As promised in my last post about Bhutan’s suicide problem, here’s a little info about religious beliefs, academic stress, and the government’s plan to address the problem.
Religious Beliefs about Suicide
Many of the articles I’ve read identify a need to promote spiritual identity as this is a protective factor against suicide. Bhutan is a Buddhist country where Tantric Buddhism is practiced. Beliefs around karma and reincarnation are central. Most of the information below is based on my conversations with Bhutanese.
The Bhutanese believe that being reincarnated as a human is rare and that the human form is among the highest. To end a human life is a sin. Additionally, suicide is seen as sinful because it harms others. For those who do commit suicide, they will have to “repeat” the life they have ended 500 times before moving on. I must admit that I do not fully understand the technicalities around repeating a life, but to the Bhutanese this is a powerful deterrent.
Recently a college student who was taking my friend’s intro to counseling class committed suicide. Class was canceled for the next two days so that the students could perform pujas (rituals). The pujas for a suicide victim are quite extensive. The mourners are attempting to help the person’s spirit have a good reincarnation and overcome the negative karma generated by the suicide.
School stress seems to be a significant stressor for those who attempt or report ideation (by my experience). Many teenage and young adult students are the first in their family to be educated; their parents are farmers and yak herders who live in remote villages or are nomadic. The students are sent to large towns to live at boarding school and feel immense pressure to succeed academically and financially to make their parents proud and to support the family.
Another factor could be the style of education provided here. As far as I can tell, teachers rely on aversive reinforcement, there is not any confidentiality regarding academic performance, and there is a lot of shame around not performing well in class. Students who are not doing well will not ask for help. If a student does not pass, he is made to stand in front of the class and receive his failing grade publically. That’s just one example. Of course, not all schools are like this, and there is a push to reform the educational system.
Addressing the Suicide Problem
The government does have an action plan which in quite extensive. It includes addressing stigma, establishing treatment centers, and training mental health workers. There is a lack of social worker and mental health workers in Bhutan.
There is one psychiatrist in the entire country and one inpatient treatment facility (where I’m volunteering). Patients have to travel for days to reach treatment, and there are no follow up services or aftercare. Often patients from the village are uncomfortable in the city and eager to leave. As I’m writing this it’s harvest time, and patients worry that they will miss the harvest and cause suffering for the whole family.
China Tibet Online (2012, March 16). The Sin of Suicide (news article). Retrieved on December 10, 2015 from http://chinatibet.people.com.cn/96069/7759971.html
Royal Government of Bhutan (2015, May 12). Suicide Prevention in Bhutan: A Three Year Action Plan (July 2015– June 2018) [pdf]. Retrieved on December 10, 2015 from http://www.searo.who.int/bhutan/suicide_action_plan.pdf