Talks By The Firelight 3.9: Hope - A Call Away
Dr. Lakshmi Vijayakumar, Leading psychiatrist, Founder — Sneha Foundation India
For an issue of immense importance, student suicides are largely ignored — or worse, brushed ignominiously under the carpet. Though suicide has been legally decriminalized, the stigma still remains as a stain our society rushes to get rid of. It is considered an act of cowardice by the general populace, and hence people who really are in need of help are made to feel ashamed of reaching out, fearing the establishment of their ‘incompetence’.
When we hear news reports about suicides, we wax eloquent about how ‘suicide is not an option’. Instead of trying to educate ourselves, we resort to victim-blaming or blaming the ‘system’. Life goes on as usual and the deaths become mere statistics. But here’s someone who’s risen above the rut and is taking concrete, powerful action along the lines of suicide prevention.
Dr Lakshmi Vijayakumar is the founder of Sneha, India’s first suicide prevention centre. A renowned psychiatrist, she established Sneha in early 1986. People in deep emotional distress can reach out through the Sneha helpline (+91 44 2464 0050; +91 44 2464 0060) or contact them through an email (help@snehaindia.org) at any time of the day to avail the emotional support they require. In a short albeit insightful interview with Festember, Dr Lakshmi Vijayakumar talks about mental health, establishing Sneha, the growing instances of suicide in India — especially among youngsters — and what each person can do, at an individual level, to prevent suicides.
As a medical professional, how was your life during the lockdown?
To confess, I had been busier than usual. Various international medical conferences that were scheduled to take place after March were held online. Further, with increasing clinical load, it had been taxing — both physically and mentally.
What are your views on the lockdown and its impact on mental health?
More impetus is given only on the medical aspects of the COVID-19 pandemic and not on its psychological impacts. Many people are living in the fear of contracting the disease and bleak educational and job prospects.
The world is simultaneously undergoing a mental health crisis, in the shadows.
With TASMAC (Tamil Nadu State Marketing Corporation-wholesale and retail alcohol vending corporation) outlets being closed (in the context of the said state), many people committed suicide due to withdrawal symptoms. There is a steep increase in the instances of domestic violence, which is especially dangerous for children. Both the perpetrators and victims of domestic assault are now forced to stay under the same roof and the children are forced to witness the uglier aspects of life, since a change of scene is virtually impossible.
What are your views on India having some of the largest instances of suicide on a global scale?
India alone contributes to 33% of the global suicide tally.
The National Crime Bureau states that about 1.35 lakh people commit suicide every year. However, according to research undertaken by WHO and Sneha, about 2.3 lakh Indians commit suicide every year, out of which 50% of the victims are below the age of 50. And the highest instances of suicide occur among the people of the age group of 18–30, a situation that is steadily escalating. Isn’t this a huge loss to our society and economy?
Suicide statistics collected and analyzed over the past 20–30 years show a worrying trend — South India has the highest suicide tally; states like Madhya Pradesh and Maharashtra contribute moderately while Northern states like Bihar and Uttar Pradesh have the lowest number of suicides. Furthermore, there is only a marginal difference between the number of suicides in rural and urban areas.
How are volunteers chosen and trained at Sneha?
Now, that’s an interesting question. We are very particular when it comes to choosing volunteers for Sneha.
Every year, an advertisement is released in the newspapers and over 200–300 people apply. With three PIs (personal interviews), the selection process is very rigid and only 9–10 people are selected every year. We don’t expect our volunteers to be trained counselors or psychologists. Being empathetic, non- judgemental, able to understand and feel the pain of others, and not imposing one’s own opinions on others are fundamental qualities that we expect from every applicant. Though we provide 30–40 hours of training, these are innate traits that can never be taught.
This is not like other forms of social work where one contributes to donation drives, distributes artificial limbs for free and feels very proud of oneself. This work involves establishing intimate connections, understanding and feeling the pain of people and trying to bring them out of their suicidal tendencies, which is pretty draining — both mentally and emotionally.
Hence every volunteer works for only one shift per week.
Juggling between your profession as a psychiatrist, a researcher for WHO and running Sneha must be very taxing. How do you ensure that all this does not take a toll on your mental health?
(Laughs) Do you know that amongst all medicos, psychiatrists are the ones most prone to suicide?
A study conducted by Harvard Medical School assessed psychiatrists for 20 years — from the beginning of their specialization to real-world medical practice and concluded that the profession had a debilitating impact on their own mental health. People even joke about this saying every student specializing in psychiatry must be slightly mad themselves!
And there are two things I do to ensure I don’t succumb to the immense mental strain that I’m subjected to — staying empathetic but neutral while dealing with cases, because there’s a fine line between empathizing with one’s patients and becoming a patient as well. Of course, that is gained only through experience; and secondly, I ensure that I’m able to devote at least one hour to doing what I love. I unwind by bonding with my family, going for a walk and reading for at least 10 minutes everyday.
India sees an alarming number of student suicides and the number seems to only increase with every passing year. What are the reasons and what should be done to prevent suicide, amongst students?
I encountered a student who had tried to commit suicide because she had missed getting a medical seat by a narrow margin. Mind you, she was what you would call a typical high-achiever — she was a school topper, a trained Bharatnatyam dancer and a tennis champion.
During our interaction she said, “Doctor, my mom taught me how to be a good Bharatanatyam dancer and my dad taught me how to become a good tennis player. My school taught me how to ace my exams — but none of them taught me how to handle failure.”
It is our overemphasis on success and a literal phobia of failure that forces students to think they have failed their parents and well-wishers — that their life isn’t worth living anymore.
Further, parents are too wrapped up in their own world to understand the needs and aspirations of children. Hence to placate them, they instantly buy all that they ask for and give in to most of their demands. This way, students are conditioned to expect instant gratification, but they must realize that their career and relationships don’t work that way.
The larger chunk of student suicides over exam failure falls under the category where the student would have failed only in 1–2 subjects. Hence, in 2004, we launched a massive campaign requesting the Department of Education, Tamil Nadu, to conduct supplementary exams within 1–2 months after the results for class 10 and class 12 board exams were published. This would ensure that students wouldn’t ‘waste a year’ to join college. This significantly brought down the number of student suicides. This initiative was lauded by The Economist journal and states like Maharashtra, Andhra Pradesh began adopting this measure as well.
If someone is feeling suicidal and has no access to professional help, can they convince themselves out of it?
Attempting suicide is actually a desperate cry for help — and even a form of communication from the victim to people around them. About 80% of suicide victims have been totally ignored by the people around them, which leads them to take that fatal step. Most of the people who want to commit suicide are ambivalent, where they don’t really want to die but do not want to go on living like this.
Feeling suicidal is a very strong emotion. One cannot feel suicidal for 6 months — their body cannot handle it. A person can feel acutely suicidal for only 1–2 weeks. Hence if one intervenes during that period, one can easily bring that person out of their suicidal tendencies.
It is a misconception that all forms of suicidal tendencies require medical intervention. All suicidal tendencies rise out of the ‘infamous triad’ of emotions — loneliness, helplessness and hopelessness.
Hence all that one requires is the presence of a warm, trustworthy, empathetic, and non- judgemental friend.
This way, a person starts feeling less lonely. They become calmer and concentrate on how to overcome their problems, becoming less helpless and more self-reliant. Once they formulate a slightly concrete action plan, they regain hope and finally break free from the nexus of the ‘infamous triad’.
Apart from providing support through helplines, what are the other things that Sneha does along the lines of suicide prevention?
We are engaged in research about suicide prevention, with special emphasis on rural India. We conduct outreach programmes in schools, colleges and even hospitals. Most rural suicides happen through pesticide consumption — hence we built a centralized pesticide storage unit in Cuddalore, where each farmer can store their pesticides in their designated lockers. This way, pesticides don’t become an easily accessible means for suicide.
We even trained Sri Lankan refugees as suicide prevention volunteers in refugee camps in Kottapattu and Thoppukollai near Trichy, to provide support to the other inmates of those refugee camps who were feeling despondent and suicidal.
In the time of crisis that we are in, what self-care routine do you suggest people to preserve their mental wellbeing?
Who even expected that an obscure single-celled organism would turn the world upside down?
These are trying times, where everyone tends to feel anxious, depressed and hopeless. At an individual level, try to follow the directives laid down by the government like wearing a mask, sanitizing, maintaining physical distancing etc. Irrespective of whether you have work, online classes or not, try to maintain a routine. Devise a timetable for everyday and try to stick to it.
The reason why everyone is feeling flustered during the pandemic is that things are unpredictable and have gone out of control.
Hence, follow a proper routine to reassure yourself that you are still in control of your life. Keep yourself occupied by trying new things — learning a new language, a new song, reading a new book, amongst others. Devote time to do what you have always wanted to do before but couldn’t due to lack of time.
Stay connected with your friends and involve in any form of physical activity — be it dancing, jogging or yoga. Further, try helping others who are in need in whichever way possible. It could be anything — buying groceries for your neighbours who might be more vulnerable to the virus or teaching kids younger than you.
This instills a sense of purpose and altruism, because when everybody starts thinking less about themselves and more about others, life would become more meaningful and the world would become a better place to live in.
The interview we had with Dr Lakshmi was an enlightening experience, where many myths were busted and individual-level reforms were suggested with a brisk call to action. While generalizing about how ‘good’ or ‘bad’ the society is and how things will never improve, we must remember that we too are an integral part of that society.
Change begins us, hence let’s educate ourselves to become resilient and create a more inclusive and empathetic world — where failure is tolerated, solution-driven approach normalized, interpersonal relationships cultivated and suicides eradicated.
You are important and you deserve help. If you are in need of immediate mental care, please reach out to your trusted contacts as well as the helplines below:
Sneha suicide prevention helpline:+91 44 2464 0050; +91 44 2464 0060 (24x7)
Tamil Nadu state suicide prevention helpline: 104
I Call (Mumbai): +91 022 2522 1111(Monday to Saturday, 8 AM to 10 PM)
Roshni (Telangana): +91 040–6620 2000 9AM to 11 PM
This interview was taken in collaboration with Naman Karn.
