The sadness and stigma of suicide

Medihelp

2021-09-10

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Almost a million people worldwide lose their lives to suicide every year. In 90% of these cases the victims, as was the case with the beloved American actor and comedian Robin Williams, suffered from depression for years.

Williams’ suicide followed those of other wellknown depression sufferers, including Nirvana lead singer Kurt Cobain, brilliant British fashion designer Alexander McQueen, world-famous author Ernest Hemingway and sexy actress Marilyn Monroe.

In South African famous people including potjiekos master and former Springbok athlete Andries Krogmann, violinist Annake de Villiers, journalist Chris Louw and the wife of President Jacob Zuma, Kate Mantsho Zumo, also chose suicide.

The picture in SA

South Africa has the eighth highest suicide figure in the world, with an average of 8 000 people who take their lives annually, or about 23 per day.

Every day another 230 South Africans attempt suicide unsuccessfully. Suicide is the third biggest cause of unnatural deaths in the country.

Although suicides occur throughout the year, there is an increase in suicide attempts from November to January, especially on Saturdays, Sundays and Mondays, explains Liam Taljaard, a researcher at the South African Depression and Anxiety Group (SADAG). In 60% of the cases the victims were depressed but never received any treatment. Sadag is a non-governmental organisation that has been specialising in this field for the past 20 years, and also runs a prevention programme for teenage suicide.

According to Taljaard the biggest risk group for suicide is people between the ages of 15 and 35. “The highest incidence is in the age group 25-35, but the incidence in the group between 15 and 24 years is increasing rapidly.”

Dr ST Potgieter, a psychologist from Bellville, says parents should be aware of teenagers’ emotions, especially during exams. “Every year during the exam period, specifically during the matric exams, teenagers in South Africa commit suicide. The elderly also has an increased risk of suicide. Senior citizens are often rejected and forgotten. They struggle financially, develop health problems and are very lonely.”

Potgieter says men who are retrenched and who struggle to find employment are often at risk of suicide. “Traditionally the man is the breadwinner of his family. When he cannot find a job he is robbed of his self-value,” he explains.

How serious is the problem?

Research and statistics on suicide in South Africa are outdated and not at all accurate, says Taljaard.

Although statistics regarding suicide in South Africa are released annually, these are based on expert assumptions and numbers from five different institutions. No register exists that can provide an accurate reflection.

According to the World Health Organization (WHO) the world average is 11,4 suicides out of every 100 000 people. The WHO’s figure for South Africa indicates that the national average here is higher, with 14,1 out of every 100 000 people committing suicide.

Taljaard has been involved in research conducted by SADAG amongst 20 000 learners countrywide. This research indicates that one in five learners have thought about suicide or have attempted suicide. Suicide is the cause of 9,5% of all unnatural deaths amongst teenagers, while 30% of all hospital visits by children are due to an attempted suicide. Yet less than 1% of psychiatric hospitals in the country are suitable for children. “This is an enormous problem and a huge gap in the health system,” says Taljaard.

‘Terminal phase of depression’

Prof. Lizette Rabe, the founder of the Ithemba Foundation that supports awareness of and research on depression, prefers to say that someone died due to depression.

“Researchers say suicide is the terminal phase of depression. Depression is a biological disease that causes a chemical imbalance in the brain. There is a dangerous decrease of the serotonin levels in the brain which results in the person not wanting to continue living,” explains Rabe.

According to her, more insight and understanding regarding depression is necessary in order to detach it from the “condemning stigma” carried by the disease. “People don’t discuss psychiatric diseases such as depression openly, despite it being a chronic disease that can be treated by a doctor just like many other diseases.”

Rabe, Head of the Department of Journalism at the University of Stellenbosch, lost her son to suicide. Fritz Hörstmann, a brilliant medical student, died in the prime of his life 11 months after he was diagnosed with depression. She also runs a website, survivorsofsuicide.org.za.

Rabe hopes that medical science can develop to the extent that one would be able to determine with a simple finger prick whether someone’s serotonin levels are dangerously low.

What’s the cause?

Colleen Strauss, CEO of the Sinoville Crisis Centre in Pretoria, says people are increasingly unable to cope with their problems, irrespective of how small these may be.

“People are easily overwhelmed, struggle to keep their head above water, and they keep their emotions bottled up. Eventually it all just becomes too much,” says Strauss.

Potgieter agrees. According to him people fall into despair easily. “It can be ascribed to several factors. One would be the high rate of unemployment which plunges people into financial difficulties. They experience a sense of powerlessness which is made worse by the aggressive climate in which we live,” he says.

According to Potgieter, depression occurs over a long period but is often only diagnosed much later because people tend to struggle internally while projecting a perfect image to the outside world. Strauss, who lost her mother to suicide, says people who decide to commit suicide often carry the idea with them for months. “They think it through before one day acting on the idea. Re-search indicates that the first attempt is often unsuccessful but that the seventh attempt succeeds,” says Strauss.

Taljaard says due to a lack of research it is very difficult to determine exactly why someone would decide to commit suicide. “One contributing factor is people’s increasing inability to cope with crisis situations. Only 10% of the people who commit suicide work through all the planning phases. Most of them carry the idea around, but eventually feel so overwhelmed that they take action,” says Taljaard.

According to him especially children are increas ingly exposed to drug abuse, peer pressure, bullying, violence, trauma and poverty, but at home they are not taught how to cope with this.

Beware of the warning signs

  • Any change in behaviour, withdrawal from family and friends.
  • Feelings of hopelessness or an empty feeling.
  • Death of a loved one
  • People who give away their possessions and/ or get their policies and other documents in order.
  • Changes in eating or sleeping patterns.
  • People diagnosed with HIV/Aids. At least 50% develop depression.
  • A family history of suicide or any other psychiatric disorders.
  • High-risk cases include people with family problems such as family violence, stressful events such as divorce or retrenchment, victims of sexual abuse or rape, drug and alcohol abuse.

Every threat is serious

Experts agree that no suicide threat should be ignored, even if it is made for the 20th time. “Every threat is a plea for help and should be taken seriously. Ask yourself if you are prepared to take the chance of ignoring it,” says Strauss.

Potgieter agrees that even indirect statements should be considered important, for instance when someone says he is planning on leaving permanently or when someone wonders what it would feel like being dead.
“You should be acutely aware of a specific plan. The more detailed, specific and feasible the suicide plan, the bigger the risk. Research indicates that people with a rigid thought pattern are more prone to suicide,” he says.

Taljaard says SADAG’s call centre handles an average of 400 calls per day, with a further 50 to 200 text messages.

Advice for those left behind

Friends and family left behind after a suicide often struggle with complex emotions. “Don’t keep wondering what you could have done differently. Acknowledge that it was the individual’s choice, speak openly about it and accept that it is normal to want to blame yourself. Get counselling,” Strauss advises.

Rabe says after a suicide loved ones are often shunned by others. “For a parent it remains a daily struggle. People look at you and feel grateful that it is not their burden to carry. You’re sitting amongst the remnants of your life, trying to pick up the pieces. You wake up with the pain and go to bed with the pain, struggling with it throughout the night,” she says.

According to Rabe 350 million people worldwide suffer from clinical depression. According to the World Health Organization depression will be the second biggest disease in the world by 2020, and the biggest by 2030.

For her it is important that as many people as possible speak openly about depression and the stigma attached to the disease. She is one of the authors of the book Hoop: ’n Troosboek (Hope: A book of comfort). In this book, Rabe, Alette Delport, Cizelle Louw and Marita Swartz tell their stories of how they had to rebuild their lives after losing a loved one to suicide. The book is dedicated to their loved ones, Piet, Louis, Hannes and Fritz.

The book is described as the “hard and cruel” reality of the four authors who each had to find a way to brave the storm, knowing there is no detour and no way out. Rabe says the book is for those who struggle to rebuild their lives after the unthinkable has happened, to know that a new day will dawn, even if it doesn’t feel like it today.

This book, compiled by Rabe, is the four women’s torch of belief, hope and love that they want to pass on in the name of their loved ones. It contains practical advice on how to survive the first traumatic days and weeks, the women’s own stories and tips on how to come to grips with life again.

Hoop: ’n Troosboek is published by Mzansimedia (mzansimedia@mweb.co.za) and you can also join the cyber community at survivorsofsuicide.org.za for those left behind.

According to Potgieter those who are left behind have to realise that mourning is a process which they cannot avoid. Anger against the person who committed suicide is normal, as are feelings of guilt.
“At the end of the process of mourning we have to treasure the good memories, but we must be able to laugh again and experience good times. Let the healing process begin, focus on the good times and the positive elements of your relationship,” he says.

  • Sonja Carstens’ brother-in-law, ao. Freddie Carstens, committed suicide three years ago by taking an overdose of pills together with alcohol. He suffered from depression but kept it hidden.

Help is just a call away

  • SADAG’s national toll-free suicide crisis line – phone 0800 567 567 from 08:00 to 20:00, send an SMS to 31393 or visit www.sadag.org
  • Get professional help. Your GP can refer you to suitable help or administer treatment.
  • Sinoville Crisis Centre – phone 012 543 9000. Councillors are available 24 hours a day.

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