Naked Naked Truth: Suicidal Facts of Imagining India Circa2010-You and Them

In few days from now, it will be curtains to 2009 and India will step into 2010 with new hope and vigour. After all, the country has been successful in beating the worst drought in recent memory and global recession. Despite a slow start, the year is likely to end with a growth rate next only to China in the world. It is thus time to celebrate and march forward irrespective of  unevenness of the growth. 


But last week when I was at Indian Institute of Management at Lucknow for a lecture series to civil services officers of Jammu and Kashmir, I was rankled by a page three report in the local edition of Hindustant Times. It was both tragic and dehumanising to read that Jyoti Rani (24) a budding aspiring doctor who was a final year MBBS student of  CSM Medical University had committed suicide. She was in serious depression on account of untimely death of a cousin in accident. I did not know Jyoti Rani but have lost too many of my friends and well wishers in my fivty years of uneven life journey to suicide. And, I know first hand how close a person suffering from clinical depression or manic depression is to the danger of suicide. This forced me to complete my half written latest post on Bipolar Stroke.


This post is dedicated to a group of Indians who had unique accomplishments in last one year or so and their accomplishments would be reckoned in the government records only two years from now. These are the men and women, boys and girls who have had high motivation levels, many of them capable of transforming India in 21st century. They all have been professionals in their own right, some accomplished  ones but most of them  budding; many experienced but many more as  future of imagining India. They are representative of all castes, religions, regions and age groups.  But as I write this blog, I have decided to talk  about them and their achievements in past tense for eminently valid reason. They all belong to the category who like Usha Rani are successful cases of completed suicide of last last one year or so.


The roll of honour is quite impressive to start with:

• "Manjit Singh Dhillon Air Vice Marshal (Retd) a Vir Chakra and Yavu Sena Medal Awardee; and Rajinder Vadra, father in law of Priyanka Gandhi; 
• Harminder Raj Singh, Jagdanand Panda and A.S. Chatwal senior I.A.S. Officers of Orissa, UP and Punjab cadre respectively; 
• Jagjit Kumar senior IPS, IG Police of Himachal and Mujeeb Usman Karjat Kar,jatkar I.P.S. Superintendent in Police in Maharashtra; Ramchandran Retd. Deputy Supdt. of Police from Chennai 
• Rohini Sonawane a doctor at KEM hospital Mumbai, Pradeep Sharma, a young psychiatrist at PGI Chandigarh; Magan Ramlingam, 25 year old surgeon in Tamilnadu; Patanjali Bhat, Assitant Professor at Kasturba Medical College, Manipal Karnataka; Dr Captain Bharati Zingade, a young doctor working in army; Sanjeev Kumar Saxena 44, a doctor at Lucknow; 
• Dalia Nayak, Associate Professor at Shaha Institute of Nuclear Physics; M P Singh, Deputy Director of Indian Council of Medical Research; Bhupinder Singh, Professor of Computer Science at Punjab Engineering College Chandigarh and K. Venkatiraman a senior official of Institute of Chartererd Accountants of India;
• S. Amravati, a boxer trainee at centre of excellence, Hyderabad; Amit Yadav and Sandeep Kashyap young lawyers from Bhilwara and Muzaffar Nagar; Sunil Khanna a journalist from Panchkula Chandigarh and Chaturvesh Sharma a 23 year student of journalism;
  
•  Yogendra Singh, a 400th rank holder of IIT Joint entrance exam and a student of IIT Kharagpur; Satyendra K. Singh a student of MCA at National Institute of Technology Jamshedpur;  G. Suman, asecond year post graduate student at IIT Kanpur; Balkrishna Gupta, a P.hD. student of IIT Mumbai; Toya Chattterji a fourth year student at IIT Kanpur
• Upendra Sharma a share broker at Rajkot; Manish Patel a business man from Ahmedabad; K L Lingesh a Bangalore based entrepreneur and founder of Lxlab; Dhanajay Brahmapurikar a senior business executive with a leading company; Namita Mehta a senior HR Executivre and Bikram Bhardwaj a senior executive of an export house both from Gurgaon
  
• Amit Budhiraj an Engineer in Infosys; Vishal Yadav, a Business Analyst at Wipro; Syed Ahmed Makdoom, a software professional at Wipro; Vikash Kumar Sharma, Senior Network Analyst at HCL; Vishwa Ganesh a software engineer at Styam Computers, Software engineer T. L. V. S. Rao from IBM and his wife;  Sandeep Selke software engineer at Persistent Systems Ltd Pune; Pradeep Kumar Gondkar 26 years software engineer at IBM and Abhijit Mukherji trainee engineer at Infosys; ; 
  
• Gaurav Gupta a first semester law student at BHU,Mercedes Kohndam, 21 year nursing student at Lady Hardinge Medical College;Priyagandha Singh who passed CBSE 12th exam with 86% marks;
• Achut Mandal an Associate Professor of Delhi University; Jqram Ahmed, retired professor of Jamia University;  
• Raj Aditya Thampu, telgu film director; Bhargavi upcoming Telgu Actress; and ex Model Monica Choudhari, 45 daughter of  noted Ghazal singers Chitra Singh and Jagjit Singh"...........  

All the above,  bright and shining stars made news in 2009, some  on front page while others in an inner page of the daily news papers. They will formally become part of government statistics two years from now when 2009 suicide data is compiled ironically by Ministry of Home. It is a different thing  altogether that these men and women, boys and girls are now part of the other galaxy and their counting should not be a difficult exercise.


These chart busters of the illustrious group which is known as "completed suicide" of  last one year chose many means to end their life. Many of them hanged themselves at home or in garden from a tree, some shot themselves, few jumped to death while others consumed or injected lethal poisons or burnt themselves alive. There were an odd case of an I.A.S. officer and a techie who also killed few family members along with them. Morever, as I complete this blog there is a news of a whole family of three Indians in gulf who took their life yesterday in a suicide pact-they literally hanged themselves to death.


All  of above have left behind them grieving families, friends and well wishers and a government which neither understands suicide nor is bothered about the implications. In a country like ours which has more problems than what we can solve in a century. why families, society and those at helms of the affairs in the country  should worry about few who were weak enough to commit suicide.


 And why I am geeting muddled  my mind for these inconsequential people. There are few reasons for the same:




One, though the above list is initself disturbing anough and the problem of professional suicides is only exacerbating by the day, the real picture is far more devastatinng. The real geastalt of completed suicide group is much larger . This includes  an ever increasing number of debt stricken farmers, poor from both  villages and towns (while the burnt of poverty and debt stricken suicide in villages is well documented now, poverty  led suicides is becoming an increasingly urban phenomena), stressed and distressed students, victims of domestic violence and  dowry victims are only few of these cases.


Two, at governmental level there is complete denial of the problem, at the societal level completed and attempted is stigma  where as at the level of family it is an unacceptable shame and  something to be swept below carpet. This realisation has not crept in that, completed and attempted suicides are symptoms and not the disease. We as a nation are not just interested in root cause analysis.


Three, suicide kills annually more individuals than terrorism, wars and homicides taken together in the world and is already one of the ten leading causes of death. Even with sketchy unrealiable governmental annual statistics of suicide (which we will confront soon) deaths from completed suicide in India per annum are higher than sum total of killings due to internal meance of naxalism and external or home grown terrorism.


Four, why do people commit suicide in the very first place? It is a complex question and suicides etiology is a  mixture of genetic, environmental, cultural and religious factors. But there is one common thread which runs across one million completed and five million failed suicides in the world every year- this is the mental disorders particularly untreated ones.


Five, researchers and scientists ( in dedeloped countries) have unanimity that there are two groups of people who commit suicide- first group of 50% of individuals who commit suicide belong to such category with a diagnosed or treated mental disorder. The second group belongs to individuals who commit suicides but have not been diagnosed suffering from psychiatric disorders. Even in this group, which accounts for balance fifty percent of suicides, psychiatric autopsies and retrospective studies have confirmed that a psychiatric disorder could be established in 90% of this later category. Famous psychiatrists Jamison and Goodwin in their book report that the above finding was the basis for The Surgeons Generals Call to Action to Prevent Suicide in USA in 1999.


Six, as a person who have suffered debilitating consequences of mental disorder for more than twelve years, a person who has  had suicidal ideation as a constant companion, had more than one case of failed or near complete suicide attempt and one who was  kept for nearly eight years on active suide watch by psychiatrists, I do understand to an extent, what goes inside the mind of a person who completes suicide or is a faillure even in the desperate bid to end his life. The life of living in ignominy of a failed suicide needs rehabilitation and not incarceration. If I am able to write this blog it is because 24*7 active suicide watch of my wife and children and becuse my greater propensity to live than die (except in horrendous state of mental disorder) has enabled me to some how live a saner life despite my debilitating manicdepressive insanity.


Seven, the menace of suicide and its familial, social and economic burden in India has reached monstrous proportions and has become one of the most dmaging public health epidemic, except that we as nation do not care. The consequence are there for all to see- unmitigated sufferings to the families of those who complete suicide, an incarcerated life for those who fail in their attempt and a great loss to national productivity as two third of those who commit suicide in India (even as per government statistics) are below the age of 44. Suicide exacts huge psychological and social costs, and the economic costs of suicide to society (lost productivity, health and social care costs) are estimated at many billions of dollars each year and more than 20 millions years of healthy life lost in the world.


In 2010, what India and we Indians need to do differently to ensure that we first recognise this social cancer, second arrest its unabated growth and then reverse the trend to a manageable level. There are many steps to be taken -all simultaneously and my pick of "Ten Key Commandments" is as under:

One, recognise the writing on the wall. The cancer of suicide if not arrested immediately is going to tear the familial and social fabric apart in near future. It is time to take stock, to get out of the denial mode and to face the world of Naked Naked Truth of Suicide boldly- take the bull by horns

Two, get the Indain suicide numbers right. If one goes by the statistics published by Ministry of Home, Government of India annual deaths from suicide are numbered at 1,22,667. This number is bad enough and represents 12% of global suicides ranking India high in the pecking order of suicidal nations. But there are two lacuane in this statistics- first it does not represent true and fair picture as it is dated.. These are 2007 numbers. More importantly, even government does not believe its numbers as in India less than 20% deaths are medically certified. There is a huge stigma and shame attached to the suicide and if we correct the Indian suicide rates for just three factors non-reporting rates due to incompletenenss, stigma and shame, Indian numbers will double up and India will be at the top of suicide league table of the world. There is urgent need to improve both reliability and validity of our data collection tools. Suicide reporting methodology of evn neighbouring China is more robust than India.

Three,  humanise and decrimininalise suicide. Section 309 0f Indian Penal Code has to be struck down the statue book as of yesterday.Section 309 says: “Whoever attempts to commit suicide and does any act towards the commission of such offence shall be punished with simple imprisonment for a term which may extend to one year or with fine, or with both.”

If any doubt persists on immediacy of removing Section 309 from Indian Penal Code, the 210th report of the Law Commission, headed by Justice A.R. Lakshmanan,  submitted to the government in 2008 dispells the myth and it says : “Section 309 provides double punishment for a person who has already got fed up with his life and desires to end it. Section 309 is also a stumbling block to prevention of suicides and improving the access of medical care to those who have attempted suicide.”

The Commission further said: “It is unreasonable to inflict punishment upon a person who, on account of family discord, destitution, loss of a dear relation or cause of a like nature, overcomes the instinct of self-preservation and decides to take his own life. In such a case, the unfortunate person deserves sympathy, counselling and appropriate treatment, and certainly not the prison. Section 309 needs to be effaced from the statute book because the provision is inhuman, irrespective of whether it is constitutional or unconstitutional.”


The commission also noted that only Pakistan, Bangladesh, Malaysia, Singapore and India have persisted with this undesirable law. “The panacea for those who attempt suicide certainly cannot be imprisonment. They need compassion, emotional support and sometimes even psychiatric help.” If attempted suicide were decriminalised it would make things more workable and “easier for all to extend their hand and support in reducing suicide in India.”

The commission has resolved to recommend to the government to initiate steps for repeal of the anachronistic law contained in section 309, IPC, which would relieve the distressed of his suffering. At present only a handful of countries in the world, like Pakistan, Bangladesh, Malaysia, Singapore and India have persisted with this undesirable law.

Four, the above recommendations of Law Commission have not yielded any result so far. After all Indian Penal Code was written by Britishers in 19th century. Let India take a leaf out of Section 1 and 2 of British Suicide Act, 1961  which has folowing message for the Indian Law makers:

"1. Suicide to cease to be a crime.The rule of law whereby it is a crime for a person to commit suicide is hereby abrogated.

2. Criminal liability for complicity in another’s suicide.— (1) A person who aids, abets, counsels or procures the suicide of another, or an attempt by another to commit suicide, shall be liable on conviction on indictment to imprisonment for a term not exceeding fourteen years.

Even the over all import of clause 2 of British Suicide Act, 1961 is such that it has been virtually eliminated the possibility of witchhunting using this clause

Five, accept the another Naked Naked truth- that 25% Indians will suffer from  one or other mental disorder at least once in their life time and at this given monent, 120 million Indians i.e. 10% of the entire population is in grip of mental disorders and half of them of serious nature. Let the realisation dawn that, they are serious target group for difficult but attainable suicide prevention measures. It is proven beyond doubt tthat he clinical and manic depression is a fundamental trigger of majority of completed or failed suicide cases.

Six, immediately set up standing highpowered National Commission of Mental Health. The detection, treatment and rehabiltation has to go hand in hand with destigmatisation, education and creating public aware ness.

Seven, have the paradigm shift at the governmental, societal and familial level- mental disorders can be managed and suicide prevention is possible. It requires total rethink of existing medical education. One will be surprised to note that in a five year medical education in the country, psychiatry is a didactic lecture content of fifteen hours and most of the students bunk the placid classes. With crhonic shortage of psychiatrists and clinical psychologists in the country there is urgent need of total integration of primary health care with targetted efforts.

Eight, there is urgent need for exponential increase in government budget allocation. As most suicides are in the productive age group there is very sound economic logic to it and financial rate of return is very very high. It will have substantial GDP inflator impact. Non-governmental efforts have to be mainstreamed  and upsacaled instead of present efforts at perriphery and government and non-government need to do a tango with individuals and target families.

Nine, it is time for the fourth estate- print and visual media to come forward in dissemination of information, education and creation of awareness. They have a collateral resonsbility and they also need to become more responsive and responsible- a new era of humanising, educating and deliberate desensationalisation needs to be ushered in.

Lastly, there is need for active intervention for improving the lot of other key target group- the deprived and poor. Both urban and rural poverty has serious implications and positive correlation with high incidence of suicide is palpable.

Last word, not all are as lucky as me.  My rainbow coalition of a deciated wife and children and accessibility to doctors has ensured that I am able to cheat death more often than is warranted. How many Indians or Asians are that lucky. Suicide is preventable. Let us take a vow to take the small first step as we welcome Circa 2010.