For the emergency department of Bhutan's largest hospital, last Tuesday was a pressing day. In the space of a few hours six people were rushed in, all suspected of having tried to commit suicide.
One of the patients, a 35-year-old housewife, said she had taken 30 sedatives after problems at home. The second, a woman of 27, had swallowed 15 paracetamol tablets after quarrelling with her husband. The third to require urgent treatment was a 17-year-old girl who was rushed in unconscious having drunk nail polisher remover after an argument with her sister. The other three cases were prisoners from the local jail who had emptied a bottle of mysterious spirit. Some reports claimed they had tried to take their lives, but officials are unsure.
By the standards of a hospital in a large city in the West the numbers might be unremarkable, but the Jigme Dorji Wangchuck National Referral Hospital is in Thimphu, capital of the Himalayan kingdom of Bhutan, which has a total population of less than 700,000. What's more, this enigmatic mountainous nation is feted around the world for its gross national happiness (GNH) – a national policy in which the emotional well-being of citizens is considered more important than their financial bottom line.
Yet evidence suggests that all is not so happy-clappy in this high-altitude Buddhist kingdom. Suicide appears to be becoming common as Bhutan's population – for centuries cut off from the outside world – struggles to deal with the pace of change. News reports detail how growing numbers are taking their lives, usually by poison or hanging. A Bhutanese newspaper claimed: "In some villages, committing suicide has almost become a norm."
Jigme Thinley, the country's first democratically elected prime minister, recently identified the surge towards modernity, breaking traditional family and community bonds, as pushing people to take their lives.
"I don't think the country is opening too quickly, but change is happening and disorientation is taking place," Mr Thinley said last week in Tokyo, where he was meeting business leaders to discuss GNH. "Bhutan isn't a happy place – there are many reasons for people to be unhappy, ranging from the physical to the material."
Bhutan, squeezed between China and India, has always been a place apart. Until recently the remote country turned its back on the outside world. Tourism has been restricted. After the seizure of Tibet by China and the absorption of Sikkim by India, Bhutan was the last of a trio of once-independent Buddhist Himalayan nations.
Television only arrived in 1999, and it was not until last year that Bhutan held its first general election. Until then the country had been an absolute monarchy, and critics, including a number of Bhutanese in exile, claimed that even that election was not as open as may have appeared.
However slow change may have been to arrive, the pace of transformation has been fast. In 2006, the much-loved king, Jigme Singye Wangchuck, announced plans to abdicate, and last year – the two-year delay explained by the insistence of royal astrologers to await an appropriate date – his young, Oxford-educated son, Jigme Khesar Namgyel Wangchuck, was crowned. During a dramatic ceremony at the Tashichho Dzong palace in Thimphu, the father, who had personally developed the idea of GNH, placed a black silk "raven crown" onto his son's head, marking the switch from one generation to another.
Reports suggest that many Bhutanese were initially bewildered by the old king's decision both to step down and to turn the country into a democracy, yet other changes have been far more harmful. Rapid urbanisation has seen many traditional networks break down, while unemployment and drug abuse has risen. It is against this backdrop that the increased number of suicides has been placed.
Statistics are hard to obtain. One report suggested that there were as many as 58 suicides in 2001, with fewer than 20 so far this year. Yet officials appear convinced that in reality numbers are on the rise.
The clues suggesting that more people may be taking their lives have been around for several years. Last year, the Centre for Bhutan Studies in Thimphu carried out several surveys as part of its work in researching the "nine pillars" – among them health, education, governance and psychological well-being – used to measure GNH. Researchers said they were shocked to find that almost 5 per cent of respondents said they had thought of committing suicide, while 1.4 per cent had actually attempted to take their own lives.
"We were surprised because this was the first survey we had taken other than the records kept by hospitals," said Tshoki Zangmo, a spokeswoman for the centre. "We did not think that so many people would be depressed."
She added: "This could be due to social factors, genetics, the environment or economics. These are all possible. But I think that the Prime Minister's [comments about the pace of change] could be right."
Michael Rutland, chairman of the Bhutan Society of the UK, is a regular visitor to the country. He said he believed the most harmful change for Bhutan was the increasing number of people moving into towns and cities. "In this regard the biggest change has been the urbanisation. It leads to a breakdown in the local communities and also means that when a young person goes into the cities they lose a large amount of the support structures," he said. "This is particularly true with something like child care where in the rural areas, everyone helps look after the children ... Of course, this is not something unique to Bhutan, but the difference is that in Bhutan this has only been happening for the last 20 years."
Despite the official stress on happiness, around a quarter of Bhutan's population live below the poverty line, and education and health care remain limited, especially outside the cities.
Doctors say they are now waking up to the psychological problems that exist in Bhutan. DK Nirola is a psychiatrist at the hospital in Thimphu, where many of the cases are taken. "Before, we had a more rural setting, where we had a very good support structure from our friends and relatives," he added. "That seems to be going away, especially as people care more about material gain. It's a contradiction when you want to promote GNH but people still want to be more consumerist."
"We still haven't met the basic conditions needed for the pursuit of happiness," said the US-educated Mr Thinley. "The positive thing is that the media is giving cause for alarm – and the government is alarmed."
Gross National Happiness: What is it?
* The happiness of the people was declared the guiding goal of development by Bhutan's king in 1972.
* The Gross National Happiness of the kingdom is seen as a healthier alternative to Gross Domestic Product as a measure of national well-being.
* An enlightened society is held to be one in which "happiness and well-being of all people and sentient beings is the ultimate purpose of governance".
* Last year Bhutan adopted the GNH Index to "track the policies and performances of the country".
* Guensel, Bhutan's daily news site, declared in an editorial yesterday: "GNH is not a philosophy to make every individual happy. It is an expression of a system of values... GNH can help us change without losing our past."