By Dr Tara Singh
An analysis of data on suicides and suicide attempts paints a different picture on the suicide problem that has been portrayed for several decades of conventional thinking. An incomplete understanding of the nature and magnitude of the suicide problem obtains if the rate of deaths by suicide alone is compiled and analyzed. Since it is known that for every suicide there are at least 7 suicide attempts, the scope of suicidal behavior is significantly larger than what has been provided in suicide studies. When data on suicides and suicide attempts are combined, the disparity in the rate of suicidal behavior between Indo-Guyanese and Afro-Guyanese is not significant. For example, Indo-Guyanese had a rate of 36.33 per 100,000 compared with 36.2 per 100,000 for Afro-Guyanese (2014). The difference in ‘suicides+suicide attempts’ rate between Afro-Guyanese and Indo-Guyanese is statistically not significant at <.05 level (X=2.7526).
The underlying causes or precipitatory factors of suicide attempts are similar to those of suicides. Both acts tend to flow from the same source(s). Equally important is that the differences between life and death in cases of suicidal behavior depends on five variables, namely, (1) the existing health condition of the individual; (2) the dosage of substance or nature of device used; (3) the potency of the device/substance used; (4) whether the suicidal behavior is planned or spontaneous; and (5) the swiftness of medical intervention.
Suicidal acts that are planned, like those where strong poison like gramaxone is ingested or in cases of hanging, have a low survival rate. Men have a much higher rate of suicide than women because they (men) often plan their suicidal act, as opposed to women, who mostly engage in impulsive action; and they (men) use more potent device/substance like hanging, gramaxone and carbon tablets. In contrast, women use less potent device/substance such as kerosene, sleeping tablets, OTC drugs, and they (women) more readily seek medical attention compared with men. The majority (77%) of suicide patients at GPHC in 2009 were discharged within 3 days, and most of them were women. These data show that quick medical intervention does save lives. One Indo-Guyanese male survived after 40 days in hospital.
An analysis of official data shows that traditional conception on suicidal behavior must give way to a new emerging perspective. For example, previous studies on suicidal behavior show that Indo-Guyanese had the highest proportion (80%) of suicide deaths; (ii) the youth (14-29) were the highest risk group; (iii) males had a higher rate than females; (iv) more suicides occurred in rural areas; (v) Hindus had the highest proportion of suicides (49.5%) compared with 8.9% for Muslims and 35.6% for Christians; (vi) poisoning and hanging were the most common methods used in the suicidal act.
However, data on suicide for 2017-2021 as well as on suicide attempts tell a different story from the traditional findings described above. The national annual proportion of Indo-Guyanese that died of suicide between 2018 and 2021, averaged 63.2%. of total suicide deaths. There have been significant changes in age structure of persons who died of suicide. In 2018, the age group 79+ had the highest rate (40.84 per 100,000); and in 2021 the age group 65-69 had the highest rate (43.37 per 100,000). The suicide hotspots of regions 2 and 6, have been surpassed by region 5 in 2017, 2018, 2019, and 2020. Also, the method used in suicide and suicide attempts are changing.
In 2011, 30.3% of Afro-Guyanese (suicides and suicide attempts) in sample used kerosene compared with 5.7% for Indo-Guyanese. Malathion, a common method in the 2000s, has given way to gramoxone, carbon tablets, and other toxins. An annual average (2017- 2021) of 55% of persons died by suicide from poison, while the annual average percentage that died from hanging was 37.7%. In a sample of 86 case studies for 2011, there was no reported case of hanging. In 2014 of a sample of 223 cases, only 2 cases of hanging were reported. However, hanging is being used by men and its incidence has increased from 2015 onwards. Why? One view is that they (men) have been blocked from access to dangerous poisons, and since they determine to die by suicide, they resort to hanging.
There is a school of thought that believes that every suicide is precipitated by an element of depression. Noting that unipolar depression is the 5th greatest contributor to disease burden in Guyana, the WHO notes that 10-15% of the population are with mental disorders, and at any one time there could be 3-5% with chronic mental disorder. The WHO study also estimates that between 75,000 to 112,500 persons are afflicted with mental disorders, and between 22,500 to 37,500 have severe mental illness.
Phillip Singer and Enrique Aranetta, Jr.’s study of Hinduization and Creolization determined that mental disorder such as neurosis is more common among Indo-Guyanese (1.6 times the Afro-Guyanese rate) and psychosis is more common among Afro-Guyanese (1.9 times the Indo-Guyanese rate). The authors believe that the disparity is attributable to the different basic personality type between Indo-Guyanese and Afro-Guyanese that has been shaped by differential cultural conditioning. However, their study did not explore the association of mental disorder with suicide or homicide. While studies in the USA show that depression (like bipolar disorder) is linked to 30-70% of suicides, a review of 61 files for 2011 at GPHC show that 67.2.% of the suicidal act was precipitated by intense family problems and 11.4% (N=7) by depression.
Professor Mc Candless, a psychiatrist, recognized the critical role of mental disorder in suicidal behavior but also emphasized the role of social factors such as loss of status, rejection, isolation, shaming, and defective socialization; a condition where the lower status individual is “devoid of methods to express open disagreement with authority figures.” He identified the critical variable of culture in shaping one’s personality as well as increasing the risk for suicidal behavior. This cultural variable has been developed by Phillip Singer and Enrique Aranetta, Jr. in their study of ‘Hinduization’ and ‘Creolization.’
The French philosopher Emile Durkheim in his classic study of suicide insisted that suicide is caused by social facts and not by psychological factors. He attributed suicide to the degree of integration and moral regulation of the individual into society. If there is a sudden rupture of the individual’s social or economic situation, he would view his life as collapsing around him and seek a way out of his interminable turmoil by ending his life by suicide (anomic suicide). When the individual’s bonds (ties) with family and society are broken, the person drifts into isolation and hopelessness which precipitate an egotistic suicidal response.
The importance of social/economic factors have been illustrated by James F Short and Andrew F Henry who argued that suicide and homicide are extreme forms of aggression, undifferentiated in their source of frustration. They asserted that in periods of prosperity, the suicide rate falls and that it rises in times of economic downturn, while crimes of violence, including homicide, rise during periods of prosperity, but fall during economic downturn. These movements are a function of frustration-aggression consequent to the sudden volcanic disruption in one’s life situation that leads either to an intra-punitive (suicide: turn aggression onto self) or extra-punitive outcome (homicide: turn aggression onto others). Simply stated: if Karan blames others for his failures, he is likely to discharge aggression outwards; if he blames himself, he turns aggression onto himself. The Short and Henry model does not fit into the Guyana situation. There is no correlation or association (R=0.125245 p-value .813181. Not significant at p<.0) between the homicide and suicide rates between 2016-2021.
Recent studies have found multiple factors, namely, social, economic, psychological, and mental disorder that precipitate suicidal behavior. But care must be taken not to cast victims into medical Moulds to allow for easy and ready treatment. Each case of suicide or suicide attempt or suicidal ideation is not necessarily the same and would have been precipitated by different social, psychological, or mental health factors. How serious is the suicide problem? Profoundly serious! Over 95% of students (N=101) at 6 High Schools in Essequibo say that suicides and suicide attempts are preventable. They further pronounce: “every life is precious, and that life is a person’s greatest gift from God.”
The views expressed in this column are solely those of the writer and do not necessarily represent the views of the THE WEST INDIAN.