Earlier this month, I had spent a good twenty four hours praying and hoping against hope that there must have been a mistake somewhere. The calm, poised, and brilliant poster boy from the world of coffee could not even think of suicide.
Of course, the prayers and hope were all in vain. And as my heart went out to those who were left behind when Siddhartha VG moved on to another realm, my mind immediately thought of SPEAK, an initiative of MS Chellamuthu Trust and Research Foundation, the well-known mental health NGO based in Madurai in south India.
Established in 2018 by Dr. Nandini Murali and based on her lived experience as a survivor of suicide loss, SPEAK works towards changing conversations on suicide and promote mental health.
As the world reels with enough stress factors that lead to mental health issues, SPEAK reaches out to people with suicidal thoughts and survivors of suicide attempts, or those who have lost a loved one or close friend to suicide.
Here are some snippets of my conversation with Dr. Nandini Murali:
Swapna: Thanks for agreeing to talk to Eyra. First of all, I must share my deep appreciation for coming forward, mobilising and setting up SPEAK. The increase in number of people who die of suicide is alarming. The ecosystem today is highly stressful and the amount of loneliness and grief that a suicide leaves behind is immense. Would you like to share some insights on the suicide rates in India? And what according to you are the key causes?
Nandini: Thank you Swapna. Every suicide is a tragedy. Suicide is a preventable public health problem. It cuts across demographic barriers and no one is immune to it.The statistics are indeed grim. According to the World Health Organization (WHO), every 40 seconds one person dies of suicide. Globally, 800,000 people die of suicide every year. Of these, 33 percent are from India. This means that around 300,000 people die of suicide every year in the country. And we also need to remember, that these are based only on instances of reported suicide. Many deaths by suicide are not reported because of the stigma around suicide.
Another concern is that India has the highest rates of suicide among women in the world, accounting for 40 percent of female suicides. Two out of every five women who kill themselves are from India. Suicide rates for women in India are twice that of the global average. The Suicide Death Rate (SDR) for women in India is 15/100,000 (15 women out of every 100,000 women India die of suicide) compared to the global average of 7/100,00. Most women who die of suicide in India are married. And compounding the scenario, India has among the highest rates of teenage suicides in the world. (Lancet Public Health 2017).
Contrary to the popular stereotype, there is no single ’cause’ for suicide. Rather, suicide is multi-factoral and complex. This simply means that there are several risk factors that propel a person to suicide. In other words, a convergence of several risk factors such as genetic, biological, psychological and environmental cause a person to attempt suicide, with fatal or non-fatal consequences.
For instance, untreated depression, substance abuse (alcohol or drugs), financial stress, death of a family member or close friend, suicide in the family, poor performance in exams, bullying and harassment in schools and colleges, gender based violence are potential risk factors that can trigger suicide.
Hence it is simplistic to search for that one reason why a person dies of suicide. For example, a student dies of suicide and the ‘reason’ being cited is poor performance in exams. However, that is only a trigger that rides on several other underlying risk factors that predispose a person to commit suicide.
Swapna: It requires a great amount of strength and you are one courageous woman to step out from your personal grief and address the issue thread bare. Would you like to tell us about why you chose to come out and set up SPEAK?
Nandini: Until my husband died of suicide, I believed it was something that happened to others. I naively presumed that it could not happen to me; in my family. My only brush with suicide was news reports in the media and a dear friend in school whose parent had died of suicide. Even then as a young girl, it struck me that my friend’s family refused to discuss it. It was cloaked in an iron curtain. I sensed there was something shameful about suicide.
Ironically, when faced with the suicide of my spouse, I too was overcome by the same sense of shame. What would I tell the family? What would I tell my friends? Would they judge my husband as a criminal? Would they judge me as having failed in my wifely duties to prevent this? I began to evolve a strategy for the official version of his death (prolonged illness, sudden death, whatever is acceptable) and the real version (death by suicide). I decided to use either of the two versions, depending on who I was talking to.
However, I decided to come out of the suicide closet. As a gender and diversity professional who works with LGBT+ issues, I am no stranger to stigma. Hence, if I chose not to talk about it and gloss over the cause of the death, wouldn’t I also be contributing to the 4S around suicide?
By coming out and SPEAKing up, I wanted to be the change I so wished to see. Truth is truth and the truth needs to be told. It was part of my ongoing desire to live an authentic life; being true to myself. However, I was certain that I was not doing it for self-glorification or martyrdom.
The pain and anguish of my lived experience of suicide loss was a powerful catalyst for change. It has turbo fired my vision to create supportive, safe spaces for compassionate conversations on suicide and mental health. It has been a decision from an empowered space. I’ve never regretted the decision to own my story and tell the truth – all for the sacred cause of suicide prevention.
Swapna: Tell us something more about the 4S that you talk about.
Nandini: Dominant narratives of suicide locate it in a context of crime and sin. As a result, suicide is still a taboo. It is something to be ashamed about or feel ashamed of. In medieval Europe, for instance, people who died of suicide were denied burial and their families were excommunicated and their properties confiscated. While societal attitudes towards suicide and survivors of suicide loss are no longer so blatant, the tradition of stigmatization nevertheless persists in several subtle and not-so-subtle forms. There is no social acceptability associated with suicide, which is viewed as a character or moral flaw.
Stigma is located within a larger social context that tends to view a particular issue such as suicide in negative ways. This is known as social stigma. And simultaneously, people impacted by suicide tend to internalize the feelings of shame, blame and judgment, known as self-stigma.
Social stigma perpetuates negative attitudes and stereotypes about suicide that are internalized by all people as a default setting. Hence for all survivors of suicide loss, the knee jerk response is shame and self-blame. It is common for people to blame the victim or the family, not realizing that the causes that drive a person to suicide are multiple and ‘lie with the forces of suicide itself in the same way that people of die of other illnesses.’ We wouldn’t blame a person or the family when the cause of death is non-suicidal, why then do we indulge in blame games and accusations when it comes to suicide: ‘Didn’t you see it coming?‘, ‘Were there any clues?‘ etc.
The stigma around suicide causes unbearable shame, secrecy and silence – the 4S. This impacts the survivor of suicide attempts and survivors of suicide loss – those who have lost a close family member or close friend to suicide. It prevents the former from seeking help and the latter from healing and rebuilding their lives after the tragic loss.
Swapna: Suicide is a mental health issue that can be identified and prevented. What do you think one should do to identify such a person with suicidal thoughts? And what should be the next steps for them?
Nandini: Yes, certainly suicide is a preventable mental health issue. In the West, 90 percent of suicides have an associated mental health issue such as depression or bipolar disorder. However, in India, around 50-60 percent of suicides have an associated mental health issue. Nevertheless, that still is high and therefore a cause for concern.
We need to remember that suicides are rarely impulsive. This simply means that people who attempt or die of suicide do not do so suddenly. Rather there is a continuum that first begins with suicidal thoughts (ideation) that gradually becomes persistent, subsequently planning (the act or how of suicide) and then the act itself.
Contrary to popular beliefs, people who attempt and those who die of suicide send out plenty of warning signs or red flags. These include verbal and behavioral warning signs. For example, statements like ‘I am tired of all this…‘, ‘If I die, everyone will be happy….‘ Or they may appear withdrawn and show no emotions (apathy).
We need to be able to recognize and respond early. Preventing suicide is everybody’s business. Not just of mental health professionals alone. Hence SPEAK offers a one-day Gatekeeper Training on suicide prevention that helps people recognize and identify the red flags. As in everything, early intervention (ideally at the ideation stage) is critical for prevention.
While reaching out to people with suicidal thoughts, it is important to be gentle, compassionate and empathetic. One of the reasons why people with suicidal ideation hesitate to seek help is because of the stigma around suicide. Hence, it is important to be non-judgmental and encourage people to seek help. We need to normalize health seeking behavior for suicide.
Gatekeepers, in my opinion, are people who can spot the crisis early enough. And they have a huge role to play because the very act of compassionate listening is all it takes to dissuade a person from the act. Of course, we then need to refer them to competent mental health professionals for pharmaco therapy, counselling and psychotherapy.
Swapna: While only the ones who have gone through this can even fathom the extent of grief, yet the instant urge is always to clam up and not speak. Do walk us through the initiatives being taken by SPEAK to prevent suicides and promote mental health.
Nandini: SPEAK is an initiative of MS Chellamuthu Trust and Research Foundation, a well-known Madurai-based mental health NGO. SPEAK, established in 2018, works towards changing conversations on suicide and promoting mental health. SPEAK offers a comprehensive range of services for suicide prevention. These include awareness and sensitization programmes for diverse stakeholders, treatment services, postvention services for survivors of suicide loss, resilience workshops, loss and transition coaching for loss survivors, especially survivors of suicide loss, research, advocacy and lobbying.
We need to mainstream empowering conversations on suicide anchored in compassion, concern and care. It takes a convergence of diverse stakeholders to break the barriers and collective wall of silence around suicide and build bridges of support and connection. As I said, preventing suicide is everybody’s business. Every voice matters…
*All images used in this article are either Eyra’s own design or widely and freely available on the internet.*