Suicide rates increase: Reflection of new realities in Egypt

Sherif Tarek , Tuesday 20 Jan 2015

Less religiosity, mounting daily life pressures and lack of help cited among the reasons for what is believed to be a rise in suicidal tendencies in Egypt

Public suicide
In September, a driver hung himself from a billboard on the Cairo-Ismailia highway. He had reportedly been struggling to make ends meet (Photo: A still from a video)

Hanaa, a middle-class pharmacist who lives in Cairo, has considered the idea of committing suicide quite a few times, but tried to end her life only once, a year ago. Her father saved her.

She has been drawn to the idea of suicide for years. Apart from therapy, religion is what has been keeping her alive.

"Because it's forbidden, suicide means the person would die an apostate," said Hanaa, who asked that her real name be concealed because of the stigma related to her story.

"I was once lured to think that God would be more gentle to me than all those around me and wouldn't send me to hell, but that's a wrong way of thinking. Suicide means you lose your afterlife," she said.

"I'm a pharmacist and I know quite well how to kill myself painlessly. If it wasn't a major sin, I would commit suicide immediately, right now," she said, forcefully.

In Egypt, religion may be a restraint for many of those who are experiencing suicidal tendencies, with both Islam and Christianity categorically forbidding suicide.

In 2012, the World Health Organisation listed Egypt as among the countries with the lowest suicide rate, at less than five suicides per 100,000 people.

But since the act is widely seen sinful, both socially and religiously, suicide cases in Egypt are often registered as accidental deaths by relatives of the deceased, meaning actual cases are higher than what is reported.

Lack of accurate records makes genuine suicide rates in Egypt largely unknown, yet recurrent media reports of suicides the past months indicated they have considerably increased.

Shwikar El-Bakry, a psychology professor in Banha University and a practicing psychiatrist, believes suicide rates have indeed increased.

"Ten years ago we wouldn't ask patients directly about their suicidal tendencies, we would have to go round it by asking if they suffer depression or severe anxiety," she said.

"We could ask them if they wished for death but would never ask them directly if they are considering committing suicide. Today, it's no longer that taboo or that uncommon. We discuss it openly."

"There are no statistics on suicide rates in Egypt but from my observation, they have risen over the past few years, and dramatically in the last one," she said.

"Last year, I've even had unprecedented cases of kids between eight and ten years old who think about suicide. Children do not sustain normal life pressures but they could be affected by the depression around them."

El-Bakry reiterates that religion still acts as a main discouragement, but faith has grown shakier among other fundamental changes that could have led to higher suicide rates in Egypt.

"Over the past two decades, there have been cultural changes in Egypt, with Westernisation bringing new ideas to society and helping making other existing ones more acceptable, like suicide."

"On the other hand, many people distanced themselves from religion after the surfacing of numerous Islamic extremists during the rule of (Islamist president Mohamed) Morsi (2012-13)."

"Once, being religious was something mostly to be proud of. Today after people turned against hardliners, in a number of circles, you could be mocked for that," El-Bakry argued.

"Also, it's increasingly common in Egypt that people, on numerous levels, don't take responsibility for their actions and always blame others for their mistakes."

"That could affect other people's behaviour in what we call regression; to go one level down and act like kids who don't want to be held accountable for anything they do," she said.

"With that mindset, people might drop the idea that they will be punished in the afterlife for committing suicide."

While religion can be a force for suicide prevention, it is never recommended to use it to dissuade someone from committing suicide, says Amira Aly, a mental health expert and behavioural medicine specialist.

Telling suicidal persons that killing oneself means going to hell might not work at all, especially if the individual is determined, she elaborated.

"What people with suicidal tendencies need is to find someone standing by them, and being supportive and understanding of their situation," she said.

'Too overwhelming'

Zeinab El-Mahdy hit the headlines when she hung herself at home in November, one of the suicide cases that sent shockwaves across Egypt. She came from an Islamic religious family, but that wasn't enough to survive. 

For a while leading up to her suicide the young activist was depressed, causing many of her friends to abandon her, recalled Mohamed Tolba, founder of coexistence-promoting group Salafyo Costa.

"She was close to the group and my family, we knew her quite well," Tolba said. "She became frustrated that a lot of people couldn't stand her while she was depressed."

"We believe she could have been saved had those around her been more supportive. But many people care about the mood more than the person I guess, and I can't really say she was in a good mood."

El-Mahdy, who died in her early 20s, was a Muslim Brotherhood member who was kicked out of the group when she decided to support Abdel-Moneim Abul-Fotouh in the 2012 presidential elections.

Abul-Fotouh was a leading figure in the Brotherhood who unilaterally decided to run for the presidency in 2012. The Islamist group dismissed him as a result.

Not only did El-Mahdy's decision to support Abul-Fotouh cause her to lose her Brotherhood membership, it lost her all her friends from the now-banned group.

"She knew nothing in life but the Brotherhood. She saw the world through them, and thus losing them was a huge turning point for her," Tolba said.

Afterwards, she started to be engaged with revolutionary groups, to discover that they are not as bad as she once thought, he continued.

She later became member of the Egyptian Current Party, founded by youth who parted ways with the Brotherhood shortly after the 2011 uprising.

After Mohamed Morsi's ouster, she had reservations about the demands of the Islamist camp that has supported him. However, her depression took a severe turn for the worse after the deadly dispersals of the pro-Morsi sit-ins in August 2013.

"She experienced ideological upheavals that were too overwhelming for her young age without support," said Tolba.

"She disappeared for a while and deactivated her Facebook account, then we heard the terrible news."

Drastic changes could be a sign of suicidal tendencies, and must not be ignored, commented El-Bakry.

"Zeinab El-Mahdy sent many messages that she has turned suicidal, like suddenly reversing her political views, or when she took off her veil and stopped attending religious classes," she said.

"Dramatic and rapid permanent changes in one's lifestyle could be a sign that family and friends should pay attention to. It doesn't have to mean every time that the person is suicidal, though."

Limited means of help

Aly underlined the importance of providing instant help to suicidal individuals, lamenting the lack thereof in Egypt.

Years ago there was a hotline to help suicidal people in Egypt, like in many other countries, operated by Befrienders Worldwide, a volunteer suicide prevention initiative.  

"Such a service could come in very handy for suicidal people who are alone," Aly said.

"And you don't have to be a specialist to help someone with suicidal tendencies, just training similar to the one customer service employees receive would be enough."

Nasser Loza, a prominent psychology professor who was involved in the service, says the Befrienders hotline was long halted because "we thought face-to-face counselling is more effective" in Egypt.

The death of El-Mahdy motivated Salafyo Costa to start a campaign in December called Esal Aleh (Check on Him) to raise awareness of suicide and how to pre-empt it, mainly by checking on people.

The campaign's opening event, a mass jog, took place with contribution from the Cairo Runners group in 6 October City on Cairo's outskirts last month. They intend to repeat the event in many governorates.

"Sports are anti-depression, and of course these kinds of events attract many people," said psychotherapist Sherine Emad, head of the campaign.

"Our events would start with a speech about the purpose of the campaign. We also have a Facebook page through which we try to raise awareness by giving tips, as well as checking on each other."

Even though the 'Check on Him' campaign was instigated by her suicide, El-Mahdy, during the peak of her depression, wouldn't have been saved by more human care, according to a close friend.

"Some of her friends were with her two days before she killed herself; they made no difference," said Hala Safwat.

"Her family urged her many times to take antidepressants but she was not responsive," she said.

"Her condition had largely deteriorated and only therapy could have saved her."

Like suicide, psychotherapy in Egypt is somewhat taboo, which makes many mentally ill people reluctant to see therapists.

"For the majority in Egypt, seeing a psychotherapist means you're crazy and many people will start treating you accordingly," El-Bakry said.

"For this reason, patients with suicidal tendencies who see psychotherapists are much fewer than the actual number of those who need treatment."

Seeking help amid constant political tensions and a deteriorating economy, as Egypt has witnessed over the past four years, is no luxury, stressed Ali.

"A multitude of unfortunate events has taken place since the 2011 uprising; many people were killed in clashes, dreams of political changes were shattered, not to mention there was a chronic economic crunch."

"All that drove many people towards the edge, so nobody should be reluctant to seek help when they feel they need any in such difficult times. One can never know when someone will snap."

Public suicides to send a message

Suicidal persons can be pondering committing suicide for years, or it could be an abrupt decision when something rubs them the wrong way, a straw that breaks the camel's back, Aly says.

"Mental strength varies widely from one person to another but with immense pressure on daily life, the probability people will reach a point where they end their lives rises."

Many of the recently reported cluster of suicides in Egypt were fuelled by financial problems.

In one infamous incident late in September, a driver hung himself from a towering billboard located on the Cairo-Ismailia highway. He was a father who for months had struggled to make ends meet.

And he was not the only one to commit suicide in public lately.

In November, a man in 10 Ramadan City in the Nile Delta governorate of Sharqiya hung himself outside his window. Financial struggles were also cited as a reason for the man's decision.

A month later, a 19-year-old girl reportedly killed herself by jumping off the Qasr El-Nil bridge near Cairo's Tahrir Square, right after being sexually harassed.

On Monday, a 50-year-old employee tried to jump off the tenth floor of the Maspero state radio and television building in downtown Cairo, after he was transferred to a new department. He was saved by security personnel.

The next day, a Mohamed Abdel Maksoud, 45, committed suicide by jumping in front of a metro train at a Cairo station.

Those who commit suicide in public are usually trying to send a message to everyone about their ordeal, Aly said.

Others would even like the prospect of being glorified as "heroes" while delivering that message, explained El-Bakry.

"For example they would look up to Tunisian street vendor Mohamed Bouazizi, who set himself on fire in December 2010 when he was prevented from selling fruit, the incident that sparked the whole Arab Spring," El-Bakry said.

Aly highlighted that as much as the Arab Spring was triggered by a self-terminating act, it seems to be ending in Egypt with more suicides.

"Suicidal people might not want to die; they could just want to put an end to their respective predicaments."

"For a while after the revolution, many people had high hopes for a better life in all aspects. The toppling of Hosni Mubarak was thought by many to be followed by prosperity, and that wasn't the case, of course," she said.

"Misery is a main reason for suicide, but what's even worse is losing hope," Aly concluded.

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