More talk on suicide?

By Ravi Dev

(What else is there to say on suicides? The following is excerpted from a 2012 piece.)

Over the years, I’ve thought a lot about the phenomenon of suicide. It’s not I’m morbid. As an Indian Guyanese, I’m not sure how one can avoid such thoughts. With almost 200 suicides annually and more than three-quarters of them being Indians, there’s hardly a week you don’t get a call from some friend or acquaintance about someone they or you know who took their life. Who hasn’t been touched?

It’s been so ever since I can remember. Friends from other communities would joke: “What’s the name of an Indian cocktail? Malathion!”

But interesting enough when I started looking into the epidemic back in 1997 when Swami Aksharananda and I organised a “Conference on Suicide in Guyana”, I found in the villages of the Bhojpuri belt from where most of us had migrated, suicide had been a rare occurrence. The figures of the 19th century showed that Uttar Pradesh had a rate of 6.3 per 100,000, while in the countries to which we had been exported to labour on the sugar plantations, the numbers had skyrocketed to at least ten times that number. From Fiji to South Africa to the Caribbean, the authorities compiled meticulous records, even as they took no measures to deal specifically with the problem. It was just another factor that convinced them Indian immigration had to continue – to fill the gaps so to speak.

We’ve been highlighting this fact since 1997 to emphasise that whenever the authorities design a suicide intervention programme, they’d have to ensure that the cultural responses of Indians to the triggering mechanisms for suicide be taken into account. There has unfortunately been a studied refusal to take the hint. In 2011, noting that “multicultural societies require cultural sensitivity in all suicide prevention efforts”, the International Association for Suicide Prevention (IASP) designated the theme for World Suicide Day as: “Preventing Suicide in Multicultural Societies.”

It was emphasised that: “Risk factors for suicide vary across cultural groups. Knowledge about common risk factors in a society often stems from research in majority populations. However, in a multicultural context we need to be aware that some risk factors may play different roles in the suicidal process as well as in suicide prevention for some minority groups compared to the majority population…

“In addition, other factors that might have a different impact on minorities compared to the majority population are attitudes towards suicidal behaviour and suicidal people (eg taboo, stigma), religion and spirituality, and family dynamics (gender roles and responsibilities).”

It is therefore not surprising that as a result, as is the case in Guyana, “the strategy/programme is often aimed at the majority population and a specific cultural perspective or focus is missing”.

One problem arising with the traditional approach in dealing with suicide has been its strong linkage with mental health services. It’s not that the latter are failing people, but that they are not always the right service in the first place. If you are deeply distressed and feeling suicidal, then visiting a place seen as dealing with ‘mad people’ would be the last place you’d want to go.

Very few persons who committed suicide sought out available mental health workers.

The PPP Government made an attempt from 2007 to get ordinary individuals within communities trained in a ‘gatekeepers’ programme to be available to counsel individuals contemplating suicide. But the initiative appears to have been mothballed for reasons that are not clearly apparent. The Minister of Health, Leslie Ramsammy had confessed that funding had always been a constraint, but we had hoped with the enormity of the problem, this would have been rectified.

In 2012, there was a report of a Peace Corps volunteer working with a local group in Black Bush Polder, the Mibicuri Community Developers. He surveyed the community’s specific conclusions as to why they’ve become the ‘suicide nest’ of Guyana. In descending significance, these were “the inability to cope, domestic-relational problems, parents disapproving of their children’s boyfriends or girlfriends, alcoholism as a pattern, impulsivity, insufficient money to live on or to repay loans, easy access to agricultural pesticides/poisons, poverty/limited opportunities, manipulation to get what they want from parents and Satan/the Devil tempting them to do it”.

These may be compared to some general factors identified by the IASP – for instance depression, unemployment, poverty, oppression, marginalisation, stigmatisation, or racism. We have to connect the specific and general triggering factors, but, more importantly, identify why the particular response is elicited. Other groups probably face these same challenges, but their response is different.

An effective intervention programme has to answer this ‘why’ and offer alternatives to the “Indian Cocktail”.