Channel Surf – CNN-IBN

A debate on the rise in suicides in urban India. In just 20 minutes?

WrittenBy:Dr. Ashoka Prasad
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I just finished watching a debate on the seemingly increasing instance of suicides in India on CNN-IBN’s Face The Nation, moderated by Sagarika Ghose. The debate made me recall the great French sociologist Emile Durkheim who had conducted some pioneering work on suicidology and whose concepts are still very much referred to whenever we try to make sense of this very distressing phenomenon.

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The immediate topicality of the subject was a study recently published in the respected medical journal, The Lancet which seemed to suggest that suicide is the second most common killer in India amongst youngsters. The other inference drawn was that it was getting commoner even in 15 year old children and that within a very short span the incidence of suicides would outnumber maternal deaths which have long been regarded as the commonest cause of mortality in our country.

The lead author of the study, Vikram Patel is a dynamic psychiatrist who has spent many years working in India as well as in the United Kingdom where he holds a position with the University of London. Vikram has clearly done a yeoman service in attempting such a comprehensive research on this topic. One of his co-authors, Professor Laxmi Vijaykumar, was on the panel along with Dr. Achal Bhagat of Medanta hospital, Sandy Andrade a suicide counselor and Neil Paul, a drug and addiction counselor.

If the purpose of this debate was just to alert the population of the dangers of continuously relegating mental health to an unimportant pedestal, it succeeded! The experts quite articulately outlined how widespread the problem is and no one was left in any doubt  that very urgent steps would need to be taken to tackle the problems  that somehow compel an individual to take his/her own life.

But if the purpose of the programme was to critically appraise the study – its methodology and inferences – and give an analytical insight into the phenomenon of suicide, I think it failed. Perhaps the major factor was that suicide, which is so incompletely understood, is too complex an issue to be dealt with convincingly in a 20-minute programme, and Sagarika really needed to extend the debate.

Unlike most other issues on which I have written, this is one area where I have had professional experience for over 30 years. I have and continue to deal with suicides and attempted suicides and have had an opportunity to evaluate it from an international as well as Indian perspective. And if my memory serves me right, my first scientific paper was on violent suicides in Acta Psychiatica Scandonavica more than 30 years ago.

So while I applaud Vikram and his team’s efforts, I still have some concerns about the methodology – which although much more sophisticated than any other suicide research emerging from this country – still in my view fell short in attempting to address the variable we all know affects medico-epidemiological research in this country viz under-reporting. This tendency is specially pronounced in the psychiatric field where for various reasons the kith and kin of the deceased choose not to report such incidents.

Dr. Vijaykumar was asked by Sagarika if that could be a factor in this study and she was quite categorical in stating that it was not. From my own experience I would very respectfully disagree. In my own pro bono practice among the lowest socio-economic strata in my mofussil town I come across incidents of suicide at least once every 2 months. And I know for certain that these are never officially reported by the families. We all know the relationship of alcohol to suicide. What has not been sufficiently appreciated is the relationship of country-made liquor such as toddy to suicide – and from my own experience I know it is widespread.

That only serves to underline that the problem is even more widespread and intense than Vikram and his team have suggested!

My other observation was while the programme touched upon the signals that most who either attempt or complete suicide betray, it did not deal with one very crucial variable that does not allow us to accord attempted suicide (or para-suicide as my teacher Norman Krietman used to call it! ) the importance that it deserves. Attempted suicide is still regarded a crime according to a Supreme Court judgment! The fear of criminal prosecution leads to massive under-reporting of attempted suicides.

I very strongly believe that the ruling is archaic and retrogressive and the sooner the Supreme Court revisits it the better. In over 35 years in the profession, I have never been able to convince myself that treating a person who is driven to take such a drastic step as a hardcore criminal violates basic human dignity in a way few other actions do. I know for certain that 59 countries have decriminalized attempted suicide and it is time that India does the same. Perhaps, through a public interest litigation.

The other dimension on which the programme needed to be much clearer than it appeared to be was its failure to elaborate on the socio-philosophical roots of suicide which could have given the viewers a much better understanding. After all it is only through proper understanding that we will be able to handle this problem.

And here I have to revert back to Durkheim’s classic work. Durkheim was the first to declare that suicide should not be seen as a homogenous entity; there are according to him 4 types of suicides:

  1. Egoistic suicide: A prolonged sense of not belonging, of not being integrated in a community, an experience, of not having a tether, an absence that can give rise to meaninglessness, apathy, melancholy, and depression.
  2. Altruistic suicide: where the individual is overwhelmed by a group’s goals and beliefs. Individual interest and goals takes a tertiary position. The hunger strikers who starve themselves to death fall into this category.
  3. Anomic suicide:  Moral confusion and lack of social direction related to dramatic social and economic upheaval, whereby people do not know where they fit in within their societies. This leads to a perpetual state of dejection. A major social upheaval in the society leads to “anomie” which if unchecked can lead to multiple suicides.
  4. Fatalistic suicide:  Which is the opposite of “anomic suicide”. Here the individual suffers from excessive regulation!

These four types of suicide are based on the imbalance of two social forces: social integration and moral regulation. Durkheim noted the effects of various crises on social aggregates – war, for example, leading to an increase in altruism, economic boom or disaster contributing to “anomie”.
(Le Suicide by Durkheim, Chapter 4)

It is very clear that in times of economic upheaval, we can expect more “anomie”. The real challenge for us would be to stop “anomie” from resulting into suicide.

Another factor that could have been emphasised, but was not because of the time constraints was the lack of Samaritan culture in India, at least in peripheral towns like mine. A major reason for this is that Samaritanism is closely linked to Christianity. I personally believe that this is deeply unfortunate. Samaritan volunteers are deeply committed individuals and in my extensive dealings with them I have never found a single person with evangelical overbearance. If Samaritanism in its present form is unacceptable to the orthodoxy, it is about time they developed a network built on local traditions.

But as I conclude, I shall reiterate that in order to deal with this distressing problem, we need to adopt a more enlightened attitude than we have done so far. A good beginning would be an approach to the Supreme Court to decriminalise attempted suicide. I compliment Vikram and his team though, for alerting the country in the manner they have done.

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