Dead End

When Faraz Ehmad, a student of Karachi University, killed himself by jumping off one of the highest buildings in the city, his friends, though deeply saddened, were not surprised. They all knew, in fact had known for a long time, that Faraz was suicidal and could kill himself any day.

Faraz’s reasons for killing himself, even if they were brutal, fall under the sociological category of ’philosophical suicide’. He chose not to live for personal reasons and preferred death and his own obliteration over life itself.

There are others, however, in the dusty, mournful city of Karachi, who have other reasons to do away with themselves for good.

In Karachi, there are several problems, especially for the unemployed, or the poor, and those who fall under the poverty line. According to the statistics of the Jinnah Postgraduate Medical Hospital (JPMC), in 2006, there were 1,620 cases of attempted suicide, with a five to 10 per cent death result. In Abbasi Shaheed Hospital, there were 1,200 attempted cases, whereas in the Karachi Civil Hospital, there were around 800 to 1000 cases.

Dr Bashir Sheikh, the Central Police Surgeon, Karachi, says that the main reason for suicide in the city is unemployment and poverty. Poverty in the country has increased to such an extent that the number of people who live under the poverty line, have increased, and their conditions are debilitating. He says there are also many who kill themselves over unrequitted love affairs, as well as adolescents who have been found hanging from the fan, only because their parents have scolded them over their school grades, or they have not consented to buying them what they want, such as cell phones.

But Dr Haroon Ahmed argued in a press conference in early 2006, that such causes are not the actual reasons for the mishap. Stress in fact is only the trigger cause. In actuality, suicidal tendencies have been developing over a period of time.

According to a study conducted in 2006, by Murad Moosa Khan, who is the head of the department of psychiatry in the Aga Khan University Hospital (AKUH), there is no official data on suicide from Pakistan, in national annual mortality statistics. But there is accumulated anecdotal evidence, that the suicide rate in Pakistan has been gradually increasing over the last few years. There is also a general lack of trained mental health researchers in the country, which is partly to blame, and those that are there, are so costly that many do not regard mental health treatment a necessity.

Suicide and attempted suicide are termed criminal offences under the Pakistani law, and are punishable with a jail term and a heavy financial penalty. Every case of completed or attempted suicide is to be legally taken to one of the Medico-legal Centers (MLCs), which are usually located in the government hospitals of the city. In Karachi, these include three hospitals, namely the Abbasi Shaheed Hospital, the JPMC, and the Civil Hospital. Because of this, people usually take patients of attempted suicide to private hospitals, to avoid having cases filed against them with the police. Private hospitals themselves may save the person from death, but do not address the underlying issues related to the suicide attempt, or the suicide itself.

A talk with Dr Amin A. Gadit, one of the top psychiatrists of Pakistan, the former chief of the Pakistan Psychiatric Society, and a Professor of Psychiatry in the Memorial University of Newfoundland, Canada, exposed that the incidence of suicides in Karachi has definitely been growing over the past few years.

He, too, says there is no official data regarding suicides in Karachi or Pakistan, but he has managed to accumulate information concerning mental health from 1947 to 2006.

The most recent statistics are of 2005, where completed suicide among males was recorded (unofficially) as 2,700, while around 1,700 females killed themselves the same year. These include cases that have come in from private hospitals as well as government hospitals.

Dr Gadit says the main cause for this is major depression, followed by schizophrenia and then epilepsy. The latter may itself be a neurological condition, but it tends to isolate its victims, thereby inviting depression. He says there is also an inheritance factor, which is linked with the secretion of a neuro-chemical called HT2.

Also, he says, those who are suicidal, are found to have a very different brain structure, as compared to others who may be depressed but not suicidal.

There is only one per cent incidence of schizophrenia in Karachi, which includes hallucinations (voices in the head, directing the patient to carry out an action), paranoia, etc, going towards a complete deterioration of personality. These are the mental health causes for suicide.

As far as social factors are concerned, Dr Gadit says that the inner city of Karachi, in other words the Central district, as well as all the underground areas, have the highest suicide rates. Factors include violence and economic disparity.

"There are only two per cent of people who actually enjoy all the privileges of life. The others are burdened by financial and economic issues," he says.

Only about 0.5 per cent kill themselves with the preference of being better off dead than alive. This relates to the philosophical cause of suicide. Some also feel that they should rather die than suffer from an incapacitating illness, but they do not actively work towards a ’suicide’, because they are tied down by religion. However, as Dr Gadit says, ties with religion are slowly weakening if not breaking down, and at a certain point when an individual is suffering to an extreme level, and actually does wish to end his life, he is not prevented by any kind of religious factor.

For males, marriage acts as a preventive measure, because they feel socially secure, but the opposite is found to be in females, because they are usually found to lead unhappy married lives. That is the reason, Dr Gadit explains, why it is single men who tend to kill themselves more as compared to married men, and married women who want to end their lives as compared to single women.

Dr Gadit says the suicide rate figures in Karachi have started to slowly resemble those in New York City, which are one of the highest in the world. The lowest are in the countries where there is less economic disparity such as Sweden, Dubai, Saudi Arabia, and Oman.

Shockingly, the incidence of suicide among children is also slowly increasing. The age range is from nine years to 12 years.

In order to prevent or keep the suicide rate in control, perhaps one of the first few steps would be to decriminalise the law that terms attempted suicide as a crime. As a result, the victim of attempted suicide will be taken to a psychiatrist instead of being transferred to a jail. Proper organised clinics or bodies should be established which deal with mental health problems, specifically those that lead to suicide.

The government’s budget for mental health should be increased. In Karachi, there is no structured medical plan, instead there are out-of-pocket expenditures by some bodies, while one or two provide free service, but most doctors who treat at low rates have a dubious medical experience. In Karachi there are only 44 psychiatrists, only 184 psychiatric beds, in a population of 14,000,000, where at least 17 per cent people suffer from depression, not counting other mental illnesses. Unemployment benefits should be given to those especially those below the poverty line.

The government often says that economic benefits are trickling down to the lower socio-economic classes of Pakistan, but this is not the case in reality. It is indeed a sad scenario where a person is forced to take his own life under circumstances that are beyond his control.