Thought for the day: On mental illness and assisted suicide

The suicides of Kate Spade and Anthony Bourdain have made me realize again how strongly the media and society regard every suicide as in some sense a failure: a failure of the deceased to get help, a failure of the caregivers to give proper help, or a failure of friends and family to notice a problem.  In general, I agree—but not always. Certainly those who have recognized suicidal tendencies, or who have been severely depressed, should be made aware of the opportunities for help, and everything should be done to provide that help.

But this doesn’t always work. Despite drugs, therapy, and so on, some people in tremendous mental distress are not improved, and simply want to end their pain by ending their lives. I don’t think that in every case we should say “they shouldn’t kill themselves.” The pain of severe depression can be so strong, and so persistent, that the sufferer feels it’s better to end the pain than to live with an incurable mental illness. Is this really so different from a terminal cancer patient in unbearable physical pain who wants the pain to stop? I don’t see how—not if every attempt to fix things has failed. After all, unbearable physical pain causes unbearable mental pain.

The Netherlands and Belgium allow people with severe psychiatric problems and suicidal ideation to undergo euthanasia, but of course only under the strictest medical and legal vetting. This has in fact happened; the story of a depressed 29-year-old who was euthanized in the Netherlands is here. (It’s in the Catholic Herald, and of course suicide is a sin in Catholicism, sometimes a mortal sin.) The idea that you’re going to hell for killing yourself is one of the many repugnant views of the Vatican.

You can also get legal euthanasia if you are old, in declining health, and yet don’t have a terminal disease. That was the case for 104 year old Australian scientist David Goodall, who peacefully ended his life in the Dignitas Clinic in Switzerland, simply because it was becoming too difficult for him to live. In effect, he was allowed to be euthanized because he was distressed at the thought of his decline.

There are at least three reasons to allow physically healthy but severely depressed people—people who have tried every recourse but failed to improve—to undergo euthanasia. The first is that if we don’t give them a peaceful death, they may well try to kill themselves in a messier, more painful, or even an unsuccessful way.  And that is traumatic for family and friends, who aren’t allowed to be there in countries that don’t allow euthanasia (you can be charged with “abetting a death”). Why not die peacefully and legally, in the presence of those who care about you?

The second is that knowing you can get barbiturates if you qualify may be the very thing that keeps you alive. I know of one 24 year old Dutch woman who qualified, but changed her mind when the doctor was on the way, and it’s likely that knowing she had that alternative is what gave her the strength to go on. You can see a video about her here. This change of mind apparently occurs in about 25% of people approved for euthanasia in the Netherlands on mental-health grounds.

Mainly, though, who are we to judge that someone in unbearable and untreatable mental pain must be kept alive at all costs? It seems to me that if you meet the criteria various enlightened nations have set out for euthanasia, severe mental illness should qualify—so long as the person is sentient enough to make that decision. Some extremely depressed people, after all, are compos mentis and simply don’t want to live.

Before you weigh in, watch this story (the mental illness caused “somatoform [physical] pain). I also recommend your watching the video about the Dutch woman in the link above.

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ADDENDUM: Actor Rose McGowan made a lachrymose video about Bourdain’s suicide (below).  This seems to me the wrong reaction: Rose McGowan put this on her Twitter feed, expressing anger at Bourdain for killing himself and for thinking the world would be better off without him (I don’ t think this is something that most suicides even think about).  It’s also horribly solipsistic (she’s since taken it down, but it’s on the news and everywhere in the media).  But most relevant for this post, it assumes that depression is always a “temporary problem”. It isn’t—not always. And anger at someone who kills themselves is a corrosive emotion: how can you know why they did it?

Yes, publicizing suicide hotlines is a good idea, but the job of those hotlines, as you may know, is to keep people alive. Most potential suicides could indeed use that kind of intervention. But as I’ve just said, not everyone should be forced to stay alive at all costs.

106 Comments

  1. Posted June 9, 2018 at 10:09 am | Permalink

    I believe in self-determination … for countries and for individuals. I believe people have a right to end their own life. I also feel a societal obligation to provide help to those contemplating suicide in case they are mistaken about their situation. But having laws against suicide is quite wrong and I laud those states trying to provide counseling and then death with dignity to those who want that. Currently every suicide tends to leave a mess behind for their loved ones or the authorities to clean up after them. Forcing people to treat their loved ones this way is wrong.

  2. shelleywatsonburch
    Posted June 9, 2018 at 10:11 am | Permalink

    My husband committed suicide in 2015. Sadly, it can sneak up on you. I have corresponded with many survivors of suicide who had no idea, no suspicion, no indication that anything was wrong. For those left behind, the sorrow and horror is made worse by the shock. And the guilt. You spend every waking minute analyzing everything that came before, asking “What did I miss? How could I not know?” You feel responsible. Friends and family don’t necessarily rally around you in support either. Some of them blame you, some of them just drift away because it’s too awkward. I struggle with my opinion that each person has the right to make life decisions for themselves, because the aftermath of suicide is so terrible. It breaks my heart. Mental illness, depression, anxiety–these still carry a stigma in society. Men in particular I think hesitate to admit weakness. They don’t want to say that they need help.

    • infiniteimprobabilit
      Posted June 9, 2018 at 11:00 am | Permalink

      I am sorry for your loss.

      A guy who sat next to me at work committed suicide. Nobody saw it coming. He had been injured in a severe and traumatic accident a year before, but had apparently fully physically recovered, though people who knew him before said he’d changed. But he seemed perfectly normal to me. He left a wife and two young children. Very sad.

      But I think that’s really a very different case from the sort we’re discussing, where the individual’s decision to end his life is well foreshadowed.

      cr

      • shelleywatsonburch
        Posted June 9, 2018 at 11:04 am | Permalink

        Of course, I recognize the distinction but I think that mental illness and suicidal ideation are messier than that. It isn’t as simple as one box holds long term despair and neat planning, and the other box has the less neat stuff. The two are connected, despite our desire to categorize.

    • Marta
      Posted June 9, 2018 at 11:05 am | Permalink

      My business partner and best friend committed suicide in 2009.

      It was at least three years before the mere ghost of a thought of him didn’t drive me to my knees in grief. But before I could get to a place of grief, I experienced so much rage that I was constantly grinding my teeth, which caused my jaws to ache and made my temples pound. That was unexpected. The rage passed; the grief lingered. Here is almost ten years later, and I wonder if I’ll live long enough to forgive him.

      I keep these thoughts to myself. You’re allowed to have some kinds of feelings about a suicide, but not some others, apparently, and the lens we use when we look at suicide currently can be very hinky.

      My heart goes out to you.

      • shelleywatsonburch
        Posted June 9, 2018 at 11:33 am | Permalink

        I’m so sorry. And yes, anger goes with it. I was angry for a long time, I still am now and then. It’s a peculiar set of emotions, and unless you’ve been through it you simply can’t understand it. I spent yesterday crying off and on all day. Anthony Bourdain really got to me, it brought all of those emotions to the surface.

        • Marta
          Posted June 9, 2018 at 12:05 pm | Permalink

          Me, also.

    • Posted June 9, 2018 at 1:24 pm | Permalink

      I’m sorry about your loss. My husband committed suicide, also. We relatives feared it, tried awkwardly to help, and didn’t / couldn’t help enough.

      It’s a strange trip for survivors, with anger, grief, and sometimes so much guilt.

  3. Rita
    Posted June 9, 2018 at 10:19 am | Permalink

    The physician who opposed assisted suicide says that our culture is messed up because we want to “eradicate pain”. But that isn’t the message I took from the video. No one is saying we must eradicate ALL pain, just unbearable long-lasting pain. There’s a big difference there.

    • infiniteimprobabilit
      Posted June 9, 2018 at 10:49 am | Permalink

      Agreed. And if there’s some pain we can eradicate, what possible excuse do we have for not doing so?

      That physician is just using the slippery-slope argument in another guise.

      cr

  4. Posted June 9, 2018 at 10:24 am | Permalink

    It isn’t a case of these people being euthanized – it is assisted suicide which is a totally different thing.

    • Posted June 9, 2018 at 10:28 am | Permalink

      It’s clear that what I’m talking about here is assisted suicide, which is the same thing as euthanasia. Look it up. Here’s one place: https://en.wikipedia.org/wiki/Euthanasia

      • Posted June 9, 2018 at 11:26 am | Permalink

        You wrote “The Netherlands and Belgium allow people with severe psychiatric problems and suicidal ideation to undergo euthanasia” and “There are at least three reasons to allow physically healthy but severely depressed people—people who have tried every recourse but failed to improve—to undergo euthanasia.”, which is why I stated that it isn’t euthanasia but assisted suicide. 🙂

        In the Netherlands, Swizerland and Belgium, the assisting doctors prepare the drink, but it is the patient who takes the cup and drinks it, so it is not a case of “termination of life by a doctor at the request of a patient” (except in the cases where the patients are paralyzed and cannot hold the cup by themselves).

        I find the term “euthanasia” a misleading term because of all the negative connotations it carries, especially in the cases of patients who are euthanized by doctors or nurses without their knowledge or consent, sometimes even without the patients’ families’ knowledge and consent, and too often for the sake of convenience.

        • Posted June 9, 2018 at 11:28 am | Permalink

          Whatever. This is just an argument over semantics.

          • Ken Phelps
            Posted June 9, 2018 at 12:23 pm | Permalink

            Agreed, but when opponents are actively and dishonestly looking for ways to misunderstand, that can be important.

          • BJ
            Posted June 9, 2018 at 1:11 pm | Permalink

            Sorry, but I agree with vierotchka. In this debate, terminology is very important, and “euthanasia” implies to most people the idea that a third party is taking the life of another. “Assisted suicide” makes clear that the individual is choosing to take their own life, with the assistance of another.

          • Posted June 9, 2018 at 1:27 pm | Permalink

            Yes, it’s an argument over semantics. But in this case, the semantics matter. “euthanasia” implies sometimes very different about where the choice resides. That implication matters.

            (I know that in this case you didn’t mean someone else chooses.)

      • Pierluigi Ballabeni
        Posted June 9, 2018 at 11:58 am | Permalink

        Assisted suicide is not the same thing as euthanasia. In Switzerland, the first is allowed the second is illegal. David Goodall was not euthanised.

      • Lee
        Posted June 10, 2018 at 7:09 pm | Permalink

        Euthanasia and assisted suicide are related, but not the same. What the vet did to my ailing hamster wasn’t assisted suicide.

  5. infiniteimprobabilit
    Posted June 9, 2018 at 10:38 am | Permalink

    “The second is that knowing you can get barbiturates if you qualify may be the very thing that keeps you alive.”

    Absolutely!

    I totally support the individual’s right to end their lives (or have their life ended for them on demand if they are physically incapacitated) but I’m also conscious that often, if you can do something any time you like, you don’t feel the need to do it right away.

    This is in stark contrast to the current situation in most countries where, if you think you’re going to want to end your life, you better do it soon before you become incapable of doing it unaided. I wonder how many people have died earlier than they otherwise would precisely because of this risk?

    And pain itself is very strongly influenced by the mind. If one knows that surcease is available the actual ‘physical’ pain experienced may be lessened. If one is condemned to stay alive regardless of suffering, the pain experienced may well intensify.

    cr

  6. Historian
    Posted June 9, 2018 at 10:41 am | Permalink

    This post reinforces what I have previously thought about the mental health profession. Namely, it is fairly good at diagnosing mental ailments, but mediocre at best in treating them. Compared to other areas of medicine, mental health treatment is in the dark ages. It is hit or miss whether any treatment, such as talk therapy, pills, or a combination thereof, really work or any patient improvement is due to the placebo effect. In some cases, the patient may improve on her own without any treatment at all. From what I have read, the efficacy of pills is often marginal at best. Most pills can have serious side effects. It seems to me also that scientific studies of the success or failure rate of any treatment are very hard to conduct. It is a pity there is no blood test. Improvements in mental health outcomes will require a much better understanding of the brain. This doesn’t seem to be on the horizon.

    • mikeyc
      Posted June 9, 2018 at 10:49 am | Permalink

      For the cases where they recover due to a placebo effect, would you consider this a failure?

      • Historian
        Posted June 9, 2018 at 11:31 am | Permalink

        You ask a good question. I suppose the placebo effect can be called a success if the recovery is long term. Maybe a method can be devised where patients are started off with sugar pills and then move to pharmaceuticals if they don’t work. Those cured by placebo pills would save a small fortune, something the drug industry would not be pleased about.

        As I noted above, in the mental health field he definition of terms like “cure” and “recovery” are murky. If a person is “cured” (no matter how you define the word), it is often uncertain as to why it happened. For example, if a person is no longer depressed by taking pills for five years and then relapses because the pills seemingly stop working, what do we say about that?

        • mikeyc
          Posted June 9, 2018 at 12:01 pm | Permalink

          One thing people I know who suffer from mental illness often say; “I am in remission”. Many understand that, like some forms of cancer, the underlying illness is still there and that therapies only keep the symptoms at bay. They also understand that despite the effectiveness of whatever therapy they are undergoing, the illness may return.

          This is not true of all those who suffer from mental illness just as it isn’t for cancer patients. But it is a reality for many.

    • Fat Bastard
      Posted June 9, 2018 at 11:08 am | Permalink

      I think the efficacy of certain psych meds is beyond doubt, at this point. I’m taking SSRIs and they truly are a God-sent for depressives.

      • Historian
        Posted June 9, 2018 at 11:19 am | Permalink

        I’m glad they work for you. Not all people can say this. More needs to be learned why certain pills seem to work for a person while others don’t. The role of the genetic component of mental illnesses needs much more study.

      • Marta
        Posted June 9, 2018 at 12:11 pm | Permalink

        Anti-depressant medicines work for the people they work for, and not for 60% of the people they don’t. If they work for you, that is excellent, but more needs to be understood about what these medicines do, how they do it, and why they provide no relief at all for so many people.

        • mikeyc
          Posted June 9, 2018 at 12:28 pm | Permalink

          You are absolutely correct and one of the many things Obama did right in his presidency was to launch the BRAIN Initiative. For years interest (which means money) has been building on understanding the human brain in much more sophisticated ways. Places like the “Allen institute for brain science” here in Seattle has been working solidly and very successfully in doing everything from mapping the neural networks in the brain to understanding the complex development genetics involved in brain function. Obama putting the force of his office behind the government initiative has kept that interest (money) up.

          One of the driving forces for all this is the very issue you brought up. Not everyone responds to these drugs and the ones that do have complex therapies. Often the correct dosage or combinations are difficult to find. People’s illnesses change over time so that complexity isn’t helpful. But for some people these therapies are life savers.

          We are in hopeful times for these afflictions, at least.

    • Ken Kukec
      Posted June 9, 2018 at 11:51 am | Permalink

      “… what I have previously thought about the mental health profession. Namely, it is fairly good at diagnosing mental ailments, but mediocre at best in treating them.”

      You mean, similar to the way historians are good at analyzing past event, but are, as a group, notoriously unreliable when it comes to prognostication? 🙂

      • Historian
        Posted June 9, 2018 at 12:10 pm | Permalink

        The difference is that a good historian, in the capacity of an historian, would not attempt to prognosticate. Trying to predict the future is usually a fool’s errand. The best that historians can do is by attempting to present an accurate view of the past current policy makers can learn from the actions of prior policy makers who were in similar situations. Unfortunately, this attempt is rarely successful. But, we never stop trying to push the rock up the hill.😎

        • Posted June 9, 2018 at 4:37 pm | Permalink

          “Accurate views of the past” change over time as cultures and attitudes change. Even though interpretations of past history may change, I still think it super important to know as much as one can about the past and not try to misinterpret or eradicate it. Individuals and society must learn and change.

          • Historian
            Posted June 9, 2018 at 4:58 pm | Permalink

            Indeed, historians tend to view the past based on the era and culture they live in as well as their ideologies. I am acutely aware of this. Many books have been written on this topic. Still, at the time they write, historians, unless their outright propagandists, attempt to describe the past to the best of their abilities. The sensitive reader should be aware of this when reading a history book and take this into account when evaluating the use of a history book in dealing with present day circumstances. For example, readers should be aware that most of the books written during the first half of the 20th century about the pre-Civil War South were written by racists reflecting the culture they lived in. They thought they were presenting an “accurate” view of the South. Today, most historians consider them terribly wrong. Who knows what historians will say 50 years from now?

            • Posted June 9, 2018 at 6:19 pm | Permalink

              I was certain that what I said about history was known by you. And, I agree that “most historians attempt to describe the past to the best of their abilities.”

              However, much of U.S history has been and is skewed by “propagandists” or individuals who want to present one view of reality as “more real” than others they don’t espouse.

              We tend not to be taught sufficiently about racism in the northeast prior to, during and after the Civil War. We tend not to be taught sufficiently about the difficulties of coming up with one or more Constitutions that didn’t address the issue of slavery. We are not taught about what led up to the religious fervor of the 1800s and the new religions formed in the context of that period. We tend not to be taught the “truth” about the “real” character and lives of all our presidents. Was Lincoln a “Christian”, as some carefully select his statements to show? Or was he an “atheist or heathen” as others choose his language to show? Or was he of different beliefs at different times?

              I love history. I wish I could be around in 50 years to read what historians have to say then (however, decrepit I’d be.)

    • Dale Pickard
      Posted June 9, 2018 at 12:22 pm | Permalink

      I’m sorry but I do not think that you know of what you speak.

    • Posted June 9, 2018 at 1:36 pm | Permalink

      Although you’re right that much more needs to be known about depression and medical vs. other interventions to help, in fact many studies indicate that pills do help, though not all people in all cases.

      Please be careful about the context in which you call into question the efficacy of pills for depression. Don’t do anything to discourage a depressed person from trying them. Even if they just give the person hope for long enough for his/her biochemistry to change on its own, anti-depressants can be life-saving.

      (I use antidepressants myself. According to my wife, they help even when I have doubts about that.)

      • Historian
        Posted June 9, 2018 at 2:18 pm | Permalink

        I am not saying people shouldn’t try these pills. I suppose they can’t hurt as long as there aren’t serious side effects. My overall point is not dealing with drugs specifically, but that the treatment of mental illnesses is often guesswork (a hope and a prayer). Mental health providers cannot simply be sure if any one therapy would work. Of course, guesswork sometimes plays a role in the treatment of physical illnesses, such as the trying of several antibiotics until one is found that works (so it is hoped). But, in the mental health field guesswork seems to be the norm.

        By the way, I consider the dichotomy between mental and physical illnesses as one of convenience only. As a materialist, I cannot see how a mental illness is not physically based.

        Over the last decade or so several papers have been published with different conclusions about the efficacy of antidepressants. The most recent study has been published in the Lancet and concludes that “All antidepressants were more efficacious than placebo in adults with major depressive disorder.Smaller differences between active drugs were found when placebo-controlled trials were included in the analysis, whereas there was more variability in efficacy and acceptability in head-to-head trials. These results should serve evidence-based practice and inform patients, physicians, guideline developers, and policy makers on the relative merits of the different antidepressants.”

        https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/fulltext

        So, it would appear likely that antidepressants are more effective than placebos in treating several depression. But, how much so? I don’t know if the article goes into this and the statistics presented are beyond my ability to comprehend.

        Here is a blog posting that discusses the study. I cannot vouch how credible the author is, but the blog does raise some interesting points about how difficult it is to judge the efficacy of such drugs, although he seems to accept the study’s conclusions that the drugs are effective for severe depression. But, again, to what degree?

        https://theness.com/neurologicablog/index.php/the-efficacy-of-antidepressants/

        In any case, research in the field of depression seems to be thriving. I hope that we will know more in the near future.

    • Harrison
      Posted June 9, 2018 at 4:14 pm | Permalink

      Saying that mental health is stuck “in the dark ages” reminds me of when Neil Tyson made an ass of himself on Steve Novella’s blog, demeaning physicians for being too stupid to figure out the ins and outs of the human body perfectly. He couldn’t grasp the complexity of the problem involved and so patronizingly concluded it was because the people working on it just weren’t smart enough.

      Treating mental illness through medications which affect brain chemistry is like doing repair work on an engine while it is still in operation.

      • Historian
        Posted June 9, 2018 at 4:46 pm | Permalink

        Thank you for supporting my point, although I don’t think that was your intention, which is that treating mental illness is very difficult, partially because there is so much to learn. Compared to many other areas of medicine understanding the human mind is “like doing repair work on an engine while it is still in operation.” Also, the systematic study of the human mind only goes back to the latter part of the 19th century. Thus, it is a young discipline that experienced several dead ends, e.g., Freud. The problem has nothing to do with the intelligence of the people in the field.

        • Harrison
          Posted June 9, 2018 at 9:34 pm | Permalink

          If that’s your point then you need to choose your words more carefully, because “dark ages” connotes a lot of very negative things. Not merely ignorance, but a period utterly bereft of scholarship.

          It’s also a bit odd that, looking above, you didn’t even know who Novella was. He’s not exactly a marginal figure in the skeptical world.

          • Historian
            Posted June 9, 2018 at 10:00 pm | Permalink

            I’ll stick to my use of “Dark Ages” as a metaphor for my contention that the understanding and treatment of mental illness is quite primitive RELATIVE to many other areas of medicine. If you wish to substitute “Middle Ages” for “Dark Ages,” I don’t have a problem. The Middle Ages was not totally bereft of scholarship and doesn’t quite have the negative connotation as the Dark Ages. If you think that the current knowledge about mental illness is on par with most other areas of medicine, then say so. Perhaps you believe that the study of mental illness is not as primitive as the Dark Ages, but has reached a Renaissance level. You’re beating around the bush. You’re entitled to your opinion. It seems to me you’re making a big ado over nothing.

            I also find it odd that you feel that I should have mentioned Steve Novella in my last comment. I will admit I am not familiar with his work, so perhaps you enlighten me as to his relevance to this discussion.

  7. Tom Esslinger
    Posted June 9, 2018 at 10:51 am | Permalink

    Physician assisted suicide is clearly the compassionate choice. I applaud those states and countries that have taken the step to legalize that choice, however I do not think that many have opened that door wide enough. In addition to mental conditions as described in the video, I feel that assisted suicide should be opened to those who have incurable dementia such as Alzheimer. Many laws now require that one has to make an informed election at the time of suicide. For many with dementia that likely means making the decision earlier in the disease than would be necessary. I suggest that a living will, or other legal instrument could spell out the conditions that one would want their life terminated. Maybe non recognition of family or other condition, but not require an informed decision at the time of termination.

    • Posted June 9, 2018 at 1:39 pm | Permalink

      I agree. This is a serious consideration for all of us as we age. At this point, all I can do (and have done) is sign a document that states that I am to be given no life-prolonging treatment if I have Alzheimer’s or other serious mental deterioration. Palliative care only.

      • Posted June 9, 2018 at 5:04 pm | Permalink

        In Oregon and a few other U.S. states, one can go through the necessary steps to legally be permitted Death With Dignity.

        My husband, who was exceedingly curious about everything, very intelligent and well-educated, wanted to live to be 150 years old because he wanted to know what would happen in the future. He chose Death With Dignity after all treatment options for his cancer were tried and there were no more options other than pills for his pain. He chose to die on his own terms with family and friends around him. They supported his choice out of love for him (whether they agreed with his decision or not, which most of us did).

        Fortunately, we had very good health insurances, or we would have had to spend all
        our monetary resources on his very costly treatments (which extended over a period of almost two years), leaving me with little or none other than a pension and social security. The pain and suffering of people without either insurances or resources is unconscionable.

        I don’t know the exact number of Oregon citizens who make arrangements for this option and then choose not to use it, but it is substantial. If just having the choice makes them able to continue their lives, I’m
        glad for them. It’s all about choice and control of your own life.

        There is a window of opportunity at the end of a person’s life when they are still physically and mentally able to drink the drink unassisted. If one can’t hold the glass or the swallowing mechanism lets you down so you can’t swallow most or all of the dose, the window may close. Then, there are no more options.

        All of us should be availed of this opportunity if it is desired. I might consider it, but fear I would not succeed because I have an overly active gag reflex.
        We’ll see.

  8. shelleywatsonburch
    Posted June 9, 2018 at 10:52 am | Permalink

    As to the assisted suicide aspect of your post–I had to give it some thought–I am on the fence. In the US, I think that we might find suicide to be an impulsive act in many cases. The availability of firearms makes suicide, as they say, a permanent solution to a temporary problem. The whole system seems to be designed for failure. If we permitted assisted suicide for depression or serious mental illness, it would certainly make it easier for families and loved ones. But it’s likely that many of the suicides that occur in the US would not qualify for this. This is based on my own experience, of course, and anecdotal knowledge from my interactions with other survivors of suicide.

    • infiniteimprobabilit
      Posted June 9, 2018 at 11:15 am | Permalink

      I think ‘assisted suicide’ would have very little affect on impulsive suicides, and it isn’t really intended to. It’s a solution to a different problem.

      Implicit in most assisted-suicide laws is that the process would be carefully regulated and with plenty of prior notice. It’s intended to alleviate the suffering of people with long-term conditions. Anyone who is hiding their suicidal impulses would not qualify for assisted suicide, as you say. I’m certain any advocate of assisted suicide would say that, if the individual’s impulse to end their life is occasioned by a purely mental condition (like depression), it is far preferable to attempt to treat their condition and alleviate it, and assisted suicide should only be considered if their condition is chronic and incurable.

      cr

    • Posted June 9, 2018 at 12:52 pm | Permalink

      Uniting some of the efforts of assisted suicice to depression and mental illness is probably a very good thing.

      It sounds like it could be a very supportive environment to put everyone on the same page and let everyone come to terms with what the victim is going through and would like to choose. I would even guess it will prevent some suicicdes.

      This is a really good idea, I think.

      • shelleywatsonburch
        Posted June 9, 2018 at 1:57 pm | Permalink

        Yes, I can see that and agree. It’s hard for me to be objective about it, because of my husband’s suicide. Before we advocate for assisted suicide, I’d like to see more advocacy for mental illness, depression and anxiety disorders. Research, availability of good treatment, loss of the stigma. People don’t seek treatment because they don’t want to tell anyone they don’t feel right. They don’t want to be patronized, judged, given a quick pep talk. So they suffer in absolute silence, until they snap. Someone who is so open about mental illness that they will publicly discuss assisted suicide is probably in a better place emotionally than the middle aged man who quietly thinks his life is going nowhere. Many of those commenting seem pleased with the tidiness of this idea, because each of us is trying to find a pattern, to understand, to make peace with surprising and upsetting things. We can offer smart analysis from a safe distance, but we can’t forget that this issue is very complicated, very messy and involves real people and real families.

        • Mark Perew
          Posted June 9, 2018 at 2:13 pm | Permalink

          Would it be possible to examine why the desire to die is nearly universally considered a mental illness?

          In the age when religion ruled and people believed that god had “fixed His canon ‘gainst self-slaughter” there might have been some grounds for a presumption of madness for those who wished to end their life. Suicide was an automatic trip to eternal perdition and only a mad person would want that. In this modern, (hopefully) enlightened age, where an increasing number of people have cast off such superstitions, why do we hold onto that aspect so strongly?

          Yes, of course, many people who wish for suicide, attempt suicide, or die from suicide are suffering from mental illness. Some treatment can and will help them.

          Do we need to assume, though, that everyone contemplating suicide is not right in the head? I don’t think so.

          • shelleywatsonburch
            Posted June 9, 2018 at 3:22 pm | Permalink

            The stigma associated with what we call mental illness is present in your statement, “Do we need to assume, though, that everyone contemplating suicide is not right in the head…” Society needs to recognize that a lot of things fall under the mental illness umbrella. Mental illness is not “not right in the head”. This is the reason people who are suffering from long term depression hide it. I would bet money that a small percentage of suicides are the result of sensible, reasoned decision-making. So we are debating the value of something that will not help the majority of people who contemplate or complete suicide. If nothing matters, why are we debating it? If it does matter, why dismiss the majority of suicides who didn’t sit down with their families and say, “I am going to end my life now. Goodbye everyone. It’s been fun.” Most people aren’t Hunter S. Thompson. Suicide, whether clean and neat or furtive and messy, affects other people. The rate of suicide increases every time a high profile person commits suicide. Families with a history of suicide are statistically more likely to experience future suicides. It’s not enough to be pleased with our own existentialism. The US consumes 75% of the world’s prescription drugs. The suicide rate has increased 30% in 16 years in the United States, according to BBC. In my state, it has increased 40% since 1999. When do we consider this a public health crisis? At the same time, the number of mass shootings in the US has increased. In the Netherlands, where assisted suicide is legal, the suicide rate is 11.9/100k people. It’s 14.3/100k in the United States. Half of suicides in the US are committed with a firearm. If that option was not available, and if our mental health support network was better, our suicide rate might half that of the Netherlands. We can’t poo poo mental illness and its broad social and health implications, and we can’t fixate on the small number of suicides who weren’t distraught.

  9. mirandaga
    Posted June 9, 2018 at 11:12 am | Permalink

    “The Netherlands and Belgium allow people with severe psychiatric problems and suicidal ideation to undergo euthanasia, but of course only under the strictest medical and legal vetting.”

    When you start hearing euphemisms like “undergo euthanasia” in lieu of “kill themselves,” you can be pretty sure that there’s something questionable going on.

    My objection to assisted suicide (which is legal in my state of Oregon) is precisely the strict medical and legal vetting required. I don’t like the idea of the state or the medical profession having the power to decide who qualifies and who doesn’t qualify to end their lives. Far better, IMO, to make the lethal drugs available OTC and let people make their own decision about how and when to use them. Too dangerous? Well, then, I suppose the person in question will just have to go buy a gun.

    • Posted June 9, 2018 at 5:12 pm | Permalink

      Good point. I am not thrilled with having churches, medical professions or governments dictate sex, birth or death for individuals.

      But, I am so grateful that my husband and I lived in Oregon where he could exercise his right to choose his own form of death without having to use one of the various guns he owned. Better for him and his family.

  10. Mark Perew
    Posted June 9, 2018 at 11:13 am | Permalink

    Life is forced upon us by our biological parents. It becomes akin to that hideous quilt gifted by a matronly aunt. We’re obligated to smile and put it on display, even though we detest it. Then the state says we have little to no say in deciding when we are done. How ignominious!

    • shelleywatsonburch
      Posted June 9, 2018 at 11:49 am | Permalink

      This is a rational thought, and I hope you don’t take offense, but this seems to me the decadent outlook of a modern society that has lost its wonder. An existence that is comparatively full and easy, dismissed without appreciation that we are here, at this time, on this planet, with all there is to marvel at and learn. How sad that we can’t see it. A Pale Blue Dot should be required reading in American schools.

      • Dale Pickard
        Posted June 9, 2018 at 12:13 pm | Permalink

        Shelly, you came up with a thoughtful reply to Mark’s comment that I could not have. His kind of negative thinking and bitter outlook on life represent the hallmark of depression.

        • Mark Perew
          Posted June 9, 2018 at 12:37 pm | Permalink

          Dr. Sagan wrote some wonderful words about our incomprehensibly rich cosmos. Dr. Feynman also penned some profound thoughts on finding awe and wonder in the natural world. Wendell Berry, Rumi, Mary Oliver, etc. all crafted lines of beauty about life.

          But, let us not wax too prosaic in our view of existence. Why is it negative, bitter, or a hallmark of depression to be honest about the ultimate pointlessness of life?

          Can we not have compassion for those who simply say, “The struggle isn’t worth it.” That seems to have been PCC(E)’s point.

        • Diana MacPherson
          Posted June 9, 2018 at 12:42 pm | Permalink

          I don’t see it as negative at all. Just factual. No one asked to be born. Certainly no one asked to suffer yet you are expected to be grateful having been born and to accept the suffering. I think it’s unfair to jump on him and dismiss him as negative.

          • infiniteimprobabilit
            Posted June 9, 2018 at 7:39 pm | Permalink

            Agree with you and Mark.

            And I’m not negative about life, I enjoy mine. (I quite enjoy being sarcastic about BS, as y’all may have noticed, but that doesn’t make me a pessimist). But if something happens to me to make me stop enjoying life and it becomes a painful experience, I don’t want to nullify my life story with a shitty ending.

            That’s what happened to my mother. Died of cancer, demanding to be put out of her misery which, thanks to the right-to-[f*ck-around-with-everybody’s]-life brigade, nobody could help her.

            cr

          • Posted June 10, 2018 at 12:14 pm | Permalink

            I think that few expect people to be grateful for having been born. Accept suffering, yes, as long as they are in the team of the living. I find a major problem in today’s increasing expectations of life to be happy. Happiness should not be normalized.

            • Diana MacPherson
              Posted June 10, 2018 at 2:13 pm | Permalink

              I agree. There is a pressure to be happy and “positive” all the time. You can’t even say “it looks like this bad thing might happen” or you are labelled negative with the implication that you have a defective character. And if you’re suffering can you please do it elsewhere? You’re making me fee, bad.

      • Diana MacPherson
        Posted June 9, 2018 at 12:25 pm | Permalink

        Not if you live in horrid, nauseating pain all the time. I just don’t see that as indulgent at all. I don’t think anyone should force anyone else to endure pain or label someone indulgent for not wanting to live or to hate the life thrust upon them. . None of this was their choice.

  11. Ken Kukec
    Posted June 9, 2018 at 11:14 am | Permalink

    There ought to be adequate safeguards (hell, more-than-adequate safeguards) to weed out people who are merely going through a rough patch, but beyond that, anyone truly intent on killing themself should have access to the means for doing so in a clean, simple, dignified manner. It sure-as-shit isn’t a “sin,” and it makes no sense to treat it as any type of crime.

  12. Randall Schenck
    Posted June 9, 2018 at 11:24 am | Permalink

    The general primitive thinking in this county on all healthcare leaves little or no hope that anything reasonable will be done about this one. Maybe one day a specific state will include this in assisted suicide but I would have little hope. Right now the republicans are attempting to rip away what is left of our care system and waiting for the rest of it to go bankrupt. If you want to kill yourself they say – get a gun. Heck, Trump is on the way to his big negotiations with Kim so maybe we will not have to worry about it for long.

    • Jenny Haniver
      Posted June 9, 2018 at 12:04 pm | Permalink

      Yeah, the Republican idea of assisted suicide: “Get a gun — We’ll make that easy for you by taking away restrictions on gun ownership; and you can take as many, students, children and other innocent people with you. We don’t much care about that either, except to engage in virtue signaling by offering our thoughts and prayers. It’s called ‘culling the herd’.”

  13. Diana MacPherson
    Posted June 9, 2018 at 11:39 am | Permalink

    Also physical pain. We don’t do enough to ease physical pain then we act all surprised that someone chooses to die rather than endure it. Doctors can’t prescribe medications that can cause addiction or damage organs to people who aren’t expected to die of their malady. So the people either turn to street drugs or kill themselves or both. Here is an article about a dentist in his 30s who committed sucide from chronic severe pain. I know the pain he had. I too have pain high in my neck that has been relentless at times. http://www.dyingwithdignity.ca/adam_ross_story

    • Jenny Haniver
      Posted June 9, 2018 at 12:53 pm | Permalink

      Adam’s story is very sad. It’s difficult to read about someone in the prime of life driven to end his life because of unbearable pain.

      I’d sure like to know what the substance was that “he carefully breathed in…that — painlessly — released him from his body and the relentless suffering that had been his reality for seven years. It would be nice to be prepared if and when that time came, and I’ve not heard about such substances (gas or something that emits a fatal aroma) that one could administer onself. I only know of pills.

      • Posted June 9, 2018 at 1:26 pm | Permalink

        Any inert gas will do. Helium is popular because it is so easy to obtain — any place that supplies party balloons will rent a cylinder for a few dollars. Nitrous oxide is also popular because it supposedly has a euphoric effect (however I was not impressed with my one experience at the dentist’s). It is a propellant used for e.g. making whipped cream, and you can order it from culinary supply houses. Nitrogen will do — you might be able to get a cylinder from a welding supply store.

        Carbon monoxide works by binding to the hemoglobin in the bloodstream and displacing oxygen. Running your car in a closed garage, or running a hose from the exhaust pipe to the interior of the car, are time-honored methods of suicide, but although CO itself is odorless I would think the smell of the other car exhaust components would make it an unpleasant way to go.

        The gas you shouldn’t use is carbon dioxide — I am informed that the body reacts to a buildup of CO2 with a feeling of panic, like drowning.

        • Michael Fisher
          Posted June 9, 2018 at 2:58 pm | Permalink

          Be careful with helium – some brands now include a percentage of oxygen. A bit of a cruel trick.

        • infiniteimprobabilit
          Posted June 9, 2018 at 7:46 pm | Permalink

          Yes, apparently the body uses CO2 concentration to judge when it needs to breathe. The feeling of suffocation is caused by a build-up in CO2, not by a lack of oxygen.

          Nitrogen is the usually recommended gas to use, because we don’t react to it (air is 80% nitrogen already), it just has to displace all the oxygen.

          As always, relatively easy for a physically fit person to arrange and near impossible without outside help for a sick one.

          cr

        • infiniteimprobabilit
          Posted June 9, 2018 at 8:00 pm | Permalink

          Oh, and the time-honoured car exhaust method may not be so effective or peaceful these days. Catalytic convertors (google says) convert carbon monoxide and hydrocarbons to CO2 (just what you don’t want!) and water.

          cr

      • Diana MacPherson
        Posted June 9, 2018 at 1:49 pm | Permalink

        I know, I was thinking the same thing and i susoect it was deliberately left out.

      • Michael Fisher
        Posted June 9, 2018 at 2:55 pm | Permalink

        The Peaceful Pill Handbook is an excellent resource. Besides laying out various suicide methodologies it also takes you through all the issues that a considerate** suicide should factor into their choices. A read of that will turn a proportion of would be suicides away from that course of action once they’ve considered the effect their actions have on the still living.

        The gassing solution can be found by googling “suicide bag” – this method of suffocation with the appropriate gas [which are listed, but already mentioned by Peter N.] avoids the panic drowning effect described by Peter N. But it should be noted that a failure in the mission might mean society & friends/relatives are then burdened with a brain damaged individual possibly for decades. e.g. One unsuccessful suicide-by-car of my acquaintance [I only know him via his parents post-suicide attempt] has been in the care of his parents for 40 years – a very cheerful, healthy robust chap of 59 with the “IQ of a turnip” [his dad’s bitter description].

        Dying well is a far more serious business than living well!

        ** Yes I know – not an option for all

      • Michael Fisher
        Posted June 9, 2018 at 3:08 pm | Permalink

        I’ve just scrolled down the Amazon book link I provided above to the “Sponsored products related to this item” section & I’m being offered a range of gasses in canister form – most of ’em inappropriate.

        I fear for our future: dumb bots in every nook & cranny.

      • Michael Fisher
        Posted June 9, 2018 at 3:18 pm | Permalink

        Sorry for all the posts! Look here for the MOST RECENT ebook version which is by subscription – thus updated regularly to account for changes in the law & changes in the availability of ‘raw materials’. Also a blog for advice/chat.

        • Posted June 9, 2018 at 5:18 pm | Permalink

          Thank you Peter N and Michael Fisher for the most useful knowledge and suggestions you present. And to all the rest for sharing your views on this most difficult and emotional topic.

          • Michael Fisher
            Posted June 9, 2018 at 6:52 pm | Permalink

            Thank you Rowena! I read your intimate posts @ #7 & #19 with great interest & appreciation. It is very good that there are people like you, Diana, Shelley, infinite, Marta & sedge who can write of suicide from a personal, emotional perspective. All of you [bar one] are women – something for us guys to think about as we go about the business of talking only in ‘impersonal generalities mode’ with regard to all the important life events.

            • Posted June 10, 2018 at 1:22 am | Permalink

              Thank you so much. I value the information you provide, as well as your opinions. As I’ve aged, I’ve become less secretive about my life, thoughts and on issues that matter to me. I may have become too talkative in the desire to share this one person’s experiences in the hope that they may be of help to someone, anyone.

          • Jenny Haniver
            Posted June 9, 2018 at 8:58 pm | Permalink

            I wholeheartedly agree, and also thank all of you for your input and for sharing your knowledge. Though I’m not ready to give up the ghost yet, tese are things people need to know. As I get older and illness, severe debility, and who knows what else, looms on the horizon, I have no idea what will happen (who does?), but I know that I will do whatever I can not to linger on in excruciating pain or be completely incapacitated; and I want to be prepared — so that, if it’s at all possible, I’ll have a choice over my exit, if it comes to that (though I’d much rather just drop dead while jogging or doing something I loved, or die in my sleep). I’ve had nitrous oxide at the dentist, and I liked it perhaps too much. I wouldn’t mind going out laughing, especially since I suffer from chronic depression (though not bad enough to be suicidal, except passively) and am essentially anhedonic and so miss being able to really enjoy life — but if it takes dying to make me laugh again, one last time. fine and dandy.

            • Posted June 10, 2018 at 1:54 am | Permalink

              I hope you, and at least a few others, will find this as funny (in a macabre way)as I do. My kids all know exactly what I want for disposal of my remains after my death because it is written in my trust and I’ve talked about it with each of them. My husband was cremated and I plan to be also. We want our ashes sprinkled together at a special location of our choosing.

              We belong to Oregon Memorial Association and recently learned I can opt for cremation by water (flameless cremation, green cremation, aqua cremation, aqua green cremation) instead of fire. The article I read left me with the impression that my bones would be returned to the family. Sprinkling my bones with my husband’s ashes doesn’t appeal to me. Other sources online indicate that the bones are ground up and returned as “ashes”.

              Anyway, this process is viewed as being more eco-friendly.

              • Michael Fisher
                Posted June 10, 2018 at 2:22 am | Permalink

                I suppose you’re referring to what’s called “dissolution” in Oregon [under legislation SB796, 2009].

                Chemically speaking it is “alkaline hydrolysis” & Wiki has this to say:

                “the body is placed in a pressure vessel that is then filled with a mixture of water & lye & heated to a temperature around 160 °C (320 °F), but at an elevated pressure, which prevents boiling.

                […] the body is effectively broken down into its chemical components, which takes approximately four to six hours. […] The end result is a quantity of green-brown tinted liquid (containing amino acids, peptides, sugars and salts) & soft, porous white bone remains easily crushed in the hand (although a cremulator is more commonly used) to form a white-colored dust. The “ash” can then be returned to the next of kin of the deceased.

                The liquid is disposed of either through the sanitary sewer system, or through some other method, including use in a garden or green space. […] This alkaline hydrolysis process has been championed […] for using […] one-quarter the energy of flame-based cremation and producing less carbon dioxide and pollutants

                SOURCE

              • Diana MacPherson
                Posted June 10, 2018 at 9:49 am | Permalink

                I’m envisioning myself just washed away with the garden hose.

              • Michael Fisher
                Posted June 10, 2018 at 10:02 am | Permalink

                @Diana “washed away” would suit me or a form of composting is probably most productive – I don’t want ‘remains’ or markers or housing in a jar.

              • Diana MacPherson
                Posted June 10, 2018 at 10:37 am | Permalink

                I want markers because having been exposed to archaeology, I know that shit endures and gets studied so I’d like to contribute to that. Grave markers are often studied for language and location.

              • Posted June 11, 2018 at 12:54 pm | Permalink

                I’ve wondered about how eco-friendly the lye based ones actually are. Having all that hydroxide around can’t be too friendly. Maybe some processes neutralize it?

              • Michael Fisher
                Posted June 11, 2018 at 1:08 pm | Permalink

                The pH level of the effluent [which smells like soap] is tested & some acid is added to neutralise, then the liquid is released down the drain. The floppy bones [& artificial hip joints] are retained – the bones are dried in a normal tumble drier [on a tray that doesn’t tumble] & then they’re crumbled into a white powder. All done.

  14. Posted June 9, 2018 at 12:38 pm | Permalink

    An enlightened article. I have myself argued for the right of every man (and woman!)to end his or her own life painlessly. For whatever reason he or she chooses.

  15. Posted June 9, 2018 at 1:20 pm | Permalink

    I sympathize with suicide in some cases. In fact, I plan (and I do mean plan) to commit suicide if faced with a very painful death or with an severe and certain mental decline.

    However, my husband committed suicide 30 years ago. Knowing what we relatives pieced together afterwards, I both sympathize better with his choice and am certain that if he had gotten effective help, he would have chosen to live.

    It’s important to do everything we can to prevent suicide. With very few exceptions.

    • Posted June 10, 2018 at 12:20 pm | Permalink

      I agree. While I fully sympathize with people who resort to suicide because of unbearable suffering, I am glad that my friends with depression got help, and I think the wish for suicide is in most cases a problem that should not be denied nor “solved” by encouraging suicide.

  16. Gareth Price
    Posted June 9, 2018 at 1:47 pm | Permalink

    I hope that crisis lines are helping some people. For me it was utterly counterproductive. Many years ago, I took an overdose: I am still alive to write here because I lost my nerve and my neighbor called an ambulance. The last people I spoke to before swallowing the pills were the Samaritans, and they pushed me over the edge. If someone has been trying to get help for a long time and nothing is helping, they probably don’t want someone on the phone trying to keep them safe until they “can get the help they need and deserve” or reassurances that they won’t always feel this way.

    I also think it is a problem that mental health workers are legally (?) obliged to intervene when they consider a patient to be an imminent danger to himself, but if they don’t help improve that person’s condition, they merely prolong her pain.

    Incidentally, I suspect mental health workers don’t wait until they consider a patient to be an imminent danger to himself but intervene if they merely suspect there is a possibility. There is a conflict between what the patient might need and the mental health worker covering herself.

  17. ejfinneranjr
    Posted June 9, 2018 at 3:21 pm | Permalink

    Thank you for expressing a probably unpopular idea. Anyone who has not experienced what these people have should consider the possibility that their ignorance of that experience can render their opinions moot.

  18. ladyatheist
    Posted June 9, 2018 at 3:58 pm | Permalink

    I don’t consider Robin Williams’s suicide a tragedy except that he had to carry out his plan in secret without letting his family in on it. He had lost his identity and had only a slow demise from Lewy Body dementia to look forward to. He should have had the choice to pick his moment with society & family approval.

    • Diana MacPherson
      Posted June 9, 2018 at 4:35 pm | Permalink

      I agree.

    • Jenny Haniver
      Posted June 9, 2018 at 9:23 pm | Permalink

      I think you’re right re what Robin Williams should have been able to do, but I think that the situation was more complicated with him because he was diagnosed with Lewy Body dementia only after his death. He did not know he had this disease, and nobody else knew. He had been misdiagnosed with Parkinson’s. (Why is doctors didn’t test for that condition is beyond me, since I read that Lewy Dementia is frequently misdiagnosed as Parkinson’s). But, something else was going on, and if he sensed that something very serious was wrong with him, not ‘just’ Parkinson’s (especially if treatment for Parkinson’s was ineffective),but not knowing what, that could well drive a person to kill themselves — when they feel that they just can’t take it anymore (and remember, this was Lewy Body dementia, and I stress the word “dementia”, so his cognition and psychological functions were deteriorating — no planning in the sense of long-term arrangements and all that, but something that he had an impulse had to be done at that moment.

      It is tragic that he did not get the correct diagnosis in the first place, so that he could get proper palliative treatment, and he and his family could make realistic plans.

      • Diana MacPherson
        Posted June 9, 2018 at 10:02 pm | Permalink

        I heard an interview with the person who wrote Robin and he was unable to do stand up anymore and struggled with remembering things. So he definitely felt the impact of his disease and it was devastating for him. He felt he could no longer be funny and that was the world to him.

  19. Posted June 9, 2018 at 5:47 pm | Permalink

    Many years ago my sister-in-law, much beloved by everyone who knew her, committed suicide by gun. She was very thoughtful about it. She covered over the kitchen window so no one outside looking in could see her. She lay down on the kitchen floor with a pillow under her head and shot herself. Very thoughtful about the mess. But, my brother returned home from work to find her like that. It was a wonder he didn’t decide to emulate her shortly thereafter.

    It eventually was known that my sister-in law
    was bi-polar.”Up” was the condition in which she was considered “normal” by her family and friends. She was very bright, loving, humorous, etc. But, when she was “down”, she was viewed as “abnormal’.

    Her childhood may have looked “normal” to most outsiders, but there was a great deal about it she kept hidden. Negative influences that I will not enumerate. She came from a family of alcoholics (treating pain, no doubt) and in the last 8 or so years of her life she used the family-method of assuaging pain. She became an alcoholic (or, at least, treated her depression with alcohol.) Her mother and brothers also were extreme alcoholics.

    • Posted June 9, 2018 at 5:59 pm | Permalink

      Oops! Not finished!

      She was prescribed different kinds of antidepressants that squashed her feelings and her “highs” so much that she stopped taking them (because “highs” were “normal” for her.) She saw a psychiatrist who was unable to help her because she was able to convince him of her “normalcy”.

      Everyone was shocked when she killed herself.
      30 years or so later, we still suffer from our inability to know what was really going on with her or to help her. Every one of us felt that we should have known, should have done something.

      I look at my sister-in-law’s way “out” vs. my husband’s way “out” and can say with my heart and mind, that his way was better for him and us. My sister-in-law didn’t have that option in California at the time she chose to kill herself. I wish she had.

  20. Gabrielle
    Posted June 9, 2018 at 8:07 pm | Permalink

    I have bipolar type II disorder, the type where the depression is worse than the mania. Over my lifetime I had 10 episodes of major depression, and have been suicidal twice. I’ve also been fortunate that the drug Lamictal has stabilized my moods for the past 14 years, without any episodes of depression or mania occurring. For me the drug has been a real game-changer. It must supply the missing ingredient that my brain chemistry is lacking.
    All this being said, getting good psychiatric care has been a real challenge, much more difficult that regular medical care. Most private psychiatrists don’t take insurance, so patients have to pay out of pocket, to the tune of $100-150 a visit. And psychiatric care means lots of visits, at least until one’s problem has improved.
    I am also no fan of the way psychiatrists prescribe medication. Back when I took anti-depressants, doctors would haphazardly change dosages, or combine medications, or ignore side effects, etc, or simply not acknowledge that a drug is not working (give it more time, they would invariably say, or lets double the dose, and so on).
    Oddly, when I told the first psychiatrist that I’d seen that I believed I was bipolar, he disagreed, saying that I needed to see him 4 times a week for psychoanalysis to explore the tragedies in my life. I declined. And this wasn’t back in the dark ages; it was in 1995.
    As for allowing a person who has been depressed for a long time to commit suicide – I am on the fence about this. If a person is 50+ years and has never had relief of their depressive symptoms and has tried everything, well maybe then. But for a 20-30 year old person, for me that is way too young to be deciding on take one’s life legally.
    As for being of sound mind when suicidal- I can only speak for myself, but I clearly feel now that I was not of sound mind when I was deeply depressed. I was delusional about myself, with constant negative thoughts about how worthless I was, how stupid, how I’d made mistake after mistake. Of course now I can see that these thoughts were not based on reality, but back then they seemed all too real. Thus, I have some reservations about considering a deeply depressed person to be of sound mind.

    • Michael Fisher
      Posted June 9, 2018 at 8:35 pm | Permalink

      Gabrielle. What approx financial loss [medical & missed earnings & missed job opportunities] have you racked up in your life due to your disease? How about relationships/friendships? Other things?

      You are fortunate to have been both diagnosed correctly & eventually prescribed an acceptable solution in Lamictal & I assume you are a user for whom the side effects are reasonably tolerable.

      Reading between the lines of what you wrote you seem to be a coper/survivor. Kudos!

      • Gabrielle
        Posted June 9, 2018 at 11:00 pm | Permalink

        It’s a bit hard to quantify missed earnings/job opportunities. I was mostly able to work through my illness when it was still an issue. What really suffered was my working relationships with other employees at my then employer. I wasn’t the most pleasant person to be around. Now I’m in a job that is less stressful, which is much better for me, although the job pays somewhat less money.

        I had a marriage that failed partly due to my illness. I wasn’t the easiest person to live with. Still, one of the issues was that my then husband would not accept that I had a serious mental illness. Even 20 years after we split up, he was still uncomfortable speaking with me about this subject when he contacted me once by phone. And this was in 2012, not in the dark ages.

        I am fortunate that I haven’t had any major issues taking Lamictal (knock on wood). For me, it perks me up somewhat, like caffeine, and I even lost some weight when I first started taking it.

        All in all, I don’t quite view myself as a survivor, just someone trying to get by through life.

        • Posted June 10, 2018 at 1:07 am | Permalink

          I’m so glad that you were able to find a treatment that helped you. Just as with depression, bi-polar disorder seems to come in an array of “flavors”. One friend of ours who was bi-polar was “normal” when “down”, “abnormal” when “up”. In a manic phase, he drove around a metropolitan area with a gun in his car because he though people at work were after him. He stayed at our house for two weeks once, mostly sitting in a comfy chair in the corner of the living room, doing nothing obvious. He didn’t move much, clean up or eat unless motivated by others.

          I don’t even think “it takes one to know one”. I think the spectrum is so diverse that
          one bipolar person’s situation may be extremely different from another’s. It is even more difficult for so-called normal people to truly understand even if the sympathize or empathize.

          Similarly, depression comes in a range of severity. My family has an inherited form of
          relatively mild depression (none of us have tried to kill ourselves so far). Some medications help. Some are useless, or worse.
          We have periodic “significant downs” that sometimes affect ability to function, but we usually come out of it somehow. But, what we experience is definitely not the super-sized kinds of depression some people live with.

          I have nothing but admiration for those individuals who continue to try to live despite the major mental health difficulties. Those who are so hurt and have tried almost everything, I sympathize with them and feel they have the right to decide the course of their individual lives. Shoving them into mental facilities or prisons (perhaps to protect them from themselves) may be cruel and unusual punishment.

  21. Diane G
    Posted June 10, 2018 at 12:52 am | Permalink

    sub

  22. Posted June 11, 2018 at 12:58 pm | Permalink

    “How you face death is at least as important as how you face life”, as the saying goes.

    The way I put it to my Inuk friend was that if she wants to walk onto the ice and not come back (or a chemical equivalent if whatever it is sudden), I would discuss and see if it seems to be really the right thing. And if she’s really ready, I would speak well of her when she’s gone.

  23. gravelinspector-Aidan
    Posted June 12, 2018 at 11:12 am | Permalink

    Is this really so different from a terminal cancer patient in unbearable physical pain who wants the pain to stop?

    Wouldn’t the new CIA Director be the person to ask? As an expert in torture, surely she is professionally qualified to compare physical pain and mental pain.
    A person of my acquaintance recently told me that my memories of my childhood near-drowning were keeping him awake at night. Which got me to thinking about Haspel, and remembering the delights of breathing a 50/50 water air mixture. Oddly, those memories keep me awake some nights.

  24. Posted June 18, 2018 at 12:44 pm | Permalink

    thank you for exploring this so people can talk about it.
    https://everydayprimate.org/2017/02/23/seven-shades-of-suicide/

  25. Wolf
    Posted July 5, 2018 at 6:19 am | Permalink

    I have written about the right to physician-assisted suicide for the mentally ill in my own blog. I may have deleted it, but I will be writing about it again. I am so glad to find someone who agrees with me. I believe in reincarnation, so I really don’t feel like suicide is such a big deal. If you are in too much pain, you come back and try it again. I have suffered from a severe depression for almost twenty years, and it is present almost all of the time. I believe in physician-assisted suicide, euthanasia, and the right to abortion. I believe these are the things that most pro-choice people believe in. What right does the government have to stop us? Absolutely none. I believe the right to die is central to any movement for the rights of the mentallly ill. Life can seem senseless when all you’re doing is suffering, and many of us know, after suffering for so long, that our diseases are incurable. Thank you for standing up for this.


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