Ilse Pauw is a holder of the Carter fellowship for mental health journalism from the Carter Center in Atlanta. This is part of her series of articles on mental health and stigma.
It was his son's suicide three years ago which set Bhabha Mkhasibe on a new career path: fighting to raise awareness about suicide.
"Sizwe's suicide came as a huge shock to all of us. He was 27 at the time. In my mind he was a happy and extroverted child who was popular amongst his friends. He was lively and jolly and would always make people laugh. What made it very hard for the family was that he didn't leave a suicide note. This made it very difficult for me to understand what led to his suicide. He phoned me the night before he died to plan my birthday party. It turned out that I had to bury my son on my birthday.
"You can't help but blame yourself if someone close to you decides to take his life. You can't help but wonder: why did he do that? And could I have prevented it? The pain is still unbearable."
Bhabha contacted the South African Depression and Anxiety Group (SADAG) for counselling. He started attending workshops and became involved in the organisation's suicide prevention work.
"It was only after my counselling sessions that I learnt to identify the warning signs. If only I'd had this information, I might have been able to intervene in time."
Bhabha says that in retrospect, there were signs that Sizwe was depressed.
"It turned out that Sizwe had a secret life which was only uncovered after his death. He had just broken up with his girlfriend and we only discovered at the funeral that he had impregnated another woman. Now I can see that there were signs. He became quiet and withdrawn. He tried to talk to us but we brushed it off. If only I had listened to him, I might have prevented this tragedy."
Bhabha's guilt, self-blame and "what-ifs" are echoed by thousands of parents who have lost a child as a result of suicide.
"Losing a child to suicide is extremely difficult for parents and siblings alike," says Janine Shamos, project manager at SADAG. "There is always self-doubt, guilt and self-blame. Parents and siblings often ask themselves questions like 'Why didn't I see it?', 'Why didn't he/she talk to me?', 'Was it my fault?'. Sadly there often aren't answers to these questions and parents are left doubting.
"No-one ever forgets how they heard about the suicide of a loved one. A key to coping with loss is understanding why it happened. In the case of suicide, understanding cannot be accomplished easily or completely. Sometimes each question that is answered creates two new ones.
"It's incredibly important that parents get help and receive counselling after a child commits suicide. Counselling is vital to addressing often unanswerable questions, looking at guilt and self-blame, and getting support for the family and putting coping mechanisms in place. Self-help groups for suicide survivors can also be an invaluable source of help and support," says Shamos.
Suicide in SA
"Sizwe fits the typical picture," says Prof Lourens Schlebusch, expert on suicidal behaviour at the Clinic in Behavioural Medicine in Durban. "There is a rapid increase in suicides, especially amongst young, black men, with hanging the most frequent method, as in Sizwe's case. Sizwe was in the group most at risk: young adults under 30."
According to Schlebusch, South Africa has a comparatively high suicide rate with 19 – 28 per 100 000 completed suicides per annum. More females try to commit suicide and more males succeed, primarily because men tend to use more aggressive methods.
"The fact that Sizwe committed suicide the day after phoning his father is not unusual. Suicidal behaviour is a process. The person thinks about it, lets go of the idea, then thinks about it more. It takes a small event to push someone over the edge. By the time they've done it, they have been contemplating it for a while."
At the funeral, people sang Sizwe's praises.
"This made me angry," says Bhabha. "I said: please people, he isn't a hero. What you are doing here is not helping me, it is hurting me more. Look at what happened and see how bad it is. If people don't talk about suicide openly and honestly, they aren't facing the problems."
Bhabha called a family meeting the day after the funeral. At the meeting, he urged his family: "Whenever you have a problem, talk about it. Come to the family first and open your heart."
Bhabha vowed to focus his energies on raising awareness about suicide. He started an NGO, Sizwe Xolani, in Johannesburg and offers workshops and counselling. He runs courses at churches and schools and often talks to the media.
"People don't talk about suicide because of the stigma attached to it. Through the support group, I encourage people to face it. I want to tell parents: look out for your child. If your child is not sleeping or eating, withdraws, spends hours in their room with the door closed, gives things away and jumps from one relationship to another, ask: what's happening? Spend more quality time with your kids and understand them.
"Let's talk about it. Let's fight this together. Let's get more involved in our children's lives. Let's expose the common causes such as drug abuse and unprotected sex which make children vulnerable to committing suicide. I don't want to see another parent losing a child." (Ilse Pauw, updated August 2010)
For more information contact:
Sizwe Xolani Mental Health Group at 072 1581984
South African Depression and Anxiety Group at 0800 567 567
Professor Lourens Schlebusch at 031 2614293
Other stories in Pauw's series on mental health and stigma:
My secret life
To tell or not
Suicidal Behaviour in South Africa, by Prof Lourens Schlebusch: order a copy here.
Mindshift: Stress management and your health, also by Prof Lourens Schlebusch.
Why they do it. The primary reason most suicides occur.