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.
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