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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

Shack study holds research and social upliftment opportunities

2015-02-10

Photo: Stephen Collett

When Prof Basie Verster, retired head of the Department of Quantity Surveying at the University of the Free State (UFS), initiated an alternative form of housing for Johannes - one of his employees - a decision was made to base research on this initiative. This research project in Grasslands, Heidedal focused on the cost and energy efficiency of green and/or sustainable shacks.

Esti Jacobs from the Department of Quantity Surveying, together with an honours student in Quantity Surveying, a master’s student in Architecture, and young professionals at Verster Berry, helped with the project.

The physical goals of the project were to create a structure that is environmentally friendly, and maintains a comfortable interior climate in winter and summer, as well as being cost-effective to erect. The structure also had to be socially acceptable to the family and the community.

“The intention was to make a positive contribution to the community and to initiate social upliftment through this project. Structures such as the ‘green shack’ may serve as an intermediate step to future housing possibilities, since these structures are relatively primitive, but have economic value and could be marketable,” she said.

Esti explains the structure of the building, which consists of gum poles and South African pine bearers, with a timber roof and internal cement block flooring. The building is clad with corrugated iron and has a corrugated iron roof finish. Additional green elements added to the structure were internal Nutec cladding, glasswool insulation in walls, internal gypsum ceiling boards with ‘Think Pink’ insulation, internal dividing wall and door, polystyrene in the floors, and tint on the windows. A small solar panel for limited electricity use (one or two lights and electricity to charge a cellphone) and a Jojo water tank for household consumption by the inhabitants were also installed.

Esti said: “Phase one of the research has been completed. This phase consisted of an investigation into the cost of an alternative form of housing structure (comparing traditional shacks with the planned structure) as well as the construction process of the physical housing structure.

“Phase two of the research, commencing in February 2015, will last for two to three years. This phase will include the installation of temperature and relative humidity logging devices inside the existing traditional shack and the new green shack. The logs will be regularly monitored by the UFS Department of Quantity Surveying and Construction Management.

These data will enable the researchers to measure the differences in comfort levels inside the two different structures. The data, together with other information such as building materials and methods, are then processed by software programs. Through the simulation of different environments, building materials, and alternate forms of energy, software models can be used to come up with conclusions regarding more energy-friendly building materials and methods. This knowledge can be used to improve comfort levels within smaller, low-cost housing units.

The UFS will be working with Prof Jeff Ramsdell of the Appalachian State University in the USA and his team on the second phase of the project.

“This research project is ongoing and will be completed only in a few years’ time,” said Esti.

The results of the research will be published in accredited journals or at international conferences.

For more information or enquiries contact news@ufs.ac.za.

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