Local media recently reported that according to the Indian government, 180 Indian expatriates living in Bahrain have committed suicide since 2014. The report highlighted that “majority were male, young, single or divorced, unemployed and with a low level of education”. Furthermore, it was thought that “majority of the victims had chronic mental disorders, mainly schizophrenia, depression and substance abuse”. The report added that “the notable environmental risks were reported to be family problems, family history of suicidal behaviour and financial and relationship problems”. Another article reported 4 deaths in a period of 7 days and most recently a 40 year old mother who took her own life. Normal statistics quote the number of suicides, their demographic or socio-economic data, but they do not provide any insight into the cause or prevention. We could be surprised by other factors the data may reveal. Accordingly, the appropriate agencies can formulate a future policy on “prevention of suicides” and save some precious human lives. Thus, more research is required to evaluate some significant aspects of suicides and how (if any) underlying issues may be addressed. Most studies agree that a substantial number of those who commit suicide have suffered one mental disorder such as schizophrenia, depression or other mental disorders. Therefore, in this article, the author hopes to: 1) elucidate a better understanding of mental illness, 2) raise awareness about this terrible human tragedy, which in many instances, could have been prevented, 4) to reduce the stigma associated with such tragedies and 5) identify if there is any way we could prevent suicides in the future.
Definitions of Suicide:
"thoughts about self-harm, with deliberate consideration or planning of possible techniques of causing one's own death". (DSM-5).
CDC defines suicidal ideation "as thinking about, considering, or planning suicide".
Suicide is a global public health problem. Every attempt or a completed suicide (loss of life) has their own unique intention, methodology and cause. Over the years, much research has been conducted to ascertain the pathophysiology, yet suicide continues to occur in all societies. Frightening statistics; over 703,000 people die from suicide annually and a further 20 million people are engaged in suicidal behaviour or attempted suicide (parasuicide). Suicide is the fourth leading cause of death in 15-29 years olds with 77% occurring in low- and middle-income countries (WHO). Risks are thought to be a combination of many factors as well as an individual's threshold to face severe life events. Compounding factors include mental health difficulties, abuse, lack of a support system, inability to access assistance from the society and an utter sense of helplessness. One must also consider the scenario when someone is ready to sacrifice their dearest asset - precious life – that he/she has reached the end of their tether and an utter state of helplessness. Even at such a “late stage”, timely recognition of a potential suicide and defusing the extreme situation by appropriate intervention, can certainly save lives. Undoubtedly, suicide has been a highly stigmatising event for the family. The latter are often ridiculed by insensitive friends/relatives as a suicide survivor is deemed a ‘timid person running away’, or in extreme cases, ‘the victim has brought dishonour to the clan’.
Coordination and collaboration of multiple sectors and segments can encourage individuals with suicidal feelings to reach out. Often, the individual may have subtly mentioned a crisis or in other cases, mental health disorders go undiagnosed, are overlooked, or medication protocol not followed (leading to a relapse of depression/ schizophrenia). Below are two common mental health conditions, although the reader should note that these are not exclusive: each attempted or completed suicide is a complex emotional battle and every individual has his/her own unique motivation.
Schizophrenia
Schizophrenia is a multi-factorial and enduring psychiatric disorder that is characterised by major disturbances in thought, emotions and behaviour. Patients suffer from psychotic episodes which may manifest with positive (e.g hallucinations), negative (e.g anhedonia) or cognitive (e.g attention deficit) symptoms. This major mental illness can be controlled by medication that is administered as per a doctor’s instructions for an indefinite period. However, research indicates that with good management the prognosis is good: 20% will not suffer from a relapse. It has been estimated, 4% - 13% of people with schizophrenia will commit suicide and 18% - 55% will attempt it, while others might be unable to function within societal norms. To ensure that the individual is safeguarded from committing self-harm or suicide, there must be high compliance to treatment, and an adequate support network.
Depression
There are several models and hypotheses of Depression. One popular one is described briefly here; Beck’s model of depression suggests that individuals with depression are more likely to: 1) attend to negative stimuli within their environment (biased attention), 2) be more perceptive of negative stimuli (biased processing), 3) have more repetitive thoughts about depressive ideas (biased thought and rumination), 4) disproportionally reminisce gloomy events (biased memory) and 5) have negative internal representations of themselves (dysfunctional attitudes). These biases are often linked to an irregularity in a specific brain region that leads an individual to have depression. It is important to realise that the individual is unable to proactively break the cycle of the above biases without intervention. Such cases should be under specialist care.
Suicide is not confined to any ethnic group or gender. Among many intentions of a suicidal individual, one is to relieve themselves of unbearable mental/psychological anguish. While discussing mental health disorders, a word of caution, please leave the intervention to a trained individual, particularly as a depressed person’s negative thought process could be due to neural dysfunction. Social media has played a key role in raising awareness, but it has also highlighted the differences and shortfalls that is undesirable.
The covid pandemic has enhanced the use of digital technology with more of the population becoming accustomed to video-conferencing. This has resulted in vast opportunities to offer virtual mental healthcare. Data indicates that the pandemic may not necessarily translate to an increase in suicide rates, especially in countries like Bahrain where short-term financial safety nets, medical intervention for everyone and public support in distribution of food and sanitary items has eased the burden on those most affected. However, the circumstances for expatriate workers are slightly different. Most of their families are financially reliant on them and job losses during the pandemic, one conjectures, may have exasperated their inability to offer monetary support which may have led to attempted and completed suicide. Hence, in depth, scientific exploration of all the latest suicides is absolutely essential to understand the real issues behind these unfortunate deaths. The sooner it is done, the more rewarding it will be.
Further analysis can help in addressing other issues such as, 1) mitigating economic hardships, 2) minimising damage to job or career prospects, 3) introducing suicide prevention interventions, 4) media messaging to support coping mechanisms and emotional resilience, 5) being more culturally sensitive and 6) presenting social cohesion opportunities within different ethnic and socio-economic groups to promote unity and healing.
Finally, it must be noted that there are a number of qualified Psychiatrists, Clinical Psychologists and Psychologists in Bahrain who must be consulted for a professional diagnosis and treatment for matters regarding mental health.
Nivedita M. Dhadphale. MSc (Psychology) (Strath), MBA (Strath).
PGD Psychology and Neuroscience of Mental Health (IOPPN, KCL)
Assistant Lecturer in Psychology at the British University of Bahrain.
Member British Psychological Society (BPS), Fellow Chartered Institute of Marketing (CIM),
Member Applied Neuroscience Association (ANA).
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