Suicide, preventable tragedy

Welcome to this week’s “Mental Health Chat Room”, this is a chat room where we discuss the basics of our mental health in order to understand and have a full grasp of the rudiments of mental health and mental well-being.

This is an essential component of our mental health advocacy activities aimed at promoting our wholesome wellness, prevent mental illness, improve our awareness of mental illness, understand that effective, qualitative and modern (technology based) mental health care services are available in Nigeria and globally to enhance quality living, harmonious interpersonal relationships and peaceful coexistence within our communities.

A recap of our last conversation where we discussed the continuum of “frustrations, sadism, religion and our collective Mental Health”. Considering the present situation of our country; do we need statistics to convince us that majority of Nigerians are not enjoying optimum mental wellbeing?

We now understand that in-between the continuum of mental ill health and mental well being, we do have the “in-betweens”, such “in-betweens” are referred to as mental distress and most times are manifested by the signs and symptoms of frustrations, sadism and over religiosity (extremism)!

Today, most Nigerians are oscillating within this confinement (between being well and being sick)!! It is quite imperative that we examine our society and the social determinants of mental ill health with the aim of addressing the social vices that will result in the monumental mental distress in which we found ourselves.

Essentially, the rampant killing of each other in Nigeria today is far beyond what we can blame on religion, the situation is challenging the sum total of our collective mental well-being as a society! Collectively, we may not be wholesomely sick, but we are yet to attain collective optimum mental well-being. As contained in the “Lord of the flies”, we may end up with; one by one we kill ourselves!!

We are all aware of the increasing spate of attempted and complete suicides in our communities; I believe every suicide is a preventable tragedy! Depression is known to be the most common cause of suicide worldwide and this is the reason we chose to discuss depression and suicide today.

I will like to illustrate today’s conversation with the story of Mike (hypothetical).

Mike is a 35years old bank officer, he was recently promoted to the rank of General Manager (GM) of the Bank and the future appeared to be bright for him, he had all that it takes to become the Chief Executive of the Bank in the nearest future. 

Mike is the third among five children of his parents, his Father is a successful businessman who sits on the board of two commercial banks, an insurance company and a manufacturing firm. His Mother is a successful lawyer (Senior Advocate of Nigeria)!

Mike graduated from one of the topmost Universities in Nigeria with second-class upper division in Economics at 20 years of age, he proceeded to Harvard Business School and earned Masters in Business Administration (MBA) at 23 years of age. He joined the bank and rose to the position of GM within 12 years. He got married to his lovely wife at the age of 28 years and both are blessed with three beautiful children.

Since leaving university, Mike has been known to be the busy type, he had few friends but focused on his work. At the age of 25 years, Mike realized he often doesn’t feel comfortable among his friends; he was losing the sense of companionship when spending time with them.

He often gets lost in his thoughts when hanging out with friends, with his mind wondering randomly and sometimes feels strange.

He most often blame this on his schedules and believes that as he moves up the ladder at work, life will be less restrictive and he will enjoy more leisure, he was looking up to the time!

Mike sometimes complaint to his sister how dull life has become, she comforts and reassures him while encouraging him to get married.

 Mike met his wife through his sister and they were married within one year after they met. The wedding was a society wedding, everyone was happy, his parents were pleased and his siblings were not only proud of his choice but were very supportive.

Everything was seemingly going on well for Mike, a young man that any young man would like to be!! However, inwardly Mike was not the happiest man though this inner feeling doesn’t manifest outwardly.

He often feels quite unhappy but cannot understand why, he gradually and progressively was experiencing difficulty in bringing to his thoughts happy and exciting memories, rather he was most times preoccupied with unhappy events that happened earlier in his life; like the death (suspected suicide) of his paternal uncle who was alcoholic, he drove his car across a speeding train.

Six months after wedding, Mike’s wife (Mrs. Mike) observed that her husband often gets moody, complaints of sadness that was difficult for him to explain and the mood change became progressively pervasive. This mood change was often accompanied by feeling tired or exhausted most of the times, with loss of interest in pleasurable activities including interest in her looks (doesn’t appreciate her appearance any more), she also observed that he lacked of sexual drive and was easily fatigued; he often complained of poor appetite and lacked of refreshing sleep.

Progressively, she observed that he lost interest in his dressings and appearance, he complained to her about his work and confided in her that he wanted to resign his work.

Five years into their marriage which coincided with one year after the birth of their second baby, Mike’s complaints to his wife became more intense, especially the preoccupation to resign from his job, in addition he complaint of feeling hopeless and sense of despair.

One day he expressed the belief of bleak future, which shocked Mrs. Mike. She decided to confide in his parents, after consultations they decided to seek help of the Church as his condition was considered to be a spiritual attack. Special prayer sessions were organized with periods of fasting to free him from the spiritual attack.

After several sessions, he felt much better and happier; his interest in work was better and he was no longer contemplating resigning, everyone was happy!

Eighteen months later, the feeling of distress returned and this time with discomforting preoccupation with thoughts of getting fed up with life and death, his parents and siblings couldn’t understand why he could be experiencing such emotional turmoil despite that he lacked nothing.

He couldn’t think straight and was exploring ways of how to end the “disabling distress”, he had the intense urge to escape from his painful predicament.

He became apologetic to his wife and his sister, telling his wife that he has saddled her with responsibility of bringing up their children. He pleaded with his sister to apologize to their parents for not living up to their expectations.

Four weeks ago, the wife returned from work and found a suicide note on the dining table and his corpse hanging from the ceiling!

Depression is a mental health disorder characterized by persistently sad/depressed mood or loss of interest in pleasurable activities (including work) or loss of energy or a combination of any of these symptoms, causing significant impairment in daily life.

Depression is a common mental disorder affecting more than 264 million people worldwide and about eight million (4 per cent) Nigerians (Female 5 per cent:Male 3.6 per cent) and suicide is a dreaded complication of depression.

Possible causes include a complex interaction between biological, psychological and social factors (sources of distress). Increasingly, research suggests that these factors may lead to alteration in some chemicals (neurotransmitters) in the brain that can cause changes in brain function, including altered activity of certain neural circuits in the brain.

The persistent feeling of sadness or loss of interest that characterizes major depression can lead to a range of behavioral and physical symptoms.

These may include changes in sleep, appetite, energy level, sexual drive, concentration, self-confidence or self-esteem. Depression can also be associated with thoughts or planning of suicide. Depression is a leading cause of disability around the world and contributes greatly to the global burden of disease.

The effects of depression can be long-lasting or recurrent and can dramatically affect a person’s ability to function and live a rewarding life.

Effective treatment for depression is available at the hospitals and in some states even at primary health care facilities including private clinics in Nigeria and, the mainstay of treatment is usually medication, talks therapy (psychological/psychotherapy), lifestyle adjustment (social) or a combination of the three (the combination has been shown to be more effective than using only one of them).

Increasingly, research suggests that these treatments may normalize brain changes associated with depression and lead to recovery.

Access to effective treatment in this part of the world is significantly limited by lack of awareness, misconceptions, stigma and trivialization of depression and suicide. I want to stress that suicide is always a tragedy that can be prevented if we take the right decisions at the right time!

I hope today’s conversation will add value to your understanding of depression and suicide.

Depression can have a profound effect on all aspects of our lives, including performance at school, productivity at work, relationships with family and friends, and ability to participate in the community.

Reader’s comments

When is substance use a problem?

Dear Prof,

I am a man of 32, and married with two children. My wife is also 32 and a full time housewife. We are happily married but I have a problem of being an alcoholic.

I drink too much alcohol sometimes to the extent that I pass out and have to be carried home.

I have tried everything that I can to stop, but I am notmaking any progress.

Is this in any way related to mental illness? what are the things that can cause one to be come addicted to substances like alcohol and other drugs, and why do people use addictive substances for whatever  reason. When is substance use a problem and where can I go for help?

What measures can be  beneficial for me and what can I do to make changes?

George, Lagos

How can I pay for mental healthcare for my family?

Dear Prof,

Are mental health services provided through the government health system, like services you receive through your local health centre or at a hospital? can it be covered by health Insurance?

For services that aren’t covered by insurance, how much would I need to pay for procedures such as psychotherapy or counselling with a private practitioner if I have to cover the costs for myself and family.

Bode T, Port Harcourt

I received wrong diagnosis, what can I do?

Dear Prot

I recently received a diagnosis for depression, but I don’t think it’s right. What can I do? Can I bring up my  concerns with the professional who provided the diagnosis or write to the health facility?

If these do not resolve the situation or a follow-up appointment isn’t possible, can I ask for a second opinion. A second opinion  from a different professional. Will this give  me better understanding of what’s going on and what to do about it an perhaps get a referral?