Warning: This article contains material that may be sensitive.

Manila (CNN Philippines Life) — When we see, hear or read about a stranger or celebrity taking their own life, most of us feel utterly powerless: in person, there is a stillness in the air in the wake of the news, a sadness difficult to articulate, impossible to act upon. Online, there is a storm of hotlines — posts that people would retweet, share or reblog “to save a life” — that tends to quiet down a number of days after the fact. We all know that this is not enough, but are often at a loss as to how to even talk about suicide.

According to 2015 data from the Global Burden of Disease Study, suicide rates in the Philippines are up to 1.9 for females, 5.8 for males, and 3.8 for both sexes for every 100,000 of the general population. Data from the same study in 2016 sheds light upon our mental health problems: we have close to 9 million prevalent cases of mental, neurological, and substance use disorders, 3.3 million of which are anxiety disorders, and 2.6 million of which are depression.

There has been an increased awareness towards mental health in recent years. Our national mental health law’s Implementing Rules and Regulations was signed just last month, indicating a bright future for mental healthcare in the Philippines. However, when it comes to suicide, policy changes will not be immediately felt by service users, and the job isn’t for advocates alone — apart from talking about the reality of suicide, it is just as important to examine our attitudes and beliefs that may be contributing towards the stigma against it.

We speak to a number of individuals, whose lives have been affected by suicide in different ways, about the Filipino discourse on suicidality (i.e. thoughts, ideation, plans, attempts) and the act of suicide.

Advocacies close to their hearts

The Philippines has a number of sincere mental health professionals and advocates. Dr. Dinah P. Nadera, UP Diliman’s University Health Services’ resident psychiatrist and president of the Advanced Wellness, Instruction, and Talents (AWIT) Foundation, recalls having been deeply affected by losing patients due to suicide: “For quite some time, I refused to see someone who was suicidal. We have lost close friends due to suicide. Families were devastated and grieved for years. We still shed tears when remembering, but keep thinking of the beautiful but short life lived. Devastation, guilt and regret are the common words to describe the feelings, but no words can express it, to be honest.”

Mental health advocates often do their work with personal experience at heart. One such example of this is Valene Lagunzad, the co-founder and executive director of Buhay Movement, a nonprofit organization for mental health awareness and suicide prevention.

“Anyone who has experienced loss because of suicide is never easy. I have lost a friend to suicide and I still visit her in her columbary every now and then.” Her friend was a co-founder of the movement as well, and ended her life in 2016.

Despite this tragedy, Lagunzad and her fellow Buhay Movement co-founders have not given up on their advocacy: “The incident left us with a lot of questions, a lot of what if’s and why’s, and we kept on thinking on what happened, what could have been done,” says Lagunzad.

“We have coped in our own ways and still continue to grieve, but are a bit more hopeful every year.”

Lagunzad knows that Buhay Movement is far from alone, and points out that she now knows upwards of 25 groups advocating for mental health awareness and suicide prevention fighting alongside her own cause.

For journalists reporting on suicide, guidelines should be stringently followed: minding one’s language (e.g. instead of “committed suicide” or “failed attempt at suicide,” say “died by suicide,” “ended their life” or “attempt to end their life.”), refraining from discussing method and location, and providing mental health resources are among the common best practices outlined by these sites.

Media’s role in portraying suicide sensitively

Public perception of suicide is shaped immensely by its portrayal on film and T.V., which range from well-meaning but misled, to simplistic and stereotyped. Both international and local media portrayals of suicide have been put into question for reducing the complex biological, psychological, and social factors into mere plot points.

While it may be easy for some to brush these depictions off, it is important to keep in mind that these skewed portrayals of suicide may be the only kind that others see.

Sophie*, a 26-year-old editor who has lost a friend to suicide, remembers that she saw “a telenovela scene as a kid where a woman, after a fit of hysterical crying, drank a bottle of bleach… We see it in various media [forms] daily, but stumble when we talk about real-life victims in our own country.”

For journalists reporting on suicide, guidelines (such as those on Mindframe and Samaritans) should be stringently followed: minding one’s language (e.g. instead of “committed suicide” or “failed attempt at suicide,” say “died by suicide,” “ended their life” or “attempt to end their life.”), refraining from discussing method and location, and providing mental health resources are among the common best practices outlined by these sites.

Dr. Nadera points out, though, that Philippine mass media is still riddled with bad practices. “Sa news articles, may sensationalism, may insensitivity, may mga judgments pa sa iba at wala namang ibinibigay na lead kung saan magpapatulong,” she says. “Sa radio, may narinig pa akong ini-interview ang namatayan. Napakawalang-galang. Sa T.V. naman, may association with crime, violence, and gross psychotic behavior.”

She explains that these reports are generally well-meaning and just people doing their job, but this kind of reporting may stigmatize suicide and other mental health problems to the general public.

Going beyond retweeting hotlines

Lagunzad muses on the benefits of social media for suicide prevention. “We still have a long way to go, but it has [changed] a whole lot compared to a decade ago. Social media played a huge role in making us aware despite its disadvantages,” she explains.

It’s no secret that Filipinos are heavy social media users, our lives now inextricable from websites such as Facebook and Twitter. The instantaneity and reach of these platforms has implications about how we talk about both suicide and mental health issues at large. Through social media, it can be much easier for those who are struggling to access help or get in touch with their support system.

Julian Mauricio, a 33-year-old journalist diagnosed with borderline and obsessive-compulsive personality disorders, anxiety and depression, has attempted to end his life five times. He talks about his attempt in 2015: “I was not in my right mind. For borderline personality disorder (BPD), the main issue is abandonment, and I was feeling pretty abandoned by those I considered important to me in my life. At the time, I was experiencing a psychotic break. I typed up a suicide note on Facebook, which a lot of people saw — my boss, my friends, my family — because of my Facebook post, they went on a manhunt to find me.”

Fortunately, someone found him before he could do anything to hurt himself, and he was assisted to safety. Still experiencing a psychotic break, he remembers only vague flashes: being carried by a guard, with Tinna Bonifacio, his mother, and Tim Macardle, his close friend, appearing shortly after.

From Mauricio’s Facebook note, his mother and his close friend at a nearby condominium were able to run to his aid. However, the reactions to the post were mixed: “Unfortunately, some of the reactions I got were ‘Ang KSP (kulang sa pansin) mo,’ ‘hindi ka dapat mamatay dahil didiretsyo ka sa impyerno,’ ‘life is beautiful so bakit ka magpapakamatay?’”

He also expresses frustration towards halfhearted platitudes: “When it’s a celebrity who attempts to end their life by suicide or admits to having a mental health problem, the whole world cares. It’ll last for about two days, three days, tops. After a while it’ll go back to normal, parang walang nangyari. If it’s someone they know in real life, they’ll say things like ‘hindi ‘yan ang solusyon,’ or ‘pray na lang.’”

Given the comments on Mauricio’s note, it is clear that social media is a double-edged sword in terms of mental health.

Suicidal symptoms cannot be prayed away

Theological responses to mental health problems are valid, but not for everyone, especially when the the act of suicide is judged due to religious belief. Jai*, a 22-year-old student, has lost a loved one due to suicide. Throughout this personal tragedy, he could not help but notice the underlying beliefs that friends, family, and acquaintances had.

“It’s sad, really. Being rooted in Christian values, suicide means loss of contact with God,” he says. “[Filipinos are] starting to become open to it, but their frame of reference is very medieval and spiritual, rather than medical and psychological.”

Religion, specifically Christianity here in the Philippines, has to do with the most common reactions to suicide. Mauricio’s aforementioned comments about eternal damnation and praying the suicidality away are all too common in our predominantly Roman Catholic country. “People need to rethink the notion na kasalanan siya sa Diyos. Even the people who attend bible studies, volunteer as ministers, attend church camp, these people are not exempt from feelings of suicidality. [Suicidality] is a symptom of mental illness, and even the most religious people may get sick,” he explains.

Lagunzad, a practicing Catholic herself, believes that people who say these kinds of religiously charged statements are well-meaning, but lack awareness. “We cannot really blame them for their lack of openness, but we have to keep on educating them. We have to keep trying,” she says.

“It is also a learning experience for me, since I was also unaware of how to handle such a sensitive issue. Do not spiritualize the matter. If you want to pray for them due to your beliefs, pray for them quietly or at least ask for permission.”

We all mean well, but this is far from enough for those hurting everyday from the grief of a loved one ending their lives; thoughts and prayers are not nearly enough for those who wrestle with suicidal thoughts and feelings, each day to get by an unsung tragedy in itself.

Filipinos may be afraid to ask for help

Dr. Nadera speculates upon the cultural landscape that shapes the way we talk about suicide: “To begin with, we have a problem with health literacy, [as well as] really bad health-seeking behavior. It is a mix of reactions, depending whether one has survived suicide or has any direct experience related to it.”

Could classic Filipino hiya be negatively affecting our ability to access the mental health services we need? As a people, we have taken to indirectness. Dr. Nadera underscores Filipino characteristics: “Sa mga Filipino kasi, may kasabihan na ‘tulak ng bibig, kabig ng dibdib,’ kaya madalas ang comment ay ‘sinasabi lang niya ‘yan.’ On the other hand, may ugali din ang Filipino na nakikiramdam, mayroon tayong pakiramdam sa isang pahiwatig. Kaya lang, ibang makipag-usap ang Filipino, hindi ito diretso, kaya pati pakikipag-usap tungkol dito ay pahiwatig din.”

Our proclivity towards indirectness, combined with the self-isolation of mental health conditions, makes talking about mental health issues more like reading between the lines.

Education and support are necessary

The general consensus among interviewees boils down to the lack of awareness of mental health problems. Mauricio’s attempt at ending his life in 2015 was his fourth attempt. It was only then that he was finally able to receive the care he badly needed.

Since seeking help, he has become much more aware of his conditions and comorbidities, and has found out a lot more about BPD in relation to suicide. He shares, “Mataas ang suicide rates ng BPD. Almost 80 percent of those with BPD report a history of suicide attempts, while actual rates range from 8-10 percent.”

Mauricio now holds down a job as the breadwinner of his family while simultaneously caring for his mother, who is recovering from a stroke. “My mom was the one who was there for me for all my five suicide attempts. When I was the one who needed help, she didn’t give up on me, so I will not give up on her.” His story is one of recovery — a testament to the necessity of mental health education and a strong support system for those with mental health needs.

We all mean well, but this is far from enough for those hurting everyday from the grief of a loved one ending their lives; thoughts and prayers are not nearly enough for those who wrestle with suicidal thoughts and feelings, each day to get by an unsung tragedy in itself.

Lagunzad recalls the callous words and attitudes of those who did not quite understand the gravity of suicide: “At times, people do not take it seriously and have no empathy towards others affected by suicide. Either they get angry and say it's a sin, or react violently saying it's their fault or their choice. However, the most unkind response for me will still be indifference.”

*Names have been changed upon the request of the interviewees.

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