What if we thought of suicide as the outcome of a terminal illness instead of the outcome of an action?
In 2009 our beloved son, a brilliant medical student in his fourth year at Stellenbosch University, died. His illness eliminated him forever and we had not even realised that it was so severe that it was destroying him in front of our eyes.
What was supposed to be the beginning of the spring of 2009 became the end of everything we ever knew.
Our son had so many plans. It was the third term of his fourth year; he would have ended that year just as well as the previous ones, with cum laude marks. Plans had already been made for the next year. He wanted to move into a flat for his fifth year. He, who loved animals, wanted a dog.
Ten days before his death, I still had to buy him not one, but two pairs of the shoes he liked wearing in hospital. He was to do his fourth-year internship, at the end of the academic year, at a mission hospital in Tanzania.
All these plans for a future that was never to be.
Almost 7 000 South Africans die each year of suicide, according to a 2009 study by the Medical Research Council. Each one of these people is someone’s child, partner, brother or friend — who can no longer face life as the result of a biological illness.
Among low- and middle-income African countries, suicide rates increased by 38% between 2000 and 2012, according to the World Health Organisation’s first comprehensive report on suicide published in 2014.
WHO data from 2016 also reveal that suicide is the second leading cause of death among 15- to 29-year-olds globally.
After our son’s death, I struggled with the phrase “committed suicide” — an expression that dogmatically condemns suicide. To “commit suicide” is a judgmental phrase. But if one dies as the result of a disease, it is not an action; one cannot consciously “murder oneself”.
A concept I immediately chose in the wake of my son’s passing was “died of suicide”, rather than “committed suicide”. Soon after, it developed into the phrase “my son died of depression”, referring to the cause of his death, like someone else’s son could die of cancer or a heart attack.
No healthy person chooses to die. The primal instinct is to survive, but the victim of a fatal depression is so terminally ill that there is seemingly no other outcome than death.
Whether it is preceded by a life-long depression or a shorter bout of the disease, as was in our son’s case, suicide is the result when the brain, the “engine” of body and soul, malfunctions, possibly because of a lack of life-sustaining neurotransmitters, or the chemicals that help transmit impulses from nerve cell to nerve cell.
In 2009, the first large-scale study comparing the brains of those who had died of suicide with and without having been diagnosed with major depressive disorder was released. As part of the research published in the journal PLoS One, scientists analysed almost 670 brain samples and noted changes in the distribution of some types of neurotransmitters between the groups. Research continues into the exact relationship between suicide and these changes.
Thus, suicide could be the biological end result of the brain, fatally spiralling out of control. One can describe it as a fatal brain attack, like a heart attack.
Meanwhile, the medical and social sciences understand so little about suicide and society does not know how to react to mental illness or its consequences.
For us who have lost our loved ones to “this terrible disease”, as Virginia Woolf wrote to her husband before her own death from depression, there is no refuge or sympathy in greater society. It is a double whammy: not just that we have lost, but also how we have lost.
Unpublished research from the University of Stellenbosch conducted among loved ones of those who have died of depression show they report feelings of loneliness, blame and lack of support. This is in contrast to the apparent sympathetic support for other types of bereavement, and it exacerbates survivors’ feelings of isolation.
But studies done in South Africa are primarily quantitative and emphasise prevention and statistics. The wider “ecology” of the survivors, such as the differences in mourning processes compared with other types of bereavement, is ignored.
Our loved ones suffered enough in their lifetime. Their illness was horrific.
I will not be complicit in judging those who died as a result of depression by saying they “committed suicide”. Our loved ones were not criminals.
People who die of depression deserve the same compassion, sympathy and respect as those who have lost their battle against other illnesses such as cancer, heart disease or diabetes. They do not deserve our judgment by using an archaic phrase.
Lizette Rabe is chairperson of Stellenbosch University’s department of journalism and the editor of the book Hope: Consolation for the Inconsolable, a guide for those who have lost loved ones to suicide. She also founded the Ithemba Foundation to raise awareness about depression and funds for research.
After losing her son to depression, Rabe set out on a campaign to destigmatise the way suicide is reported and spoken about.
In Afrikaans, the term often used for suicide is “selfmoord”, which directly translated into English is “self-murder”. Rabe advocated instead for the use of “selfdood” or “self-death”, in everyday speech and reporting.
Rabe explains: “Besides being an archaic term from a time of ignorance, the term ‘selfmoord’ makes a value judgment, implying that the person is a criminal.”
Her pleas for kinder language resulted in changes to the official reporting styles of most Afrikaans media titles, which now use selfdood instead of selfmoord. In 2015, she was awarded Stellenbosch University’s Chancellor’s Award for her advocacy.