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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

Kovsie student and reigning Miss Lesotho en route to Miss World 2015

2015-11-03

Relebohile Kobeli - the beauty queen of Lesotho

Relebohile Kobeli was crowned Miss Lesotho 2015 earlier this year, and is now en route to Miss World International 2015 in China to represent the mountainous Kingdom. The beauty pageant, which takes place between November and December, will see contestants from over 150 countries contending for the title.

The nineteen-year-old second-year Geography and Environmental Management student at the University of the Free State (UFS) also won Miss Lesotho in 2014. She holds other titles, such as Miss Outeniqua 2014, and First Princess Face of Lesotho 2013.

What would it mean to be the first from Lesotho to sit on the Miss World throne?

I believe that it would be a turning point for pageantry in Lesotho. We are one of the few countries that do not fully recognise pageants, and the value they add to the tourism industry. Winning the throne would be putting into practice the theory that we, as beauty queens in Lesotho, always practice what we preach.

Since beginning this Miss World contest, in what way have you reached out to your community through the Beauty with a Purpose project?

My Beauty with a Purpose project focuses mainly on introducing and helping start up sustainable projects in communities. I wanted to move away from giving people donations to giving them the skills to ensure their long-term livelihood.

What skill sets do you possess that are essential to succeeding as an international first queen?

I am a very creative individual who thinks on her feet. That is important for me because, when you are far away from home, should things go wrong, there's no room for panic. I am sociable and human-centered, I relate to different people, regardless of cultural differences, and, as an international queen, it is important to be appreciative of others’ way of life, regardless of how different it is are from your own.

Rolene Strauss, the current Miss World, stated her ambition to capitalise on promoting forgiveness, hope, and unity during her tenure. What are you hoping to achieve, given the chance as her successor?

I would definitely speak about self-reliance among young women and the youth at large. I come from a country where not everyone is lucky enough to get a job. In such cases, young men and women fall into crime, young women become victims of sexual abuse or prostitution, and, although one may argue that that is self-reliance, is it sustainable? Is it not escaping one fire to jump into another? It is important for me to represent every girl who has ever had a dream. I am spreading the message of possibilities when the world is yelling "Impossible!"

What has been the highlight of your term as Miss Lesotho?

My greatest highlight was finding myself through service to others. I discovered that the more I invest in myself, the more of me I can give and share.

The Miss Lesotho 2016 competition is around the corner, what words of wisdom would you like to share with hopefuls?

Pageantry is not all about pretty dresses and tiaras. It is hard work. Always be humble, and remember that, whatever the outcome, it is your life's journey. You are destined for greatness. Don't deny yourself that privilege.

In your experience, what is the Kovsie feeling referred to in the maxim “Only a Kovsie knows the feeling”?

It is the desire to want to be great, the motivation to live to my full potential.

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