The evolving narrative of death by Suicide necessitates a deeper, empathetic understanding by society of what it is, the reasons is happens, the factors that facilitate or inhibit its occurrence, the way we respond to it and how we talk about it. We need to develop a more robust conceptualization of this phenomenon which leaves in the minds of most people numerous questions, confusions and alarm reactions.

The phenomenon called ‘death by suicide’

Professionals who work in the field of Mental Health prefer to speak about someone who has been lost to suicide as having died of it. The rationale for this lies in the understanding that when a term like ‘committed’ is utilized it places the onus and responsibility of the act solely on the individual in question. The way we talk about a thing, the words we to describe it define the emotions and the connotations that get attached to it. It does not account for the innumerable factors relating to the experiences, the environment, and the emotional and psychological makeup of the person at the time that it occurred.

As mental health professionals we strongly strive to eliminate blame and guilt creation for those who ‘died by suicide’. Through the utilization of this specific terminology we attempt to create neutrality in the way in which the individual and their circumstances are seen by everyone.

It is important to remember that the choice to end life by suicide is not one that any individual wishes to make. Research has shown that close to 90% people who die by suicide had a untreated, partially treated or undiagnosed Mental Health Illness. Any conversation or understanding of suicide needs to take into account this aspect as well.

Proximal and distal factors associated with suicide

Most people in their attempts to decipher a suicide focus on what happened immediately preceding the event. The focus on proximal factors like the situations that happened immediately prior, the conversations that person had, their mood and state of mind at the time before, take away from much else that had been going on for long.

There is a need to look at long term, distal factors that can potentially contribute to an attempt at suicide. These factors include aspects like long standing mental health illness, history of multiple health conditions, previous suicide attempts, family history of mental health problems and suicide.

The complexities associated with preventing suicide: Werther’s syndrome and Papageno effect

In 1774 Goethe published the book ‘The Sorrows of Werther’ in which young Werther dies by suicide after being rejected by a lady with whom he was in love. Post the publication of the book many young men too died by suicide, imitating the actions of Werther. These incidents brought to light the phenomenon of copycat suicides and suicide contagion where people identified with the plight and actions of Werther and acted as he did and this happened at mass levels.

This led many to think of and review the ways in which suicide is spoken of and how it is reported within society to prevent the recurrence of such an incident. Whereas it is important to talk about and sensitize people about suicide, the person who dies by suicide, the environmental and other associated factors surrounding it, there needs to be a sensitive approach to handling these.

This is when Papageno found immortal fame after he was introduced to the world in Mozart’s Singspiel and his famous opera ‘The Magic Flute’, first performed in 1791. Similar to Werther, Papageno thought of dying by suicide post losing his lady love. In contrast, while Papageno was planning his death, he is saved by three child spirits who remind him of the reasons for not dying.

Mental health professionals advocate for the application and utilization of the understandings of the Papageno effect and its impact in preventing suicides.

The next steps in suicide prevention

Decriminalization of suicide in the National Mental Health Policy is a welcome step in the direction of changing the social narrative around death by suicide. This acts as an important first step in helping people understand the complexities surrounding suicide and what goes on in an individual when they decide to die by suicide.

Changing the social narrative around how suicide occurs and the approach we take to people with mental health conditions is an important step in preventing the occurrence of suicides. The fact is that suicide is preventable and only a sensitive approach that is focused on enhancing the counters to the thought of suicide as is demonstrated through the Papageno effect can give the required results. The early identification of vulnerable people can be facilitated if society is more aware of the signs of mental health illness which can predispose an individual to look at death by suicide. Creating awareness is thus an important facet of preventing suicide.

At the same time sensitive reporting of an incident of suicide can have an impact on others who may be in similar situations. Research has consistently shown that reporting on suicidal thoughts instead of suicidal actions reduces the incidence of suicide. The presence of details like the name or the type of person the victim was, the manner of committing suicide, details of the situation or suicide note, the impact on the families and how they are currently can increase the likelihood of a person who is contemplating dying by suicide of actually doing it. It is imperative that expert opinion and helplines be provided when a suicide is reported. Unembellished reports are ideal for reporting of suicides which can help prevent further similar acts.

We need to talk about mental health and issues that surround it. Busting myths and stigma around it are imperative. Encouraging help seeking is of paramount importance and even more important is having a continued sensitive approach to those who face mental health challenges.

Blog by Dr Samir Parikh and Kamna Chhibber