Special Report – The Rise Of Suicide
From struggling students to celebrated artists, a disturbing number of South Africans kill themselves each year — and a growing number are reported to be black youth. Why? And what can we do about it?
Even South Africans hardened to headlines of death were left stunned last October by news that hip-hop icon Jabulani Tsambo, AKA Hip Hop Pantsula, had gone – allegedly by his own hand. As outpourings on social media made clear, it was especially painful so soon after the suicide of acclaimed cardiologist and UCT Dean of Health, Professor Bongani Mayosi.
HHP, 38, was found in his bedroom. According to The Sowetan, in his final hours he had said: “I’m depressed. I’m going out of control. I’m losing it.” It wasn’t the first time the rapper had spoken that way. In an interview on CliffCentral two
years earlier, he described attempting suicide three times, even visiting a suicide website for information on how best to do it. The inability to end his life had seemed to him just one more failure: “F **** ing hell, I’m a loser,” he said.
Yet like Mayosi, this was a man who for most South Africans epitomised success. He had fame, family, awards and the material trappings of achievement. Despite all this, homie and fellow rapper Khuli Chana told TimesLIVE, “It breaks my heart that he was never able to overcome that dark space he was in.” This was an echo of what Mayosi’s family had said in a media statement: “In the last two years he has battled with depression, and that day took the desperate decision to end his life.”
Depression darkens the lives of about 4,5 million South Africans – nearly one in 10 of us, according to Dr Sebolelo Seape, chairperson of the Psychiatry Management Group. The South African Depression and Anxiety Group (SADAG) reports that around 70% of those who try suicide have a mental health disorder, and the most common by far is depression.
What makes depression particularly deadly for black South Africans is their reluctance to address it – or even acknowledge that it’s a mental illness that exists and can affect anyone, say mental health professionals. Benonibased psychologist Tshidi Maseko sees it in her practice. “Although barriers have been broken in creating awareness about mental illness in general, many black people continue to be in denial of depression because they think it’s about being weak,” she says. “They say things like ‘We all have problems, we grew up in poverty, we experienced apartheid. How can we be depressed about things now?’ Some call depression a ‘white man’s disease’ and say we’re copying them. If someone claims to be depressed, they call them ‘self-centred coward’ and mock them. They tell them to snap out of it, to be strong. And if it’s a son, a brother, they tell them to be ‘a man’.”
Nkini Phasha, a medical scientist, senior spokesperson and board member for SADAG echos this view. “Cultural beliefs around masculinity are a major contributor to fuelling myths and stigma around depression and suicidal behaviour. Men are still raised not to express emotions – perpetuating the the ‘real men don’t cry’ myth,” she says. Unable to face their dark reality, many escape in alcohol and recreational drugs, or in endorphin-dependent behaviour like excessive workouts at gym, and high-risk behaviour such as gangsterism, reckless driving and having multiple sex partners, or they become workaholics. The end point can be not only suicide, but family suicide. “The man sees himself as the provider, and if he can’t fill that role he believes no one else can either, so he takes out his family too,” Phasha adds. “It’s a tragedy we’re seeing more often.”
Even if people are brave enough to seek help, in the black community it’s often not from qualified health professionals, but from preachers, traditional healers or sangomas, who interpret depression as being bewitched, and treat it with prayers or traditional muti. “Unfortunately, you can’t simply pray away depression any more than you can pray away diabetes or HIV,” Phasha says matter-of-factly. Depression is a real medical condition and it’s implicated in about 80% of HIV/AIDS-related suicides, says Maseko. And just as you need insulin and ARVs to recover from them, you need professional treatment – usually therapy and medication with antidepressants.
But even those who do reach out for qualified professional help may struggle to get it. “The South African health system still needs to prioritise and streamline mental health intervention adequately,” Maseko explains. SADAG reports a finding that GPs fail to detect between 33% and 50% of depressive disorders in patients presenting to them.
For young black South Africans in particular, a host of other issues also feed into depression and suicide, from substance abuse to relationship problems and adjustment disorders, and what Maseko describes as “the obsession with materialism since freedom and democracy”. “This has brought fierce competition, from which school you attend to what car you drive. We see children placed in schools where they don’t fit in culturally or academically, but parents insist, as much for the prestige as to secure them a brighter, more lucrative future. It’s a mismatch, and children burdened with fear of disappointing their family are ripe for depression.”
Many also battle with bullying. Stories abound of youngsters whose previous life experience has not equipped them to deal with their ‘new norm’, from how to eat breakfast cereal in res (thinking cornflakes are chips, and taking a handful), to how to access computer programmes. Embarrassed to ask for help, they suffer in silence or attract snide comments. Today, these swiftly grow into cruel social media postings shared widely in seconds. For young people who have not yet developed problem-solving and life skills, and are struggling with other issues of adolescence, it can end in suicide. “There’s been an increase in student deaths across campuses caused by the rising rate of suicide,” says SA Union of Students (SAUS) president Misheck Mugabe. And he condemns “the poor implementation of psychological interventions” to address challenges students face.
At the other end of the spectrum are the masses who, almost 25 years into democracy, are still struggling in poverty and joblessness, and with the crime, violence and other ills this brings. “Although a number of other factors are implicated in developing depression, environmental stress and lower socioeconomic level alone could account for much of the elevated presence of depression (and so suicide) in the black community,” reports SADAG.
WHAT CAN BE DONE
So where should we start, if we’re to curb it? “On a personal level, the best way to protect those you love against depression and suicide is to constantly remind them that you love them and are there to support them,” says Cassey Chambers,
Children burdened with fear of disappointing their family are ripe for depression
operations director at SADAG. “Reach out and ask what’s troubling them. Don’t be afraid to ask if they’re considering suicide – you’re not planting an idea, you’re giving them a chance to talk.”
Listen closely and non-judgmentally. “Reassure them that whatever the problem is, they aren’t alone, you are there for them. And let them know that suicidal feelings are temporary – depression can be treated and problems can be worked through. If they threaten suicide, never dismiss it as an empty threat or attempt to get attention. You may regret it,” Chambers advises, adding that it’s also wise to remove dangerous objects, monitor them closely and get professional help straightaway (see sidebar).
On a social level, we need to destigmatise depression by getting boys and men, especially, to understand that it’s okay to be emotionally or psychologically distressed. “It’s a sign of being human, not weak,” Phasha says. And on a broader level, we need to push for more school and university programmes to provide information and guidance on depression. Last year, after the spate of student suicides, SAUS and Grades and Levels SA launched a student mental health care 24-hour call centre, but more help is required.
“We need to have intervention programmes in schools, where pupils can be trained in peer counseling so they are able to support one another,” Maseko suggests, adding that “Mental health needs to be taken seriously, just like we did with the HIV/AIDS pandemic. And teachers and parents need to be trained to recognise the signs of depression and suicide, ask questions, and take preventive action.”
SADAG initiated a schools suicide prevention programme in 2014 called Suicide Shouldn’t Be A Secret. It also has projects to train teachers and traditional healers to recognise signs and refer people to mental health professionals. It even runs ‘counselling containers’ in some townships where people lack access to mental health care. But funding is so tight that SADAG’s crisis lines were recently under threat of closure. What’s needed is national recognition of the nature and extent of depression and its price in human misery, coupled with commitment and investment in combating it. Perhaps the build-up to this year’s elections is a good time to press government (through counsellors, politicians and women’s groups) to take action.
Bottom line? Suicide is a preventable cause of death – and we all need to spread the word, support projects around it, and above all, watch for signs and direct those at risk to find help. “No one needs to live with depression or resort to suicide,” Chambers says, “Making use of free online resources and support groups can help you cope.”
“Start the conversation with friends about someone like HHP,” Phasha urges. “Just talking about depression and suicide is the best way to bring light where there’s darkness, and save lives.”