Studies published in 2021 on suicide and coronaviruses surprised those who were betting that the first would go off due to the spread of the second. According to the polls, that wasn’t quite the case. Fear of contagion, confinement and uncertainty did not necessarily lead to a greater number of deaths attributed to you. Suicides, including in Brazil, remained at a stable level. In some countries, like Australia, they even fell.
Data from the Brazilian Public Security Yearbook 2021, released in July by the Brazilian Public Security Forum, reveal that the number of suicides in Brazil in 2020 was 12,895, with a variation of only 0.4% compared to 2019, when 12,745 were recorded cases. The states with the highest number, repeating the previous year, were São Paulo, Minas Gerais and Porto Alegre, in that order. The trend in the country is high: in 2012, there were 6,905 cases.
“A person in a suicidal crisis is highly ambivalent and, in general, does not exactly want to die, but to put an end to unbearable suffering”, says psychiatrist José Manoel Bertolote. “When faced with a concrete threat of death, her survival instinct is mobilized to fight the new enemy,” she adds.
At the beginning of the pandemic, Bertolote says that some of his patients with suicidal ideation insisted on online treatment because they did not want to expose themselves to the virus. They preserved themselves from imminent and unknown danger. A first question that remains is what can happen when this enemy leaves the horizon, even if little by little.
Bertolote, one of the creators of the World Day for the Prevention of Suicide (10/9), which in Brazil gave rise to the September Yellow, is among those who bet, based on information from similar previous critical situations, that the increase in suicide rates at the beginning of the pandemic was unlikely. “But I stayed preaching in the desert,” he says. “Even after we got the results of the study, several people resisted accepting them.”
He refers to research done in 21 countries on suicide trends in the first months of the pandemic published in Lancet Psychiatry in April of this year. Volunteer professor at the Faculty of Medicine of Universidade Estadual Paulista (Unesp), coordinator of the Life Protection Network and responsible for the creation of the Global Program for the Prevention of Suicide of the World Health Organization (WHO), Bertolote joined 69 other researchers in this approach on the number of suicides in 16 high-income and five upper-middle-income countries. In the latter, they included Brazil.
The group of scientists concluded that there was no increase in suicide rates in the studied spectrum, with the exception that it was not possible to expand the analysis to low- and middle-income countries, as most of them do not have a good quality death registration system. nor does it collect data on these deaths in real time.
In the study itself, however, the researchers assess that it is necessary to pay attention to the economic factor. They recall that many countries quickly enacted support initiatives to mitigate the economic consequences of the pandemic, but that these would be being reduced or withdrawn in certain populations. As support expires, those previously protected may experience increasing stress.
No to reductionism
In March of this year, President Jair Bolsonaro read, in his weekly live, a letter from an alleged suicide. He wanted to attack the indication of social isolation as a protective measure against the coronavirus. “We are having suicide cases in Brazil because of the lockdown”, he said.
Then, his son Eduardo Bolsonaro, federal deputy, published on social networks (and later deleted) the photo of the author of the alleged letter, contradicting both the guidelines of the World Health Organization (WHO) not to sensationalize the topic or disseminate farewell messages , attitudes that can lead to the contagion effect, that is, the reproduction of the act.
At the beginning of the pandemic, suicide specialist Karina Okajima Fukumitsu released a recommendation note in which she sought to deconstruct the immediate association between covid and suicide. “Putting out news linking Covid-19 contamination to suicide is reductionism,” he wrote.
She highlighted the possibility that some people could feel alone, while others would understand that the time of seclusion was an opportunity to organize themselves. It pointed out some warning signs, such as increased use of alcohol and other drugs and previous suicide attempts, but it made it clear that suicide is multifactorial and the truth goes away with those who killed themselves. “Unfortunately, we will never know the real reasons.”
A year and a half later, she reckons that some aspects of family confinement, for example, have shown a certain protective effect. “Self-injury processes also did not increase during this time, perhaps because relatives and parents were more present”.
Self-injury or self-mutilation, known as “cutting”, is a practice of attacking the body with cuts, bumps or burns in areas where the marks can be hidden by clothing or by accessories, such as the arm, leg and abdomen. “Even with the fights, there was more vigilance”, emphasizes Fukumitsu, author and organizer of books on the subject, including “Survivors Bereaved by Suicide: Care and Interventions”, and coordinator of the graduate program in Suicidology at the Municipal University of São Caetano do South (USCS). Suicide attempts, continues the psychologist, may also have decreased due to this curtailment of intimacy.
She is concerned, however, with the false lull of the moment, and warns of those who may have been deeply ill but remain silent. “A person who is in intense suffering, if he doesn’t explode into illness, he can implode”, he says. Fukumitsu suggests an expansion of care and indication of psychotherapy and psychiatry, including in terms of prevention.
The psychoanalyst Margareth Arilha, a researcher at the Center for Population Studies Elza Berquó (NEPO), at Unicamp, argues that suicide, in addition to the psychopathological aspect or mental illness, typical of the medical universe, is a social phenomenon. “It is a radical act that expresses the impossibility of maintaining a life of exclusion, whether from affection in family life or from social life.”
Arilha recalls that, if in the beginning it was a sanitary crisis of containment, now there are mournings to be dealt with, whether for the loss of one or more family members, or for the demolition of life projects. Arilha thinks about the young people, about their undefined careers and their in-person interactions that were abruptly interrupted: “They say ‘My life only happened on screen’”.
The psychoanalyst also criticizes a certain naturalization of psychic suffering even before Covid-19, suffering that was increased by the pandemic. And it casts a spotlight on women: “They are managers of productive and reproductive life at home, caregivers of their families and communities, working on front lines in education and health and have been facing an additional burden of anguish, often without space to be expressed.”
Health professionals at the limit
On June 26, 2020, the last Friday of the month, a nurse from Quarteirão da Saúde, a hospital unit located in Diadema, Greater São Paulo, was found dead in the institution’s women’s bathroom. She was 37 years old and allegedly committed suicide with an intravenous injection of medication.
Pediatrician Mônica Guarnieri Machado, then director of the IST/HIV Viral Hepatitis reference center at the unit, was on the second floor of the building and was one of the first to arrive at the site, guided by the screams of her colleagues. He followed the nurse’s impossibility of resuscitation, but also immediately identified the need for post-vention, as the care for survivors is called, those who face the suicide of a close person.
A Care Committee was then created for this welcome, and 20 employees of the approximately 300 who work there spontaneously came. “The first thing that comes is guilt,” says Machado. The idea was to try to minimize the impact, but also to prevent another attempt or extreme act. There were those who even claimed to have suicidal ideation for some time.
In the following days, in addition to ecumenical spiritual support, conversation circles were instituted by professional groups, which culminated in a report delivered to the management with the demand of an institutional psychologist for preventive actions, who was incorporated into the team. It was joined by integrative practices, such as meditation, labor gymnastics and chronic pain prevention.
“The front-line professionals are exhausted, under enormous physical and mental fatigue, some with the burden of having taken the virus home and infected family members”, says Machado, recently retired from the public service and determined to take prevention to the suicide in schools. “I worked at Médecins Sans Frontières and I know that, after the war, the social crisis increases. I fear the pandemic is akin to war. We need to anticipate to minimize this suffering.”
If you need help or information, look for the Center for the Valorization of Life (CVV), which provides emotional and preventive support for suicide. Call 188 (toll free) or visit www.cvv.org.br.