Thistopic does not rank in anyone’s top ten favorite topics for pleasant discussionwith friends or family. It’s not an easy lift. It gets even heavier when youare personally or even remotely affected. The best we can do at all times is tohave a good dose of empathy when discussing this topic. Always keep in mindthat it’s not about you, but about the afflicted and affected amongst us.Having established that premise, let’s try and see if we can begin tounderstand this malady and perhaps down the line we may start to find a way toreduce and control the scourge.
Outof respect to the families and friends of the recent victims of suicide in oursociety, I’ll not be rehashing those cases on this page. More so I cannot claimto know them, their stories, or what led them to that point of definition. Wewould rather do what I believe they would hope we do with their misfortune; useit to shine the light and educate ourselves on these issues.
Depressionand suicide are related the way nausea and vomiting are related. One oftenleads to the other. In the same vein, early recognition of one may lead to itscontrol and eventual prevention of the later sequel. That said, I’ll be thefirst to admit that this analogy over-simplifies the problem-solutioncorrelation. A patient stepwise approach would give us a better grip and a morefoundational understanding of depression and suicide.
Depressionas a communicative expression of an emotion is completely different fromDepression as a medical condition. Sadness, grief, self-pity, all fall intothat same category as the earlier. They are emotional reactions to events. Theyare expected, they last only so long, and they often eventually slowly fade away.Each person reacts and responds differently to these emotions. The stoic andstrong amongst us may not even show these emotions or show only a glimpse ofit. They bounce right back and keep on moving without faltering in theirstride. The not so stoic and strong may suffer a bit more, show a bit more, crya bit longer, then heal slowly. It’s a spectrum, we all fall in somewhere oneand all.
Depression, on the other hand, is a medical condition just like diabetes and hypertension. You can control it, but you can’t just will it away. It is as real and as present as the morning sun. Sufferers deserve our empathy. I know a lot of them.
You can be too full after a heavy starchy meal, your blood sugar would be high as a result, but that is not the same thing as being diabetic. The diabetic patients have a biochemical problem that affects their ability to control their blood sugar levels, they need help with that. It is not enough for them to take a walk to get their blood sugar down, like after a heavy meal in a non-diabetic person.
Depressionis a Neuro-biochemical imbalance in the brain. It involves a deficiency in someneurotransmitters that have to do with our moods and sense of wellbeing. Thisimbalance makes the affected person more prone to low mood, poor sleep, unableto fully enjoy recreational activities, even in the face of seeminglysuccessful life outlook. Many prominent figures in history were known to havestruggled with Depression, Bipolar disorder and other mood disorders at somepoints in their lives. The list includes Douglas Adams, Isaac Newton, VincentVan Gogh. In 1621, Robert Burton wrote Anatomy Of Melancholy solely based onhis own experience with depression and his observation of other similarlyafflicted individuals. His work formed the foundation for further studies ofmood disorders.
According to the Society Of Family Practitioners Of Nigeria (SOFPON), only one out of every five patients with clinical depression get any treatment at all, and only one in 50 get the right kind of treatment that they need. World Health Organization says 3.9% of the Nigerian population (that is seven million) suffer from clinical depression. The socio-economic plight of the average Nigerian, fueled by corruption, definitely has something to do with this depressing statistics.
Peoplewith clinical depression are more prone to the effects and bad outcomes of lifemisfortunes like bereavement, job loss, rejection, failure et al. Nonetheless,they do not necessarily need these triggers to go off the deep end. They justmake it easier.
Depressedpatients are more prone to suicide than the average person. However, not alldepressed patients commit suicide, and not all suicide victims are depressed.But like in a Venn diagram, a good chunk of these two circles overlap. We allknow what suicide is (one takes his/her own life) and we have explored how itrelates to depression and otherwise. World over, about 800,000 people commit suicide every year, translatingto one suicide every 40 seconds (WHO). Of the 183 countries with high suiciderate, Nigeria ranks 30th in the world and 10th in Africa. Only in 2017, Nigeriarecorded 332 cases of reported suicide. Rivers State alone accounted for 103 ofthese cases, that is 31% (Nigeria Bureau of Statistics).
Thesenumbers possibly only scratch the surface. A good number of suicides in Nigeriago unreported for obvious reasons. Chief among the reasons is shame and stigma.Many ethnicities in Nigeria believe that suicide brings a curse to the family,hence a ritual is done to appease the gods, and any further discussions of theissue are very limited.
To make a bad case worse; Nigeria has a law against suicide or attempted suicide (section 327 of the Criminal Code Act), that carries a sentence of one-year jail term if convicted. Noteworthy is that we do not have a law (Suicide Act) that outlines the role of government in helping to prevent suicide or manage survivors. This embarrassing law is a vestige of colonial rule, but the British have gone on to enact a well-detailed Suicide Act since 1961. Guess we forgot to copy and paste that after Independence. A rare silver lining in this grey cloud is the Lagos State government that decriminalized suicide in 2015 and mandated that they (survivors) be treated instead. At the national level, it is still business as usual.
Religionhas also played a hand in the stigma associated with suicide. There is a strongbelief amongst Christians that suicide is a judgment and condemnation toeternal damnation all by itself. Suicide victims are believed to be goingstraight to hell for eternity. This belief puts believers in a peculiar placewhere empathy is hard to come by and judgment is in full supply. When youconsider that the average Christian is running a lifelong race to haven, youstart to understand why it’s hard for him/her to feel sorry for someone whomthey think willingly chooses to go to hell. You hear Christians say things like‘I reject it’ and ‘it’s not my portion’ based on this line of belief. Based ontheir beliefs, they have their point. We are not here to judge. We are onlyasking for just a little love and empathy. There’s a victim here. There’s agrieving trail of family and friends left behind. They are dealing with abarrage of conflicting and painful emotions; guilt, loss, anger, denial, doubt.Judging them or the victim only deepens their pain. If God is Love, then letlove lead the way. Not judgment.
TheChurch is well positioned as often the first point of contact with theemotionally troubled amongst us. They come to the pastors willfully sometimes,families bring them and at other times, or complain to the pastors aboutchanges in behavior noticed at home. If pastors know the early signs ofclinical depression, they may help in counseling these families and patients toseek sound medical help. This should not stop the pastor from continuing withhis prayers for the family and patient. It’s not an either-or kind ofsituation. When both are applied well and in the right sequence, they have asynergistic effect.
Government could do a whole lot better than is presently the case. For starters, we need a National Suicide Act that would have a well-detailed suicide prevention modality, which should include all the levels of preventive medical care (primary to tertiary). Lawmakers should not wait to be lobbied to do this. I want to believe there are some trained medical practitioners amongst our lawmakers. This should be up their neck of the wood. NMA, SOFPON, Nursing Council, all could push in one direction regarding this.
Lawsalone will not solve the problem. The bulk of the heavy lifting will be done bymedical practitioners. Starting from educating patients and families on thesigns and symptoms of clinical depression to look out for. Detailed andrepeated screening for depression, substance abuse, in patients during routineand all medical visits.
The ground zero of depression and suicide is the family unit. This is where the impact and pain is felt most. This is also where the earliest signs can be detected and preventive measures could be most effective, if and only if the family is made aware of what to look out for and what to do when the red flags are noticed.
Love and communication are the two most crucial tools the family needs to make a positive impact in this battle. Offer the victims and each other love and support. Communicate your concerns with your Doctor, Pastor, Imam (whom hopefully would counsel them to seek professional help, while also praying for and with them). DO NOT JUDGE OR BLAME THE VICTIM. Offer them your support, presence, listening ear, a shoulder to cry on. Anything, just be there for them. Sometimes it’s just a cloud and it will pass, they just need companionship within that darkness.
Chukwuocha is a Nigerian trained Medical Doctor, rights advocate who lives and practices in California, USA.