Focus on growing problem of suicide

Jamila will never forget the day she tried to take her own life. “I could not bear the suffering any longer, so I used razor blades to slit my wrists,” she told IRIN. “They bled straight away, and I just sat in my bedroom until I became unconscious,” she said. But Jamila’s attempt failed. “I woke up in hospital and was devastated that I was still alive,” she said. Doctors said she was lucky to have survived, having lost a tremendous amount of blood. Asked why she had tried to kill herself, the 25 year-old said she had missed her family after getting married away from her home province. Traditionally, the extended family system common in Pakistani society provides a comfort blanket for family members suffering from depression. But in this case it had been absent, resulting in an attempt that might never have been reported. However, a prominent researcher, Professor Murad Khan of the Aga Khan University in Karachi, told IRIN that the extended family system could also be a factor influencing suicide. “It is very common for Pakistanis under pressure from the family or in-laws to feel suicidal.” Other reasons behind why people in Pakistan commit suicide are similar to those in the West. “For women, it usually boils down to relationship problems, while for men - unemployment and financial matters,” Khan explained. Commenting on poverty-related suicides, Khan said: “Poverty is something that bothers us. Lack of jobs and no opportunities in the country are major factors in suicide cases.” The official figure for unemployment in Pakistan stands at 25 percent Khan also linked the international economic sanctions imposed on the country following nuclear tests to the rise in suicide rates by men. The economic downturn three years ago after the Islamic nation declared itself a nuclear power made it even more difficult for men to find work and provide for their families in this male-dominated society. According to an observational study conducted by Khan, it is clear that most suicide victims in Pakistan are from the lower and middle classes of society. He maintains the root of the problem stems from the lack of knowledge about mental illness in the country, and the lack of adequate assistance available for the mentally disturbed. At the Islamabad psychiatric clinic, 30 percent of outpatients were suicidal, a psychiatrist, Dr Aftab Khan, told IRIN. He, too, believed that mental illness is the main cause of suicide cases. “There are a number of underlying reasons for people committing suicide,” he said. “But if you are depressed you are more likely to kill yourself,” he added. At least one out of 100 patients seen daily at the Institute of Psychiatry in Rawalpindi is suicidal. Statistics show that in 1999, some 129 male and 120 female suicidal patients were admitted. “These are only the patients that were able to visit the clinic,” Dr Khalid Saeed, associate professor at the institute, told IRIN. “We fear the number of suicides in this area is more than double,” he said. Saeed said it was vital to decide how serious each suicide case was, saying that when a patient walked through the doors of the institute, he or she was assessed on the frequency of suicidal thoughts. Doctors then tried to establish whether they had attempted suicide, and whether a serious method, such as firearms or other weapons, had been used. According to Saeed, people from the lower income groups may not even realise they are getting depressed due to high levels of illiteracy, coupled with their financial situation, which makes them “highly unlikely to go and seek help”. Concerned about the acknowledgement of mental illness among rural communities, Saeed said there was an urgent need for integrating services for disturbed people in primary health care in Pakistan. Awareness and acceptance of the problem were crucial. As a starting point, the institute is arranging workshops to get the health data gathering centre to record mental illness by making people aware of how serious a condition it is and what it could lead to. “If we keep on pushing mental health issues under the carpet, and we know the serious repercussions, we are virtually pushing suicidal people over the edge,” he said. The Human Rights Commission of Pakistan (HRCP) collects statistics based on newspaper reports of suicides. According to the figures, 2,000 suicides were reported between January and August last year. But according to studies by Khan, this figure is totally unrealistic in a population of 140 million. “Suicides are grossly under-reported in Pakistan,” he said. Based on the HRCP method of collecting data, he estimated the figure for the entire year to be 3,000. He fears, however, that it could actually be much higher. “It may be eight to 10 times higher,” he said. “We just do not know.” Global figures arrived at by the World Health Organisation (WHO) show that in countries with a low incidence rate, eight to 10 people out of every 100,000 commit suicide every year, and in those with a high level, the number is more than double. “Pakistan’s statistics do not even fall into the lowest category, so there is something seriously wrong with those [HRCP] statistics,” Khan maintained. Compounding the problem is the country’s central health data gathering system, which does not record suicide or mental illness as causes of death. Nor, like other developing countries, does Islamabad report mortality rates on suicide to the WHO. Khan has asked the government to conduct a comprehensive nationwide study on the issue, although he faces stiff opposition. Suicide is a taboo subject in Pakistan. In Islam, it is a sin to take one’s life. Suicide is therefore a criminal offence in Muslim countries, carrying a jail sentence or a heavy fine, thereby deterring those who have attempted suicide from seeking help, he explained. “Muslims should not be committing suicide. It is haram [unlawful],” Amir Qazi Hussain Ahmad, the spokesman for the religious group, Jamaat-e-Islami, in the capital, Islamabad, told IRIN. “It is written in the holy book, and only God decides a Muslim’s fate,” he said. “This is our religion, and people know what the law is.” According to Khan, however, Islam is no longer a strong deterrent. “Religion no longer prevents Pakistanis from committing suicide,” he said. He argues that this is borne out by a dramatic rise in suicides over the last five to six years.