Seeking an Answer Did We Miss the Early Warning Signs?

Suicide Prevention Begins Long Before the River.

By: Dr. Fiaz Maqbool Fazili

A few days ago, I watched a video I wish I had never seen. A man climbed over the embankment and jumped into the River Jhelum. But what happened next shook me far more than the jump itself. As the current carried him away, he desperately struggled towards the bank and cried for help. He wanted to be rescued. Someone stood recording the tragedy on a mobile phone while others eventually rushed to save him. That disturbing scene has refused to leave my mind. If he had truly decided to die, why did he fight so hard to live only moments later? That single question became my dilemma. Every time I read of a young boy hanging himself, a student jumping into a river, a girl consuming poison, or someone ending life after an examination failure, financial ruin, family conflict, addiction or public humiliation, the same question returns: Do people who attempt suicide truly want to die, or do they simply want their unbearable pain to end?

Perhaps we have been asking the wrong question all along. Instead of asking, “Why did he die?” we should ask, “What happened in the days, weeks and months before he reached the river?” The tragedy does not begin at the riverbank. It begins much earlier. Modern psychiatry describes this conflict as ambivalence. During an acute suicidal crisis, many people experience two opposing desires at the same time. One part of them wants to escape overwhelming psychological pain; another still hopes someone will notice, intervene and save them. The suicidal impulse may be intense, but it is often brief. Interrupting that moment can save a life. That is why suicide is regarded as one of the most preventable causes of death.

Finish it! Reality or Adrenaline Rush.: Did We Misread the Early Warning Signs? This thought took me to the clinic of distinguished mental diseases consultant, Prof/ Dr. Mushtaq Margoob sahib, seeking his free time, where, over tea and samosas, I found not only his wisdom but also the valuable insights of clinical psychologist Ms. Aiman and their team. My question to them was simple: Has society failed these young men and women long before they reached the river? Their answer, though nuanced, was clear. Suicide is rarely an impulsive act without a history. In many cases, it is preceded by weeks or months of warning signs—withdrawal, hopelessness, disturbed sleep, sudden behavioural changes, giving away cherished possessions, expressions of being a burden, substance misuse, or repeated statements such as, “I am tired,” “I cannot take this anymore,” or “Everyone would be better off without me.” The tragedy is that these are often dismissed as mood swings, attention-seeking or weakness.

Looking back at the man in the river, I found myself asking another question. Did he say to someone the previous evening, “I am exhausted”? Did anyone notice that he had stopped laughing, stopped meeting friends, or withdrawn from his family? Did someone hear his silent cry but mistake it for ordinary stress? Between despair and death lies an invisible vacuum. A vacuum between pain and being heard. Between loneliness and companionship. Between depression and treatment. Between

hopelessness and hope. Between a silent cry and a compassionate response. That vacuum is where lives are either lost—or saved.

Perhaps he did not need someone to rescue him from the river. Perhaps he needed someone to rescue him a month earlier. A father who asked one more question. A mother who listened without judgement. A friend who refused to ignore a disturbing message. A teacher who recognised a withdrawn student. A doctor who looked beyond physical symptoms. A neighbour who simply knocked on the door. In medicine, we speak of the Golden Hour after trauma. Suicide prevention has its own golden hour—but it comes before the attempt. Sometimes it is a five-minute conversation, a reassuring hand on the shoulder, timely counselling, or simply the courage to ask, “Tell me what is hurting you.” Then while searching for in depth evidence, one thoughtful article from M Iqbal , Chief Editor buzz bytes and Heaven mail, titled, “Fencing the Bridge Ignoring the Abyss, “stirred my restless conscience wrapped in stormy skirmish thoughts — somehow the central theme was hitting the same pain inside me.I read the finely crafted opening and argument , go to root cause, don’t

treat branches go to roots ., prevention is better than cure still holds good that merely fencing

bridges while ignoring the emotional abyss that drives people towards them can never be a complete solution. That poignant observation, painted by Mr. M. Iqbal with the brushstrokes of vivid words

and the sighs of lived experience, has stayed with me ever since. Barriers may prevent one attempt, but they cannot heal despair. Prevention begins not with concrete and steel, but with connection, compassion and accessible mental healthcare.

There is another painful dimension to this story we rarely discuss. Families devastated by suicide tragedy often endure not only unbearable grief but also stigma, whispered gossip and social isolation. Instead of receiving empathy, they may face judgement. Yet they, too, are victims—left carrying questions that may never be answered. This piece is not an attempt to justify suicide.

Absolutely Not! Nor does it diminish the sanctity of life, which every faith upholds. Rather, it asks whether we, as families, friends, teachers, healthcare professionals and neighbours, are doing enough to recognise suffering before it reaches a point of no return.

Every suicide death should compel us to ask not merely who failed, but where the chain of care broke. The most important rescue did not begin when people threw a rope into the river. It should have begun much earlier, when someone first started drowning in despair. Perhaps every life cannot be saved. But if we learn to recognise the EWS- early warning signs, listen without judgement and intervene with compassion, many can. That may be the difference between another obituary and another tomorrow.

As I scribe the final lines of this article, I find myself haunted by Jagjit Singh’s timeless ghazal. I do not know why these verses kept echoing in my mind, as though they were speaking not only for one person, but for every life lost while hope still flickered. “Jis waqt tum chale gaye…Ek aah bhari hogi, humne na suni hogi,Jaate jaate tumne awaaz to di hogi.-Har waqt yehi hai gham, us waqt kahaan

the hum,Kahaan tum chale gaye…”; “When you departed…  Perhaps you let out one final sigh, but I never heard it.  Perhaps, as you were leaving, you called out, but I failed to listen.  The sorrow that never leaves me is this: where was I at that moment?  Where have you gone?” These haunting words summon three unforgettable images. A beloved teacher and mentor, struck down by ruthless killer.A young girl, clutching the Holy Qur’an, whose innocence was met with unimaginable brutality. And

the recent video of a young man battling the water with every remaining ounce of strength, swimming towards the bank—not towards death, but towards life. He fought until he could fight no more. Three different tragedies. Three different circumstances. Yet they leave behind one haunting

question: What passed through their minds in those final moments? Was there one last cry for help? One last hope? One last wish that someone would reach them in time?

That, perhaps, is the question at the heart of this article. Do people who attempt suicide truly want to die? Or do many desperately want the unbearable pain to end while a part of them still longs to live? The drowning youth struggled towards the shore until his last breath. Human instinct is often to survive, even when circumstances seem hopeless. That is why experts repeatedly remind us that many people in suicidal crisis are not seeking death as an end in itself; they are seeking an escape from suffering, believing—often temporarily and mistakenly—that no other escape remains.

If that is true, then our responsibility as families, friends, neighbours, colleagues, teachers, counsellors and society becomes immeasurably greater. The unanswered phone call, the unnoticed silence, the dismissed cry, the untreated depression, the unspoken despair, the unseen disappointment—these may be the difference between life and death. Perhaps the greatest tragedy is not merely that someone is gone. It is living forever with the question, Ek aah bhari hogi, humne na suni hogi…” “Perhaps they sighed one last time… and we did not hear.”

If this article leaves the reader with one thought, let it be this: before we ask why a person died, let us ask whether we truly heard them while they were still trying to live.

(Author is a Medico, writes on civil issues , social reforms)