‘I hate myself and I want to die.’ This is how author Elizbeth Wurtzel begins her 1994 cult-book “Prozac Nation”, which narrates the dark and miserable lives of people steeped in depression and suicidal thoughts, through her painful personal experiences.
Over most of the next 350-odd pages, she tells us agonisingly how miserable normal life is and the best escape is to kill oneself, even while trying to pursue a normal life.
Beginning in her early teens, depressive and suicidal thoughts persists in her adolescent and adult life. She stays alive with the support of some fine doctors who take her calls at odd hours and stand by her, trying out a mix of therapy and medicine even as she and the people around her make the lives very unpleasant for each other.
Most of it happens while she was very young and was at the university. Later, we learn that there are millions of young people like her struggling to stay afloat.
She survived to see the emergence of Prozac, the wonder-drug of the late 1980s and 1990s, that brought a semblance of normality to her life. Since then, Prozac, along with a few other medicines, has become a lifeline for millions people with depression in the US and elsewhere in the world. As author Siddhardha Mukherjee noted in his NYT article, Post Prozac Nation, by 2008, it was the third most prescribed drug in America.
Even while discounting a lot of avoidable pill-popping, the Prozac statistics was a direct indicator of the burden of depression on the general population, particularly the young people. Added to that, depression is one of the mood disorders that drive people to kill themselves. Along with bipolar disorder, it accounts for the highest number of suicides.
Syliva Plath killed herself because she was depressed; so did Virginia Woolf, Earnest Hemingway and Kurt Cobain. In my own backyard, I have seen men and women hanging from the branches of cashew trees, willfully drowning in temple ponds and consuming pesticides; and have read fantastic poetry by severely depressed people (mostly women) who glorified death in their writing and killed themselves young.
Now, take a look at the recent Lancet study on suicides in India. The socio-economic landscape is completely different, but a lot of underlying factors might be similar. While “valium and whiskey chaser” might be a more accepted way of committing suicide in the West, in India, 50 percent of our people kill themselves by consuming pesticides while the next common choice is by hanging.
According to the Lancet study, the country has one of the highest rates of suicides in the world and about half of that occurs among young people of 15-29 years of age. Young women are at substantially higher risk than men. The study also reveals that suicides in rural areas were twice as many as in urban areas.
An earlier study by the Christian Medical College Vellore in rural southern India was equally striking. It said that suicides accounted for about a quarter of all deaths in young men, and between 50 and 75 percent of all deaths in young women. The average suicide rate for young women was 148 per 100 000, and for young men 58 per 100, 000.
The trend of the young women’s additional vulnerability to suicide is clearly established in the Lancet study as well: 40 percent among men and 56 percent among women, which is in sharp contrast to the situation in higher income countries where the ratio is 3:1.
The Lancet study also brings forth the strange correlation between higher education and better socio-economic conditions with suicides. “More than 42% of suicide deaths in men and 40% of suicide deaths in women occurred in these four southern states, which together constitute 22% of India’s population aged 15 years or older.”
The richer southern states were at 10 times higher risk than the poorer northern states. More educated were at higher risk as well.
The most common lesson to take home?: Young people, rural populations, richer and better educated southerners and more women than men are committing suicides in India. Perhaps, there is also a link between and higher aspirations and despair.
The socio-economic cost of these deaths, given that India is betting on its youth, is not available; but even a commonsensical conjecture based on similar calculations for other illnesses is good enough to assume that it will cost the nation a lot.
This is where the state needs to worry and think about solutions. How can we save our young people, mostly rural and women, from ending their lives? The numbers are not just a handful, but staggering: twice as many deaths due to HIV/AIDS and deaths among women that equal the number of maternal deaths.
They don’t happen out of thin air or instant desperation, but out of deep-rooted structural factors that hardly get any attention. Evidence from elsewhere, as noted by Elizabet Wurtzel in her personal case, shows that one of them is indeed related to mental health and access to mental health services.
Scientific literature shows that 30 percent of the suicides are because of mood disorders, do we have systems to dealtwith them?
A study in England and Wales shows that implementation of mental health services between 1997 and 2006 led to lower suicide rates.
The provision of a round-the-clock crisis care was associated with the biggest fall in suicide rates. The biggest beneficiaries were also from the most deprived areas. Such initiatives also could help formulate suicide prevention efforts and improve mental care efforts.
The short-term solution offered by the Lancet study might sound funny: restrict the availability of pesticides. But the journal does go beyond the short term and emphasise the need to address the mental health context.
Mental health needs to be urgently mainstreamed into our public health system with quality services available at least at the district and Taluk hospitals. This is however, not to reduce the importance of structural interventions to mitigate the socio-economic risk factors that drive people to terminal despair.
The country’s mental health policy needs a paradigm shift.