What are your thoughts on the criminalisation of attempted suicide? Some believe it is best to have the law to “frighten” people into thinking of attempting such an act, but many believe the victims should be treated instead of incarcerated.
Malaysia is one of the few countries that criminalises suicide .We have this archaic law that we inherited from our colonial past. Section 309 of the Penal Code states that a person who attempts suicide faces a one-year jail sentence, a fine, or both. Fortunately, this section has been rarely evoked despite many having survived suicide attempts. It is about time we decriminalise suicide. To detain and charge a person immediately after an attempt is to deny him appropriate treatment, diminishing any hope for recovery. Justice needs to be tempered with mercy. Any suicidal attempt is a cry for help and it is unlikely that such a person is “frightened” by the law.
It is well known that depression is a contributing factor to suicide, but how does this work in the Malaysian context? What could cause depression among those residing in Malaysia (e.g. social factors, economic?)
90% of suicides are as a result of Depression. Many factors including social factors, economic, interpersonal relationship issues, chronic or severe physical illness like Cancer or HIV /AIDs, loneliness, humiliation and shame can cause Depression leading to suicide. Some people have personalities that predispose them to suicidal attempts and others are genetically more prone to succumb to triggers leading to Depression and suicide.
Recently we are seeing an increase in reported cases of suicide among adolescents. This is a worrying trend, reflecting problems associated with the pressure to perform well and meet the expectations of others.
Which demographic in Malaysia do you think is most prone to suicide? Has it always been this demographic, or has the demographics changed over the years?
The Malaysian Indian community has always recorded higher suicide rates than others but in terms of numbers the Chinese community tops the list.
What is the most common method of suicide they usually turn to? (Also if the common methods differ based on geographical area etc.)
Hanging and strangulation are the most popular methods in Malaysia, but jumping off tall buildings are getting more popular probably due to more people living in high residential buildings as a result of urbanization and high cost of landed property . Ingestion of poison or pesticide is a more popular method among the rural population.
Are the other prominent reasons that lead to suicide?
Mental illness is the main cause of which Depression forms the bulk of cases. Schizophrenia, Substance abuse (alcohol dependence or drug use) personality disorders are other cases of mental illness leading to suicide.
Is suicide still a very taboo issue and how far are we in overcoming this issue?
Major religious persuasions frown upon suicide. Suicide rates in Predominantly Catholic and Muslim countries show very low suicide rates. In many communities, discussion of suicide is also taboo and those with suicidal thoughts are seen to be weak. In other communities, suicidal attempts are seen to be the natural method to escape from the vicissitudes of life. The Indian community in Malaysia demonstrates the highest suicide rates in the country. We need to examine is one of the causal factors is the influence of movies and television serials which perpetuate this thinking.
From the clinical perspective, how do you deal with patients who have depression/ suicidal tendencies (and their families)?
First of all, it is important to determine if Depression is the underlying cause for the suicidal attempt or suicidal thoughts. If so, then a short period of hospitalization would be helpful. If hospitalization is not possible, close supervision is essential. New antidepressants with least side effects should be started in addition to psychotherapy or counselling –which help in restructuring their thought processes to remove negative thoughts about themselves or their future. There is a myth that once started on antidepressants, they would need to be on in life long. This is only true in some cases in which long term medications are needed to prevent relapse.
The “moving on” process for those suffering from depression is highly dependent on their surroundings and the people around them – if the depression persists and feelings of hopelessness and self-isolation are prevalent, then close ones must be watchful for a repeat attempt.
We were previously told that suicide will soon overtake accidents in being the top cause of death. What is your opinion on this?
In the United States, suicide has overtaken motor vehicle accidents as a leading cause of injury deaths. Our official statistics in our country show 1.3 suicides per 100,000 population but it is well known that suicide is grossly under reported in Malaysia. Real statistics if known will be alarming, particularly when we see the trend of adolescents and youth suicides on the rise.
Dr. Andrew Mohanraj 