BackBehind Puducherry’s suicide problem
For the last three years, the Union territory has recorded suicide rates that are more than three times the national average
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Puducherry: When she was a child, her grandmother would say: Don’t go near the yellow flowers. A few seeds in, and you will be dead.
The day the 20-year-old decided to take her life, she did exactly that—left her home without telling anyone, plucked a flower, rubbed out five seeds, crushed them in her palm, went back home and swallowed them. For two hours, she lay down on her bed, giddy. No one noticed till she started vomiting. Her mother rushed her to a hospital, but her daughter had fainted. The variation in heart rhythm pointed to yellow oleander poisoning, one of the commonest ways to commit suicide in Puducherry.
The Union territory of Puducherry has the highest suicide rate in India, according to the National Crime Records Bureau (NCRB). The all-India rate was 11 per 100,000 people in 2013. Puducherry reported a rate of 35.6, followed by Sikkim, Andaman and Nicobar Islands, Tripura and Kerala. For the last three years, the southern Union territory has recorded suicide rates that are more than three times the national average.
‘Family problems’, according to NCRB, caused 57.5% of suicides in Puducherry in 2013.
“In high-income countries, mental disorders are present in up to 90% of people who die by suicide. However, mental disorders seem to be less prevalent (around 60%) among those who die by suicide in some Asian countries, as shown in studies from China and India," according to Preventing suicide: A global imperative, a 2014 report by World Health Organization (WHO).
These figures need to be read with caution, says Vivek Benegal, additional professor of psychiatry, deaddiction centre, National Institute of Mental Health and Neurosciences (Nimhans), Bengaluru. “Many cases are not reported (in India) because of the stigma of mental health, of suicide and poor reporting system. Figures hide a lot of complexity."
Balan Stephen, head of psychiatry at the Indira Gandhi Government General Hospital in Puducherry, adds, “Suicide is always indicative of an underlying psychological disturbance. The reasons can be infinite. And all the psychological disturbances are aggravated by substance abuse."
According to the WHO report, India has the highest suicide rate in the world in the 15-29 age group.
The latest NCRB numbers confirm the WHO data, showing that the age groups of 15-29 and 30-44 were the most vulnerable in Puducherry. Representatives of local non-governmental organizations (NGOs) say the most common reason for teenage suicides is failed love affairs; in the age group 19-26, it is generally the burden of education loans and poor performance in colleges and universities; for people more than 26 years of age, it is extramarital affairs and alcoholism.
Unpacked, these may point to conservative Indian social attitudes toward relationships among teenagers and those out of marriage, as well as societal pressure to excel in academics at the expense of other areas of life.
Alcoholism and suicide
The 20-year-old’s story is typical of Puducherry. Her father is an alcoholic. The family has loans to repay. For as long as she can remember, her father had been drinking and beating her mother. Two weeks before her suicide bid, he started beating her as well.
Evidence from around the world shows a link between alcohol abuse and suicide.
“Alcohol dependence and abuse were found in 35% of suicides," says a 2007 paper by Lakshmi Vijayakumar, titled Suicide and its Prevention: The urgent need in India, published in the Indian Journal of Psychiatry. “Around 30-50% of male suicides were under the influence of alcohol at the time of suicide and many wives have been driven to suicide by their alcoholic husbands," the study says.
This is because alcohol abuse lowers the level of serotonin, a chemical produced by the human body that is thought to be responsible for maintaining mood balance. Lower serotonin levels are associated with depression.
“Suicidal behaviour is strongly determined by two important factors: aggression and impulsivity. A lower serotonin level has been implicated both for the aggression/impulsivity and suicidal behaviour," says another study, Putative Effect of Alcohol on Suicide Attempters: An Evaluative Study in a Tertiary Medical College, published in 2012 in the Indian Journal of Psychological Medicine.
Alcoholism is considered a family disease and not just something that affects an individual.
In 2010, India had an estimated 12 million dependent users (those who are addicted), 24 million harmful users (not addicted but can cause harm, for example, drunken driving or domestic violence after drinking) and 34 million habitual users (those who use alcohol moderately without causing harm), according to a 2011 study conducted by Nimhans.
“Alcoholism is a major public health problem in Puducherry. What is cheap and easily available here is hard liquor. For a person who is already vulnerable, this is dangerous," says Ravi Philip, psychiatrist at the Jawaharlal Institute of Postgraduate Medical Education and Research (Jipmer) in Puducherry.
Recalling his own experiences, Philip says, “When I first came here four years ago, I was looking for a phone booth. I found three liquor shops on the road before I found a phone booth."
However, easy availability of alcohol alone cannot be cited as a reason for suicide.
Whether it is a psychological or a social issue, suicide never happens due to a single reason, says Vijayakumar, director of Chennai-based suicide prevention centre Sneha. “A person may have committed suicide because he failed in his exam but not all who fail commit suicide. It is a combination of biological vulnerability, genetic component and brain chemistry that makes responses to stress different."
White Town, Black Town
Just two-and-a-half hours away from Chennai, Puducherry is a Union territory on the Coromandel coast, within the borders of the state of Tamil Nadu.
The town itself is divided into two. The world mostly knows it from what is known as the White Town. From beautiful heritage buildings to churches, 18th-century bungalows to private homes with bright yellow facades, quaint streets named after Suffren, Dumas or Goubert, to police constables wearing gendarme-style kepis—everything here is a reminder of the territory’s French colonial past.
White Town is mostly inhabited by well-heeled citizens, tourists, a small number of French nationals and people living in and associated with the Aurobindo Ashram, a spiritual community.
“Those people have a totally different lifestyle. And just under the 19th-century whitewashed lighthouse, you have a typical slum area," says Siva Mathiyazhagan of the NGO Trust for Youth and Child Leadership. “The four streets of White Town and almost 11 commercial streets don’t define Puducherry. But these streets are what the world imagines as Puducherry."
Puducherry has a sex ratio of 1,038 females per 1,000 males, a child sex ratio of 965 and an infant mortality rate of 22 per 1,000 live births—a promising picture compared with the national sex ratio of 943 females per 1000 males, child sex ratio of 918 per 1000 males and infant mortality rate of 50 per 1,000 live births.
But there is a visible difference of attitudes towards women in many parts of this tiny place. Abutting westernized White Town is the Tamil-dominated so-called Black Town, where women wear traditional Indian clothes and sport jasmine flowers on their hair. As an 18-year-old student in the Aurobindo Ashram puts it, “If you wear jeans or skirt, people think you have a ‘loose character’. Inside the ashram and in the White Town area, we can wear what we want to."
Dinesh Bhugra, professor of mental health at the Institute of Psychiatry at King’s College, London, says, “If you have traditional values and you are stuck in a modern structure, the social expectations are different. There is a discrepancy between achievement and aspirations and that hits a person’s self- esteem. They believe they have no way of bridging the gap except by taking extreme steps."
Here in Black Town, there is a feeling among many students that Puducherry doesn’t offer much by way of jobs, which in turn leads to a general feeling of negativity.
Till early 2000, Puducherry was an attractive destination for industries because of tax incentives. However, businesses started pulling out with the introduction of value-added tax in 2007. “The sops were the primary reason why investment was flowing in the past. After 2007, the writing on the wall was clear—Puducherry didn’t have much to offer," says B. Sriram, tax partner at consultancy EY.
“This is not a unique situation—post-tax holiday period is usually marked by this transition," adds Confederation of Indian Industry Puducherry chairman Syed Sajjadh Ali. “There was a sag period. However, the centre and state governments have taken up the matter and things are getting back to normal." Currently, the electronics and automobile businesses are doing well here.
“Every year, 140,000 students come out of engineering colleges in Puducherry and Chennai—obviously we do not have a job for everyone," Ali said.
At present, an estimated 20,000 people work in the factories of Puducherry. Ali said special measures were being taken to train students based on the needs of industry.
A Technology Training Centre has been launched with government support to hone the skills of young entrepreneurs and help develop the small enterprise sector in Puducherry.
According to S. Mahalakshmi, senior medical officer, health centre, at Pondicherry University, students are insecure since they see even PhD holders unable to secure jobs.
Pondicherry University and Jipmer are considering conducting a study of the causes of suicides in the Union territory and formulating a plan to tackle them.
However, so far there has been no substantial evidence-based study on the subject, in spite of the high rate of suicides in Puducherry.
Suicide among students
It was a normal working day in the middle of December at a leading university in Puducherry. At around 11.30am, students were asked to gather for a condolence meet—a 30-year-old PhD scholar had committed suicide. Nearly 100 people gathered, and faculty members told students about the need to share their problems, never to let their classmates live in isolation and how every problem has a solution.
Just a month ago, another PhD scholar from a different department had committed suicide. Before that, in another leading university, two professors had taken their lives.
In the recent past, the media has reported suicides at leading universities and educational institutions in Puducherry, and in October, the Madras high court asked institutions in Puducherry to form a committee to study reasons behind the suicides.
A medical student at a leading college, who everyone thought efficient, committed suicide after her MD admission results came out. Her rank was 10th. Her suicide note said she had decided to take her life because she had failed to get the first rank.
“A lot of these cases happen in institutes where there is a lot of pressure to excel. People know they have to excel but aren’t given the help to reach the goals set. People don’t share, mostly because their problem isn’t so dramatic that people aren’t already aware about it—but for them, it is huge. Subtle forms of harassment like ragging, bullying and subtle sexual assaults are taken casually and left unaddressed," says Jipmer’s Philip.
The literacy rate of the Union territory is 85.8%, much higher than the national average of 74.04%. But here, too, the evidence is not that clear-cut.
A. Shahin Sultana, head of the department of social work at Pondicherry University, who has been working on issues relating to counselling, says, “Even though evidence says literacy is high in Puducherry, the situation on the ground, in rural areas, is different. Illiteracy is still a major concern."
Even though Puducherry has emerged as one of the main educational hubs of south India, Sultana says medicine and engineering continue to be the most coveted careers, limiting the options for students.
Lack of support systems
It seems like the high rate of suicides in Puducherry has inured its people to the problem. A Jipmer study among hospital residents found how doctors from Puducherry were much more accepting of suicides than those from other parts of the country. “They think it’s normal to commit suicide because so many they know have done it," says V. Chitralekha, a social welfare officer at Jipmer.
The absence of support systems, such as helplines, is thought to be a contributing factor to the high rate of suicides.
A 15-year-old attempted suicide because her classmates teased her, pairing her up with a boy she didn’t like. She swallowed pesticides, thinking only one teaspoon wouldn’t kill her. She thought this was the only way she could spite the people who had teased her, not realizing she’d have to go through a painful process of treatment in the ICU for over a fortnight with doctors struggling to save her. Although she was vulnerable, she had no responsible adult to turn to—someone who would have talked her out of contemplating suicide.
Chitralekha says, “Suicide is sometimes an attention-seeking tactic, mostly for students. Among school girls, parents scolding is a reason for so many to commit suicide. Small conversations become a big issue."
Astonishingly, there is only one suicide helpline in Puducherry. Called Maitreyi, it is short of volunteers. Last year, it had 20 volunteers; this year, there are only eight. Authorities at Maitreyi say the helpline works from 2pm to 8pm five days a week rather than round the clock. “A shortage of volunteers is the reason why we can’t run it the same way as we used to," says
K. Kumar, a resource person at Maitreyi.
Some, however, believe that being a small town, the high suicide rate may just reflect the statistical norm. “Puducherry has a rate of 35/100,000 that is higher than a few other states and Union territories. The answer lies in the numerator and denominator, and is linked to population size," says
G. Gururaj, head of the department of epidemiology, Centre for Public Health, Nimhans.
South vs north
Several studies have found that southern states and Union territories have an average suicide rate that is higher than 15, while in the northern states, the average rate is as low as three. “This variable pattern has been stable for the last 20 years. Higher literacy, a better reporting system, lower external aggression, higher socioeconomic status and higher expectations are the possible explanations for the higher suicide rates in the southern states," according to a 2007 report in the Indian Journal of Psychiatry.
For instance, neighbouring Tamil Nadu, too, has a high suicide rate but, unlike in Puducherry, the state has introduced several intervention and awareness programmes for schools, parents and NGOs.
Shivanand Kattimani, assistant professor at department of psychiatry, Jipmer, says, “People of south India have a tendency to internalize their feelings. There is very little external aggression. Instead of directing their anger or frustration outside, they direct it towards themselves."
When she came to know about her husband’s extramarital affair, a 33-year-old mother of a nine-year-old, attempted suicide, not once but thrice. “I thought if he left me, I would have no reason left to live. Now I know it is foolish, but it hurt a lot. My parents were against the marriage and I had no place to go to," she says.
Praveer Ranjan, inspector general of police, Puducherry, says, “Emotionally, the society is vulnerable and charged. You can see it in everyday conversations. Within the society, there should be a mechanism to detect the mental state of people—an alternative support system—and it should be easily available."
Sultana from Pondicherry University agrees: “Socialization pattern is not very open here. The concept of community is missing."
Once, a young businessman telephoned Mathiyazhagan’s NGO, saying he was about to commit suicide because his business had collapsed. Since it’s not a suicide helpline, the people at the NGO weren’t sure of how to respond. But there was one thing they could do—listen to a man in distress. And because they listened, the simple act proved liberating. The young man took a step back, and is now looking for ways to establish a new business.
Often, such small shifts can mean the difference between life and death to someone on the edge—in this case, having someone there for you, at the other end of the line.
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