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General Conference

The Path Back

Brasilia, Brazil | Leonardo Siqueira

S uicide is the 17th leading cause of death worldwide. Among young people, it is the second. Each year, 800,000 people take their own lives, according to data from the World Health Organization (WHO), which considers the issue a priority global public health problem.

Although science has not yet fully understood the reasons that lead someone to end existence, researchers from the Universities of Glasgow (United Kingdom) and Harvard (USA) suggest that this drastic attitude is the result of a complex interaction of several factors.

For Rory O'Connor, from the University of Glasgow's Suicide Behavior Research Laboratory, and Matthew K. Nock, from Harvard University's Department of Psychology, personality, cognitive and social aspects, as well as negative or traumatic experiences play an important role in adopting suicidal behavior.

Survivors

"It was a shock," recalls Paloma (fictitious name), who lost her mother due to an overdose of medication. She is a survivor, a term given to children or close relatives of someone who committed suicide.

Contrary to what common sense might suggest, her mother showed no signs of sadness or depression on the day she took her own life. "She even seemed more willing that week," she says. The mother, Cristina, signaled having overcome depression and recent episodes of attempted suicide.

“Her record was very complicated. She even had a very heavy psychiatric treatment and the crises stopped. But there were symptoms of depression and her thoughts were very negative. Just before she died, her condition worsened because a loved one died. However, with therapy, she had improved a lot. Under the guidance of a therapist, she got involved in some projects, thought she was fine and, because of that, stopped taking the drugs, in addition to interrupting the treatment. However, nobody knew that”, she reveals.

Fatality took everyone in the family by surprise. “I was nervous, and a feeling of sadness hit me. I couldn't believe she did that,” says Paloma. Cristina left some letters for family members and took several medications. After that, time seemed to stand still. That was when Paloma's stepfather found her, almost breathless, and took her to the emergency room, but it was not possible to save her.

For language teacher Martina Tejano, who lives in the interior of São Paulo and has struggled for years with depression, the desire to take her own life is, in fact, a desperate attempt to end unbearable suffering. “Nobody wants to die. The desire to die is the desire to end that invisible and heavy pain. The problem is that the suicidal person has the perception that he has already exhausted his attempts to improve the situation. That is why the person is idealizing, not the act of killing himself, but of ceasing to exist” she explains.

She says that her symptoms of depression appeared after the loss of a baby. Even living with the disease, after her son's death and divorce, she moved to the United States, where she ended up also suffering in an abusive relationship.

“I thought it was just a 'complicated' relationship. I never told anyone what was going on at home. However, I suffered mental and emotional abuse, and I was raped by my partner ", reveals the teacher, who did not attempt suicide, but had to seriously fight depression and prejudice." I did a little psychotherapy, which helped tremendously, much more than medicine”, she compares, explaining how she dealt with depression. “It is a physical and mental struggle. It is learning to listen to your internal dialogue, analyzing it, and then showing you are in control of the situation”, she details.

Martina compares depression - the leading cause of suicide death - with a scratched record that repeats the same negative connotation. However, it is necessary to stop this “disc”. “Everything isn’t going wrong; this is [a] normal [part of life]. It (bad moments in life) doesn't just happen to me, it happens to everyone. I deserve a good thing too”, she stresses, by repeating thoughts that show the need for a mental restructuring.

Seeking help

In the study published by O'Connor and Nock in the scientific journal Lancet Psychiatry, in 2014, the researchers pointed out that most people who struggle with suicidal thoughts do not receive treatment. "Some evidence suggests that different forms of cognitive and behavioral therapies may reduce the risk of further suicide attempts," wrote the scientists, although they recognize that there is little evidence in the academic literature about "protective factors" against this problem.

For those who unfortunately mourn the loss of a loved one, a fundamental resource is to seek help from their own family. “Accepting help from family and friends who knew that person well is also beneficial,” says Paloma, the daughter who is now a motherless daughter.

However, perhaps the biggest challenge for more people to seek and receive assistance is to overcome the stigma surrounding the theme. Every problem that is a taboo ends up not being discussed as it should be by society. According to Psychiatrist Jorge Salton, Professor of Medicine at the Federal University of Passo Fundo (RS), recent losses, mental disorders, use of drugs and alcohol, family suicide history and bullying are some warning signs. However, several other factors can prevent the early identification of the problem, such as fear of talking about the subject.

Therefore, he believes that this matter needs to be dealt with honestly. “Such a taboo does not disappear without the effort of all of us. The difficulty in seeking help, the lack of knowledge and attention on the subject by health professionals and the idea that suicidal behavior is not a frequent event hinders prevention”, he enumerates.

Global epidemic

However, the challenge of facing this social taboo and a public health problem is a challenge for nations around the world. In countries like the United States, for example, suicide is the tenth leading cause of death. According to the WHO, this is a worldwide phenomenon, the greatest impact of which has been felt in the poorest and developing countries, where 78% of suicides in 2015 were recorded.

It is also in these countries that the numbers may not reflect reality so well because, according to the WHO, for every adult who takes his own life, there may be another 20 trying to do the same thing. Among young people and adolescents, the numbers are higher than the general average. Suicide already represents the second cause of death for people aged 15 to 29 years. According to the Youth of Brazil 2014 report, suicide rates had increased by almost 63% between 1980 and 2012, increasing the pace since the turn of the century, both in the general population and amongst young people.

In Ecuador, on the other hand, young people also appear to be vulnerable. “They are the ones who most commit suicide,” says researcher Lorena Campo Aráuz, a professor at the Salesiana Polytechnic University. According to the professor, the most common method for taking one's own life in the country is hanging and, among women, the ingestion of toxic substances.

She is one of the organizers of the book Etnografías del Suicidio en América del Sur (Ethnographies of Suicide in South America) and she recently published a study on the ritual process of signifying suicide in her country. “At the time of death, people reproduce scenes representative of their own life and culture,” he explains. “To speak of suicide is to speak of pain. What is evident is the ritual process, that of giving meaning to the act, and the social reactions to a 'voluntary' death” underlines the researcher.

Although South American countries have expressive suicide rates, they are low compared to the figures for Finland, China, Lithuania, Hungary, Russia, and South Korea. This does not necessarily mean that this public health problem here is less alarming, but that other countries have more reliable records of suicide cases. "They have more rigid records, which allow reducing the possibility of masking the data", adds the professor. In South America, many suicide cases end up being reported as an accident or an unknown cause, which compromises the reliability of national statistics.

Finding Solutions

To change this situation, many people around the world have been working to support those struggling with depression and suicidal thoughts. In Argentina, there is a Suicide Assistance Center (CAS); in Uruguay, the NGO Ultima Recurso; in Chile, Colombia, Ecuador, Spain and Portugal, the voluntary organization Telephone da Esperança and, in Brazil, the Life Valuation Center (CVV).

In the United States, institutions like the American Suicide Prevention Foundation (AFSP) and the National Mental Health Alliance (NAMI) offer support programs for survivors and people who deal with suicidal thoughts, in addition to up to date information and statistics on the problem in the country.

In the field of public health, countries such as Chile and Argentina have developed their own projects, such as the National Suicide Prevention Program, which adopts, among other action fronts, risk assessments, regional intersectoral plans, aid systems in crisis situations and training for health professionals.

There are also independent initiatives, such as the Live This Through project, by the psychologist, photographer, and writer Dese'Rae Stage. The work of this activist, who has already tried to take her own life, consists of disseminating a collection of portraits and stories told by those who survived an attempted suicide. In 2013, she raised $23,000 through a digital collaborative financing tool to travel the United States in order to take pictures and collect reports. As of August 2016, she had photographed 166 people in 28 American cities. Another vehicle for giving voice to this drama is the blog, The Suicide Project, through which people are encouraged to tell how they found the strength to give up suicide.

If on the one hand the internet connects people and offers help and motivation to individuals struggling to survive, the world wide web can also be a dangerous web for those who are vulnerable.

In early 2017, a game called Blue Whale appeared on social networks, in which participants were encouraged to complete a series of tasks. Among them is watching horror movies, mutilating oneself and, finally, taking your own life. The game, which appears to have been produced in Russia, spread across the world, caused some deaths, and took the sleep of parents and educators. According to the English newspaper The Sun, at least 130 deaths were associated with the game.

Also, in early 2017, a Netflix series on suicide put the topic up for discussion in society. The controversial production, 13 Reasons Why, was considered by epidemiologist John Ayers and four other researchers as irresponsible in addressing such a delicate subject. According to the scientists, in the 19 days following the launch of this series, the Internet search for terms related to suicide grew by 19%; much of the research was about details on taking your own life.

“It is not clear whether the searches preceded any real attempt. However, the search for information on accurate suicide methods increased after the series was launched,” they warn. The main criticism of these experts is that the production could have followed WHO guidelines on how to approach the topic in the media, which foresees not showing suicide scenes and including help service contacts in each episode of the series.

Prevention

Although the suicide epidemic is worrying, it can be combated and prevented. Sometimes, as already mentioned, the taboo on the subject prevents a more open discussion on the subject. The point is that asking about suicide will not necessarily encourage the act itself. On the contrary, talking about it responsibly is a way of offering shelter to those who think about taking their own lives and help to reduce the anxiety of those who do not see a way out of suffering.

Another preventive measure is to restrict access to dangerous objects and exposure to situations that may facilitate suicide. “It is necessary to make psychiatric treatments more accessible to the general population, considering that almost all cases of suicide are related to mental illnesses”, observes psychiatrist Jorge Salton, professor at the Federal University of Passo Fundo (RS).

"How can you help a person with depression? Invite them out, pull the person out of the house to distract them a little and laugh. If you have ever had depression, you know how hard the struggle is; so, sponsor someone who is experiencing the same problem. Talk about what you feel, exchange experiences and keep an eye on who you are following” advises Professor Martina.

If the causes of suicide are multiple, the prevention of this epidemic is also the result of numerous factors. Breaking the silence to talk about this topic can be the first step that will lead to other breakthrough steps.

This article was originally published on the South American Division’s Portuguese news site

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