Understanding Suicide
Suicide is death caused by injuring oneself with the intent to die. A suicide attempt is when someone harms themselves with any intent to end their life, but they do not die as a result of their actions, as defined by the American Centers for Disease Control1. However, suicide is more complex and a serious concern. The World Health Organization published its 2019 Global Health Estimates Suicide report, and a breakdown of suicide rates per country was provided. It is stated that 13 774 suicides were reported in South Africa in 2019. Of these deaths, 10 861 were men while 2 913 were women. This translates to rates of 37.6 per 100 000 for men and 9.8 per 100 000 for women. South Africa recorded the third-highest suicide rate out of all African countries in the report, at 23.5 per 100 000 population.2 On average, almost 3 000 people die by suicide daily. For every person who dies by suicide, 20 or more may attempt to end their lives.3 In recent months prominent figures have died by suicide in South Africa, and their deaths are shining a light on suicide and the state of mental health. Understanding suicide can be difficult for someone who has not experienced overwhelming feelings such as hopelessness or worthlessness or being overwhelmed by thoughts of not wanting to live. For people in this state of mind, suicide becomes an alternative to ending their pain and despair. The intention is not necessarily to die, but simply, to end the intense and overwhelming weight of their circumstances. The complexity of suicide requires that it be understood in a broader context of mental health and social circumstances which may contribute to suicidal behaviour. Not all people who die by or attempt suicide will display these risk factors, however, this is a guide to some of the signs that may be present. The various factors that contribute to suicide include, however not limited to substance use or abuse, depression, bipolar mood disorder, anxiety, trauma, losing a loved one, either through a breakup or death, losing one’s employment, poor academic performance or being bullied, socio-economic situation, recurrent ideation about harming oneself, resolved plans and preparations to carry out the suicide, and previous suicide attempts, to name a few. Furthermore, risk can be at its greatest when an individual has the means, opportunity, a specific plan to carry out the suicide and the lack of a deterrent. Suicide is not a singular event as it has a far-reaching impact both on the person who has lost their life or attempted suicide and on the people in the person’s life. This causes significant physical, emotional and economic disruption. The health and well-being of loved ones, friends, colleagues and the community are affected by suicide and suicide attempts; as seen with the recent and publicised deaths of actor Patrick Shai and musician Ricky Rick which had devastating effects on their family and fans. The surviving family and friends are likely to experience shock, anger, guilt, trauma, blame, and symptoms of depression or anxiety. The suicide survivor may suffer from long-term health challenges, which may exacerbate depression and other mental health problems. Suicide can happen at any stage of an individual’s life, the differences are in the unique social, cultural, mental, emotional and economic experiences and circumstances that influence an individual to consider suicide. Suicidal behaviours among children and adolescents revealed risk factors such as difficulties in problem-solving, managing stress, social and family problems, influences of negative peer pressure or self-destructive behaviour and having suffered abuse. Further risk factors include difficulty in expressing emotions, low self-esteem and struggles with sexual identity, internally and externally, as seen in the recent News24 report of a 15-year-old Grade 9 learner from Soweto, who died by suicide after a teacher mocked him about his sexuality. With adults, difficulties in their relationships, financial challenges, career and employment, and other social determinants and mental health issues are contributors and the current economic climate in South Africa may further exacerbate suicidal behaviours. Among the elderly, it is commonly recognised that the overwhelming feelings of loneliness, regret and stagnation and depression are the major factor attributed to suicidal behaviour. Untreated depression may lead to suicide. It is important to note that the risk factors for suicidal behaviour differ according to age and life stages as people experience different life demands based on age, thus making it important to understand the many vulnerabilities, risk factors and triggers in a person’s life. Some people who perceive suicide as an option believe that they have become a burden on others and by no longer being around they are being selfless and that people will be better off without them, freeing them of the burden. Most people generally struggle to speak about their mental health struggles as these in some cultures or societies are heavily stigmatised and taboo, so there is more difficulty when speaking about suicide. Thus, when a person mentions suicide, it may be their way of warning us about what they are going through or thinking. To brush it off as something frivolous can be the difference between someone staying alive or dying. It is often misconstrued that people who mention that they want to die are perceived as attention seekers or weak or cowards, while in fact, they are deeply suffering and this is their cry for help. Talking about suicide does not necessarily lead to suicide, however, it offers people an opportunity to express what they are struggling with. At an individual level, taking time to listen and understand what others are experiencing may help save a person’s life. Most people who have suicidal behaviour and thoughts may not know where to seek help or fear talking about what they are experiencing openly out of fear of being judged as suicide carries a stigma. Educating and raising awareness and breaking the stigma and taboo around suicide is an important step in preventing suicide. Seeking professional help is critical in assessing and treating suicidal behaviour and a multi-disciplinary approach will yield better results and involve the relevant support structure in the process. References: Crosby A, Ortega L, Melanson C. Self-directed violence surveillance: Uniform definitions and recommended data elements, version 1.0 [PDF – 1 MB]. (2011) Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Suicide worldwide in 2019: global health estimates. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO.
Quality Relationships - the Key Ingredient to Mental Wellbeing in Young Professionals
"A deep sense of love and belonging is an irreducible need of all men, women and children. We are biologically, cognitively, physically and spiritually wired to love, to be loved and to belong” Brene Brown Relationships are an important tool for survival. They promote feelings of wellbeing, confidence and contribute to mental wellness. They can be the greatest source of pleasure or a great source of pain. There is a correlation between people who have healthy self-esteem and are in healthy relationships. You can see this in how they speak, act or feel about themselves. Significant Relationships for Young Professionals Young professionals are at a stage where they are finding themselves, becoming independent and practicing autonomy within all their relationships. At this stage in their lives, they need both horizontal and vertical relationships. Vertical relationships are with someone older who has more life experience and can offer advice when needed – it could be a parent, a caregiver or a manager. Career development benefits from having a mentor or a manager that is supportive but also challenges one to grow. A healthy relationship with superiors mitigates against psychosocial risks in the workplace such as burnout. It is most beneficial compared to having a manager who bullies or belittles work efforts resulting in professional unhappiness and stress. Horizontal relationships are with peers, people who are going through the same life stages and experiences so that they can do life together. These could be friends or work colleagues that you hang out with after work. They too are navigating roles, responsibilities, loyalties and even pressures from families. Owing to the amount of time spent together, peer relationships revolve around encouraging and supporting each other. In a workplace setting, horizontal relationships involve collaboration and communication to accomplish goals. Horizontal relationships could also be of a romantic nature between husband or wife or partner. Intimacy versus isolation is a big thing among young adults between 19 and 35 years old. As they are on a journey to finding themselves, they also take the opportunity to find their romantic partners, and even get married. Navigating a romantic relationship can be a big deal. There is a lot of trial and error. When the relationship is healthy and loving, this leads to a close and intimate relationship. However, if there is failure in forming a loving and strong relationship, what may follow is isolation and loneliness. Building blocks to relationships There are a number of essential building blocks that help create and sustain healthy, fulfilling relationships. Below are the top 3. The first building block is self-awareness. To have successful interpersonal relationships, start with being in tune with yourself. When you don’t know who you are and what you want, it is difficult to foster healthy relationships with others. People who don’t have healthy relationships with themselves tend to become controlling or people pleasers. In addition, they may have rigid or invisible boundaries that affect their self-esteem, how they see themselves and the world. When you are self-aware and know your strengths, weaknesses, values, needs and wants, you become mindful of the people you surround yourself with. You attract people who pour into you, and, in return, you reciprocate that. In such instances, it is not wrong to want to please another in a loving and healthy relationship. It means you are mindful of the other person’s needs and make them feel seen or heard. There are also benefits to a firm and structured way of thinking. It means you are not swayed easily and have something different to contribute. Ultimately, self-awareness also leads to resolving conflict in a timeous and effective manner. The second building block is communication. It plays a huge role in all healthy relationships. For communication to be effective, it must be honest and clear – both verbal and non-verbal. It is important to know your own communication style. For example, are you a passive communicator – someone who doesn’t say much and is always agreeable? Or are you a passive aggressive communicator who resorts to silent treatment, ghosts, and blue ticks’ people instead of opening about your feelings? Or are you a clear and assertive communicator who can articulate your experiences and your feelings? Communication and listening go hand in hand, you might be a great communicator but your efforts – verbal or non-verbal – are futile when there is there is no one hearing you. At the core of relationships is reciprocity or a mutual understanding. Listening is the skill that communicates empathy and validates relational concerns and issues. In the workplace, withholding information or unclear instructions can result in a stressful work environment. It feels good when communication between you and your colleagues and manager is open and effective in a way that allows you to flourish in your professional life. It also feels good when you communicate with your partner, family, or friend, about the difficult day you had at work, and they hear you – and even show empathy. However, it is discouraging when the other person speaks past you and ignores you instead of acknowledging your feelings. Not being heard and seen affects mental and emotional wellbeing negatively and usually becomes a presenting problem when people seek therapy. The final building block involves the setting of boundaries. Terry Cole, a Psychotherapist who has written on Boundaries, describes the importance of boundaries as “breaking free from Over-Functioning, Over-Delivering, People-Pleasing, and ignoring your own needs so you can finally live the life you deserve” and create strong, healthy relationships.Boundaries in relationships are very important because you get to determine what is yours to take accountability and responsibility for and what is not yours and out of your control.When you have worked on your communication skills, but the other person is not willing to change their unhealthy behavior, you need to set boundaries. These need to be clear and communicated with lucidity. For example, you handed in a project report on time and your manager sends you an email late at night with questions on the project. Acknowledge the mail and inform them that you will address their questions during working hours. Before you jump into relationships with others, it is very important to introspect on how you would like to be treated and how you would like to navigate different relationships.Relationships serve an inherent need for human beings who have a basic need to connect and to belong. Remember, 3 keys to establishing healthy relationships require intentionality in cultivating healthy self-esteem, working on your communication skills (mean what you say and say what you mean) and lastly establish healthy boundaries.Quality strong relationships over a lifetime are correlated with happiness, success, good mental and emotional wellbeing and increased longevity. Make time to cultivate the right relationships for you and your mental wellbeing.
Living with Bipolar disorder
Experiencing changes in
mood is part of daily life and these changes in mood can last a few hours at
most for most individuals. The problem is when the fluctuation in moods last
for days and affects or impairs daily functioning. This is the case with bipolar
disorder.When the intensity of mood fluctuations, this can be disruptive to a person’s relationships and impact negatively on occupational functioning. The mood changes in bipolar disorder go together with immense behaviour change. Individuals with bipolar disorder experience alternating depressive episodes with periods of manic symptoms.Bipolar mood disorder is one of the most common mental health conditions and according to the World Health Organization, affects more than 45 million people around the globe. It is estimated that 3-4 % of South Africans have bipolar disorder, this is according to the South African Depression and Anxiety Group (SADAG). Research suggests that a combination of factors could increase one’s chance of developing bipolar, as the exact cause is unknown. This includes physical, environmental, social conditions, biochemical, genetic and psychological factors. A diagnosis of bipolar can be scary and difficult to accept as it can leave one with uncertainty about the disorder and how to cope.What is Bipolar?Bipolar disorder is a brain disorder and it is a category that includes three different types for this article: bipolar I, bipolar II and cyclothymic disorder. Bipolar I disorder is characterised by a manic episode or symptoms for at least seven days and due to its severity usually requires hospitalisation, while bipolar-II disorder is associated with depressive and hypomanic episodes. During the manic episode, the individual may engage in multiple overlapping new projects. The projects are often initiated with little knowledge of the topic and nothing seems out of the individual’s reach. Individuals often do not perceive that they are ill or in need of treatment and vigorously resist efforts to be treated, during a manic episode. While during a depressive episode, the individual experiences depressed mood (feeling sad, irritable, empty) or a loss of pleasure or interest in activities, for most of the day, nearly every day. Individuals with bipolar disorder are at an increased risk of suicide. Cyclothymic disorder is for individuals (2 years in adults or 1 year in children or adolescents) who experience both hypomanic and depressive periods without ever fulfilling the criteria for an episode of mania, hypomania, or major depression. Mania and hypomania are two varied types of episodes with symptoms that are alike, however mania is more severe than hypomania and may cause more noticeable problems at work, school, social activities or in relationships. Psychosis can be triggered during a manic episode, immediate medical attention in required in such an instance.Bipolar disorder causes intense alterations in mood and energy levels. This can be overwhelming for the person diagnosed with bipolar disorder as they may feel out of control with the intense change moods and not certain how to cope. Managing these symptoms can be challenging for someone living with bipolar disorder and those around them can be affected as a result. It starts with the individual accepting the condition, learning and understanding the symptoms of the disorder to assist in better management of the disorder. Managing BipolarSince there is no cure for bipolar disorder a combined approach of medication, therapy and lifestyle change are beneficial in management of the disorder. Partnering with the treating team goes a long way in assisting in managing the condition. Keeping a record of change in mood and how they affect treatment, feelings and sleep, can be helpful in identifying triggers or when an adjustment in treatment is required. As result of the stigma at times associated with bipolar disorder, symptoms such a suicidal ideations, low self-esteem and strained relationships can be exacerbated. Learning to manage bipolar is ongoing process and developing effective coping strategies can go a long way in managing symptoms and prevent conflict with loved ones. Having a support network provides for opportunity to ask for help when the individual is not coping. The people the individual surrounds themselves with can offer valuable insights about their behaviour when it is most needed, such as observations during a manic episode.Some people with bipolar prefer to keep their condition confidential at work, out of fear of being discriminated further in the workplace. This may limit that level of support they could receive from their leaders, if they are not aware of their condition. Mental health has been more recognised in the last few years, with workplace programmes to support employees. By cultivating trust through talking, training and connecting with each member of the team, employee engagement and performance is likely to improve. With the correct treatment and support a person with bipolar can lead a functional life.Avoiding triggersThere are some aspects to consider in preventing episodes and triggers, such as:1. Avoid drugs and alcohol2. Watch for early warning signs3. Take medication exactly as directed4. Manage stress and recharge5. Keep a sleep schedule and involve friends and family