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    Tuesday, 21 May 2019

    SUICIDE AND DEPRESSION: The Nigerian Context By Dr. Uzoma Chukwuocha

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    THIS topic does not rank in anyone's top ten favorite topics for pleasant discussion with friends or family. It's not an easy lift. It gets even heavier when you are personally  or even remotely affected. The best we can do at all times is to have a good dose of empathy when discussing this topic. Always keep in mind that it's not about you, but about the afflicted and affected amongst us. Having established that premise, let's try and see if we can begin to understand this malady and perhaps down the line we may start to find a way to reduce and control the scourge.

    Out of respect to the families and friends of the recent victims of suicide in our society, I'll not be rehashing those cases on this page. More so I cannot claim to know them, their stories, or what led them to that point of definition. We would rather do what I believe they would hope we do with their misfortune; use it to shine the light and educate ourselves on these issues.


    Depression and suicide are related the way nausea and vomiting are related. One often leads to the other. In the same vein, early recognition of one may lead to its control and eventual prevention of the later sequel. That said, I'll be the first to admit that this analogy over-simplifies the problem-solution correlation. A patient stepwise approach would give us a better grip and a more foundational understanding of depression and suicide.


    Depression as a communicative expression of an emotion is completely different from Depression as a medical condition. Sadness, grief, self-pity, all fall into that same category as the earlier. They are emotional reactions to events. They are expected, they last only so long, and they often eventually slowly fade away. Each person reacts and responds  differently to these emotions. The stoic and strong amongst us may not even show these emotions or show only a glimpse of it. They bounce right back and keep on moving without faltering in their stride. The not so stoic and strong may suffer a bit more, show a bit more, cry a bit longer, then heal slowly. It's a spectrum, we all fall in somewhere one and all.


    Depression on the other hand is a medical condition just like diabetes and hypertension. You can control it, but you can't just will it away. It is as real and as present as the morning sun. Sufferers deserve our empathy. I know a lot of them.

    You can be too full after a heavy starchy meal, your blood sugar would be high as a result, but that is not the same thing as being diabetic. The diabetic patients have a biochemical problem that affects their ability to control their blood sugar levels, they need help with that. It is not enough for them to take a walk to get their blood sugar down, like after a heavy meal in a non-diabetic person.

    Depression is a Neuro-biochemical imbalance in the brain. It involves a deficiency in some neurotransmitters that have to do with our moods and sense of wellbeing. This imbalance makes the affected person more prone to low mood, poor sleep, unable to fully enjoy recreational activities, even in the face of seemingly successful life outlook. Many prominent figures in history were known to have struggled with Depression, Bipolar disorder and other mood disorders at some points in their lives. The list includes Douglas Adams, Isaac Newton, Vincent Van Gogh. In 1621, Robert Burton wrote Anatomy Of Melancholy solely based on his own experience with depression and his observation of other similarly afflicted individuals. His work formed the foundation for further studies of mood disorders.

    According to the Society Of Family Practitioners Of Nigeria (SOFPON) only one out of every five patients with clinical depression get any treatment at all, and only one in fifty get the right kind of treatment that they need. World Health Organization says 3.9% of the Nigerian population (that is seven million) suffer from clinical depression. The socioeconomic plight of the average Nigerian, fueled by corruption, definitely has something to do with this depressing statistics.

    People with clinical depression are more prone to the effects and bad outcomes of life misfortunes like bereavement, job loss, rejection, failure et al. Nonetheless, they do not necessarily need these triggers to go off the deep end. They just make it easier.


    Depressed patients are more prone to suicide than the average person. However, not all depressed patients commit suicide, and not all suicide victims are depressed. But like in a Venn diagram, a good chunk of these two circles overlap. We all know what suicide is  (one takes his/her own life) and we have explored how it relates to depression and otherwise.  World over, about eight hundred thousand people commit suicide every year, translating to one suicide every 40 seconds (WHO). Of the 183 countries with high suicide rate, Nigeria ranks 30th in the world and 10th in Africa. Only in 2017, Nigeria recorded 332 cases of reported suicide. Rivers State alone accounted for 103 of these cases, that is 31% (Nigeria Bureau Of Statistics).

    These numbers possibly only scratch the surface. A good number of suicides in Nigeria go unreported for obvious reasons. Chief among the reasons is shame and stigma. Many ethnicities in Nigeria believe that suicide brings a curse to the family, hence a ritual is done to appease the gods, and any further discussions of the issue are very limited. 

    To make a bad case worse; Nigeria has a law against suicide or attempted suicide (section 327 of the Criminal Code Act), that carries a sentence of one year jail term if convicted. Noteworthy that we do not have a law (Suicide Act) that outlines the role of government in helping to prevent suicide or manage survivors. This embarrassing law is a vestige of colonial rule, but the British have gone on to enact a well detailed Suicide Act since 1961. Guess we forgot to copy and paste that after Independence. A rare silver lining in this grey cloud is the Lagos State government that decriminalized suicide in 2015, and mandated that they (survivors) be treated instead. At the national level, it is still business as usual.


    Religion has also played a hand in the stigma associated with suicide. There is a strong belief amongst Christians that suicide is a judgement and condemnation to eternal damnation all by itself. Suicide victims are believed to be going straight to hell for eternity. This belief puts believers in a peculiar place where empathy is hard to come by and judgement is in full supply. When you consider that the average Christian is running a lifelong race to haven, you start to understand why it's hard for him/her to feel sorry for someone whom they think willingly chooses to go to hell. You hear Christians say things like 'I reject it' and 'it's not my portion' based on this line of belief. Based on their beliefs, they have their point. We are not here to judge. We are only asking for just a little love and empathy. There's a victim here. There's a grieving trail of family and friends left behind. They are dealing with a barrage of conflicting and painful emotions; guilt, loss, anger, denial, doubt. Judging them or the victim only deepens their pain. If God is Love, then let love lead the way. Not judgement.

    The Church is well positioned as often the first point of contact with the emotionally troubled amongst us. They come to the pastors willfully sometimes, families bring them other times, or complain to the pastors about changes in behavior noticed at home. If pastors know the early signs of clinical depression, they may help in counseling these families and patients to seek sound medical help. This should not stop the pastor from continuing with his prayers for the family and patient. It's not an either-or kind of situation. When both are applied well and in the right sequence, they have a synergistic effect.


    Government could do a whole lot better than is presently the case. For starters, we need a National Suicide Act that would have a well detailed suicide prevention modality, which should include all the levels of preventive medical care (primary to tertiary). Law makers should not wait to be lobbied to do this. I want to believe there are some trained medical practitioners amongst our law makers. This should be up their neck of the wood. NMA, SOFPON, NURSING COUNCIL, all could push in one direction regarding this. The private sector and NGO's have done a lot in this struggle. In the absence of a centralized government plan for suicide prevention, a group Nigeria Suicide Prevention Initiative has one of the first Nigeria Suicide Hotlines 08062106493, 08092106493. The telecom companies can also help in this regard by coordinating efforts to come up with a simpler toll free number in this regard.

    Laws alone will not solve the problem. The bulk of the heavy lifting will be done by medical practitioners. Starting from educating patients and families on the signs and symptoms of clinical depression to look out for. Detailed and repeated screening for depression, substance abuse, in patients during routine and all medical visits.


    The ground zero of depression and suicide is the family unit. This is where the impact and pain is felt most. This is also where the earliest signs can be detected and preventive measures could be most effective .... If and only if the family is made aware of what to look out for and what to do when the red flags are noticed.

    Love and communication are the two most crucial tools the family needs to make a positive impact in this battle. Offer the victims and each other love and support. Communicate your concerns with your Doctor, Pastor, Imam (whom hopefully would counsel them to seek professional help, while also praying for and with them). DO NOT JUDGE OR BLAME THE VICTIM. Offer them your support, presence, listening ear, a shoulder to cry on. Anything, just be there for them. Sometimes it's just a cloud and it will pass, they just need companionship within that darkness.


    Written by Dr. Uzoma Chukwuocha

    Dr. Uzoma Chukwuocha is a Nigerian trained MD, practicing in the US. He is working on his first book.



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