Earlier this month, a grade-six female student committed suicide at a private school campus in Hyderabad by jumping off the roof of her school building.

Initial reports and the suicide note she left behind suggests that the girl was quite sensitive and had been mentally disturbed for some time. Last month, a 15-year-old O’ Levels student committed suicide by jumping off his high storey flat balcony in Karachi’s area of Defence. It wasn’t clear what led to his taking such a drastic action. In August last year, a 22-year old student of the Asian Institute of Fashion Designing in Karachi’s Iqra University killed himself. Quoting preliminary investigations, police officials said that depression was the cause of suicide. The deceased suffered economic distress due to her deteriorating financial condition.

Suicide ranks second in the leading causes of death for college students. Suicide amongst students have become a rising concern worldwide and it is about time that we as a society learn how to tackle the issue that has become endemic among youth.

ASIAN SHAME AND STIGMA

In Asian cultures, shame and stigma significantly contributes to suicide. Due to religious and cultural norms associated with the act, there is not enough empathy in the masses for those who commit or attempt suicide.

Such is the stigma, that it was only earlier this year that suicide was legally decriminalised in Pakistan. The topic of suicide is considered taboo and it is a widely held belief in this region that talking or raising awareness about suicide would promote the idea in ‘impressionable young minds’. Hence, this issue is swept under the rug and rarely addressed with the complexity that it deserves.

As a mental health professional, I have organised several wellness workshops and events in different institutes. Yet, it was surprising for me to discover that even seemingly progressive A-level colleges would not allow the topic of suicide to be addressed in their events.

Similarly, in the majority of attempted suicide cases that I saw in my private practice, the families of the victims of suicide would rather believe that they did it because of their “weak faith in God” or because they were “under the influence of a djinn.”

It becomes clear then that any reason would be treated as being better than admitting that the victims committed suicide of their own volition. By turning a blind eye to the real cause, the families of the victims are actually perpetuating the stigma around the topic, rather than making concerted efforts to dispel it.

DEPICTION IN MEDIA

Children these days have access to global content which frequently depicts suicide. In recent times, a Netflix show called 13 Reasons Why garnered a lot of debate because of its depiction of suicide. The show is about Hannah, a young woman who takes her own life and leaves behind a mysterious box with recordings of herself explaining the 13 reasons why she decided to end her life.

This show received a lot of backlash, in particular, because it treats its heroine’s death as a triumph over her enemies, a way for her to achieve immortality and timeless glory. Such messaging can be misleading for a lot of people who are being oppressed or bullied, who might consider it an honourable way out of their misery.

According to a study published in the Journal of the American Academy of Child and Adolescent Psychiatry, 13 Reasons Why was associated with a 28.9 percent increase in suicide rates among American youth aged between 10-17 in April 2017, following the show’s release.

The number of suicides was greater than that seen in any single month over a five-year period. Over the rest of the year, there were 195 more youth suicides than expected, given historical trends. The study also found that boys were far more likely than girls to kill themselves after the show debuted.

While this study sparked a lot of media attention, the results should be interpreted with caution. Correlation does not imply causation, so there is always a chance that an external factor was involved in the spike in suicide rates. The outcry gained so much momentum that a Netflix spokesperson had to come out with a statement.

“This is a critically important topic and we have worked hard to ensure that we handle this sensitive issue responsibly,” said the spokesperson to The Associated Press.

SUICIDE CONTAGION

Suicide contagion — or copycat suicide — is when, after one person commits suicide, others may be more likely to imitate them and die by suicide. Suicide contagion can happen in response to the suicide of a family member, peer or a celebrity, and often coincides with media reports about the suicide.

Suicide contagion is most likely when a prominent suicide becomes media fodder, leading other people who are struggling with suicidal ideation to try to kill themselves. Adolescents and young adults are the most vulnerable group to this phenomenon, since they are the biggest consumers of media and also the most impressionable.

Most of the data in favour of suicide contagion is related to media coverage of real suicides, especially controversial celebrity suicides such as those of musician Kurt Cobain or actor Marilyn Monroe. But there’s much less data about whether suicide contagion also transcends to fictional depictions of suicides. Regardless of the validity of the results of a single study, it is evident that portrayal of suicide will affect youth in the way violence does.

Hence, it is important to create a safe space for the youth to discuss and voice their beliefs and curiosity about such topics.

In our households, the solution is usually to prohibit children from watching such content, which only triggers more curiosity and interest. It inadvertently creates more desire to discover the banned content than it would be without affixed ratings, like marking it as ‘PG-13’. This notion is referred to as the ‘forbidden fruit hypothesis’.

THEORY OF SUICIDE

One of the seminal theories of suicide is the “interpersonal psychological theory of suicidal behaviour” that was discovered by American psychologist Thomas Joiner in 2005. It proposes that an individual will only commit suicide if s/he has both the desire to die by suicide and the ability to do so.

The desire to die occurs when people hold two specific psychological states in their minds simultaneously — ‘perceived burdensomeness’ and ‘thwarted belongingness’ or social alienation.

Perceived burdensomeness is where the person believes themselves to be a burden on others. They are projecting their false perceptions of liability and self-hate on to others. On the other hand, thwarted belongingness is social disconnect or loneliness and an absence of reciprocal care.

There is growing empirical support for the interpersonal theory of suicide in explaining suicidality among college students. To identify and mitigate suicide risk among college students, it is important to examine the extent of their suicidal ideation and understand the factors and processes that may place some students at heightened risk.

Destigmatising suicide — or suicidal ideations (thoughts) — and having open conversations about it is the first step towards preventing student suicides. Parents and schools especially need to be media savvy in order to have difficult, but relevant, conversations with children, which address their preconceived notions or ideas regarding this topic.

Educational institutes need to have counselling services and support services specially curated for high-risk students who have either self-harmed or are having thoughts about it. The most crucial aspect is how the support system of the student, comprising their family and peers, handles them. If their response is too aggressive or defensive, it will be counter-productive for the student, who already is in a vulnerable state.

Punishing, shaming or ridiculing them would only drive them deeper into their downward spiral. Teachers, counsellors and psychologists should get specialised training in how to deal with suicide-risk students and their families.

The writer is a clinical psychologist working at AKUH and a freelance journalist. She can be reached at rabeea.saleem21@gmail.com

Published in Dawn, EOS, February 26th, 2023