Healthcare, New Delhi.
Dr Parikh recalls working with a survivor recently. She is 31, a successful entrepreneur, and tried to kill herself after a long-term relationship broke down. She swallowed sedatives that had been prescribed for her mother, who was under treatment for depression, and was fortunately taken to the hospital in time and saved. Dr Parikh says: “It was an impulsive act on her part when her fiancé humiliated her in front of her friends and broke off." She regrets the attempt and is doing well now, and is happy, really happy, at this second chance at life.
“Once out of that dark period of her life, she thought clearly and accepted that attempting suicide was a very irresponsible thing to do, as she had her whole life ahead of her, and also her mother to look after. Plus, she was doing so well professionally that later she confessed that what she thought unfixable was actually not that important a part of her whole being," says Dr Parikh. “Suicide survivors should meet a mental health expert. A lot of survivors realize that they have made a mistake by attempting suicide, are often relieved to be alive, and are glad to get treatment."
Depression, the hidden source
“The fact is that everyone feels depressed, sad, lonely and unstable from time to time, but when these feelings are persistent and disrupt normal life, then the condition becomes a depressive illness, often leading to suicidal attempts," says Meena Kasargod, consultant, psychiatry, Columbia Asia Hospital, Bangalore.
According to a 2010 report published in the Indian Journal Of Psychological Medicine, depression is the second cause of disability (after neuropsychiatric disorders, which also includes bipolar disorder) in the 15-44 age group and is projected to reach second place in the disability ranking for all ages by the year 2020. “Disability" here is defined as functional impairment which has an effect on a person’s normal day-to-day activity. These numbers exceed disability due to all forms of cancer and diabetes mellitus combined.
According to the same report, depression is associated with high suicidality. About 50% of individuals who have committed suicide carried a primary diagnosis of depression and mood disorders underlie 50-70% of all suicides. Union health ministry estimates state that 120,000 people commit suicide every year in India. And over 400,000 attempt it.
Dr Kasargod accepts that the suicide number is on the increase in India because of a lack of awareness of mental illness. “People just do not understand, and even if it (the mental state) is diagnosed there are just too many stigmas attached to them. Families, our society, do not accept them and often delay treatment," she says. Dr Parikh agrees: “I see at least four-five mental issues-related suicide cases every week at the hospital and often the problem worsens because the patient did not seek treatment early enough."
Dr Parikh recalls the case of a 34-year-old, New Delhi-based marketing executive who tried to hang himself after losing his job and falling into debt. He had a narrow escape. He was later diagnosed as suffering from clinical depression and was started on medication and psychotherapy counselling. “Plus, we involved his family (wife and brothers) to help him get his self- worth back," says Dr Parikh. “It took him three-four months to get sorted, and now although still on medication, he is back to work, and well on the way to recovery. His family has been counselled too and are trained to keep a lookout for the signs of resurfacing depression (see The signs of depression), as the beginning year or so is tough for everyone," he adds.
Alcoholism and other mental conditions like bipolar disorder too can be reasons people try to give up. Hines was diagnosed with bipolar disorder when he was 17. “Bipolar disorder is a condition in which people go back and forth between periods of a very good mood and depression," explains Dr Kasargod. “These mood swings can be very quick."
“The problem is that most of the mental health issues go undiagnosed for really long. While regular illnesses with symptoms like cold and fever, etc., get caught fast enough and get attention, as there is enough awareness about them, symptoms like mood swings, chronic sadness, excessive anger, etc., are most often dismissed as personality flaws, and ignored, often to great peril. No one thinks of getting these checked by a doctor," adds Dr Malhotra.
The aspect that shocked people the most about actor Robin Williams’ suicide was just how happy he had seemed on the surface. There were signs of course; he had been treated multiple times in the past for cocaine and alcohol addiction, and had had troubled marital relationships. The signs are always there, doctors say, it’s just that we often refuse to see them.
Dr Malhotra recalls the case of a 42-year-old corporate executive who is a father of two. “He was under a lot of pressure at work, his promotions were long overdue and finances were getting tough. He had become overly anxious, and suffered from severe insomnia." But in his case the signs were not ignored.
His wife realized he was depressed and kept tabs on him. One day, he left office, leaving his car behind, without informing anyone. When his wife called the office and was told he was not there, she began calling him up. He ignored her calls, but she did not relent and launched a search with the help of friends and family. Finally she got through to him and kept him engaged in a dialogue till someone reached him and brought him home. He had decided to kill himself by swallowing a bottle of sleeping pills he had bought from a chemist near his office, but the conversation with his wife delayed the attempt. He was immediately put into therapy.
“It is important for the family and friends to look out for any kind of impairment of functioning like mood swings, avoiding going to work, suddenly becoming withdrawn, anxious, irritable, sudden loss of interest in friends or staying off social media," says Dr Parikh.
Dr Kasargod says that a person showing these signs should be taken to a clinical expert as soon as possible. The prevention of suicide depends on it.
The signs of depression
—Meena Kasargod, consultant, psychiatry, Columbia Asia Hospital, Bangalore
Act if you find a friend or family member suffering from any of these symptoms:
u Frequent mood swings
u Lack of interest and motivation
u Irregular sleeping pattern (sleeping less or more)
u Sudden decrease or increase in energy
u Decrease of appetite
u Poor temper control
u Withdrawal from involvement in activities
u Very upset (agitated or irritated)
u Undue anxiety about financial, health or other issues.
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