Book Description

Suicide is a topic that invariably shocks and saddens any heart. We the Behavioural Scientists often are so helpless and cannot prevent all suicides. As in the developed countries the rate of suicide has gone up along with socioeconomical development and urbanisation in this country. The status race (D. Morris) leaves many of us frustrated and subsequently aggressive (west). If this drive cannot be externalized, it is internalised causing suicidal behaviour. Dr. C. G. Deshpande's monograph on suicides has come at the right time to awaken social scientists to this rude challenge posed by the spectre of suicidal death. He has painstakingly conducted a controlled and statistically validated study of the Epidemeology, Aetiopathology, Classification, management and prevention of suicidal behaviour. His elaborate overview of the previous studies by researchers and experts like Durkheim, W. Breed, Gibbs and Martin, Pretzel, West, J. Jacobs and Fendell as well as learned observations by authorities like Freud, Jung, Adler, K. Horney and Sullivan is very informative. Dr. Deshpande has further detailed the various aspects of suicidal phenomena, its history, the cross cultural aspects and types of suicide; and its clasification by karl Menninger, klopfer and Schneidman. The various methods of study such as psychodiagnostic testing, analyis of suicide notes and relationship with the different factors that influence suicidalbehaviour viz. Age, sex differences, culture, home environment, neurochemicals, etc. are described along with his studied comments. In chapter 3,4 and 5 he has explained the methodology and findings of his research study along with elaborate explanations and analysis of findings, especially dynamics of suicidal behaviour. His motivational and emotional analysis of suicide along with case studies are very lucid and enlightening. Next he has elaborated the social and sexual adjustment in suicides, from his sample of respondents. The illustrative case studies incorporate revealing statements by the respondents regarding their motivation and its causes. Case discussion at the end is quite convincing. The adjustment Inventory prepared by Dr. Deshpande is original and very useful in determining the personality characteristics of the suicide attempters as compared with normal people. His observation on each of these characteristics and the final conclusion based on the results are impartial, factual and reliable. He has given the historical aspects of the attitudes of authorities and government from ancient Indian setting to modern Indian conditions. He has made exhaustive comments on the laws in British India and in Republic of India; after giving details of the trial cases. He has further written on the history of thoughts on euthanasia and their modification in modern times. His final and sincere request for legislation on euthanasia and assisted suicide (in exceptional cases) is quite appealing and deserves government's prompt consideration. The prevention aspects of suicidal potential along with detailed description of various scales, inventories and questionnaires to measure and assess suicidal intent, follows next. The utility of these psychometric methods to identify and assess suicidal potential as well as to take preventive measures, is well established. Crisis intervention through emergency telephone contacts by suicide planners has been advocated. Finally he has outlined the management of suicide attempts through various modes of psychotherapy. Postvention is congently justified to protect the close relatives of suicide victims from the aftermath as well as to prevent such attempts by others who may take the suicidal act as a model. This monograph is not only very enlightening but also thought provoking. I have personally been bemused and saddened by suicides by my patients which were very often unexpected. Such experiences by most of the clinical psychiatrists and psychiatric social workers as well as practising psychologists warrant a specific and special study of the factors that influence a patient's decision to commit suicide. West's theory of frustration aggression model to explain murder cum suicide was amply proved and illustrated by the following tragic end of a doctor couple and their sons. A busy family physician had to shift his lucrative practice from a smaller city to pune where better educational facilities were available. His elder son was not doing well in a medical college in Bombay for which he had taken my advice and his regular treatment was considered necessary. He later showed positive signs and symptoms of schizophrenic disorder. Treatment over a period of 2 years did not help. He kept avoiding classes and failing. This caused Depressive Reactions in his mother who could not adjust to the change of place and practice and anxiety regarding her son. Her second son also showed negative symptoms of schizophrenia and poor response to treatment. His father who was already struggling in his practice and worried all the time about the mental health of his three dependents, became dejected and angry. He became desparate when he found no way out this predicament, and made an elaborate murder cum suicide pact with his wife who could not resist him. He gave intravenous anaesthesia to both of his sons under the garb of treatment and killed them. He confirmed their death by thrusting very long screwdriver into their abdomens and hanged himself along with his wife. In another shocking case, a young widow was severely depressed for over one year after the accidental death of her husband. She took no treatment and eventurally influenced the thinking of her parents and younger unmarried sister in a Folie a quartre (Madmen should by four) situation. They all jumped in a deep well after tying their legs along with the infant son, in the middle of a dark night. Her father who was a retired professor; active in social service had agreed for this suicide pact along with murder of his grandson. His actions shocked the community who had not even suspected such mindless suicidal behaviour from an otherwise very sober and responsible person! Such horrifying incidents undermine the confidence of Behaviour Scientists who are committed to prevent suicides. Two more illustrative case reports, glaringly exposes a helplessness to prevent certain type of suicides. A medical student, a case of Refractory Endogenous Depression had made genuine suicidal attempts inspite of intensive treatment. He finally succeeded in a suicidal act which he committed abroad where his pilot father had killed himself in a deliberate air crash. His act was probably his model. A medical post-graduate student had not recovered from deep depression in spite of proper antidepressant treatment including Electric shock Treatment. As advised his father was watching him all the time but in a moment of lapse the doctor slopped and ran to the Railway station. His father ran after him to see his son's head severed from his trunk by arriving train! In a recent magazine report, a "Pranam" sect leader influenced his small group of followers to seek "Mukti or Moksha" by jumping in a steep waterfall near panna in Central India. This death would give them direct entry into heaven. Six, including four from a family, died but two others survived because they did not jump out of great fear. Some of the inferences one may draw from these case reports are 1. Death is seen as a final extinction or liberation of the soul. 2. A gateway to enternal bliss and peace or as a deliverance from life's suffering. 3. Retribution for sins (often imagined) made in life. Some of the participants of suicide pacts are convinced about the emptiness and meaninglessness of life. In other cases, some see death as a triumph over their frailty or suffering. Some believe, death will lead them to their beloved who have departed earlier, as in the case of a medical student whose father had died in an air crash. The other explanation was identification with his suicidal father. Why do these unfortunate victims become so desparate as to make a suicide cum murder pact snuffing out the life of very young dependents? Do the social prejudices and attitudes which frown on such persons for their suicidal attempts, contribute to their Death wish! Joad's caustic reference to the social attitudes is justifiable as they are still prevalent, viz. "those who succeed in their suicidal acts are lunatic and those who fail are criminals." Till recent past the lawmakers had primitive laws for suicidal attempts, ignoring their suffering and scoffing as the justifiable reasons for the suicidal attempts. As a matter of fact, suicidal attempts are cries for help made by suffering persons, even though these may be only attention seeking and do not have a suicidal intent. If only others in the family as well as neighbours or colleagues were attentive and sympathetic and offered some help or guidance, many a suicide could be prevented. While differentiating a suicidal attempt from intended suicidal act, one must not be carried away by any dictum. Sometimes a sucidal attempt may lead to unintended death, accidentally. So also a truly intended suicidal act may fail. One of patients was saved after taking 200 phenobarbime 60 mg. tablets which is 4 times a fatal dose. She was taken to the hospital promptly by her alert relatives, so also the alert and zealousteam of doctors fought for her life, and saved her in spite of coma which had ensued. In such cases one has to be very careful as the act very often is repeated with fatal result. Suicidal attempts and gestures are considered to lack any risk to life and hence at times neglected. But the indifference by close relations may deject them and drive them to perform a successful suicidal act. So all such persons with suicidal behaviour deserve our attention, sympathy and expert help. Viz. psychiatric or psychosocial sympathetic attitude must be the base for any preventive effort to reduce suicide rate.