Pushed over the edge

Priya Bose (14), Pinki Lal (17), Abhishek Tiwari (18) and Karvesh Choudhary (19) today exist only as impersonal case numbers in police diaries. Not too long ago, all four were teenagers with dreams and hopes. But varying degrees of stress pushed them over the edge last month, adding to the alarming numbers of young Indians who are killing themselves.

Bose was the first to go. A student of Lucknow's City Montessori School (CMS), she was driven to anxiety over her performance in the class eight final examination. Three months earlier, she had performed poorly in the half-yearly exams. Though she had been absent from school when the final exam answer sheets were shown to students (the school has a policy of showing these to the students before report cards are made, so that any discrepancies can be pointed out), she must have guessed that she wouldn't make it. So on March 30th this year, after having a cup of tea with her mother, she went up to her room, bolted herself in and used a bed sheet to hang herself by the ceiling fan. The stunned mother, who discovered the body, found a suicide note that read: "I am doing this because I am fed up and irritated with my life. Nobody but I am to be held responsible. Sorry Ma."

A day later, Lal, who had just finished giving her board examinations at New Public School, was found hanging from a fan in her room. Her parents told the police that she feared the ridicule that would follow in case her board results were poor. Two days after that, Tiwari, a class 11 student of a different branch of CMS, killed himself because he had successively failed in his science practical exams. Choudhary, a first year BTech student of the Saroj Institute of Management and Technology, hanged himself on the eve of his second semester engineering exams on April 8. He had failed in four papers in the first semester and had been denied re-examination. Lonely and away from his family, he made one final phone call to his father in Faizabad before hanging himself from the fan of his rented one-room accommodation.

Since then, 18 other young adults have taken their lives in Lucknow, throwing into disquiet school administrators, teachers, parents, counsellors and the government. According to the city's police, only five of these are clearly attributable to academic stress, a neat categorisation that falters when considering a case such as that of Pushpendra Kumar.

A class 11 student of Dayanand Inter College, Kumar hanged himself over his parents' refusal to allow him to attend his elder sister's pre-wedding ceremony. By his parents' own admission, Kumar was an outstanding student who had topped his class in the last exams. On April 16, he had a science practical exam but tried to convince his parents that he was well-prepared and hence should be allowed to be part of the ceremonies. When they refused, he hanged himself from an iron railing around the stairs in his double-storeyed home. Was Kumar then a victim of a family argument or academic stress? According to RC Jiloha, professor and head of the psychiatry department at Govind Ballabh Pant Hospital, New Delhi, "While the main cause for suicide is frustration, a belief that this life is not worth living, there may be a number of reasons that contribute to that feeling. Any one incident can act as a trigger."

SUICIDE WARNING SIGNS

- Radical change in daily routine
- Withdrawal from family and friends
- Sleeping too much or too little
- Any mention of suicide
- Loss of interest in everyday activities
- No sense of humour
- Feelings of excessive guilt or fault finding
- Being preoccupied with death or dying
- Neglecting personal appearance
- Performing poorly at work or in school
- Becoming too philosophical
- Making statements such as these:

• 'I cannot go on any longer'
• 'I hate this life'
• There is no point in living anymore'
• 'Everyone would be better off without me'
• 'Nothing matters anymore' and
• 'I do not care about anything'

 •  Teen suicides mount in TN
 •  The sociology of suicide
 •  Kerala sets new course

The Lucknow cases are worrying for two reasons. One, because overall, the incidence of suicides in Uttar Pradesh (UP) is low compared to most other states. According to data from the National Crime Records Bureau (NCRB) (http://ncrb.nic.in/ADSI2006/home.htm), of the 1,18,112 people who committed suicide in 2006, only 3,070 came from the country's most populated state, making it 20th in the aforementioned list. Two, while the national average is 10.5 suicides per lakh of population, the state's average is still less, standing at just 1.7. Only Manipur, Nagaland and Bihar report lower suicide rates than UP.

Yet, between 2002 and 2007, the state saw high numbers of suicides due to academic stress. In this period, the figures were 91, 105, 143, 93, 121 and 95 for each year respectively, making "failure in exams" the sixth most common reason for suicides in a list of 22 offered by the state's police department, alongside other grounds such as illness and family problems. While only two percent of suicides all over India are because of poor performance in exams, in UP this figure is almost double (lower only than West Bengal, where the rate is 4.4 percent). This could stem from the fact that in this Hindi heartland state, low on industrialisation, success lies only with those who become doctors, engineers or bureaucrats.

Perhaps the starkest note on the fragile mental health of the country's young is made by the NCRB. Till 1998, the bureau did not have a separate category of "persons under the age of 14" committing suicide, owing to the negligible numbers. But the numbers in this new category have steadily grown as have entries under the "failure in exams" head. In 2006-07, the number of deaths attributable to failure in exams across all age groups stood at 2,378. Of the 2,464 youngsters under the age of 14 who gave up on life, 512 were driven by failure in exams.

Worrying as these figures are, they might just be the tip of the proverbial iceberg. Suicide identification is a problem due to non-reporting, which in turn exists because of the social and legal consequences of such deaths, and is compounded by inefficient municipal registration systems. Conversely, suicides due to other reasons might also be tagged in the "failure in exam" category due to its comparative social acceptance over reasons such as failed loved affairs or teen pregnancies.

Understanding suicides is difficult as studies are based on assessments of survivors, not victims. While most teen suicides are impulsive acts, spurred on by feelings of absolute helplessness in the here and now, the reasons themselves could be deep standing. Thus the teen who kills himself or herself over a bad examination result will probably have a history of low self-worth, marginalisation by the peer group, lack of communication with parents and the like, all of which will be magnified by an upsetting event.

While growing up was always serious business, in today's India, an erosion of buffers and growing levels of competition have made it an even more complicated issue. The emphasis on success at all costs means that even five-year olds are being coached to clear entrance exams to prestigious schools. Parents who cough up the high fees for these schools in turn pressurise children to do well and get into colleges or professional courses of repute. Add to that the demise of the joint family, a lack of interest in sports and co-curricular activities, and the increasing isolation of the nuclear family, and what remains is a situation fraught with the possibility of mental and emotional breakdown. Moreover, while a galloping economy means a proliferation of opportunities, it also translates into a growing disconnect between abilities and aspirations. Being second best is no longer an option.

Instant gratification is another reason why children find it difficult to cope with life's disappointments. Pressed for time, parents try to compensate with pocket money and immediate fulfillment of children's demands, some of which are often unreasonable. A study conducted by the Associated Chambers of Commerce and Industry of India's (Assocham) Social Development Foundation, titled 'Plight of Working Parents Towards their Children' and released earlier this year, concluded from a sample of 3,000 working couples that parents who work full time spend only 30 minutes with their children.

Another Assocham study of 2,500 children between the ages of 10-17, titled 'Trends of Pocket Money in Urban India', also released earlier this year, fills in the other dots. According to it, with the rise in income levels of parents, pocket money has risen by about six times to Rs 1,800 per month from Rs 300 per month over the past 10 years. The majority of this money goes towards fast food, soft drinks, clothing, gift articles, mobile recharge coupons, chocolates, cosmetics, magazines, computer games and movies. A related statistic is provided by a June 2006 study of the Cellular Operators Association of India (COAI), according to which 58 percent of the teenagers who own mobiles spent between Rs 3,000 to Rs 7,500 on a handset, putting them only behind the 35-49 year age group.

Reena Tiwari, a resident of Lucknow and the mother of a bright 18-year-old who has recently given his class 12 exams from St Paul's School, provides the illustration to this statistic. "My son, otherwise a good student, would spend hours on the Internet looking up high-end mobile handsets. He never said he wanted one, but often spoke of peers who had brought the latest models. For all our belief in the virtues of waiting, we finally got him a handset worth Rs 15,000 to steer him back to his books," she says. It is reasonable to conclude that when such children, used to having their way within the cocoon of the family, face life's hard knocks, they find it difficult to handle the situation. Overall, this suggests a systematic failure of the family, the education system and the society at large.

On April 16, JS Rajput, former director of National Council of Educational Research and Training, tried to explain the problems in an article in the widely circulated Hindi daily Dainik Jagran: "A failure in examination is not a failure of the child, it is a failure of the whole system," he wrote.

Prabhat Sitholey, professor and head, department of psychiatry, Chattrapati Shahuji Maharaj Medical University (CSMMU), Lucknow, avers that the black hole in parental pressure is the belief that education is a one size fit all. "Just like genes for height and complexion are distributed normally within a given population, so is intelligence. We are wrong in believing that each child must at least pass class 10. Even within this framework, we are promoting an education that does not encourage the asking of questions or creativity. It is sheer drudgery. Each child is gifted separately and the educational system must define capabilities and strengths. Parental love should not depend on examination marks," he says. He also blames the media for sensationalising suicides. However, Jiloha from Delhi's Govind Ballabh Pant Hospital cautions against whipping the media. "Media reports will adversely affect only those who are gullible, they will appear suggestive only to those in a particular frame of mind," he says.

Krishna Dutt, clinical psychologist at CSMMU, whittles down the reasons behind teen suicides to the I's of impatience and individualism. "There is no time to wait and watch as patience levels are falling across generations. While individualism leads to growth and development, it also causes us not to learn from the experiences of others," he says. On the day Dutt speaks to us, he is counselling a 19-year-old, who is so unnerved about her engineering exams that she cries when asked to speak.

Tears are just one sign that something is drastically wrong. Most cues tend to be more muted and easy to miss (also see box alongside). So easily missed in fact that even traditional psychology held that a child was essentially incapable of depression. Modern psychology, however, holds that signs of depression in a child are merely different from those in adults. Thus a child who is consistently irritable or aggressive, prone to behavioural problems such as constantly seeking attention, or addiction to something, is crying for help and is not simply a 'problem' child.

"Parents are too wrapped in their expectations to notice what a child really needs and often the child blurs the distinction between himself and the parents thinking of himself as merely an extension of his parents and a tool to further their ambitions," says Nalini Sharad, principal of CMS. She illustrates her contention with the example of a class 10 student who despite being severely sick ignored the advice of doctors and came to write her board exams with a drip attached to her. "She threatened to commit suicide if not allowed to write the exams and the parents did not try to reason with her even once. In such a situation, what does the school do?" wonders Sharad.

Schools are also handicapped by the lack of access to child and educational psychologists, an issue that has to be looked at in conjunction with the low numbers of trained psychologists available in the country as a whole. According to the World Health Organization (Atlas: Country Profiles on Mental Health Resources 2001), India, which lacks a national policy on mental health, has just 0.4 psychiatrists, 0.04 psychiatric nurses, 0.02 psychologists and 0.02 social workers per 100,000 population. Moreover, the availability of mental health professionals is restricted to mostly the larger urban centres. Given this situation, it's not surprising schools do not have access to mental health services. The few schools that offer the services of counsellors do so only for career guidance.

Alok Sinha, psychologist and motivational trainer, points to a lack of understanding on the nature of counselling. "Receptionists at computer training institutes who provide information on courses are termed counsellors as are clerks who allot colleges on the basis of marks. A counsellor is a listener, not a provider of information. But even highly educated parents who approach us for counselling their children merely want us to make the children comply with the parents' wishes. Even when it comes to extra-curricular activities, all they want is for the child to be the best, and say, win a reality contest," he says.

Within the state's secondary education department, there is little acknowledgement of the department's own role and failings in making education the nightmarish experience that it is today. Stock replies about lack of staff and resources are given to explain why the department has not overhauled the board examination system that catered to 40 lakh students this year.

SUICIDE PREVENTION

- Remain calm
- Ask the child directly if s/he is thinking of committing suicide
- Focus your concern on their well-being and avoid being accusatory
- Listen
- Reassure them that there is help and they will not feel like this forever
- Do not judge
- Provide constant supervision. Do not leave the youth alone.
- Remove means for self-harm.
- Peers should not agree to keep the suicidal thoughts a secret and instead should tell an adult. Parents/school staff should seek help as soon as possible.
(Source: Delhi Psychiatry journal, October 2007)

 •  Teen suicides mount in TN
 •  The sociology of suicide
 •  Kerala sets new course

Sarvesh Kumar, an additional director at the department, is a rare voice of despair. "The government spends Rs 2,700 crores as salary for the staff of this department. Yet there are no measures of performance. The lone figure of students appearing for the board examination cannot be a criterion to judge our performance. We are least bothered about the quality of education being imparted and will resort to strikes at the least provocation. We are not expected to deliver, merely to keep the machinery functioning in its present state," he says.

Kumar's contention is borne out by the Annual Status of Education Report (ASER), brought out by the non-government organisation Pratham. According to the 2007 ASER (Rural) report (http://www.pratham.org/aser07/aser2007.php), in UP, 3 out of 10 children in class 1 to 8 cannot read capital letters, while 7 of 10 cannot recognise numbers between 1 and 99.

At a seminar on the causes of suicide, organised in the second week of April, principal secretary of secondary education, AK Misra, elaborated on the educational system's failure. "Of the 16,000 inter-colleges in UP, only 160 can lay claim to offering quality education. Thus only five percent of those with aspirations have access to quality resources. Private schooling has become completely profit- and result-oriented. The child is filled with worry about whether he will be allowed to write the board exam or will be held back so that the school's results are not affected negatively. By raising fees, the stakes have been artificially upped, as parents who are called upon to pay exorbitant amounts will expect their children to do well at any cost. There is no getting away from the fact that we need swift policy changes or our children will be driven to meltdown," he warned.

There are no easy answers on what these changes should be. As a first step, we need to talk about the issue and improve the systems of reporting and recording suicides. As part of its Suicide Prevention Programme, the World Health Organization suggests a comprehensive approach that involves the departments of health, police and education besides religious leaders, families and the media. This would be in addition to school-based interventions involving crisis management, self-esteem enhancement and the development of coping skills and healthy decision-making. Better communication within the family, greater acceptance of a child's abilities and a more flexible examination system would also help. Ultimately each one of us shares the responsibility to help the young around us cope with the turbulence of coming of age.