As students challenge a name they believe trivialises mental health issues, we look at the the work of scientists trying to understand despair and resilience

Last Sunday marked the official end of exam term at Cambridge University, a day of garden parties and boat races. Over the years, this final Sunday of exam week has has gained the popular moniker “Suicide Sunday”, a tongue-in-cheek suggestion that students should celebrate making it through the stressful exam period without killing themselves.

The name is intended in jest, but the presence of mental health problems among the student population remains a dark undercurrent of university life. A survey undertaken by the National Union of Students found that 1 in 10 experience suicidal thoughts. There are no official figures available for suicide rates at Oxbridge. However, in their guidance to staff, the Cambridge University Counselling Service states that approximately 40-50 students a year accessing the service will have had or discussed serious suicidal thoughts. However, they are also at pains to point out that in fact the confirmed suicide rate is in fact lower than in the general population of the same age.

The fact remains however, that students, particularly those those at “elite” universities, are perceived as being at an increased risk of mental health problems. Consequently, the past few months have seen a widespread student-led campaign to rename Suicide Sunday, as many feel the name trivialises the problems a number of students face during this period, as well as mental illness in general. “I was pleased to see [the campaign],” says Jack Wright, Welfare and Rights Officer at Cambridge University. “Given how many students I see panicking in the aftermath of their exams, the last thing they need is suicide being both normalised as a response and considered funny.”

Campaigns such as the one around Suicide Sunday are a great first step in terms of raising awareness and de-stigmatising mental health issues. Added to this is the increasing body of psychological and neurological research into the root causes of suicide and suicidal behaviour. Professor Danuta Wasserman of the Karolinska Institute in Stockholm has devoted her entire career to understanding what drives people to such intense despair, and how to prevent such tragic events occurring.

Wasserman and others have studied the mindset of suicidal individuals, which is almost always characterised by a deep lack of self-worth. There is no common route to reach this state of mind, which is why suicides can be extremely difficult to predict, but Wasserman believes that clues can actually be found by looking at the personalities of these individuals.

“Personality is inborn, it is shaped by our genetic set-up,” says Wasserman. “And there are certain personality types which can make people more vulnerable to this type of thinking. For example those who are more impulsive and aggressive. When they feel they cannot cope, they become very, very angry. And also pessimistic personalities, people who struggle to see anything of value in front of them. It is not uncommon that people who are highly ambitious are also very easily hurt. When they cannot achieve their goals, they start to think, ‘I am not worth anything so why should I fight [any]more.’”

Wasserman strongly believes that those prone to impulsive or depressive thinking should be encouraged to attend psychotherapy classes, even while in high school, to learn how to cope with their own personality and demands along with the everyday challenges of life.

But while suicidal thinking can be inbuilt, actually following through with the act is not. “Suicide is never a destiny,” Wasserman says. “Genetic predisposition is like the colour of your eyes. It affects your personality, your expectations, how you perceive the world, even what it means to be lonely or not, but it is not enough. This is only 50% of the story. The remainder is still your environment and the interaction between genetics and your environment which means a lot can be done to counter this biological vulnerability.”

The shift from thoughts to actions requires a certain disassociation with reality, which is why suicide often goes hand in hand with the onset of a disease such as depression or schizophrenic delusions and paranoia, as in the recent death of Kalief Browder. Browder spent three years incarcerated in New York’s Rikers Island prison despite not being convicted of a crime, suffering physical abuse and going on to develop schizophrenia-like symptoms.

Our ability to rationalise and put things in perspective can also be heavily influenced by lifestyle choices such as physical exercise, alcohol and substance misuse, diet and sleep. The latter factors are often heavily compromised during university life and their combination with stress, peer pressure, a competitive environment and an underlying biological vulnerability can push people to the edge.

“We know quite a lot about how both lack of sleep and the combination of alcohol and drug-taking can push vulnerable individuals to suicidal behaviour,” Wasserman says. “Sleep is very important for the biological system to recover. There are many factors like this which don’t get enough attention and need to be more heavily researched. They mean that you’re unable to function in your usual way, and then any external factors such as family problems, economical problems or relationship problems end up driving you deeper and deeper into a dark hole.”

While depression is behind many suicide cases, there are also many depressed people who do not commit suicide. Researchers are trying to understanding the factors which can increase resilience, and time and time again one of the key elements is the person’s ability to perceive that they have a strong support network.

“Because of their state of mind and a lack of physical and emotional strength to interact in the proper way, these vulnerable people are usually very isolated,” Wasserman says. “When a person’s depressed, it’s very important not to leave them alone. It doesn’t mean you need to disturb them all the time, but it is very important that people are around and can help with everyday things to let the person come back to their previous state.”

One of the prevailing stereotypes in science is that resilience has a cultural element, and people of certain nationalities are not so easily driven to the edge. Over the past few decades, anthropologists concluded that while depression is a universal condition, people from Asian countries may express the symptoms in different ways to western societies. They found that their distress tends to be manifested more in a somatic sense – aches in different parts of the body – while in western culture depressed individuals are more likely to experience cognitive symptoms such as low self-esteem, lack of interest and fatigue.

This has led to the belief that Asians may be more naturally resilient to sinking into a suicidal mindset, but more recent research has challenged this conclusion, one that Wasserman believes is highly dangerous. “I don’t think you can link culture to suicide rate,” she says. “Look at countries such as Italy and Lithuania which are both Catholic nations, and religion is known to enhance a sense of cohesion and belonging. But Lithuania has a far higher number of suicides. And with the rapid globalisation, our cultures are becoming more and more similar. A study conducted in a small village in Vietnam showed that people with a suicidal mindset would often behave recklessly or violently. These are not somatic symptoms, they are behavioural expressions of despair. And in our own culture, some people’s discomfort will be manifested through physical pain rather than verbal or behavioural expression.”

Instead she believes it is more effective to look at global similarities in expressing such extreme emotions, to identify the best ways to help and understand the deficits in our societies which prevent more people getting the help they need. “There are a lot of similarities, and not just in those who attempt to commit suicide, but in the environment they live in. All over the world, we are not used to noticing or helping others in need. We feel we don’t have time, don’t have the skills, or are simply afraid to approach people who are not feeling well. I see that across all cultures.”

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