There are many factors that can influence a person’s decision to commit suicide, the most common being severe depression, psychologists say. Depression can make people feel great emotional pain with no hope, sadly making them unable to see another way to relieve the pain other than ending their own life.

According to an article published by Very Well Mind, "A person who has had a traumatic experience, including childhood sexual abuse, rape, physical abuse, or war trauma, is at a greater risk for suicide, even many years after the trauma.”

Some of the aforementioned situations literally sum up 30-year-old Mary’s (not real name) earlier life—sufferings that led to a suicide attempt.

Mary’s story

Currently a Kigali resident and small business owner, Mary lives with her son, brother, and mother. Her anguish started when she was just a child, going on like a never-ending nightmare. 

"When I was five years old, I suffered from rickets which left my legs deformed. Children in my neighbourhood used to make fun of me, saying that I didn’t walk like girls, or that my walk was worse than my brother’s,” she recalls.

"Then when I was around eight years old, our gatekeeper raped me when my mom and the house-help had gone to the market. I can’t remember where my brother was, and my dad was at work as usual. Nobody came to my rescue when I screamed for help. I couldn’t fight back as he suffocated me. The memories remain fresh in my head to this day.

Mary says she feared to say anything at first, but after two weeks, she did. "I got the courage two weeks later, my mom found it hard to believe because when she took me to the hospital, the doctors couldn’t prove anything. My father believed me though, and fired the guard later that night when he came home. I felt some support in that, but, sadly, my dad died in a bus accident 10 months later, which worsened my anguish.”

Bullied well into secondary school too, Mary had to deal with students mocking her because of her legs. "They said I was deformed because I was a prostitute who slept with gatekeepers. I didn’t make any friends there. By the time I was 14, my mom had lost her job, and so I started stealing money from my classmates. It went on like that for two years till I was caught. The dean beat me in front of everybody, I couldn’t bring myself to go back to school after that, so I quit.”

"I was unhappy,” Mary says, "I isolated myself from everybody till I was 19, when I met the love of my life. Or so I thought. We decided to live together, after which I got pregnant. My body was changing in a way I didn’t understand, I had constant mood swings, and I didn’t like myself. He also didn’t seem to like me anymore and became distant. I used to tell him I would die if he left me.

"I suspected he was cheating on me, but he still came home every night. On the night I gave birth, I couldn’t reach him on phone. I failed to push and so I ended up having a C-section. The baby then developed a condition called hypoxic-ischemic encephalopathy.

Hypoxic-ischemic encephalopathy is a type of brain dysfunction that occurs when the brain doesn’t receive enough oxygen or blood flow for a period of time.

"I hated my life, I hated the baby, I hated his dad, and I couldn’t forgive myself for what had happened. I hated my mother too for not being there, and I had no news of my brother’s whereabouts. Nothing made sense in my life. I was tired of feeling unwanted by everyone. So I tried to kill myself. I still have the scar.”

Doctors came to her rescue in time. In the following days, a psychiatrist would come in to talk to her, and continued to do so even after she was discharged.

Like Mary, many have been driven to suicide by despair and suffering.  It’s difficult to imagine what led a friend, family member, or even celebrity to commit suicide. There may have been no clear warning signs, and you may wonder what clues you might have missed.

According to Dr Bizoza Rutakayire, a psychiatrist and psychotherapist at Caraes Ndera Neuropsychiatric Hospital, suicide results from complex interactions of biological, genetic, psychological, sociological, cultural and environmental factors that lead one to end their own life. Suicide mortality rate (per 100,000 population) in Rwanda was at 5.6 % in 2019, with a higher percentage for men than women according to the World Bank collection of development indicators.

The cause, according to BBC Future, is simply that men are likely less able to admit their vulnerability and are more restrained to see a doctor compared to women. Suicide, however, has grown frequent for the past two years in Rwanda than the years before.

Why do people commit suicide?

Psychologists say many factors could lead one to suicide, and some of them are:

·      Previous suicide attempt(s).

·      History of depression or other mental illnesses.

·      Family history of suicide or violence.

·      Physical illness.

·      Feelings of solitude.

According to Centers for Disease Control and Prevention (CDC), young adults between 18 to 29 years of age, discriminated populations, and retired military personnel are also at a high risk.

Dr Cindi Cassady, a clinical psychologist at Caraes Ndera Neuropsychiatric Hospital, views suicide as a three-stage process;

"Stage 1 is the period of having suicidal thoughts, where a depressed individual begins to think about suicide more and more.

"Stage 2 is the ‘planning’ phase, during which the person’s negative thoughts move to devising a particular suicide plan.

"Stage 3 begins when a suicidal individual decides to take his or her own life. When a decision is made, it becomes ‘unconscious’, and the person enters into ‘auto-pilot’ mode. People in Stage 3 are on the verge of death, but they appear more normal than they have in a long time.

"Be alert when a depressed patient who doesn’t seem to improve after months of intervention suddenly seems to get better. Instead of relaxing, we should become more vigilant when we see a sudden, overnight improvement,” says Dr Cassady.

She adds that people should listen closely to any indication that the individual has decided to end their life, and mobilise support among family, friends, and medical/behavioural health providers.

According to Dr Rutakayire, there are some warning signs that people reveal when they are at the brink of taking their own life:

● Talking about wanting to die or taking significant risks that could lead to death, such as crossing the road without checking the traffic.

● Talking about feeling empty, hopeless, having no reason to live; talking about feeling trapped, or feeling like there is no solution.

● Talking about being a burden to others, feeling great shame/pain, and withdrawing from family and friends.

● Making a plan to kill themselves, such as searching for lethal methods online, stockpiling pills, or buying poison.

● High anxiety and using alcohol or drugs more often.

● People can show different signs; it requires those close to them to be more vigilant.

According to the National Institute of Mental Health in the US, anyone who talks about suicide should be taken seriously. There shouldn’t be assumptions that they are seeking attention.

Prevention

According to the World Health Organization, one could be protected from suicide by enhancing strong personal relationships, religious/spiritual beliefs, and lifestyles that incite them to live positively.

Dr Rutakayire suggests ways that could thwart suicide:

·      Family and friends’ support

·      Spiritual support, giving purpose and meaning of life

·      Community activities to avoid isolation, hence enhancing social interaction and integration into community

·      Early access to treatment and mental health services

·      Comforting those who lost someone

·      Drugs/alcohols to be avoided, instead, cultivate contentment, gratitude, and a positive mind, giving more value to what you have than what you lack

A positive way forward

Mary’s mother, Uwera (not real name), says she made peace with her daughter. "I apologised for neglected her before it was too late. I love her, and I think she knows that now.”

"I was abroad when she attempted suicide. I came right away, and it’s only then that I realised how distant we had grown over the years. I’m glad she is now well with her sweet son. It made me heal from some things I had ignored too,” her brother, Ishimwe (not real name), says.

If someone says they want to kill themselves, don’t dismiss it as seeking attention or leave them to their business, talk to them and encourage them to open up to a trusted person about it, or consult a doctor. If you have suicidal thoughts or know someone who does and needs help, please reach out to Dr Bizoza Rutakayire on 0788682568.