Counting Suicide

International data on suicide indicate that, overall, more women attempt suicide than men. Numerous studies have proven that this has to do with the lower social, political, legal and economic status of women vis-a-vis men, as well as the societal expectation that women act restrained and submissive. When it is no longer possible to put up a brave front, some women are liable to take the extreme step of committing suicide.

 The research carried out for this article was to study suicide among women in Nepal and to see if there was any unique trend that differentiated the 'suicide-status' of Nepali women from those elsewhere. The search for information proved elusive. Firstly, all across South Asia, suicide data are considered unreliable. This is compounded in Nepal by numerous practical hurdles faced by researchers in data collection and analysis. A general picture of the nation as a whole is difficult to formulate because of religious, cultural and ethnic diversity.

Between July 1988 and Apri11991, according to police records, 976 women took their own lives in Nepal. That, on average, at least one woman commits suicide every day in the country is worrisome. The mental anguish and psychological trauma which lead to such drastic action, cumulatively add up to an enormous national burden that must be addressed by researchers, social workers and the government.

Unfortunately, educated Nepalis who should be concerned are busy revelling in the tourist guidebook-influenced belief that all Nepalis, men and women, are psychologically stable. There is no government-mandated programme that takes a hard look at suicide figures and makes policy recommendations. Social organisations are too busy conducting sewing classes or organising symposia. The few psychiatrists, all Kathmandu-based, are too overburdened with individual (normally upper class) patients to be able to look at the nation.

According to the police records, during the last fiscal year (July 1989 – July 1990), there were 819 cases of suicide in the country. However, the poor collection and transmission of data lead to unlikely situations. If the police are to be believed, there were no suicides (male or female) in the entire Karnali Zone of western Nepal.

During the same period, Kathmandu Valley reported 115 suicides, which was 15 per cent of the total s uicides that presumably occurred across Nepal that fiscal year. Of the total reported female suicides, 16 percent were said to have occured in Kathmandu.

There are experts, however, who question the validity of the police data. Says psychiatrist Dr. Nirakar Man Shrestha of the Mental Hospital in Kathmandu, "Even in the western context, because of social reasons and leg al complications, only one-fourth of actual suicides get reported. The majority are written down as natural death." Dr. Shrestha believes that the Nepali figures cited above must be multiplied by four in order to attain a more realistic number.

BIASES

Available suicide figures (as exemplified by the zero number for Karnali Zo ne) are not believable as there are too many biases in the acquisition of suicide data. Analysis based on such faulty information must be suspect.

One of these biases is the registering of murders as suicides. This is true, among others, in cases of dowry deaths in the Tarai. One social worker from Janakpur, in the Tarai, believes that the majority of deaths of young women by burning are listed in police records as suicides. This also works the other way around. He says local policemen are known to extort money by threatening to report a genuine suicide as murder.

While murders reported as suicides might lead to increased suicide data, they are more than offset by apparent suicides being reported as natural deaths. As a police inspector from Gorkha says, "If a woman is found at the bottom of a cliff, how do I know if she jumped off, was pushed off, or lost her balance while collecting fodder?"

Another Kathmandu-based police source, requesting anonymity, conceded that his department's data were so totally unreliable that it would be wrong to base any suicide-related study on them. "The name of the deceased might be there, but even that might have been changed by the family to avoid stigma. The age and ethnic background could be completely contrived as well. After all, the dead person's citizenship certificate is never asked for."

No study of suicide can afford to ignore cases of attempted suicide. This is especially important because, while the completed ("successful") suicides are dead and gone, attempted suicides live on, often as mental wrecks, some attempting suicide again and again. Unfortunately, the Nepali police does not keep data on attempted suicides.

According to international literature on suicide, attempted suicides are generally three times higher in females and completed ones three times higher in males. Interestingly, if the Nepali police data are to be believed, the male-female ratio of completed suicide came to about 10:9. We have no way of knowing what the gender-specific 'attempt rate' may be. Taking into account poisoning cases that were admitted into the four hospitals of Kathmandu valley (Bhaktapur, Bir, Teaching and Patan) and assuming were all suicide attempts, the male-female ratio comes to 10:17.

POISONING IN KATHMANDU

While national data are more or less useless in studying incidence of suicider among women, there are at least a few medical professionals that have been studying the subject in Kathmandu. Collection of data on poisoning cases in Kathmandu hospitals showed that women attempt this method of suicide more often than men.

Dr. B al Krishna Subedi and Dr. Bijayeswar Vaidya of B it Hospital, for example, have studied 291 cases of deliberate self-poisoning admitted to the Bir Hospital emergency ward. They found attempting suicide by poisoning (mostly by swallowing insecticide or rodenticide) was highest among poorer families, and that 'marital disharmony' was the most common cause for attempting to take one's life. The 14 to 30 age group constituted 74 per cent of total suicide attempts, of which 28 per cent were males and 46 per cent were females. Out of the 291 cases, 71 attempts were made by housewives and 16 by girl students who had suffered a 'personal tragedy' (12 were male students).

A study by Dr. Himanshu R. Vaidya and Dr. Mark. D. Zimmerman, of 130 poisoning cases admitted to Patan Hospital over a period of 35 months (September 1988 to August 1991) showed that 58 per cent were women.

Psychiatrist Dr. M.K. Nepal says that according to his observations at the Teaching Hospital of Tribhuvan University, the number of female suicide attempts is increasing 'unbelievably'. The hospital data collected indicate that some 64 per cent of all poisioning cases were women.

In Nepal, suicide attempts by poisoning seems the most well recorded. There are, certainly, other methods, such as drowning, hanging and gunshot, the last being most common among men. More studies are required to understand the magnitude of completed and attempted suicides, as well as the proportional contribution of each of the various methods.

LACK OF COUNSELLING

The fact that scores of women commit suicide in Kathmandu every year indicates the need for a concerted programme of counselling. Dr. Shrestha, a psychiatrist, says that psychological assessment is conducted in only one out of 500 cases of attempted suicide. The hospitals are ill-equipped to carry out such assessment. At the same time, he says, most patients and even many doctors lack the 'psychological sophistication' required to understand the nature of psychiatric problems and the need for cure. Even when the person who has attempted suicide gets referred to a psychiatrist, it is unlikely that the visit to a 'mind-doctor' is ever actually made.

A professor of psychology in a women's college in Kathmandu, who has been observing the impact of changing mores and new demands upon young city women, says that women are having difficulty coming to 'a point of compromise' between the values prescribed by traditional society and the demands of being 'modem', the definition of which eludes them. "On the one hand, there is society's stereotyping of the 'pure woman', and on the other, they are being asked to cope with too many changes, too soon." Unable to discuss matters with family or with friends, many young women are liable to take drastic action when confronted with a situation that is hard to cope with.

Sociologist Dyuti Baral believes that many suicide attempts are actually veiled calls for help. "If only there were mechanisms in society to help these young women, the majority would never take the final step," she says. Gauri Manandhar, another psychologist who teaches at a girl's college in Kathmandu, says the time has come to start suicide prevention programmes and counselling organisations where women would be able to come and talk about the problems they face and support one another.

It is a senseless loss of life if a young woman takes her life just because she does not have someone to talk to. In another society, where support is available, she might actually never contemplate taking the extreme step. It is clear that in Nepal there will be more women attempting suicide in the future than have in the past, particularly in the expanding urban areas. The society must gear itself to meet the challenge, because every success will mean a life saved from senseless demise. Since the problem is clear, it does not really matter that the data are inadequate or faulty.

Aryal is a writer based in Kathmandu