By CAROL MATROO Sunday, September 23 2012

Attempting or committing suicide is oftentimes a cry for help. A person may be experiencing emotional turmoil, abuse, bullying, unemployment ... it all leads to one thing – a feeling of hopelessness.

According to the World Health Organisation (WHO), an average of about 3,000 persons commit suicide daily, and for every person who completed a suicide, 20 or more may attempt to end their lives. Suicide is among the three leading causes of death among those aged 15 to 44 years in some countries, and among 15 to19-year-olds, suicide is the second cause of death worldwide after accidents. At least 100,000 members of this age-group die as a result of suicide each year.

Suicide rates are also high among the adult population, with the highest rates among those aged over 75. The elderly are likely to have a stronger motivation and tend to use more lethal methods than those used by younger people, thereby achieving higher success rates.

In Trinidad and Tobago, there has been a significant increase in the number of reported suicides, with an average of 1,000 admissions annually related to self-harm or suicide at the nation’s major hospitals.

The Global School Health Report for Trinidad and Tobago (2007) reported that about 18 percent of students within the 13-15 year age group who were interviewed, had considered attempting suicide, and 20 percent of the female students were more likely to plan how they would attempt suicide.

Speaking in the wake of the marking of World Suicide Day (September 10), behaviour change consultant Franklyn Dolly said people who attempt are placed into three groupings, and the majority of them do so because they believe it gave them something in the afterlife.

“They give up their life for a bigger cause, although I can’t recall that we have had any. The second type is where people are depressed. It is like living in a black hole and there is no light. They don’t feel like there is anywhere else to go and to end their life seems to be a solution,” Dolly told Sunday Newsday.

He said while some people thought depression was just case of make believe in the person’s mind, depression is very real.

“Depression is a real issue, it is real to the person who is experiencing it. That experience is really dark for the people who are experiencing it. When it continues for a period of time you really see no solution. They have described those kinds of feelings to me, people who have survived it. It is real to the person as standing at a corner and getting bounced down by a car, it is that real to them. They feel that there is no hope,” he said.

“The treatment that we employ is that those who need medication, we give them medication, and the others receive counselling to help them to see at least that there is a little light and that they can go on another day, another week, another month.”

The third grouping, Dolly said, features men who have a sense of control. These men feel they are responsible for someone else’s life and therefore control it, he said.

“If they are losing that control over the person’s life, they are actually losing control of themselves and the only way to end it is to sometimes kill themselves. But more likely than not they have to kill the person because nobody else could take care of that person besides them. They cannot leave that person to suffer, therefore both people die,” he said.

“A lot of women who come in for counselling and are having difficulty with men who are the controlling type, said during the early courtship period it is really beautiful. The men go out of their way to be nice, they don’t want you walk, they will bring a taxi to drive you. If you have a problem at home, they buy a television for you to have in your own room. These kinds of things really makes a person feel proud.”

He said this is no game for this person because they really want to take care of the female. In their minds, he said, these men want what is best for their partner, until it reaches a point where they believe they know what’s best for her better than any other human being in the world, including the woman herself.

“What starts to happen is after a while the beauty of the courtship stops feeling good. Sometimes you want to do something on your own, you just want to stay home, or you want to go out with your friends, but they will find ways of not allowing that to happen because they will be there for you,” Dolly said.

“If you want to go out with your friends, they will come and drop you, come back and pick you up, calling you during the time that you’re there. All those little things are signs of power and control that are important to this person.”

Secretary of the Associations of Psychiatrists of Trinidad and Tobago, Dr Varma Deyalsingh, said any kind of drastic change in one’s behaviour and personality could be a strong indicator something.

Deyalsingh said TT had a relatively high suicide rate and is currently ranked 40th in the world and number one in the English-speaking Caribbean. He said there was a gender difference relative to suicide and suicide attempt, in that while more women attempt suicide, more men succeeded in completing the act. While the choice for suicide among 15-19-year-olds is hanging, the weedicide Paraquat is the number one killer among adults, with East Indians playing the major role, he added.

“Now we can’t change government and we cannot change our race, so if we know East Indians are more at risk, we have to try and find out why. Is it that we are genetically predisposed to suicide?” he asked.

“In the past there have been calls for the government of the day to ban or restrict the sale of this weedicide. However, if somebody really wants to kill him/herself, they could use any other object around the home like a rope, or electrical cord, overdose on medication ... Government should be able to legislate against persons who can get access to this poison.”

The doctor said there is what is known as a “suicidal belt” in TT, which includes areas from Sangre Grande, Rio Claro, Siparia to Caroni.

“If we know that these are the areas that have a high suicide rate, they would probably need better access to centres that can deal with stress, because we find that marital or relationship problems and family of origin disputes were two major factors that have been linked to depression which lead to suicide,” he said.

“The government could decide that in the suicidal belt area, let us put more centres with more mental health officers that could be available to deal with family disputes and relationship problems. In schools, have the counsellors deal with these issues where teens form romantic relationships.”

Deyalsingh said the family of origin factor may mean a teenager in a home acting out against rules in the home, or a dispute among family members over property. He said children who were sexually abused were 15-20 per cent more likely to commit suicide because they were in a quandary as to what to do, or were afraid to talk about what was being done to them.

“If you feel you’re worthless and can’t escape from the abuse, you’re trapped, you can be prone to commit suicide. People who are verbally and physically abused are three or four times more likely to kill themselves,” he said.

Deyalsingh said while some people may attempt suicide for attention, any attempt is an emotional cry for something, so all reports of abuse must be taken seriously. There are also those who commit the act without thinking and suicide pacts where both parties, usually male and female, decide to kill themselves together. This usually involves conflicts between the families.

People who are terminally ill and in severe pain also prefer to kill themselves than live with pain.

Children who tend to suffer from anxiety disorders or start substance abuse, such as using marijuana and alcohol, are at increased risk of attempting or committing suicide.

According to the WHO, one of the best ways of preventing potential suicide is to identify those who are at most risk. The strongest predictor is a history of previous suicide attempts or self- harm. There is a 30 to 40 times greater chance of suicide among this group than among members of the general population. About half of those who seriously consider suicide have also been diagnosed with some kind of mental disorder during their lives, he said. Depressive disorders and substance-related disorders, schizophrenia and personality disorders are all major contributors.

Lifeline, a non-governmental organisation, provides support to people who may be contemplating suicide by providing a hotline. All calls are anonymous and confidential.

One of the counsellors, who spoke anonymously, said they did not give any advice to their callers, but listened.

“People who call just want someone to listen, to lend a shoulder, to know that there is someone out there to give them some kind of support. The people who call in do not really want to kill themselves. If they wanted to kill themselves they would do so no matter what. They just want to know that someone cares,” she said.