Trigger warning: This article contains discussions of suicide
“Anyone who dies by suicide is mentally weak,” my colleague said to me, leaving me jolted.
I often hear such dismissive statements about suicide from the general public, but I thought at least my fellow doctors would refrain from using such tropes. But clearly some, or perhaps many, do not.
During my medical school days, we had a handful of attempted suicide cases amongst the student body and one tragic death of a resident doctor by suicide. More often than not, the alleged reasons for their drastic actions were dismissed in private. But in public, my fellow classmates continued expressing sympathy. The conversation around each incident became a macabre cocktail of gossip, innuendo and a casual indifference to mental illness.
During my internship, I was chided by a resident doctor for ‘wasting my time’ on a severely mentally ill patient with a history of self harm who was brought to the casualty ward by her family. She was ultimately referred to a psychiatrist, but I felt it was my responsibility to record the patient’s history and speak to her family about her condition even though her case did not fall under the department in which I was posted.
A study by Rajiv Radhakrishnan and Chittaranjan Andrade published in the Indian Journal of Psychiatry in 2012 found that suicide in India is heavily associated with domestic violence, sexual and physical abuse, poverty, lack of educational and employment opportunities, marital discord, dowry related harassment, and common mental disorders. The highest number of suicides in India are recorded in people aged 15 to 29 years. Despite this harsh reality, Indian society has chosen to be in a state of denial rather than take stock of the grim situation.
By calling a person who dies by suicide ‘weak’, our society refuses to recognise the intersectional nature of suicide. Society often seeks a sole cause that pushes someone off the cliff. This attitude is often imbibed by a section of doctors, too. A reductive approach taken by such medical professionals to deal with suicidal patients inadvertently compromises the quality of care they can provide.
Rather than create a friendly environment for a person who is mentally ill or subject to abuse or being deprived of opportunities, we choose to remain silent. When the same individual dies by suicide, we otherise them as ‘weak’ and ‘cowardly’. For every single individual who dies by suicide, there are scores of others who live with suicidal ideation. This othering and condemnation further discourages them from seeking help and adds to the stigma. By association, such individuals may also be made to feel ‘weak’ for having suicidal thoughts. Rather than encourage them to reach out for help, such callous language shames people into silence and only serves to perpetuate a vicious cycle of ignorance.
Friends, family and loved ones of the deceased also become collateral damage. They are forced not to seek help for their own emotional trauma, since they become tainted by their association with the ‘weakness’ of their loved one.
Death is the final frontier that humans are afraid of. When a person chooses to take their own life, they let go of their fear of death. In its own way, suicide becomes an act of courage. The person taking the knows the finality of their action and that there’s no coming back from it. I don’t seek to glorify suicide. I only say this to underscore the extent of the despair, suffering, and desperation that forces a person to embrace death.
To begin with, the medical fraternity must discard outdated notions of mental illness that have been propagated by archaic medical textbooks. We must incorporate a modern approach to treating mental illness. Paying lip service is not enough; words must be supplemented with deeds.
It is of paramount importance to call out the usage of labels and tropes in society when it concerns an issue as sensitive as suicide. More so than the public, students of medicine and allied healthcare fields must be taught not only the complex nature of suicide but also sensitive techniques and language when it comes to dealing with such patients. Rather than criticising the supposed weakness of suicide victims, it would serve us better to question the weaknesses in our collective approach to mental illness and suicide.
If you know someone – friend or family member – at risk of suicide, please reach out to them. The Suicide Prevention India Foundation maintains a list of telephone numbers (www.spif.in/seek-help/) they can call to speak in confidence. You could also refer or accompany them to the nearest hospital.
Adarsh Singh is an accidental doctor fretting about the future while spending his time gaining knowledge on niche things that nobody cares about.