August 8, 2004

‘When the depression is acute, a person with suicidal tendencies can’t always hurt himself, but once the level of depression comes down, he may go for the kill,’ explains Professor Musarrat Hussain

Suicide is depression’s extreme complication, says Professor Dr Musarrat Hussain. It happens when a person completely loses hope and pessimism takes the better of him, adds Professor Musarrat Hussain, who is head of the Psychiatry Department at the Jinnah Post Graduate Medical Centre (JPMC).

In an exclusive interview with Dawn Magazine, Prof Musarrat Hussain discussed what makes some people take their own lives. Following are the excerpts:

Q. How would you describe suicidal tendencies?

A. Suicide is not a crime. It is a cry for help. In other words, it is intentional death. When a depressed person finds himself completely helpless or defenseless, he goes for this option. Here one must bear in mind that there are different stages of committing the act. One can contemplate it and attempt it. But only ‘complete suicide’ is the actual suicide.

Taking one’s own life is part of aggression, a continued act of violence when one has lost hope. This is the stage when the person doesn’t listen to anyone and no warning leaves any impact on him.

Q. Is it a psychological ailment or a social problem?

A. It is definitely a psychological illness, which can be caused by some social conditions that a person has no control over. It is usually known as a personality disorder. What happens is that a person, owing to problems that affect his life, first passes through an attention-seeking phase. This later on reaches the help-seeking stage. But when he doesn’t pass through them successfully, he intends to kill himself. Unmarried people under the age of 30 are more prone to severe depression than those who have crossed 30. Mind you, sometimes attention-seeking can be very manipulative. This is where special care of the patient is needed.

Men’s ways of committing suicide are more violent than the ones women resort to. Men would strangulate or shoot themselves in the head. Whereas women would gulp down poison or sleeping pills etc. Men would also jump off bridges or tall buildings. There’s a famous bridge in San Francisco called the Golden Gate. So far, 800 people have jumped off that bridge and killed themselves.

Q. Do financial hiccups play a role in suicide attempts?

A. They are the most significant cause. There’s a thing called ‘drift hypothesis’ according to which mental illness drifts people towards economic deprivation.

Q. But it can be other way round as well. Doesn’t economic deprivation drift a person towards mental illness?

A. I tell you an interesting thing. According to a report, in England any member of the family that owns at least two cars rarely suffers from mental disorders.

Of course, there are other reasons as well. For example, in the Scandinavian countries, people commit suicide because of the ‘seasonal affective disorder’. You know, in those countries people hardly get to see the sun. The weather is mostly dull and gloomy.

Q. Is it a proven fact that weather conditions can affect a person’s psyche?

A. From 1975 to 1985, we at the JPMC, conducted a research, giving attention to all four seasons of the year. We discovered that most mentally ill, stressed out or depressed patients visited the hospital during the months of January, February, March and April. Then their graph would dip for five months and their frequency decrease. But from October it will again pick up. This means that when the sun is out, chances are that one may not suffer from severe depression. Interesting to note is the fact that religious occasions like Ramadan and Muharram also fell in this period (1975-85). Educational institutions were off too in the season.

Actually there is something called the pineal gland that is found in the human brain. This forms a substance known as ‘melatonin’, which regulates the body metabolism with respect to day and night variations.

Q. So basically suicidal tendencies rear their head because of depression.

A. Suicide is depression’s extreme complication. It is a strange phenomenon. When depression is acute, the patient can’t always agonize himself. Once the level of depression comes down a notch or two, the patient might be able to bring his life to an end.

Q. Isn’t there any way to treat the illness or anticipate it?

A. It’s a tricky scenario. When an extremely depressed person starts improving a bit, his family members get relaxed and take their hands and eyes off him. However, no suicide attempt is without a suicidal gesture or some form of communication. For example, seemingly calmed-down patient during regular conversations would often utter sentences like “dekhyey dobara miltey hain ya nahin”, “ab to agley jahan mein mulaqat ho gi” etc.

Recently it was reported in the newspapers that a member of a terrorist organization wrote a letter to his family prior to wreaking havoc on some country. He wrote, “Pretty soon I’d be involved in a noble cause and the entire world would get to know about it.”

Here the thing to be noticed is that a person with suicidal inclinations will somehow want you to know of his intentions. There are phases that need to be kept in mind here. Initially the patient improves. Then what happens is that an intervening phase takes place, which leads to the postponement of the patient’s intention to take his own life. This is where one has to be very careful, because this is the point when the patient gets re-energized or recharged and can commit harakiri.

Q. So, by and large, suicide is an individual act. It doesn’t really have a collective phenomenon

attached to it.

A. Yes, it is an individual act, very self-oriented. But collective tendencies have been witnessed as well, which have their own reasons. Still, individual acts heavily outnumber the collective ones.

Q. How would you describe anxiety?

A. Anxiety is a normal psychobiological response of an individual to stress. It may not necessarily be a negative thing. Sometimes it can make you go places and achieve coveted goals. It can work otherwise as well. Three types of anxiety are generally detected: personal, social and occupational. It is the social type that often gets morbid and turns into pathological anxiety. The marked difference between anxiety and depression is that the former is future-oriented and the latter is past-oriented. In anxiety the patient constantly thinks about what’s going to happen to\with him in the future. How he will fare financially or with respect to relationships. Whereas in depression the patient always ponders over the mistakes that he committed in the past and how his certain acts and deeds could be rectified or reversed.

Q. What about social injustices? How big a role do they play in turning a person into a glum and depressed individual? I’m referring to things like unemployment, social disparity etc.

A. They play a pretty important role. But not everywhere in the world. Yes, in Pakistan if one made a list of the causes of suicide, economic deprivation and social injustices would feature at the top of that list. You see, anything that causes helplessness and pessimism, be it inequality or broken relationship, leads to severe depression.

As far as issues like fragile relationships are concerned where no financial snag is involved, they fall into the category of ‘social capital’. This is where cases of unrequited love, loss of a dear one etc take their toll on a person. In our region such cases take place quite frequently. Having said that, the ratio of suicide in the Western countries is much higher than the Asian countries. In the United States, for instance, a suicide case is reported every 18th minute.

Q. How is the media faring in making people aware of the issue?

A. The media primarily identifies the severity of the issue. Therefore, it has a limited role to play.

Q. What’s your take on suicide bombings?

A. As far as the Middle East goes, suicide bombing is an act of ‘altruism’. It refers to the fact of caring about the needs and happiness of other people more than your own. These acts are conducted by an idealogized group of people.

Q. What about suicide bombings in other parts of the world? Would you call it terrorism?

A. Well anything that can frighten or scare is terrorism. But again, it depends on how you view the situation.

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