Stepping Back from the Ledge: Motivations and Restraints

Despite heightened awareness of mental health's importance during the COVID-19 pandemic, the rise in suicide cases in Malaysia remains deeply troubling. According to statistics from the Royal Malaysia Police (PDRM), 1,087 cases of suicide were recorded in 2023 compared to 981 cases recorded in 2022, recording an increase of 10 per cent.

Someone who has survived a suicide attempt is referred to as a Survivor of Suicide – one who has attempted suicide at least once in their lives but failed due to their change of mind to fulfil the act itself, external intervention or failed methodologies to complete the act.

Associate Professor Dr. Anasuya Jegathevi Jegathesan, Dean of the Faculty of Psychology and Social Sciences, aims to help through her research, which examines the transitional thought processes experienced by the Survivors of Suicide from the moment of suicide ideation (thought and consideration about ending one's own life) to long-term recovery.

The role of therapy is critical in supporting those who have attempted suicide. According to research literature, the benefits of cognitive behavioural therapy, psychotherapy and dialectical behavioural therapy in lowering the risk of suicide reattempts have been proven effective.

Her research titled “Surviving Suicide: The Realities Faced by Suicide Survivors” studies suicide through the lens of the survivors and identifies factors that kept them alive after the attempt. Her qualitative research utilises interpretative phenomenological analysis, which is an interview-based method that explores personalised lived experience in its terms rather than one prescribed by pre-existing theoretical preconceptions. Pre-existing theoretical preconceptions refer to ideas, beliefs, and assumptions that researchers or theorists hold before engaging with new data or conducting new research.

Recognising the importance of Dr. Anasuya’s research and mission, the Selangor State Government awarded a grant of RM67,000 to conduct the research and other projects related to helping those who are suicidal or are having a self-harm crisis.

This research delved into the minds of 19 respondents who were not in active therapy for suicide at the time of the interviews. All respondents participated on a voluntary basis upon seeing an advertisement published either on WhatsApp groups or Facebook. Once consent was acquired from the respondents, they were interviewed either face-to-face or virtually.

“Bearing in mind that the in-depth interview can be overwhelming for respondents we assured that they were free to stop at any time either to cry, have a drink or take a break altogether. In fact, all respondents were offered free therapy sessions post-interviews,” says Dr. Anasuya.

Based on her findings, it was found that the most common method of suicide utilised by respondents was attempting suicide through an overdose of an over-the-counter paracetamol easily purchased locally. The research identified three influencers of suicide based of the answers of the 19 respondents.

The first stemmed from Internal Negative States motivated by daily life stressors, which resulted in feelings of Worthlessness, Hopelessness, and Loneliness. The second was from an intense One-off Crisis Event that caused suicide ideation. The final influencer revealed a unique finding in the realm of psychology, which the researcher termed Anticipatory Hopelessness, whereby the respondent is in a Positive Internal State.

Anticipatory Hopelessness is a feeling for individuals who were not in a crisis, nor were they experiencing negative influencers when they attempted to end their lives. In these cases, suicide is perceived not as a solution to end pain but as the best option to exit life at a high point or at a moment when there are no further expectations placed on them and few if any, external responsibilities to fulfil.

“Anticipatory Hopelessness happens when an individual is in a good place or at a high point in their lives and feels suicidal. They feel that they need to stop living at that exact point in time. Though this individual is satisfied at that point in time, the individual anticipates that their satisfaction is temporary. So, before the feelings of hopelessness come, they feel they need to end their lives now. Because they know that there is no promise for a better tomorrow and they definitely will not feel as happy and satisfied as they are now,” explains Dr. Anasuya.

Two of the respondents from this study were found to be suffering from this state of being. One of the research respondents, a married female with three children, described herself as having a loving husband and supportive family members. She has attempted suicide 3 times. Her first attempt was during her honeymoon; after the stress of the wedding planning, everything was finally peaceful, and since everyone was happy at the wedding, she felt that it would be a good time to die on her honeymoon.

It is as though they have reached a peak in their lives, and there would be nowhere else to go but downward. And the thought of that happening is daunting enough to form suicide ideation.

Additionally, Dr. Anasuya found that these respondents externalised their sense of worth by doing things for others until they reached a point where there were no active expectations placed on them and they had few or no external duties to fulfil. Their suicide attempts leaned more towards the preservation of their fulfilled or content states.

These respondents had high levels of concern and care for others but seemed unable to extend that same care to themselves. While they are able to feel for others or have a sense of empathy for them, they are unable to feel the same for themselves and both believe that they would most likely reattempt suicide in the future.

“This is the first time that I've come across individuals having these thoughts. I’ve tried to look for more research about this condition, but there have been none so far. I’ve spoken to colleagues in the industry and found that they have also had one or two clients like that. I realised that we actually have a narrow idea of suicide. Because a minority of people face this condition, it will be difficult to research this. However, I am keen to explore more on this and look forward to focusing on this area of research in the future.”

“I decided to focus more on the majority of individuals who faced suicide due to an Internal Negative State or those who have a One-off Crisis Event in this research to reduce suicide, but I hope to be able to help the minority who are facing these unique issues in the future,” added Dr. Anasuya.

One of the biggest findings of the research found that the most common way that the act of suicide is stopped is when the individual is literally in the midst of the act and is intervened by an external party. And this is usually by a lay person, not by professionals. The only time a professional was involved was when the individual would intentionally call them to help them stop the very act itself. Those who intervened during the act of suicide were found to be mostly friends, families or strangers.

Based on these findings, Dr. Anasuya, together with colleagues from the Faculty of Psychology and Social Sciences, organised a Suicide Attrition Intervention Workshop to teach members of the public what to do if someone they know attempts cutting or is suicidal. The free public event, which was sponsored by the Selangor State Government and the university, with the collaboration of Yayasan Chow Kit and the Positive Psychology Association, took place in March 2024 at the Buddhist Gem Fellowship in Petaling Jaya.

"This suicide attrition initiative is about getting regular people – those who are present, listening, or attached to non-profit organisations including religious ones such as mosques, temples, churches, and even teachers – who aren't trained in mental health issues to help. It helps regular people learn how to connect with someone in their circle who is cutting or suicidal and know what to say to make them change their mind and get help," she says.

As part of the initiative, an informative YouTube video on the Cascade Method of Managing Suicide Crisis has also been produced.

Those suffering from mental health issues or contemplating suicide can reach out to the Mental Health Psychosocial Support Service (+603-2935 9935 or +6014-322 3392); Talian Kasih (15999 or +6019-261 5999 on WhatsApp); Jakim’s Family, Social and Community care centre (+6011-1959 8214 on WhatsApp); and Befrienders Kuala Lumpur (+603-7627 2929 or visit befrienders.org.my/centre-in-malaysia for a full list of numbers and operating hours).

This contributes to the United Nations Sustainable Development Goals: