Dr. Padma Angmo, Psychiatrist, SNM Hospital, Leh:  Suicide is a personal tragedy that prematurely takes the life of an individual and has a continuing ripple effect, affecting the lives of families, friends, and communities. A total of 1, 64, 033 suicides were reported in the country during 2021 showing an increase of 7.2% in comparison to 2020. Similarly, suicide cases and attempted suicide cases are often reported in Ladakh nowadays. As per my observation, suicide cases is very much prevalent in Ladakh society earlier also but went unreported because of the stigma attached to such death in the society and the legal implication of suicide attempts. Today, because of the digital era and awareness, cases are reported. It will be difficult to conclude about suicide cases in Ladakh because there are no proper studies done on such issues.

In SNM hospital, we deal with approximately 400 to 500 patients suffering from mental illness in a month, and around 30 to 40 percent are suffering from depression. Those with diagnosable mood disorders, such as major depression and bipolar disorder, are at higher risk for suicide. Other disorders such as schizophrenia, and anxiety are also susceptible to suicidal thoughts and behaviors. Among all the patients we deal with there are patients who are suffering from diagnosable mental illness. Apart from that, we also see people suffering from psychological distress which is also a risk factor for suicide. We come across patients who talk about having suicidal thoughts because of academic stress, relationship complications, family troubles, financial issues, unemployment, marriage instability, etc. Some people who end their own lives feel there is no other option to relieve them of their pain. They might experience a sense of hopelessness, and feel that things cannot get better and find suicide is the only way to end their distress.

According to the National Crime Record Bureau, the family problem is the prime reason in India for suicide. Around 30% of people who commit suicide are because of family-related issues. The second reason is mental and chronic illness and also around 6.4% of suicide is because of substance abuse. The same pattern is in Ladakh also, there are cases of substance abuse in which the person did self-harm or attempted suicide. It is important to understand that suicide is the result of many factors in a person’s life and not one particular event or discussion. 

Preventing Suicide

Most of the suicides can be preventable. There are some early signs or symptoms that the people who take their lives display. The most important thing is that a family member, friend, or any near and dear one of a person who is suffering from depression or any other mental illness or chronic disease needs to understand his/ her condition. 
Notice the changes or warning signs of a person which include:
•    Change in behavior
•    Suddenly preferring to stay alone
•    Less interaction and withdrawal from friends, family, or society
•    Talking about suicide, death or dying, or intention
•    A drop in school or work performance
•    Lack of interest in things previously important, and the future

There is various school of thought, many say that we should not discuss or talk about suicide to a person directly who are at risk but according to some research, it says that talking and discussing the issue helps. This is because people who are at very high risk and in severe conditions only think of suicide. One can prevent such unfortunate incidents by talking about it, giving the right advice and support to the person who in distress, not being judgmental, understands his/ her problem or the situation, and giving a helping hand and support to solve the problem. A supportive conversation allows them to talk about their distress. Encourage or help the person to access professional help. With effective treatment, social support, and time, many who have tried to end their life, or considered ending their life, can go on to live full and meaningful lives.

Social awareness in such cases is very important. Earlier, suicide attempts are considered a crime, and rather than giving support people ends up terrifying and threatening the person more. As per the new Mental Health Act, a person who attempts suicide is in distress and is in need to help. Thus, in case there is a person who attempted suicide needs to be taken care of rather than hiding or covering up the issue. We must all understand that suicide attempt is a cry for help and we must all stop considering it as a crime. 

In SNM hospital, whenever we come across such patients who are having suicidal thoughts and have attempted we consider it an emergency case. Since we have an inpatient facility now, we admit the patient and start treatment according to the patient history. Along with medicines, a counseling session is also arranged. The medicine, dosage, and counseling may vary with the case. 

Also, I would like to add that The Government of India announced Tele Mental Health Assistance and Networking Across States (Tele MANAS) helpline which the public can access by dialing the toll-free number or shortcode. The caller will be counseled, and needed care based on the condition of the person. The programme is started in Ladakh also in which a counselor will be there 24x7 for your help. The toll-free no. is 14416 and you can also select your choice of language. 

Solutions
•    Society plays a big role starting right from our homes to make free and open space for every individual to share his/ her problems without any fear or shame. Let’s normalize mental illness as any other physical illness like common headaches, flu, stomach ache, etc.
•    Discussing the concerns openly and non-judgmentally with them is very important. 
•    For parents, I must say that teaching children how to face problems, cope with the situation, and reach out for help when in need. 

Khanpo Konchok Sherab: The recent emerging suicide cases in the region are very disturbing. We are a spiritually and culturally imbued community with a long history of ecstatic and self-contentment living. However, this unfortunate development is yet another reminder for us to take serious note and reflect on the causative element of this extremely violent act.  

Human life is a precious gift and ending it for a trivial reason is a sheer insane act. It is unfathomable how hard we worked in our past lives to obtain it and we must be overwhelmingly proud of our past deeds. The circumstances our parents go through initially giving birth, raising, and shaping our future are love and dedication that cannot be compared with any material richness. The Buddha in the White Lotus Sutra says: “Human life is hard to obtain.” Hence, it is believed the human body is a result of the positive deeds we accumulated through many past lifetimes. 

According to Mahayana Buddhism, human life is the only potential vehicle you can drive to achieve enlightenment. Thus, the great master Shantideva while giving the importance to getting the maximum benefit out of it when we live, says: 

Supporting by the boat of the human body, 
Free yourself from the massive ocean of suffering. 
It is difficult to get this boat again,
You ignorant! Do not fall asleep [seize the opportunity]. 

Thus, an elaborate statement on how human life is precious can be found in many sutras, tantras, and treatises taught by the Buddha and other prominent Buddhist masters.  

In Vajrayana, tradition of Buddhism has even greater advocating statements in respecting and revering the human body. The Fourteen Root Downfalls of Vajrayana states: 

“The human body is the nature of the five Buddha families. 
Disdaining it is the eighth downfall.” 
This means you cannot even utter bad words about yourself or your physical body. 

Rejections, breakups, failure, bankruptcy and so forth misfortune could be the causative elements for the extreme step the people choose especially the youths. But, is there no option B? If you think ending your life is the end of your suffering. This is completely wrong! Instead it is the opposite. You might be leaving the body but you never escape the karmic trapper. You continuously carry on your cause of suffering even if you leave the body behind. Suicide is a heinous crime. 

So, now the question is: what could be the method one can adopt to prevent such self-destructing violence? Given the facts of how human life is precious spirituality teaches us to appreciate and how fortunate we are just simply being born human. The inner development of a positive attitude about life at a very early age is of utmost importance. Gradually the children will build up a strong inner muscle of positivity about life and it will help them to overweight the challenges they face at different stages of life. Instead of giving so many theoretical lectures, the focus must be shifted from brain-to-mind training, meaning emphasizing practical meditation during the public spiritual lecture/sermons rather than merely the transmission of empty words. This could greatly help to pull oneself back from the negative force when one passes through a difficult phase of life. 

The time has come to shift our focus from brain training to mind training, commercial mind to compassion mind, and competitive attitude to composure approach.
 
Solutions

•    The inner development of a positive attitude about life at a very early age is of utmost importance.
•    Emphasize practical meditation during the public spiritual lectures/sermons.