It’s World Suicide Prevention Day! Although I have trouble taking “day”s very seriously (Friendship Day, Teachers Day, Siblings Day, Women’s Day, Grandparents’ Day, Aunty-Uncle Day, Marketing campaign for Hallmark cards to make more money day) I have to admit I still enjoy the excuse to talk about issues I am otherwise just thinking about, and suicide prevention is something I’ve spent a substantial amount of my time thinking about! Someone dies every 40 seconds from suicide. Every 40 seconds mean by the time you are done reading this, approximately 15 people. This should make you question why it’s Ebola that is making you feel panicky!
Rather than reiterate tips and information on general suicide prevention strategies (which tend to be the same worldwide and are easily found online – listen, be compassionate, non-judgmental, and patient, and assist the suicidal individual in seeking help), I’ll share some thoughts on suicide prevention in Bangladesh specifically. Many (but not all!) of us know and accept that it’s important to seek help for depression or for suicidal thoughts. Help is available in many forms, of course: counselling centres, anonymous helplines, psychiatrists, that wonderful professor who you can somehow talk to about anything in your life.
In the process of working with Kaan Pete Roi, Bangladesh’s only emotional support and suicide prevention helpline (see www.shuni.org orfacebook.com/kaan.pete.roi for more information), I’ve thought a lot about getting help and connecting people to the resources they need, but I’ve also thought about what is in the way of getting help. That is, what stops you? What are the barriers? Here is a preliminary list, not meant to be exhaustive, but that I bring up in the hope that it will get people thinking about the way class, education, family structures, schools all intertwine for any person’s situation.
1. Resources – Simply put, lack of money. Not being able to afford a doctor’s services, the cost of the trip to Dhaka to see the psychiatrists that your local medical college hospital recommends, or the cost of the complex mix of drugs those psychiatrists prescribe. The richer you are, the more likely you are to be able to muscle your way into an appointment with a much-coveted doctor. But if you’re lower or lower-middle class living in a rural town, things can be much more difficult, ranging from the availability of resources nearby to not being able to afford them.
Intimately tied to wealth, of course, is education. There is a reason that “socio economic status” or “social class” are measured not only by wealth and income but also by education. With education comes knowing that something is wrong that needs outside help, knowing how to learn more, and having the savvy to look for resources.
2. Logistical – On the Kaan Pete Roi helpline, we often discuss how we need to increase the hours our lines are open. Not because “people are more depressed at night” (which is something people suggest to us a lot – but this is an assumption and so far is not backed up by any of our data!) but simply because we are very aware that people are often unable to call because they do not have the privacy in which to do it, and they just might have a little bit more privacy when everyone at home is asleep. Even besides the helpline, there are logistical issues (often tied to financial ones) involved in trips to a hospital or counselling centre. In the context of Dhaka today, the time constraints involved in getting from one place to another can be prohibitive. Besides the issue of time, what if you need someone to go with you, or stay home with the baby, and you don’t want to tell anyone what’s going on because of stigma?
3. Stigma – by far the most interesting and difficult problem to tackle. Defined (by Google’s Dictionary) as “a mark of disgrace associated with a particular circumstance, quality, or person.” Breaking it down a little bit, stigma can be:
– Unwillingness to admit there’s a problem: An unwillingness to admit to oneself, and then an unwillingness to admit to others. Even to a stranger on a helpline, or to a medical doctor. It’s tough to say something’s wrong.
– Unwillingness to ask for help: “I’m not the type.” “I wouldn’t go to a psychiatrist.” I’ve heard this from the most educated of people and it continues to surprise me.
– Bangladesh’s Silent Culture: In Bangladesh, as a rule, we do not talk about things that are unpleasant. Issues that are related to drugs or sex or mental illness are definitely taboo; we just do not want to talk about them. This culture of silence is a terribly dangerous thing, and I like to quote Audre Lorde, “Your Silence Will Not Protect You.” Not talking about things lets them fester, bubble, and simmer under the surface. It allows them to go on unchecked until they boil over. Or perhaps they never boil over, maybe they cause a silent, quiet pain forever. Parents teach children and friends teach other friends what is okay to discuss and what isn’t. Mental illness is one of those things that’s not okay. I’ve seen people laugh, make obnoxious jokes, walk away, change the subject when mental illness comes up in conversation.
Bridging the gap between needing help and getting it is, obviously, a complex problem. I offer no solutions, just food for thought! But that last point in particular, the culture of silence, is one that may take years to deconstruct, but it’s one that we can begin to combat right now, today. It is, after all, suicide prevention day, and if there’s one appeal I could make to everyone, it would be to ask that we all engage in the conversations that are difficult to have. Gently, kindly, respectfully, curiously. Remembering that we have just as much to learn (probably more) than we have to teach. I promise that speaking about these things will make it one step easier for someone who is reaching out for a hand to grab.
Yeshim Iqbal is a doctoral student in the Psychology and Social Intervention Program at New York University.