[INDIAN JOURNAL OF PEDIATRICS Vol. 42
June, 1975
SUICIDE AMONG CHILDREN
No. 329
IN B A N G A L O R E *
K . SATHYAVA'I HI
Bangalore Suicide among children seems to be a controversial issue since suicide in children is considered to be rare by m a n y such as Durkheim (1952), K a n n e r (1950), Schachter (1957), Marls (1069), Balser and Masterson (1959), to mention only a few while contrary views are expressed by T o o l a n (1962), Whitis ( 1 9 5 8 ) a n d others in that suicide among children is not rare as is usually thought of. Voluminous literature is available on the t o p i c in adults but there is very little data concerning children. According to K a n n e r (1950), a feeling o f disgust in life is unnatural for children as childhood is full of a positive will to live and enjoy life. He even opines that it is against the nature of children to think o f indulging in self destructive activities like suicide except perhaps in their day dreams. Schilderand Wechsler (1934) from their study on the child's concepts of death have indicated that children do not usually recognise the finality of death but view it as a reversible process. Since there are 'suicidal equivalents' such as antisocial acts, running away, accidental injuries and the like, suicide is said to be rare in *From the Department of Psychology, National Institute of Mental Health a n d Neuro-Sciences, Bangalore--560027. Received on February 12, 1975.
children. According to Marls (1969) children have fewer circumstances leading to feelings o f hopelessness as there are lesser physical and mental illnesses, greater scope for changes in situations and the facility for giving vent to their aggression being larger, there is a low rate of suicides in them. F u r t h e r Balser and Masterson (1959) opine that child suicides are rare as depression is rare in children. Contrary to this, T o o l a n (1962) points out that one of the reasons for overlooking the possibilities of ~uicide in children is the erroneous view that depression is uncommon in them. It is also argued that since child suicides are impulsive, such depression may go unnoticed or more often there could be a precipitating cause for the depression which in turn may lead to an impulsive suicidal behaviour in them. Further, differences in the signs and symptoms of depression o f children and adults are also known. Whitis (1968) thinks that suicide rates in children are underestimated due to a grealer possibility of classification u n d e r the category of accidents, knowingly or unknowingly, by parents or even by well meaning physicians. But one point on which most of the investigators have agreed is that suicide in children below 10 years is
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extremely r a r e or even nonexistent in most studies. T h e r e a r e some suicides in children b e t w e e n 10 to 14 years and a distinct increase a m o n g those between the 15 to 19 years. Most studies on suicidal
b e h a v i o u r of
children are often coupled with adolescents also. K a n n e r (1950) reports figures of child suicides in U.S. between 1926-29 as ranging from 33 to 53 per y e a r in the age g r o u p 1 0 t o 14 years. At a later period between 1942--1946 it ranged from 46 to 67 per year. F u r t h e r it was r e p o r t e d t h a t between 1933 and 1946 only 2.5% of children were in the 5 to 9 year-old g r o u p while the r e m a i n i n g were between 10 to 14 years. Balser and Masterson (1959) reported t h a t between 1951--1955 the suicide rate ranged from 37 to 58 per year in those between 10 to 14 years in the U.S. According to H i r s h (1959) in 1955 the suicide rate for Whites per 100,000 population was 0.4 for males a n d 0.2 for females in the age g r o u p of 10-14 years. M a r i s (1969) reported only 2 suicides in those below 14 years between 1959-1963 in his Chicago study. Toolan (1962) r e p o r t e d t h a t in 1958 there were only s suicides in tho~e between 5 to 8 years o f age as against 74 in the 10 to 14-year old group. Statistics of suicides in Ceylon for 1964 indicated that there were 37 cases who were under 15 years o f age. R e p o r t s of the Ministry of H o m e Affairs, G o v e r n m e n t of I n d i a (1967-1971) on suicide in I n d i a provide figures for those below 18 years in a single category and no separate figures for those below 14 years are available.
Shah
(1960) r e p o r t e d t h a t in G u j a r a t (former S a u r a s h t r a state) there were 6 cases of suicides in those below 12 years o f age and 92 between 13-18 years during 1952-55. T h e above findings make it a p p e a r that suicides
are either r a r e or totally absent in those below 10 years of age but one does come across suicides in those between 11-14 years relatively m o r e frequently but which is m u c h less as c o m p a r e d to the n u m b e r of suicides in the subsequent age g r o u p of 15 to 19 years.
Aim. T h e present study examines some of the aspects associated with successful suicides a m o n g children in Bangalore city.
Method and Material T h e present study covers a 7-year-period from 1967 io 1973. For each suicide that occurred in the city Of B~ngalore and was b r o u g h t to the notice of the police, a case file is m a i n t a i n e d by the police d e p a r t m e n t . These police records constituted the source of d a t a for the present study. During these 7 years, 1834 suicides had occurred in Bangalore. Each of the 1834 cases files were gone t h r o u g h in detail and the required d a t a were collected by the author. When the d a t a thus obtained were analysed with regard to the age variable, it was found t h a t there were 45 children who were either 14 years old or below a n d 351 cases between 15-19 years of age. As most of the studies cited above have considered children suicides as those who were 14 years and below, the present study also employs the t a m e criterion. T h u s during the 7 years period covered in the study only 45 suicides come in the children's category which constituted only a b o u t 2.4% of the total suicides. These 45 cases of suicides 0f children constituted the matexial for the present study. F u r t h e r it m a y be pointed out t h a t tl~e n u m b e r o f children suicides r a n g e d from 2 to 8 per year i.e. there were only 2 child. ren suicides in 1967; 7 during 1968; 6, 8 8,6
S A T H Y A V A T H I - - S U I C I D E AMONG C ~ I L D R E N I N B A N G A L O R E
a n d 8 during 1969, 1970, 1971, 1972 and 1973 respectively.
Age. O f these 45 children suicides, there was only a single instance of a 5 - y e a r - o l d boy c o m m i t t i n g suicide while the r e m a i n i n g ranged from 11 to 14 years. F u r t h e r it was found that there was one child 11 years old, 4 children 12 years old, 11 of 13 years old, and the r e m a i n i n g were 14 years of age. One observes that there is a g r a d u a l increase in the n u m b e r of suicides with increase in age. Sex.
Studies of children suicides h a v e indicated that suicide ia boys is relatively more t h a n those in girls. C o a t r a r y to this in the present study only 24.4% of these children were boys while the remaining 75.6% were girls. According to Toolan (1962) agres~iveness is expressed by males more easily either towards themselves or
towards others so t h a t successful suicides are m o r e in t h e m r a t h e r than females. The present study poses a p r o b l e m in that female children have o u t n u m b e r e d the male children in the p r o p o r t i o n of almost 3:1. In the ab~ence of figures it cannot be thought of as a national pattern.
Marital Status. In the I n d i a n set up at the present time, it m a y not be uncommon to find a 13-or-14-year-old married girl, as observed in an earlier study by ~he author (Sathyavathi and R a p 1962). Hence an analysis of marital status of these children suicides was done as there were m o r e girls in the study group. But such an analysis revealed that all the 45 children were u n m a r r i e d at the time of their suicides. Religion. Occurrence of suicide in children is not restricted to any one religious
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group; the results o f this study indicated t h a t 93.4% were Hindus; 4.4% were Muslims, a n d the r e m a i n i n g 2.2% were Christians.
Occupation. O n e m a y wonder as to w h a t occupation children can have but this study has p r o v i d e d certain interesting i n f o r m a t i o n in this r e g a r d . Analysis o f information obtained indicated t h a t 38% of these children were working at the time of their suicides as 'coolies' (daily wage) or as labourers, domestic servants, errand boys and the like. It is w o r t h pointing out t h a t none of these children was e m p l o y e d by the G o v e r n m e n t . Another point of transcultural interest is the prevalence of the ' j e e t h a ' system in the society. I n the ' j e e t h a ' system, children are left in the l a n d l o r d ' s house to do any and every type of work o r d e r e d by the l a n d l o r d and all his family members, including the children, for no p a y m e n t for the services r e n d e r e d by these children. T h e children are ' p l e d g e d ' , as it were, since the parents of these children will have taken loans from the landlords and they would not be in a position to p a y the interest or the loan. T h e loan may vary from a few hundreds to t h a t of a few thousands. In the present study there were children under the ' j e e t h a ' system working in these l a n d l o r d s ' houses. Further, doing household work in their respective homes was accounted for by 29% of these children; 22% were students, and for the r e m a i n i n g cases no information was a v a i l a b l e in this regard.
Family Set up.
T h e persons with w h o m the children were living at th e time of the suicide has been considered as one of the i m p o r t a n t factors in children's suicidal behaviours. Hence this aspect was analysed for the
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present study. Such an analysis revealed that 80% of these children were living with their parents (either one or both), and in a certain percentage of these, other relatives like grand parents, uncles and aunts, married brothers and their families; while 16~ were staying with others families~ i.e., people known to their parents or relatives. For the remaining 4~/o of cases information was not available.
VOL. 42, 329 drowning in the latter. According to this, in the present study one finds that 47% of these children have employed active methods as against 51% using passive methods. In other words, a more or less equal percentage of children have preferred the active and the passive methods to end their lives. But in the study of total suicides in Bangalore ~Sathyavathi, in the press) it was observed that nearly 82~/o have used passive methods as against only 18% resorting to
Methods. T h e methods employed by individuals to end their lives have been a point of interest to researchers in suicidology. Analysis of data with respect to this aspect revealed that burning and drowning constituted the most favoured m e t h o d by an equal percentage of children. In other words, burning and drowning each accounted for 38~/o; while poisoning with 13% occupied the next preferred m e t h o d of choice; and hanging occupied the last place with 9% only. In 2% o f cases a combination o f poisoning and hanging, i.e., multiple methods were employed. In many parts of the world today, the most favoured method of suicide in general has been found to be poisoning which finds corroboration in the study of the total suicides in Bangalore (Sathyavathi, in the press), teenage suicides in Bangalore (Sathyavathi 1972) as well as student suicides in Bangalore (Sathyavathi 1973). In contrast to this the observed trend of methods employed by the children in the present study reveals that poisoning is resorted to only by 13% of them, getting third place in the order of preference. Further, categorizing the methods o f suicide into active and passive types; burning and hanging could be put under the former category while poisoning and
the active methods. F u r t h e r it is reported in the literature that males prefer to use fire arms and hanging while females prefer poisoning, even among children and adolescents. However, in the present study a majority of the boys had chosen hanging, burning and poisoning in that order while girls had used burning, drowning and poisoning in that order. T h e finding that children resorting to active methods more often as c o m p a r e d to the total population of suicides in Bangalore, may p r o m p t one to agree to a certain extent that children are probably driven to suicides due to greater aggressiveness which might have induced them to choose active methods in preference to the passive ones to end thief lives.
Social context of suicide. T h e next aspect that would be of interest is the question as to what was the social context in which these children committed suicide. Analysis revealed that 53% of these children had indulged in the suicidal act when they were all alone on the scene; 31% had done so when others were nearby as in an other room or talking with someone outside the house; and 2~/o of cases had done so when others were asleep. For the remaining 90/o information in this regard was not available.
S A T H Y A V A T H I ~ S U I C I D E S A M O N G C H I L D R E N IN B A N G A L O R E
Place of committing suicide. A majority of these children to t h e o x t e n t of 45% had chosen their own residences to commit suicide. The remaining cases in varying proportions had chosen private wells, private gardens, public tanks, other's houses, the roadside and field, in that order. Time of comn~itting suicide. It was observed that 47% o f these children suicides had occurred during the day time as against only 15% during the nights. For the remaining cases information was either not specific or was not available. Discovery of the suicidal act. Information concerning the discovery o f the suicidal act of these children relate to three specific aspects which would be o f interest. These aspects are: (a) who discovered the suicidal act for the first time; (b) how was the suicidal act discovered; and (c) what was the condition of these children at the time of discovery. (a) Who discovered the suicidal act. 67% of these children's suicidal act was discovered by their relatives; 22% by known people like neighbours and friends, while in the remaining 11% strangers seem to have discovered it initially and later on it had come to the knowledge of relatives. (b) How suicidal act was discovered. It was found that in all cases the relatives had no idea regarding these children's suicidal intentions. In 65% o f these children the discovery o f their suicidal act was considered as purely accidental; in 31% of cases the children were not found a r o u n d as usual and the relatives became apprehensive regarding the safety o f the children; hence a search was instituted and the discovery made. In the r e m a i n i n g
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4% o f cases, the discovery was through some clues like the children shouting, calling the parents and the llke.
Condition at the time of discovery. By the time the suicidal act of these children were discovered,47% of them were already dead; 38% were unconscious and hence were rushed to hospital or doctors were called in, but they could not be saved. In 7% o f these children the condition was such that they were not only conscious at the time of discovery but they confessed as well about their suicidal act. In 4 % the children were conscious but were struggling and as such they probably could not say anything to the discoverer in spite o f their enquiries. T h e remaining 4 % o f these children were conscious and they could also speak, but they did not say anything concerning their suicidal act in spite of repeated enquiries from their relatives. (c)
Causes. Causes or motives driving individuals to commit suicide in general and children in particular has been a controversial issue, but no doubt, a crucial one. T h e r e are several theories concerning the 'why' o f suicides in general and that o f children in particular. Although m a n y an explanation is offered by researchers and mental health professionals working in the area concerning the probable factors for a low suicide rate among children, as cited already, there have been studies on children's successful suicides as well as their suicidal attempts or threats which highlight the possible causes for suicidal behaviour. Hence in the present study the causes as reported in the police case records of these children were analysed. Analysis o f this aspect revealed that of the 45 children suicides, the cause was reported as unknown
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in 10. Regarding the remaining 35 cases, more than -20 causes, either single or in combination, were cited as reasons for the suicides. Therefore, categorization of these causes was essential, and as such the causes were broadly grouped under the following headings: (a) Social causes, (b) Illness with social factors, (c) Mental illness, (d) Combination o f more than one o f the above factors. (a) Social causes. T o begin with, it m a y be worthwhile citing the case o f the 5-yearboy who ended his life by taking poison. T h e child was reported to be a stubborn boy, always wanting the relatives to yield to his desires. T h e relatives used to yield to his wishes always. On the day the child committed suicide, the mother and other relatives of the child were planning to go to a movie in the afternoon. T h e y did not intend to take the child with them and in spite of all the tactics of the child, for the first time in his life they did not yield to his wish and they began to get dressed to go to the movie. As the relatives were in the process of getting dressed they saw the child running towards the house from outside and then falling down near the doorstep. T h e m o t h e r and other relatives rushed to him and found him rolling on the floor and struggling. When asked about the trouble, with great difficulty the child took out an empty " T i k 20" container (insectiside) and held it before them and in the meantime he became unconscious. By the time the child was taken to the hospital he was already dead. O f the 35 cases for whom information about the causes for their suicide was available in the police case files, analysis revealed that the highest n u m b e r of children suicides, to an extent of 43%, was accounted for by social causes. These
VoL. 42, No. 329 included such things as being scolded and/ or punishment by parents/relatives for various reasons (coming late to the house; disobedience in not carrying out instructions o f the parents; not fulfilling the parents' expectations; not going to school; mixing with bad company; going to the movies without informing the parents; indulging in play or roaming about with fsiends without paying attention to studies, etc.); ill treatment by family members or employers; fear associated with examinations and the like. (b) Social causes with illness fcctor. In 29% of these children illnesses such as asthma, tonsilitis, fits and stomach ache were associated with social causes, such as, scolding, punishments from parents, relatives, or employers for not doing work; not earning and helping the family; not attending to work; not going to school regularly; getting low marks in the school; failing in the examination and the like. In these cases where the illness factor is coupled with social factors, one may presume that more than the illness factor, the social factors could have acted at least as the precipitating cause for the self destructive acts of these children. Children suicides are well known for their impulsive nature; and thus these children who were already victims of suffering due to their illnesses, must have felt like ending their lives and impulsively put their thoughts into action when scolded or punished by parents or others. Thus, taking those eases where social causes alone were responsible together with those eases whre social causes were associated with the illness factor, one finds in 72% of these children suicides, social causes playing their roles directly or indirectly. All the situations which are
SATHYAVATIII--SUICIDES
AMONG
CHILDREN
IN B A N G A L O R E
said to have driven the children to suicidal acts m a y be viewed from different standpoints. A few o f these are discussed below. D u r k h e i m (1952) has rightly pointed out that children are also influenced by social causes which w o u l d drive t h e m to end their lives by suicide. F u r t h e r he points out t h a t suicides in children are numerous in large cities quoting Morselli (1881) and highlights how city dwelling children are exposed to the currents and cross currents of civilization m u c h earlier and m o r e completely, a n d as such, are likely to be victims of their effects. According toMaris 1969), when aggressiveness cannot be channelized towards the object of frustration or whenever children get the lbeling of threat of the loss of being the love object, they do develop feelings of helplessness and worthlessness on the one h a n d , and rage on the other, w h i c h in turn m i g h t prompt t h e m to indulge in self destructive acts. Similarly, Bender and Schilder (1937) stated that suicidal b e h a v i o u r is the children's reaction to an u n b e a r a b l e situation, most often a situation of deprivation of love t h a t would provoke aggression against those denying the love; and as a way of escaping from the situation, they are likely to indulge in suicidal acts. Lourie's (1967) view is also akin to the above, in t h a t aggression and escape f r o m reality are considered to be the most frequent factors in children suicides. In the present study, at least in some of the cases, scolding or p u n i s h m e n t by parents must have been felt by the children as indicative of loss o f love or lack of love; and this could have led to frustration which in turn gave rise to aggression, prompting them to direct it on to themselves, as they could not p r o b a l y direct
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their aggression on to the object of frustration, namely, the parents or relatives. Meninger (1938) p r o b a b l y refers to this type of suicide as ' m u r d e r - i n - t h e - o n e - h u n d r e d and eight-degree'. Meerloo (1962) emphasizes the role o f rejection a n d loss o f self esteem giving rise to h u m i l i a t i o n in children which in turn drive the children to resort to suicide. I t m a y be r e m e m b e r e d t h a t there were 3 children in the present study who were working in landlords' houses u n d e r the ' j e e t h a ' system. These children h a d often a p p e a l e d to their parents to take t h e m back to their homes. About 10 days prior to the suicide, one of these boys had run a w a y f r o m the l a n d l o r d ' s house to his parents' home, which was a b o u t 30 miles from Bangalore, and h a d pleaded with the parents not to send him back to the landlord's house. In spite of the child's pleadings, the parents scolded him and accompanied h i m back to the l a n d l o r d ' s house. Jn the presence of the landlord's family the child was m a d e to apologise for running a w a y and was m a d e to promise that he would not r e p e a t such acts. T w o days after this, the child was found hanging in in the cow shed of the l a n d l o r d ' s house. These instances of the ' j e e t h a ' system are p r o b a b l y reliable indicators of children's feelings t h a t they are rejected by their parents; and to escape f r o m that the children use suicide as the only possible way out. Likewise, scolding from parents or punishment from parents m i g h t have been taken by these children as rejection by t h e m or even as loss of self esteem, as reported in the following case. A girl, after being scolded by her parents in the presence of her friends, b u r n t herself to d e a t h the same night. Schrut and Michael (1969) also
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have
indicated that some children after failure to fulfill the expectations o f their parents and incurring their displeasure, resort to suicide. S c h a c h t e r a n d Cotte (1957) state that affection hunger, rebelliousness against parents, protesting against parents coming in the way o f their
freedom, and w o u n d e d pride, are some o f the factors associated with suicidal behaviour o f children. Finally, K a n n e r (1950) mentions fear o f failure in school or examinalions with the anticipated consequent punishment by the parents; fear o f the cruel behaviour o f alcoholic fathers; and t y r a n n y o f t h e parents as factors in driving children to suicidal acts. T h e present study, even though retrospective in nature, p r o b a b l y gives clues in some instances which would fit into each o f these standpoints cited above. (c) Mental illness. Mental illness was reported as the cause o f suicide in 12% of cases. As there was no mention as to the details of mental illness in the police records regarding these children, it would be difficult to discuss this aspect. However, schizophrenia and depression are said to be associated to a certain extent with the suicidal behaviour o f children. K a n n e r (1950) even mentions the spite reactions in emotionally unstable feeble minded children leading to suicidal behaviour. (d) Combination of causes. In the remaining cases different combinations of the above mentioned factors were reported as r e s p o n sible for the suicide. Thus in the majority o f these children suicides, it appeared that there were disturbances in the child's relationship with the members of the family which can be considered as a severe b r e a k d o w n in the
VOL. 42, No. 329 " e m o t i o n a l homeostasis" o f the child's life. Thus the present study serves as an eye opener in that children are also prone to suicidal behaviour, and this problem needt the attention of the profession as welt as of the family and of the society. Summary
T h e study comprised 45 cases of suicides a m o n g children that occurred in Bangalore City during a 7-year-period from 1967 to 1973. Police records served as the source of data. T h e d a t a obtained was analysed with respect to variables like age, sex, religion, occupation o f the subiects as well as several other aspects llke place, method, time, social context of suicide and the like. T h e highlighting feature was that in nearly 75% o f cases social factors seemed to have played a significant role in driving these children to end their lives. A point o f transcultural interest m a y be the 'Jeetha' system being responsible for the suicide of 3 children. The author expresses her deep and sincere thangs to the Inspector General of Police, Bangalore, and his colleagues for permitting her to utilize the police records on suicides in Bangalore as well as f0r providing all the facilities for the collection of data for the study. References
Accidents and Suicides in India, Reports of the Government of India, New Delhi (1967, 1968, 1969, 1970, 1971). BMser, B.H. and Masterson, J. (1959). Suicides in adolescents, Arab,. 7. Psychlat. 116, 400. Bender, L. and Schilder, P. (1937). Suicidal preoccupations and attempts in children, Amer. ~. Orthopsyehiat. 7, 275. Gonnell, P.H. (1965). Suicidal attempts in childhood and adolesce me in Modern Perspectives in Child Psychiatry, HoweUs, J.G. (Ed), Oliver Boyd, Edinburgh, 403,42?.
SATHYAVATHI~SUICIDE AMONG"C H I L D R E N IN B A N G A L O R E Darkheim, g. (1952). lfegan Paul, London.
Suicide, Routledge &
Hirsh, J. (t959). Suicide, Meqt. H.yg.43, 516. Kanner, L. (1950). Child Psychiatry, Charles, C. Thomas, Springfield, Lourie, R.S. (1957). Suicide and attempted suicide in children and adolescents. Texas ivied. 63, 53, in Suieidology Ab3tracts, Bulletin o S'~ividology, Fall 1970, No. 7. Marls, R..W (1969). Social Factors iu Urban Suicide, The Dorsey Press. Illinois. Meerloo, J.A.M. (1962). Suicide and Mass Suicide, GruneandStratton. New York. Meninger, K. (1938). Man Against Himself. Hatteourt, Brace and Co., New York. Quoted by Marls, R.W. Morseili, H. (1881). Suicide, Kegan Paul, London, Quoted by Kanner. Sathyavathi, K. and D.L.N. Mufti Rao (1962). A study of suicides in Bangalore, Transactions of A.I.LM.H. No. 3, 5. Sathyavathi, K. (In the Press) Epidemiology of suicides in Bangalore, Accepted for publication in C.B.L journal, New Delhi.
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Sathyavathi, K. (1972). Teenage suicides in Bangalore. Proceedingsof the 6th International Conference for suicide prevention, Mexico, 226-232. Sathyavathi, K. (1973). Can we afford to loose our young people who are our assets ? FDS, 9, 29. Sathyavathi, K. (1973). Student suicides in Bangalore, Indian J. Soc. Work. 34, 101. Schachter, M.D. (1957). The recognition and treatment of suicide in children in Clues to Suicide, $chneidman, E S. & Farberow, N.L. (Ed)McGraw Hill, New York. Schaehter, M,D. and Cotte, S. (1957). Quoted by Connel P.H. Schrut, A. and Michael, T.(1969). Suicidology Abstracts, Bulletin of Suicidology, 1971 Fall, No. 8. Schilder, P. and Wecheler, D.J. (1934). Quoted by Toolan, J.M. Shab, J. (1960). Causes and prevention of suicides, Indian aT. Soc. Work, 21, 167. Suicide Statistics in Ceylon,-l~64, VITA, Official .Newsletter for the International Associatign for Suicide Prevention, Sept, 1970, 6, 2. Amer. jT. Psychiat. 118, 719. Whirls P.R.. (1958). The legacr of a child's suicide, Family Process, 7, 159.
June, 1975
SUICIDE AMONG CHILDREN
No. 329
IN B A N G A L O R E *
K . SATHYAVA'I HI
Bangalore Suicide among children seems to be a controversial issue since suicide in children is considered to be rare by m a n y such as Durkheim (1952), K a n n e r (1950), Schachter (1957), Marls (1069), Balser and Masterson (1959), to mention only a few while contrary views are expressed by T o o l a n (1962), Whitis ( 1 9 5 8 ) a n d others in that suicide among children is not rare as is usually thought of. Voluminous literature is available on the t o p i c in adults but there is very little data concerning children. According to K a n n e r (1950), a feeling o f disgust in life is unnatural for children as childhood is full of a positive will to live and enjoy life. He even opines that it is against the nature of children to think o f indulging in self destructive activities like suicide except perhaps in their day dreams. Schilderand Wechsler (1934) from their study on the child's concepts of death have indicated that children do not usually recognise the finality of death but view it as a reversible process. Since there are 'suicidal equivalents' such as antisocial acts, running away, accidental injuries and the like, suicide is said to be rare in *From the Department of Psychology, National Institute of Mental Health a n d Neuro-Sciences, Bangalore--560027. Received on February 12, 1975.
children. According to Marls (1969) children have fewer circumstances leading to feelings o f hopelessness as there are lesser physical and mental illnesses, greater scope for changes in situations and the facility for giving vent to their aggression being larger, there is a low rate of suicides in them. F u r t h e r Balser and Masterson (1959) opine that child suicides are rare as depression is rare in children. Contrary to this, T o o l a n (1962) points out that one of the reasons for overlooking the possibilities of ~uicide in children is the erroneous view that depression is uncommon in them. It is also argued that since child suicides are impulsive, such depression may go unnoticed or more often there could be a precipitating cause for the depression which in turn may lead to an impulsive suicidal behaviour in them. Further, differences in the signs and symptoms of depression o f children and adults are also known. Whitis (1968) thinks that suicide rates in children are underestimated due to a grealer possibility of classification u n d e r the category of accidents, knowingly or unknowingly, by parents or even by well meaning physicians. But one point on which most of the investigators have agreed is that suicide in children below 10 years is
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extremely r a r e or even nonexistent in most studies. T h e r e a r e some suicides in children b e t w e e n 10 to 14 years and a distinct increase a m o n g those between the 15 to 19 years. Most studies on suicidal
b e h a v i o u r of
children are often coupled with adolescents also. K a n n e r (1950) reports figures of child suicides in U.S. between 1926-29 as ranging from 33 to 53 per y e a r in the age g r o u p 1 0 t o 14 years. At a later period between 1942--1946 it ranged from 46 to 67 per year. F u r t h e r it was r e p o r t e d t h a t between 1933 and 1946 only 2.5% of children were in the 5 to 9 year-old g r o u p while the r e m a i n i n g were between 10 to 14 years. Balser and Masterson (1959) reported t h a t between 1951--1955 the suicide rate ranged from 37 to 58 per year in those between 10 to 14 years in the U.S. According to H i r s h (1959) in 1955 the suicide rate for Whites per 100,000 population was 0.4 for males a n d 0.2 for females in the age g r o u p of 10-14 years. M a r i s (1969) reported only 2 suicides in those below 14 years between 1959-1963 in his Chicago study. Toolan (1962) r e p o r t e d t h a t in 1958 there were only s suicides in tho~e between 5 to 8 years o f age as against 74 in the 10 to 14-year old group. Statistics of suicides in Ceylon for 1964 indicated that there were 37 cases who were under 15 years o f age. R e p o r t s of the Ministry of H o m e Affairs, G o v e r n m e n t of I n d i a (1967-1971) on suicide in I n d i a provide figures for those below 18 years in a single category and no separate figures for those below 14 years are available.
Shah
(1960) r e p o r t e d t h a t in G u j a r a t (former S a u r a s h t r a state) there were 6 cases of suicides in those below 12 years o f age and 92 between 13-18 years during 1952-55. T h e above findings make it a p p e a r that suicides
are either r a r e or totally absent in those below 10 years of age but one does come across suicides in those between 11-14 years relatively m o r e frequently but which is m u c h less as c o m p a r e d to the n u m b e r of suicides in the subsequent age g r o u p of 15 to 19 years.
Aim. T h e present study examines some of the aspects associated with successful suicides a m o n g children in Bangalore city.
Method and Material T h e present study covers a 7-year-period from 1967 io 1973. For each suicide that occurred in the city Of B~ngalore and was b r o u g h t to the notice of the police, a case file is m a i n t a i n e d by the police d e p a r t m e n t . These police records constituted the source of d a t a for the present study. During these 7 years, 1834 suicides had occurred in Bangalore. Each of the 1834 cases files were gone t h r o u g h in detail and the required d a t a were collected by the author. When the d a t a thus obtained were analysed with regard to the age variable, it was found t h a t there were 45 children who were either 14 years old or below a n d 351 cases between 15-19 years of age. As most of the studies cited above have considered children suicides as those who were 14 years and below, the present study also employs the t a m e criterion. T h u s during the 7 years period covered in the study only 45 suicides come in the children's category which constituted only a b o u t 2.4% of the total suicides. These 45 cases of suicides 0f children constituted the matexial for the present study. F u r t h e r it m a y be pointed out t h a t tl~e n u m b e r o f children suicides r a n g e d from 2 to 8 per year i.e. there were only 2 child. ren suicides in 1967; 7 during 1968; 6, 8 8,6
S A T H Y A V A T H I - - S U I C I D E AMONG C ~ I L D R E N I N B A N G A L O R E
a n d 8 during 1969, 1970, 1971, 1972 and 1973 respectively.
Age. O f these 45 children suicides, there was only a single instance of a 5 - y e a r - o l d boy c o m m i t t i n g suicide while the r e m a i n i n g ranged from 11 to 14 years. F u r t h e r it was found that there was one child 11 years old, 4 children 12 years old, 11 of 13 years old, and the r e m a i n i n g were 14 years of age. One observes that there is a g r a d u a l increase in the n u m b e r of suicides with increase in age. Sex.
Studies of children suicides h a v e indicated that suicide ia boys is relatively more t h a n those in girls. C o a t r a r y to this in the present study only 24.4% of these children were boys while the remaining 75.6% were girls. According to Toolan (1962) agres~iveness is expressed by males more easily either towards themselves or
towards others so t h a t successful suicides are m o r e in t h e m r a t h e r than females. The present study poses a p r o b l e m in that female children have o u t n u m b e r e d the male children in the p r o p o r t i o n of almost 3:1. In the ab~ence of figures it cannot be thought of as a national pattern.
Marital Status. In the I n d i a n set up at the present time, it m a y not be uncommon to find a 13-or-14-year-old married girl, as observed in an earlier study by ~he author (Sathyavathi and R a p 1962). Hence an analysis of marital status of these children suicides was done as there were m o r e girls in the study group. But such an analysis revealed that all the 45 children were u n m a r r i e d at the time of their suicides. Religion. Occurrence of suicide in children is not restricted to any one religious
151
group; the results o f this study indicated t h a t 93.4% were Hindus; 4.4% were Muslims, a n d the r e m a i n i n g 2.2% were Christians.
Occupation. O n e m a y wonder as to w h a t occupation children can have but this study has p r o v i d e d certain interesting i n f o r m a t i o n in this r e g a r d . Analysis o f information obtained indicated t h a t 38% of these children were working at the time of their suicides as 'coolies' (daily wage) or as labourers, domestic servants, errand boys and the like. It is w o r t h pointing out t h a t none of these children was e m p l o y e d by the G o v e r n m e n t . Another point of transcultural interest is the prevalence of the ' j e e t h a ' system in the society. I n the ' j e e t h a ' system, children are left in the l a n d l o r d ' s house to do any and every type of work o r d e r e d by the l a n d l o r d and all his family members, including the children, for no p a y m e n t for the services r e n d e r e d by these children. T h e children are ' p l e d g e d ' , as it were, since the parents of these children will have taken loans from the landlords and they would not be in a position to p a y the interest or the loan. T h e loan may vary from a few hundreds to t h a t of a few thousands. In the present study there were children under the ' j e e t h a ' system working in these l a n d l o r d s ' houses. Further, doing household work in their respective homes was accounted for by 29% of these children; 22% were students, and for the r e m a i n i n g cases no information was a v a i l a b l e in this regard.
Family Set up.
T h e persons with w h o m the children were living at th e time of the suicide has been considered as one of the i m p o r t a n t factors in children's suicidal behaviours. Hence this aspect was analysed for the
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present study. Such an analysis revealed that 80% of these children were living with their parents (either one or both), and in a certain percentage of these, other relatives like grand parents, uncles and aunts, married brothers and their families; while 16~ were staying with others families~ i.e., people known to their parents or relatives. For the remaining 4~/o of cases information was not available.
VOL. 42, 329 drowning in the latter. According to this, in the present study one finds that 47% of these children have employed active methods as against 51% using passive methods. In other words, a more or less equal percentage of children have preferred the active and the passive methods to end their lives. But in the study of total suicides in Bangalore ~Sathyavathi, in the press) it was observed that nearly 82~/o have used passive methods as against only 18% resorting to
Methods. T h e methods employed by individuals to end their lives have been a point of interest to researchers in suicidology. Analysis of data with respect to this aspect revealed that burning and drowning constituted the most favoured m e t h o d by an equal percentage of children. In other words, burning and drowning each accounted for 38~/o; while poisoning with 13% occupied the next preferred m e t h o d of choice; and hanging occupied the last place with 9% only. In 2% o f cases a combination o f poisoning and hanging, i.e., multiple methods were employed. In many parts of the world today, the most favoured method of suicide in general has been found to be poisoning which finds corroboration in the study of the total suicides in Bangalore (Sathyavathi, in the press), teenage suicides in Bangalore (Sathyavathi 1972) as well as student suicides in Bangalore (Sathyavathi 1973). In contrast to this the observed trend of methods employed by the children in the present study reveals that poisoning is resorted to only by 13% of them, getting third place in the order of preference. Further, categorizing the methods o f suicide into active and passive types; burning and hanging could be put under the former category while poisoning and
the active methods. F u r t h e r it is reported in the literature that males prefer to use fire arms and hanging while females prefer poisoning, even among children and adolescents. However, in the present study a majority of the boys had chosen hanging, burning and poisoning in that order while girls had used burning, drowning and poisoning in that order. T h e finding that children resorting to active methods more often as c o m p a r e d to the total population of suicides in Bangalore, may p r o m p t one to agree to a certain extent that children are probably driven to suicides due to greater aggressiveness which might have induced them to choose active methods in preference to the passive ones to end thief lives.
Social context of suicide. T h e next aspect that would be of interest is the question as to what was the social context in which these children committed suicide. Analysis revealed that 53% of these children had indulged in the suicidal act when they were all alone on the scene; 31% had done so when others were nearby as in an other room or talking with someone outside the house; and 2~/o of cases had done so when others were asleep. For the remaining 90/o information in this regard was not available.
S A T H Y A V A T H I ~ S U I C I D E S A M O N G C H I L D R E N IN B A N G A L O R E
Place of committing suicide. A majority of these children to t h e o x t e n t of 45% had chosen their own residences to commit suicide. The remaining cases in varying proportions had chosen private wells, private gardens, public tanks, other's houses, the roadside and field, in that order. Time of comn~itting suicide. It was observed that 47% o f these children suicides had occurred during the day time as against only 15% during the nights. For the remaining cases information was either not specific or was not available. Discovery of the suicidal act. Information concerning the discovery o f the suicidal act of these children relate to three specific aspects which would be o f interest. These aspects are: (a) who discovered the suicidal act for the first time; (b) how was the suicidal act discovered; and (c) what was the condition of these children at the time of discovery. (a) Who discovered the suicidal act. 67% of these children's suicidal act was discovered by their relatives; 22% by known people like neighbours and friends, while in the remaining 11% strangers seem to have discovered it initially and later on it had come to the knowledge of relatives. (b) How suicidal act was discovered. It was found that in all cases the relatives had no idea regarding these children's suicidal intentions. In 65% o f these children the discovery o f their suicidal act was considered as purely accidental; in 31% of cases the children were not found a r o u n d as usual and the relatives became apprehensive regarding the safety o f the children; hence a search was instituted and the discovery made. In the r e m a i n i n g
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4% o f cases, the discovery was through some clues like the children shouting, calling the parents and the llke.
Condition at the time of discovery. By the time the suicidal act of these children were discovered,47% of them were already dead; 38% were unconscious and hence were rushed to hospital or doctors were called in, but they could not be saved. In 7% o f these children the condition was such that they were not only conscious at the time of discovery but they confessed as well about their suicidal act. In 4 % the children were conscious but were struggling and as such they probably could not say anything to the discoverer in spite o f their enquiries. T h e remaining 4 % o f these children were conscious and they could also speak, but they did not say anything concerning their suicidal act in spite of repeated enquiries from their relatives. (c)
Causes. Causes or motives driving individuals to commit suicide in general and children in particular has been a controversial issue, but no doubt, a crucial one. T h e r e are several theories concerning the 'why' o f suicides in general and that o f children in particular. Although m a n y an explanation is offered by researchers and mental health professionals working in the area concerning the probable factors for a low suicide rate among children, as cited already, there have been studies on children's successful suicides as well as their suicidal attempts or threats which highlight the possible causes for suicidal behaviour. Hence in the present study the causes as reported in the police case records of these children were analysed. Analysis o f this aspect revealed that of the 45 children suicides, the cause was reported as unknown
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in 10. Regarding the remaining 35 cases, more than -20 causes, either single or in combination, were cited as reasons for the suicides. Therefore, categorization of these causes was essential, and as such the causes were broadly grouped under the following headings: (a) Social causes, (b) Illness with social factors, (c) Mental illness, (d) Combination o f more than one o f the above factors. (a) Social causes. T o begin with, it m a y be worthwhile citing the case o f the 5-yearboy who ended his life by taking poison. T h e child was reported to be a stubborn boy, always wanting the relatives to yield to his desires. T h e relatives used to yield to his wishes always. On the day the child committed suicide, the mother and other relatives of the child were planning to go to a movie in the afternoon. T h e y did not intend to take the child with them and in spite of all the tactics of the child, for the first time in his life they did not yield to his wish and they began to get dressed to go to the movie. As the relatives were in the process of getting dressed they saw the child running towards the house from outside and then falling down near the doorstep. T h e m o t h e r and other relatives rushed to him and found him rolling on the floor and struggling. When asked about the trouble, with great difficulty the child took out an empty " T i k 20" container (insectiside) and held it before them and in the meantime he became unconscious. By the time the child was taken to the hospital he was already dead. O f the 35 cases for whom information about the causes for their suicide was available in the police case files, analysis revealed that the highest n u m b e r of children suicides, to an extent of 43%, was accounted for by social causes. These
VoL. 42, No. 329 included such things as being scolded and/ or punishment by parents/relatives for various reasons (coming late to the house; disobedience in not carrying out instructions o f the parents; not fulfilling the parents' expectations; not going to school; mixing with bad company; going to the movies without informing the parents; indulging in play or roaming about with fsiends without paying attention to studies, etc.); ill treatment by family members or employers; fear associated with examinations and the like. (b) Social causes with illness fcctor. In 29% of these children illnesses such as asthma, tonsilitis, fits and stomach ache were associated with social causes, such as, scolding, punishments from parents, relatives, or employers for not doing work; not earning and helping the family; not attending to work; not going to school regularly; getting low marks in the school; failing in the examination and the like. In these cases where the illness factor is coupled with social factors, one may presume that more than the illness factor, the social factors could have acted at least as the precipitating cause for the self destructive acts of these children. Children suicides are well known for their impulsive nature; and thus these children who were already victims of suffering due to their illnesses, must have felt like ending their lives and impulsively put their thoughts into action when scolded or punished by parents or others. Thus, taking those eases where social causes alone were responsible together with those eases whre social causes were associated with the illness factor, one finds in 72% of these children suicides, social causes playing their roles directly or indirectly. All the situations which are
SATHYAVATIII--SUICIDES
AMONG
CHILDREN
IN B A N G A L O R E
said to have driven the children to suicidal acts m a y be viewed from different standpoints. A few o f these are discussed below. D u r k h e i m (1952) has rightly pointed out that children are also influenced by social causes which w o u l d drive t h e m to end their lives by suicide. F u r t h e r he points out t h a t suicides in children are numerous in large cities quoting Morselli (1881) and highlights how city dwelling children are exposed to the currents and cross currents of civilization m u c h earlier and m o r e completely, a n d as such, are likely to be victims of their effects. According toMaris 1969), when aggressiveness cannot be channelized towards the object of frustration or whenever children get the lbeling of threat of the loss of being the love object, they do develop feelings of helplessness and worthlessness on the one h a n d , and rage on the other, w h i c h in turn m i g h t prompt t h e m to indulge in self destructive acts. Similarly, Bender and Schilder (1937) stated that suicidal b e h a v i o u r is the children's reaction to an u n b e a r a b l e situation, most often a situation of deprivation of love t h a t would provoke aggression against those denying the love; and as a way of escaping from the situation, they are likely to indulge in suicidal acts. Lourie's (1967) view is also akin to the above, in t h a t aggression and escape f r o m reality are considered to be the most frequent factors in children suicides. In the present study, at least in some of the cases, scolding or p u n i s h m e n t by parents must have been felt by the children as indicative of loss o f love or lack of love; and this could have led to frustration which in turn gave rise to aggression, prompting them to direct it on to themselves, as they could not p r o b a l y direct
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their aggression on to the object of frustration, namely, the parents or relatives. Meninger (1938) p r o b a b l y refers to this type of suicide as ' m u r d e r - i n - t h e - o n e - h u n d r e d and eight-degree'. Meerloo (1962) emphasizes the role o f rejection a n d loss o f self esteem giving rise to h u m i l i a t i o n in children which in turn drive the children to resort to suicide. I t m a y be r e m e m b e r e d t h a t there were 3 children in the present study who were working in landlords' houses u n d e r the ' j e e t h a ' system. These children h a d often a p p e a l e d to their parents to take t h e m back to their homes. About 10 days prior to the suicide, one of these boys had run a w a y f r o m the l a n d l o r d ' s house to his parents' home, which was a b o u t 30 miles from Bangalore, and h a d pleaded with the parents not to send him back to the landlord's house. In spite of the child's pleadings, the parents scolded him and accompanied h i m back to the l a n d l o r d ' s house. Jn the presence of the landlord's family the child was m a d e to apologise for running a w a y and was m a d e to promise that he would not r e p e a t such acts. T w o days after this, the child was found hanging in in the cow shed of the l a n d l o r d ' s house. These instances of the ' j e e t h a ' system are p r o b a b l y reliable indicators of children's feelings t h a t they are rejected by their parents; and to escape f r o m that the children use suicide as the only possible way out. Likewise, scolding from parents or punishment from parents m i g h t have been taken by these children as rejection by t h e m or even as loss of self esteem, as reported in the following case. A girl, after being scolded by her parents in the presence of her friends, b u r n t herself to d e a t h the same night. Schrut and Michael (1969) also
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have
indicated that some children after failure to fulfill the expectations o f their parents and incurring their displeasure, resort to suicide. S c h a c h t e r a n d Cotte (1957) state that affection hunger, rebelliousness against parents, protesting against parents coming in the way o f their
freedom, and w o u n d e d pride, are some o f the factors associated with suicidal behaviour o f children. Finally, K a n n e r (1950) mentions fear o f failure in school or examinalions with the anticipated consequent punishment by the parents; fear o f the cruel behaviour o f alcoholic fathers; and t y r a n n y o f t h e parents as factors in driving children to suicidal acts. T h e present study, even though retrospective in nature, p r o b a b l y gives clues in some instances which would fit into each o f these standpoints cited above. (c) Mental illness. Mental illness was reported as the cause o f suicide in 12% of cases. As there was no mention as to the details of mental illness in the police records regarding these children, it would be difficult to discuss this aspect. However, schizophrenia and depression are said to be associated to a certain extent with the suicidal behaviour o f children. K a n n e r (1950) even mentions the spite reactions in emotionally unstable feeble minded children leading to suicidal behaviour. (d) Combination of causes. In the remaining cases different combinations of the above mentioned factors were reported as r e s p o n sible for the suicide. Thus in the majority o f these children suicides, it appeared that there were disturbances in the child's relationship with the members of the family which can be considered as a severe b r e a k d o w n in the
VOL. 42, No. 329 " e m o t i o n a l homeostasis" o f the child's life. Thus the present study serves as an eye opener in that children are also prone to suicidal behaviour, and this problem needt the attention of the profession as welt as of the family and of the society. Summary
T h e study comprised 45 cases of suicides a m o n g children that occurred in Bangalore City during a 7-year-period from 1967 to 1973. Police records served as the source of data. T h e d a t a obtained was analysed with respect to variables like age, sex, religion, occupation o f the subiects as well as several other aspects llke place, method, time, social context of suicide and the like. T h e highlighting feature was that in nearly 75% o f cases social factors seemed to have played a significant role in driving these children to end their lives. A point o f transcultural interest m a y be the 'Jeetha' system being responsible for the suicide of 3 children. The author expresses her deep and sincere thangs to the Inspector General of Police, Bangalore, and his colleagues for permitting her to utilize the police records on suicides in Bangalore as well as f0r providing all the facilities for the collection of data for the study. References
Accidents and Suicides in India, Reports of the Government of India, New Delhi (1967, 1968, 1969, 1970, 1971). BMser, B.H. and Masterson, J. (1959). Suicides in adolescents, Arab,. 7. Psychlat. 116, 400. Bender, L. and Schilder, P. (1937). Suicidal preoccupations and attempts in children, Amer. ~. Orthopsyehiat. 7, 275. Gonnell, P.H. (1965). Suicidal attempts in childhood and adolesce me in Modern Perspectives in Child Psychiatry, HoweUs, J.G. (Ed), Oliver Boyd, Edinburgh, 403,42?.
SATHYAVATHI~SUICIDE AMONG"C H I L D R E N IN B A N G A L O R E Darkheim, g. (1952). lfegan Paul, London.
Suicide, Routledge &
Hirsh, J. (t959). Suicide, Meqt. H.yg.43, 516. Kanner, L. (1950). Child Psychiatry, Charles, C. Thomas, Springfield, Lourie, R.S. (1957). Suicide and attempted suicide in children and adolescents. Texas ivied. 63, 53, in Suieidology Ab3tracts, Bulletin o S'~ividology, Fall 1970, No. 7. Marls, R..W (1969). Social Factors iu Urban Suicide, The Dorsey Press. Illinois. Meerloo, J.A.M. (1962). Suicide and Mass Suicide, GruneandStratton. New York. Meninger, K. (1938). Man Against Himself. Hatteourt, Brace and Co., New York. Quoted by Marls, R.W. Morseili, H. (1881). Suicide, Kegan Paul, London, Quoted by Kanner. Sathyavathi, K. and D.L.N. Mufti Rao (1962). A study of suicides in Bangalore, Transactions of A.I.LM.H. No. 3, 5. Sathyavathi, K. (In the Press) Epidemiology of suicides in Bangalore, Accepted for publication in C.B.L journal, New Delhi.
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Sathyavathi, K. (1972). Teenage suicides in Bangalore. Proceedingsof the 6th International Conference for suicide prevention, Mexico, 226-232. Sathyavathi, K. (1973). Can we afford to loose our young people who are our assets ? FDS, 9, 29. Sathyavathi, K. (1973). Student suicides in Bangalore, Indian J. Soc. Work. 34, 101. Schachter, M.D. (1957). The recognition and treatment of suicide in children in Clues to Suicide, $chneidman, E S. & Farberow, N.L. (Ed)McGraw Hill, New York. Schaehter, M,D. and Cotte, S. (1957). Quoted by Connel P.H. Schrut, A. and Michael, T.(1969). Suicidology Abstracts, Bulletin of Suicidology, 1971 Fall, No. 8. Schilder, P. and Wecheler, D.J. (1934). Quoted by Toolan, J.M. Shab, J. (1960). Causes and prevention of suicides, Indian aT. Soc. Work, 21, 167. Suicide Statistics in Ceylon,-l~64, VITA, Official .Newsletter for the International Associatign for Suicide Prevention, Sept, 1970, 6, 2. Amer. jT. Psychiat. 118, 719. Whirls P.R.. (1958). The legacr of a child's suicide, Family Process, 7, 159.
