Monsters in Our Heads

“I am 18. When I was 12, I often thought obsessively about death. Death, in general, as an idea. Later, I began to imagine my own death, the thoughts eventually having turned into suicidal thoughts. But they were just thoughts. Now I imagine every day how I could commit suicide; it is a habitual thing with me. I’ve been doing it for years.

Sometimes I think it would be easier if I got an incurable disease. It would be much easier for me to die this way than doing it to myself. I’m alive only because I’m scared of death and I feel sorry for my mother. I love her, but I don’t want to live. I understand I have a problem, but I don’t know what else I can do. It feels ridiculous when I talk about myself and about how I feel. I’m glad I don’t have many people who will suffer if I die. I don’t want to leave too much pain behind. I cry almost every day, for no reason.

I sit on the floor and cry, thinking how pathetic I am. One day I wrote a farewell letter. I folded it and put it in my wallet. Then I looked for articles on how to make knots. I went to the store to buy rope, but there I started to cry, terrified of my thoughts. These days, death seems to me the only happy option. I don’t know why I’m writing this … I think I just want to give myself one more chance for the last time.”

This anonymous note is one of the over 3,500 messages posted on the chat of the Green Line for Suicide Prevention, a resource for troubled Moldovans for the past seven years.

“This letter accurately depicts the inner conflict of a person who is genuinely struggling with suicidal thoughts. She does not want to take the step, but she is in a lot of pain,” says psychologist Liuba Ceban, the hotline’s founder.

The suicide rate in Moldova is higher than most European countries. According to the National Bureau for Statistics, last year 489 people committed suicide. The World Health Organization (WHO) recommends multiplying this number by five to estimate the actual number of suicides.

A Major Cause of Death

Although official data are not even close to the actual figures, such numbers show that deaths by suicide in Moldova far outnumber deaths by murder and road accidents combined.

Yet, while the state focuses on policies to prevent road accidents and crime, the subject of suicide stays almost invisible, according to experts in the area of mental disorders. The main reasons for suicide attempts are family relationships and emotional problems, incurable diseases, and financial distress.

At least 200,000 Moldovans suffer from depression, a leading cause of suicide, according to the WHO.

What We Don’t Talk About

“While talking to these people, we try to find the core reason for their pain, because, every time, the main factor that leads to suicidal thoughts is psychological pain that the person can no longer endure,” Ceban says. People need emotional support; they want to share their pain, to somehow get rid of this “burden that eats them from inside,” she says. Once free from psychological distress, the person becomes lucid and starts to look for effective and safe solutions. Otherwise, such a person frequently tries to commit suicide.

Ceban founded the Green Line for Suicide Prevention in 2012, when she returned to Moldova from an exchange of experience program in the United States. She was inspired by the approaches to suicide prevention she saw there.

Over the years, though, repeated confrontations with official indifference or even hostility have drained her enthusiasm. She points out that Moldova lacks a national hotline to assist those troubled by suicidal thoughts. “Moldova is not prepared for this issue,” she says with disappointment.

No National Policies

WHO statistics for 2016 estimate the suicide rate in Moldova at 24.1 per 100,000, among the highest in Europe. However, the WHO recognizes, at least indirectly, that the statistics on suicides submitted by each country seriously underestimate the actual number.

Moldova lacks a unified database of suicide statistics. The National Bureau for Statistics compiles data collected by the Health Ministry, while the government data portal date.gov.md publishes data from the Interior Ministry. The two ministries’ data do not match up.

Arcadie Astrahan, a psychotherapist and program director of the Community Center for Mental Health in Chisinau’s Botanica district, rhetorically asks who would want a single national database, suggesting a lack of interest in making this a priority.  He helped draft changes to a law on suicide prevention that parliament approved in 2018. The document provided for establishment of a suicide prevention hotline and related assistance and for organizing meetings with parents to reduce suicides among children – all still not implemented. 

Every country should have a suicide hotline, Astrakhan says. This task cannot be handled by just one NGO, and the 112 emergency service is not appropriate, because its staff are not properly trained to talk to depressed people, he says. “As for training parents,” the psychotherapist continues, “there is no evidence that they could somehow prevent suicide attempts.” Specialists are required, but there are not many experts on suicide in Moldova.

Learning to Ask for Help

Depression has no selection criteria by age, social, or financial status. No one can be sure that he or she will not get depressed no matter what environment they come from, rural or urban. “A person living alone in an urban area has a higher risk than one who lives alone in a rural area. Finding a support person is easier in the village,” says Olga Jalba, a psychologist, cognitive behavior therapist, and coordinator of the Community Center for Mental Health in the city of Orhei.

The way we talk to people with depression is very important.

“We need to listen to them and to talk to them about our own emotions. We shouldn’t tell them to be strong, to think positively or not to think of doing stupid things. This only aggravates the low and desolate state of a depressed person. Relatives have to tell them: it hurts to see you like that and to understand that I can’t help you,” Arcadie Astrahan says.

Statistics show that men commit suicide most frequently, while women talk about suicide more often. People in rural areas are three times more likely to commit suicide than city residents. Experts surmise this stems from village residents being more likely to ignore signs of depression.

“In the 20 years I have been working as a doctor in a village, no one told me that he or she might be suffering from depression. It is us, the doctors and the neighbors, who should pay attention, observe and guide people to consult with specialists,” says Viorica Ipati, a family doctor at the health center in the village of Budesti, near Chisinau. According to her, over the last year, the suicide rate in the village has risen.  “Earlier, we could have one suicide case over a period of five to seven years, while last year we had three cases. All were people aged 30 to 50.”

Over the last five years, a growing number of people have come to doctors with depression-related complaints. Far from reflecting the deteriorating mental health of the population, this statistic testifies that many who once suffered in isolation and fear now have the courage to ask for help and to visit a community mental health center.

Since 2014, 40 such centers have opened their doors in each district and municipality, offering free counseling and treatment for mental disorders, with the state bearing the costs. A joint Swiss-Moldovan initiative, Mensana, helped train staff at the centers on treatment methods and communicating with those who come to the centers for help.

“According to local stereotypes, having a psychiatric record still means being dangerous to oneself and society, being useless and doomed to isolation. It is for this very reason that there are still people with depression, anxiety, and behavioral disorders who choose to keep silent and face the symptoms and pain alone, hoping that they will go away on their own. Unfortunately, such people seek specialist help when it is too late,” says Victoria Condrat, the Moldovan manager of the Mensana project.

In 2018, just over 73,000 people in Moldova were seen by specialists in mental and behavioral disorders. Currently, statistical data on mental health are not reported separately for each type of disorder.

The Green Line, the only suicide prevention hotline in the country, works out of a 20-square-meter office with two outdated, very slow computers and a small staff of volunteers who interact with the anonymous users that write or phone in. They offer online help only two hours a day.

“We are online from 7 to 9 p.m.,” a Green Line staff member says. “It is at this time that our great struggle for every life and thought takes place, the thoughts being the greatest monsters that eat people from inside.”

This article originally appeared on Moldova.org, a multimedia platform for in-depth reporting. Transitions has edited the text for length and style. Translated by Elena Bivol.