 Welcome everyone to week 12 of our class. We're just another three weeks to go this week and another two weeks to reach the end of our course. I hope the entire course has been a blessing to each of you as we've looked into very many details and very many areas of counseling. We started over the last two, three weeks, we've started different particular issues in counseling and today we're going to be looking at another significant issue and concern which is suicide. So I've clubbed a little bit of depression and suicide in it. I know we did go through some bit of mental health earlier two weeks ago, but it may be important for us to bring these two together so that we have a better understanding of what is suicide, how do you see, how do people present with it, how could we minister, how can we help, what are some signs that we may need to look at. And also in your notes you will have certain scriptural verses on about suicide, that prohibits suicide. So these could be helpful even as you minister or even as there are questions that come about. So we're going to be looking at both depression and suicide. I've clubbed the two a little together so that I think it flows well when we have it in the context of depression as well. Just give me a minute, I'll share my screen. So we're going to look at depression and suicide. So before we get there, I just wanted to bring about certain questions to you all or rather certain statements to you all to really give us an evaluation of how we think about depression or how we think about suicide. Because I think just to have a good understanding of working knowledge of what it is and how it kind of crushes people and where does that come from, all of that is something I thought was important for us to look at. So I've just put down a couple of statements and would like to hear from you all as to what your thoughts are. So the first one is suicide attempts are about seeking attention. What are your thoughts? You could either put it up in the chat or you could just quickly type what your thoughts are or whether you agree, whether you disagree and maybe why you agree or why you disagree. Okay, I have one response. Defina said no, they are not about seeking attention. Anybody else thinks otherwise? Any other comments? Okay, so we will be addressing these questions as we keep going ahead. So I'm not going to get too much into detail of this. Next one, people who come in suicide are being selfish and think it is the easy way out. What are your thoughts? Okay, I think I've got a lot of no's. I don't know which one you'll have answered it for. But then I suppose it's this one again that you'll have answered it for that people who commit, okay, they're not selfish and it is actually not the realest easy way out. Okay, often there is a clear reason for every suicide. Okay, Divya said they could be selfish. Okay, all right. There is a clear reason for every suicide. Not necessary. Not necessary. Okay, I think some of you said no, some of you said yes, some of you said not necessary. Okay, you'll get to know more. There could be. There could be. Yeah, there could be, I suppose. Okay, all right. There could be. Okay, there could be certain reasons. Okay, next one. Asking somebody, this is an important one and I'd really like to hear some thoughts on this. Asking somebody whether they are suicidal and discussing whether they have a plan or method will simply give them the idea and increase their risk of suicide. What are your thoughts? I don't think so. It will increase their risk of suicide. Okay. But I think it's good to speak up. Sorry, definitely didn't hear you. But I think it's good to speak about it. I'd like to ask them. Okay, maybe the same question is different whether they have a plan or method seems very different for me. Okay. Okay, so you're saying it feels better to ask them, but whether they should talk about whether they have a plan or not is something you don't know, but it's something that needs to be discussed. Okay, I think even Divya has said. Yes. Sorry, success is not able to hear you very well. Can you hear me now? Yeah, yeah, that's better. Yes. Okay. The question is asking someone whether they have suicide and discuss whether they have a plan or method will simply giving them the idea to increase the risk of suicide. Yes, I would say here, especially our Muslim brothers and sisters. You know, I have opportunity to interview the suicide bomber in Borno State under. I asked him when God delivered him. I asked him, why do you want to commit suicide? And why do you want to take people along with you? And he's gave me the reason that you have a plan and the plan is once they commit suicide, they kill somebody from Muhammad. They have seven wives over there in Arjan, in Paradise. So most of them, they just want to have seven wives over there and they don't know that they're going to hell. So they have a plan and their plan is selfish. They are brainwashed. So they have the plan because of what they told them and they believe in what they told them and it's a very wrong one. Thank you. Thank you. Thank you so much for sharing that. Yeah, so like I think Success has said, in certain cultures it is actually believed to be, you have treasures up in heaven. So over here there's a plan, there's a method. Yeah, and to talk about it in itself could definitely give somebody an eye opener. In other forms, I think we will discuss that as we keep going. All right. Yeah, next one. Depression is the same thing as feeling sad and grief. It's the same thing as someone would feel sad or someone would feel grief. Do you think it's the same or it's different? It's intense. Okay, Daphina says it's intense. Yeah, Daphina, go ahead. Yeah, that's Daphia here. Daphia, sorry. Yeah, I think it's more of despair and hopelessness. Like it's going to an extent of hopelessness. Okay, right. Yeah, so in other words, yes, it is different. It's very different from the common feelings of sadness or the feelings of grief. It's a lot more deeper like both Daphia and Daphina said it's very, very intense. I'll show you all a video that will help to give it a little bit better understanding. Okay, next one. Depression means weakness. Depression means weakness. What are your thoughts? Does it mean weakness? Yes, very weakness. Okay. All right, we've got mixed responses here. Okay. Depression means weakness because when you are depressed, I can really tell you everything about you will be shut down. You cannot do anything. You are weak emotionally. You are weak mentally. You are weak because you are depressed. When you see someone that is depressed, the pressure can lead to many things. And the weakness, again, because no one, according to me, to make it strong for weakness, the pressure can make you to be weak. So I go for depression. Okay, all right. Okay, so we will look at it a little bit more in detail to understand it better. Yes, a person who has depression could feel emotionally weak, but depression, someone who has depression doesn't mean that they are weak. It could make them emotionally and physically very, very tired out and exhausted and a sense of weakness. But weakness doesn't, it's not that someone who has depression is weak. Okay, so there is a little difference if we have not understood the statement well. Okay, next one, real believers don't get depressed. Real believers don't get depressed. Get a silence on this one. It's not true. Okay. They do. Real believers don't get depressed. So it's true that they don't get depressed, right? That's what I think both of you have said. No, no, ma'am, I said it's not true. It's not true. All right, it's not true. All right. Okay, next one. Depression is a sign of a lack of faith. No. No. Okay. No. Okay. Depression always has a spiritual cause. No. Not necessarily. It can have, but not necessarily. Okay. I think suicide ideation is a sign of deviance. Someone who wants to commit suicide or even have thoughts of it is a sign of deviance. Maybe mental deviance, mental deviance. So we have to know where to give it. I think I should. Maybe. Maybe. Maybe. Okay. Okay. So you're saying there could be chances where it can be secondary to something that's mentally not okay. Okay. All right. Okay. Next one. People who talk about suicide won't do it. People who generally talk about suicide won't do it. 50 by 50-50. Some do, some nots. Okay. I think Jeffina, you didn't say false for this. Something else. Okay. Suicide is a purely personal decision. No. Yeah. No. Someone else is saying something. I think it's a personal decision. Maybe. It's not deciding to commit suicide. No one is forced to do it. Mostly. Okay. Be upbeat when you respond to a depressed person. When you're responding to someone who's depressed, you need to be upbeat. You need to be joyful and happy. No. Okay. What state would you need to be in? Maybe listening or comforting not really upbeat. There is no joining that person. That doesn't make sense. Okay. All right. Okay. Sorry. A lot of understanding. Yeah. Okay. Okay. And the last one, people who really want to kill themselves are beyond help. In the sense of that, if people want to kill themselves, they will finally do it. So whatever help you give them, it's not going to really work. No. We can help. Okay. All right. Good. I have a couple of statements that I picked up from general conversations with people and what they think. And just to see how we can really look deeper, dig deeper into some of these statements. Are they a reality? Are they not? Is there something that do we need to have a different kind of a mindset even as we deal with people who are depressed or also upset? Okay. So like we had mentioned, just a quick recap on this is to understand what depression is. So when you look at depression, as you'd see, it's a common mood disorder. It's a debilitating mood disorder. Now, this is more than just sadness, which is in response to maybe certain life struggles or setbacks. The thing about depression, it changes the way you think. It changes the way you feel. It changes the way you function in day to day activities. It can also interfere with one's ability to work, to study, to eat, to sleep, and even to enjoy life. And the general feelings of hopelessness, helplessness and worthlessness can be so intense and it can be so unrelenting and there is sometimes very little relief. So depression is a common mood disorder. And so people generally describe it as living in a black hole or living with a black cloud or having a sense of impending doom. Others sometimes describe it as feeling lifeless. They feel empty or just apathetic in a lack of interest. Sometimes it can present itself in anger or absolute restlessness. So no matter how you experience a person experiences depression, if it is not treated, if it is not helped, it can become a very serious health condition. But it's important to remember that these feelings of helplessness and hopelessness are symptoms of depression and it's really not the reality of their situation. Like just yesterday I met an elderly man who is 76 years old and he's had his first episode in 2012 where he had significant depression, had an attempt of suicide, got into medication but finally things got better. Then again, 2018, when his wife passed away, he went into depression again. This time a lot more serious with symptoms called psychotic symptoms and something that we call as catatonia. Catatonia is where there is a lot of rigidity in the body. He would just sit for hours, he would just lie down for hours, not open his mouth to eat, not drink any water, not talk at all. And it got a little worse and then again there was a treatment then permitted and now again there has been another recurrent episode of depression. So this man has a family of sons who's all taken care of him. When you look at his state of living or his reality, he's got everything that is needed for an elderly man. But nevertheless, there is this constant feeling of helplessness and hopelessness which again is not actually a reality of his situation. So these symptoms, these feelings of helplessness, it has nothing to do with the reality of their situation. So in depression, alongside with medical health, there are many ways that one can lift their mood to overcome that depression and to enjoy life. But when we're looking at depression, we see it as a condition, as a disorder and how it affects a person's day-to-day activities, affects their emotions, affects their cognitions, affects their ability to relate to others, affects their spiritual life. So this is what is it that we call as depression. Now just to give you a quick statistic, just for us to have a better understanding of what it is, is that in fact depression is one of the most common mental health concerns that have been actually reported. And actually these numbers have actually gone up. It's as three out of every hundred urban. It's actually a lot more, it's maybe four to five at this point of time as the current statistics go. When we look at, and this is only three out of four, I'm sorry, four out of hundred, what we're talking is only reported cases. There may be a lot more that go unreported. I think that suicide and depression is often the second leading cause of death, especially in the age group of the 18 to 29 years. And the fact that India, India is the world's second largest suicide country, or with people especially at this age group of between 15 to 20 for 29 that usually do attempt, or in fact even commit suicide. And you would see the kind of help that is available is, it says it's just one psychiatrist or very few mental health professionals that are there for fall like Indians. Which means there's so much that we also, even those of us who may be in different parts of ministry, being able to help and work with people who may be going through these significant kind of issues. Now just to discuss a little bit more, when we're looking at depression, we are looking at it as two types. So there are two different kinds of depression that you would see. And there are two words that is used. It's either reactive or reactive depression or what we call as endogenous depression. Now the reactive depression is, this is a way of distinguishing between depressions that relates more to causes rather than symptoms. So these two, it relates more to the causes. What are the causes of this? So the endogenous depression as the name suggests comes from within. And it is generally thought to be caused by chemical imbalances and is explained and treated best by what they say is the medical model. Whereas a reactive depression on the other hand is caused maybe by external factors, maybe a loss of job, a death of a relative or significant relational issues or financial conditions. Many other, many situational factors. So it's more reactive. That is the reaction is as a result of something that hasn't gone well. Whereas endogenous is more within, it's more from within and may not have too much of a root cause of any of a situational factor. So that's where the models of how we approach people, whether they have an endogenous or a reactive depression, that it really matters how we approach them. So like for someone who has an endogenous depression, if we are going to get into trying to dig and sort out whatever their problems may be, even when you can't find anything. Whereas maybe there are physiological issues that's causing the depression, we've moved out of how to respond to them. If you remember in our second session when we spoke about understanding human needs, we spoke about how man is a being, is a functional being of five, when we looked at five factors, right? We saw physical, emotional, rational, volitional as well as spiritual. So the first and foremost thing is to look at it, feel them like an onion. First it's to see if there is anything, any kind of physical causes that's causing the condition or causing the issue or causing the problem and then rooting it into the more core things that are there. So reactive depression is where we may come into talking about those needs that we spoke about. Remember the need to be loud, to be significant and to be secure. These were the needs that we spoke about. So a lot of that reactive depression would fall in that category. Moving ahead, when we're looking at basic causes of depression, we consider it as an illness that can result from different factors. And this is what is generally studied and that's what I've kind of brought to you. The factors being, one of them being biological where there are, you know, everyone has a brain where there are certain chemicals that's called as neurotransmitters and people generally with depression may have either too much or not enough of these chemicals and that's what really causes the depression and that's where we call them the endogenous type of depression. Maybe there is a genetic contribution to it also where there's a family history of depression. It can increase the risk of developing the condition in a person. There can be environmental conditions. Like we said, that's where we fall under the reactive depression where it can be trauma, there can be loss of a loved one, a significant difficult relationship or a stressful situation that can cause or that can trigger these symptoms of depression. There could also be psychological factors which is a person's mental and emotional state or a personality that can influence their perception of certain events in their life. So even though there may be, then whatever the situations may be, it depends on the way they perceive certain conditions that could result in depression. There is also the co-occurring conditions that people who may have certain physical illnesses, for example, like stroke, heart disease, cancer, Alzheimer's, diabetes, other kind of hormonal disorders are likely to develop depression. So it's important to treat both depression and the co-occurring physical or psychological condition and then of course spiritual, that it can also be significant crushing of the spirit as someone having a crushed spirit and as a result having depression. So that of course requires deliverance and prayer and standing on the word of God. All of this of course do require that, but specifically when it is a spiritual attack, we do see that it's important to stand on that. For those of you who are interested and I think I'll put up some maybe reading material on Tim Keller's, he talks about the wounded spirit. It's a series on problems. He talks about the crushed and the wounded spirit and to have a good spiritual perspective of that is wonderful and I'll probably put that up on the stream and all your notes and you could have a look at it. You could listen to it whenever times possible. Let's just look at what are certain risk factors that are there when you're looking at depression. This is what you call, generally what you call is predisposition. What are some factors that make people more at risk for having depression? So here are certain things that have been put up. One of them is the socioeconomic status of how they are with regards to their finances. There can be other factors such as the inability to achieve a certain goal, an expected goal or a desired outcome and that could probably be a factor for depression. Marital problems or separation or divorce when there are significant issues in marriage and family relations, they can be of risk factor for depression. Death of a loved one again is something that can cause significant hopelessness, constant physical illness or any kind of a terminal condition, any form of accidents or even childbirth. You would have heard of these terms of postpartum depression. So that in itself can trigger depression. Then a certain occupational or financial issues or losses that can cause depression and next upbringing in the person's childhood also is a factor of causing, important to remember that even that can cause depression. So when you look and not cause depression, it can be a factor towards depression. So it's important to remember that each of us are different and it may be a combination of factors that puts a person at risk of depression. Like for example, you may see someone who has maybe who's come from a poor socio-economic status, may have problems in relationships, may have seen multiple deaths, but may be okay and not have depression. But you may see someone else who has a physical condition or a physical illness, they may have depression. So there could be different factors. Even your personality, the way that you approach life also becomes a predisposition. The people who are warriors, those who are extremely anxious, again, these are certain risk factors and that's why in scripture it keeps telling you do not fear, do not fret, do not be overcome by worry because a constant mind, when the mind is constantly worrying, so our brain is so versatile, it adapts extremely well, that it forms certain neural pathways depending on the way that we engage in certain thoughts. So the more that we engage in the word of God, we engage holistically, wholly, we are forming new neural pathways, physically we're forming new neural pathways that help us in our living. But on the flip side, when there are constant nagging, negative thoughts, negative worries, we're engaging in that, that also forms a certain sense of a neural pathway and it's very interesting, it's called as neuroplasticity and there is, I think her name is Catherine Sheen, I think I've forgotten her name, but then she talks about, she's a believer and she talks about how in her research she's done that and how people being in the word of God really have, they've seen how their thinking patterns are very different and how their lifestyles and the way they live are so much more healthier and wealth. So certain risk factors are what they're talking about, about it causing depression. Now, just certain ways, I've just put in this slide to help you to identify how sometimes people talk about depression. So they may describe it very, very differently, but you know that they are attempting to articulate it, to share with you what they're going in and these are some things that we've kind of put down. So the way they describe it, I have lost the ability to enjoy life, I can't imagine my future, I feel I'm stuck in a box which I can't get off, I feel like I don't matter at all, I feel like my mind is breaking, I feel constant shame and embarrassment, I've forgotten who I really am, I can't have fun anymore, I feel like an actor playing me and I'm forced to smile when I don't feel like doing so, I feel miserable without any reason at all, I feel hopeless, life is no meaning, I feel numb, I don't know why I feel this way, it's almost like I'm having another out of body experience looking at myself and not feeling well. So these are some things that you would commonly hear people talk about and how they relate to depression. Now, we need to understand that there is a significant relationship between depression and suicide. There's a huge relation that you will find between depression and suicide. Depression and the risk for suicide is very, very closely related. You will see that the vast majority of people who go to commit suicide in fact have a diagnosis of depression or another mood disorder and we could almost closely label it to around 60 to 70% of people who commit suicide. When you look back, there is a diagnosis of either depression or some other kind of a mental health condition, it can even be substance use, it can be schizophrenia, there could be certain mental health condition that can cause suicide. So that's why depression and suicide understandably go hand in hand, which means that for many people, suicide prevention becomes an integral part of dealing with the depression. So why not every depressed person attempts or commits suicide, most people who kill them, who suicide or kill themselves are definitely dealing with the depression and that's something that we need to be cognizant about the understanding. Now even as I'm going to be talking about this, we're going to be discussing maybe suicide, suicide assessment, we're going to be looking at one or two videos. Be sure that you're monitoring your own personal reactions to this as we're talking. If you do feel significant strong emotions that's rising up within you, please take time to talk with somebody you trust. It is common to feel anxious or to feel worried or to feel concerned, especially if it triggers certain memories or if you've known of people who've committed suicide or heard of it or it makes you uncomfortable, please monitor your own personal reactions and if you need to talk and be available or if you do have someone who you can trust to talk about this, it's important to do so. It's just for you to be aware that these reactions can take place but we're here to support it to help. Now when we look at suicide, there are certain things that we need to look at. There are different kinds of behaviors that you would see when we're looking at suicide or any kind of life-threatening behaviors and I just want to bring two or three for us to understand, to have a distinction between these three. So suicide is, yes, the action of killing oneself intentionally. They take away their lives intentionally. It's an intentional attempt. There is another life-threatening behavior is what we call as a para-suicide attempt, which is a non-fatal act in which the person deliberately causes injury to themselves or any prescribed or therapeutic dose in excess. So it is a desire to commit suicide but maybe it's not completely successful or for the fact that they have not, you know, their plan or what they have planned has not reached the bar of a suicide but then the intention is still there. The para-suicide attempt is a non-fatal act. So maybe there is a desire to kill themselves so there may be medicines or a high dose of medication that they may take but it could cause injury or it could just put them to a strong sleep. Just that there is an intention. Again in para-suicide attempt there is an intention but it is a non-fatal act. And the third one is self-harm and this again is a life-threatening behavior. The deliberate attempt to harm or destroy the body but there isn't any intent to kill oneself. And you would have heard of times when people are in significant emotional struggle and trauma how they attempt to harm themselves, either hitting oneself on the wall or pulling hair or taking a blade and cutting their arms or legs. In some way maybe cigarette butts burn the skin with that. This is not an intent to kill but an intent to destroy or intent to finish off life. It is more an attempt to bring down the pain or the sadness or the numbness that they may be feeling within. That's what causes them to create this. Now nevertheless these are all behavioral and emotional issues that a person has although a person is just self-harming does not mean that they may not commit suicide at a later point of time. Self-harm, we see people with self-harm also can be depressed and it can also move again once more into causing depression. Alright, I'll just take a break at this point of time before I get into the whole chunk of depression which I thought I will do from next hour. Anyone has any questions up until now? Any questions? Yes, yesterday. Go ahead. Yes, thank you ma'am. I just wanted you to, can you please explain once again reactive and endogenous. I didn't quite understand it. So these are two kinds of depression. The endogenous depression as it is spoken about is something that comes from within which usually is related to these neurotransmitter changes that are there. So our brain has even our emotions, our behaviors, there are certain parts in our brain that is responsible for our emotions, for our reactions, for our behaviors. There are certain parts of our brain that helps us to be either emotionally stable or unstable. Even though situations may cause emotions, there are still, especially when you look at mood swings, maybe hormonal changes brings about emotional changes. You will definitely see a relation that's there without any significant cause or significant factor in your situation or wherever you are when there isn't any kind of a significant cause but generally endogenous depression is caused because of changes in the neurochemical reactions in the brain. That's what causes endogenous depression. Whereas a reactive depression comes as a result of certain life situations like a relational issue, like a loss of a loved one, maybe hard circumstances, issues in finances, issues in housing, being alone, maybe upbringing that's been very traumatic. So reactive depression comes as a result of certain long standing stressful situations whereas endogenous depression may not have many factors that causes depression. It's a lot to do with the biochemical changes in the brain and that's why generally people with endogenous depression, you would help them take on a medical model. That is, get them treated medically, give them medication, help them treat it medically because there isn't anything that really is causing the depression. They may need counseling for the way that their thoughts are being processed but they may not be any certain cause or a source for the depression. Whereas in reactive depression people may need to learn better coping strategies or dealing with their loss or dealing with their situations or whatever could be a factor towards that. So that's the difference between the two. I hope that was clear Divya. Yes. So Suman, does endogenous, is it also called like a clinical depression? Yeah, endogenous is what you call is a clinical depression but you know when there are doctors who are writing off clinical depression, you can also have significant depression as a result of your reactive depression can also have significant symptoms of depression. It may also need medication but nevertheless there is something that you see could be a source of the depression but generally clinical depression would be in the first one, the endogenous one. Okay, thank you. Okay, good. Let's take a break for 10 minutes. We'll be back at 11 o'clock. We'll take a break and come back.