Table of content:

1. Introduction
2. Critical Analysis
3. Profiling and Identification of Risk Factor
4. Reflection from Cultural and Historical Heritage of India
5. Methods and suicide
6. Personality disorder
7. Personality variables those are associated with suicidal behavior:
a) Impulsivity

b) Hopelessness

c) Neurological or Genetic factors for suicidal behavior

8. Suicide in different section of society

a) student suicide

b) farmer suicide

c) suicide in armed force

d) family suicide

9. Factors Gaining Momentum in Influencing Suicide in India

a) Problems with parents-in-law and spouses:

b) Impact of internet

10. Implications on possible change in legal trends:

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 a) euthanasia

b) Gay and lesbian marriages

c) mental health care bill 2010

11. Basic survey for laymen to understand causes and consequences

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Introduction:
Suicide (felo de se) is a Latin term which means deliberate termination of one’s own physical
existence or self-murder, where a man of age of discretion and compos mentis voluntarily kills
himself. It is an act of voluntarily or intentionally taking one’s own life. According to concise
oxford dictionary, it means intentional killing of oneself.

In the halsbury’s laws of England the word suicide has been dealt in the following words: A
finding of suicide must be based on evidence of intention. Every act of self destruction is, in
common language, described by the word “suicide”, and provided it is the intentional act of a
party knowing the probable consequence of what he is about. Suicide is never to be presumed.
Intention is the essential legal ingredient.

According to black’s law dictionary, suicide is self destruction; the deliberate termination of
one’s own life and “attempt”, ordinarily means intent combined with an act falling short of the
thing intended. It may be described as an endeavor to do an act, carried beyond mere preparation
but short of execution. Hence after the conjoint reading of the meaning of “suicide” and
“attempt” it can be deduced that attempt to suicide is an endeavor to do suicide which is carried
beyond mere preparation but falls short of execution.

Life is a stage with one entrance but many exits. Among these, suicide is one exit having a long
ancestry. In 1986, the World Health Organization defined suicide as “a suicidal act with fatal
outcome”. World Health Organization defined suicide as “a suicidal act with fatal outcome “.
WHO labeled, suicidal acts with non-fatal outcome as “attempted suicide.”

Over 8, 00,000 people die due to suicide every year and there are many more who attempted
suicide making it a major health problem in every country and every community worldwide.
Suicide occurs throughout the lifespan and was the second leading cause of death among 15-29
year olds globally in 2015.

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The WHO in its World Suicide Report released on September 5, 2014, stated that of the 192
countries, only 25 had specific laws and punishment for attempted suicide. It recommended
decriminalization of attempted suicide.

According to concise Oxford Dictionary the word decriminalize means cease to treat as illegal.
Decriminalization is an official act generally accomplished by legislation, in which an act or
omission, formerly criminal, is made non-criminal and without punitive sanctions.

In India on average more than one lakh persons committed suicide every year during the decadal
period from 2004 to 2014. The highest incidents of suicides were reported in Maharashtra and
Tamil Nadu.

According to the data published by the National Crime Records Bureau in the year 2015, the
main factors responsible for suicide were marriage related problems, family related problems and
illness indicating towards the fact that most of the person who attempted to commit suicide
needed help and treatment instead of being put on trial and subsequent imprisonment.

Critical Analysis:

More than one lakh lives are lost every year due to suicide in India. In the last three decades
(from 1975 to 2005), the suicide rate increased by 43%. The rates were approximately the same
in 1975 and 1985; from 1985 to 1995 there was an increase of 35% and from 1995 to 2005, the
increase was 5%. However, the male-female ratio has been stable. There is a wide variation in
suicide rates within the country. The southern states of Kerala, Karnataka, Andhra Pradesh and
Tamil Nadu have less suicide rate while in the Northern States of Punjab, Uttar Pradesh, Bihar
and Jammu and Kashmir, the suicide rate is more. This variable pattern has been stable for the
last 20 years. Higher literacy, a better reporting system, lower external aggression, higher
socioeconomic status and higher expectations are the possible explanations for the higher suicide
rates in the southern states.

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Majority of the suicides (37.8%) in India are by those below the age of 30 years. The fact that
71% of suicides in India are by persons below the age of 44 years imposes a huge social,
emotional and economic burden on society.

The near equal suicide rates of young men and women and consistently narrow male:female ratio
denotes that more Indian women die by suicide than their Western counterparts. Poisoning
(34.8%), hanging (31.7%) and self-immolation (8.5%) were the common methods used to
commit suicide (accidental deaths and suicide 2007). Two large epidemiological verbal autopsy
studies in rural Tamil Nadu reveal that the annual suicide rate is six to nine times the official
rates. If these figures are extrapolated it suggests that there are at least half a million suicides in
India every year. It is estimated that one in 60 persons are affected by suicide. It includes both,
those who have attempted suicide and those who have been affected by the suicide of a close
family or friend. Thus, suicide is a major public and mental health problem which demands
urgent action.

Fifty four articles on “Suicide” have been published in the IJP from 1958 to 2009. The relative
paucity in publications can be attributed to several factors but chiefly to the fact that it is an
extremely difficult area to take up for research considering its sensitive nature, associated stigma
and legal implications. It is interesting to note that the first article on attempted suicide appeared
only in 1965. The articles ranged from references to suicide in ancient literature to
psychobiological variables in suicide, epidemiological studies to prevention strategies.

Profiling and Identification of Risk Factors:

Majority of the published studies on suicide have dealt with identifying the socio-demographic
and psychosocial aspects of suicide attempters and those who have completed suicide. Some of
these have also attempted to identify the characteristic differences between the two groups. Most
of these were hospital based studies. The study methods used varied, from use of psychological
autopsies to interviews to perusal of records.

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hospital based study on suicide attempts reported a preponderance of males and identified the
vulnerable age group as being those from 15 to 25 years. Lack of social cohesion was identified
as a significant risk factor. 20% of the attempters also had a family history of mental
illness/suicidal attempts. The method of attempting suicide as well as the time (during daytime or
night), were not seen as factors influencing intent.

In another hospital based study it was reported that women attempted suicide more often, were
below 30 years of age, were housewives or domestic help, married and income levels of 83.4%
was less or equal to Rs. 200 per month. Females with lower educational level and joint families
and males with higher educational levels and from unitary families attempted suicide more
frequently. Similarly, a study also revealed that younger people (age range of 10 to 30 years)
were more likely to attempt suicide. The primary causes were identified as Mental illness and
disturbed interpersonal relationships. Extramarital affair was also identified as a risk factor for a
spouse to attempt suicide.

There was an investigation of the relationship between availability of lethal insecticide and the
incidence of suicide. The study concluded that there was no association between the easy
availability of the lethal insecticide and the high incidence of suicide but rather it was the motive
which actually determines the incidence of suicides.

He also attempted to examine the relationship between unemployment and suicide and concluded
that though unemployment may be an important factor in suicide it did not appear to be the
causative factor. The study postulated that both unemployment and suicidal behavior could be
due to some common psychopathological factors. However, it was identified that unemployment,
presence of a stressful life event in the last six months, suffering from physical disorders and
having idiopathic pain as definite risk factors for attempting suicide.

In their study from Ludhiana, it was reported that single males and married females were more
likely to attempt suicide. They, however, did not find type of family, economic status and
educational levels as being significant variables. Mood disorders and adjustment disorders were
diagnosed in a significant number of them.

A study was conducted. on 521 patients admitted for suicidal behavior and reported that the
degree of intent was low, duration of suicidal ideas ranged from more than 1 year (2%) to it

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being an impulsive act in 17% of them, 18% communicated about the attempt while the majority
of women (76.1%) attempted suicide in the presence/proximity of others. Previous attempts were
reported in 7% with 2.4% having more than one previous attempt. Depression (39.73%),
schizophrenia (24.4%) and hysteria (14%) were the most common psychiatric diagnosis made.

On a study on farmer suicides in the Vidarbha region, researchers employed the psychological
autopsy method to understand the phenomenon and have identified the following reasons for
farmer suicide

(1) chronic indebtedness and inability to pay debts accumulated over the years

(2) economic decline that leads to complications, family disputes, depression, alcoholism, etc.
(3) compensation following suicide helps the family repay debts

(4) rising costs of agricultural inputs and falling prices of agricultural produce.

Reflection from Cultural and Historical Heritage of India:

In almost all societies individual and social life was governed by social customs during the
ancient and medieval ages. Social value preceded human values. India is no exception to this
rule. India had too remained under the rule of customs, how so ever; some of them might appear
as tyrant and unjustify today. Indian culture seems to create an ambivalent attitude towards
suicide and euthanasia, on the one hand sanctity of life was taken to be the highest value and the
violation of it including suicide was considered the highest sin. But on the other hand suicidal
acts were glorified if they occurred in defense of social values. The customs of Sati, Jauhar, Saka
(Keseria) may be taken as evidences of providing the above arguments. Sati stood for a custom
of self-immolation of a widowed woman by setting on the funeral pyre of her deceased husband.
Although, there is scholar like Varun Prabhat who argued that Sati was not an ancient custom
but its modern connotation was invented by Christian Missionaries. Varun Prabhat writes: “Sati
is an ancient Sanskrit term, meaning a chaste woman who thinks of no other man than her own
husband. The famous examples are Sati Anusuiya, Savitri, Ahilya etc. none of them committed
suicide, let alone being forcible burned. So how is that, that they are called Sati? The word ‘Sati’
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means a chaste woman and it has no co-relation with either suicide or murder. The term Sati was
never accompanied by ‘Pratha’. The phrase, ‘Sati Pratha’ was a Christian Missionary invention.
Sati was taken from the above quoted source and ‘Pratha’ was taken from the practice of Jauhar,
(by distorting its meaning ‘Suicide’ to ‘Murder’) and the myth of ‘Sati Pratha’ was born to haunt
Hindus forever”. Whatsoever might had been the truth, the fact remains that, even at the dawn of
the modern age, Raja Ram Mohan Ray (1772-1833) had to initiate the movement against Sati
Pratha and did not relaxed till the horrible custom was abolished in 1829 by Lord William
Benting, the then Governor General of East India Company. Even in recent times a woman Roop
Kanwar in the village Deorala district Sikar of Rajasthan performed sati on the burning pyre of
her husband. There were many local people who supported her and asked everyone to do what
she had done so bravely and uphold the Hindu traditions and long followed customs of the
village. Customs indeed, do die hard sati pratha of course and obsolete custom now. About
Jauhar and Saka Wikipedia informs us: “Jauhar and Saka refer to the voluntary deaths of men
and women of the Rajput clan in order to avoid capture and dishonour at the hands of their
enemies. This was done sometimes by Hindu and Sikh women in Mugal times and are recorded
incidences of this on a much smaller scale during the partition in 1947, when women preferred
death then to being raped by enemies or, turned into a slave or being forced in to a marriage and
to take their enemy’s religion”. Jauhar was originally the voluntary death on a funeral pyre of the
queens of the royal women folk of defeated Rajput Kingdoms. The term is extended to describe
the occasional practice of mass suicide carried out in medieval times of Rajput women and men.
Mass self-immolation by women was called Jauhar. This was usually done before or at the same
time their husband, brother, father and sons rode out in a charge to meet their attackers and
certain death. The upset caused by knowledge that their women and younger children were dead,
no doubt filled them with rage in this fight to the death called Saka. Besides, Sati, Jauhar and
Saka which were performed in defense of social values and customs, there are umpteen stories in
Purans and Vedas in which both men and women voluntarily accepted death by immolating their
mortal bodies by various means, including fire. The power of yoga makes them oblivious of the
pain of the decay of the mortal body. V.G. Julie Rajan (1999) aptly writes : “Hinduism does
provide a means to end one’s own life when faced with incurable illness and great pain that is
fasting to death prayopavesa, under strict community guidelines. Gandhi’s associate, Vinoba
Bhave, died in this manner, as did recently Swami Nirmalanand of Kerala. It is generally thought

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of as a practice of yogis, but is acceptable for all persons. Prayopavesa is a rare option, one
which the family and community must support to be sure this is the desire of the person involved
and not a result of untoward pressures. Thus, Hinduism made the provision of self-willed death
also. In his book ‘Merging with Siva’ Satguru Sivaya Subramuniyaswami wrote about Hindu
view of death in the following words: “Pain is not part of the process of death. That is the
process of life, which results in death. Death itself is blissful. You did not need any counselling.
You intuitively know what’s going to happen. Death is like a meditation, a Samadhi. That’s way
it is called Maha (Great) Samadhi”. Jains, a leading religious and business community of India,
claim same, or some time more antiquity as Hinduism. They have an ancient custom called
sallekhana or santhara, according to this custom a person can take a vow not to drink or eat food
till his last breath. Even in modern India, it is reported that Jain resort to santhara in a sizable
number. Gujrat, Rajasthan, Maharashtra and Karnataka account for most santharas in the
country. It is also to be maintained that santhara is not the preserve ofjain monks who have
renounced worldly affairs.

Institute of Indology “In fact, more ordinary Jains take up santhara than monks. Another
common misconception is that only people suffering from illness embrace the practice. That’s
not true. Santhara is taken up with a view to scarifying attachments, including one’s boby”
Besides, women-men ratio of santhara practitioners stands at 60 : 40, perhaps because women
are generally more strong willed and have a religious bent of mind. The cultural tradition of
santhara among Jains is not an exception to its critics or opponents who claim to be rationalists
and humanists. In 2006 Human Rights activists Nikhil Soni and his lawyers Madhav Mishra file
a public Interest Litigation (PIL) with the High Court of Rajasthan. The PIL claimed that
santhara was a social evil and should be considered to be suicide under Indian legal statute. It
also extended to those who facilitated individuals taking the vow of with aiding and abetting an
act of suicide. For the Jains, however, the courts or any other agency intervention in such case
would be a clear violation of the Indian Constitution’s guarantee of religion freedom. This
landmark case sparked dabate in India, where bioethics is a relatively new phenomenon. The
defenders of sallekhana or santhara argued that santhara has a religious context, where as suicide,
and abetment to suicide fall in criminal context. Moreover, hunger strikes are a common form of
protest in India but often end with forced hospitalization and criminal charges. Besides, the
suicide is itself contentious, since it would punish only an unsuccessful attempt at suicide, also

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punishable how far this provides deterrence is questionable. Lastly, suicide is usually and
outcome of acute mental depression followed by self-isolation a person may leave a suicide note
also. The act of suicide is instantaneous and not a prolonged ritual, where as in santhara the
person takes a vow not to have food or water and it is a slow process which takes place admits
the dear ones and other fallow co-religionists. Santhara is not practiced with an intention to end
one’s life but to end his own karmas and to achieve self purification through act of renunciation
of all worldly actions including food and water. In addition to it if an individual feels he can
continue or has a desire to live, an individual can break a vow. Thus, santhara can not be in any
way considered as suicide. With sallekhana or santhara, death is welcomed through a peaceful,
tranquil process providing peace of mind for everyone involved. In fact philosophically santhara
can be rationalized by many angles and Jain philosophers and religious leaders have actually
done so. As regards the question of its legality, it can be stated that like all religious practices the
question cannot be decided on the bases of rationality and law alone. At present it is not clear on
what grounds and statistics, santhara is to be held illegal. Thus, the cultural heritage of Indian
reflects a cultural ambivalence towards suicide and euthanasia. In fact, it is important to make
two observations here: First, that Sati, Jauhar or Saka or Maha Samadhi by yogis or santhara
among Jains is certainly more different than euthanasia used in the modern sense. All societies
including advance and developing societies glorify the killing of enemies in a war and; secondly,
the controversy over euthanasia is of recent origin due to advancement of medical science and
technology and longevity. It is the product of almost last three or four decades. In India the
controversy gained momentum after the case of Venkatesh in 2004. In reality it is related to
medical context and socio-legal setting. Voluntary euthanasia and physician assisted suicide have
become the focal points. There appears no need of justifying them or rationalizing or legalizing
them on support of cultural history of India. Since the controversy on legalizing euthanasia in
India is of recent origin, it has to be resolved and settled with reference to contemporary socio-
medico-legal situation in India.

Methods and Suicide:

The most common methods in many studies presented here are poisoning (in almost all cases,
pesticides) and hanging. These being easily available with no laws for restriction of access are
resorted to by many Indians who attempt suicide. Self-immolation, drowning, and jumping from
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heights are other significant methods. Women more commonly than men choose self-immolation
and drowning as methods of suicide. This prevalence of self-immolation among young women
probably has deep socio cultural roots in India, with “fire” considered as an agent of purification
in Hinduism or as an attempt at escape from hardship or humiliation. These themes were
reflected in ancient archaic practices such as “sati” and “jauhar.” As India has stricter licensing
laws restricting the use of firearms compared to countries such as the United States of America,
this method is considered to be less often used. Firearms are not focused on in Indian suicide
literature; however, as the medico legal studies reveal, they can be chosen by a significant
proportion of people if accessible.

Personality Disorder:
Personality disorders involving an inability to control anger and impulses have also been noted
among suicidal patients. The majority of persons who commit suicide have experienced serious
difficulties with their parents during childhood. More than half have been rejected, abandoned or
physically or psychologically abused. These early adversities may make them more likely to
mistrust other people and less able to face difficulties such as marital separation or financial
distress. Almost half of suicides clients suffer from severe depression. Nearly 22% of the
suicides in India have been among students caused by nonattainment of expectations. Among the
youth major causes are examination failures, parental pressures, high expectations of school and
colleges, disappointment in love and conflicts. India has seen a lot of farmers (15%) die in recent
years. Debt and the resulting harassment at the hands of money lenders is a major cause. The
reason for suicide is not known for about 43% of suicides were due to illness while family
problems contribute to about 44% of suicides. Divorce, dowry, love affairs, cancellation or the
inability to get married (according to the system of arranged marriages in India), illegitimate
pregnancy, extra-marital affairs and such conflicts relating to the issue of marriage, play a crucial
role, particularly in the suicide of women in India. A distressing feature is the frequent
occurrence of suicide pacts and family suicides, which are more due to social reasons and can be
viewed as a protest against archaic societal norms and expectations. In a population-based study
on domestic violence, it was found that 64% had a significant correlation between domestic
violence of women and suicidal ideation (World Health Organization, 2001). 90% of those who
die by suicide have a mental disorder. In Chennai, 25% of completed suicides were found to be
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due to mood disorder. They reported that more than 60% of the depressive suicides had only
mild to moderate depression. Media reporting is also an important factor for suicides. The effects
of modernization, specifically in India, have led to sweeping changes in the socio-economic,
socio-philosophical and cultural arenas of people's lives, which have greatly added to the stress
in life, leading to substantially higher rates of suicide. In India, the high rate of suicide among
young adults can be associated with greater socioeconomic stressors that have followed the
liberalization of the economy and privatization, leading to the loss of job security, huge
disparities in incomes and the inability to meet role obligations in the new socially changed
environment. The breakdown of the joint family system that had previously provided emotional
support and stability is also seen as an important causal factor in suicides in India. Lack of belief
in God is one of the factor for committing suicide in Chennai. Lack of religious belief was a risk
factor. The actual data on attempted suicides becomes difficult to ascertain as many attempts are
described to be accidental to avoid entanglement with police, courts and media.

Personality variables those are associated with suicidal behavior:

1. Impulsivity:
Neurobiological research has studied the connection between the personality dimensions of
aggression and impulsiveness in suicidal and violent individuals. Researchers focused on
impulsivity together with anger and hostility. Two personality disorders associated with suicidal
behavior are: 1. Antisocial personality disorder 2. Borderline personality disorder Suicidal
individual tend to be controlled by external events rather than moderated by internal stimuli.
Perfectionism, tendency to withdraw and aloofness are among some of the personality traits that
are also associated with suicidal behaviour. "Extremeness" is also responsible for suicidal
behaviour. The suicidal individuals are more rigid and extreme in their thinking than non-
suicidal persons. Another study reported similar results that suicidal individual are more rigid
and inflexible and less able to change their problem solving strategies. Other studies have found
similar results, showing that young suicide attempters were more field-dependent (that is, their
decisions were more influenced by their environment). Studies suggest that cognitive deficit
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make it difficult for a depressed person to generate new or alternative solutions to the problem.
Successful problem solving depends largely on the quality of the type of memories individual are
able to retrieve. Depressed and suicidal patients are poor at problem solving because they are
unable to access specific memories successfully. Specific memories are very useful as a resource
in solving problems.

2. Hopelessness:
If a person feels defeated and there is little chance of escape he/she becomes very vulnerable.
Hopelessness is one of the main mediating factors in the relationship between depression and
suicidal intent. Lack of positive expectancies a contributing factor in suicidal behavior and
should be taken into account more explicitly in assessments and interventions.

3. Neurological or Genetic factors for suicidal behavior:

Serotonin and Dopamine have also been examined by measuring the growth hormone response
to apamorphine in depressed persons, some of whom later commit suicide. Alcohol and drugs
also have a major influence on attempted suicides. Approximately one million people die by
suicide and this is becoming an international public health concern on the same levels as illness
such as malaria. Alcohol dependence and abuse were found in 35% of suicide. Alcoholism and
drug addiction, with their associated loss of control over emotions and actions, are also
associated with suicide.

Suicides in Different Sections of Society:

1. Students suicide:
Suicide of students has risen from 5.5% of all cases in 2010 to 6.2% in 2013. The vulnerability

13
of the student population depends on several factors. The findings those students with a parent
not alive and those whose mothers were working were at a higher risk for suicidal behavior
suggests the importance of parent's support and their availability for ensuring the adolescent
capacity to prevail over various stresses in life. On the contrary, it must also be noted the parents'
over expectations on their academic achievements and criticisms on their underperformance
could be contributing factors for suicidal behavior. Humiliations meted out in schools and
problems in sexual relationships could also be among other factors.

In the current scenario in India, employment opportunities are shrinking. Policies including for
self-employment require to be framed, quality of education needs to be strengthened, and the
feeling that education has not made them employable needs to be addressed.

2. Farmers suicide:
The number of farmers who had committed suicide in 2010 has reached a peak with 15,964
deaths as against 11,096 in 2009. Although there is a decline in 2013 (11,772), the figure is still
higher than in the earlier years. The state of Maharashtra seems to have more number of victims
more recently.

It has been observed that the farmers who committed suicide were under huge debts, and the
income from agriculture was not adequate to repay the borrowed money. In the absence of any
help, these farmers perhaps chose to end their lives. This phenomenon is imposing a challenge
not only to mental health professionals, but also to political and social reformers. What are the
strategies to be adopted here? A multipronged approach including financial, material, and
psychological support is needed to reduce the incidence of suicide among the farmers who are
the back bone of our country.

3. Suicide in armed forces:

According to a Government of India report, 597 military personnel have committed suicide in
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the last 5 years. Whether this trend in armed forces was already an existing one or it is only a
recent occurrence is not clear. Soldiers posted in far flung areas and on prolonged deployment
undergo tremendous mental stress for not being able to take care of the problems faced by their
families back home. This could be compounded by the lack of basic amenities, ineffectual
leadership, and sometimes humiliation at the hands of their officers. On analyzing 22 cases of
attempted suicides in armed forces, it was observed the noteworthy problems as service-related
in eight personnel, disciplinary proceedings in two, bad peer relationship in six, and family
issues in three.

4. Family suicides:
Taking cognizance of an increase in press reports of family members committing suicide
together, the government has begun enumerating such suicide pacts from the year 2009.
Accordingly, in 2010 the number of such victims was 290 and in 2013 it was 108. Certainly the
figures might be far less, as the government sources have confessed that 11 States have not
furnished this information. At any rate, most of such family suicides are reported to be the end
result of extreme poverty and debts, although other factors such as intractable ailments of
important family members, humiliating incidents to the family, and superstitious beliefs might
also be contributory.

Factors Gaining Momentum in Influencing Suicide in India:

1. Substances abuse:
Although substance abuse has been well documented from the pre-Christian era; their role in
suicidal behavior has drawn the attention of the researchers only from the previous century. One
of the earliest reports revealed, 10.3% among the male suicides to be under the influence of
alcohol and drug abuse. This observation was strengthened by some of the subsequent studies,

15
although their number was a little less. While a few studies have not reported any case of
substance abuse in their sample, some recent studies have reported the alarmingly high
proportion of such cases. At any rate, such observations have to be interpreted with caution as
there is no uniform policy on alcohol or drug use in different States in India.

Many of the substance abusers attempt suicide while under the influence of alcohol. Perhaps, the
conflicts regarding various domestic and other problems, feelings of guilt, and death wish come
to the fore uninhibited at this stage. That apart, neurobiological changes occurring under
intoxication, development of complications such as psychotic disorder, depressive disorder,
delirium, and physical illnesses might drive them to this end.

2. Problems with parents-in-law and spouses:

One of the earliest studies on suicide noted domestic problems as an important factor. In the year
1967, when the NCRB first commenced its enumerations, quarrels with parents-in-law and
spouses formed 16.3% of all causes, whereas in 2013 this figure has risen to 24% and the
problems with parents-in-law and spouses have been the foremost among the causes over several
decades. But, more recently there is a spurt in this proportion. The incidence of divorces,
separation of the spouses due to interpersonal problems, broken homes, and maladjustment
among family members could be cited as some of the important emerging causes.

Elsewhere, it was reported marital maladjustment as the cause of suicides in 6.3% males and
23% females (total 14%). Similar was the finding (13.3%) in another study. It is distressing to
note that even higher prevalence has been observed by some. On analyzing exclusively the cases
of burns, marital problem was observed in 51% of victims. While observing that among female
suicides, 12.3% were due to alcohol and drug abusing husbands, the behavior problems and
symptoms such as delusional jealousy manifested by the alcoholics were noted to be important
driving factors. Hence, the need for popularizing family and marital counseling has been
advocated.

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3. Impact of internet and other communication networks on suicide:
Increasing cases of group suicides of strangers who meet over internet has been reported in Japan
since last decade. The victims are normally found to be young and meet over the internet through
burgeoning number of suicide-related sites and chat rooms where participants are online, not to
dissuade, but to support one another in their desire for suicide. Fears have been raised in the UK
over link between suicide and internet, after 5981 internet suicides were reported in 2012.
Perhaps such people are still looking for companionship, even after death. Through interactions
over mobile phones and internet, teenagers are being lured to meeting each other that may lead to
risk-taking behaviors such as substance abuse and promiscuous sexual relationships. Such
activities might end in suicide due to eventual psychosocial problems.

Although the prevalence of such suicides in India is yet to be ascertained with accuracy, I
suggest preventive measures before this problem becomes incurable. In this context, noteworthy
is an Indian study which has reported that excessive users of internet were found to have high
scores on anxiety and depression.

Implications on possible change in legal trends:

1. Euthanasia
The much-awaited Supreme Court judgment delivered in 2011 that has legalized passive
euthanasia in India might trigger more such pleas in future. Accordingly, the physicians and the
concerned specialists would be entrusted with the responsibility of clinical assessment of the
case. But, the evaluation of the mental status of the patient would be the inevitable task of the
psychiatrist. The depressive and other psychotic features that might have contributed to such
pleas, but nevertheless amenable to successful psychiatric intervention should be thoroughly
examined. In addition, an in depth consideration of the ethical, legal, and also possible biases
likely to be induced by extraneous circumstances including those by the family members, might
be needed before the psychiatrist could give his opinion.

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2. Gay and lesbian marriages
This issue is likely to become a subject matter of debate in the courts of law in future in our
country. Apart from the usual factors that influence the suicidal behavior in same-sex oriented
individuals, such as discrimination, humiliation, rejection by the parents, and society, an eventual
marriage between these individuals might more often than not contribute some more factors.
Those with ambivalence of will and cognition about their sexual orientation are likely to be
motivated in giving their consent for gay/lesbian marriages under the influence of their partners.
An explicit legal sanction might be a vital motivating factor promoting such bondages. But, in
later life of such individuals conflicts may arise regarding their decisions, particularly in those
having a predisposition for a heterosexual relationship also leading to guilt feelings and
depression. Sexual orientation is reported to be a risk factor, with increased rates of suicidal
behavior of 2–6 times among youth who identify themselves as gay, lesbian, or bisexual.

3. Mental health care bill 2010

If the bill becomes the act, an increase in suicide rate among our patients could be speculated.
Escalation in the number of untreated and undertreated patients could be anticipated, as the
psychiatrists may resort to defensive practice in the face of numerous ill-conceived restrictions
imposed on diagnostic aspects and the treatment strategies proposed in this bill. An in-depth
critical review of this bill has dwelt upon the disaster effects of this act on the care of the
mentally ill.

Basic Survey for laymen to understand causes and consequences:

1. What should you do if someone tells you they are thinking about suicide?

Suicide is preventable. Any statements about suicide should be taken seriously; 50 to 60 percent
of all people who died by suicide gave some warning of their intentions to a friend or family
member. Most people considering suicide need help getting through their moment of crisis.

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Often they have tried to find solutions but may begin to feel hopeless and unable to see
alternative solutions to problems. If someone tells you they are thinking about suicide listen non-
judgmentally, and help them get to a professional for evaluation and treatment. If someone is in
imminent danger of harming himself or herself, do not leave the person alone. You may need to
take emergency steps to get help, such as calling 911. When someone is in a suicidal crisis, it is
important to limit access to firearms or other lethal means of committing suicide.

2. Is it possible to predict suicide?

At the current time there is no definitive measure to predict suicide or suicidal behavior.
Researchers have identified factors that place individuals at higher risk for suicide, including
mental illness, substance abuse, previous suicide attempts, family history of suicide, history of
being sexually abused, and impulsive or aggressive tendencies. While many people may think
about suicide, attempts and death by suicide are relatively rare events and it is therefore difficult
to predict which persons with these risk factors will ultimately complete suicide. What is
important is that people considering suicide usually do seek help; for example, in one study,
nearly three-fourths of those who died by suicide visited a doctor in the four months before their
deaths, and half in the month before. Being aware of risk factors and warning signs can help
detect someone that may be at risk for attempting suicide.

3. Why do people attempt suicide?

Unfortunately, there is no simple answer to this question. People die by suicide for a number of
reasons. A suicide attempt is a clear indication that something is gravely wrong in a person’s life.
The majority of people who take their lives (estimated at 90 percent) were suffering with an
underlying mental illness and substance abuse problem at the time of their death. No matter the
race or age of the person, how rich or poor they are, it is true that most people who die by
suicide have a mental illness, emotional disorder and/or chemical dependency. The most
common underlying disorder is depression, with an estimated 60 percent of suicides were by

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people suffering from depression. However, it is very important to remember that the vast
majority of people living with depression do not attempt or die by suicide.

4. What are the most common methods of suicide?

Firearms are the most commonly used method of completing suicide, accounting for more than
50 percent of all suicides. The majority of all firearm suicides are completed by white males. For
women, the most common method of suicide was self-poisoning. The presence of a firearm in
the home has been found to be an independent, additional risk factor for suicide. Thus, when a
family member or health care provider is faced with an individual at risk for suicide, they should
make sure that firearms are removed from the home.

5. Why do men complete suicide more often than women do?

More than four times as many men as women die by suicide; but women attempt suicide three
times more often during their lives than do men. A probable reason for higher suicide rates in
males is that males tend to use more lethal methods (e.g., firearms) and women are more likely to
use less lethal means, such as self-poisoning. In countries where the poisons are highly lethal or
where treatment resources scarce, rescue is rare and female suicides outnumber males.
Additionally, males are more involved than females in all forms of aggressive and violent
behavior.

6. Is suicide related to impulsiveness?

Impulsiveness is the tendency to act without thinking through a plan or its consequences. It is a
symptom of a number of mental disorders, and therefore, it has been linked to suicidal behavior
because of its association with mental disorders and/or substance abuse. The mental disorders
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with impulsiveness most linked to suicide include: borderline personality disorder among young
females, conduct disorder among young males, antisocial behavior in adult males, and alcohol
and substance abuse among young and middle-aged males. Impulsiveness appears to have a
lesser role in older adult suicides. Attention deficit disorder with hyperactivity and impulsivity is
not a strong risk factor for suicide by itself. Impulsiveness has been linked with aggressive and
violent behaviors including homicide and suicide. However, impulsiveness without aggression or
violence present has also been found to contribute to risk for suicide.

7. Can the risk for suicide be inherited?

While suicidal behavior is not genetically inherited, it can be socially learned from significant
others and many risk factors for suicide can be inherited. A healthy person talking about a
suicide or being aware of a suicide among family or friends does not put them at greater risk for
attempting suicide. And mere exposure to suicide does not alone put someone at greater risk for
suicide. However, when combined with a number of other risk factors, exposure to suicide can
increase someone’s likelihood of an attempt. Major psychiatric illnesses, including: Bipolar
Disorder, Major Depression, Schizophrenia, alcoholism and substance abuse, and certain
personality disorders, which run in families, increase the risk for suicidal behavior. This does not
mean that suicidal behavior is inevitable for individuals with this family history; it simply means
that such persons may be more vulnerable and should take steps to reduce their risk, such as
getting evaluation and treatment at the first sign of mental illness.

8. Do alcohol and other drug abuse increase the risk for suicide?

A number of recent national surveys have helped shed light on the relationship between alcohol
and other drug use and suicidal behavior. A review of minimum-age drinking laws and suicides
among youths age 18 to 20 found that lower minimum-age drinking laws were associated with
higher youth suicide rates. In a large study following adults who drink alcohol, suicide ideation
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was reported among persons with depression. In another survey, persons who reported that they
had made a suicide attempt during their lifetime were more likely to have had a depressive
disorder, and many also had an alcohol or substance abuse disorder. In a study of all non-traffic
injury deaths associated with alcohol intoxication, over 20 percent were suicides.

In studies that examine risk factors among people who have completed suicide, substance use
and abuse occurs more frequently among youth and adults, compared to older persons. For
particular groups at risk, such as American Indians and Alaskan Natives, depression and alcohol
use and abuse are the most common risk factors for completed suicide. Alcohol and substance
abuse problems contribute to suicidal behavior in several ways. Persons who are dependent on
substances often have a number of other risk factors for suicide. They may be experiencing
depression, social problems and/or financial issues. Substance use and abuse can be common
among persons prone to being impulsive and among persons who engage in many types of high
risk behaviors that result in self-harm. Fortunately, there are a number of effective prevention
efforts that reduce risk for substance abuse in youth and there are effective treatments for alcohol
and substance use problems. Researchers are currently testing treatments specifically for persons
with substance abuse problems who are also suicidal or have attempted suicide in the past.

9. Do people attempt suicide to prove something or to get sympathy?

No a suicide attempt should never be ignored and is a warning that something is terribly wrong.
Most people who attempt suicide are not 100% certain they want to die—they just want their
pain and suffering to end. It isn’t to try and get someone to feel bad for them, that's usually the
last thing they would want.

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10. Apart from talking to a suicidal person and encouraging him or her to go
for counseling, what else can we do to prevent this?

Going with someone to the counselor often helps. If the person won't listen to you, you may need
to talk to someone who might influence him or her. Saving a life is more important than violating
a confidence. For a person determined to attempt suicide the desire to live is overshadowed by
the seeming hopelessness of the disease. The decision to attempt suicide is really a desire to stop
suffering. Never give up on someone just because they say they’ve made up their mind.

11. Why do people attempt suicide when they appear to feel better?

Sometimes a severely depressed person contemplating suicide doesn't have enough energy to
attempt it. As the depression lifts, they may regain some energy but feelings of hopelessness
remain and the increased energy levels may contribute to acting on suicidal feelings. Another
theory proposes that a person may "give in" to depression because they can't fight it anymore.
Resolving to die relieves some anxiety, which makes them appear calmer in the period preceding
a suicide attempt.

12. Why don't people talk about mental illnesses like depression, bipolar
disorder and suicide?

Stigma and lack of understanding are the main reasons mental illness and suicide remain topics
we avoid. People suffering from a mental illness fear others will think they’re crazy or weak, or
somehow a lesser person. Cultural norms are slowly changing, and people are becoming more
aware of the nature of mental illnesses and their impact on a person’s well being. Education will
help reduce stigma and save lives.

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Alcoholism, drug addiction, HIV and AIDS are examples of medical conditions previously
attributed to a weakness or character problems. Today, they are widely recognized as medical
diseases and people feel comfortable openly discussing the impact of the disease and seeking
help through a variety of treatments. The dangers of alcohol and substance abuse have been the
subject of major national public health campaigns in the United States, leading to a general
public more aware of the value of prevention. Breast cancer is another medical illness that for
many years went unspoken, but today receives millions of dollars in research funding, supportive
programming and awareness.

13. What does 'suicide contagion' mean, and what can be done to prevent it?

Suicide contagion is the exposure to suicide or suicidal behaviors within one's family, peer
group, or through media reports of suicide and can result in an increase in suicide and suicidal
behaviors. Direct and indirect exposure to suicidal behavior has been shown to precede an
increase in suicidal behavior in persons at risk for suicide, especially in adolescents and young
adults. The risk for suicide contagion as a result of media reporting can be minimized by factual
and concise media reports of suicide. Reports of suicide should not be repetitive, as prolonged
exposure can increase the likelihood of suicide contagion. Suicide is the result of many complex
factors; therefore media coverage should not report oversimplified explanations such as recent
negative life events or acute stressors. Reports should not divulge detailed descriptions of the
method used to avoid possible duplication. Reports should not glorify the victim and should not
imply that suicide was effective in achieving a personal goal such as gaining media attention. In
addition, information such as hotlines or emergency contacts should be provided for those at risk
for suicide. Following exposure to suicide or suicidal behaviors within one's family or peer
group, suicide risk can be minimized by having family members, friends, peers, and colleagues
of the victim evaluated by a mental health professional. Persons deemed at risk for suicide
should then be referred for additional mental health services.

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14. Is there such a thing as 'rational' suicide?

Some right-to-die advocacy groups promote the idea that suicide, including assisted suicide, can
be a rational decision. Others have argued that suicide is never a rational decision and that it is
the result of depression, anxiety, and fear of being dependent or a burden. Surveys of terminally
ill persons indicate that very few consider taking their own life, and when they do, it is in the
context of depression. Attitude surveys suggest that assisted suicide is more acceptable by the
public and health providers for the old who are ill or disabled, compared to the young who are ill
or disabled. At this time, there is limited research on the frequency with which persons with
terminal illness have depression and suicidal ideation, whether they would consider assisted
suicide, the characteristics of such persons, and the context of their depression and suicidal
thoughts, such as family stress, or availability of palliative care. Neither is it yet clear what effect
other factors such as the availability of social support, access to care, and pain relief may have on
end-of-life preferences. This public debate will be better informed after such research is
conducted.

Conclusion:
I will not give my opinion on this issue because suicide is so much common in our country that it
will be very complicated to speak something on it. Further I will suggest some suggestions which
can be enforced to prevent suicide.

 Opening up of special clinics such as De-addiction and Marital Counseling Clinics in all
the major hospitals, might help to counter the factors arising due to substance abuse and
family problems.
 Conducting educational programs periodically for the medical officers and paramedical
personnel of the above hospitals and also to those in general practice (through Indian
Medical Association and other organizations), primary health cares, and rural areas, so

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 that they can be trained for the detection and preliminary management of depression and
other psychiatric conditions.
 Restricting the access to means of suicide including measures for control of availability
of pesticides, medications, etc.
 Adequate barriers to deter jumping from high places even when the Government or
Private Agencies design such structures.
 Opening up of students guidance clinics to be run by visiting psychiatrists not only to
improve their psychological well-being, but also to enable them to explore their own
potential to engage themselves in today's world with immense avenues, and also
conducting guidance sessions for parents in schools and colleges.
 Revamping the educational system with an objective to promote holistic development of
the child, rather than the undue emphasis on scoring of marks in various subjects.
 Opening up of suicide prevention clinics in all the Medical College Hospitals, District
Head Quarters Hospitals, and if possible in Taluk Head Quarters, and also in private
hospitals. Such measures will at least help to prevent repeat attempts.

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BIBLIOGRAPHY:

1. Vijaya kumar L. Suicide in India in Suicide in Asia. In: Yip PS, editor.
2. Accidental Deaths and suicides in India. National Crime Records Bureau.
Ministry of home affairs. Government of India. 2007.

3. Lal N, Sethi BB. Demographic and socio demographic variables in

attempted suicide by poisoning. Indian J Psychiatry. (1975)

4. Venkoba Rao A. Marriage, parenthood, sex and suicidal behavior. Indian J

Psychiatry.

5. http://www.ivarta.com/ columns/OL_060328.htm

6. "This Date in History: Sati in India". Atheism.about.com. (2006)

7. Times of India (2011) “Voluntary Death has Religious Nod” Tuesday, 8th
March, New Delhi, pp. 14.
8. (http://www.indianjpsychiatry.org/article.asp?issn=0019-
5545;year=2015;volume=57;issue=4;spage=348;epage=354;aulast=Ponnudur
ai

9. https://wmich.edu/suicideprevention/basics/faq

10. www.shodhganga.in

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