Satnam S. Atwal, M.D.
Of all the confounding attempts at explaining the vagaries of human behavior, none rivals the phenomenon of suicide. It truly is, in the words of Winston Churchill, a mysterious puzzle wrapped in an enigma, Each year more than 29,000 Americans ‘commit suicide, making it the 8th leading cause of death in the United States.
According to our religious teachings, life ‘a precious gift from God which should be lived, enjoyed and relished.
However, contrary to the teachings, we daily hear people discarding the precious gifts by throwing themselves in front of the fires of guns, hanging themselves from the ceilings or overdosing with the medications.
The suicide victims may think about ending their miseries by committing suicide, but their perceived relief generally leaves behind several unanswered questions which the surviving relatives or loved ‘ones have to probe helplessly and many a times in vain. Thus the tragedy of suicide is accompanied by unbearable sufferings from guilt, feelings of helplessness and mental anguish for the surviving relatives. Such tragedies in a way send chills to the entire community.
In the past several precious lives have fallen victim to suicide which is one of the potentially preventable causes of death. Therefore it becomes mandatory that we should attempt to put together the myriad parts of this jigsaw puzzle of suicide and think about ways to prevent the repetition of similar painful happenings.
Predictors Of Suicide
Although some suicidal patients may be genuinely death seeking, most of them attempt to communicate their pains, mitigate isolation, avoid squeal of status change, seek revenge and transmit a host of other meanings. Suicide is an impulsive and frequently unpremeditated act. It constitutes a death rate of 12.5 deaths per 100,000 U.S populations. Out of every 20 attempted suicide one succeeds,
Suicide rates in the United States, ranks at or near midpoint of national rates as reported to United Nations by industrialized countries. The rates range from as high as 25 per 100,000 in Scandinavian countries to as low as 10 per 100,000 in Spain, Italy or Greece. The suicide rates peak after age 45 in men and after age $5 in women. However during the last decade we have witnessed dramatic increase in adolescent suicides. Suicide is more common in persons who have a family history of suicide and who are socially isolated. Marriages reinforced by children reduces the risk of suicide,
Physical Health and Suicide
Chronic, lingering physical diseases predict higher number of deaths from suicide. Factors associated with illness and contributing to both suicides and attempts were: loss of mobility among persons from whom physical activity was occupationally or recreational important, disfigurement and chronic pain.
Psychiatric Illness And Suicide
It has been reported that majority (90%) of suicide victims were suffering from psychiatric illness at the same time of attempt. It has been estimated that only 10 percent of completed suicides were found to fall into an undiagnosed or unspecified psychiatric illness category. Two psychiatric diagnoses, namely Depression and Alcoholism have been found to be associated with 70 percent of completed suicides.
Depression causes plethora of symptoms ‘and makes life miserable for those who suffer from it. Feelings of worthlessness and hopelessness become overwhelming. Life becomes a painful existence without promise or expectation of relief. This pathetic state of mind, allures the suffer to think about ending the miseries by committing suicide.
‘One fifth of all the suicide victims were diagnosed as having bad alcoholism. Alcoholics of long standing seem to undergo an almost unlimited number of troubles in their home lives and still maintain the urge to renew relationships or form new ones. In suicides of alcoholics, however it is most often the case that suicide act closely follows one last incident in a string of violated and wrecked relationships.
Immigrants and Suicide
Immigrant population is at much higher risk for suicide as compared to U.S. born population. According to one of my estimates 18 per 100,000 Asian immigrants in this country kill themselves annually. Process of immigration results in special life changes or stressful life events for immigrants, this high level of life changes may reflect the difficult process of coping and surviving in the apically perceived American society. This may result in their persistent difficulties in adjustment. The net cumulative effect of these life changes is to ‘compromise both the immigrant’s physical and mental health; several studies have mentioned higher level of depression and paranoia among immigrant population. In one study, the prevalence rate of depression among Vietnamese population was around 50 percent. While 54 percent of them suffered from physical disorders. As there is direct co-relation between depression and suicide, the immigrant group is more likely to resort to self-inflicted harm after they perceive themselves becoming objects of contempt and ridicule.
Following are main reasons for higher suicide rates among immigrants.
Ethnic Differences and Linguistic Barriers
The language barriers, difference in color, unfamiliarity with local customs ‘often provoke overwhelming feelings of rage and worthlessness among immigrant population which is further exacerbated by presumed or real experiences of rejection and discrimination because of their inherited traits. Those who do not learn to adapt to the stresses of daily new life and ‘grow accustom to the deprivation of some of their rights, are at higher risk of suicide.
Sense Of Uprooting
Most Asian immigrants come from extended family system. In their native cultures, they maintained a very close knit family ties. There they enjoyed both emotional and social support. This intragroup cohesion was a validating force for them in their native land. However, at the time of immigration, pervasive sense of uprooting from their close knit environment prevails and persists thereafter. This results in character depreciation, increased identity confusion and suicide becomes a potential result.
Unfamiliarity with American
A culture Asian culture encourages interdependence and strong ties to the family system. On the contrary, American culture advocates independence and autonomy. What is more important here is the individual, not the family, groups or larger organizations. Thus process of immigration throws immigrants into a culture to which they are not familiar with. The uncertainty in the new environment tends to increase isolation and thus sense of worthlessness ‘grows. The anger generated by such exposures is internalized, predisposing them to fall a prey to suicide.
Acculturalization
Theory of acculturalization is also suggested for high suicide rates among immigrant population, Acculturalization describes the interactions of any dominate and non-dominate group in given set of people, Here in this case, the dominate group being majority American born citizens and non-dominate being minority immigrant class. It is felt that the interactions of these two ‘groups, the degree of conflict between them and eventual style of adaption of non-dominate group, determines its suicide rate. The adaptation style called marginality, where non dominate group refuses to participate in accordance to the dominate culture’s customs and also has minimum esteem for its own, is more likely to resort to suicide.
Social Stigma of Mental Illness
Mental illness is still considered to be a stigma all over the world, but much more so among Asian cultures. Mental difficulties are presumed to bring disgrace to the family and are not only hidden by the family members, but also completely denied. The results that, an individual continues to suffer from mental agony without seeking professional help, Their continued pain and anguish can ultimately culminate in feelings of ending such sufferings by committing suicide. To be continued
COLOMBO:
At least five Muslims were killed and 40 others injured 10 of them critically when Liberation Tigers of Tamil Eelam (LTTE) militants fired on residents of Kalmunai in eastern Sri Lanka a spokesman of the northeastern provincial council said cover telephone from Trincomalee.
Article extracted from this publication >> February 9, 1990
