Wednesday, November 5, 2008

Assisted Suicide

I am intending this discussion to be focused specifically on the theme of suicidal thoughts which occur in chronic depression. While I think some of these ideas generalize to other areas of human suffering, I cannot claim to have a great deal of experience working with people outside the area of primary psychiatric illness, and so I don't want to sound preachy about an area outside my knowledge and experience.

When struggling with the question of whether to live, or whether to die, often there is longstanding ambivalence. The struggle with this question may have been going on for years. Reasons to live may lie in small or large connections with other people, other meaningful activities, other small pleasures, other small moments of relief, other hopes that things might get better in the future. Reasons to die may involve observations that things aren't getting better, that positive connections are disappearing or absent, that treatments aren't working, that hopes are fading or gone. Sometimes the ambivalence progresses to the point that one more bad, disappointing, enraging, or painful life event can "tip the balance".

While struggling with this kind of longstanding ambivalence, it can be an annoyance to hear many of the standard encouragements to live, such as:

1) "depression is a treatable illness!"
[well, yes it is, but often times the treatments don't work so well--and if they aren't, it can leave the person suffering from a refractory depression feeling even more alienated, hopeless, and irritated by someone sharing the cheerful news about treatability]

2) "it's wrong to kill yourself"
[while moral qualms can deter many people from killing themselves, moralisms can also sound irritating, preachy, and the product of a perspective which doesn't really understand the nature or intensity of depressive suffering]

3) "it will hurt or devastate your family or friends"
[this may be a deterrent for many, but often times with advancing chronic suicidal ambivalence, this thought may change to something like "my family will accept my decision in time", or "they're better off without me", etc. ]

...there are probably many other examples...

I understand that life can be intolerable. Maybe your life has been intolerable for a long time.

I encourage all of those who suffer to know that there is relief available in life. Always. There is connection available in life. Always! --either improvements of existing or past connections, or development and growth of new or future connections. Loneliness need not ever be permanent.

Some problems cannot be solved or fixed, but regardless of this, it is always possible for things to be better--in some way--than they are. It is always possible for pain to be relieved. It is always possible for a new connection to be made, or for meaning to be found and nurtured. No matter how bad things are, or have been, and no matter how long things have been bad (weeks, years, decades...), a new path can be forged today. If mistakes have ever been made, things can be mended, starting today.

I realize that the above advice may also be, for some, an annoyance to hear, perhaps the same old trite, easy-for-me-to-say attempt to console, or to instill hope. I deliberately say this, though, not as a person wanting to enter into an ethical debate about "right-to-die" issues, etc. but just so that a person researching suicide may encounter a consoling point of view. I do see that many with chronic illness can recover, or have a good quality of life, despite what can seem like a grim or intolerable prognosis.

Some people may be researching "assisted suicide" in their state of suffering and ambivalence. In today's world, such research may yield all kinds of advice about how to kill oneself. There was a front-page article in the newspaper the other day about this. I note that there was no article on the other side of that front page which was devoted to reasons NOT to consider assisted suicide. Therefore, despite the accuracy of the article, the newspaper did not give a truly balanced presentation of the subject. Therefore, if an ambivalent person were to read such an article, it could be an event leading to "tipping the balance."

While I support freedom of speech, I also recognize that research, especially on the internet, can cause an ambivalent person to become immersed in a highly biased information environment. What may be seen as research can become persuasion. A huge persuasive element in the world is social pressure (for a person researching assisted suicide, it may influence a person to choose suicide if they find an online community of others who are also choosing suicide). The presence of a positively-toned newspaper article on assisted suicide may encourage suicidal actions in people who are acutely struggling, but who may not be receiving good treatment yet for their underlying problem.

I encourage people to be wary of biased external persuasive factors. These may be altering your judgment, sometimes without you even knowing it. A guiding principle of many who espouse the idea of "assisted suicide" has to do with freedom, with human rights. However, biased persuasive factors are obstacles to free choice. The solution is for information to be fair, balanced, and thorough, with adequate presentation of multiple points of view. Most research on the internet does not offer such rigor. Most newspapers--unfortunately-- do not have a balance of articles having different points of view.

If you have searched for information on "assisted suicide" on the internet, and landed on this blog entry, I hope to remind you that connection and relief are possible, even if they seem unavailable to you. You deserve respect and support, given the very heavy burden you have been carrying, and I remind you that others are available to share the burden and to help you. It may be a difficult journey, though, to find the support and help that is best suited for you. I wish you the continued strength and courage to carry on.

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