September is globally observed as Suicide Prevention Awareness Month — a time to raise awareness of this stigmatised, and often a taboo topic.
Millions of people around the world suffer intense grief or are profoundly impacted by suicidal behaviours of self or their kin. According to the World Health Organisation, suicide was the fourth leading cause of death among 15-29 year-olds globally – 35% of recorded suicides in India occur in this age group.
India ranks 43rd in descending order of rates of suicide with a rate of 10.6/100,000 reported in 2009, according to the WHO.
More often than not, the only force standing between a person and their urge to end their life is a caregiver, who is almost never off duty.
A lonely battle
From a tender age, Radhika had learnt to reach out to suicide helplines on the dialler each time her mother made an attempt on her own life; though “no one” answered her calls.
“I had learnt by heart all the helpline numbers even before I learnt all the numeric tables. It was beyond stressful actually because I couldn’t speak about it to anyone. I had seen my mother trying to end her life several times, but I could never share it with my father or my sibling,” she says.
Much later in her life, she took to reading about Psychology to try and understand her mother’s behaviour.
“I started unpacking what I went through only after I started reading a lot about Psychology. Then we began to have more meaningful conversations on mental health. I also began to understand my own responses and reactions to her behaviour. Though, while growing up, the atmosphere at home inevitably turned unpleasant and I felt really lonely and unable to escape,” she says.
“It almost felt like a taboo to talk about these things,” Radhika adds. “Due to this I developed dysthymia (a depressive disorder) and even now I don’t easily open up about these things,” she adds.
Rounak describes his life as “perpetual exhaustion” for constantly being “ignored”. He feels “heavy” with inexplicable emotions.
“No one actually asks me how I am dealing with things because I am supposed to be the pillar of strength for my partner. I care for her a lot and most of my waking hours are spent tending to her. But I would also sometimes like to be asked about my emotional state. Everybody becomes vulnerable at some point,” the 34-year-old says.
“In fact, it’s she (his partner) who asks me how I am. But I feel I cannot unburden my stress on her,” he says. The young IT professional “doesn’t find much time” to continue with his regular therapy. He instead spends his leisure time with his partner.
Psychiatrist Dr RP Beniwal, threw light on the mental exhaustion of caregivers in light of the issue at hand. “Caregiver stress has been acknowledged as a significant source of psychological and physical morbidity in caregivers of diverse groups. The effects of caregiver stress have been characterised as ‘widespread and unnecessary suffering, isolation, fear, error, and at times bankruptcy’. This highlights the effect of caregiver stress on both the caregivers themselves, and those being cared for.”
“Although suicidal ideation seems to be related with both burden of care and alexithymia (difficulty experiencing, identifying, and expressing emotions), there is no study investigating the correlation between these factors and suicide probability in informal caregivers of psychiatric patients in the literature,” he continued.
On the caregivers’ suicide probability, he said, “It was related to variables such as caregivers’ sex, economic status, presence of any disease, duration of care, and patients’ education level, psychiatric diagnosis, duration of illness, presence of physical illness, compliance with treatment. In addition, caregivers’ burden and alexithymia levels were significantly associated with the participating caregivers’ suicide probability.”
The mental tax
“The mental stress of witnessing a person sink and their health deteriorate can have a life-long impact on a person. Watching a person die or hearing about their suicide can send shockwaves through their minds,” says Zain Ullah, a British actor and director.
How a person is impacted also depends on the intensity of their relationship. The closer they are to a person with a tendency to end their life, the longer and more intense the impact is.
“To see someone you love lose hope in life or die can push you into a dark place mentally. Moreover, the closer you are to the person, the more it mentally and physically affects you. Eventually, it can cause you to be less happy in your present moment as well as in the future life,” he says.
More often than not, caregivers are stuck in a tight spot where they are making sure that they don’t lose someone dear to them and, at the same time, struggling to fend for themselves.
“I love my partner and every other week I watch her sink. At the same time, I can’t imagine a life without her. I mean, I am constantly in a loop of negative thoughts. And obviously, I can hardly care for my mental health while trying to save my girlfriend’s life,” says Rounak.
While Zain has been a witness to the mental anguish of his cousin, who jumped off a bridge, Rounak is a primary caregiver for his live-in girlfriend, who is on medication.
Loop of constant fear and questions
Many such caregivers talk about always feeling guilty and upset for not being able to provide enough support to their near ones.
“We simply do not know what the suicidal person is going through, their mental state of mind or the past history. It should be handled delicately. Those living with people who get suicidal thoughts may themselves suffer from mental issues. But more than that, there is constantly the question of ‘How much more I could’ve helped’,” says Zain, who has filmed the critically-acclaimed documentary ‘Life After War: Iraq’.
“When I am out at work, I seldom get calls from my neighbours. But when I do, I shudder to think what it could be for. My first instinct always is that something awful has happened,” Rounak says.
“Caregivers fear answering the phones, being constantly anxious of hearing about the loss of the person they love. The caregiver experiences anxiety because they are living with a person who is always living on the edge,” says Zain.
Replication of behaviour
For the most part of Radhika’s adolescent and early adult life, she was overwhelmed by her mother’s behaviour, until therapy and her reading helped Radhika snap out of it.
“My response to crises is based on what I have seen in my house as a child. You tend to replicate what you see growing up. I always wanted to ask my mother whether she picked up her suicidal thoughts from someone in her family because I certainly inherited my anxiety from her. I want to comprehend it but I never got the opportunity to explore these things,” she says.
Radhika adds, “I feel like I have aged early because of such experiences and that I lost a significant part of my childhood.”
Using her own experience of replicating her mother’s responses, she explains how she reacted to situations. “I used to lock myself up and google ways to die easily. I was really upset and found no hope. So, ending my life felt like the only way out of it. I never thought that I could get myself out of this vicious cycle,” she says.
Expanding her social circle has “really helped” her find empathy in others. Yet, she feels, “I don’t think I have met someone in my life who understands what it means to be in my situation,” she says.
Difficult imageries
Radhika used to get “triggering thoughts” as a child. “I would be happy for days together and then I would suddenly have thoughts of my mother dying or attempting to end her life and I would feel scared. Thoughts like ‘what if they are not there in my life’ would go through my mind a lot,” she says.
At a tender age, she used to feel suffocated in her house and always wanted to “reach out to someone” and also tried to “reason” with her mother. “But, you know, reasoning hardly works here,” she says.
Rounak says, “I have developed this tendency to prepare myself for that day when I lose my partner to suicide. It’s my way of toughening up, but it hardly works that way. In the end, you are just constantly worrying.”
From taking a shower to parties or office, these difficult images have made a “permanent place” in Rounak’s mind. He has been on anxiety medication for three years now.
“Today, I feel responsible for her life. Sometimes I want to give up. But then, I can’t stop caring for her. So, that puts me in a state of permanent dilemma,” Rounak says.
For Radhika, her whole relationship with her mother has changed. “When your mother, who is supposed to be your caregiver when you are a child, needs you to be constantly there for her, it feels like a role reversal. I really hope that my children don’t have to bear the trauma that I have been through,” she says.
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