Every year on September 10, World Suicide Prevention Day, there is a concerted effort to highlight the tricky topic.
But what happens when it’s too late, when the suicide has happened? When the signs were completely missed, and now the person will be too?
What happens to the people left behind?
And what happens to those who attempted suicide, and survived?
According to the South African government, almost 3 000 people worldwide commit suicide, on average, daily and for every person who completes a suicide, 20 or more may attempt to end their lives.
For those affected by suicide - or attempted suicide - the emotional impact can become an emotional minefield afterwards. Losing a loved one to suicide can even create post traumatic stress disorder in those left behind.
Diaan Bisogno, a clinical psychologist at Akeso Stepping Stones in Kommetjie, says those who have attempted suicide and been saved, have every chance of rebuilding their lives again, with support.
“As long as they want to live, we can help them build resilience and learn good coping mechanisms. But we can’t give them the will to live.”
Not wanting to live is, she says, a reality for some. But even in those cases, more often than not, if the person learns what lies beneath this thought, they can create meaning for themselves again.
Dr Bisogno says today’s society is starving for meaning, purpose and connection.
Some suicide attempts, she says, are more a cry for help or a form of manipulation against somebody who they feel hurt by, but for those who bear unthinkable pain they can no longer carry, suicide is an answer.
It’s a complex thing to understand, she says, and there are many factors which contribute to attempting suicide.
“As therapists or psychologists, we have to look at all the angles. If you have suicidal thoughts, do you also have a plan? If you have a plan, do you have access to the things needed in that plan. Have you taken steps to put your affairs in order?”
Changes in life circumstances - even physical illness - could pre-empt a depression which goes unnoticed. She also points out that in every instance there is personal responsibility too.
“If you do have depression or anxiety, it may be a good idea to go to a psychiatrist rather than a GP for help, because you are looking for an in-depth answer to what is causing the depression. Even some medications can have adverse effects: if you are given pills which worsen the depression or have unexpected side effects, tell your specialist, communication is key.”
Stigma still exists around suicide, but Dr Bisogno is very clear that not all people who attempt suicide suffer from mental illnesses. Some people with bipolar or depression are perhaps more prone to it, but not all suicide attempts are the result of a mental illness.
There is a concept called cognitive constriction which explains what happens in the brain during a suicidal crisis.
“The actual physiological functioning of certain parts of the brain changes in this acute suicidal moment,” says Dr Christine Moutier, chief medical officer of the American Foundation for Suicide Prevention.
“What’s happening in the brain is there’s a narrowing of coping options that stems from changes in the brain’s ability to come up with three or four ideas to problem-solve, like it usually would. The actual functioning of the brain changes in this acute suicidal moment.”
Cognitive constriction can be described as a feeling of tunnel vision. People in this state can’t see beyond their circumstances and don’t believe their pain will ever end. Which is why suicide-attempt survivors say things like, “I thought it was the only way out.”
The mental distortion they feel in that moment isn’t permanent, but it feels like it is. In truth, it may last only a few minutes, or up to an hour. But then it changes, and the brain recovers its ability to think again.
Dr Bisogno says anyone who has attempted suicide and survived, and the loved ones left behind by a suicide, can heal. It takes work and the learning of new coping mechanisms, but it’s entirely possible, she says.
“I think anyone who has lost anyone, not even necessarily to suicide, should have a few counselling sessions. But especially if by suicide, because often there is anger, and many people hold back on expressing this because they don’t want to upset the other family members or friends. And yet expressing the anger safely is necessary for their own recovery.”
Many people feel awkward addressing the surviving family. “You need only listen more, speak less. Just say that you know they are going through something difficult and you are willing to just be there for them,” she says.
Resist the urge to tell the person their loved one is in a better place now or that they will see them again.
South Africa, according to government data, has the eighth highest rate of suicide in the world: each year, approximately 6 000 to 8 000 people commit suicide, making suicide the third greatest cause of unnatural death in the country, after homicide and unintentional causes.
That is 667 deaths by suicide every month, 154 each week, 22 every day and virtually one every hour. Get help from: LifeLine’s helpline at 0861 322 322; LifeLine’s Western Cape Crisis Line at 021 461 1111; Akeso Stepping Stones at 087 098 0453; The South African Depression and Anxiety Support Group Helpline at 0800 21 22 23 (8am to 8pm) or 0800 12 13 14 (8pm to 8am) or SMS 31393; Suicide Crisis Line (8am - 8pm)at 0800 567 567 or SMS 31393 and Suicide Crisis: 0800 12 13 14.