by Abu Aaliyah
“… And do not kill yourselves [or one another]. Indeed, Allah is to you ever Merciful.” (Qur’an 4:29)
On a gorgeous Summer afternoon, with no clouds in sight, Sarah returned from work, opened the garage door to her house and found her husband hanging from the ceiling.
Kareem had killed himself.
I was Kareem’s counsellor at the time. And never had a client of mine killed themselves. Kareem and I worked on his issues closely. His suicide was a horribly novel experience that I wish I could erase from memory. In some way, by killing himself, Kareem also killed those who loved and cared for him.
As a result, I avoided talking or writing about him for a long time. However, in the wake of the controversy surrounding the Netflix show “13 Reasons Why”, I knew I needed to write about it now. Much of what I’ve heard in the news after the release of “13 Reasons Why” reminds me of my front-line experience at the time of Kareem’s suicide. Just last week, a 23-year old Peruvian man, inspired by the show, left behind 13 tapes before committing suicide. Each year, approximately 4000 Canadian citizens lost the battle with suicide.
Furthermore, I felt a need to write after attending the funeral of a young Muslim within my locality a few months ago who had reportedly committed suicide. He was one of the five suicides the Muslim community has had to deal with this year. Muslim communities across the world are susceptible to mental health and suicide. Last year, an 11-year old Pakistani Muslim in UK hung himself after being subjected to repeated bullying in school.
In the United States, suicide is the 2nd leading cause of death in colleges specifically and 3rd leading cause of death in young people generally. In where I am from, the province of Ontario, Canada, suicide is the leading cause of death within the 15-34 year-old age groups, after car accidents.
So here are my thirteen reasons for why I think Kareem killed himself. Hopefully they give people a more holistic, less sensationalized, and more evidence-based understanding of why someone might choose to end their life.
Reason 1: He suffered from a Severe Mental Illness
Some of the primary mental illnesses that underlie suicide include Schizophrenia. Depression, and Bipolar disorder. In fact, more than 90 percent of suicide victims have a diagnosed psychiatric illness. Kareem suffered from depression. Severe depression is a positive risk factor for suicidal thoughts and feelings. In fact, depression is the major cause of suicide in all age groups. Severe anxiety is also a risk factor for suicide.
Reason 2: Gender
Suicide kills men 4 times more than women. In Ontario, Canada more men have died by suicide in the past 10 years than in car crashes. Women, however, make 3 to 4 times more suicide attempts than men. Women are also hospitalized in general hospitals for attempted suicide at 1.5 times the rate of men. Women who have been sexually abused have a higher number of lifetime suicide attempts versus men who have been sexually abused.
Reason 3: Previous History of Suicide Attempts
One of the risk factors for suicide is prior suicide attempts. A family history of suicide and genetics have also been implicated as risk factors for suicide. Although no one had attempted suicide in Kareem’s family before, Kareem had attempted suicide previously. He had walked to the edge of the top floor in a parking garage and tried to jump off. But he could never find the courage to do it. He frequently spoke of his lack of courage as a determining factor for not attempting suicide.
Reason 4: Publicizing Suicide
Comedian Robin Williams killed himself by hanging himself in his home. That same week Kareem killed himself by hanging himself in his home.
Kareem often spoke about not having the “courage” to follow through. Perhaps, it was Robin Williams’ suicide that gave him this “courage”. That week alone emergency departments and psychiatric wards in Toronto hospitals were flooded with individuals who were feeling suicidal or had attempted suicide.
I am against the publicizing and glorification of suicide. It’s not that we must shy away from a discussion on suicide. But the seriousness of suicide – the vulnerability of the individuals involved and devastating consequences – demands that the discussion not be wrapped in media sensationalism nor intellectually loose cause-and-effect arguments.
When the means of suicide and the places it occurs are publicized, they have a bearing on methods chosen by vulnerable individuals. For instance, ever heard of Aokigahara (Suicide Forest) and Mount Fuji? It is estimated that more than 100 people in Japan kill themselves in this forest every year. The beginning of this awful trend is attributed to Seicho Matsumoto’s novel Kuroi Jukai (Black Sea of Trees) published in the 1960s. In the novel, a pair of young lovers kill themselves in the forest. However, in 2009 the local officials decided to stop publicizing the suicides in order to reduce suicide rates in the area.
Reason 5: Socioeconomic factors
Although a direct cause-and-effect relationship has not been proven, socioeconomic factors do combine with mental health and personal factors to affect suicidal behaviour.
Kareem had a strong desire to help. He wanted to contribute equally in his marriage to Sarah. He wanted to sweep the floor, mop the house, cook for her, make the bed, etc. But his mental illness wouldn’t let him. Kareem couldn’t work. Sarah supported both of them financially. Kareem had strong feelings of guilt and shame about this. He wished he could help.
Reason 6: His Relationships Suffered
Kareem frequently felt that Sarah would leave him though Sarah had repeatedly voiced she wouldn’t. He, however, looked at how one-sided their relationship was. She did everything for the both of them. Kareem felt very guilty about this. Victims of mental illness often do.
Mental illness disrupts the family environment. Many families experience it like a death in the family. The healthy person you once knew is no more. Instead, what once was a healthy, thriving, independent, and/or successful individual is now experienced as a sick, vulnerable, and suffering dependent. As a result, families often have difficulty coping with the experience. For them, their loved one feels like a stranger.
Often the family will go through phases, especially if care, compassion, and empathy have been values instilled within the family. In the beginning there will be much confusion about what is happening to their loved one. Doctor, hospital, and ER visits become normal. If its the child who is sick, the parent will strive hard to find answers. This initial period is filled with sadness, anger, confusion, and uncertainty for the family.
Diagnosis brings a sense of relief for the family. They finally know what’s “wrong” with their loved one. Diagnosis also brings with it hope. “If we know what’s wrong, that means we can fix it”. This phase involves searching for a cure. However, unlike taking a pill to cure a health condition, mental illness is more complicated. Often there’s no cure, no magic pill for some of the severe mental illnesses such as Schizophrenia. Sometimes even with medication and psychosocial treatment, their loved one never completely returns back to who they are. Some of the symptoms linger on and can be very troublesome for families to cope with. Families have a tough time adjusting to and grasping this reality.
At the same time the scales are heavily tipped on one side. The family has lost its balance. The sick individual draws on so much of the family’s resources. Months go by. Sometimes years. Family members begin to accept the stark reality that their loved one might never be the same again.
At the juncture of acceptance, tough decisions are made. Members negotiate within themselves, other family members, and/or service providers by asking:
- How long can I go on?
- How much is this compromising my identity?
- How much of my life, my health is being compromised in caring?
- How burnout am I?
Some families choose to remain by the side of their loved one, coping with their mental illness. Others try to strike whatever balance they can between caring for their loved one and caring for themselves. Other family members might, quite understandably, decide to disengage and live their own lives. The latter is especially true of siblings of a loved who is sick or a child of a parent who is sick.
Reason 7: He felt Isolated
Isolation is one of the risk factors for depression. With a debilitating mental illness, Kareem hardly left the house. Sarah worked long hours to support them both. There were no children in the family. And extended family members were rarely around. I would visit Kareem 2-3x/week for an hour or a little over. But most of the time, he was alone.
Vulnerability to suicide is reduced by protective factors such as effective problem-solving skills, enhanced self-esteem and strong social/family relationships. The Coroner’s Working Party on Suicide (1997) has reported that after mental illness, the next most common risk factors for suicide were “feelings of worthlessness, general dissatisfaction and relationship problems… less than a quarter of the attempters regarded family relationships as close and warm’. Sometimes suicide occurs even in the presence of close and warm relationships.
Reason 8: He felt stuck in a vicious cycle of feelings, thoughts, and behaviors
Despair, hopelessness, and feeling stuck was a recurring theme in my work with Kareem. Almost everyone who has contemplated or completed suicide has told someone or left some clues about the level of despair and hopelessness they feel. In fact these two emotions are key red flags that someone maybe considering suicide. Those who have been thinking of suicide have usually been suffering for a long time. The pain is often prolonged, intense, and unpalatable. This unbearable pain is often too much for its victim to express. For the suicidal individual, the overwhelming pain crumbles any hope for intervention.
Thoughts accompanying such feelings include:
- If only it could all end
- It will all be over soon
- I can’t go on
- I’m better off dead
- I feel like ending my life
Behaviours accompanying the thoughts and feelings may include:
- Saying goodbye (appears unusual)
- Seeking out lethal means (sometimes not easily apparent but in conjunction with other thoughts and feelings, you can make an assessment)
- Getting affairs in order
- Sudden calmness (individual feels relief that it will all be over)
- No hope for the future
- Giving personal belongings away
- Withdrawing from others
- Talking about suicide
Furthermore, mental illness often impairs its victim’s social skills. This leads to the suffering of social relationships, which further exacerbates feelings of hopelessness and helplessness, which are linked to suicide. Feelings of loneliness together with social isolation, particularly when allied with depression, substance abuse and poverty can increase risk of suicide.
Reason 9: System gaps
Often its the gaps in the system that fail our vulnerable loved ones.
For instance, Canada has a two-tier system for child and youth mental health. This means only the cost of seeing a Psychiatrist is covered by government provided health-care. However, wait times to see a Psychiatrist can be more than a year. The other choice is for caregivers to pay for a private psychologist or social worker. Many times caregivers cannot afford to do this. Children’s mental health cannot be funded as social services. They need to be funded as health services in order for the cost to be covered, wait times to reduce, and a more interdisciplinary approach to occur.
Furthermore, more funding and better continuity of care is needed from the transition from hospital to the community. This reduces readmission rates to hospital. Kareem was frequently a revolving door – going into the hospital, out to community, in again, out once more. Perhaps, more adequate funding would have provided more resources to help Kareem. Perhaps, better continuity of care post-discharge may have allowed longer, healthier periods of stay in the community.
Reason 10: Easy access to means
Kareem hung himself. Hanging is the most common means of suicide in both males and females. It is not possible to restrict access to such a universal means; ligature points and ligatures are readily available. Easy access to means needs to be implement in conjunction with other suicide prevention strategies such as early assessment for risk factors, diagnosis, and possible hospitalization until the individual is treated.
Reason 11: Suicidal Serotonin
Many neurotransmitters and hormones have been implicated in mood regulation and activation of behaviours leading to suicide. Serotonin is one of these neurotransmitters – a chemical in the brain – that has been linked to sleep regulation, depression, aggression, and suicide.
Research with rodents and monkeys shows that when the availability of serotonin is curtailed, the animals become more aggressive and impulsive. This is important because suicidal acts are often impulsive. A survey of individuals who attempted suicide highlighted that more than of them thought about it for less than 5 minutes. These individuals stressed that impulse was a factor in their decision. Furthermore, professional writing analysts have found notes written by suicide victims to be more impulsive, agitated, and aggressive. In many countries, murder is following by suicide.
Furthermore, postmortem studies have shown reduced serotonin in the brains of suicidal victims. Low concentrations of Cerebrospinal Fluid 5-HIAA – a breakdown product of Serotonin – is associated with a marked increase in suicide risk.
Reason 12: He couldn’t see any other way out
After a suicide, loved ones often say things like, “If only Kareem:
- knew how loved he was
- knew how much his friends cared for him
- could hold on longer
- how talented everyone thought he was
- recognized that he mattered to us and the world
Perhaps, somewhere, in the distant parts of his mind, Kareem knew all of this. However, as is often the case, depression most likely prevented him from accessing the hopeful, future-oriented part of this thinking. The sun may have been shining outside but Kareem’s mind was cloudy. And not of his own doing. That’s just how mental illness works. That’s just how debilitating it can be.
Reason 13: We don’t know
What causes such extremes in emotion, thinking, and action in people? I have discussed some of the risk factors above. However, predicting when and who will commit suicide is a guessing game. 70 percent of those who killed themselves had denied any suicidal thinking or plans, previously.
As Muslims we always believe that there is a light at the end of the tunnel. That with hardship comes ease. That all tests/tribulations we endure in this life will be rewarded in the hereafter. However, whether you are Muslim or not, no one should have to suffer through these challenges alone. Have trust in Allah. But do your part as well, whether you are sick or a loved one of someone who is.
Seek help now.
If you or a loved one is experiencing feelings of hopelessness, depression, and/or suicidal thoughts, there is help available. Here is a list of distress centers you can call in Ontario. There’s also the Naseeha Helpline available across North America for Muslims or non-Muslims. There’s Muslim Community Helpline and Muslim Youth Helpline in the UK. There’s a helpline in Australia you can contact as well called Islamicare.
If you are reading this article and know of resources in your community, please post it in the comments below and share. If you are not from Ontario, call 911, tell a loved one, or check yourself into your local emergency department if you are feeling depressed/suicidal.
If you are a family member or caregiver who wants to learn more about suicide prevention and intervention, I recommend the safeTALK program from LivingWorks. For healthcare professionals, I recommend their ASIST program. Their training programs are available internationally.
Please spread the word and share this article. Make our communities more aware and less ignorant of mental health.
(Identifying information has been changed to protect privacy and confidentiality of individuals)
13 Reasons Why. Netflix: Netflix, 2017. video.
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Qur’an. Surah an-Nisa. Verse 29.
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