Thursday, November 3, 2016

Indonesia - Why artists die young: A tale of suicide and mental health

Every year, nearly 800,000 people commit suicide. Suicide was the fifth leading cause of death among those aged 30 to 49 in 2012, globally, and the second in the 15 to 29 age group. The International Association for Suicide Prevention (IASP) and the World Health Organization (WHO) are committed to preventing suicide.

Suicide is complex because it has no single cause. Suicide is most of the times caused by a combination of many different factors, such as psychiatric disorders, social pressure, psychological trauma, biological factors, genetic factors and physical disorders.

Data from psychological autopsies carried out in 1999 showed that mental illness was among the major factors for suicide with more than 90 percent of suicide cases accompanied by mental disorders. Based on data from the Indonesia Health Research (Riskesdas) in 2013, the prevalence of severe mental disorders (psychosis or schizophrenia) in Indonesia's population was 1.7 per 1,000 people. The prevalence of mental emotional disorder in the population aged 15 and above was 6 percent.

Previous research shows that artists were more susceptible to committing suicide than other population groups because of the ostensible prevalence of mental disorder in artistic people. Two contemporary painters, S (1973-2003) and A (1975-2005), both decided to end their lives by hanging themselves in 2003 and 2005, respectively.

This is my story of performing a psychological autopsy of the two deceased painters.

Coming to Yogyakarta

I tried to locate S’s and A’s paintings in Yogyakarta and a curator introduced me to their family members and fellow painters.

I managed to find the locations of the deceased painters’ rented houses. One of the painters committed suicide in a rented house in Yogyakarta while the other did it in his parents’ house in Magelang, Central Java. There was a similarity to both houses: quiet and isolated, providing an opportunity for a painter to seek ideas, think, and reflect.

Both painters hung themselves at the age of 30, still considered within the young adulthood group, according to Erik Erikson’s psychosocial development category. At this stage, people share themselves more intimately by exploring relationship toward long-term commitments with someone other than family. Successful completion of this stage can lead to comfortable relationships and a sense of commitment, safety, and care within a relationship. Avoiding intimacy, fearing commitment and relationships can lead to isolation, loneliness, and sometimes depression.

Back in Jakarta: Psychological autopsy

In my psychological autopsy on photos of the paintings by the deceased painters and the interviews with family members and fellow painters, I found streaks of psychopathology appearing. 

S’s psychopathology began to appear with a change in behavior beginning 2001. He complained of hearing voices that he felt as an attack against himself (auditory hallucinations). He felt that he was being harmed by black magic and persecuted by those devilish people (persecutory delusion). Approaching his death, he felt his hands were rotting and ravaged by maggots (bizarre delusion). Affective components can be seen from the great energy he had in painting various paintings of great size, day and night without stopping, and sadness towards suicide. Meanwhile, A experienced dominant psychotic symptoms, such as auditory hallucinations, delusion of being controlled, and persecutory delusion. There were somatic symptoms and sadness toward the end of his life. Family witnessed him cry and lose interest in painting.

Protective factors did not prevent them from committing suicide. S showed social withdrawal prior to suicide. He also came home and showed worsened psychopathology, but the family did not take him for psychiatric treatment. A turned to religion but was misguided by a spiritual healer. Both had precipitating factors: S got dumped by his girlfriend, while A became increasingly desperate with his illness and showed warning signs by saying he wished to die and bought rope at the nearest warung. He even came back to look for a longer rope.

Family history also plays a major role. S had no family history of suicide or substance abuse. Neither did A, but A’s brother showed signs of psychopathology in auditory hallucination.

An expert, Dr. Eugen Koh, who is a psychiatrist from the art psychiatry unit of St. Vincent's Mental Hospital, director of the Dax Collection and Anthony White Lecturer in art history at the University of Melbourne, has also helped me analyze the paintings.

Koh analyzed the photographs of the paintings I sent through e-mail and came up with possible differential diagnoses. A definite diagnosis was not possible because the deceased painters did not undergo psychiatric interviews. 

Koh’s Differential diagnosis on S:

Possible schizophrenia and schizoaffective with narcissistic personality traits. Narcissistic Personality Disorder tends to use the defense of mania. There seems to be an impression of mania (visible from the habit of painting the whole night while singing) in the early stages of his psychosis.

Koh’s Differential Diagnosis on A:

Possible schizophrenia or anxiety neurosis with episodes of depression with obsessional personality.

Are these differential diagnoses stigmatizing their suicide? No. These diagnoses are evidence that mental illness should have been treated like any other disease before it leads to suicide.

I conducted my research in 2008, until now, no further research has been done on this psychological autopsy level. 

Stigma often inhibits the reporting of suicide cases so that not all cases are reported. In many countries, suicide cases are underreported. The World Health Organization (WHO) and the UN recommend all governments to have a national suicide prevention program linked to related public health policies.

Screening mental illness in vulnerable groups is a form of suicide prevention. Connection is crucial to individuals who may be vulnerable to suicide. World Suicide Prevention Day sponsored by the IASP that fell on Sept. 10, promotes the theme "Connect. Communicate. Care." And the media—according to the 2014 Mental Health Law, has a role to play in socializing the importance of being aware and taking part in suicide prevention in a way that is conducive to the growth and development of mental health.

You can find older posts regarding ASEAN politics and economics news at SBC blog, and older posts regarding health and healthcare at IIMS blog. I thank you.

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