By Ubiratan Pereira de Oliveira*
A live of the president served to sabotage the fight against the pandemic and suicide prevention
President Jair Bolsonaro used his live of March 11th to try to assert once again his denialist arguments and little scientific basis in relation to the pandemic, lockdown, vaccines, and so on. In a messianic effort to justify his position against isolation and social distancing measures, he read a letter from an alleged suicide, attributing the motivation for the act to the restrictive measures of the governments of Salvador and Bahia, respectively.
In the broadcast, the president also mentions an alleged suicide that took place in Fortaleza and argues that depression and suicide could kill more than the COVID-19 virus itself. Immediately, the president's son, federal deputy Eduardo Bolsonaro, reproduced on a social network the letter read during the live, also posting images of the alleged suicide, including lifeless. After much criticism and denunciation, the post it was erased. It was not clear whether by the author, or by violating the rules of the social network, which excludes, often belatedly, content exposing suicide cases.
The Regional Council of Psychology of the Federal District issued a note of rejection of President Bolsonaro's attitudes, condemning the political misuse of the letter, in addition to calling the gesture unethical and reckless. It also states that the attitude goes against the guidelines regarding the non-publication of letters and images of people who commit suicide, whose objective is to avoid contagion and imitation, already verified in several studies and historical contexts.
In November 2020, when the president was waging an ideological war against the “Chinese vaccine”, a serious adverse effect that occurred with one of the participants in the Coronavac testing phase, made ANVISA suspend the studies. The death of a volunteer became sarcastic irony in yet another chapter of verbose aberration in which President Jair Bolsonaro attributed a victory to himself. Shortly afterwards, it was confirmed that the volunteer's death was due to suicide, having nothing to do with the vaccine testing phase.
The political Manichaeism of the aforementioned contexts minimizes the complexity that pervades the theme of suicide in contemporary society, in addition to raising legal and ethical issues related to the inconsequential and disrespectful disclosure of suicide cases. Added to this, it is necessary to think about the impact of the pandemic, isolation, mourning, depression and any and all suffering or psychic disorder driven or caused by the permanent state of fear, impotence, consternation and perplexity that has crossed the subjects, either because of the virus or because of their inability to manage the pandemic.
Indicators of suicide are not always easy to quantify. As much as the World Health Organization (WHO) and other health authorities establish continuous monitoring, the information is not always standardized and the territorial designs must be read according to local specificities, observing the methodologies in relation to the quantification of deaths by suicide and attempts to end one's own life.
Even so, the indicators published by the WHO have been a world reference, which end up guiding the conduct of local studies and guidelines for suicide prevention and promotion of mental health in general. In the publication released in 2019, Suicide in the world: global health estimates, the WHO indicates a reduction of 9,8% in the suicide rate in the world, in the period from 2010 to 2016. This trend is not followed in the Americas, where there is a growth of around 6% in general data.
In 2016, Brazil registered 13.467 deaths by suicide, an increase of approximately 14% in relation to the WHO indicator for the year 2012, when the country registered 11.821 deaths. Regarding self-inflicted violence, the Ministry of Health points out that between 2011 and 2018, almost 340.000 notifications were registered. The indicators, in addition to being subject to underreporting, consolidate numbers from years prior to the consolidation of statistical data, which may bring some inconsistency if we want to draw a picture of the moment in relation to the problem of suicide.
Despite some published studies and specific data, it is still not possible to have broader, more reliable and universal indicators that allow a quantitative analysis of the increase in the number of suicides in the pandemic. However, the Pan American Health Organization (PAHO) has pointed out that the pandemic has significantly increased risk factors for suicide. The high incidence of mental disorders, the constant losses resulting from COVID-19, the impact related to the need for social isolation, are aspects that may reflect on the increase in suicide cases.
With a more rigorous and efficient suicide notification system, Japan announced that in October 2020 alone, the country recorded more than 2.000 deaths from suicides, which would have surpassed the death toll from COVID-19 in that month. The case of Japan must be analyzed in greater depth, as it is inappropriate to make comparisons that do not take into account cultural differences and other specificities. However, it is significant to note the importance of this indicator, even more so when a downward trend was observed in the ever alarming numbers of suicides in the Asian country. Another important factor that needs to be analyzed is that in this specific month, Japan was not facing any restrictive or lockdown, as a result of the pandemic.
But, let's go back to Bolsonaro's speech of convenience. When trying to crudely relate the publicized increase in suicides as a result not of the broader context of the pandemic, but specifically of the restrictive measures of social isolation, the president forgets another indicator, which it is important to deepen.
The latest epidemiological studies published in 2017 and 2019 by the Ministry of Health (MS) point to firearms as the third most common means used in deaths by suicide in Brazil. In the two epidemiological bulletins cited, the MS even emphasizes the WHO recommendation regarding the restriction of the means most used by suicides, such as pesticides/pesticides and firearms, as methods that reduce the incidence of suicide, being considered universal prevention strategies . Another factor that generates a necessary debate is the high lethality of a suicide attempt when the means used is a firearm, in addition to the impulsiveness that can accompany someone who has easy access to the weapon and who is in a situation of psychological vulnerability.
The fact is that Brazil is moving in the opposite direction to the guideline pointed out by the WHO and recognized by the Ministry of Health itself. Several decrees published by the Bolsonaro government make access to a firearm more flexible and may, in the near future, significantly increase the number of suicides in Brazil. Studies carried out in several countries point to this correlation, suffice it to say that in the USA, in addition to being the most used means by those who commit suicide, the country concentrates the highest suicide rate in the world by firearm.
The current scenario of dismantling successful mental health policies, which presupposes various services and care strategies at different levels of complexity through the Psychosocial Care Network (RAPS), makes this situation even more bleak. Attacks on substitutive services and other devices of psychiatric reform, observed since 2015, have intensified in the current government, which, in addition to several setbacks, has proposed a “revocation” of a set of 100 ordinances that regulate the national mental health policy.
The document Suicide and self-mutilation treated from the perspective of the family and the meaning of life, published in 2019 by the Ministry of Women, Family and Human Rights, reorients the theme that no longer has the dimension of a public health problem and starts to be dimensioned in other aspects, such as in the spiritual, family and educational plan. At no time is the Psychosocial Care Network mentioned or any device, service or strategy inserted therein, responsible for the reception of victims of self-mutilation and/or suicide attempts.
In addition to thinking about suicide prevention strategies, which go beyond a universalizing saying, it is also important to think about assistance and/or devices that can welcome those who may have suicidal ideation or some type of disorder that may increase the risk factor. for suicide. It is always subtle and difficult terrain to walk, since the risk factor in the case of suicide can be an indication, but does not respond in an absolute way. In several cases, there is no disorder, but there is a unique motivation for each subject, where the absence of listening spaces can enhance a suicidal act.
Finally, the facts reported here demonstrate that the supposed concern of President Jair Bolsonaro in warning that the restrictive measures would be responsible for the increase in suicide cases, in addition to minimizing the issue, serves as a smokescreen in an attempt to hide the absence of policies effective actions by the federal government, not only in relation to the fight against the pandemic, but also in relation to suicide prevention in general. In the last 7 days (March 07th to 13th) almost 19 Brazilians died from COVID-13.000, almost the same number of deaths from suicide in the entire year in 2016. No less important data, but one that tends to increase, mainly due to the absence of effective prevention policies and mental health care for those who decide to take their own lives.
*Ubiratan Pereira de Oliveira, psychologist, was councilor and municipal secretary in João Pessoa.
