Monday February 6 2012

Returning to life after a failed suicide attempt




Nobody had seen any sign of darkness in Mathew Okello. Not even his girlfriend with whom he spent a lot of time, nor his mother. Not even his campus roommates could say his behaviour was really out of the ordinary. Yes, sometimes he was moody, but who isn’t? Yet, here they were surrounding a hospital bed trying to wrap their head around the fact that the very popular 23-year-old had overdosed himself in an attempt to end his own life.

“I was bewildered, didn’t know whether to berate him, or break down crying. After running around trying to get doctors to work on him and finally knowing he was out of danger, I felt hollow, devoid of emotions, overwhelmed and all I could do was cry,” says Leonida Achen, Okello’s mother, trying to explain the feelings that engulf those who find themselves at the centre of such a tragedy.

Suicide may be a cry for help, a last resort for some who sees no point in living but it is a living nightmare for those close to the suicide victim or survivor. For those who have had a relative, friend or spouse try to end their life, surviving suicide goes beyond the tense emergency room session.

“Imagine waking up and finding that your own son almost died and not by an accident or attack but by trying to end his own life. Time stops for a while, at least it did for our family. For a while, everyone was moving around in a daze unable to talk about it,” says Ms Achen.

“It is a long road back to normality full of unanswered questions and suddenly there are all this uncertainties. So should I suicide proof our home, jump to his every whim or just give him tough love?” she says what went through her mind the first few days after leaving the hospital. She says that her younger children needed her and that she had to get back to living. This is what many people grappling with the reality of suicide so close to home want, to get back to the life before the suicide issue reared its ugly head.

To not have to grapple with unanswered questions - the shock and the stigma of having a member of their family attempting suicide hanging over their heads like the sword of Damocles. And that’s not all as Dr Eugene Kinyanda, a consultant psychiatrist who has specialised in suicide for 12 years says: “There are also feelings of guilt.” Lots of it, for having not noticed that something is wrong, or not paying due attention if at all one had an inkling that something was seriously wrong. And to top it all, there come supressed feelings of anger, resentment, and confusion.

Suicide is one of the issues our society is too quick to sweep under the carpet for a long time. But with a growing number of suicide cases we may not afford to do so for a long time. Not with more and more people susceptible to depression, one of the leading causes of suicidal tendencies. In Uganda, many people attempt suicide due to depression brought about by interpersonal conflicts, drug abuse and financial causes - basically the pressure of certain life situations.

“Others are pushed to suicide after discovering terminal illness, like what happened some years back when people discovered they were HIV positive,” says Kinyanda. While others get the thoughts due to their mental disorders like schizophrenia and bi-polar.

But whatever the cause, suicide cases are on the increase, due to what Dr Kinyanda calls a “psycho-social environment” which pushes more and more people to the brink of desperation. There may not be proper records of all suicide deaths and attempts but figures released by the police last year showed 175 deaths were recorded in the months between January 2011 and June 2011, hint at the gravity of the problem.

“The first thing everyone should know is that nobody attempts to take their own life for fun,” says Dr Kinyanda which means almost for every suicide victim, there is a problem that needs fixing. He goes on to say judgement and blame will therefore not help anyone. Neither is just getting on with life hoping it will all go away.

“Instead of blaming the person, the family or friends should seek the root cause of the problem that drove the person to such depths of despair,” says Kinyanda.

Blame worsens the situation
Often families run to blame the victim, seeing them as bringing in extra expense on hospital bills, or as ungrateful for all the care and attention they have showered them with, throughout their lives. “But this could be potentially dangerous,” says Joseph Atukunda, a suicide survivor who now works with people recovering from mental health issues. He remembers the aftermath of his suicide attempt, the negative comments from his family members that almost pushed him over the edge again.

“Luckily, someone told them that meanness would not make the problem go away and I was referred to a mental health specialist and eventually a mental health institution to get the help I needed,” he says. Other families may not have the benefit, of someone to advise them like Atukunda was. “They then continue feeling like the victims in this story, where those who attempted suicide star as the ungrateful attention seeking villain especially if they have had a history of being troublesome,” he adds. Atukunda also thinks the first step those close to a suicide survivor should do is take them to a psychiatrist echoing what Dr Kinyanda says, to establish the problem.

A constant fear that dogs those around suicide survivors is that they will try it again. Achen vividly remembers waking up at night to call her son who had gone back to school, and ask if he is doing fine.

“Even when he said he was, I would imagine certain sadness in the way he talked and would fret for days,” says the mother of two. This is a normal behaviour for many people whose close relatives have attempted to take their lives. Their fears while they may sound unfounded have a solid scientific backing according to Kinyanda.

Several studies on suicide patterns over the years, Dr Kinyanda explains, have proven that people who have attempted suicide once before are at a higher risk of attempting it again. But all is not lost, as the psychiatrist says, a further attempt can be prevented by solving the root cause.

It is a matter that the family must intervene, and fix. He gives an example of financial problems, those close by can come in and if it’s as a result of mental illness, there’s medication to combat it. “Usually suicide victims are able to find the will to live with support from those close to them and after the problems are fixed,” he says.
But, there’s a catch in trying to help, Dr Kinyanda cautions, people should only do what is humanly possible, not strain themselves and risk also getting depressed or getting suicidal thoughts of their own.

A person who attempted suicide should not hold others ransom because he is a suicide risk. The doctor explains that in some instances, there’s little one can do to prevent another from taking their life.

“Everyone is in charge of their own life and while we can help each other out, it should not be to the extent that they use their problem as a way of getting attention.”
There may not be a sure way of knowing that a person close to you may commit suicide, but Dr Kinyanda recommends looking out for loss of interest in activities a person used to enjoy especially if you already know the person has mental issues and alcohol problem or has gone through a major life changing event. But even with this, you can’t be too sure.

“Sometimes, a person will be the perfect picture of happiness, then the next thing you hear, they took their own life,” says Dr Harriet Birabwa, a psychiatrist at Butabika Mental Hospital.

“It helps to talk about the incident itself as well as about suicide as a family,” Dr. Birabwa explains, that talking in the presence of an expert will help the family come to terms with the near disaster, as opposed to keeping quiet and everyone tries to cope on their own.

Dr Kinyanda seconds this putting emphasis on the person being referred to a trained mental health worker. Many families find it difficult to talk about suicide whether among themselves or with outsiders due to societal stigma. They fear rejection, and ridicule that is associated with such cases which he says goes as far as other families avoiding to marry from a home where a person attempted or committed suicide.

Talking about it may be hard - the whispers, stares and pointing, is frustrating at least to those whose relatives or dear ones survive suicide. A chance to ask questions and get right answers can be helpful. Dr Kinyanda says getting a trained professional to speak to the person will help in understanding the whole incident and that is already halfway coping.

Atukunda says he doesn’t blame his family for their reaction. “My mother resignedly said if it was God’s will for me to die at that tender age, so be it,” he says pensively. Now aged 42, Atukunda understands the pain his mother must have been in so many years ago. He knows she was overwhelmed by the issue that had imposed itself on her life. She may have coped the best way she could – she may have warned, condemned and blamed him, but she meant well. However, it was not until the old lady eventually realised that her son needed help when he was diagnosed for manic depression and put on medication.

Dr Kinyanda concludes, “Emergency care at the hospital does not address the real problem. The tough part for a family begins after leaving the hospital gate. But it is something that has been and can be done with whole hearted support for the person and professional help for both the survivor and the family.”