This year Oxford University Press and renowned scholar Susan Stefan (2016) released a very thoughtful book on one of the most controversial subjects with which any tome could ever deal—the question of suicide and the laws and public policies surrounding it. A long book of 540 pages, it is called Rational Suicide, Irrational Laws.
This is without question an excellent book. It is highly comprehensive, including an examination of a vast number of related laws and issues. While focusing on the US, it has international scope and provides a critical overview. For example; of assisted suicide laws throughout the world. It explores the criminalization and decriminalization of suicide. It analyzes laws by which “mental health” professionals and organizations are held accountable or “liable.” It exposes horrific contradictions in how laws are applied. In particular, problematizing the assumption that people who kill themselves are suffering from a “mental illness” which makes them “legally incapable.”
Also, the legal contradiction of people deemed capable when going along with mental health professionals’ wishes, when these very same people are deemed incapable otherwise. It weaves real cases, and the plight of very real people, throughout. Moreover, the underlying research includes at once depth analyses of statutes and legal journeys, and personal interviews with a large number of different folk, including health professionals. What is especially gratifying is its inclusion of people who have tried to kill themselves—a group arguably with the most relevant expertize and yet one which recognized “experts” on the topic characteristically sideline.
Finally, it is at once a compassionate and an intelligent book, written by a researcher who listens intently and who is trying to do justice to a complex issue about which she deeply cares. All of which is obvious right from the introductory remarks.
As the title of the book suggests, the story which Stefan tells and the analysis proffered is largely one of “rational” suicide and “irrational” laws and processes. Positions arrived at/articulated include:
- The state has an interest in preserving life and, as such, a balance between the interests of the state and those of the person needs to be struck.
- The vast majority of people who opt to end their life, including psychiatric survivors, have the legal capacity to make this choice and should be treated accordingly.
- The state should be getting rid of “suicide magnets” — such bridges without protective barriers — and should require the safe lockup of personal firearms.
- We should be moving away from an emphasis on detection and the immediate stopping of suicide to addressing the systemic issues that incline people toward suicide.
- A full range of help options should be made available to people, including safe houses, peer counseling, even long term 24 hour wrap-around services.
While there are some who are “suicidal” for whom short-term involuntary confinement is necessary given their lack of capacity, contends Stefan, in most cases, this is not so. It is critical that people who are considering killing themselves be able to talk about it freely without the threat of being apprehended — an outcome which is traumatizing in itself, and which increases the likelihood of suicide. What goes along with this is the need to change laws that make “mental health professionals”liable for the suicide of their non-committed clients, so that professionals are not pre-disposed to avoid the topic of suicide, or call 911.
Stefan goes on to state that assisted suicide should be legal, but only if a number of stringent conditions are met, including:
- The existence of capacity
- The fact of having no more than 6 months to live, and
- Having considered one’s options carefully.
Stefan makes a sharp distinction between “assisted suicide,” and “euthanasia,” — regardless of whether or not euthanasia is actively solicited by the capable person themselves — calling for euthanasia to be utterly prohibited and treated like ‘homicide.” Optimally, according to Stefan, neither strangers nor family members should be allowed to “assist.”
Do I agree with all of the above? Decidedly not. However, before I touch on disagreements and what I see as problems (some of them major), let me say that there is much in this book that makes me want to stand up and cheer. A deep awareness of the problems caused by trying to control people would top that list. Stefan is understandably horrified by the ease with which police are summoned, with vulnerable people concomitantly cuffed and dragged to “hospital” simply because they have mentioned suicide. As part of countering this expectable reaction Stefan recommends legal, policy, and educational changes so that therapists, for example, stop focusing on control and start focusing on connection. Correspondingly, she is crystal clear that the status quo generally makes a suicidal person’s plight worse. Consider in this regard this thrilling passage:
People who are struggling with a reason to stay alive don’t want to be “assessed.” They don’t want to be asked endlessly if they have a plan, if they have the means, if they will contract for safety. They want to talk about someone who cares, about hope, about solving the problems that seem insolvable, about how to get through the night. (p. 309)
Or consider this one:
The most skilled mental health professionals doing their best work must necessarily take risks that their patients will commit suicide. The journey to a life that a suicidal person considers meaningful and worthwhile must carry some risk. To increase the quality of life and the absolute number of lives saved, we have to be prepared to tolerate the reality that some people may kill themselves, We cannot continue creating unnecessary misery, increasing costs, and reducing both the availability and the quality of treatment to nurture the myth that all suicides are preventable. They never have been and never will be. (p. 277)
She opines that there would be considerably less suicide if we put less emphasis on controlling people and more on connecting with them.
In this regard, while our opinions are far from identical on this issue (for I place greater emphasis on freedom and personal autonomy than Stefan) let me share a bit of my own professional history for the ways in which it solidly supports Stefan’s point: for well over three decades as a therapist, my specialties have been adult clients who:
- Are psychiatric survivors;
- Have been profoundly traumatized;
- Live with alternate realities, and;
- Want to kill themselves.
As a matter of principle, I am clear with clients right from the start that I will not prevent them from killing themselves, and will not call 911, so they have no need to censor themselves. Bottom-line positions for me are that people desperately need to be safe to talk about “suicidal” thoughts, that we should not presume to know what is best for others, nor make decisions for them. Moreover, that people in dire distress need to connect, and to deny them the possibility to do so safely is ultimately to make counseling and therapy unavailable to those in the most dire distress. What is significant in this regard is that in all these decades, despite my having a specialization that makes the suicide of my clients a statistically strong possibility, not a single client of mine has ever killed themselves. As such, while there is certainly some degree of luck involved, I am highly aware that there is wisdom in what Stefan is alleging and recommending here.
More generally, what this book does well is to introduce us bit-by-bit to the legal territory, and the place of culture in determining what conceptualizations are viable. Similarly praiseworthy and major contributions are the author’s insistence that — whatever laws are created — psychiatric survivors must not be discriminated against, and must be treated like everyone else.
However she draws a sharp distinction between adults and children, arguing for:
- Prioritize addressing the systemic problems that commonly underlie people’s desire to kill themselves (e.g., in the case of children, bullying)
- Pushing toward less control and more connection/compassion
- Highlighting contradictions in psychiatric diagnosis/diagnoses
- Unmasking so many current practices in this area that are illegal and/or irrational
- Downplaying medical solutions as well as the recognition of how causal they can be in suicide
- The recommendation that society consider different types of suicide, and find ways of providing the various types of help needed; and finally, what goes along with this,
- Caution against the advent of assisted suicide becoming just another way of letting society “off the hook.”
Which brings me to the problems.
From my perspective—and I suspect most people would critique Stefan from the opposite perspective—the author seriously understates the problems caused by psychiatry, and in no way touches on the invalidity or the inherently damaging nature of its biological “treatments.” As such, while she wants to protect people’s rights as far as they are “legally capable,” and while she remains very critical of psychiatry, she still sees a place — and a privileged place — for psychiatry. More generally, while she would greatly reduce it, she ultimately accepts the “need” for involuntary psychiatric detention — and, no, I do not.
What relates to this, (once again, being critical) is that Stefan accepts a view of incapacity that would still have a huge number of people declared incapable (albeit far less than are so deemed today). For example, she sees people who are “floridly psychotic” as obviously incapable and, as such, would have no compunction over 911 being called on them if, for example, they are actively suicidal. What this position invisibilizes is that there are people with such different ways of processing that they are automatically seen as lacking reason. As demonstrated in Burstow (2015, Chapter Nine), this failure to comprehend is largely a limitation of the “sane,” as well as a deficit — indeed, a correctable deficit — in our education systems. Correspondingly, society’s failure to understand people whose minds work differently does not make such people “incapable,” per se.
An example pertinent to the issue at hand: A client of mine who dwelt in an alternate reality was “suicidal,” and who would certainly have been seen by most as ‘incapable,” announced one day she was going to kill herself forthwith in order to join the trees. To the average person, it would look as if she had lost her power of reasoning and so could not conceivably be competent. An understandable reaction, sure, but what this view leaves out is that she was literalizing a metaphor. What she was saying, in “sane parlance,” is that she wanted to return to nature, to dust, as it were. That is, finding life meaningless, she wanted to rid herself of the existential burden of being a separate and cognizant being. Now I can well understand why a situation like this gives us — and indeed must give us — pause.
Nonetheless, is not a variant of this position held by most people considering ending their lives — including those, I would add, that the average person would “recognize” as “capable”? Indeed, if we were to step totally outside pathologizing frameworks (always a good thing), is not her question a variant of the ultimate existential question that philosopher Albert Camus (1975) sees facing all of us? To be clear, I am not suggesting that anyone “support” her decision. However, how can we uphold a framework, in good conscience, which would not only thoroughly invalidate her but would inevitably lead to her apprehension?
Less obvious, but more fundamentally problematic, is the statist framework which Stefan uncritically employs. Note; while I well understand the need to balance community rights with individual rights, weighing the needs of the individual against “the interests of the state” (in this case in “preserving life”) which the author is advocating is a different matter altogether. To be clear, while I am decidedly “on board” with wanting to improve society and people’s situation for a variety of reasons, including such that fewer end up feeling that they have no recourse but to kill themselves, not one of those reasons is that the “state” “has an interest in preserving life.”
By the same token I see as inherently problematic concepts like “suicide prevention,” so rampant in this book, and indeed the very conceptualization of people “committing suicide.” Note, in this regard, “committing suicide” is a concept tied to the state. As institutional ethnographer Dorothy Smith (1983) so astutely put it decades ago, while people indeed end their lives, “no one commits suicide.” While I appreciate that shifting a framework this hegemonic is hard, and runs directly counter to legal training, attempts to bring about a more humane approach, I would suggest, are minimally jeopardized by statist ways of thinking and statist problem-solving. By the same token, while I applaud the author for wanting and pushing for better services, I question the degree of improvement possible in our current statist arrangements, for states have their own interests, as do their representatives. Note, these are the very people in whose hands lies the state’s parens patriae powers—ergo, the power (and responsibility) to commit and to intrude (see Burstow, 2015).
Finally, we come to Stefan’s positions on assisted suicide and euthanasia (issues with which I would agree that, as things currently stand, we need to involve the state).
To put this simply, people in dire distress who rationally choose to end their lives often need more than either decriminalization or assistance to live, significant though both are. As a society, of course we need safeguards and of course we need standards, and of course — contrary to how we currently act — we need to prioritize doing whatever we as a community can to help improve the quality of everyone’s lives. And of course, having the right to end one’s life does not automatically translate into having the right to assistance with this — far from it. Nonetheless, let me suggest such assistance is often in order.
On a simple level, no one wants to die alone. Most people would greatly prefer having the peace of mind that comes from knowing that the procedure will not be botched. Correspondingly, allowing assistance of this ilk only in those cases where the person has but six months to live (one of Stefan’s provisos) is woefully inadequate. What, for example, about the person who is not in the least terminally ill but is in terrible pain that cannot be stopped; who in essence cannot be “made comfortable”? Take, for instance, the person who has advanced arthritis together with exceptionally severe gastro-intestinal problems along with such a dire case of multiple chemical sensitivity, along with a body with such low intolerance that no pills will alleviate her suffering, that no medication whatever, however introduced, can be tolerated. Imagine further that she has spastic conditions that will not allow her to tolerate even seemingly non-intrusive measures like acupuncture or mindfulness or indeed any of the other options in the medical repertoire. Do we as a society really want to say to such a person that while we will not stop her from ending her life unless she has but six months to live, we will neither help her nor allow others to?
Enter the author’s recommendation for how assisted suicide might work. Understandably worried about the involvement of doctors, Stefan recommends that persons with only six months to live enter a hospice, whose operator in turn gives them a voucher which allows them to receive a fatal dose of medication from a pharmacy. To go back to the previous example — which, as it happens is not a hypothetical but a real situation with which I am highly familiar — besides that the person in question would not be eligible, for she has way more than six months to live, she is unlikely to be able to enter a hospice, because the presence of everything in it would instantly make her vilely ill. Moreover, the medication is highly unlikely to be something her body would tolerate. It is hit-and-miss with injections or other similar solutions. Nor would starvation (a method suggested in this book) be endurable, for her body reacts even worse to food deprivation than to eating.
Which brings me to the question of euthanasia. Stefan unequivocally rules it out and equates it with homicide, even where the person in question actively requests it, waits the required amount of time, and carefully considers their options. To be clear, of course far more stringent oversight is needed if we allow direct second party involvement, and of course, we need to keep in mind what has been called “the slippery slope,” but at the bare minimum people’s peace of mind in dying can at times be greatly enhanced by making more direct assistance possible. Again, note the person referenced earlier.
With solutions that work with others habitually backfiring with this person, do we not want her to have a medical expert there to deal with physical reactions that might suddenly happen, that might make an otherwise seemingly uncomplicated procedure unworkable and/or tortuous? Or do we want to leave what happens to her to chance? Correspondingly, are we okay leaving as one of the only options that does not leave her trapped or feeling guilty (the latter because of a route that involves legal jeopardy for potential helpers), the lonely and indeed frightening option of crawling away and shooting herself?
The point is clear. Society has been moving to assisted suicide because we do not want people in agony stuck with such dilemmas. However, we cannot provide what is needed without considering the real dilemmas that real people in extremis face. Correspondingly, we cannot just accept models that might work for many. Any model that places anyone in such dilemmas is unacceptable.
Time for greater clarity on the example at hand: In short, what I have done here is draw on several of my own conditions, while leaving out the vast majority of disabling but nonterminal physical conditions I have (e.g., inability to sit, to eat more than 4 specific foods, to travel at all, to see anything without significant distortion, to treat a single ailment, to be around sounds louder than a hush, etc.). Factor in all of these and the need for active help to be available is even more apparent.
To be clear, I am 71 years old. I have a wonderful life, continue to be highly productive, work with awesome students and fellow activists, am a professor at a leading university, have just become head of my program; and I have no intention whatever of retiring any time soon — leave alone killing myself soon, if ever. However, if things get so bad that life was no longer tolerable irrespective of the help offered, a society that could only push “solutions” that would make my plight worse at me, and/or would in any way penalize anyone who helps me bring my life to a peaceful conclusion, would surely be failing me — not to mention the helper. And mine is just one set of circumstances.
Who knows what worse circumstances others and — indeed younger individuals — might be facing? Bottom line: the criteria for qualifying for assisted suicide, stipulated in this book, together with the dismissal of more active help, seriously “misses the mark.”
Two final observations: While there are unquestionably people, including doctors, whose “help” in this area qualifies as undue influence, and/or borders on criminal negligence, moreover others for whom it is downright murder — both of which are “beyond unacceptable” — at this point in history, that is hardly typical; processes and laws that operate as if it is are themselves sadly wanting.
Moreover, often people — including doctors and including family members who go “the extra mile” do so because individuals who are by conventional standards demonstrably “capable” want them to — are clear that they urgently need them to. Question: Can we not find better processes and ways of distinguishing what is happening? And cannot we not respond accordingly? As for bone fide helpers who cross the still-to-be-negotiated line, let us deal with that for sure, but in a way that factors in their predicament, and society’s inevitable role in this.
Finally: Like Stefan, and like virtually all disability activists, I too consider “beyond unacceptable” any slippage whereby states start using assisted suicide as the ultimate solution to their “problems”; as a cost-effective and convenient way of ridding themselves of whatever or whomever they see as burdensome. Correspondingly, as I, too, see a danger here, and as I want better — not worse —services, I personally would favour a policy whereby for every penny that a state spends on the combination of assisted suicide and requested euthanasia, an equal amount has to be added to the coffers supporting programs intended to help people in difficult circumstances live. That is: to help them lead lives of meaning to them.
As I stated at the outset — and I would reiterate it at this juncture — Rational Suicide, Irrational Laws is a ground-breaking, brilliant, indeed courageous book. I encourage people to read it. There is information, analyses, and wisdom to be gleaned from it. What is also important; it is written by someone who is clearly highly ethical. Reading the reflections and considered opinion of those who are guided by a strong sense of decency is in itself good for the soul.
My invitation? Pick up the book, engage with it. Where you find yourself agreeing, ask yourself why. Similarly, when you find yourself disagreeing, continue thinking about the issues raised. Through the lens of suicide, and societal responses to it, it implicitly asks what kind of society we want and, as such, it holds significance for all of us; addressing, in the detail it does, issues that cannot but touch each of our lives. At the same time, it holds special significance for psychiatric survivors, for survivors of childhood trauma, for lawmakers, for therapists, for educators, for people who are sick or dying, for anyone who has themselves — or whose loved one — has ever seriously entertained killing themselves. Hence my particularly interest in drawing your attention to it.
In ending, I would additionally say this to the author: I hope that some of what I have written holds meaning for you, including both where we agree, as well as where we disagree.
And regardless, Susan, thank you for penning this book.
For this article and others by Burstow, see http://bizomadness.blogspot.ca/
* * * * *
- Burstow, B. (2015). Psychiatry and the business of madness. New York: Palgrave.
- Camus, A. (1975). The myth of Sisyphus. New York: Penguin.
- Smith, D. (1983). No one commits suicide. Human Studies, 6, 309-359.
- Stefan, S. (2016). Rational suicide, irrational laws: Examining the current approaches to suicide in policy and in law. New York: Oxford University Press.
I really don’t agree that the medical community should be given the right to assist in suicides. Although based upon my experience with a now FBI arrested and convicted doctor, who I was medically unnecessarily shipped a long distance to, then “snowed” by; I do know there absolutely are unethical doctors who have taken on the task of trying to murder kind organ donors who have dealt with prior easily recognized iatrogenesis, which was covered up via controversial iatrogenesis (psychiatric misdiagnosis and drugging).
Power corrupts, and the medical community today already has been given too much power, resulting in a “medical mafia” taking control. The right to force treat anyone needs to be taken away from today’s psychiatrists and doctors. And it’s absurd that adverse reactions to toxic “torture” drugs, should be called “treatment resistance.” Some people just don’t benefit, at all, from the psychiatric drugs. Period. The medical community needs to face this reality. “Forced psychiatric treatment is torture,” and the right of doctors to profiteer off of making people “psychotic,” via poly pharmacy induced anticholinergic toxidrome poisoning, needs to be taken away. $30,000 was defrauded from my private medical insurance group, for my medically unnecessary hospitalization.
I want doctors to have less power rather than more. And I would absolutely prohibit forced treatment. That said, I don’t want a situation where people cannot get help getting a peaceful death, and the state is uneasy about decriminalizing such help for anyone except doctor.
Huh, you’re talking criminalization of suicide, but not medicalization? Curious, as failure at suicide means certain diagnostic labeling and treatment.
I see much value in Susan Stefan’s book, and much value in your criticism of it as well. I see a little more value in her proviso regarding 6 months of life, and so-called “physician assisted suicide” than you do. I remember reading an article on the subject of “assisted suicide” that featured a US citizen with a bipolar label who would seek help in exiting the world from physicians in Switzerland. I question whether doctors should aid anybody suffering from non-physical pain, and without a terminal condition, in ending life. DIY termination would certainly be more messy and less scenic, but I have a lot of qualms about physicians ending rather than extending life. Where non-physicians assist in ending another person’s life it is usually called, and more correctly so, man slaughter or homicide.
I certainly agree with you, on the other hand, on the subject of impugned “incapacity”. It has to be a horrible fate to be stripped of one’s human and civil rights by the callous decisions of mental health professionals and judges. I wouldn’t say that it should be done with more care, or more rarely. I would say that it shouldn’t be done at all.
I would be curious to see research conducted into the extent to which, as I feel it must have done, so-called “suicide prevention” efforts have increased the incidence of suicide in this country. I figure if you really wanted to do something about the suicide rate you would have to do something about the human misery rate. I don’t think, overall, many people are doing much to make the planet a more environmentally friendly and inhabitable place for their own species.
I’m also curious about whether the suicide rate always surpassed the murder rate. The present rate would seem to fly in the face of Freud’s opposing Eros (life instinct) to Thanatos (death wish). Another question is how are people being reared and taught to under value life in this regard, and can we do anything about it.
Frank, I am not sure who you are talking to in the first sentence, for I am not in the least in favour of criminalizing suicide–nor is Stefan.
You use the words criminalization and decriminalization in your post in reference to Susan Stefan’s book. I’m not an academic. I can’t afford to dish out 85 $ for any book, and that is what Amazon.com is charging for hers. (70 $ used.) I can’t be certain what is meant in this instance by criminalization. Michel Foucault mentions death, perhaps during the middle ages, as a penalty for attempting suicide. I don’t get the idea that that is what you are talking about when you say criminalization.
I was toying with idea of killing myself at one time. I’d set a timeline for myself, and if I hadn’t achieved success, in my view, before this timeline was out, I was going to off myself. Eventually I figured I didn’t really want to die anyway, but not before doing a stint or two in the hospital and engaging in what looked to other people like some awfully risky behavior.
I’m not sure what you mean by criminalization here. I haven’t known anybody to do prison time for attempted suicide although I have known people to do hospital time for attempted suicide. Mental hospital is a euphemism for prison, albeit psychiatric prison, however, of course, the rationale given for such imprisonment is “medical”. If suicide is being “criminalized” I guess you could say the same about distraction and anxiety, not to mention madness.
Great post anyway, however “out of his league”.
Frank: When I refer to Susan talking about the criminilization and decriminalization, what I am referring to is historical. Not that long ago, most states listed suicide as a criminal office–ergo criminalized it. What she traces is how they came to remove it from their criminal code (decriminalize it).
Thanks. Now I understand that much.:)
Well this is always going to be a complex issue. Of course people should not be involuntarily confined, at least not for long. And they should never be given meds.
But then the only laws that mean anything about suicide are about assisting it.
I remember a Bruce Sterling Sci-Fi novel where suicide is the only right you have. And if you say you want to exercise it, they zap you with a disintegration beam right then and there. Not good.
But usually pro-suicide choice people are not actually advocating for anything like this.
Thanks for letting us know about the book.
I take exception to the polling on legalizing assisted suicide.
I have found (serving 60 fair booth days) that about half of the public thinks they are in favor of such a law, that is until they learn about the flaws in the laws that create new paths of elder abuse with immunity. Once they learn that a predatory heir may steer the signup process and then forcibly administer the lethal dose without oversight, they all said, “I am not for that!”.
Anyway all of these Oregon Model bills have the same flaws that work together to eviscerate flaunted safe guards.
For example how many times have you nodded your head when the proponents declared that the lethal dose must be self-administered?
Well, read the language of the law/bill and you will find that there is no means provided to insure that marketing point. For example “self-administrate” was mentioned 11 times in the 8 page Minnesota SF 1880 and yet there was no means provided to confirm that the lethal dose was forced on not, who would know if they struggled and not consented.
In fact what is provided is that there may be no investigations allowed after the death (page 6 of 8 Subd. 12. In addition allowing a stranger that claims to know how the person communicates may speak for them eviscerates all the intended safeguards, page 1 of 8 (e).
Along with allowing predatory heirs and staff to witness even as other family members are not required to be contact.
This is a very dangerous public policy that by their own records in OR and WA is establishing poisoning as the “medical standard of care” for people that have “feelings” of fear of the loss of autonomy.
We are all at risk of abuse by these poorly composed laws/bills.
MTaas dot org
everyone always has strong views on this issues.
Good article Bonnie. Many of the points in it are acute and telling, especially the following:
– accepting the risk of suicide and not trying to control people paradoxically results in less suicides at a group level.
– going to a mental hospital and encountering the dehumanization and discouragement of the medical model usually increases the risk of suicide at a group level.
– engagement with the societal forces underlying suicide attempts is much more important than “detection” and stopping incipient suicide attempts. This point cannot be emphasized enough.
After a childhood full of severe abuse, I was once suicidal and 10 years ago had a very clear plan involving jumping off a very high 300+ foot bridge in one of our major cities here in the US. I had written all my goodbye notes and was intent on carrying the deed out. It probably would have worked because such a high drop is almost always effective in killing. But I failed because my dear friend, my only close friend at the time, found my suicide note in my backpack only about 5 hours before I was going to drive to the bridge. As he told me later, he felt a 6th sense that something was very wrong and went searching in my bedroom for that “something”, an action he had never taken before. I probably wouldn’t be here if he hadn’t done this.
Anyway, ironically, my friend got me committed involuntarily – he called the psych hospital and they surprised me and took me away in the police car, with my being confronted and shamed with the suicide note – which infuriated me and at first resolved me even more to kill myself after leaving the hospital. But this friend came and visited me and we talked every day and eventually I felt a bit of hope. I decided I would fight and not give up. This was during 2 weeks of being at the hospital where the drugs, group therapy, and psychiatrists were absolutely useless and did nothing to help me process what was going on. But my friend visited me every day and wouldn’t give up, and after that things got better.
So ironically, even though I hate psych hospitals, I must admit their generalized limits can occasionally save lives, as they may have done mine… because without this one, I don’t think my friend could have stopped me from carrying out my plan at the time. Or, maybe he could have… I don’t know.
In any case, the medical model approach of the hospital is a serious problem in making suicidal people even more hopeless. Luckily I knew by that time that biological brain diseases were fictions so didn’t internalize the psychiatrists’ lies, only enough pills to get me released upon which I promptly discontinued the drugs against doctors’ orders.
The directors and leading psychiatrists at most psych hospitals are so profoundly afraid of legal liability that everything at the hospital becomes focused around controlling and labelling people, and real issues contributing to suicidal thinking can rarely be openly discussed.
My situation was similar to yours. By the time I was admitted to the “state hospital”l after being held at a private hospital for 17 days, I was absolutely sure that I was going to kill myself when I got out. I did have a good friend who visited me every work but the people who helped me decide that I didn’t want to die were my fellow “patients” on the unit I was held on. They were the ones, along with my one friend, who gave me the hope that I could pick up the pieces of my life and go on. Strange where help comes from sometimes. It surely didn’t come from the clinical staff of the unit I was on. Now I work with some of those very same staff and it’s an interesting experience.
The medical model surely is a problem. As for forced detention, it occurs to me that it is not the detention, but your friend reaching out to you that gave you what you needed, That said, while none of us know how things could have happened differently, for all we have in front of us is what did play out, in a more caring society, possibly there might have been “n” number of people who would have noticed that things were not going well for you and would have spent time with you and and helped you get back your hope. A question, I suspect worth asking. Be that as it may, I am delighted that things worked out for you–also that you are alive today. And thank you for sharing as you have.
What I learned the hard way:
1. Never talk about suicidal thoughts.
2. Never talk about suicidal plans.
3. For heaven’s sake, don’t screw it up.
Understood. I think that is something that a huge number of people have learned and learned the hard way. And it surely speaks to a massive deficit in society that this is currently the safest option for most people.
You do good work, Bonnie. My post does not address you, but others who come to this site:
Medicalization of mental states and suicide absolutely leads to diagnosis (which in the future will be regarded as one step above witch doctor stuff), detention and forced treatment. Doctors and lawyers are enabling this system every hour of every day by 1) not voicing disgust and disbelief of psychiatry, 2) not advocating for people caught in the system and 3) taking money for useless “help” and harmful prescribing. They have to live with their place in the medical establishment–I’m sure the falsity of their positions eats away at them. It is the sacred responsibility of every professional in the system to speak out and act out–anyone who doesn’t is part of the evil.
Yes, every professional who does not speak out surely is responsible.
My thanks to you and Susan for opening up the thoughtful discussion of this complex issue. Too often denied is the state’s denial of the inevitable pain of living/dying and the proffering of too simple, inadequate assistance that often does more harm than good. I strongly agree that a significant detriment to the work of professionals – medical and alternatives – is the risk aversion encouraged by government and supported by the “ethical standards” of the professional guilds. I too have practiced the therapeutic principles that you listed and also have been lucky or whatever might be attributed to it, of not having been involved in a successful suicide. I just want to mention that many years ago, my dear friend and mentor, Rae Unzicker used to lend me books from her library of “fugitive” literature, and at the time, the most memorable was Shrink Resistant, authored by you and Don Weitz.
I am very glad for the work you have done and continue to do.
Much thanks for writing this, Ron. Good to know that you also are out there
Reading this took me back 15 years. I made a very serious and almost successful attempt to end my life and I have spent a lot of time in meditation reflecting on what happened that would lead me to this place.
First of all, I am a believer in free will with respect to our own agency, and my choice to end my life was a conscious one which I felt was reasonable at the time (before I knew what I know now, I’ve learned so many vital things about life and energy since then). Looking back, I’d still say this. Based on the message I was being given coupled with the fact that my psych drugs-withdrawing mind was temporarily disabled at the time and focused only on that which made me feel seriously fearful and broken, and without the spiritual awareness I have today, I can still perfectly empathize with the old me. Given all the factors and lack of awareness at the time, still makes perfect sense to me that I would have done this. The difference now is that I have so much deeper understanding of who we are as humans, as energy, as spiritual beings, and I know get where all these thoughts came from, and I have addressed, shifted, and healed all of that.
Mainly, I was very ill from having withdrawn from tons of psych drugs, eager to get on with my life, and I found myself surrounded by extreme narcissism in the form of “mental health clinicians.” I didn’t identify them that way then, I was too wrapped up in my own pain, fear, panic, and despondence to analyze or assess anything outside of myself. I only knew how it felt, and the word for that is ‘brutal.’ ‘Cruel’ would be another fitting word.
I had gone to great lengths to heal, and it was being perpetually undermined, simply from the dangerously stigmatizing beliefs regarding who I was supposed to be, with no inkling of who I really was (and still am) on their radar.
I was perpetually provoked-then-demeaned, it happened repeatedly. I knew the difference from what it felt like to be a respected citizen, because I had been all (at that time) 40 years of my life. But once I turned to the mental health system, I was no longer considered worthy of respect, and I could feel that down to my bones 24/7. It literally drove me crazy, endless loops of chaotic thinking, trying futilely to figure out how to make this mental messiness stop. My heart was nothing but an empty hole, there was no love nor light there of which to speak.
I would not wish that feeling of being treated like a marginalized second-class citizen on anyone. For me, that is when things appeared hopeless, because I did not have the strength or clarity to fight it at that time, I just knew it crushed me and I felt doomed. I was in my 40s, had a first career under my belt, and a masters in psychology, including internship hours. How could life had gotten so sour so quickly?
Well, in reality, it wasn’t that quick, it was a slow decline. But for some reason, we all enabled this decline. That is what I’m continuing to look at–where the neglect (including self-neglect) begins.
We are supposed to be in control of our lives, that is the freedom for which we all strive. At what point do we hand over our power to others? I think that is where we lose not only our sense of control and power over our own lives, but we also lose our sense of safety and hope. It is hard to imagine living a quality life with no sense of control over it. Choosing to end one’s physical life is one way of regaining control over our agency, and it speaks volumes to those around us.
I believe rendering people powerless physically, emotionally, and politically is what is doing most harm, and causing rage, hopelessness, chaos and a host of social ills. That’s the damning effect of blatant stigma, it is a tool used to make people believe they are less than, and non-deserving. That is purely psychological sabotage, in my book, and it is rampant in the field; and it works if people believe it about themselves, or who believe they are trapped, and waiting for something on the outside to change before changing anything on the inside.
Considering that this comes from the ‘mental health world,’ I’d call it criminal social abuse, and, indeed, it is logical that it would lead to suicide. This is the cause of horrendous chronic pain which is constantly dismissed, disregarded, belittled, and negated. There is no soothing it.
It makes me angry to think about this. As a member of the human race, I find it absolutely unacceptable, it is cruelty beyond measure, all to preserve ego and profit.
So how on earth to get the system to show a bit of humility and self-responsibility is beyond me. All I experience from that world is duplicity, then conflict, then avoidance. Seems the truth is the enemy. A conundrum, indeed.
I’d say it’s time for the world to allow itself to be uplifted. When life is joyous, we desire it–
I keep having thoughts of suicide right now and feel I have nowhere to turn. I don’t want to be hospitalized and drugged again. So there’s no way I’ll be reaching out for help!
Killing myself seems like the logical and right thing to do on so many levels.
1. It’s logical because I have no hope for the future. I am suffering from nerve damage for effexor withdrawal and can’t tell anyone. Very sick most of the time and I haven’t even gotten off the blasted stuff yet. Still tapering. Things will never improve. I’m sick of the way people treat me and the never-ending poverty. Who wouldn’t prefer death to the kind of life I lead?
2. It’s right because I’m a burden on society and am no use to anyone.
My only regret, if I can screw up the courage to go through with it, is that I didn’t go through with it 22 years ago when I was first diagnosed. Suicide is the rational and sane response to a diagnosis of mental illness. I know that mental illnesses as such do not exist but in the minds of most people they do. Everybody hates people with such diagnoses. This makes life unbearable for most of us. Along with the imprisonment and torture. I feel no guilt for my diagnosis, but shame. Guilt is for what you have done. Shame is for what you are–and in my case I’m flawed and rotten to the core. Statistics show most people would rather live near a convicted felon than someone like me with a diagnosis of bipolar.
Knowing the things I know and with no real hope for this life, how can anyone say this desire for death is just my illness talking? I’ve never been so sane in all my life.
Thanotos is the rational choice in my situation.
I’m sorry you are in so much pain, RachelE. 🙁 I relate to your wanting to escape from all the discrimination and poverty, and the pain of withdrawal. But I don’t think that you are flawed and rotten. I have the impression that you are a good person, with a lot to offer the world, and I hope that there is some way for you to stay. It is the system that is flawed and rotten, not you.
You sound like someone in the throes of withdrawal from a psych med! From what I’ve read on support sites, and from my own personal experiences (with Effexor, too, among many others), feeling like you want to die is part of getting off the ‘medications’….I used to (still do–my brain has been straight up hijacked!!) ruminate on all my past crimes and my many faults and imperfections.
But I have hung on so far…living in poverty, just like many of us who ended up in the system. Finding joy in the small things.
Just getting thru the day is an accomplishment at times; realizing the ripples of pain I would cause if I offed myself keeps me on the planet *so far*.
The best thing I have learned from the BenzoBuddies site (despite it’s many imperfections) is the ploy of distracting yourself, in whatever way is at all appealing to you. I lose myself in stupid movies…a lot of iatrogenic victims use adult coloring books…I also find I feel better if I can be outdoors.
Please know you aren’t alone. There are thousands and thousands of us. Get thru the next minute, the next hour, the next day and you will feel differently with the passage of time. Everything changes; even our thoughts and feelings.
Just want you people to know that I went to the hospital, but am out now and am going to try a different kind of tapering for effexor this time–called micro-tapering. A good friend (by supernatural means) stopped me from killing myself. She called up just in time with a premonition that I was going to take the easy way out. As Christians, we believe the Holy Spirit told her to.
Thanks for your support. I will be much more careful this next time! 🙂 On a full dosage of effexor, but coming off abilify again. Amazing how easy the anti-psychotic and mood stabilizer were to withdraw from compared to the anti-depressant!
So glad you are still out there, RachelE! 🙂 Good luck with the micro-taper.
Too abashed and scared to try “tonguing” or “cheeking” some of the meds. Just as well I didn’t. For me, they were a temporary solution. Temporary–but a solution nevertheless. A hair of the dog that bit me. The dog is named Psychiatry.