Preventing suicide

There’s a discussion going on over at Mental Nurse.  I’m posting here, rather than on the Mental Nurse site, because I don’t currently have the willingness or ability to get involved in a protracted bun-fight.  As part of the discussion, beakie said this:

Human beings do not exist in a vacuum. No man is an island, as someone once said (now who WAS that?) In saving someone, we also save them “for the family”. Maybe at the point they are unable to see beyond their severe depression, we are saving them primarily “for the family”. I have absolutely no problem with this as I would hope, were I in the same state, that someone would also save me “for the family”.

Well, I’m sure beakie is a nice enough person in real life, but this opinion is simply monstrous.  What this means is that, in beakie’s book, it’s ok to force someone to live on and on and on in the most intense misery and suffering imaginable, simply on the grounds that if they died, their families would be upset.  No, no, no, no, no.

It is immoral to justify the suffering of one individual on the grounds that it will prevent or reduce the suffering of someone else.  The idea that, simply because they were conceived by the same parents (or they once underwent a quasi-legal ceremony together, or whatever the connection is), individual A has the right to insist that individual B leads a life of unrelenting misery and pain is just wrong.

Think about what this means.

It means that person A is being valued more highly than person B.  The enforced continuation of person B’s suffering prevents the suffering of person A, therefore person B should be forced to suffer.  Person B’s suffering is deemed to be of less concern than person A’s.  Person B is deemed to matter less than person A.    Person B isn’t even really a person anymore – what happens to them doesn’t matter the way what happens to person A does.

This way of thinking is – I’ll say it again – immoral.

The basic immorality is made worse by the fact that, when person B is locked up and drugged into immobility for the sake of person A, person A won’t even be around.  A couple of hours every few Sundays, maybe, but other than that it’s ‘out of sight, out of mind’.  Or maybe person A will say “I can’t bear to see him like this”, and will never show up again.  But either way person B will continue to suffer in the interests of person A.  This isn’t just immoral, it’s sick.

Beakie does try to finesse the point, when he argues that the pain and misery of person B is only temporary (‘at the point …’), but the fact of the matter is that no-one (not me, not beakie, not person A) knows whether the suffering is temporary or not.  Neither do they know how intense the suffering is.  Only person B knows that.  Only person B can make the decision as to whether the suffering is bad enough, or permanent enough, to justify suicide, even with all the grief and upset to others that suicide will cause.

Attitudes like those of beakie terrify me.  I am scared half witless by the thought that I may at some point find myself in the enforced care of someone like him.  Someone who is convinced, in the absence of any knowledge of what I am going though, that it is necessary for me to keep going through it.  That they – automatically, unquestionably – know what is best for me better than I do, even to the point of denying me the most basic, the most fundamental right there is.

This is why I will never be honest with any MH professional.  Even under great pressure, I’m a good liar, and I’ll lie through my teeth, if I have to, to preserve my right to self-determination.  It’s also why, if I ever do take the decision to kill myself – and, rest assured, it won’t be a decision I take lightly – I’ll pick a method that I know will work, and I’ll pick a place where I know I won’t be disturbed, and I’ll go off and do it, with no fuss, and no fond farewells, and no ‘crying for help’.

The right to live and the right to die are mine, and I will not surrender them to anyone.  Not even a well-intentioned tinpot little god of a MH professional who thinks a few letters after their name, and the authority of an Act of Parliament on their side, means that they have the ‘duty’ to confiscate them whenever they choose.

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18 Responses to Preventing suicide

  1. The Chuckle says:

    “Human beings do not exist in a vacuum. No man is an island” Funny, during periods of deep depression (where suicide has been a very real possibility) I’ve felt very much like I’m in a vacuum, on an island, all alone – not because there weren’t people who loved me or cared for me, but because I couldn’t connect with them or anyone or anything else. At those times just struggling through the day is like a living hell and there are still times when I wished I hadn’t. In many ways I know how much my suicide would badly effect others, but I don’t think it’s beyond the realms of possibility that one day that won’t matter enough – I agree with you A, freedom of choice is essential for quality of life. There may be times where intervention works out to be the best thing, but how can you say that that’s always the case? Or that the wishes of somebody else should reign over a person’s life?

  2. Socrates says:

    I’d like to second your last paragraph…

  3. Strong stuff, and well said. Take care, D

  4. jessa says:

    Hmm… when I read that comment of beakie’s, I guess I didn’t think he was serious. I thought he was articulating that this is the only way of rationalizing the way we treat patients. How we do it against their will and tell them, “but oh! your family will miss you!”

    Actually, I just reread his comment, and now I, like you, see in it more of a “this is my sincere position.” Which is horrifying to me. Still, I think he does articulate the only possible rationalization for what is done to patients. This rationalization is, in a sense, a consequence of what people do to patients, even when they do not explicitly think these things.

    Am I making sense? I am trying to say that even if you don’t think through the rationale for what you do, your actions still express that rationale. And if you don’t think about that rationale beforehand, it might be horrifying and you don’t even realize it. I think that there are people who act in accordance with this rationale without realizing how horrifying it is because they have never thought about it. I am still not certain I am expressing my ideas adequately. I apologize. Ask me questions and maybe I can explain it better.

  5. aethelreadtheunread says:

    Thanks for the comments (and sorry that this is the first time for a while that i’ve replied – it wasn’t anything personal, honest!)

    TheChuckle – You’ve put into words very neatly something i was struggling to express – i know, if i ever do kill myself, that i’ll be missed, but i also know that that, on it’s own, may not be enough to prevent me for ever. It’ll be a factor in my decision – a big factor – but it won’t neccesarily be the deciding factor.

    There seems to be an assumption among some MH professionals that people only ever kill themselves because they think that no-one will miss them when they’re gone. It’s almost as though knowing that i’ll be missed is supposed to be some kind of panacea that, on its own, magically resolves every problem i face. It’d be nice if it did actually work that way, and that fixing depression was so easy.

    Socrates – thank you. So… the motion’s been proposed and seconded – doesn’t that mean we have to go to some kind of a vote…? ;o)

    abysmal musings – thank you. And you take care as well, you hear? :o)

    jessa – this is a tricky topic, and i’ve struggled to get my thoughts into order on it, so there’s no problem with you ‘feeling your way around’ the subject. :o)

    I think i may know what you mean. I think what you may be trying to say (and sorry in advance if i’m getting this wrong) is that people may grab hold of a rationalisation for what they do without neccesarily having thought through all the consequences. Is that right?

    If that is what you mean, then i tend to agree with you. I’m certain that beakie, when he was still working on the wards rather than as a teacher, didn’t consciously think to himself that he was devaluing the life of the patients in his care. I’m sure he would be horrified to think that he was – no doubt he went into nursing because he was motivated by a sincere desire to help people. But i also think the case i set out is an inevitable consequence of the opinion he expressed.

    I think the crux of the problem is that beakie thinks of mental illness as a temporary problem, even if it turns out that the ‘temporary problem’ lasts forever. My point is that, for some people (and it would seem as though i may be in this group myself), it isn’t temporary, it’s permanent. I can see the logic and the compassion in intervening to ‘save’ someone who may be in the grip of a short-term crisis. But to me it is monstrous to deny someone the right to ever bring their suffering to an end, just beacuse their death would have a negative impact on other people.

  6. jessa says:

    aethelreadtheunread: Yes, you did mostly understand what I was trying to get across. Awesome! I did better that I thought I did. But in addition to people grabbing hold of a rationalization without having thought through all the consequences, I think there are also people who act without considering that rationalization at all. People who learn, “this is how we handle situation X because it is best,” but who never question why we handle situation X that way. In this category of people who are not really considering the rationalization at all, I would include people who maybe thought about the rationalization once, or were taught it, but who never thought through all its consequences and don’t tend to think of that rationalization on a regular basis when they carry out their handling of situation X.

    I do agree with you that the temporary vs. permanent nature of mental illness is where part of this problem originates. I also think, however, that part of it comes in not allowing others to have values that differ from one’s own. Perhaps this isn’t as intentional as I make it sound, I doubt people actually go around saying, “you must agree with my value system and priorities!” I expect that this comes more from just never stopping to consider that others may have vastly different values and priorities, even so different that they seem inconceivable to oneself. I would expect that many in mental health care find a system of values and priorities that allows for the possibility of suicide inconceivable, which is why they assume that this can come only out of current, active mental illness.

    With temporary vs. permanent as the frame for this, I am inclined to say that even if one knows that suffering is temporary, if it is intense enough, who gets to decide that it isn’t enough suffering to warrant death? Right now, it is the professionals and the law, and they seem to say that no amount of suffering can outweigh the costs of death. Again, I think they are not allowing a different value system into their consideration of this.

    I know that my beliefs on suicide changed after I experienced depression and that they have remained changed even though I am not currently depressed. Yes, it was mental illness that changed my beliefs, but my beliefs on this are not a symptom of mental illness. I have experienced that level of suffering and realized that I had previously underestimated it (previously being when I was 13, because that was my last pre-depression year, which is admittedly young and a naive age anyway). Even now, having known depression but not currently experiencing it, I feel I underestimate the suffering; when I read my old journals, I don’t know how I could have withstood such suffering. I wonder how much of the value and priority differences between patients and professionals comes from professionals not having experienced the depths of their patients’ suffering and underestimating it. Even with the rest of their values and priorities intact, if they truly understood the depths of possible suffering, would they allow for the possibility that suicide really might be preferable, even on an entirely rational level? I don’t know, but I would hope so.

  7. Socrates says:

    I think the crux of the problem is that beakie thinks of mental illness as a temporary problem, even if it turns out that the ‘temporary problem’ lasts forever.

    My experience of being autistic very much fits into this category of everlasting and incurable problem.

    HoHum.

  8. cellar_door says:

    I do agree with you, it seems sadistic to force someone truly miserable to live for the sole sake of someone else. I think the trouble from the professionals point of view is, at what point would we give up on someone and say, ok, so this seems to be permanent, we won’t intervene if you try and kill yourself (if we were able to legally etc)…as opposed to a series of episodes that may concievaby end at some point.

    I’m not sure that makes sense. It’s been a long day…

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  10. Sister Y says:

    Thank you for writing this. The piece that’s so often ignored in discussions of suicide is the suffering of the suicidal individual. The solution is to reduce people’s suffering – not to lock them up and take their jewelry away and make them wear paper clothes.

    It is so often assumed that in all situations the suffering of “the family” in the event of a suicide will far exceed the suffering of a suicidal person who is forced to remain alive. In addition, it’s assumed that it’s just temporary, that everyone “gets better” from suicidality. I think it’s important to consider that the lifetime suffering of a suicidal person may be great even in comparison to the suffering of those left behind if he commits suicide, and that his suicidality might be so severe and permanent to make suicide rational for him.

    I believe that the idea that “all suicide is preventable” actually contributes to the suffering of relatives of a suicide. It forces them to blame themselves and see the suicide as a tragic event rather than an inevitable one.

  11. About 2.5 weeks ago, an online friend of mine posted a suicide note to her blog. I sent her a message asking her what was going on and she replied tha she had taken the tablets and was hoping it wouldn’t take long.

    She knew that I didn’t know her address.

    I spent about 1/2 an hour trying avenue after avenue until I was able to phone the police dept in her US town and give them her land line number to reverse lookup. It turns out about half a dozen other people did the same, she got taken to the ER and is now OK.

    The resulting stress and sleepless nights following are almost certainly what set off my recent hypomanic episode (aka how actionreplay’s illness worked out how to fuck up her life in a new and interesting way).

    Suffice to say I respect your right to self-determination, but if I am in a position that I know someone is going to try to kill themselves or doing so I WILL take action to get them an ambulance and psychiatric help, regardless of what they tell me at that point, sorry.

  12. aethelreadtheunread says:

    DeeDee Ramona – I am really sorry to hear about your online friend, and i’m sorry as well to hear about the negative impact the stress and worry has had on you. Needless to say, i hope you’re back on an even keel soon.

    I guess there’s really just two things i’d like to say. First of all, i’m not against the idea of preventing suicide altogether. Unless i knew that it was a long-standing and firmly held wish to die, i think i would have done exactly what you did for your friend (although i’m not sure i’d have had the resourcefulness to think of the police being able to trace an address from a phone number). I’m only against two things – people being forced to live against their longstanding and unchanging wishes, and (the thing that triggerred this post in the first place) being forced to live because of the distress it would cause their famillies if they died.

    The second thing i want to say is that, personally, i would never put anyone in the situation your friend put you in. I think it is absolutely unfair to expect another person to bear the responsibility either of allowing someone to die, or taking the decision to call for medical support for them.

    Obviously i don’t know your friend at all, but i have some niggling doubts about whether your friend wanted to die, or just had a desperate wish for someone to step in and save them. If i wanted to leave a suicide note on my blog, i’d set up an automatic delay to make sure the post didn’t appear until after i knew i would be dead. Alternatively, if i didn’t know how to do that, i would have replied to messages like yours by saying that i had been feeling suicidal, but in the end i’d decided not to go through with it. To my mind, your friend’s actions sound like a cry for help – an absolutely last-ditch, if people can’t help me then i want to die cry for help – but a cry for help nonetheless.

    People who are crying for help in so desperate a way absolutely need help and support to find other solutions and ways out of their difficulties, and, from a personal perspective, i’d say that you did absolutely the right thing in calling for help for him/her.

  13. Thanks Aethelred. I haven’t posted about it on my LJ because I don’t want her reading it and feeling guilty, she was and is very ill and I don’t blame her in the slightest.

    Having been in the situation myself where I took a load of tablets and then thought twice, what goes through someone’s head at the time can be extremely confused and not logical.

    The human being has a very strong survival instinct. I’ve had the experience of that survival instinct overriding what I thought was then my sincere wish to die, and forcing me to get help. Therefore I’ll always assume that no matter how many people someone alerts, that there’s still a strong chance they are determined – I know that’s not what you were implying, just putting this in as aside as I thought you might find it interesting.

    So someone can at the same time do things to try to die, and things to try to survive, and it’s not the manipulation some people accuse unsuccessful suicides of.

    If I was working in a nursing home, and a resident had what the US calls a DNR order, I wouldn’t go against it. I guess you’re talking about a mental health DNR?

  14. Mariah says:

    I’ve finally caught up on blog-reading.

    I’ve tried to explain many times how a choice like suicide cannot be made by anyone except that one suicidal person, because everyone’s views of “what’s worth living for” are different.

    I cannot possibly deny that suicide has an astounding impact on those close to the dead person. In my case, a suicide of a close friend is what triggered my own suicidal thoughts.

    But a right to life means nothing without a right to death as well.

    Why are there few respected MH professionals who see suicide as a valid choice? There’s a huge difference between ENCOURAGING someone to commit suicide and seeing suicide as a choice a person can rationally make.

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  16. I’m with you on the lying. My MH team have said that they’d do everything to stop me killing myself. The choice is mine to make, not theirs. So I just won’t tell them.

  17. jessa says:

    Mariah: I am so so with you on this. The decision to live or die cannot be made accurately by anyone other than the individual whose life is at stake because only that individual can properly assess the pros and cons of that situation from that individuals perspective.

    I am always so glad to hear from people who really “get” this.

  18. Mr Ian says:

    Wish you’d written this over there… but I can understand.

    My only rule – no one dies on my shift.

    Too much paperwork. :o)

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