By Nisar Ahmed
Suicide is the act of hurting oneself with the desire to take one’s own life (Reyes, et al. 2015). It is a serious health issue and one of the major factor of death for people of all ages (Taliaferro, et al. 2012) The World Health Organization defines suicide as “the act of intentionally killing oneself” (Shah and Erlangsen 2014).
In the recent years suicide has become a leading public health problem in Pakistan. Data on suicide is not encompassed in the national annual mortality statistics. As a result, national rates regarding suicide are neither known nor reported to the World Health Organization (World Health Report 2000). Regardless of this, there is convincing evidence that occurrences of suicide have increased in Pakistan in recent years. The media in Pakistan regularly report on suicide incidences in Pakistan. These news reports are published on surveys of police stations, reports of non-governmental organizations (NGOs) that gather information on suicides. Suicide is one of the ten leading causes of death in the world today, accounting for almost a million deaths worldwide annually (Bertolote and Fleischmann, 2002).Data on suicide from Islamic countries is absent, including those with populations beyond 100 million people such as Bangladesh, Indonesia, and Pakistan (Khan, 2005). Pakistan spends 0.7% on Health in the national annual budget. Mental health does not have a separate budget but is assumed to be 0.1% of the health budget. The Islamic religion clearly forbids taking one’s life, seeing it as a sin (Chaleby, 1996). Individual-level factors related with suicide consist of psychiatric disorders, a former suicide attempt, alcohol use, divorce or separation, social isolation and childhood trauma (Goldsmith et al. 2002; Cavanagh et al. 2003)
Researchers have identified numerous factors leading to suicide. Psychological problems are main factors that work together to indulge a person to engage in suicidal behavior. Joiner (2009) proposed the relational psychological theory of endeavored and completed suicide (also called the “crescendo” model of suicide behavior), which assertions that to die by suicide a person must have both the longing and the potential. In Pakistan married women under 35 years have more incidences of psychiatric problems than elder married women (Ali, et al. 1993). Marital friction, mental and physical abuse from husband, helplessness, low self-esteem, economic issues imposed by the spouse, and in-law issues are bulging psychosocial stressors for female (Fikree and Bhatti 1999). In the Northern Areas particularly Gilgit-Baltistan, high level of incidents of domestic violence against women are observed (Khan, et al. 2009).Cultural restrictions of women’s role in marriage may also be a reason of high ratio of female suicides than male suicides especially in Asian countries as compared to Europe and the United States of America. In countries like India, Pakistan, and Sri Lanka where arranged marriages are common, the society and family compels a woman to stay married even in belligerent relationships appears to be one of the factors that set to suicide in women. In some cases, young couples, who marry by family disagreement and face indeterminable clash either live apart by separating ties or take suicide either together or alone.
Gilgit Baltistan is rich in its unique culture, values and owns many scenic valleys and most heightened peaks in Pakistan. Unfortunately, suicide is becoming an alarming issue in the mountain-ringed territory. Shumaila Jaffery reporting to BBC narrates, “The scenic valley is described as the Jewel of Pakistan, but it has a problem. The rate of suicides among women there is the highest in the country.” Youth in the region especially between ages of 14-28 are highly affected in Gilgit-Baltistan. According to Ghizer Times, from 1996 to 2010, more than 300 cases of suicide were registered at various Police Stations of Ghizer. But the figure might be much higher as some cases are hidden, and not reported to the Police Department due to some internal issues and family threats (Times 2014). Since 1995, more than 260 people have committed suicide at various villages of Ghizer districts, keeping in view it’s a small population district and worrisome for the region.(Brooshaal Times). According to an anonymous shopkeeper of Ghizar District, there are several cases of honor killing in the district, latterly reported suicide by the pressure of family members or villagers. Aziz Ahmed and Sultan Rahim Barcha conducted a research, ‘Female suicide rates in Ghizer’ in 2005. According to their collected data, from 2000 to 2004, 49 women committed suicide in the Ghizer district. The following years saw speedy upsurge in suicide rates. According to mass media reports, 340 women committed suicide in the period from 2005 to 2011. Despite the seriousness of the circumstances, no research has been conducted to identify the likely, socio-psychological roots of female suicides in Ghizer. No authenticate data has yet been gathered from the other districts of Gilgit-Baltistan which might be much more alarming than expected.
Likewise, Hunza District, well known for its highest literacy rate, tourism hub and exemplary entrepreneurship reveals worrisome result on suicide. In the previous year’s several suicide cases have been highlighted through the local media reports. Three schoolgirls jumped in river when couldn’t pass matriculation exams. In other incident male students finished their lives after knowing about their failure in the school examinations. Families, peers and many others look down upon students who fail in their school exams. Such an atmosphere jams breathing space for young people. Eventually, some of them seek suicide as a convenience and end their lives. (Dad 2014). In upper Hunza (Gojal Valley) 13 suicide murders have been reported in the last two years (2013-2015) according to an anonymous government source. Majorly, young male (20-35), commit suicide by hanging themselves with trees or pillars placed at traditional homes. Females use poisonous food or jump into the river and end their lives. The mysterious death of youngsters have not yet been probed at government level nor has any substantial research taken place to reach the root causes. Burdens of modernization, growing materialism, sense of comparison and social competition seem to agonize the situation, moreover, the broadening gap between age-old tradition and galloping transition leave the community ambivalent which is again responsible for raising of these issues. (Samina Sher, Humera Dinar Anthropological research) Modernity has empowered the mind, but could not provide space to celebrate freedom.(Dad 2014)
There is dearth need for a standard system of recording of suicides in Gilgit-Baltistan and all over in Pakistan, so that true figures can be recorded. This will assist in drafting policy and checking effectiveness of suicide prevention programs. Under Pakistani law both suicide and deliberate self-harm (DSH) are prohibited acts, punishable with a jail period and a weighty financial penalty. Every case of suicide or attempted suicide should be taken to government hospitals chosen ‘‘medico-legal center’’ (MLC), where the police register a case and conduct an inquiry into the situations of the act (Mahmood, 1989). People sidestep going to the MLCs and many pursue treatment from private hospitals that neither diagnose such cases as suicide nor report them to the police. There are also strong social stigmas against suicide and families of victims are often not accepted. For these explanations, suicide is under-researched and under-studied in Pakistan. It is authoritative that suicide and attempted suicide be de-criminalized in Pakistan. This will help in establishing true rates of suicide in Pakistan. Prevention of suicide is not the core responsibility of any one sector of society. Schools can make cultures in which young people feel it is healthy to talk through emotional and other complications. Accident and Emergency staff can guarantee all young people who have attempted suicide get specialist mental health checkups. Every individual can pay close attention to the overall mental health of our loved ones to diminish the risks of them taking their lives. Nearly 34% of Pakistani population suffer from common mental disorders and depression is associated in more than 90% of suicides. There is immediate need to be addressing the issue at community level. Preferably, mental health and suicide prevention programs should be integrated within the primary health care (PHC) system and counseling centers should be initiated at community and at local government level. It is important to review and revoke the law regarding DSH and suicide in Pakistan so that people who need psychological help can do so without fear of being persecuted by the police. The new Mental Health Ordinance, 2001 that outdated the Lunacy Act of 1912 has been a step forward and delivers for a psychiatric assessment of survivors of suicide attempt. Section 49 of the Ordinance relates to suicide and DSH and states: ‘A person who attempts suicide shall be assessed by an approved psychiatrist and if found to be suffering from a mental disorder shall be treated appropriately under the provisions of this Ordinance’. However, it does not go far enough to categorically decriminalize DSH.( Murad M Khan, Department of Psychiatry, Aga Khan University, Karachi)
Murad M. Khan , Haider Naqvi , Durrane Thaver & Martin Prince (2008) Epidemiology of Suicide in Pakistan: Determining Rates in Six Cities, Archives of Suicide Research, 12:2, 155-160, DOI: 10.1080/13811110701857517
Abramson, A., Tobin, M. & VanderGoot, M. (1995). The changing geography of metropolitan opportunity: the segregation of the poor in U.S. metropolitan areas, 1970–1990. Housing Policy Debate 6, 45–72. Agbayewa,
- O., Marion, S. A. & Wiggins, S. (1998). Socioeconomic factors associated with suicide in elderly populations in British Columbia: an 11-year review. Canadian Journal of Psychiatry 43, 829–836.
Barclay-McLaughlin, G. (2000). Communal isolation: narrowing the pathways to goal attainment and work. In Coping with Poverty: The Social Contexts of Neighborhood, Work, and Family in the African-American Community (ed. A. Lin and S. Danziger), pp. 52–76. University of Michigan Press: Ann Arbor.
Status integration and suicide: Occupational, marital, or both? Gibbs, Jack P Social Forces; Dec 2000; 79, 2; ProQuest Central pg. 363
Ahmed, Z., Ahmed, A., & Mubeen, S. M. (2003). An audit of suicide in Karachi from 1995–2001. Ann Abbasi Shaheed Hosp., 8, 424–428.
Dad, Aziz Ali 2014 Self, Society and Suicide in Gilgit. International the News.
Times, Ghizer 2014 Number of Suicide in Ghizer District of Gilgit Baltistan from 2007 to 2012. https://www.linkedin.com/pulse/20141022 054825-323217835-number-of-suicide-inghizer-district-of-gilgit-baltistan-from-2007to-2012
Brooshaal Times (2014), Rising suicide cases worry Ghizer residents
Khan, Murad M., Aziz Ahmed, and Sultan R. Khan 2009 Female Suicide Rates in Ghizer, Pakistan. Suicide and Life-Threatening Behavior39(2):P. 227-230
Khan, Murad M 2002 Suicide on the Indian Subcontinent. Crisis: The Journal of Crisis Intervention and Suicide Prevention 23(3):104.
Lalani, Sunita, Zainish Zafarullah Hajiani, and Sajid Khan, Ina Abdul Majeed and Jasmin Zahid 2013 Suicide among Young Adults. ChitralTimes.com http://www.chitraltimes.com/english13/ne wseng40b.html
Fikree, Faryal F, and Lubna I Bhatti 1999 Domestic Violence and Health of Pakistani Women. International Journal of Gynecology & Obstetrics 65(2):195-201.
Samina Sher, Humera Dinar (2010),ETHNOGRAPHY OF SUICIDE: A TALE OF FEMALE SUICIDES IN DISTRICT GHIZER, GILGITBALTISTAN
Euguene S Paykel(1971)Suicide Attempts Following Acute Depression
World Health Organization Report (2002)