DEPRESSION knows no boundary. Neither does it respect religion, social status, race, color, or even looks.
By Kudakwashe Pembere
It is no secret that Mrs Ellen Maponga (35) a Zimbabwean woman based in South Africa is a dazzling beauty. Her sparkling glassy grey eyes and slim figure could easily deceive one into thinking that the World Mental Health Day commemorations which she was also a part of in Harare was a beauty pageant.
Besides just being a beauty, Ellen stands out as one of the few individuals who have successfully overcome suicide and all it brings. Having attempted suicide more than five times owing to prolonged sexual abuse and stress, Ellen says sharing is the best medicine to depression and could save lives.
I attempted suicide more than five times and it was a very terrible journey. It was severe depression. I decided to reach out because I knew that if I tried it again that would be last time I would fail,” said Ellen.
“Those attempts were actually me taking pills and me doing those mutilating things. And I just never died. And I know that this is because of God. Being here, has nothing to do with me today, my life is preserved by God.”
She says her supportive husband, children and sisters, this young mother, a 35 year old mother of two is grateful to be alive today have made her realise that there is more to life than just her.
“When I have those voices telling me I am unworthy I repeat to myself I am worthy. I have friends that I call upon. I speak to my husband, my sisters are supportive. I have got children that I want to see getting old.”
She says she has tried everything in the suicide manual just to take her own life but no avail.
“I have taken Malaria drugs, pumped myself with some crazy stuff. I went through sexual abuse when I was six. The first time I tried to commit suicide I was 12. And you think someone who is 12 years old, what do you know? And for someone like that I felt why should someone have to do this to my body? When I was 16, a friend of my sister was a doctor tried to rape me. And also thinking again what is wrong with me?
“Like in my head I was thinking you are so unlovable, you are so unworthy, you don’t deserve to be happy. You know I tried to kill myself and it didn’t work and I thank God for it. Fast forward when I was 21, it happened. Three times with strangers. I had reached a point where I said that everybody can go to hell. I was so, so depressed. I was thinking a lot, I didn’t want to eat,” she said.
She added that she would have very intense suicidal thoughts in her head.
“During that time when I resorted to taking the pills or mutilations, the voices very intense were just saying kill yourself, you are not worthy to live, you do not matter, who’s gonna miss you anyway,” she said .
“And to be honest with you when I reach out, during those times nobody answers their phone. Funny enough, their phones are on voicemail. I call someone and they say I will call you later. And that’s the time when I really need to talk.
“I’m really feeling isolated and like there is nowhere completely. I take sleeping tablets the whole batch I was prescribed by the doctor. Very lethal and I took norolol, the malaria tablets. I will tell you that it’s the grace of God that brought me to where I am today,” she says.
Despite telling her husband six years into their marriage, she was never shunned. Her husband, along with her sisters, friends and children have been there for her providing psychosocial support.
“So i shared with my husband because I had never shared with him. We have been married for 11 years but I decided to tell him six years within the marriage that I decided to kill myself within the house. Then he sought help.
“We went to a church and I got counselling and I even read a lot online on how to keep my mind at peace. I exercise. I changed my diet and I have got a supportive network of friends that help,” said Mrs Maponga.
She says she is always grateful to her husband, friends and family for their treatment.
“Thank God, my husband doesn’t treat me like a patient. He is very understanding. He will even ask me, baby is anything wrong. And sometimes when I go into a shower, he knows there is a trigger somewhere.
“When I go and become alone. He makes an effort to reach out and always ask me is everything ok? Do you want to talk? And if I can’t share with him, he makes sure I find someone to talk to. My kids are the most fantastic people. I have a 11 year old and a five year old,” says Ellen.
How she stays off the Edge of the Suicidal Urges
Ellen does not dismiss the power of clinical interventions although she uses herbal therapies.
“I opted for no medication. It works for other people. I read the side effects, I changed my diet. I even went on a hormone replacement therapy. It’s a herbal pill called Chasteberry vitex which actually helps with my hormone especially after post-natal depression. That actually helped me a lot.
“They advise you what you need and then you take a pick from everything. So I like more exercise, better nutrition, less time on social media, on my phone,” she said. She stays off line for seven days.
“Every month I take seven days off social media. I only go online to post my poetry on Facebook,” said Mrs Maponga.
The church that helped her is called LifeGate Assemblies.
“Meditation, prayer that connection with God, very, very important. Also confessing on all sins and taking responsibility when I have made mistakes,” she said.
Her words to those with suicidal thoughts
She tells people with suicidal thoughts that they are not alone.
“Those thoughts are not you. There is always a way out. You feel like you are stuck in a cage but if you manage to, when they start just talk them out of your mind. If a thought comes out to say I need to die, just say no! I need to live.
“I have got goals. There is always something to live for. No problem is big enough to end a life. No problem requires your life,” said Mrs Maponga.
She referred to a Japanese experiment called White Rice to self-talk one’s self out of suicidal thoughts. She has seen positivity self-talk within her mind helping.
“So I want to share with you just one thing. There is an experiment called the ‘white rice experiment.’ It’s about this Japanese scientist who came up with this using water. But what you can do, you can do it home.
“Boil white rice. Have three jars. Put the rice in those three jars and label them. Label the first ‘love’, the second ‘hate’, and the last ‘ignore’. For 21 days, speak to those jars. Say to the ‘love’ jar, I love you, you are worthy, you are accepted, you are appreciated. Twenty one days. Go to the ‘hate jar’, I hate you, you should not live, you are no good. And then just ignore the ‘ignore’ jar.
“After 21 days, the rice in the ‘love’ jar isn’t that rotten. It’s still ok. The ‘hate’ jar, the rice is moldy, it’s terrible. The ‘ignore’ jar, yep there is not that much mold.
“So basically what I am trying to say is that self-talk, helps. Talk to yourself, in your mind. Are you telling yourself you are unworthy, unlovable, useless because that’s gonna create mold in you.
“And that’s a real big step for wanting to attempt suicide. So please be kind to yourself, be tender to yourself, have pride in yourself because you can’t love anybody else if you cannot love yourself,” said Mrs Maponga.
She says she wants to be a centenarian living a longer life than former President of Zimbabwe Robert Mugabe who lived up to 95 despite wishing a 100.
According to the Zimbabwe Republic Police (ZRP) statistics, there was a 42 percent rise in suicides in the first quarter of 2019 from the same period last year. A total of 129 suicide cases were recorded between the months of January and March 2019 in Zimbabwe, compared to 91 reported in the same period last year.
Saddening latest statistics stats from the World Health Organisation (WHO) state that for every 40 seconds one person around the world kills himself and or herself.
Suicide is defined as the act of killing one’s self intentionally. There is more to the ‘intentions’ leading to this act often ignored or overlooked through sharing and even positive monologue, and even clinical interventions, suicides could be averted.
Suicide is often a result of depression, anxiety, obsessive compulsive disorders, multiple personality disorder and a whole lot of other mental illnesses.
When depressed one feels they have nothing to offer or that they would not be missed if they were no longer alive. This is a sign of severe depression.
Clinical psychologists however say it is difficult for people who survive suicides to open up. In many instances, people with foiled suicide attempts begin to open up on why they wanted to commit sign, it’s a sign they are on the road to recovery against the severe mental illnesses.
Suicides are often attributed to socio-economic woes bedevilling individuals, Zimbabwe in particular. These, the Police note are linked to the prevailing economic meltdown and even marital or relationship problems. To students, academic pressures can be factored in.
But suicide is a universal occurrence affecting anyone and everyone directly or indirectly. South Africa is regarded as an African economic powerhouse as evidenced by the massive migration of people to that country.
We could to a larger extent rule out the economic turbulence as a cause to suicides but rather social issues tormenting people.
What do experts say?
Mrs Maponga was what mental health experts’ term parasuicidal. There is something odd in suicide descriptions from the community especially after multiple attempts. The word used is “they will eventually succeed.” It’s linguistically packaged as if it is an achievement. But it’s not. Rather, it’s a loss.
American psychiatrist Katherine Anne Comtois in her academic article dubbed ‘A Review of Interventions to Reduce The Prevalence’ of Parasuicide defines parasuicide as any nonfatal, self-injurious behaviour with a clear intent to cause bodily harm or death.
“Thus parasuicide includes both lethal suicide attempts and more habitual or low lethality behaviours such as cutting or other self-mutilation,” she says.
She adds that this definition is not universal as studies often use the term ‘suicide attempt’.
“In other studies, suicide attempt applies only when suicide was the individual’s clear intent or when the individual’s behaviour had a high likelihood if death. In a majority of studies, the definition is not clear articulated,” Comtois says.
Zimbabwe National Association of Mental (ZINAMH) clinical psychologist and national coordinator Mr Ignatius Murambidzi says it is possible for one to have suicidal tendencies for more than five times but rarely eventually end their lives.
“People experiencing suicidal crisis don’t want to end their life they want to end the intense emotional pain and suicide seen to be the only way at that point to end the pain. This explains the ambivalence common among people with suicide ideation. When one attempt suicide there are four possible outcomes
- The attempt may be successful resulting in death
- The attempt may fail so the person will survive that is a person may have used a non-lethal method (the poison taken way not be toxic enough to end one’s life so the person will survive.
- The attempt may be interrupted for example some people may quickly notice the attempt and emergency help is given to save life.
- The attempt may be aborted i.e the individual may suddenly change their mind whilst attempting to take their life so they abort the plan half way,” he says.
Mr Murambidzi adds, “In view of the above it’s possible to service numerous attempts. Also important is that suicidal feelings are often transient. Because of the intense pain at that particular time the person may experience a suddenly and strong urge to end their life.
“These feelings are temporary building up and down during a short period of time. That’s while one can prevent suicide by engaging the suicidal individual thus distracting them from executing their plans when the suicide feelings are high.”
Psychiatrist Dr David Mukwekwezeke said Mrs Maponga’s case is similar to one he once attended. He concurs with Mr Murambidzi that if one fails to commit suicide they rarely want to try again.
“It is very possible. In fact when you described that case I almost felt sure that I had met that patient before because I have encountered similar cases in my own practice. Sexual abuse is one of the most prevalent triggers of suicide and is a very strong precipitating factor of Major Depressive Disorder.
“However its influence can also be ephemeral if psychological intervention is expedited. In my humble experience, using a cursory glance of the statistics I have at our Mental Health Unit, most people who fail to commit suicide once do not try again. This is largely due to the protocol we have in place in our emergency and psychiatric units in Zimbabwe,” he says.
To Dr Mukwekwezeke parasuicide is a psychiatric emergency, one of the few emergencies in the entire field of Psychiatry. He explains how suicide survivors are taken to the emergency unit before being referred to the psychiatric unit.
“When a patient presents at a medical facility with a history of attempting to cease his/her own life using deliberate means they are taken to the Emergency Unit rather than to a Psychiatric Unit because they have to be first resuscitated physically before they can be resuscitated psychologically. “After they are deemed physically stable enough they are then transferred to the Psychiatric Unit for rehabilitation and in some instances they are placed on what is called Suicide Watch – this entails a second-by-second surveillance by at least one member of the Psychiatric staff.
“Ideally psychiatric intervention has to start in the Emergency Department therefore a Psychiatrist or someone standing in for one has to be consulted immediately after a diagnosis of Parasuicide is made. A lot happens between admission and discharge but the caveat is that the patient has to be free of suicidal ideation before being sent back home,” he says.
He notes the toll task of convincing someone of the need to continue living if the trigger for the suicide attempt is not resolved.
“In the government set-up we rely heavily on Medico-social Workers to assist in resolving these triggers. They are the physical conduit between the hospital and the home. Upon discharge some patients might need to be started on psycho-pharmacological aides such as anti-depressants or anxiolytics but adherence remains a challenge due to a number of factors such as intolerable side effects and stigma,” says Dr Mukwekwezeke.
Dr Mukwekwezeke finds his experience with parasuicide cases inspiring.
“The key is to act fast and to use a holistic approach. Medico-social workers are the unsung heroes in Mental Health. I work very closely with them and they are very enthusiastic about their job. Mental Health Nurses are indispensable of course. When it comes to parasuicide they do the bulk of the counselling,” he says.
Asked what these people who commit suicide go through he refers me to what is technically termed suicide risk assessment.
“That’s a very interesting question. There is a technical term for what you are trying to ask. It’s called suicide risk assessment. It’s an interesting topic which I encourage you to read up on,” Dr Mukwekwezeke says.
He goes onto explain that in the Zimbabwean context most parasuicide patients in our set-up have a definite trigger which they can easily point out – invariably a dispute of some sort.
“Only a minority admit to having a preceding phase of melancholy with the suicide attempt itself only serving as a means of catharsis. The events leading up to the act give us an idea of just how serious the individual was when they made the decision to take their own life,” he said.
There are some questions that have to be answered to determine the suicide risk.
“Here are some examples: did they go to a secluded place where they knew they would not be interrupted (such as a bushy area away from a foot-path) or they chose an area where they obviously would be intercepted? If they went into a room did they lock the door? (those who really intend to die will lock it) Did they inform anyone that they intend to kill themselves? (e.g. a phone call to a close relative).
“How many times did they attempt? (e.g. if they chose hanging did they try again when the rope got loose, if they chose poisoning did they increase the dose as time went by, etc). These are the kinds of questions we ask to assess severity of the intent. In generic terms the question “did you really want to die?” has to be fully exhausted. It is important to remember that some people use suicide attempts as a way of crying for help or attention,” Dr Mukwekwezeke.
Suicide is never an option. It will never be tolerated. At all! There is always a way out. It can be prevented through clinical means as well as psychosocial support. As Mrs Maponga says, self-talk within one’s head piling thoughts of positivity can lead to a mentally healthier and longer life.