Girls are under more stress all over the world including Pakistan and making a suicide attempt is a sign of extreme distress, experts say. - Photo by AFP

“Yaqoob shot himself dead with a pistol at his home after his father, Kaleem, scolded him for not taking interest in his studies,” reads a report on the National pages of today’s newspaper.

It goes on to add: “Mr Kaleem told police that his son was unwilling to go to school due to bullying by his class teacher. He said that he would also scold Mr Yaqoob whenever he resisted going to school. Frustrated with the harsh attitude of his father and teacher, Mr Yaqoob went home and shot himself dead with a pistol.”

Fourteen-year-old Yaqoob was the fifth such teenage student to take his life within the span of two weeks.

Teenage is the best of times and also the worst. It is the age of innocence mixed with a little foolishness. On the threshold of a carefree childhood and a wiser adult life, the world is their oyster, when nothing seems impossible as they strive to reach for the sky.

So when one hears of five young teenagers committing suicide in such quick succession, one cannot help but wonder what happened to a life of fun and frolic snuffed so callously.

Eighteen-year-old Khursheed studying at Islamabad Model College for Boys shot himself with his father’s pistol when his father scolded him for refusing to take an entry test; 17–year-old Shan from Gharibabad swallowed poison after his parents attempted to stop him from spending time with friends and not concentrating on studies; seventh-grader Abdul Mobin in Abbottabad who took his life because of torture at school and a 13-year-old student in Karachi hanged himself by the ceiling fan after he failed in exams.

Why would young people get so bored with life just as they enter its most exciting phase?

“If they don’t have the right balance of opportunities, resources and hope, they can get ‘bored’ and hopeless,” explains Dr Murad Musa Khan, chairman of the Department of Psychiatry at Aga Khan University Hospital, Karachi.

Perturbed by the recent suicides, Khan says there is every reason for concern because “even one suicide is one too many”. He sees “lots” of young people, some even as young as 12, who have attempted suicide because of “academic pressures, relationship problems, identity problems, parental discord, use of drugs, bullying (including cyber-bullying)”. In addition, there are many, he says, who suffer from low self-confidence and low self-esteem.

However, Karachi-based clinical psychologist, Dr Asha Bedar, does not believe child or teen suicide is a result of boredom. “It’s usually about either mental illness (e.g., depression) or emotional disturbance caused by circumstances.”

While many adults associate childhood/teenage with fun and a carefree outlook towards life, Bedar points out: “unfortunately, that is not the case for many children and young people around us.”

Like adults, she says, many children and young people suffer from mental illness, such as depression (often undiagnosed and therefore untreated in a country like Pakistan) and extreme emotional distress or disturbance caused by circumstances around them.” During her practice, she sees many young people who have attempted but “even more who have thought about suicide”.

Bedar emphasises that other than a mental illness, abuse has been one of the most common issues which many young people, who come to her, have suffered from. “This could be exposure to severe violence at home - perhaps a home environment characterised by tight parental control, terror and sadness. Or it could be ongoing exposure to severe physical violence/bullying outside the home, sexual abuse (including rape), cyber-bullying, blackmailing.”

The reasons why young people (aged anywhere 14 to 24), or even younger, commit or attempt suicide, are multiple says Khan. Usually, however, a combination of “life stresses and a vulnerable personality” veering the person towards depression, with “hopelessness” as a predominant feeling, leads on to suicidal behaviour.

According to the independent 2012 annual report of the Human Rights Commission of Pakistan (HRCP), poverty and an uncertain future are turning teenage girls in Karachi to end their lives.

Citing the National Poison Control Centre, at Jinnah Post Graduate Medical Centre, in Karachi, HRCP’s annual report for 2011, reported that there were 1,153 attempted suicides across Pakistan and 2,131 suicides in 2011 with five or six teenagers attempting suicide every day in Karachi. Of these, 60 per cent are teenage girls and families are reluctant to register the case as attempted suicide.

In 2002, the World Health Organization estimated that over 15,000 suicides were committed in Pakistan, but Khan estimates it to be “probably about 5,000 to 7,000 suicides” annually. In addition, he says, there are approximately 50,000 to 150,000 cases of attempted suicides. The majority of suicides and attempted suicides are in people under the age of 30 years.

Of these, he says, approximately 25 per cent of the cases would be in the teens. “These figures are the best estimate one can ascertain from all the studies on suicide that are available,” Khan tells Dawn.com.

In almost all settings all over the world, including Pakistan, says Musa, more girls than boys attempt suicide but more boys commit suicide than girls.

“Generally speaking girls are under more stress all over the world including Pakistan and making a suicide attempt is a sign of extreme stress/distress,” he says.

But why are young people in Pakistan so troubled?

Musa has no qualms about putting the blame squarely on the adults. “Because the elders have failed to provide the young with a safe and secure environment for them to live and prosper under,” he says, adding: “Just drive around on a Sunday and see the number of young boys playing cricket on the roads or dirty grounds. Why can’t proper grounds and equipment be provided to these young men?” He thinks the issue of suicides is both a human rights one and a fundamental rights one.

Dr Shifa Naeem, a Karachi-based psychiatrist, believes today’s teenagers “are exposed to many more stresses” than their counterparts were a generation or two back.

“Expectations are higher from them, while support systems are weaker,” she says explaining the scenario by taking two imaginary profiles of a teenager from the 1960s and one of today.

“The young teenager from the 1960s was spending some time of the day in physical exercise (as it used to be mandatory); he or she would have good chances of having an involved and committed teacher who’d also be a mentor. In addition, parents, too, were spending more time with them and life was generally simpler.” On the other hand, Naeem points out, the teenager of today is “expected to excel in studies and studying at a school which the parents can feel ‘proud’ of, should also look cool and be popular with all the kids at school, should have more friends on Facebook than the rest, have a glamorous life-style (similar to the one he or she sees on the TV and which includes marijuana, cigarettes and alcohol).”

That is not all. “A poor law-and-order situation and the helplessness and a sense of hopelessness prompted by injustices and 'might is right' – they all add up,” she concludes.

Bedar is of the view that while children are “typically resilient” and get over a difficult period; professional help must be sought for mental illness.

“One isolated incident does not cause a child to contemplate or attempt suicide - it is usually an ongoing chronic situation (for instance, abuse/violence at home or at school, debilitating poverty, etc.), something that makes the child feel completely helpless, fearful and trapped like there is no way out and no hope. One incident can, however, be a trigger, pushing a child/teenager over the edge, serving as the final straw,” she explains.

The more worrisome factor is that while some get “cured” so to say, many attempt and re-attempt and eventually succeed in killing themselves.

“The chances of a person re-attempting increase greatly after one attempt as the person crosses a certain threshold and the fear of the attempt is decreased,” says Khan, adding that he/she finds it easier to attempt it again.

“In many cases, the underlying psychological stressor is not addressed, though medical treatment is given (stomach washout, antidotes, among others). Each suicide attempter, he says, must undergo a psychological evaluation and the underlying psychological problem must be addressed.

Khan also emphasises that the way media reports the issue has a major impact on suicide attempts and suicide rates. “If it is glamorised and portrayed in such a way that it sounds that suicide is an acceptable way of dealing with life’s problems than it gives encouragement to other vulnerable people who may be in the same situation as the one who has committed suicide.”

Therefore, he adds, it is important for the media to also report that suicide is not the way to deal with life’s problems, that there are other healthy ways to deal with problems and to give names and contact details of where people in suicidal crisis situations can seek help.” There is a 24-hour psychiatrist available at the AKUH for any emergency including suicidal emergency, he says.

In addition, recently the Aman Telehealth has started a 24-hour telephone hotline where trained counsellors can help people in distress. The number is 111-113 737.

“Our counselling is both medical and psychological,” says Jennifer Younas, working at Aman Telehealth. Started just six months back the response has been tremendous. However, she says not many people know that they provide life-saving help for suicidal emergencies. “You can say for every 100 general calls (including seeking counselling for chronic diseases like blood pressure, heart problems to psychological disorders including schizophrenia, depression anxiety etc, we get two cases where help is sought for suicide,” Younas points out.