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- Every death by suicide is the product of a complex interplay of biological, genetic, psychological, societal and environmental factors.
- Death by suicide among students has been known to be driven by caste-based discrimination and by familial and societal pressure to score higher in standardised tests.
- We must address suicides as a public health emergency in India brought about by a combination of mental, social and political factors.
- The NCRB also needs to stop collating data from police records and extend itself to other sources, in order to improve suicide reporting.
Trigger warning: Discussions of causes of suicide
To raise awareness to prevent premature deaths due to suicide, the WHO observes ‘World Suicide Prevention Day’ on September 10 every year. According to India’s recently published National Crime Record Bureau (NCRB) report for 2021, 1.64 lakh persons in India died by suicide – an increase of 7.2% from the previous year. Given the large number of persons taking their own lives and the causative factors, suicide is a critical public health concern in India and merits a closer epidemiological assessment.
A 2019 report by the WHO said suicide is one of the top four causes of death worldwide, after road injury, tuberculosis and interpersonal injury. According to this report, one million individuals die by suicide every year and 20-times more attempt it. In other words, more people die by suicide every year than due to malaria, breast cancer, war and homicide combined.
Every death by suicide is the product of a complex interplay of biological, genetic, psychological, societal and environmental factors. It is the leading cause of mortality among young people in India, with the risk remaining high throughout adolescence and early adulthood. According to recent data, one student dies by suicide every 40 minutes, and roughly 36 students die by suicide every day. The rising frequency of student suicides has caused grave alarm in the country’s health and education systems.
The epidemiology of suicides among students, in particular, in India indicates that it is a major mental-health and social issue. Student deaths have increased despite claims of reforms in the education system. According to the NCRB report, the number of students who have died by suicide has increased 77% since 2010.
Those who have graduated, or better, account for a significantly smaller fraction of deaths by suicide. The rate is highest among students during matriculation and higher secondary education.
In 2021, 1,673 students died by suicide reportedly because they fared poorly in exams. Their mental trauma and suffering is hard to imagine, and for this reason we shouldn’t address suicides through a strictly quantitative lens.
Students at risk of dying by suicide confront us with a mental health issue as well as structural social, cultural and political problems. Class-aspirants eager to secure a prominent place in their social and political lives are also eager to maximise their economic well-being. In the process, they glorify specific jobs and exams to less-than-constructive ends, undermining their own abilities and capacity for innovation.
Caste in particular is a robust social determinant of public health in India, via its manifest and latent functions, and is also an important factor in many deaths by suicide. The tragic stories of Rohith Vemula and Payal Tadvi attest to the reality of caste-based discrimination even on the campuses of supposedly more progressive institutes of learning. Discrimination frequently takes on violent forms as well, as in a recent incident in Indra Meghwal in Rajasthan, where a student was beaten allegedly for touching an item belonging to an ‘upper caste’ teacher.
Individuals who have suffered in this manner can carry their trauma throughout their lives, especially if they don’t receive timely and proper care and support. But since care of this sort is often privileged to the supposedly ‘higher’ caste groups and wealthier sections of society, their trauma is left to fester.
An issue as important as recognising the forces driving self-harm is reporting. Indeed, a big problem with the NCRB data is that it collates its information from police records, and thus records only those instances in which an FIR relating to the death by suicide has been registered. It excludes instances for which no police records exist. There are many socio-economic and political reasons for cases to not be registered, and the NCRB analysis overlooks them.
Another major drawback with the NCRB data is that it does not classify the data according to age, gender, caste and school-level – thus stopping short of facilitating focused structural reforms and policies to avail emergency care.
More broadly, suicide is low on the list of India’s public health priorities, concerned as they are chiefly with infectious diseases and noncommunicable diseases. Its increasing medicalisation and psychiatrisation mask its critical nature, and it should in fact be treated as a public health emergency. The British psychiatrist Joanna Moncrieff wrote in 2021,
“… rejecting the medicalisation of so-called mental health problems is necessary for revealing some of the fundamental contradictions of capitalism and laying the groundwork for political change.”
As sociologist Emile theorised Durkheim in his famous work, Suicide: A Study in Sociology (1897), suicide is not a psychological phenomenon; instead, it is sociological because it is the result of how a person has been regulated and integrated into society.
Our larger socio-economic and political discourses determine our education, well-being and the character of the policies that guide our professional and social responsibilities. So the discourses – including those on suicide – should be such that they improve people’s lives. This is how we will also be able to materialise the WHO’s definition of health (emphasis added): “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”
Pankaj Kumar Mishra and Harinder Happy are PhD scholars at the Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi.