KARACHI, May 1: Various causes and reasons for exceedingly high rates of suicide in the world were highlighted by Dr Murad Moosa Khan during a presentation titled ‘The Enigma of Suicide’ at T2F on Wednesday evening.

Dr Khan is a professor and chairperson of the department of psychiatry at the Aga Khan University.

Dr Khan commenced his talk by asking members of the audience if anyone of them had ever tried to commit suicide or known those who had killed themselves. A couple of people raised their hands. He formerly started the presentation by showing the picture of a 12-year-old boy, Mobin, from Abbotabad who in 2012 took his own life and left a suicide note citing that he was not happy at the hostel he was living in.

Dr Khan said the case was unusual because it involved a 12-year-old, a suicide note, a boarding school and a close monitoring system. He claimed that the untimely death could have been prevented, if things such as life-skills programmes, psychological counselling and peer sensitisation had been in place.

Dr Khan said that the suicide behaviour comprised ideation, attempt and suicide. The ‘intent’ was crucial to the whole idea. He stressed that it was a difficult and personal act caused by depression because of unresolved questions with strong psychological and mental consequences. It was not a disease, but a complex phenomenon constituting biological, psychological, personal and social factors.

Tracing the history of the issue he mentioned those who committed suicide — Egyptian queen Cleopatra, Roman politician Brutus, painter Vincent van Gogh, writer Ernest Hemmingway, German leader Hitler, composer Tchaikovsky and rock star Kurt Cobain.

He said while in the medieval times it was not recognised as a phenomenon and the person who killed himself was divested of his property, things began to change in the Middle Ages.

Dr Khan argued that it was Sigmund Freud who saw the subject with a humanistic angle. Things could improve if a multidisciplinary approach was adopted to tackle the issue. He told the audience that every year one million people in the world committed suicide (one person every 40 seconds). Russia and the Central Asian republics had the highest rates while Pakistan was one of those countries where data was not collected. However, he iterated, in Muslim countries the ratio was low. In terms of numbers, China and India accounted for 40 per cent of suicides. In China more women killed themselves than men.

Dr Khan showed the pathway to suicide which had the following progression: social factors, depression, thoughts, ideation, access to means and suicide. Alcohol sped up the process. Touching on the epidemiology of the subject he said more men took their lives (because they adopted lethal methods and did not seek help) than women, while more women attempted to kill themselves. The young (between 15 and 25 years) and the elderly were likely to commit suicide.

Referring to social causes of suicide, Dr Khan said according to French sociologist Emile Durkheim, they were divided into four types: egoistic (separation from a larger group), anomic (broken norms of society), altruistic (excessive integration) and fatalistic (excessive regulation). With regard to psychological causes, depression was a major reason as 80 per cent of them were cases of clinical depression. When it came to evolutionary psychology, according to De Catanzaro, men did not value life as much as women because they were not responsible for the survival of their offspring therefore women were evolved to be more fearful of death. In terms of interpersonal psychology, when a person became hopeless or began to feel a burden on others he’s likely to kill himself. With respect to philosophy he quoted Albert Camus, “There is only one serious philosophical problem and that is suicide.” The struggle to find an answer would keep us alive, he said.

Dr Khan then spoke on the controversial areas of the subject which were rational suicide, mass suicide, copycat suicide, cultural suicide and suicide bombing.

Giving the example of cultural suicide he pointed out the Tunisian vegetable vendor Mohammad Bouazizi who killed himself when the municipal officials asked him to take his cart away. The incident set the tone for the Arab Spring. Dr Khan termed suicide bombing as homicide bombing and argued that in Palestine the phenomenon was different because there the warfare was asymmetrical. In Pakistan, religion was being exploited. He asserted that Islam was explicitly against suicide and it was even a crime under the Pakistan Penal Code. In Pakistan since the 1990s the number of such cases had increased and known people such as actor Rafi Khawar (Nannha), politician Omar Asghar Khan and NAB official Faisal Kamran were a few high-profile examples.

Dr Khan said that economic factors leading to depression were also one of the reasons for such a high suicide rate in the country and poverty was a risk factor as 50 per cent people in Pakistan lived under or around the poverty line.

He named jobs, connectedness, family and religion as some of the protective factors provided the issue was addressed upstream. He, however, conceded that preventing suicide was a formidable challenge stating that by 2020 the number of such cases would increase to 1.5 million. He added there was a need for having preventive measures, public and mental health programmes and social policies. On an individual level one should show compassion towards a suicidal person, be patient and know the myths of suicide.

After the presentation the floor was opened for a question-answer session.