Suicide, ironically, perhaps represents the epitome of self-control, an act of self-empowerment that makes us free above everything the world has to offer. At the same time, it is perfectly synonymous with the lowest depths a person can reach, the nadir of our emotional range, and the only point where life’s tribunals can halt, abruptly.
It’s often called a selfish act, but that implies egoism, and suicide, I think, rests in a place when the ego is so deflated it almost ceases to exist. That’s why not many people sign-off; there’s nothing left to say. Suicide notes drive plots in novels, but in real life they are rare. The act is harmful, however, to everyone but yourself for a long time after its initial impact. It fills the beloved of the deceased with an uncompleted grief, a sorrow that can never be requited with the act itself, because we’ll never know why they did it. And we will ask ourselves, possibly for the rest of our lives, what we could have done to prevent it.
I know this, because a good friend of mine threw himself off a condo building last year in Chiang Mai, and I’m still going over scenes in my head in which something I could done, or said, might have changed the way things played out.
News reports of foreigners leaping from balconies, or locals swilling noxious chemicals, seemed, and still seem, to be commonplace in Chiang Mai. Working as a local news reporter I saw a lot of decomposing bodies that had chosen their own unhappy ending; hanging from beams in farm houses, broken on concrete car park floors; couples that likely blushed at first touch, lying in a blood-spattered bed with the back of their skulls stuck to the wall. It’s a harsh reality, and hardly Citylife material, but it happens, and we need to talk about it.
My friend was depressed, severely depressed, and the drugs, they didn’t work, as they so often don’t; as the song goes _ they just made things worse. He was an incorrigible self-medicater, who I think underestimated the influence legal drugs had on him. But whatever conclusions the newspapers, and his friends, might have come up with, the reason a person commits such an act is riddled with complexities we’ll never fathom; mentally, emotionally, there’s a trail left behind that final act, however impulsive it might have seemed. The reason we might feel guilt is because we failed to notice this trail, or resisted intervention upon it. He reached out (the fact he likely would have mocked anyone who used the very TV-American, sometimes mawkish sounding term reach out, was one of the reasons he didn’t reach out enough) at times, but not enough, and those few of us who knew about his problems, I don’t think understood exactly how to help him.
It seems kind of cold to now blunderingly segue into a story full of facts, but then there’s just no right way to talk about a friend killing himself and subsequently talk about the broader problem, and offer advice. So, here goes:
Thailand seems to be coming to grips with depression and suicide, however much the two – that are almost inseparable – have been taboo subjects in the past. Indicative of this is the fact that survivors of suicide in Thailand are now covered under various medical schemes, such as social security and the thirty baht universal healthcare scheme, while Narong Sahametapat, the Permanent Secretary of the Public Health Ministry, admitted in 2013 that Thailand has a significant number (around 1.5 million) of citizens aged over fifteen who suffer from depression (twice as many women as men, according to Narong).
Trakarn Chensy, the Director of the Samaritans of Thailand, said there are very different reasons foreigners and Thais might call the helplines, which are assisted by 60 trained English and Thai speaking volunteers. “Most foreign callers call when they are usually in a critical state,” said Trakarn. He explained that 80% of the foreign callers are men (75% of Thai callers are women), and the problems often relate to failed relationships, a Thai spouse that has cheated the man and left him penniless. The numbers of westerners calling the helpline – which if it doesn’t have an English speaking volunteer, will get back to the caller within 24 hours of the call – has risen lately, to around 100 callers last year.
Dr. Kittiwan Thiamkaew, a senior psychiatrist at Suan Prung Hospital in Chiang Mai, echoed what Trakarn had said, that the majority of depressed or suicidal westerners are men who have been hoodwinked by Thai lovers _ leading to emotional and financial crisis. In an interview with Kittiwan she told me that in spite of what I, and people talking on web forums (on Thaivisa for instance there have been numerous discussions of the apparent rising number of westerners killing themselves), might think, the number of suicides in Thailand has not risen – at least the total number; there is no account I can find for western suicides. The number is around 6 in 100,000 people, which is less than the world average of around 11.4 (World Health Organisation). The north of Thailand does however have a higher rate than other parts of the country, Lamphun being the highest, at 14.81 per 100,000 (Chiang Mai: 12.24).
“There’s no clear reason,” she says, why the north has the highest rate, but she says that Lamphun, like Rayong, which also has a high rate of suicide, is an industrial town, and the loneliness, drudgery, of industrial work might have something to do with it, she says. Men, says Kittiwan, are three times more likely to die from suicide than women. This does not reflect the number of suicide attempts though, as more women attempt suicide than men, according to the Department of Mental Health (DMH) National Programme for Suicide Prevention; but men often choose a more “lethal method”, according to Dr. Kittiwan.
Thai people, says Dr. Kittiwan, have mostly grown up in an environment where they have not been able, or encouraged, to express their emotions. “It’s not Thai,” she says of expressing one’s feelings, and “we often hide emotions. This is different from western culture.” She adds that in the past mental problems were stigmatised, “if you saw a psychiatrist people would say you were crazy, but that kind of discrimination in society nowadays is better, the younger generation put more importance on mental health, but it’s still a problem.”
Consuming our hearts away
Kittiwan believes that in the past depression in Thailand was not a widespread problem, as it is now; and it was not regarded as a serious illness, as it is now. The media, and various ongoing Department of Mental Health campaigns, she says, have helped to de-stigmatise depression and more people are seeking help.
“Thai society has changed,” Dr. Kittiwan explains, “there is more competition.” She also says that the “intimate relationship of the extended family” is not as it once was in Thailand. Many depressed people, she says, are older people who have been left behind in villages by family members who have gone to the cities in search of work and financial rewards.
“Globalisation, consumerism,” Dr. Kittiwan explains, has created more depression in Thailand. “Thai people integrate too easily with global consumer goods, anything that is new. We haven’t learned to think critically about consumer goods. It’s like an outbreak of mass consumption. And we haven’t analysed this.”
The consequence is often debt, she says, and Thailand’s surging household debt is at a “crisis point” (90% of the GDP), according to the Bangkok Post in March this year. We may be on our way to another finical crisis in Thailand, similar to that of 1997, which, statistically, was the year suicide and depression ranked most highly, and by a long way. “Thai kids watch TV, or use an iPad/tablet, there is not much of a reading culture in Thailand,” Kittiwan says, and she explains that advertising is pervasive, which she believes has a negative effect on people’s mental well-being, as well as personal economy.
Talk to Someone
The Samaritans has been running in Thailand for 36 years, and has its main centre in Bangkok, but also one in Chiang Mai. The director, Trakarn Chensy, explained that all the volunteers on the helplines go through rigorous training due to the stress of the job, and often the seriousness of the matter which a volunteer often is asked to try and attenuate. Unfortunately the Samaritans is understaffed, and the service is not funded by the government (not since 2011), although pharmaceutical companies help fund the service, as does the Rotary Club, says Trakarn. “We organise formal training sessions, 30-40 people at a time,” he says, adding, “we select qualified candidates for further training; three weeks intensive training, and on the job training for 3-4 months.” The Samaritans is currently looking for volunteers, Thai or English speaking.
While 90% of foreign callers call in a critical state, meaning a high possibility of suicide, Thai callers, around 50%, he says, call due to problems of inter-personal relationships. “Our callers are diverse, some with major, and minor problems, but we consider all problems major.” The service does not give advice, rather it gives, “much needed emotional support… non-judgmental, unconditional, support,” he says. “A lot of people feel a sense of relief,” he says, when they are able to reflect on their feelings, and this can greatly reduce suicidal tendencies. The helpline has a very good success rate in helping people who are depressed, and people contemplating suicide. “People call back to thank us after personal problems have been resolved,” says Trakarn.
“We are seeing an increased number of callers calling with problems related to economics,” he explains, “a significant number of calls relate to financial difficulties, consumerism, not being able to afford things people feel compelled to have because their peers have them; unable to pay debts, with no way out.” The highest number of callers to the Samaritans was in 1997, the year of the financial crisis, when there were 10,000 callers. The average is 6-7,000 callers each year.
“You don’t have to be suicidal,” he says, to call, and the line is free.
Perhaps, I don’t know, as major depression often seems to support an intractable stubbornness in a person, my friend wouldn’t have leaped from that balcony had he called the Samaritans that night. He refused to exercise, and was not prone to discuss his feelings, which are perhaps the greatest efforts we can make to fend off negative feelings. Maybe when the time comes when you decide to make the leap, or choose your weapon, it’s too late, and at that moment you’re unstoppable. But there is likely some procrastination before that time, some amount of doubt, and it’s then when you should make the call; reach out – as cheesy as you might think that sounds – submit your weakness to someone else for a change. And when there’s nothing left in you, there’s still the will to do good. Schopenhauer said that, and he made fending off misery a life’s work.