A young Bollywood actress just ended up taking her life. There were loads of television programmes dealing with the stresses which young people face in the industry which forces them to take such a drastic step. There were some very extremely moving bytes of the actress’ mother who was trying desperately to contain her grief. And as per the usual custom, there were some pointed conjectures as to what immediate provocation could have resulted in such an extreme reaction.
What was significantly missing for me as a psychiatrist with an interest in forensic psychiatry was a debate on our attitude towards attempted suicide – which is pretty medieval to say the least. Let us for a moment hypothesise that the young girl had managed to survive this suicidal attempt. The consequences she would have had to face would have been extremely distressing. Attempted suicide is a crime under our statutes. 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. For that very reason alone, I comprehensively dismiss any epidemiological figures that are prevalent on the incidence of suicide. I personally have known of at least 50 cases of attempted suicide in the last year alone that came to my attention. None of them were ever medico-legaled for investigation. The reason for that is not difficult to fathom. Even a plea of diminished responsibility would have been unlikely to bring the actress any relief as my own experience suggests that the Indian courts are very reluctant to enforce the mens rea principle in the way they should.
I very strongly believe that the ruling is archaic and retrogressive and the sooner the Supreme Court revisits it the better. Treating a person who is driven to take such a drastic step as a hard-core criminal violates basic human dignity in a way few other actions do. I know for certain that 59 countries have decriminalised attempted suicide and it is time that India does the same. Perhaps through a public interest litigation.
The other dimension on which these TV discussions needed to be much clearer than they appeared to be were their failure to elaborate the socio-philosophical roots of suicide which could have given viewers a much better understanding. After all, it is only through proper understanding that we will be able to handle this problem.
French sociologist, Emile Durkheim had conducted some pioneering work on suicidology, the concepts of which are still very much in fashion whenever we try to make sense of this very distressing phenomenon. He was the first to declare that suicide should not be seen as a homogenous entity; there are according to him 4 types of suicides:
a. 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. He referred to this type of suicide as the result of “excessive individuation” – where the individual becomes increasingly detached from other members of his community. These individuals are essentially loners, not bound to any social group and have no adherence to traditions and goals.
b. Altruistic suicide: Where the individual is overwhelmed by the group’s goals and beliefs. Individual interest and goals takes a tertiary position. Hunger strikers who starve themselves to death fall into this category. I recall how upset my senior colleague and a pioneer in epidemiological psychiatry, Dr Krietman was when I referred to the Irish Republican Army hunger striker Bobby Sands who died as an example of “altruistic suicide”. Perhaps because the word altruistic has a very positive connotation. Suicide bombers would also fall into this category. If I recall correctly, the only exception Durkheim makes in his book is the death in a military war.
c. Anomic suicide: Moral confusion and lack of social direction, which is related to dramatic social and economic upheaval and lack of definition of legitimate aspirations through a restraining social ethic, which could impose meaning and order on the individual conscience. People do not know where they fit in within their societies. This leads to a perpetual state of dejection. A major social upheaval in society leads to “anomie”, which if unchecked can lead to multiple suicides.
d. Fatalistic suicide: Which is just the reverse 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)
As readers would note, this is a very useful model to conceptualise suicides/attempted suicides.
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 believe that this is deeply unfortunate. If samaritanism in its present form is unacceptable, it is about time a network is built on local traditions.
What is abundantly clear, though, is that it is nothing short of a phenomenal affront to human dignity to regard a vast majority of attempted suicides as criminal acts. Although I concede that a tiny percentage of them well may be.
In this context it was a welcome relief for professionals like myself to note that the government has declared that it is taking steps to decriminalise attempted suicide. This was long overdue and the government deserves to be complimented for bringing this distressing dimension of public health into focus. The disappointment for me, though, was that this landmark announcement was not given the importance it deserved by the media.
Suicide and attempted suicide are very important aspects of public health and if this step motivates us to focus our attention on the agony of those who indulge in it, a very important purpose would be realised. We need to try and understand this, rather than stick to the moralistic posture that has until now defined our sensibilities.
Summing up I shall refer to Durkheim once again:
For if society lacks the unity that derives from the fact that the relationships between its parts are exactly regulated, that unity resulting from the harmonious articulation of its various functions assured by effective discipline and if, in addition, society lacks the unity based upon the commitment of men’s wills to a common objective, then it is no more than a pile of sand that the least jolt or the slightest puff will suffice to scatter. – Émile Durkheim