Suicide

...what good is a long life to us if it is hard, joyless and so full of suffering that we can only welcome death as a deliverer?...

Sigmund Freud, Civilization and its Discontents

How can we distinguish 'psychiatric illness' from a rational assessment of one's own life?

Freud suffered many years with cancer of the jaw, and endured many painful operations. In the end, he decided when he had had enough, and was given morphine.

Shouldn't every person have the right to decide what for them constitutes an acceptable quality of life?

...American society, by richly rewarding the healing of the ill and the postponement of death, has fostered the development of such measures as respirators and devices to maintain nutrition and hydration, but by failing to modify its traditions and laws, obliges doctors to prolong life in the terminally ill, the permanently unconscious, and the hopelessly agonized...

Morton Hunt, The Story of Psychology

In the mad rush to preserve and extend life at all costs, we fail to see the overall picture, and are in fact increasing misery rather than alleviating it.

...Difficulties in life merely precipitate a suicide... they do not cause it...

Kay Redfield Jamison, Night Falls Fast

It's not one incident that causes a suicide. A person's life as a whole has to be considered. There may be a genetic predisposition to be affected in certain ways by life's events, but it remains unclear to me whether biology really is more of a factor than environment and experience.

Jamison's book focuses on keeping the patient from suicide at all costs - there is no significant examination of what the quality of life will be for those who live. Drugs, or ECT, if they prevent suicide, if they reduce psychological pain - don't necessarily mean they provide the possibility of a life worth living - in the patient's estimation.

My experience is that in spite of all the lofty sentiments and the desperate need to 'keep the patient safe' until the suicidal crisis has passed, the hospital experience is incredibly superficial. Many patients line up for their meds exactly like people lining up at a liquor store - only with 'official' approval that they are doing something good for their health. They put their trust in the 'professionals', and give up responsibility to others who know that we don't really know a lot about the human psyche and how it operates.

Jamison's book focuses on those under the age of 40 and she believes that most of those who commit suicide are suffering from psychiatric illness. However, within her book she herself mentions that there are high numbers of those who kill themselves for reasons that are to do with social issues, which in themselves might lead to depression or other types of 'psychiatric illness'. Her book is called Night Falls Fast Understanding Suicide, but I don't think the second part of her title fits what she's attempted to explain. If psychiatric illnesses could be healed with greater tolerance in society, improved or increased options for those who currently lack them, increased civil rights, and overall equality, if older people had continuing social outlets and relevance, would there be as much 'psychiatric illness'?

...Ignoring the biological and psychopathological causes and treatments of suicidal behavior is clinically and ethically indefensible...

Kay Redfield Jamison, Night Falls Fast

This poses some problems if no one agrees completely about what these biological and psychopathological causes and effective treatments are.

But so is disregarding the psychological and social roots of suicide and ignoring potentially useful psychological and social treatments...

Kay Redfield Jamison, Night Falls Fast

Again, can all those in the profession agree on what the psychological and social roots are, can they recognize them or understand their importance, are there adequate answers, or are some/many of the problems that are actually social in nature 'unsolvable' at present except with medication to calm the person or keep their behaviour within 'normal' limits?

Jamison goes on to say that the patient must feel that the therapist takes him/her seriously and understands. But, the book focuses mainly on medication, and points out that psychotherapy "is expensive, difficult, and time consuming to do and to study" and that there is a lot of conflict regarding types and duration.

Jamison also points out that stigma and lack of accessibility to or awareness of existing services are significant factors, and that patients who cannot afford either meds or therapy can be dismissed as 'noncompliant'. In fact, a lot of homeless people probably just can't afford treatment, and so have to go without. Likewise for people whose families or friends don't care enough to get involved. Perhaps their psychiatric illness is partly the result of loss of ties, rather than the other way around?

Many of the risk factors for suicide appear to be social, but the focus of treatment is not on social/environmental change, and when it comes to research, it is like it is more of a priority to find biological reasons for suicidal risk. It may be difficult to pinpoint some of the social issues that may impact the development of psychiatric illness, due to lack of awareness of the significance of some issues, or due to a patient's need to keep certain things private.

For the moment, we know that some groups of individuals are much more likely to kill themselves than others: those who have previously made serious attempts; those who suffer from depression, manic-depression, alcoholism, schizophrenia, or personality disorders; patients who have recently been released from psychiatric hospitals; young men in jails or prisons, especially those who are mentally ill, isolated or living in overcrowded spaces; police officers; gamblers; the unemployed; homosexual and bisexual men (who have a higher risk of suicide attempts but not as clearly for suicide); Native Americans; Alaskan adolescents; and increasingly, young African-American males. Worldwide, young women in China and adolescent boys in Micronesia are among those at particularly high risk for suicide...

Kay Redfield Jamison, Night Falls Fast

Also, people in professions where there is more access to methods of suicide, e.g., doctors, police officers, have higher rates of suicide than other professions. I can see potential psychological issues that would arise from dealing with death, disease, trauma, misery, and crime on an ongoing basis, up close and personal.

...Finally, at the most practical level, suicide prevention programs may never reach their target population, adolescents most at risk for suicide. Incarcerated and runaway youths, as well as dropouts, have extremely high rates of suicide...

Kay Redfield Jamison, Night Falls Fast

Many policies and products now reflect awareness of making suicide less accessible, e.g., catalytic converters, airbags, low toxicity antidepressants.

In Australia, it is illegal to discuss suicide methods by phone, fax or on the internet. I would like to point out that the newsgroup alt.suicide.holiday, on which suicide methods are one aspect of what is discussed, is the place where I met GK, through whom I have had much more of a 'life'. In fact, this 'dangerous' group, composed in large part of sufferers of 'psychiatric illness' helped me far more than any of the medications or therapies prescribed by the so-called professionals. Anyone who thinks that access to information alone is what causes suicide is wrong. Even detailed discussions about suicide seem to provide more of an outlet for release than an encouragement to commit suicide. When I first met GK, he himself had a well-known internet site which shared methods of suicide. The methods have since been removed, as it is against the law to leave them on his website.

In Jamison's book, the chapter entitled This Life This Death is about a guy named Drew who eventually killed himself - nobody could understand it because before he became ill he had everything going for him, was a success with school, career path, girls, was good-looking, athletic.

I found myself wondering if he was actually experiencing some kind of identity crisis - not wanting to be who everyone thought he was, but not having a Plan B or any recourse to change openly - there was too much pressure from everyone else to continue to be the 'beacon' that he was, and that eventually his unconscious doubts burst through in the form of 'illness'. It is incredibly difficult to give up the support of others, and to challenge the very beliefs you have grown up with.

What if he found that he was having doubts about being in the Air Force, maybe even doubts related to the realities of what has to be done? What if although he was a 'heartbreaker', he was actually questioning his sexuality, but all those he knew would not have accepted him? What if he was so used to living up to the expectations of others that it was unthinkable to let them down, and so he wasn't even able to get in touch with his own doubts on a conscious level?

I don't think what is written in the book makes it clear that he had a physical illness that required medication. To people locked into the system, conventional existence, any deviation can sound more horrifying and less objective than it may be. One friend wouldn't repeat some of the 'horrible' things Drew said, in order to protect his memory - I think it would be very relevant to know these things.

I identify with Drew's guilt over 'owing' - he owed for his education, for causing people disruption, for his treatments, for people having to deal with the expense and emotional unpleasantness of having to take responsibility when he knew he should be able to do it himself. I have a lot to feel 'guilty' about, and over the years the idea of eventual repayment just seemed more and more unobtainable until it seemed completely unrealistic.

It's assumed that everything was hunky-dory, but sometimes even family relations that seem 'perfect' may hide some serious unresolved issues. And although 'everybody liked him' gives a certain kind of picture, and moves the brain along a certain course, the truth is that life is ruthless and competitive, and there is no way that any person can totally escape that.

As I read this chapter, I noticed religious sentiments and ritualistic honouring of the profession (Air Force) and the people in it - what if Drew came to question these things? When you are used to the support of the very people you now question, you may realize you are seeking something 'more' but you cannot shut out the noise of the repetitive brainwashing long enough to figure out what that is or what steps to take to get it.

In Drew's case, 'evidence' of how ill he is includes: a few days before his death he was unshaven and dressed completely in black (!) His friend was uncomfortable, partly because Drew matter-of-factly said 'I love you guys.'

Drew's suicide is blamed on failure to continue to take medication - but here I really don't see that it is so simple. If people are going to argue that Drew really wanted to be in the Air Force, then they should think it significant that he couldn't be if he was on medication. To me, it looks like there was a possibility he could see no place for himself in life he wanted - maybe he could not get out from under previous expectations of all who knew him, maybe he was questioning deeply the makeup of society and human life - maybe he didn't know or couldn't face that his rational computations regarding life did not add up to something that felt genuine to him. The 'plan' he made which included working in a bank was probably about doing something about paying back what he 'owed', and he could not get out from under all the expectations constantly coming at him, he could not stand up to all the prejudiced thinking of the people, the community he knew - he was not strong enough, and consciously could only see that he was 'failing'.

It takes a lot of effort, although it may seem effortless, to be 'on top' academically and in other ways. You may not realize how much until you stop doing what you used to do. You don't have time or extra energy to think 'maybe this isn't what I want for myself, I would like to explore my other options' without a fairly immediate drop in status that may have a snowball effect. Once you 'know the formula' for success, it's extremely difficult to abandon it, for a variety of reasons, and one of the practical ones is that you lose 'success' if you abandon the formula and it may be impossible to get the momentum back. You have to have a very strong sense of self to be able to handle 'letting people down' or coping with the fallout that includes people gossiping about you, losing respect for you, thinking you are making a mistake. If people see you as a leader, and they see you questioning your 'normalcy', they may falter themselves - and that may feel like a huge responsibility.

I don't by any means think I have 'solved' this case. I am just seeing potential explanations - there may be completely different ones, and it is likely that what I have written says more about me than about Drew. My point is that the way the story was summed up doesn't necessarily indicate the truth of it or Drew's experience. People will often blame the 'failure' of a cure on the patient's refusal to take meds - I just want to point out that in this case there was no clear sign that Drew wanted the life he could have on meds, or would have eventually wanted the life he could have on meds if he stayed on them long enough to be 'cured' - there are big question marks. And those are the kinds of things that need to be explored.

What if 'psychiatric illness' is something everyone, including the patient is brainwashed into accepting, and this ends up influencing not only how the person is perceived and treated, but how the person thinks of himself or herself in the long run, which may end up being another obstacle to overcome?

"I know well the feeling of life being objectless and all being vanity of vanities."

Charles Darwin, letter to JD Hooker

How do we accept suicide as a valid choice or option without devaluing life? I see it as a very individual matter, but do see potentials not only for abuse, but that there is also the possibility that some people may devalue their own lives.

At age 16, I wasn't really obsessed with suicide. I was enduring an unendurable existence. My anxiety was unmanageable (or I had lost motivation to try to manage it), I was depressed, I couldn't concentrate, I couldn't control my eating habits, I felt bad about my personal appearance, I had low self-esteem, I couldn't concentrate in school. I had good days, but much more frequently I was acting out in desperate ways and I was not coping. A prescription for tricyclic antidepressants hadn't helped at all, and after a couple of months I began hoarding them for a possible suicide attempt. I didn't know what else to try. I had asked to see a psychiatrist. It wasn't until after I tried that that I became more hopeless, and stopped resisting peer pressure to try alcohol and drugs. Anyone who thinks I 'went bad', and that drugs and alcohol were my downfall is seriously mistaken. I tried everything I could think of first, I resisted peer pressure for two years successfully while my depression and anxiety grew, and it was only after asking directly for psychiatric help that turned out to be disappointing that I tried these things, and when I tried these things it was in a desperate kind of way.

In the years of not going outside from age 16-22, I was not consciously suicidal, or obsessed with suicide. I began more and more to wish to die of some freak thing by age 22, but I did not plan a suicide. I wanted to live, I wanted to have a life. I was in a frightening kind of limbo I didn't know how to get out of. It was like I was not allowed to discuss my situation because it was so shameful, but no one seemed to pay much attention to me. I felt guilty for being dependent, and suspected that I was a source of resentment, but no one ever talked about it.

I didn't become constantly sure I wanted to die until I was 23 years old. I have often linked this to contracting genital herpes, but I think there was another significant factor or two.

Not long before my father had the police take me to a psych ward, he confided in me that his psychic friends had agreed I'd kill myself by age 21. I know general knowledge has it that psychics who give people such info are unethical, but my father was not considered to be the general public. He was considered at the time to be a powerful psychic himself who was just beginning to develop his powers. It didn't register at the time, but afterward, when I thought about the years he had this information, and about my attempts to talk to him about my situation and his brushoffs, and then his getting the police to take me to the hospital when he was about to move into his own place and didn't want to have anything more to do with me, it began to dawn on me that perhaps he was actually disappointed I hadn't fulfilled the prediction, and that what the 'psychics' had picked up on was not my future, but my father's unconscious wish that I die. I hadn't consciously processed this yet, but on the way to the hospital, with police officers who thought I would become violent (because of what my father told them) I couldn't stop crying. My father didn't understand me at all. He had left the problem for years and had hoped I would kill myself so he would never have to deal with the problem.

After a hideous traumatizing hospitalization, I had to accept welfare in order to 'save myself'. I felt that the doctor who had diagnosed me did not have my best interests in mind (he would not share his diagnosis with me, and would not answer questions about what was being prescribed for me and why, yet called me 'stupid' for refusing therapy), but in order to be allowed to leave, I had to agree to accept welfare. The stigma of accepting welfare was overwhelming, and every time I picked up the money I dropped a suicide note into the trash outside the welfare office.

I no longer wanted to live. The idea of dying before I got older seemed appealing to me. At any time, if any person had tried to have an in-depth conversation with me, I would have been up to the task of articulating my situation.

I have not changed in this regard since that time. It is not that in spite of enormous handicaps and odds I haven't been able to find appropriate partners, or that I haven't been very lucky with regards to opportunities that have come my way, it's that I don't truly enjoy life. I try to make it possible that I can, I approach it from as many angles as I can to at least reduce my distress and the effects of my distress on others, but in the end for me life is always something to endure, not something I enjoy. I feel happiest when I think it's possible to die. My fantasies which are hopeful are about death. It has now been more than 20 years that I have lived in this state of waiting for death.

Maybe when people see certain details, a move to Australia, world travel, they assume that I am 'fine' now, that for me the deathwish comes and goes, I have periods of depression and periods of remission, but I experience a significant depression and anhedonia that fluctuate very little, and my wish for death is also constant. Maybe I come across as numb or even too coherent to be truly suffering. This is just the way I suffer, and the way I attempt to articulate it. My continuing existence is a horror to me. Maybe it's habit, maybe it's genetic, but it does not appear to be going away. I do not see any therapies that are likely to work at this late stage in my life. If anyone has a differing opinion, I'd like to see it and have a chance to think about it and discuss how I see it in relation to my situation.

I don't know of any family members who have committed suicide, but perhaps some were well-kept secrets. I think it's possible that there were quite a few who suffered from serious long-term depression, and that my grandmother with rheumatoid arthritis was helped along by a hushed up mercy-killing, that both my parents at least at some point were obsessed with death or wished to die.

It's possible that while I have at least in theory the ability to procreate I will face the excessive pressure of the survival instinct, but that once I hit menopause the survival instinct will slacken considerably, removing the 'blocks' I had thought were psychological, and which I had trouble understanding.

...We, that is our brains, are separate and independent enough from our genes to rebel against them. As already noted, we do so in a small way every time we use contraception. There is no reason why we should not rebel in a larger way, too...

Richard Dawkins, The Selfish Gene

Why do we have to accept aging? Isn't it valid to question the survival instinct and to try to override it if you have weighed up all your options in life, taken into account your flaws and strengths, and made an accurate assessment regarding your future? I do think that it is valid to question the quality of one's own life, to assess oneself and one's potentials honestly and thoroughly, and to come to the conclusion that as an individual you would prefer to make the effort to override the survival instinct and society's insistence in the face of overwhelming contradictory experience that prolonging life as long as possible is to be desired in all cases.

The survival instinct is a rule I am trying to break.