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09 September 2021 | Story Dr AA George | Photo Supplied
Dr AA George, Clinical Psychologist at the Free State Psychiatric Complex and Senior Lecturer, Faculty of Health Sciences, University of the Free State.

Opinion article by Dr AA George, Clinical Psychologist at the Free State Psychiatric Complex and Senior Lecturer, Faculty of Health Sciences, University of the Free State.


A fleeting thought of suicide is not an uncommon experience for quite a number of people, especially during moments of stress or strife. Sadly, for some, their surrounding circumstances or confronting situations seem so insurmountable that these evoke feelings of despair, hopelessness, and constrict the individual reasoning abilities to a point where suicide seems to be the only reasonable solution to their problem. Thinking about ending one’s life (suicide ideation) on a frequent basis can lead to increased pre-occupation with suicidal thoughts, to the point where a detailed plan is put into action – also called a suicide attempt. Optimistically, we hope that the suicide attempt is effectively managed towards a complete recovery, with the necessary interventions. If loss of life has occurred due to the suicide attempt, the individual has completed suicide. Although the suicidal mindset focuses on eradicating the pain or stressor, the left-behinds (surviving family/friends) are often shocked or disillusioned by these acts, an aspect often less discussed. 

A glance into suicidal thinking

“Take the saddest/most embarrassing moment in your life and multiply this by 1 000
Then subtract your libido, self-confidence, and appetite
Now add feelings of slipping deeper and deeper into a state of pain and non-resolution”
(Author unknown)
This suicidal experience is associated with thoughts such as:
“There is no point in going on”
“Nothing I do will be able to help me”
“I’m probably better off dead”

“Even though I try, I will make no difference”


Who are most at risk?

The global trend of suicide prevalence has changed over the past few decades. Initially, the adult and elderly population were at higher risk, which was in line with the age-related stressors (loss of employment, financial debt, divorce, illness, experiencing a growing number of losses, as well as the experience of loneliness) during these age groups. Currently, the suicide picture has significantly swung the pendulum to the point where the age group of 15-29 years is at the highest risk of suicide (WHO, 2021). Accordingly, one person complete suicide every 40 seconds, and for each suicide at least 20 or more persons will attempt suicide. Within the confines of South Africa, the South African Depression and Anxiety Group (SADAG) expressed much concern about the youth, given that 17,6% of teens considered attempting suicide, while more than 20% of 18-year-olds had one or more suicide attempt. These alarming figures cannot be viewed with complacency and need our urgent attention as community, professionals, and government. 

Why our youth are at higher risk

Transitioning into adolescence and then into early adulthood is typically accompanied by a number of challenges and adjustments. Such challenges are varied, and depending on an individual’s resources and support, many social exposures (alcohol and other recreational substances, romantic relationship challenges, competitive educational environments, poor parent-child relationships, to name but a few) may be satisfactorily traversed. Unfortunately, many of these challenges transgress into stress factors which, if allowed to escalate, can negatively impact on the individual’s mental health.

In addition to these social pressures, South Africa is viewed as one of the more violent countries in the world, while its high unemployment rate and associated repercussions have placed inordinate stressors on family well-being (OSAC, 2020). Compounding this effect, is the presence of uncertainty in the socio-political arena. These economic uncertainties contribute to a strained societal environment in which the most vulnerable are often neglected in terms of adequate and efficient resource provision. The youth are more impulsive and less skilled in problem solving, thereby increasing their vulnerability to the above stressors. 

Reading the warning signs 

IS PATH WARM (APA, 2010)
I – Ideation: Talking/asking about suicide content
S – Substance use: Substances can disinhibit protective impulses and serve as a means to escape the unbearable/painful thoughts
P – Purposelessness: Questioning meaning in life, including your purpose
A – Anxiety: Agitated and emotionally difficult 
T – Trapped: Feeling that this situation is inescapable
H – Hopelessness: Loss of purpose and meaning
W – Withdrawal: From family, friends, social and community activities, and previously engaged-in groups 
A – Anger: Rage, uncontrollable anger, vengefulness
R – Recklessness: Don’t care attitude, inconsiderate and reckless actions seemingly without cause 
M – Mood changes: Mood improves in a positive manner, happier, more agreeable, etc.

Tell-tale warning signs:
• Significant changes in academic marks or uncharacteristic absenteeism from classes/lectures
• Uncharacteristic sharing, to the point of giving away precious possessions
Risk factors for suicide
The presence of risk factors compounds the probability that suicide behaviour may occur (Turecki & Brent, 2016; WHO, 2021).
• Previous suicide attempt: Still the number one factor that predicts future attempts
• History of suicide: Family history or attempts by close friends increase risk
• Alcohol/substances: Decreases inhibitions and causes mind-altering changes 
• Life situations: Marital separation, romantic break-up, difficulty adjusting to new circumstances
• Recent loss: Death of a person very close, physical amputation or loss of other physical functions
• Limited social resources: Poor support system by family, friends, etc.
• Psychiatric history: History of a mental illness or presence of psychotic conditions
• Various forms of trauma
• Stressful life experiences: Household violence, criminal violence, disaster situations, physical illness, chronic diseases, financial or legal difficulties

Responding to suicide

Suicidal thinking consists of constrictive thought patterns that seem polarised; however, research has indicated that reasoning is still possible and that a suicidal individual can change their mind (Yasgur, 2016). For the individual who is suicidal, the following ‘tips’ may prove useful (Malema, 2019; WHO, 2019).
• Take your mind off and rest by counting digits backward from 10 to 1
• If you feel angry, avoid the situation, but face it again after 10 minutes
• Accept help from colleagues and friends to deal with your worry
• Participate in distraction activities, e.g., regular exercise, regular sleep, or good nutrition
• Seek professional help, as this is key in helping you deal with your problems
As a family member or friend, you may become aware that someone is suicidal
• Do something now. Avoid delaying, ignoring, or denying
• It is a shock to your system. Acknowledge it, BUT know that you are targeted for help
• Support emotionally. Be there for them 
• If you can, enquire about possible methods being considered and, where possible, remove any dangerous items
• Get extra help and accompany them. Make suggestions and listen to the person’s wishes regarding who they might talk to

• Do not withdraw suddenly after the person has been stabilised

Professional help is available and can make a big difference. Consult a GP or go to your local casualty department, where you should receive some help and be referred to a psychologist and/or psychiatrist, depending on the need. These professionals will be able to do a risk assessment and advise accordingly in terms of treatment and a psychotherapy plan to assist, support, and guide the person towards coping more effectively with life challenges.

Concluding

COVID-19 is the most recent global health challenge that has placed pressure on health facilities. Most notably, developing economies seem to have been under greater response pressure in managing the pandemic. Some evidence suggests that a short-term decrease in suicide rates following the immediate aftermath of the pandemic onset was noticeable. Disaster events seem to trigger what is called the ‘pulling together effect’, leading to an environment filled with social concerns, cohesiveness – including the presence of social and emotional support – which are also needs that buffer the effects of suicide behaviour (Gordon et al., 2011; Wilkinson & Pickett, 2020; Zortea et al., 2020). Unfortunately, as the levels of hope in managing the pandemic have become more palpable, the ‘pulling together effect’ tends to decrease in effect. As the presence of the pandemic extended over time, the measurable risk of depression and suicide screening numbers steadily increased, especially in females (Mayne et al., 2021).

Suicide has been a public health challenge for many centuries, and we have learnt a great deal about the personal, social, and interactional dynamics related to suicide behaviour. As mentioned earlier, effective management warrants responses from all levels of society, and South Africa is currently in urgent need of a national suicide prevention strategy policy. Unfortunately, the existing National Mental Health Policy Framework and Strategy Plan lacks detailed content and is not suicide prevention specific. According to the WHO (2021), the most effective response to suicide requires every nation to implement a comprehensive and multi-sectoral strategy approach plan. 

 

News Archive

Media: ANC can learn a lesson from Moshoeshoe
2006-05-20


27/05/2006 20:32 - (SA) 
ANC can learn a lesson from Moshoeshoe
ON 2004, the University of the Free State turned 100 years old. As part of its centenary celebrations, the idea of the Moshoeshoe Memorial Lecture was mooted as part of another idea: to promote the study of the meaning of Moshoeshoe.

This lecture comes at a critical point in South Africa's still-new democracy. There are indications that the value of public engagement that Moshoeshoe prized highly through his lipitso [community gatherings], and now also a prized feature in our democracy, may be under serious threat. It is for this reason that I would like to dedicate this lecture to all those in our country and elsewhere who daily or weekly, or however frequently, have had the courage to express their considered opinions on pressing matters facing our society. They may be columnists, editors, commentators, artists of all kinds, academics and writers of letters to the editor, non-violent protesters with their placards and cartoonists who put a mirror in front of our eyes.

There is a remarkable story of how Moshoeshoe dealt with Mzilikazi, the aggressor who attacked Thaba Bosiu and failed. So when Mzilikazi retreated from Thaba Bosiu with a bruised ego after failing to take over the mountain, Moshoeshoe, in an unexpected turn of events, sent him cattle to return home bruised but grateful for the generosity of a victorious target of his aggression. At least he would not starve along the way. It was a devastating act of magnanimity which signalled a phenomenal role change.

"If only you had asked," Moshoeshoe seemed to be saying, "I could have given you some cattle. Have them anyway."

It was impossible for Mzilikazi not to have felt ashamed. At the same time, he could still present himself to his people as one who was so feared that even in defeat he was given cattle. At any rate, he never returned.

I look at our situation in South Africa and find that the wisdom of Moshoeshoe's method produced one of the defining moments that led to South Africa's momentous transition to democracy. Part of Nelson Mandela's legacy is precisely this: what I have called counter-intuitive leadership and the immense possibilities it offers for re-imagining whole societies.

A number of events in the past 12 months have made me wonder whether we are faced with a new situation that may have arisen. An increasing number of highly intelligent, sensitive and highly committed South Africans across the class, racial and cultural spectrum confess to feeling uncertain and vulnerable as never before since 1994. When indomitable optimists confess to having a sense of things unhinging, the misery of anxiety spreads. It must have something to do with an accumulation of events that convey the sense of impending implosion. It is the sense that events are spiralling out of control and no one among the leadership of the country seems to have a handle on things.

I should mention the one event that has dominated the national scene continuously for many months now. It is, of course, the trying events around the recent trial and acquittal of Jacob Zuma. The aftermath continues to dominate the news and public discourse. What, really, have we learnt or are learning from it all? It is probably too early to tell. Yet the drama seems far from over, promising to keep us all without relief, and in a state of anguish. It seems poised to reveal more faultlines in our national life than answers and solutions.

We need a mechanism that will affirm the different positions of the contestants validating their honesty in a way that will give the public confidence that real solutions are possible. It is this kind of openness, which never comes easily, that leads to breakthrough solutions, of the kind Moshoeshoe's wisdom symbolises.

Who will take this courageous step? What is clear is that a complex democracy like South Africa's cannot survive a single authority. Only multiple authorities within a constitutional framework have a real chance. I want to press this matter further.

Could it be that part of the problem is that we are unable to deal with the notion of "opposition". We are horrified that any of us could become "the opposition". In reality, it is time we began to anticipate the arrival of a moment when there was no longer a single [overwhelmingly] dominant political force as is currently the case. Such is the course of change. The measure of the maturity of the current political environment will be in how it can create conditions that anticipate that moment rather than ones that seek to prevent it. This is the formidable challenge of a popular post-apartheid political movement.

Can it conceptually anticipate a future when it is no longer overwhelmingly in control, in the form in which it currently is and resist, counter-intuitively, the temptation to prevent such an eventuality? Successfully resisting such an option would enable its current vision and its ultimate legacy to our country to manifest itself in different articulations of itself, which then contend for social influence.

In this way, the vision never really dies, it simply evolves into higher, more complex forms of itself. If the resulting versions are what is called "the opposition" that should not be such a bad thing - unless we want to invent another name for it. The image of flying ants going off to start other similar settlements is not so inappropriate.

I do not wish to suggest that the nuptial flights of the alliance partners are about to occur: only that it is a mark of leadership foresight to anticipate them conceptually. Any political movement that has visions of itself as a perpetual entity should look at the compelling evidence of history. Few have survived those defining moments when they should have been more elastic, and that because they were not, did not live to see the next day.

I believe we may have reached a moment not fundamentally different from the sobering, yet uplifting and vision-making, nation-building realities that led to Kempton Park in the early 1990s. The difference between then and now is that the black majority is not facing white compatriots across the negotiating table. Rather, it is facing itself: perhaps really for the first time since 1994. It is not a time for repeating old platitudes. Could we apply to ourselves the same degree of inventiveness and rigorous negotiation we displayed up to the adoption or our Constitution?

Morena Moshoeshoe faced similarly formative challenges. He seems to have been a great listener. No problem was too insignificant that it could not be addressed. He seems to have networked actively across the spectrum of society. He seems to have kept a close eye on the world beyond Lesotho, forming strong friendships and alliances, weighing his options constantly. He seems to have had patience and forbearance. He had tons of data before him before he could propose the unexpected. He tells us across the years that moments of renewal demand no less.

  • This is an editied version of the inaugural Moshoeshoe Memorial Lecture presented by Univeristy of Cape Town vice-chancellor Professor Ndebele at the University of the Free State on Thursday. Perspectives on Leadership Challenges In South Africa

 

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