An Unfortunate Journey from Hopefulness to Hopelessness
Everyone is surprised by the fact that how a powerful IPS Officer, a Reputed spiritual guru can commit suicide. As they were the one; who were giving hopes to multiple people around them. HOW CAN THEY even think of committing suicide? Now-a-days in addition to that we see people from farmers, comedians, LGBTQ population, football fans, students, adults and even Senior Citizens taking such a drastic step.
What are the reasons? What is the root cause? Why is this happening? Is it preventable?
Yes. It is preventable. Being the psychologist that’s the major reason I thought I need to write something concrete about it. A very simple answer to the question asked above is, most of them who committed suicide were patients of depression and to be very precise “AN UNDIAGNOSED DEPRESSION”. Answer seems very simple but then why we are not being successful in preventing it? Let’s discuss about it in more detail.
According to World Health Organization (WHO) Depression is the leading cause of ill health and disability worldwide. More than 300 million people are now living with depression, an increase of more than 18% between 2005 and 2015. Depression is a common mental disorder, characterized by persistent sadness and a loss of interest in activities that you normally enjoy, accompanied by an inability to carry out daily activities, for at least two weeks.
Depression also known as Major Depressive Disorder (MDD)/Clinical Depression; is a mental illness defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM provides the diagnostic criteria used by doctors for major depressive disorder (MDD) and all mental disorder diagnoses. This again states that above mentioned symptoms should at least last for two weeks for diagnosis of Depression.
According to American Psychiatric Association (APA) Depression symptoms can vary from mild to severe and can include:
- Feeling sad or having a depressed mood
- Loss of interest or pleasure in activities once enjoyed
- Changes in appetite — weight loss or gain unrelated to dieting
- Trouble sleeping or sleeping too much
- Loss of energy or increased fatigue
- Increase in purposeless physical activity (e.g., hand-wringing or pacing) or slowed movements and speech (actions observable by others)
- Feeling worthless or guilty
- Difficulty thinking, concentrating or making decisions
- Thoughts of death or suicide
Symptoms must last at least two weeks for a diagnosis of depression.
Also, medical conditions (e.g., thyroid problems, a brain tumor or vitamin deficiency) can mimic symptoms of depression so it is important to rule out general medical causes.
These can also be considered as Warning Signs. Reputed mental health organizations, manuals such as World Health Organization (WHO), Diagnostic and Statistical Manual of Mental Disorders (DSM), American Psychiatric Association (APA) and Indian institutes such as National Institute of Mental Health and Neurosciences (NIMHANS), Bombay Psychiatric Society and Counsellors Association Of India(CAI) also support the symptomatic details and duration mentioned above.
If you have noticed the duration carefully it talks about SHORT PERIOD OF ATLEAST TWO WEEKS. It simply means that a person can be very brave otherwise, may have done very courageous and inspirational work in PAST, but that does not IMMUNE a person from depression or any other psychological disorder. Just as a non smoker can have cancer; a highly motivational speaker can suffer from depression and it’s evident.
If we analyze critically life of these famous personalities, in many interviews given by people who were close to them, it came out that they were showing signs of depression and some of them were masking their emotions which went UNNOTICED by people around them. As they were suicides, a suicide note was written, a gun given for their own safety was used to take their own life in cruel manner. And it symbolizes that it was a highly planned decision. There was financial loss or severe health issues in their LAST DAYS. Identification of depressive thoughts could have helped us to save them but unfortunately that didn’t happen.
It’s been observed over the period that in reality more number of females ATTEMPT suicide but males become successful in COMMITING the same as the means they use for suicide are more hazardous.
Risk factors for suicide include:
- Family history of mental disorder, depression, substance abuse or any combination of these factors
- Prior suicide attempts
- Family history of suicide
- Domestic violence, including physical or sexual abuse
- Exposure to others with suicidal behavior
Suicide is a state of mind indicating its temporary urge which can be diverted in a healthy manner. Frustration intolerance and self defeating believes can be major contributing factors from the point of view of Rational Emotive Behavioral Therapy(REBT) developed by Dr. Alber Ellis.
General population is only evaluating a cause of suicide on final trigger presented in front of them such as less marks in board exams, losing the football match, failed marriage, or unsuccessful career. But the actual trigger can be something else or maybe they have touched a threshold of tolerance and committed suicide which went unnoticed.
There is a difference between distress, disorder and disability for understanding this issue in greater detail. This differentiation is also related to duration, intensity and frequency of symptoms. It indicates that only duration is not the indicator of depression but intensity and frequency are also one of the significant indicators of same.
Psychological distress is a general term used to describe unpleasant feelings or emotions that impact your level of functioning.
The latest edition of the American Psychiatric Association’s diagnostic manual, the DSM-5, defines a mental disorder/Psychological disorder as:
“…a syndrome characterized by a clinically significant disturbance in an individual’s cognitive, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental process underlying mental functioning. Mental disorders are usually associated with significant distress in social, occupational, or other important activities.”
A psychological disability or psychiatric disability refers to a spectrum of mental disorders or conditions that influence our emotions, cognitions, and/or behaviors. Psychological disabilities may include depression, anxiety, schizophrenia, and bipolar disorder.
DEPRESSION IS TREATABLE
Sometimes one moment is enough to save yourself but it may not be a depression disorder at that time. It can just be a fleeting thought indicating distress. It may get converted into an impulsive act if intensity increases. Risk assessment needs to happen at that time.
- Intent: Severity and significance of a person’s need to die.
- Ideation: Thoughts, images and other manifestations of their wish to die.
- Plan: Deciding means for execution of ACT.
- Preparatory Behaviour: Engaging in the actual ACT.
To give a living example “Vitthal Kamat” Head of Kamat Hotel Chain and Owner of “Orchid Hotel” admitted in his recent interview that he also came across thought of committing suicide after a huge loss in his business. Fortunately he saw one man working on a construction site just opposite his hotel. This man was working on one of the top floors without any Safety gear. The fact that, a person can risk his life just for 6000/- ; gave Mr.Kamat courage to deal with that challenging situation; and NOT to commit suicide.
- Letter to Self
- Introspection and self-reflection
- Fact and Fiction Analysis
- Generating alternatives
- Increasing social support
- Coping cards involves creating useful Affirmations
- Engaging in pleasurable activities like hobbies which they enjoy
- Psycho-education as in “Why a person is still alive? And what they wish to do?”
- Jar Activity suggested putting photographs of all people close to our heart, any inspiring poem etc.
- Hope Kit introduced by Dr. Aaron Beck in his Cognitive Behaviour Therapy (CBT) comprises items that serve as visual and tactile reminders of reasons for living. For example, letters from friends, inspirational music or poems, and prayer cards. These can be kept in an easily accessible place so that patients can utilize it in times of crisis.
- Self Compassion: Gently challenging their inner critical voice & replacing it with an inner compassionate voice. Significant research was done by Dr. Kristin Neff on same in last decade. http://self-compassion.org/
What to do?
- If you are suffering from one or more symptoms then please share your thoughts and feelings with people who are close to you or take help of a mental health professional and vent out. Awareness is the first step and then dealing with those emotions in a psychologically healthy manner is more important than that which can develop insight and change in dysfunctional behavior.
- If you are a person who is well wisher then; please avoid giving advice and sympathy, Only Empathy is needed. It means that you will be an active listener and understand another person’s thoughts, feelings, and condition from their point of view, rather than from your own.
- Take it seriously
- Do not leave the person alone
- Listen without judgment
- Do not promise confidentiality
Whom to contact?
Depression is treatable, with therapies or antidepressant medication or a combination of these. A person experiencing depression related symptoms mentioned above can firstly contact a counselor/Psychotherapist OR a psychiatrist. But if they are not comfortable to visit any mental health professional physically they can resort to help lines or online counseling options to vent out and try to address the issue in a more constructive manner.
Please remember they just need your support, not your doubt or piece of advice. A helping hand which, can empathize with them and understand them. I would like to conclude my article with the help of one realistic affirmation I truly believe in; which is helpful for a person to keep their mental health intact:
Grant me the serenity to
Accept the things I cannot Change,
The courage to change the things I can
wisdom to know the difference.
Ms.Netra Kher is a Counseling Psychologist with Disha Counseling Center