India’s Suicide Capital: Sikkim

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By Diwash Gahatraj

Despite a booming economy, Sikkim has the highest suicide rate among all Indian states, second only to the Union Territory of Puducherry.

Gangtok: For Sukhrani Limbu of Sordung village, about 120 km from Gangtok, 29 May 2016, was just another usual day at work. But upon her return home, she found her eldest son, 30-year-old Aitey Singh Limbu, hanging from the ventilation shaft in his room.

Life somehow went on for the grieving mother. But then came 29 May 2018, when her third son, 27-year-old Aitey Hang Limbu, hanged himself from the same ventilation shaft in the same room.

“There was no suicide note, no signs of sickness… I am still clueless about what triggered their suicides,” Sukhrani says, fighting back the tears.

Sukhrani is not the only mother or family member in Sikkim who’s searching for answers. A National Crime Records Bureau study reported that the landlocked Himalayan state witnessed 241 suicides in 2015, 2.1 per cent of all the suicides in India that year.

But in terms of suicide rate in the last decade, Sikkim has the highest (37.5) among all states, and the second highest in the country after the Union Territory of Puducherry (43.2). Suicide rate is the number of suicides per one lakh population. According to the 2011 Census, Sikkim’s population was 610,577.

The West district, where Sukhrani lives, is Sikkim’s worst-affected region. Between 2008 and 2018, 278 cases of suicide were reported here.

Underbelly of the ‘golden state’

Sikkim joined the Indian republic in 1975, and has gradually become the poster child for development and a booming economy. Between 2004-05 and 2011-12, the state witnessed the highest net state domestic product in the country, and was the third richest state in India according to the 2015-16 Economic Survey.

In September 2018, Sikkim got its first airport at Pakyong near Gangtok, and in October, it was awarded by the United Nations for becoming the first state in the world to become 100 per cent organic. Literacy and cleanliness are high, and it’s often referred to as a ‘golden state’.

Yet, it has a sordid underbelly, which is manifesting itself in suicides and the questionable mental health condition of its residents. Regardless of age, gender, rural-urban divide, economic or health status, suicide looms everywhere.


Also read: What the history of foreign invasions tell us about suicides across India


A number of factors

“It would be very difficult, and even unfair, to pinpoint a particular reason for why Sikkimese people are turning suicidal. There are several factors: A long history of alcohol and drug abuse, unemployment, high aspirations, ignorance of mental health illnesses and changing family structures,” said Yumnam Suryajeevan, assistant professor of sociology at the Sikkim Manipal University.

Social worker Dr Satyadeep Chhetri adds three more factors — lack of socialisation, loneliness and high rates of adultery.

“Around 70 per cent of people who have committed suicide were loners — either they were separated couples, aged people living away from their children, or kids from broken families. There is no study to connect suicide with adultery or other factors, but many people have committed suicide due to marital discord,” Chettri said.

A case in point is that of a 12-year-old girl who committed suicide on 26 June 2017 because she longed for parental love.

The seventh grader from Timberbung village in West Sikkim used to live with her old grandparents after her parents drifted apart and started living with their respective lovers, said an investigating officer from Soreng police station.

Drugs and alcohol

Many Sikkimese youth are high on pharmaceutical drugs like Nitrosun 10mg, Spasmo Proxyvon (SP) and cough syrups like Corex and Phensedyl, which are smuggled into the state from the neighbouring Siliguri in West Bengal.

“Drug users are very vulnerable to suicide,” said Prashant Sharma, member of the Sikkim Drug User Forum.

Former drug user Robin Rai recalls trying to kill himself during one of his weak moments nine years ago. Rai, who works as a counsellor at a suicide helpline centre in Gangtok, said he gets numerous calls from drug users with suicidal tendencies.

The state’s climate, geographical location, and the easy availability of alcohol has made it vulnerable to alcohol abuse as well.

Sikkim’s history with alcohol dates back to 1954, when Sikkim Distilleries was set up in Rangpo to ensure quality liquor for its citizens at a reasonable price. The then Chogyal (king) agreed to give the company absolute monopoly for the manufacture of alcohol, on the condition that the government was given 47 per cent of its shares. The state earns considerable revenue every year from alcohol sales — in 2013-14, the figure stood at Rs 120.64 crore.

K.C. Nima, a public health activist, shared the story of Suresh (name changed), a 40-year-old chronic alcoholic who had attempted suicide twice.

“The Sikkim High Court had to order the state to provide rehabilitation for him. There are many such cases,” Nima said.

Charvi Jain, a Kolkata-based psychotherapist, said that dysfunctional families, loneliness and drug and alcohol abuse are all interconnected. “It can be a deadly cocktail for suicide,” she said.


Also read: Suicides high among married women: Crisis in Indian marriages or mental health stigma?


Unemployment

According to a report by the Labour Bureau of the Ministry of Labour & Employment, Sikkim has the second highest unemployment rate in India.

Prawesh Lama, guitarist for the popular local band Tribal Rain, said the rush for government jobs had something to do with it.

“The problem of educated unemployed youth is high here. Sikkimese youth focus only on government jobs. But such jobs are for just a few who have the ‘right’ contacts,” Lama said.

“People are not willing to compete in the private sector. In this struggle to grab a government job, many youth get frustrated-some fall victim to drug and alcohol abuse, while a few even lose the urge to live.”

Cultural stigma of mental illness

Historically, the rulers of Sikkim have had no record of suicidal deaths. However, according to local tribal myth, adultery in a past life could lead to unnatural deaths, said L. Khamdak, professor of Limbu cultural studies at Namchi Government College in South Sikkim.

Tshering Tamang, a shaman based in Pelling, West Sikkim, added: “Every person has a predestined time to live. If someone kills themselves before time, their soul turns into Sian (evil spirit).This Sian can take lives of other people known to him or her in the similar way. More suicides will take place till the spirit completes its life-circle.”

In Sikkimese religious practices, mental health is often misunderstood. People with serious mental health illness approach religious gurus and shamans rather than coming to a doctor, said a psychiatrist based in Geyzing, West Sikkim, who did not wish to be named.

What has the administration done?

Other than an unpublished study conducted by Sikkim University, the state government has done very little research on the issue. ThePrint repeatedly tried to contact state health minister Arjun Ghatani, health secretary Vishal Chauhan and other senior officials, and emailed them questionnaires on the issue. But the only official response was an email from the health department, acknowledging receipt and saying it would take time to reply to the questions, “as this is a government procedure”.

However, that’s not to say there haven’t been efforts to curb suicides. A senior health department officer said on the condition of anonymity that the state was trying its best to combat the growing problem.

“The Sikkim Mental Health programme is operational since 2011, and we are conducting many awareness campaigns across the state,” the officer said.

In 2015, a state-funded 24×7 suicide helpline centre (03592-2021111, 18003453225) equipped with trained counsellors was started from the psychiatric department of the Sir Thodup Namgyal Memorial Hospital in Gangtok. However, the centre has received just 182 genuine calls so far, because hardly anyone seems aware of it. There were no advertisements for this number in Gangtok or West Sikkim, and helpline head Dr Jigmee K. Topgay said the reason was a lack of funding for promotion.

Hardly any local psychiatrists or health department officials were willing to speak on record when contacted for this report, because when a few of them spoke to a national daily on this issue, they were transferred from Gangtok to far-flung regions of the state.

One exception was Dr Satish Rasaily, a psychiatrist who has worked closely in the past with the government on suicide awareness programmes.

“The state has done several suicide prevention campaigns in Gangtok,” he said.

But outside the state capital, the track record of awareness programmes gets a bit murky. On the one hand, health department officials claim they conduct regular camps, as do local government officials like Hemant Limbu, vice-president of the Darap village near Pelling.

“We have a conducted a community level awareness programme where doctors, psychiatrists and suicide counsellors from Gangtok visited our area on the occasion of World Mental Health Day on 10 October 2018,” Limbu said.

But on the other hand, people in many other villages in West Sikkim said such camps were a rarity.


Also read: One in every 3 women who commit suicide globally is an Indian


How to fix this problem

Parul Agarwal, a Siliguri-based counsellor and psychotherapist suggested that the Sikkim government should work on spreading awareness about mental health.

“Forming a team of well-trained counsellors and psychiatrists who can work at the grassroots level can be a good start. Regular workshops, seminars in schools and colleges and a compulsory HR policy on mental health awareness at workplaces can be helpful,” she said.

Among all the religious groups in the state, incidents of suicide are least among the Christian community, and that’s because of a conscious effort that others could emulate, said Father Moni Clement Lepcha of St Mary’s Catholic Church, Geyzing.

“We regularly hold conversation with our parish members. When we talk about our problems, it helps a lot in venting out,” he said.

Social worker Chhetri added: “We have to tap the emotional quotient of Sikkim’s citizens. We have to tackle this situation as a society. We need to be more open to talk to each other, create occasions to meet and socialise.”

How To Help A Friend Who’s Suicidal Without Sacrificing Your Own Mental Health

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As of 2017, the United States alone saw an estimated 1.3 million suicide attempts. Needless to say, suicide, often misunderstood and stigmatized, is a desperately urgent issue in America—and not solely for the people battling it firsthand. Supporting a suicidal friend can be a taxing, often frightening, stressful, and heartbreaking experience. But, being the best support system possible requires you to put yourself and your own needs first.

Easier said than done, though. As any caring and thoughtful friend would be, you’re likely worried about the wellness and safety of the person who you suspect to be in crisis. This situation can lead to bouts of self-doubt (“Am I doing and saying the right things?” or “Am I making things worse somehow?”), but Christine Moutier, MD, chief medical officer for the American Foundation for Suicide Prevention, says to trust your instincts. “Asking about suicide will not make someone suicidal if they do not already have those thoughts. Usually people feel relieved to share, especially if you are respectful and compassionate,” she says.

While you should open the lines of communication by asking your friend what they need, know what your own boundaries are, says Dese’Rae L. Stage, suicide awareness activist and creator of Live Through This. “If you’re not in a position where you can help, be honest. Say, ‘I’m not doing too well myself, but here’s a way we can find you help.” Going this route is not only best for you and your own sense of wellness, but it can also make you more approachable to your friend. “It shows how much you truly care about your friend and also allows you to be human and acknowledge you don’t have all the answers either,” says therapist Amanda E. White, MA, LPC, adding that this dialogue can come as a relief to someone who is suicidal, because so many people tend to walk on eggshells around them.

“If you’re not in a position where you can help, be honest. Say, ‘I’m not doing too well myself, but here’s a way we can find you help.” —Dese’Rae L. Stage, suicide awareness activist

Another option for helping your friend without sacrificing yourself is to call in additional support. Stage suggests tapping other friends, especially if you are in a tight-knit group, to make it a team effort of sorts. “Take shifts if you can,” Stage says. “See what [your friend] needs. Are they having trouble in their living space? Do they need help with laundry or dishes? Do they need someone to sit there and watch TV with them and order a pizza? Do they need to get out? [Helping with] things like that are good starters.”

If that arrangement—or any other, for that matter—doesn’t work for you, one thing that certainly can is honesty. Tell your friend you are there in the capacity you can be, whatever that may be, and that you love them. “Let them know they’re supported, even if you can’t necessarily be the one to do it,” Stage says. When you’re having this chat, or any conversation around suicide, it’s best to be direct, open, and a good listener. “People who are suicidal just need to be heard and validated. Even if you don’t agree with them, just say, ‘I hear you, and that sounds really hard.’”

“Focusing on your own health and wellness is important when you are trying to support someone in your life. If you are not well, you won’t be able to be a support to someone else who is struggling.” —Christine Moutier, MD

Dr. Moutier echoes that your time and attention alone can be a huge help. “Know that by simply caring and offering a listening ear and a feeling of support, you are providing them with everything a friend should.”

That said, you yourself may benefit from talking through this ordeal with someone who can guide, support, listen to you. “You are not alone—whether you’re the one struggling or the friend supporting them.” says Dr. Moutier, who says seeking therapy or support groups could be a smart avenue to explore for self-preservation. “Focusing on your own health and wellness is important when you are trying to support someone in your life. If you are not well, you won’t be able to be a support to someone else who is struggling.” In addition to seeking counseling for yourself, she recommends getting regular exercise, eating healthy foods, “and doing whatever you can do reduce your own stress.”

To be your best self—for the sake of your own well-being and ability to be source of support for a friend in crisis—you must always take care of yourself. And doing so, White says, is anything but selfish. “The most important thing is to make sure you are spending time with people who empower you and provide you with energy and love.”

If you or someone you love is suicidal, please contact the National Suicide Prevention Lifeline at 1-800-273-8755 or visit suicidepreventionlifeline.org.

TedTalk: Real Advice For Those Who Have Attempted Suicide

Link here

Live Simply. Avoid the material trappings of a fabulous life, but rather find joy in simple things – walks on the beach, instrumental music, or fresh flowers. Choose what works for you. For example I shared an apartment with a roommate, rather than trying to buy a place or live alone to keep my life simpler.

Cultivate Sacred Spaces. Have a corner of your room which is ideal for reading, journaling, praying or meditating. Find a church or temple or park or art gallery where you can go easily in the midst of a pressure-filled day to “recompose” yourself.

Journal Regularly. This has been vital for me; I have a friend who, at the very least, jots down the time he goes to bed. Sometimes he can get another word, or sentence, or paragraph, or page written… but he’s developed a discipline to at least begin. Don’t just journal the bad, but record the joys and the progress. I often paste simple items (ticket stubs, plane tickets, business cards) from the day onto the page facing what I wrote for the day as a visual remembrance.

Create Works of Beauty. Whatever moves you: do it. Throw pottery, weave tapestries, take photos, learn to dance – the medium (or how good you are) doesn’t matter, but find a way to get outside yourself regularly.

Abstain from Substances. Even if addiction is not one of your issues, I’d urge you to eliminate drugs and alcohol from your first year back from an attempt. It dulls the pain, yes, but it also can steal from you the chance to live fully your feelings. Tackle life’s joys and setbacks head on – without the false help a drink, a joint, or a line can provide.

Assemble Your Dream Team. The exact nature of who you need to help you will depend on the issues you are facing. But strive to put a small and committed group of people in your corner to assist you with the physical, social, spiritual, and personal healing which is needed. Be entirely honest with them so that they know your successes as well as your setbacks.

Manage your Primary Illness. Whether it is depression, addiction, bi-polarity, an eating disorder, or something else which brought you to the brink of death, it requires your primary and unwavering focus. If you put anything (a boyfriend or job or volunteer commitment) ahead of managing your primary illness … you will likely lose that very thing you thought was more important.

Find A Caring Community. Seek out others with similar needs and develop a network you can rely on. Those of us who are in recovery can find this in an AA or CMA meeting, you may need to locate a support group, join a small group at church, or seek an online community of others who get the depths and severity of what you face.

Avoid Dating. You need to first get at ease in your own skin before trying to be intimate with another again. If you are already in an intimate relationship, it is often advised to not get out of this relationship until you are stronger. Consider your “relationship bone” to be in a splint and cast for a while. You need to go easy on it until it is strong enough to handle more weight.

Earn a Modest Income. Be sure your basic needs are met, so as not to add financial pressures to your life, but this is not a season to be closing huge deals, seeing great raises, or starting new and demanding jobs. In essence, during this season (likely a year or so) your full-time job is recovering your life. There will be time in the future when you can be more dedicated to a demanding job and/or fulfilling career.

Comply with Prescriptions. This is especially necessary as it regards anti-depressants. Only reduce or increase your meds under the specific guidance of your doctor. There are terrible tales of patients who begin to recover, with the help of today’s psychiatric drugs, and then feel they no longer need them and simply cease using them and weeks later end up suicidal. These meds have helped millions, but are powerful change agents in our life. Use them with care and strict adherence to what your doctor says.

Share your Story Selectively. It is critical that you create trust with others before sharing your story entirely. Certainly be fully honest with your “dream team,” but you may find others (employers, roommates, bowling buddies, even family members) don’t need and don’t want the full details.

Optimize this Time of Strength. Have conversations with loved ones when you are strong and tell them what to watch for if you “backslide.” Give them guidance as to what you may need but not ask for, should a crisis happen in the future. Some patients have actually created advanced directives of what close friends or family can/should do. As Kay Jamison in Night Falls Fast points out:

“Patients who decide, when rational, that if they again become suicidal they wish to be hospitalized or receive antipsychotic medications or undergo electroconvulsive therapy, but who also know that they are unlikely, when ill, to consent to this, may in some areas of the country draw up “Odysseus” arrangements. Based on the mythic character’s request to be strapped to the mast of his ship so that he might avoid the inevitable call of the Sirens, Odysseus agreements (or advanced instruction directives) allow patients to agree to certain treatments in advance.”

Eliminate Easy Access to Destructive Means. Get the pills, guns, and booze out of the house. It is imperative that you clean house (literally) while you are in a place of strength, possibly with a trusted friend helping you. Don’t leave a “back door unlocked” which could undo all your good work later on when things get tough.

Be Gentle With Yourself. Strive for incremental progress, but don’t beat yourself up over a bounced check or missed appointment. The 12 step literature urges “spiritual progress not spiritual perfection.” All of us who are recovering from a serious suicide attempt are doing a remarkable thing as we reclaim our life. Take heart in your progress, celebrate and rejoice in the small victories. For the first year after my attempt, on the 11th of each month, I’d go out and buy a CD for my collection. Typically show tunes … what can I say?

Suicide Flashbacks

This fucked me up. It is almost an actual play-by-play of my failed suicide attempt. Except I got the cap off, & nothing fell on the floor. Dramatics are on point.

Now with the antidepressants having done some good, seeing this is really screwing with me. I can see the stress I saw in my boyfriend’s eyes, the almost word-for-word dialogue before he carried me to the bathroom, the reality of how she really isn’t just screwing around. That’s me.

I promise new Snowboarding & Suicide Series posts are on their way.  I was working on one when I saw this, & I need a minute. Dab pen time.