The alarming rise of teenage suicides in Pakistan Zofeen Ebrahim 08 JUNE 2012 Yaqoob shot himself dead with

a pistol at his home after his father, Kaleem, scol ded him for not taking interest in his studies, reads a report on the National pa ges of todays newspaper. It goes on to add: Mr Kaleem told police that his son was unwilling to go to scho ol due to bullying by his class teacher. He said that he would also scold Mr Yaq oob whenever he resisted going to school. Frustrated with the harsh attitude of his father and teacher, Mr Yaqoob went home and shot himself dead with a pistol. Fourteen-year-old Yaqoob was the fifth such teenage student to take his life wit hin the span of two weeks. Teenage is the best of times and also the worst. It is the age of innocence mixe d with a little foolishness. On the threshold of a carefree childhood and a wise r adult life, the world is their oyster, when nothing seems impossible as they s trive to reach for the sky. So when one hears of five young teenagers committing suicide in such quick succe ssion, one cannot help but wonder what happened to a life of fun and frolic snuf fed so callously. Eighteen-year-old Khursheed studying at Islamabad Model College for Boys shot hi mself with his fathers pistol when his father scolded him for refusing to take an entry test; 17year-old Shan from Gharibabad swallowed poison after his parents a ttempted to stop him from spending time with friends and not concentrating on st udies; seventh-grader Abdul Mobin in Abbottabad who took his life because of tor ture at school and a 13-year-old student in Karachi hanged himself by the ceilin g fan after he failed in exams. Why would young people get so bored with life just as they enter its most exciti ng phase? If they dont have the right balance of opportunities, resources and hope, they can get bored and hopeless, explains Dr Murad Musa Khan, chairman of the Department of Psychiatry at Aga Khan University Hospital, Karachi. Perturbed by the recent suicides, Khan says there is every reason for concern be cause even one suicide is one too many. He sees lots of young people, some even as y oung as 12, who have attempted suicide because of academic pressures, relationshi p problems, identity problems, parental discord, use of drugs, bullying (includi ng cyber-bullying). In addition, there are many, he says, who suffer from low sel f-confidence and low self-esteem. However, Karachi-based clinical psychologist, Dr Asha Bedar, does not believe ch ild or teen suicide is a result of boredom. Its usually about either mental illnes s (e.g., depression) or emotional disturbance caused by circumstances. While many adults associate childhood/teenage with fun and a carefree outlook to wards life, Bedar points out: unfortunately, that is not the case for many childr en and young people around us. Like adults, she says, many children and young people suffer from mental illness , such as depression (often undiagnosed and therefore untreated in a country lik e Pakistan) and extreme emotional distress or disturbance caused by circumstance

s around them. During her practice, she sees many young people who have attempted but even more who have thought about suicide. Bedar emphasises that other than a mental illness, abuse has been one of the mos t common issues which many young people, who come to her, have suffered from. Thi s could be exposure to severe violence at home perhaps a home environment charac terised by tight parental control, terror and sadness. Or it could be ongoing ex posure to severe physical violence/bullying outside the home, sexual abuse (incl uding rape), cyber-bullying, blackmailing. The reasons why young people (aged anywhere 14 to 24), or even younger, commit o r attempt suicide, are multiple says Khan. Usually, however, a combination of lif e stresses and a vulnerable personality veering the person towards depression, wi th hopelessness as a predominant feeling, leads on to suicidal behaviour. According to the independent 2012 annual report of the Human Rights Commission o f Pakistan (HRCP), poverty and an uncertain future are turning teenage girls in Karachi to end their lives. Citing the National Poison Control Centre, at Jinnah Post Graduate Medical Centr e, in Karachi, HRCPs annual report for 2011, reported that there were 1,153 attem pted suicides across Pakistan and 2,131 suicides in 2011 with five or six teenag ers attempting suicide every day in Karachi. Of these, 60 per cent are teenage g irls and families are reluctant to register the case as attempted suicide. In 2002, the World Health Organization estimated that over 15,000 suicides were committed in Pakistan, but Khan estimates it to be probably about 5,000 to 7,000 suicides annually. In addition, he says, there are approximately 50,000 to 150,00 0 cases of attempted suicides. The majority of suicides and attempted suicides a re in people under the age of 30 years. Of these, he says, approximately 25 per cent of the cases would be in the teens. These figures are the best estimate one can ascertain from all the studies on su icide that are available, Khan tells Dawn.com. In almost all settings all over the world, including Pakistan, says Musa, more g irls than boys attempt suicide but more boys commit suicide than girls. Generally speaking girls are under more stress all over the world including Pakis tan and making a suicide attempt is a sign of extreme stress/distress, he says. But why are young people in Pakistan so troubled? Musa has no qualms about putting the blame squarely on the adults. Because the el ders have failed to provide the young with a safe and secure environment for the m to live and prosper under, he says, adding: Just drive around on a Sunday and se e the number of young boys playing cricket on the roads or dirty grounds. Why ca nt proper grounds and equipment be provided to these young men? He thinks the issu e of suicides is both a human rights one and a fundamental rights one. Dr Shifa Naeem, a Karachi-based psychiatrist, believes todays teenagers are expose d to many more stresses than their counterparts were a generation or two back. Expectations are higher from them, while support systems are weaker, she says expl aining the scenario by taking two imaginary profiles of a teenager from the 1960 s and one of today. The young teenager from the 1960s was spending some time of the day in physical e xercise (as it used to be mandatory); he or she would have good chances of havin g an involved and committed teacher whod also be a mentor. In addition, parents,

too, were spending more time with them and life was generally simpler. On the oth er hand, Naeem points out, the teenager of today is expected to excel in studies and studying at a school which the parents can feel proud of, should also look coo l and be popular with all the kids at school, should have more friends on Facebo ok than the rest, have a glamorous life-style (similar to the one he or she sees on the TV and which includes marijuana, cigarettes and alcohol). That is not all. A poor law-and-order situation and the helplessness and a sense of hopelessness prompted by injustices and might is right they all add up, she conc ludes. Bedar is of the view that while children are typically resilient and get over a di fficult period; professional help must be sought for mental illness. One isolated incident does not cause a child to contemplate or attempt suicide it is usually an ongoing chronic situation (for instance, abuse/violence at home o r at school, debilitating poverty, etc.), something that makes the child feel co mpletely helpless, fearful and trapped like there is no way out and no hope. One incident can, however, be a trigger, pushing a child/teenager over the edge, se rving as the final straw, she explains. The more worrisome factor is that while some get cured so to say, many attempt and re-attempt and eventually succeed in killing themselves. The chances of a person re-attempting increase greatly after one attempt as the p erson crosses a certain threshold and the fear of the attempt is decreased, says Khan, adding that he/she finds it easier to attempt it again. In many cases, the underlying psychological stressor is not addressed, though med ical treatment is given (stomach washout, antidotes, among others). Each suicide attempter, he says, must undergo a psychological evaluation and the underlying psychological problem must be addressed. Khan also emphasises that the way media reports the issue has a major impact on suicide attempts and suicide rates. If it is glamorised and portrayed in such a w ay that it sounds that suicide is an acceptable way of dealing with lifes problem s than it gives encouragement to other vulnerable people who may be in the same situation as the one who has committed suicide. Therefore, he adds, it is important for the media to also report that suicide is not the way to deal with lifes problems, that there are other healthy ways to de al with problems and to give names and contact details of where people in suicid al crisis situations can seek help. There is a 24-hour psychiatrist available at the AKUH for any emergency including suicidal emergency, he says. In addition, recently the Aman Telehealth has started a 24-hour telephone hotlin e where trained counsellors can help people in distress. The number is 111-113 7 37. Our counselling is both medical and psychological, says Jennifer Younas, working a t Aman Telehealth. Started just six months back the response has been tremendous . However, she says not many people know that they provide life-saving help for suicidal emergencies. You can say for every 100 general calls (including seeking counselling for chronic diseases like blood pressure, heart problems to psycholo gical disorders including schizophrenia, depression anxiety etc, we get two case s where help is sought for suicide, Younas points out. http://dawn.com/2012/06/08/the-alarming-rise-of-teenage-suicides-in-pakistan/ ------------