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September 23, 2020 Wednesday 12:29:43 PM IST

It’s Suicidal

Health Monitor

The annual exultation over Kerala state’s strong performance in the CBSE examinations have come alongside the revelation that 66 school-age children have committed suicide in Kerala since March 25 to July 10, 2020, when the nationwide lockdown to contain COVID -19 was in force. The state has a higher rate of suicide compared to other states in India. Kerala is celebrated for its education healthcare, life expectancy, and low infant mortality, and yet the state has struggled to formulate a strategy to stem suicide among children. 

Higher literacy, a better reporting system, lower external aggression, higher socio-economic status and higher expectations are the possible explanations for the higher suicide rates in the southern states (Vijayakumar L, 2008). Mr Pinarayi Vijayan, the Chief Minister of Kerala, attributed the deaths--mostly in the 12-18 years age bracket—to psycho-social problems, such as discord in the household, parental pressure or neglect and substance abuse which might have been exacerbated by the pandemic.

COVID-19 Blues!                

Mental health experts predict that COVID-19 crisis may increase suicide rates during and after the pandemic. Mental health consequences of the COVID-19 crisis including suicidal behaviour are likely to be present for a long time and peak later than the actual pandemic. Studies have shown that both objective social isolation (e.g. living alone) and subjective sense of being alone are associated with suicidal ideation and behaviour. There has been an increase in self-harm and suicide ideation among people since the COVID -19 pandemic hit, says a study, ‘Covid-19 Blues’, conducted by Bengaluru-based Suicide Prevention India Foundation (SPIF). Studies indicate that social isolation, anxiety, fear of contagion, uncertainty, chronic stress and economic difficulties may lead to the development or exacerbation of depression, anxiety, substance use and psychiatric disorders in vulnerable populations including individuals with pre-existing psychiatric disorders.

After 66 school-age children committed suicide in Kerala since March 25, 2020, the state government launched a slew of initiatives to address the mental and emotional well-being of children. Both the government and individuals have begun conducting research in this area. Among the 66 suicides during the lockdown period, 61 were by hanging, three by poisoning, one by jumping from a height and one by setting herself on fire. Though the state mental health programme’s counselling outreach, Ottakkalla Oppamundu (‘you are not alone, we are with you’), has reached out to 64,000 students in two weeks in July 2020, officials were able to identify only seven children with suicidal tendencies. The isolating effect of the lockdown could have adversely affected the state of mind of several children who might have become overly sensitive to domestic issues. The same could be said about their parents who are caught up in the uncertainties of the pandemic. In some of these 66 cases, the reasons were as seemingly minor as being disciplined for playing mobile games or bunking an online class, etc.


Attention Seeking

Is it a message that a person wants to send out to the world? Many suicides fall into that category where the person is trying to tell us a tragic reality. As Freud said long ago, “The inability to affirm life doesn’t imply the ability to affirm death. The anxiety of fate and death controls the life of those who have lost the will to live.”  Though general academic pressure, relationship issues and substance or alcohol consumption are perceived to be factors that go into increasing helplessness among children, the act of suicide itself is a cry for help. The World Health Organization, in a circular on March 18, 2020, titled ‘Mental health and psychological considerations during the COVID-19 outbreak,’ asked for utmost care to children during the pandemic.  Noted psychiatrist Dr C.J. John says that it is a matter of grave worry as to why the children of the state die by suicides when they are with their families in the lockdown period, considering that the presence of loved ones is held as reassuring. This looks paradoxical, and yet needs further in-depth studies. The psychosocial dynamics in our families in these changing times deserve serious attention and reflection leading to positive changes. Here are a few pointers for further investigation in this direction:

Parental Bonding

The quality and integrity of this primary relationship is vital to meaningful and all-round human development. Unfortunately, there seems to be a decrease in this vital connection between parent and child. There are many factors that lead into this unhealthy situation, such as early separation of a child (from a working mother/father), job stress, the physical absence of either or both parents due to work, marital conflict, financial problems, parental addiction to screen, alcohol, substance, etc. When a child has a problem, especially a problem with family or a close friend, they may lose important sources of social support which may increase the risk of depression and suicidal behaviour. This is the reason why the stressors from parents and friends are significantly related to depression and suicidal ideation and behaviour. Research has found a positive and significant correlation between depressive illness and suicidal ideation with early parental deprivation (Badrinarayana A. 1980). Early intervention may be necessary to protect the quality and integrity of these primary interpersonal relationships.


CEN

Another important emotional disconnect that is taking place in families with far-reaching negative impact is ‘childhood emotional neglect’. CEN is a parent’s failure to respond enough to a child’s emotional needs. It happens when your parents fall short in the area of acknowledging, validating, and responding to your feelings as they raise you. Emotional Neglect is a parent’s failure to act. It’s a failure to notice, attend to, or respond appropriately to a child’s feelings.  Because it’s an act of omission, it’s not visible, noticeable or memorable. Because their emotions were not validated as children, they may have difficulty knowing and trusting their own emotions as adults.  They may have difficulty understanding their own feelings, as well as others’.  Because an important part of themselves (their emotional self) has been denied, they may find themselves feeling disconnected, unfulfilled or empty. Childhood emotional neglect can cause trauma and long-lasting devastating effects on cognitive and emotional development, and relationships.  And they also learn to be ashamed of their own feelings, despite the fact that their emotions are the deepest, most personal expression of who they are. Mental health practitioners can testify to the negative impacts of this silent killer on the lives of children, adolescents and adults (J.Webb 2012).

ACEs

The term ‘adverse childhood experience’ refers to a range of negative situations a child may face or witness while growing up. Individuals who have faced more difficult childhood experiences have been found to be at higher risk for impaired cognitive and social development, as well as for drug abuse, unintended pregnancy, depression, and PTSD. Environmental experience shapes emotional, cognitive and neurobiological development throughout childhood. It is an individual’s unhealthy attempts at coping and self-regulating the experiences of emotional pain, anxiety, anger, and, or, depression related to unresolved adverse childhood experiences that lead to physical or mental illnesses. Across multiple studies, it has been shown that approximately one-third of all mental disorders worldwide are attributable to exposure to adverse childhood experiences (Green, et al., 2010).  In response to this alarming rate, researchers have been exploring not just the reduction of ACEs but the promotion of positive childhood experiences (PCEs). Thus in any measures intended to prevent suicides, ACEs and PCEs will be quite significant.           


Parental Conflicts
The postmodern, post-industrial era family life provides numerous stressors to parents, and if they are unable to sort them out and deal with them effectively through dialogue, the marriage and family will be in great trouble. Constructive communication and conflict resolution processes are not so familiar even to educated parents. Early exposure of children to parental violence seems to affect their personal development and relational life, including marital life. Experts predict that there will be an exacerbation of already existing problems in families due to the pandemic.

Undue Expectations

According to sociological studies, the majority of the population in Kerala are in an ‘upward-moving mode’, into higher income and status. This involves tremendous pressure exerted on children, motivating them relentlessly to be high achievers. Clinical evidence shows that too much pressure backfires and students turn out to be under-achievers or totally dysfunctional persons. Suicide is one of the ultimate desperate acts of cope-out that these unfortunate victims take recourse to. (Avoidant acts and addictive alibi precede such desperate acts, which are well-known to clinicians).  Add to this the massive number of suicides after exam results. (In 2018, 2540 students committed suicide in India because they “failed” in the exams (NCRB). Many students complain about their parents’ constant comparing and discounting talks in matters related to study and outcome.

Emotionally Overcharged Families


The isolating effect of the lockdown could have adversely affected the state of mind of several children who might have become overly sensitive to domestic issues. Living under the constant watchful eyes of the parents can be quite demanding. Bereft of friends and social mingling, without relaxation from their favourite sports and games, the youngsters feel a lot of stagnation and emotional suffocation. No wonder the youngsters complain about their parents’ over-involvement, over disciplining, irritability, impatience, etc. On the other hand, parents are also undergoing great stress and strain due to the ‘lockdown’ caused by the pandemic. Children sometimes have no idea as to what level of anxiety and anguish their parents go through. No wonder, parents get overly sensitive to seemingly simple issues and chores of domestic life which children conveniently ignore. Yes, indeed, families are treading an untrodden path in the history of humanity.

Understandably medical professionals and public health specialists are focused on taking care of individuals who are very sick while containing the coronavirus’s spread in the general population. Less attention is given to the mental health issues of the COVID-19 crisis. However the recent spate of suicides among our school-going children has been a wake-up call, and many crisis intervention programmes are in place. The focus of the present discussion was to bring to the fore the extreme importance of the primary interpersonal relationship and the deadly consequences of a rupture in that foundational support system. Studies show that such disconnect precipitates depression, suicidal ideation and behaviour, especially in the younger age group. Future research should examine the role of those variables that are capable of reducing the negative impacts of chronic strains, such as social supports, personality styles and coping skills. Early intervention seems necessary to protect the quality and integrity of these primary interpersonal relationships and its nurturance.


Dr. Jose Cletus Plackal

Licensed clinical psychologist, BET-MRT, Jeevas Centre, Aluva, Kerala.

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