Jo* had a career that was on track and would let him become director of sales at a plush hotel in Bangkok before Covid-19. He took great pride in being able to afford the fine things in life for his wife and children.
However, when the 45-year-old was made redundant overnight due to the pandemic, he found himself emotionally vulnerable and unable to cope. Even though his wife, who still had a job, was bringing in some income to help cover the family's daily expenses, Jo fell into a deep depression that led to insomnia that lasted for weeks. His family encouraged him to see a psychiatrist as his mental health had begun to deteriorate. However, he decided not to and that began the spiral of decline and his ability to reason with his self-harm behaviour often going undetected by his family.
After a couple of unsuccessful suicide attempts, Jo ended his life with a bullet to his brain, using a firearm belonging to his uncle.
Cases such as Jo's and others have contributed to the rise in suicides reported recently by the Department of Mental Health, which announced that last year the number of deaths had spiked to 7.3 per 100,000 people, the first reported climb in approximately five to six years. Factors attributing to this rise included interpersonal relationships, chronic physical and mental illnesses, and the economic fallout of the Covid-19 pandemic.
To better understand the phenomenon behind the rise in suicides in Thailand, psychiatrist Dr Kraisit Narukhatphichai said one has to first realise the internal and external factors that can lead to it.
His professional take is that the most obvious reason for a jump in the number of suicides is a person's inability to cope with the enormous external pressures of life that are beyond the person's control with financial and health-related issues as being the most prevalent.
"What we are seeing today is that external factors and the pressure on individuals to survive have risen exponentially in the last couple of decades. One of the most profound impacts has come from the education system where there is an intense and competitive environment to succeed where we look forward to a promising career path and thus stability," said Dr Kraisit.
"Of course, there are other underlying factors and trigger points such as climate change that impact our emotions we have no control over but still overwhelms us. Other factors contributing to a decline in Thai people's mental health is the ongoing pandemic. Today, people find themselves struggling to cope with the external issues in their life while internal factors such as family support have weakened as there is an acute lack of family time. The family unit can become both the solution to a person's problem as well as its root cause."
Regarding Covid-19 and its impact, he said that for many it has been the survival of fittest not only in terms of staying financially afloat but also emotionally. He said people that are emotionally strong can navigate their way in these trying times while others might not be able to tolerate unprecedented events such as the pandemic.
Citing an example, he said a coping mechanism to address financial loss today can involve making drastic changes to one's lifestyle to stay buoyant.
Having said that, he noted that it was easier said than done because people with low coping mechanisms find themselves emotionally distraught, sometimes to the point that they can convince themselves that suicide is the best way out.
Dr Kraisit said among other factors leading to suicide often comes from depression, an impulsive disorder, or psychosis, which can create hallucinations in individuals to harm themselves.
"During a hallucination episode, patients often share how they have heard voices in his or her mind telling them to jump from a high-rise building to save the world from the pandemic. Others have hallucinations of being chased by demons and them jumping off the balcony as they flee."
Dr Kraisit said depression should not be taken lightly because it starts with emotional mood swings.
"It is important to monitor your emotional health. The seeds of depression can often be sewn by emotions that create a sense of gloom and doom. If these emotions are not rectified in the initial stages, it can lead to an inability of that person to see reality in its totality. Loss of hope and a will to live further leads them down the dark abyss. These individuals can become preoccupied with the negativity around them to the level that it creates in them a strong sense of worthlessness.
"This is a very debilitating time for their emotional self as they can begin to entertain thoughts of how leaving this world would benefit everyone around them. Such suicidal thoughts are often gradual and increase with time. Eventually, these thoughts then lead them to find ways to kill themselves. I must say that not everyone who is suicidal has a high pain endurance level and that is why some copy suicides they see on the news which they believe is quick and painless.''
Dr Kraisit said when patients become delusional, they reach a stage where they are unable to listen to reason. This is because due to long periods of stress, the brain's chemicals are altered and medication is the only intervention to help bring them back to some form of reality and rational thought.
According to the specialist, one of the biggest reasons Thais contemplate suicide is economic woes and as a result, psychiatrists and counsellors have to help them see the options they have in navigating a bumpy road back to recovery.
"As these patients are living without a sense of a better tomorrow, instilling hope in them is the best way to start," he said.
Dr Kraisit said that the rise in suicide cases is a clear indicator that society at large is not doing enough to care for their mental health, often seeking medical help when their condition has deteriorated to the level that they require medication for the rest of their life.
He said a collective effort has to be made to involve both the family and the patient's social circle in monitoring the behavioural pattern of such patients and make sure that they are encouraged to seek medical help at the earliest detection of irregular behaviour.
"Early detection is early intervention. While Thais are more open to seeking psychiatric help today, I believe more can be done to encourage people to pay attention to their emotional health by keeping a watch over their daily stress levels. As we shower daily after we reach home to get all the dirt and grime off our bodies, in the same manner, we need to detox our soul each day from the stresses of life. This is where it is imperative for the person to have his or her own private time to indulge in activities that helps them to release stress."
"It is also imperative to keep abreast of one's emotions, so you can better control the manner with which you react to the negative stimuli that might make you react in an impulsive manner."
Dr Kraisit said the manner with which people deal with stress can be a good indicator of one's emotional health.
"Find ways to lessen expectations and become more flexible in your business and private dealings."
*Not his real name.
