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Opening Remarks of the President of the Kenya Psychiatric Association at the Beginning of the 2021 Kpa Annual Scientific Conference at the Lake Naivasha Resort in Naivasha.

Salutations

  1. The Presidential advisor on mental health, chairman of the Chiromo mental hospital, and chairman of the mental health task force: Dr. Frank Njenga.
  2. The director of mental health and immediate past president of the KPA, Dr. Simon Njuguna.
  3. The associate director of brain and mind institute and the dean of medical college East Africa, Aga Khan University Prof Lukoye W’Atwoli.
  4. The director of Mathari National Teaching and Referral Hospital and vice-president of the Kenya Psychiatric Association, Dr. Victoria Wamukoma
  5. The KPA national executive committee members present,
  6. All Past KPA presidents (chairmen) present and all past KPA officials, All professors of Psychiatry present.
  7. All senior lecturers, lecturers and colleagues – senior, contemporaries and younger colleagues.
  8. All our invited and highly esteemed guests and presenters at this conference and participants from all walks of life both present physically and attending virtually from around the world.
  9. All our sponsoring organizations whose generosity has eased the burden of organizing this conference,
  10. All protocols observed.

Welcome & Covid-19

It is my honor to welcome you to the 13th annual KPA scientific conference. The theme for this three-day scientific conference is Suicide prevention. The theme will be divided into four sub-themes: Policy and legislation, Access to treatment, Vulnerable populations, and media and suicide reporting. Kindly check the program for details of the many interesting presentations lined up for our intellectual nourishment.

I wish to also take this early opportunity to remind us of the Covid-19 pandemic and the need to take all possible precautions to prevent exposure to risk. Should you experience any symptoms that raise your suspicion do not hesitate to take measures to excuse yourself from the conference and seek necessary help at a health facility of your choice.  The Kenya Psychiatric Association team and the Lake Naivasha Resort team will be at hand to help in case of any other health crisis. Reach out to us.

Brief Background on KPA (Vision)

The Kenya Psychiatric Association was formed in 1986, as a non-political, non-religious, and non-profit professional organization to advance the practice of Psychiatry and promote and improve mental health in Kenya. Our vision is to be a leading association in mental health globally. I invite you to read more about our strategic direction in the KPA strategic plan 2021-2025. We also welcome our members to join the Annual General Meeting to be held on Thursday 9th September 2021 from 4.00 pm.

Question of Suicide

The purpose of all our annual scientific conferences is to promote evidence-based best practices in mental health. At this year’s conference, our interest is in suicide prevention. Suicide has had a long history and continues to elicit opinions spanning religious, philosophical, sociological, legal, psychological, and medical provinces. This list may not even be exhaustive.

We may be limited in understanding what the pre-historic human attitude truly was towards suicide. However, for most African cultures we can conclude that suicidal behavior especially attempted and completed suicide was disapproved on the basis that they brought curses on the families and the community. To avert the curses, a raft of rituals had to be enacted ostensibly to cleanse the families. Among the Igbo of Nigeria, suicide (igbu onwe) was an abomination (nso ani).  A person dying by suicide was not mourned, people do not cry or express any sign of grief, Nobody touched the corpse, no washing or dressing up and the family faced stigma including discrimination while looking for marriage partners. (the perception of suicide igbo religion, a study in African traditional suicidology, Rev. Fr Christian O. Ele). This is illustrated in Chinua Achebe’s “Things Fall A part”. When the main character Okonkwo kills himself following an altercation with a colonial messenger, his kinsmen could not touch his body or bury it.

Socrates, Plato and Aristotle all opposed suicide for different reasons. For Socrates, the gods had imprisoned man’s spirit in the body as punishment and therefore man could not escape. When given a chance to escape from Athens having been accused of corrupting the youth, he chose to remain and face the punishment of taking his own life by drinking Hemlock. His death came to be viewed as martyrdom for philosophy. Plato termed suicide as disgraceful but provided four exceptions: ones mind is corrupted and the character cannot be salvaged, By Judicial order, extreme and unavoidable personal misfortune, shame at having participated in grossly unjust acts (Laws ix 854a 3-5)

 Aristotle opposed suicide basis on harm to the community and state.

St. Thomas of Aquinas opposed suicide on the basis that life belonged to God.

Stoics: Once the means of living a rich and flourishing life are missing, suicide is justifiable; the character or virtue of the concerned individual notwithstanding. Lucretius, Epictetus, Marcus Aurelius, and Seneca the younger all saw suicide as a legitimate means to end suffering.

Scientific Era

The scientific age with regard to the question of suicide arguably began with French sociologist Emil Durkheim whose work “La suicide” translated to “ the suicide” laid the foundation for later work. Among other things, Durkheim investigated the sociological origins of suicide. He classified suicides into egoistic, altruistic, anomic and fatalistic. Egoistic (too little integration), altruistic (too much integration), anomic (too little regulation), fatalistic (too much regulation).

Suicide further has been explained using psychodynamic, cognitive-behavioral and biological theories. Sigmund Freud in “Mourning and Melancholia” proposed that suicide resulted from internalized anger that had originally been directed to someone close to the person. Aaron Beck describes a causal role of hopelessness. In biological terms, suicide has been explained in terms of dysregulation of the serotonergic system in the ventromedial prefrontal cortex and an activating psychosocial stressor.

In recent times Klonsky and May have researched on the 3ST theory of suicide; which proceeds from pain and hopelessness, to lack of connectedness and the capacity.

Conclusion and Expected Outcomes

Human attitudes towards suicide have continued to change with advancing knowledge. While in the past suicidal behavior was almost purely a moral issue, today it is a symptom of disease requiring empathy and management. However, the best evidence is yet to translate into best practice. For instance, we still have section 226 of the penal code in our statute books. People still ask questions such as what we will replace the section with if repealed. In our communities especially in rural areas persons who survive attempted suicide continue to face discrimination. We still have work to do to bring religious leaders on board.

For these reasons, we hope that knowledge shared at this conference will translate into a better attitude and practice because effective suicide prevention can only happen when policies and laws apply scientific evidence.