Dr Meenukrishna S
ABSTRACT
Suicide is a very serious public health concern. Globally close to 800000 people die by suicide every year; and it is second leading cause of death among aged 15- 29 years. The development of suicide risk is complex, involving contributions from biological, psychological, clinical, social and environmental factors. Prevention is a key to reduce the number of suicidal deaths and prevention efforts include universal, selective and indicated interventions. Homeopathy through its biopsycho-social framework can eradicate the suicidal thoughts and help the individual to evolve into a healthy and mentally stable person.
INTRODUCTION
Suicide is an emerging and serious public health issues all over the world, however it is preventable with evidence based and often low cost intervention. Worldwide the annual global age standardized suicide rate of 10.5 per population. Globally it is the second leading cause of death among aged 15- 20 years in adolescents and young adults, suicide rates are 2–4 times higher in males than in females, while suicide attempts are 3–9 times more common in females. 1
India has one of the highest suicide rates in the world, particularly in south India. The suicide mortality rate in India 100000 per population in 2016 is 16.5, while the global average is 10.5 per 100000 population, the most vulnerable are the 15-29 years old, elderly and persons with special needs.2
FACTORS AFFECTING SUICIDE RATES
SEX: suicide rates are 2–4 times higher in males than in females, a man makes completed suicide, but women make more attempts.
AGE: Suicide is more common among 15- 24years of age
MARITAL STATUS: Status of being unmarried, divorced, widowed, have high propensity for suicide.
HEALTH FACTORS-PSYCHAITRIC DISORDERS : Major Depressive Disorder (MDD), Bipolar Disorders, Anxiety Disorders, Alcohol And Substance Misuse, Schizophrenia, Eating Disorders, Personality Disorders, Different Types Of Trauma, Chronic Somatic Disorders.
PSYCHOLOGICAL FACTORS: Hopelessness is the one of the strongest predictors for suicidal behaviour. Aggression and impulsivity, lack of reasons for living, feeling of worthlessness and helplessness, an extremely negative self-image, poor problem solving capabilities
ENVIRONMENTAL FACTORS: stressful life events which may include a death , divorce, or loss job, prolonged stress, access to lethal means including firearms and drugs, exposure to another person’s suicide , isolation and lack of social support.
FAMILY FACTORS: it is estimated that in 50% of youth suicide cases, family factors are involved ,both fatal and non-fatal suicidal behaviours have been linked consistently to negative parent- child relationships ( e.g. high conflict , low closeness), child maltreatment , residing with less than two biological parent, and family history of affective and antisocial disorders. A family history of suicide attempts may also have an impact on suicide attempt
COMMON METHODS OF SUICIDE: Pesticide Poisoning, Hanging, Firearms, Drug Overdose, Fatal Injuries, Exsanguinations, Suffocation, Drowning.3, 4
LEGAL ISSUES: In India, attempted suicide is a punishable offence. Section 309 of the Indian Penal Code states that “whoever attempts to commit suicide and does any act towards the commission of such an offense shall be punished with simple imprisonment for a term which may extend to one year or with a fine or with both”.
However, the aim of the law to prevent suicide by legal methods has proved to be counter-productive. Emergency care to those who have attempted suicide is denied as many hospitals and practitioners hesitate to provide the needed treatment fearful of legal hassles. 5
10th September – World Suicide Prevention Day: The World Suicide Prevention Day was formally announced on 10thSeptember, 2003. Each year the International Association for Suicide Prevention (IASP) in collaboration with WHO uses this day to call attention to suicide as a leading cause of premature and preventable death.
MANAGEMENT
The psychiatric assessment identifies some of the problems that contributed to the attempt and helps the physician plan appropriate treatment. It consists of the following:
- Establishing rapport and listening to the patient’s narrative
- Understanding the suicide attempt, its background, the events preceding it, and the circumstances in which it occurred
- Enquiring about symptoms of mental disorders that are associated with suicide and any drugs the patient may be taking for treatment of the disorders.
- Fully assessing the patient’s mental state, with particular emphasis on identifying depression, anxiety, agitation, panic attacks, severe insomnia, other mental disorders, and alcohol or drug abuse (many of these problems require specific treatment in addition to crisis intervention).
- Thoroughly understanding personal and family relationships as well as social networks, which are often pertinent to the suicide attempt and follow-up treatment.
- Interviewing close family members and friends
PYSCHOSOCIAL TREATMENT: Family Therapy, Cognitive Behavioural Therapy, Problem Solving Therapy, Group Therapy and Medications.5
HOMEOPATHIC MANGEMENT
Homoeopathic medicines holistically treat the individuals also caring for the psychological aspect of the disease. Homeopathic medicine together with counselling can bring down the suicidal thoughts and ideation
- MIND: SUICIDAL DISPOSITION: Aeth.Alum.Anac.Ant-c. Ant-t.Ars.AUR-M.Bell.Calc.Caps.Chin.Cimic.Hep.Hyos.Ign.Iodof.Kali-br.Lac-d.Lach.Lyss.Merc.Merc-aur.Nat-m.NAT-S.Nux-v.Plb.PSOR.Puls.Sep.Spig.Stram.Zinc
- SUICIDAL disposition
- Axe, with an: naja
- Blood; at the sight of: abhors the idea; though she- Alum
- Courage, but lacks: CHIN. NUX.V.Sulp
- Despair from: Ruta.Sep.Spong.Tritic-vg.
- Drowning by: Arg-n.Aur.Bell.Dros.Hell.Hyos.Lach.Puls.Rhus-t.Sil.Ust.
- Love, from disappointed: Aur.Hyos
- Grief: from: Nat-s
- Hanging by: ARS.Bell.
- Pains from: AUR.Nux-v.Ruta.
- Perspiration, during: ARS.AUR.CALC.Hep.MERC.SPONG.Thuj.
- Shooting by: Ant-c.STAP
- Thoughts-meditates on easiest way of committing suicide- LAC-D
- Thoughts-restrains himself because of his duties to his family: NAT-S
- Throwing height, himself from a: Arg-n AUR.BELL.Lyss.Nux.v.Stram.6
AURUM MET: The central theme of Aurum is extreme depression and loathing of life which progress to suicidal thoughts and, finally, self-destruction. An extreme depression does not develop overnight, and not without earlier stages. They are better when thinking of suicide, feeling of freedom and cheerful when thinking of death. He plans his suicide in silence. He imagines he is not fitted for the world, he therefore longs for death, of which he thinks with the most intense delight. They commit suicide by throwing himself from a height, from a window. Suicidal thoughts and dwelling on suicide by methods like drowning, poisoning, and shooting themselves, or jumping from a high place.
NATRUM SULP: They want to get appreciated and recognized by others in their relationship. When a relationship is not successful they go into a stage of deep sadness, depression and become melancholic get suicidal thoughts or attempts of suicide .They want to commit suicide, but feel restrained by their duty towards family and children. Anxiety, loathing of life with suicidal impulse must use all self-control to prevent taking his life
ARSENICUM ALBUM: Arsenicum state of pathology initiates on the physical level, progresses to a state of anxiety and insecurity, then to fear of death and finally to despair, loss of interest in life and suicidal disposition .He feels his disease is incurable and thoughts of death constantly occupy his mind. Arsenicum patient may develop despair and suicidal disposition quite suddenly after a severe fright or shock or even during asthmatic attack
ALUMINA: Alumina person’s identity has been suppressed that he doesn’t know who he is any more. They have mental confusion with violent thoughts and impulses. Alumina feels violent at times towards herself, and at other times towards those around her. Alumina is usually a quiet, gentle person who hates her violent side. These violent thoughts nearly always involve cutting, can be suicidal or homicidal. During depressive moods Alumina will feel hopeless, and will often contemplate suicide Alumina has a very characteristic impulse to kill herself when she sees a knife or other sharp object. There is often a marked increase in moodiness before the menses. Both despair and aggression may increase at this time, along with the fear that the patient will hurt herself.
ANTIMONIUM CRUDUM: Antimonium Crudum preferentially affects the emotional level. These patients display an unbalanced emotional state, the emotions oscillating between an extreme sentimentality, which is expressed, and a much closed, withdrawn state of moodiness and sulkiness. Suicidal disposition from disappointed love by drowning or shooting.
NUX VOM: His destructiveness can also be self-directed, and this is one of the most frequent remedies for suicidal thoughts (“when looking at a knife he is inclined to stab himself, when at water to drown himself”: Boenninghausen) particularly if the patient “wishes to commit suicide but is afraid to die” (Hering).
RHUSTOX: Anxiety arises out of the pains and he became restless, apprehensive and tremulous. He feels as if he has come to the limit of his endurance and could not keep up anymore on account of the beating and drawing pains in his limbs .Disgust for life thoughts of suicide, wants to drown himself, with fear of death, with desire to die, without sadness. He weeps with great despondency at the utter helplessness of his condition.
IGNATIA: Ill effects from hearing bad news; from vexation with reserved displeasure; from grief, or suppressed mental sufferings; of shame and disappointed love. Melancholia after great grief and much domestic trouble; complete sleeplessness; suicidal thoughts and desire to escape.
CONCLUSION
Each suicide is a personal tragedy that prematurely takes the life of an individual and has a continuing ripple effect, dramatically affecting the lives of families, friends and communities. Suicide prevention efforts require coordination and collaboration among multiple sectors of societies, both public and private including health and non-health sectors. Homeopathic remedies can prevent suicidal tendencies in people with suicidal disposition and thoughts, if it is detected at appropriate time.
REFRENCES
- https://www.who.int/news-room/fact-sheets/detail/suicide
- Mythri SV, Ebenezer JA. Suicide in India: distinct epidemiological patterns and implications. Indian journal of psychological medicine. 2016 Nov;38(6):493.
- Sarkhel S. Kaplan and Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10 th Edition. Indian Journal of Psychiatry. 2009 Oct 1;51(4):6664-6685.
- Bridge JA, Goldstein TR, Brent DA. Adolescent suicide and suicidal behavior. Journal of child psychology and psychiatry. 2006 Mar;47(3‐4):372-94.
- https://www.msdmanuals.com/professional/psychiatric-disorders/suicidal-behavior-and-self-injury/suicidal-behavior
- Radar software: Frederik Schroyens Synthesis Repertory, Version 9.1
- Hering C. Herings Guiding Symptoms of Our Materia Medica. B. Jain Publishers; 2003 Jun 30.
- Bailey PM. Homeopathic Psychology: Personality Profiles of the Major Constitutional Remedies. North Atlantic Book
Dr Meenukrishna S
PG Scholar
Department of Materia Medica
Government Homoeopathic Medical College and Hospital
Dr.Siddiah Puranik Road, Basaveshwarnagar, Bengaluru,560079
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