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Death by suicide: the final symptom of mental illness

09 September 2022 | Story Angela Vorster | Photo Andrè Damons

Angie Vorster — Angela Vorster is a Clinical Psychologist at the School for Clinical Medicine, University of the Free State (UFS).

Opinion article by Angela Vorster, Clinical Psychologist at the School for Clinical Medicine, University of the Free State.

Twenty-three people will die from suicide today in South Africa. Another 460 South Africans will try to end their lives today. They are from different cultural groups, different income groups, attained different levels of education, speak different languages, range in age from childhood through to elderly, have different genders and sexual orientations. These people have very little in common except that their lives all ended due to the final symptom of an illness. People who experience thoughts of ending their lives describe this mental space as feeling grey. Their thoughts tend to keep returning to the futility of being alive, what a burden they are to those around them, how nothing will ever get better and that nobody can help them. They tend to experience feelings of worthlessness, self-hatred, guilt, hopelessness, immense sadness and despair. Their suffering and emotional pain are excruciating. Nothing is enjoyable anymore. There is nothing to look forward to. Everything is difficult, boring, scary or meaningless. Inwardly they are drowning. But very often they smile, do their job and pass their exams, go on dates and vacations, make plans for the weekend and check up on their loved ones. They look happy in their photos. And when someone asks them if they are okay they say yes. Because they don’t feel like they deserve to feel better. They don’t want to be a bother. They might not call a helpline or make an appointment to see a psychologist or go to their GP for anti-depressants. Because they just don’t have the energy. It’s exhausting pretending to be fine all day. The one thought that brings relief is that they can end this pain. And one day they do. And their colleagues, friends and family are left reeling with shock and disbelief. How could this have happened? How could they have missed the signs? What should they have done differently to prevent this?

The causes are as complex and varied

This is the purpose of World Suicide Prevention Day which takes place internationally each year on 10 September and through which the International Association for Suicide Prevention endeavours to increase awareness of suicidality, as well as to fight the stigma associated with suicide. Wanting to die can occur along with many other symptoms and disorders including, but not limited to, depression, post-traumatic stress disorder, bipolar disorder, psychotic disorders, personality disorders and substance dependence or abuse disorders. The causes are as complex and varied as the manner in which suicidality may present. It is dangerous to regard only certain signs and symptoms as indicative of suicide risk, because we know that suicide can be extremely unpredictable. There is no way to tell if someone is a suicide risk based purely on their behaviour. However there are certain factors which may indicate an increased risk for self-harm. These include, but are not limited to, having previously tried to end their life, having a psychiatric illness, being seriously ill or having chronic pain or the misuse of substances. Experiencing legal, relationship, financial or academic stressors may increase suicide risk, as well as having access to lethal means to end their life along with being unable to access mental health care.

So what can you do if you think someone may be at risk of self-harm? Say something. Talk to them. Tell them what you are worried about and give them the space to express how they feel without judgment or condemnation. Reach out to their support system and share your concerns with them. Encourage the suicidal person to make contact with a health care professional – this can be a psychologist, GP, psychiatrist, social worker, psychiatric nurse, counsellor or a suicide prevention help line. Other important members of our community who provide a great deal of assistance to suicidal people and their families include religious and spiritual leaders, teachers, support groups and employee assistance programmes. There are actually so many ways and places to receive health care and support; however the most significant barrier to making use of these resources is sustained by the stigma associated with suicide and mental illness. In our culture of toxic positivity where our photos are touched up, our statuses updated and our successes plastered on various social media platforms, the authentic act of acknowledging when we feel defeated, unhappy or like a failure has become a rarity. The more real, honest and vulnerable we can be about our ‘undesirable’ emotions and experiences, the more space we create for those around us to do the same. When we normalise not being okay at all times, we give ourselves and others permission to speak up when we need help. And this is our greatest weapon against suicide – authentic connection.

What suicide is not

We’ve explored what it may feel like to be suicidal, now let’s focus on what suicide is not. Suicide is not a moral failing. It is not because the person was weak or selfish, it is not because their family was dysfunctional or their faith not strong enough. Suicide is the final symptom of mental illness – and every single person is vulnerable to experiencing suicidal thoughts. Each one of us will be affected by suicide during the duration of our lives, either directly or indirectly. This is irrespective of how successful you are, how supportive your family is or how strong your religious convictions are. Dying by suicide is not a shame. It is not a failure. It is no different to a patient dying from any other disease. And just like any other illness there are symptoms we can look out for and treatments and medications that can assist in recovery.

Please think before you speak about someone who died due to suicide. I guarantee that at least one person in the conversation has suffered the pain of losing someone in this way. But you probably wouldn’t even know, because stigma silences. Stigma disconnects and alienates those who need support the most. Our words have the power to shame and silence, or to empower and encourage connection, which is lifesaving. Treat each conversation as though there may be someone present who is having suicidal thoughts or is working through the loss of someone they love due to suicide. Often we want to reach out and support families affected by suicide, but don’t because we are afraid of offending, or upsetting or because we ourselves are so uncomfortable with mental illness. But all these survivors of suicide need from you is your calm, empathetic, kind presence, a safe space to express difficult and messy emotions. Without being blamed or shunned or shamed. Support suicide survivors as though a terrible illness took the life of their loved-one. Because that is exactly what happened.

On 10 September this year I encourage you to light a candle and place it in your windowsill around 8pm wherever you are. This is in remembrance of those lost to mental illness and to show your support to those they left behind. In the words of the International Association of Suicide Prevention: “By encouraging understanding, reaching in and sharing experiences, we want to give people the confidence to take action. To prevent suicide requires us to become a beacon of light to those in pain. You can be the light.”

• If you or someone you know is at risk of self-harm please take a look at these websites and call the SADAG suicide emergency helpline.

International Association for Suicide Prevention

South African Depression and Anxiety Group

SADAG suicide emergency helpline 0800 567 567

News Archive

Resource Manual on Trafficking in Persons for Judicial Officers sees the light

2012-03-27

Judge Connie Mocumi, President of the South African Chapter of the International Association of Women Judges (SAC-IAWJ), during the launch of the Resource Manual on Trafficking in Persons for Judicial Officers.
Photo: Leonie Bolleurs
27 March 2012

On Human Rights Day the Department of Criminal and Medical Law in the Faculty of Law at the University of the Free State (UFS) hosted the launch of the Resource Manual on Trafficking in Persons for Judicial Officers compiled by the South African Chapter of the International Association of Women Judges (SAC-IAWJ).

The manual, which will be used by members of the South African judiciary, will equip officials in adjudicating the multifaceted crime of human trafficking.

“Presiding officers must be sensitised about the complexity of the crime. Human trafficking has many faces and presents itself in different ways. A person may for example be trafficked for sexual exploitation, forced labour, the removal of body parts, as well as forced marriages. Expert knowledge is needed to handle these cases effectively in court,” said Dr Kruger, also responsible for the human trafficking initiative in the Unit for Children's Rights at the UFS.

Prior to the launch, a total number of 300 judicial officers, including six judges from the Southern African Development Community (SADC) received training on human trafficking. After receiving this training, the officers were sensitised to scrutinise domestic violence cases as well as inter-country adoption cases in order to identify possible human trafficking activities.

As keynote speaker at the launch, Dr Beatri Kruger from the Department of Criminal and Medical Law at the UFS, said that human traffickers were running operations like a well-oiled machine. They have abundant and sophisticated resources and often bribe corrupt officials to further their criminal activities. In South Africa, people combating human trafficking struggle with a lack of resources as well as comprehensive legislation. Most cases are prosecuted under the Children’s Act and the Sexual Offences Amendment Act of 2007. Unfortunately, this legislation still leaves a gap in the prosecuting of perpetrators. Only trafficking cases where where children are trafficked can be prosecuted under the Children’s Act. In terms of the Sexual Offences Amendment Act perpetrators can be prosecuted for trafficking persons for sexual exploitation only, and not for labour of other forms of trafficking. Therefore the comprehensive Prevention and Combating of Trafficking in Persons Bill 2010 needs to be finalised to cover all forms of trafficking.

There are more slaves today than at any time in the history of humankind. “To combat this serious problem, we need to follow a holistic approach,” said Dr Kruger. This includes prevention (raising awareness), effective prosecution and suitable punishment, the protection of victims, and partnering with all relevant stakeholders, including people in the communities. Community members are often whistle blowers of this crime.

The President of the SAC-IAWJ, Judge Connie Mocumi, handed copies of the manual, a three-year project, to judicial officers present at the launch. The manual covers, among others, the definition of trafficking in persons, trafficking in persons in South Africa and the Southern African region, a legislative framework, victims’ rights and criminal proceedings.

“It is critical that judicial officers appreciate the phenomenon of trafficking in persons in its broader socio-economic context. Therein lays the ability to deal competently with the often-nuanced manifestation of this scourge. The incapacity to recognise these nuances can deny victims access to justice. In that regard, the manual, amongst others, is to become an important empowering adjudication tool for judicial officers,” said Judge Mocumi.

More copies will be printed and be ready for distribution by the beginning of May this year.

Judge Belinda van Heerden, who also attended the launch, said: “There is progress on the judicial and legislative front to bring wrongdoers to book. This manual will go a long way in giving judicial officers insight into the problem.”

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