Monday 10 August 2015

Discussion on high suicide rate in Swaziland


Swaziland has a very high suicide rate. According to statistics released by the Royal Swaziland Police, 160 people committed suicide from January 2014 to January 2015. Of these, 126 were men. One hundred and sixty people in 12 months effectively mean about 13 people commit suicide in a month, and that’s a staggering figure. One of my friends, a beautiful woman called Siphelele Mngomezulu, is a Psychotherapist. I had wide-ranging discussion with her regarding why Swazis commit suicide at such an extensive scale, whether they are receptive to counselling and what can be done to curb this scourge, among other things. She’s a woman of many words, but an absolute pleasure to listen to. Please note that she spoke in her personal capacity, not on behalf of the organisation she works for. This is what she said:  

The high suicide rate in Swaziland is mainly cause by socio-economic issues, broken families, and lack of support in the family, but mainly it’s a result of financial meltdowns. People are not coping with finances, and then they commit suicide. Suicides also have a lot to do with relationship breakdown. You find that when women commit suicide, usually their husbands have cheated or left, and there’s no more money for school fees and other expenses.
HIV is also a major factor leading to depression which in turn leads to suicide. People are struggling to accept suicide as just a chronic ailment that you can live with. Right now our system is such that we initiate counseling for everyone that comes to the hospital. On arrival you are told to test. If as health workers we say, “We want to know your status before we treat you,” we are practically saying test or you won’t be treated. It doesn’t necessarily translate to readiness for testing for the patients. The comebacks are terrible. We get a lot of psychosis; people are failing to accept because they were not ready in the first place, mental meltdowns.  People will think, I went to the hospital with stomach problem and I came back HIV positive, how do I even begin to tell my husband. Doctors are increasingly resistant to treating people whose status they don’t know because they don’t want to treat the symptoms and instead of the source.
HIV is donor-funded. First they came with “voluntary counseling”, now we have provider-initiated HIV counseling. How do you say no to someone you need services from? When someone declines to get tested, ideally we should say it’s OK, but now the doctor will start explaining to you why it’s important for you to test and will demand the HIV results. So ready or not, the patient has to test. We cater for low to medium earning people who can’t afford to walk away from our institutions where very little is charged, R20 for consultation and treatment. Some, however, will accept that the test was a push in the right direction because they will get the right treatment and engage in more responsible behaviour.
It goes back to cope under difficult or new situations.
Rarely, you also get suicide when there’s abuse in the family, for instance children that are being abused by parents or teachers. Women in relationship ages like 17 – 40 have a lot of problems with their husbands and they feel they have to die as a result of those problems. Very few women commit suicide for financial reasons. They sometimes come for counseling because of stress and headaches, but seldom want to kill themselves for that. The majority of suicides are over relationships that break down, and most of them breakdown because there’s no money and they are not coping with the pressure. So the reasons are interlinked, somehow. They all have an effect on the other.
For men it’s usually because of financial pressures. They’ll think, “This woman cheated on me because I don’t have a job, I have so many debts and am not meeting family expectations.” I have also noticed there is a trend, there’s a season for a reason. In January we get a lot of attempted suicides because of school fees issues, finances are bad after the festive season. At some point in March you get a lot of school-leavers that have not done well in matric and then attempt suicides. Of course relationship-related suicides are all year round. But I find in the majority of cases, it’s a cry for attention more than a genuine wish to die, or fear of how will I be received having failed, more than wanting to die. If I’ve cheated and my husband has caught on, I’ll attempt suicide and go and lie on a bed somewhere while a social worker harmonises the situation, whereas if I had just gone home, the husband would have probably just picked up a sjambok, run after me and tell me to pack my bags and go. So I’m going to pretend I want to die. This is also evident in the types of methods people use to try and commit suicide. They’ll take Blue Death, for crying out loud it doesn’t even kill ants, how is it going to kill you, a whole human being? They’ll take an OD of a few Panados. Those who really want to die go for the weevil tablet, try to hang themselves, take very strong pesticides. Those who use the very small things, I always think they don’t really want to die.
Siphelele Mngomezulu: Psychotherapist
During counseling sessions, they want to call in the husband and harmonise the situation. They are not content with just being counseled and changing their mindset. The women are determined, “No! I want to come here, then you’re going to call my husband and make it a big issue and sit us down. And you’re going to make us ok. That’s what I want!” They feel getting counseling and advice on how to make their lives better isn’t enough. The man will say, “I want my wife here. I want you to tell her to forgive me, to tell her that I tried to kill myself because I love her.”
In situations where the woman tries to commit suicide because the husband is having an extra marital affair, she just wants to hear him on the hot seat saying, “I’m sorry, I’ll repent, I’ll make things better, I love you.” But two weeks down the line she’s back again after another suicide attempt because the husband is still not back. Sho it’s like forcing someone to change. They won’t change. You need to change your mindset. You need to be the one that’s better equipped to deal with it, than try to kill yourself, that’s my theory. Why must I die when I’m not in the wrong? You cheat, I die? How does it work? Why can’t I just move and start again? Most of the time we have women saying, if I move I don’t have anywhere to go, I can’t afford rent, I’m not working…” – socio-economic  factors linking again to relationship breakdowns. Root cause was the meltdown. The person will be attached and will say, “You took me out of school, I don’t have a qualification, you made me your wife, I have four children with you now, where must I go, so I’d rather die.”
These are even better than boyfriend and girlfriend scenarios.  A lot of girls try to kill themselves because their boyfriends are with someone else. Sometimes it’s about school fees. I know a child who went to pay fees at the bank. On her way back she lost the deposit slip and was afraid of the parents hitting her. She kept quiet. At exam time she was told she couldn’t write as she hadn’t paid. They couldn’t trace the money from the bank. She attempted suicide because she couldn’t face telling her parents that you’ve paid fees for the whole year and I’m not going to write exams because I lost the deposit slip. She really didn’t want to die. She just wanted someone to go and break the news to her father and make her look like the victim.
We live in a society that glorifies suicides. Our media sells with negative reporting, for some reason. Headlines like “Woman and man found naked doing witchcraft” get all the attention, but if a group of women stands up and goes to the rural areas to donate blankets, no-one wants to cover them. Reporters don’t want to cover you for doing good. They want to cover you for bad. Suicide is glorified. Also, in society when someone commits suicide, we talk about it. It becomes such an issue. And if we talk over and over about, it makes an impression on immature mind.  Suicides are then mimicked. Sometimes our children just wants to be centre of attention for a while, they don’t really know what they’re doing or why they’re doing it. A child committed suicide at a primary school and it was widely spoken about at the school. During that period I got a lot of children from that same school attempting suicide. Do you even know what it feels like to die? No. did you really want to die? No. Do you know where you go when you die? No. In about 8 out of 10 cases of children attempting suicide, there is someone known to them who committed suicide.
People that commit suicide might lose interest in things that they previously liked, suffer from lack of sleep, tiredness, and isolate themselves from other people. Some will become tearful with constant crying and general depression. But when you dig into a person’s problem and find the common trends of people who wanted to die but didn’t die, they have this underlying depressing issue, like, “I’m failing to come to terms with the fact that my son is autistic.” That’s real, they really wanna die because you have this feeling of not being a perfect mom, there’s turmoil in your soul. But some people that commit suicide are people that you sit down with and chat, and find tomorrow they’ve committed suicide. It’s not real, it’s a cry for attention, you don’t really wanna die. It’s difficult to pick up signs from a person who is doing it to get attention, because usually the signs just aren’t there. They think, “I might not die, I don’t wanna die, so what can I take to make me almost dead but not dead.” That’s when you get your Panado overdose, who’s gonna die from Panado? And they make sure they do it when they know they will be found before they die, like around the time the husband comes home from work. People that really want to commit suicide will send people away, they’ll be found dead for hours. They will create an environment that is conducive for committing suicide.
These methods also help us to assess the realness of the urge to really wanna die, because we could be spending a lot of time on counseling for people who don’t really need it. They just want your intervention to harmonise the situation they are in.  We spend a lot of time on those that clearly really want to die. Those that shout, “I’ll kill myself, I’ll kill myself, stop me before I do!” usually don’t really want to die but it is important not to ignore them. They should still be helped with whatever is making them even want to talk about suicide before they try. If you ignore them, they’ll attempt to take their lives to get attention and they could actually die. Even though we think it’s a cry for attention, we still don’t take it lightly. It’s only called attempted suicide if you survive. If you succeed, it’s suicide! You’re gone and we’ll never have answers. We’re left with questions and thinking if only I’d listened, if only I’d helped when she said it. Suicide is like a mental block and the only solution that stands is suicide. Those that commit suicide or try to do so for attention don’t get that. They deliberately go at it. That is the difference between someone who is suicidal and one who does it for attention. Those that keep things to themselves are really dangerous. Those are the ones you wake up to find dead with a packet of weevil tablets by their side.
That person, who is suicidal in more cases than one, suffers from a mental illness like depression, schizophrenia, bipolar disorder, or Attention Deficit Disorder, and at some point their brain shuts down. There is a relationship between suicide and mental illness. Those that attempt suicide for attention don’t have that, and during psychotherapy you discover that you can’t treat it because it’s not there in the first place, they just want your intervention.
I believe we all are mentally ill to a certain extent. I always say it’s a thin line between sanity and insanity. From time to time we cross over to insanity and then we cross back to sanity, just that some people don’t have the opportunity to come back. When they go, they go for good. And if you allow emotions, feelings, depression,  and situations to lead you to insanity too many times too much, you don’t have an accepting spirit, you don’t talk about things, you’re not going out there to get help, chances of crossing and not coming back are very high. People with addictive behaviour cope with situations in different ways. Some drink alcohol, in turn they become alcoholics because they’ve allowed problems to push them to the other side and have not come back from time to time to check if they’re still OK. So yes, our brains do get to a point where we do things that we don’t understand, that we wouldn’t do under normal circumstances. We should be able to trace back and say, “This is where it came from, this is the source,” and you should be able to deal with the source, not the symptom. Like if it pushes you to club a lot, understand why you’re clubbing, what’s pushing you away from your home so much. Deal with the root cause because you can’t solve clubbing for as long as the problem at home is still there. Set standards for yourself and keep checking if what you are doing is still normal.
People have a lot of mental illnesses, lots and lots and lots that go unnoticed. I was telling people the other day that so many people are functioning normally yet not so normally. We put it down to them having an attitude problem or taking out their stress on others at work. It’s a mental challenge and the only way to curb it is to confront the source. As long as you don’t solve it, it will eventually surface as abnormal behaviour.
Counseling helps a lot but people only come when they are referred. It’s a guided conversation that helps you think out of the box, someone talks to you without judging you, and helps you look at your situation from a different angle. Unfortunately Swazis are not receptive to counseling. They believe in tibi tendlu – you don’t air your dirty linen in public. You keep it to yourself. If my wife is cheating, I can’t go and talk to someone about it, I’m going to be mocked. And they don’t believe in telling their problems to a stranger or to each other. It makes it worse that counseling is a new profession in the African context and it’s mainly practiced by younger people. If an old man walked in and found me in a chair, he’d say, “What can you tell me about life, what do you know?” At the moment people are almost being forced to come for counseling, “Your BP is uncontrollably high, go for counseling.” If you ask them to come back again in a week for another session, they never do.  Because of limited resources, our follow-up system is almost non-existent. If you’re lost to follow-up, you’re lost.
Counselling works best when it’s voluntary. To force something down someone’s throat doesn’t mean they will swallow. We still leave people to exercise the freedom of choice in that regard, so that we know whatever advice or guidance we give will be received, it will be used and it will help.
Life generally presents a new situation every day. How do you handle it? You can pick up a child’s coping abilities from an early age. When you say, “No you can’t have sweets,” does your child throw a tantrum, does he cry, does he accept it? Like when I was about to have my baby, my mother said you can’t go through labour, you have to get an elective C-section. You don’t deal well with pain, taking out a tooth is a mission, labour will make you lose your mind. Lack of knowledge makes us miss a whole lot in understanding those around us. You know when you hit your child, does he sulk for a week, do they feel inadequate? If they do, then you know when you say to that child, “Ngifuna ukukushaya wena (I want to hit you) when you come back from school,” they might go and not come back because they are afraid. You should find ways of punishing your child that will not push them over the edge. Sometimes we push people around us over the edge because we don’t take time to understand each other.
Sometimes people don’t know that the walls are caving in on them until it’s too late. Others around them also don’t realise it until it’s too late. We hardly do mental education in schools. We need to educate parents and teachers on being observant of their children. You know there are children who, when the teacher says, “Who was making noise, I going to give you all three strokes,” they could wet their pants in fear. That is genuine. You don’t just wet your pants. To say to a child like that, “Tomorrow, I’ll get you,” that child you have put in suspense for the whole day and night won’t sleep nor eat. If that child has heard of suicide or knows how to commit suicide, won’t they try it before the next day? People need to be taught how to look out for the signs and know how far you can go with whom. We take things lightly and want to push people, keep pushing people, for what?

Previously counselors were found at the psychiatric hospital, so people have not come to terms with that. People still associate counseling with mental illness which is still discriminated against in our communities. The Ministry of Education needs to have counselors in schools in order to nip the problem in the bud. 

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