Monday, December 15, 2008

A Response to Suicide.org on the Right to Suicide

Kevin Caruso, in a piece titled "Don't I Have the Right to Die by Suicide?" attempts to scare people into calling a suicide hotline on the grounds that there is, in fact, no moral right to commit suicide. (Note that Caruso is the one who says we should use the unnatural phrase "die by suicide" instead of the more natural construction "commit suicide" because the latter is hurtful to the friends and family of people who commit suicide.)

Many of Caruso's questions are answered more formally in my essay, "The Harms of Suicide." But I think it is worthwhile to have a single document answering a representative set of (implied) pro-forced-life arguments.

Caruso poses questions (typeset in bold), to which I propose answers (typeset in regular typeface):

Do you have the right to devastate your family?

We often "devastate" our families by exercising our rights. Some "devastate" their families by coming out of the closet, or by refusing to be doctors, or by moving across the country, or by refusing to have children. Where concerns of personal autonomy and suffering outweigh the interests of others in maintaining our company, then we do indeed have the right to "devastate" others.

Do you have the right to cause intense, almost unbearable pain for all of the loved ones that you leave behind?

Everyone dies. Nothing we can do will prevent our own death, nor the suffering our death will cause to those close to us. Suicide merely causes this pain to be experienced earlier.

In fact, the policy of suicide prohibition and prevention - not the act of suicide itself - must be seen as a major cause of the special pain and grief suffered by suicide survivors. (Also, not everyone is lucky enough to have "loved ones." Are lonely people free to commit suicide, according to Caruso?)

Do you have the right to take away any possibility that you would get better?

Who has the right to decide whether a given treatment is in one's best interests, or not? With physical illnesses like cancer, the decision rests with the patient as to whether a given treatment is worth the suffering it entails. We have the right to refuse treatment. With good reason - many treatments for suicidality, while possibly effective, are so damaging as to simply not be worth the cost. And, as with cancer, for some people, nothing works.

Do you have the right to take away all of the wonderful things in life that you have yet to experience?

Who but me has a right to decide whether the suffering the rest of my life will entail exceeds the value of the "wonderful things in life" I have yet to experience?

Do you have the right to take an action that is a permanent solution to a temporary problem?

One of the most common mushy-headed objections to suicide is that it is a "permanent solution to a temporary problem." In reality, for many of us, suffering is an all-too-permanent problem.

Do you have the right to cause irreversible brain damage to yourself if your suicide is not completed?

Damage to oneself as a result of an unsuccessful suicide attempt is entirely an artifact of the suicide prohibition. Given a genuine right to comfortable, reliable suicide, this would simply not occur.

Do you have the right to cause yourself to become disfigured if your suicide is not completed?

See above. And, yes, one has the right to cause oneself to become "disfigured" by body modification. But an unchosen disfigurement caused by a suicide attempt is a sad consequence of the immoral suicide prohibition.

Do you have the right to cause yourself permanent paralysis if your suicide is not completed?

See above. Paralysis and akinetic mutism caused by suicide attempts are tragic consequences of the suicide prohibition, not of suicide.

Do you have the right to end your life instead of focusing on ending your pain? (It is the pain that you want to end, not your life.)

The pain may well be permanent. Caruso naively assumes that a given suicide has not done anything to try to alleviate his pain. But, yes, one has the right to decide when one has done enough to try to alleviate one's pain, and when the pain appears permanent enough that a permanent solution is indicated. One's life is one's own.

Do you have the right to not receive treatment for the mental illness that you probably have -- the treatment that will make you better?

Generally, we do have the right to refuse treatment - even potentially life-saving treatment - in the interest of bodily autonomy.

Again, "treatment" for mental illness is not a sure-fire way of relieving the suffering that leads to suicidality. Caruso assures us that treatment "will make you better," but that is hardly the case for all suffering people. It is unfair and cruel to cheerfully assume that anyone can get better if he just tries the next experimental treatment.

I have written extensively on the mistaken idea that suicide is caused by mental illness. Even Thomas Joiner proposes that suicide is not caused by mental illness on its own, but rather by the alignment of the ability to commit suicide with the desire to commit suicide.

And mental illness causes severe suffering. Don't the mentally ill, as much as the physically ill, have a right to end their pain?

30 comments:

  1. "Do you have the right to not receive treatment for the mental illness that you probably have -- the treatment that will make you better?"

    About 5 years ago, I was homeless and sleeping in my truck. At the stroke of midnight, I got hit by some drunk kids in a stolen car. I chased them down, got their license, and sicked the cops on them.

    Needless to say, I was a bit distraught. I drove over to my ex's house (formerly my house) some hours later to drive my kids to school. They let me sneak in and clean up a bit after the ex left for work, but she showed back up and started lecturing me. I threw a bit of a fit (non-violent), but she called the cops, and they hauled me away to the mental ward for observation.

    While there, everybody kept waving Welbutrin in my face, and when I refused to take it, every damned one of them asked, "But, don't you want to get well?" I finally took them, because they threated to keep me there until I did. All that happened was that I didn't sleep for two nights, but the docs in charge said they could tell I'd 'improved', and I walked out of there 5 days later, barefoot.

    What is 'well'? Life is a mixture of mindstates and environments, and each of us are uniquely representative of those things. Am I sane because I can smile while living in shit? Am I nuts because I'm clear about where all of it's eventually heading, instead of placating myself with delusions, rose colored glasses, and a glass half full, can do attitude?

    Pardon me, Mr. Caruso, but I'd invite you to go fuck yourself. Your questions are mostly formulated to guilt people into not taking an early train out of here. According to your own tone, life isn't about happiness. It's about duty, and fear. You seek to turn our own empathy against us, so that we can maintain the illusion that all's swell if we'll just grin and bear it out, gosh darn it! You seem to believe that the natural default position of the human species is happiness, and those of us who even question that conclusion are 'ill'. What's your scientific validation for this? Where's your research?

    Perhaps more importantly, who gives YOU the right?

    Sorry for the rant, Sister. Peace out.

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    1. If you die, who can carry on your legacy that suicide is the answer?
      I am checking websites here and there about suicide, this is the first, but probably not the last, pro-suicide site I have found. The last anti-suicide site pointed out how disgusting dead bodies are what a mess they are to clean up, and how some people even poop when they leave this world. I started an anti-suicide project and I am finding, as you said, that it is kind of trite to say the old: suicide is a permanent solution to a temporary problem. However, does it give you pause to see me say the 'dead bodies are gross' comment I just said? I think there is a prevalent idea in our consciousness that after that consciousness has passed (death) we will be able to witness or interact with who or what caused the problem in the first place. This is not so. Suicide is illegal, but there is no need to enforce that law because it usually receives the death penalty already. Also curious...why leave notes-you are not going to know who reads them. They will not be among anyon's treasured mementos.

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    2. What country do you live in? I'm just asking because suicide itself is not a crime in the United States and I'm not sure where you are

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  2. Jim, great to hear from you. Hope you are doing well.

    Interesting that your experience with involuntary hospitalization was the same as mine has been (take the pills that are offered, and, even though the manufacturer of said pills does not claim they have any effect for 4-6 weeks, say the right things and be released within a few days).

    Lobotomy served the needs of caretakers and relatives of the mentally ill back in the day. Modern treatment tends to serve those same needs.

    I've been on meds (from single meds to rather extreme polypharmacy) voluntarily for long periods of time and they've seemed to have a temporary effect until I stopped believing in them - so the doctor would switch to the next one or increase the dose or add a new med or I'd switch to the next doctor. A suspicious pattern resembling placebo response. I hear they work for lots of people, though. But then, so do acupuncture and crystals. And booze.

    Google "treatment resistant depression" to see the new scary experimental treatments. Many of which resemble the old scary experimental treatments.

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  3. I'd like to double-dog-dare Mr. Happy to mention suicide to a medical professional. I got bunged in a ward just for mentioning it to a bartender. When you can't curse life to your friendly neighborhood brain-insulator, I don't know what this world is coming to...

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  4. That's horrible!

    Yes, the culture of take-every-mention-of-suicide-deadly-seriously-and-lock-them-up is a major cause of suffering.

    It makes talking honestly about suicide dangerous. It affects the flow of information in a way similar to a practice of shooting the messenger.

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  5. Too true. Every time I've tried to talk (soberly and voluntarily) to a psychiatrist about it, their warning reaction ('I'm going to have to do something serious if you really mean that') means I have to pretend I was joking... not that I'd trust them much to help. I don't see psychiatrists voluntarily anymore. I would tell them about my insomnia and anxiety and phobias and they'd keep telling me I'm depressed and giving me Wellbutrin, because if you're foolish enough to say 'yes' if they ask whether drinking makes you feel better, then they won't give you anxiety meds because clearly you are an alcoholic and will surely wind up dissolving them in motor oil and shooting them into your eyeball... sorry if I sound unhinged but it's been another sleepless night... why do these knee-jerk-judgmental, unsympathetic people go into psychiatry? Is the old cliche about them being addled themselves and wanting to learn how to fix it true? If so it seems to me that the problem most of them suffer is being sociopathic... but on the other hand, as you imply, they're perhaps in fact reacting like social animals to a social taboo against suicide (or mental illness, or using non-clinical substances to manage pain, or what have you). You just happen to be an individual who has violated it, making cruelty to you not wanton or pathological on their part but justifiable as a defense of group beliefs -- so maybe this cruelty is not, by their definition, sociopathic at all...

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  6. It is that - the breaking of a taboo - but if that were all it were, I think there would be some psychiatrists out there who wouldn't be vulnerable to it. In my experience - personal and professional - it's suspiciously universal. I think it has a great deal to do with the (completely unfair and counterproductive) legal restrictions placed on psychiatric doctors. They must harden their hearts because of what might happen to their malpractice insurance - and license to practice - if they acted with common sense and compassion.

    I had a similar problem with a marriage counselor who (based on her layperson's reading of Tarasoff) insisted she had to report to my husband at the time - a 6'3" Marine, no less - that my diminutive 5'6" self sometimes wished he would die. Great job, doctor.

    Psychiatrists like Thomas Joiner talk about the Standard of Care as if it were this thing that were set in stone that psychiatrists bear no responsibility for changing if it is wrong. They think of "ethics" as a legal issue, not at all as an unsolved domain of human inquiry.

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    1. Is it wrong to wish death to the person causing you pain? It is a natural reaction to an emotional pain deliberately reaped upon the recipient. Married 37 years to a person who cares not how you feel and deliberately says hurtful, painful untruths -- periodically wishing death on that person is not a crime. Thoughts are not criminal and we should be free to have those thoughts. Acting on those thoughts is the crime.

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  7. I've been to two shrinks in my life. In both cases, my reasoning was simply that I needed to talk and I felt certain that what needed saying would be a burden to those whom I cared about. By DSM standards I was depressed, but this never seemed terribly significant.

    Initially, I was very clear about all of this. But I remember how during the first session things quickly collapsed into combat when I expressed my considered view - in response to a direct question - that life was essentially without meaning. I wasn't proffering some weary existentialist signal; I was making a roughly Darwinian point about stochatic phenomena and naturalism - a point that doesn't much trouble me, in fact. But I was roundly scolded. I was told this was a symptom of my depression. And a licensed professional proceeded to hang everything on what I considered to be a point of irrelevance. She badgered me with warmed over newage and Disiderata platitudes. After that, I wasn't about to mention suicide. Or much else that might have mattered. I was well trained. (Though I did make the mistake of mentioning booze, which has never let me down. I stuck to my guns on that one.)

    Fool me once. The second time, I was clear up front that I was interested in medication. I held out for a scipt and never looked back. I think the pills helped on that occasion, but it's an open question, I know.

    I fear this is all too common. One of the key insights that Szasz brings forward in his critique of psychotherapy is that this professionally guarded process consists of little more than talking and listening. Therapists would do well to drop their scientistic pretense and adopt a little humility. Sometimes, a person simply needs to talk, freely and without the burden that attaches to intimate relationships. With this much understood, it could be a valuable service. It's not science. It's not even a craft. It's talking, and listening.

    But within an institutional framework, the elemental point is lost. Taboos are reified by dint of professional codes and caselaw. Analysands take their cue, as a matter of course. Because the consequences are clear enough, and there are laws. Or rumors of laws.

    Honestly, you're better off confiding in a fucking priest. Or keeping a lid on it. Or drinking .

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  8. In many ways, a philosopher is what you want in that kind of situation - not a psychologist. A psychologist makes a poor adviser for the reasons above and others.

    My boyfriend claims that there is a trend for philosophy PhDs to hang out their shingles as sort of "philosophical therapists" - not sure if this is related to the logotherapy school of therapy. But - wouldn't that be nice?

    A philosophical adviser without an agenda is what is really wanted by your average high-functioning "depressive," I'd bet. Even a Philip K. Dick-style coin-operated robot therapists would be an improvement over the current situation, though Dick's android therapists all seem to be of the psychoanalysis school.

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  9. I would be interested to see you elaborate on this a little. What precisely is it that you think a philosopher has to offer for help in such cases?

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  10. Anonymous, will do (elaborate) - possibly in an article. Thanks for the question.

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  11. I wrote a short piece about "philosophical counseling" here.

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  12. No one has written here for almost 4 years. I definitely appreciate how this site shows this side of one is not crazy but actually quite clear and calm when owning one's life and how to survive what has been beyond control for years no matter what was done and to whom reached out by means of suicide. It is selfish to judge those who do suicide as wrong, the person committing suicide is not the selfish one. Are there no more comments? Thanks to those who have written and shared.

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  13. Thank you for this blog post! I am not suicidal, but was in the distant past. While reading some sociology links about death rates online I was struck by how high suicide rate is. Somehow I came across Caruso's website and was absolutely appalled. It is people like him who force suicidal people into the closet. Oddly, Caruso's gung-ho, prevent death at any cost mentality causes people to clam up, because if you tell someone who agrees with Caruso you can't have a genuine, honest discussion. The zealots think suicide is the worst and they'll (1) do whatever they must to prevent it, without respect to the sufferers very real dilemma, and (2) you'll then have a medical record of your discussion, which will say "suicidal ideations," which means you'll never be able to get life insurance (I used to work for a high-risk life insurance company, a last resort place where people who couldn't get life insurance thru another company would apply. If our underwriters declined your application, then that was it, you aren't getting life insurance at all. If the phrase "suicidal ideations" appears anywhere in your medical record, then it's an automatic decline. There is no option for you not to include your medical records/ Insurance aside, you'll also be branded by friends and family as untrustworthy and unstable from that point on. If the world were all in agreement with Caruso, the best thing for a person considering suicide could do is either keep your mouth shut about it and do it, or forget about it, and don't do it. Telling someone has too many negative consequences under Caruso's plan of prevention.

    Oh, his site angered me so! He thinks he's performing a service, and I hope he does help some people, but I suspect that genuinely suicidal people with half a brain run as far away from Caruso as they can. The people he "saves" are people who wanted that kind of attention and probably weren't serious about going through with the act. Someone needs to give that man an enema.

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    1. The most convincing argument I've heard against suicide even in the face of great suffering is that there's no guarantee that what's on the other side of death is any better than our current situation

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    2. On the other side of death is simple non-consciousness. You are your brain functions. When they cease, you cease. It's as simple as that.

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  14. "Do you have the right to take away all of the wonderful things in life that you have yet to experience?"

    I wonder if Caruso is willing to pay the financial cost of those things for complete strangers, without coercing them to work.

    Ok, I'm not really wondering. The answer, of course, is no.

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  15. it just doesn't work. i have asked for help from so many sources with the only response being having my questions turned around on me to evaluate my feelings. after reading this article and the responses, it is clear to me that we are all doomed.

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  16. A person with a a healthy brain does not want to commit suicide. Our brains are not wired that way. Our very instinct is to fight to stay alive. Suicidal thoughts are a symptom of a disease called Mental illness.

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    1. hannibal lector: "kill them all and save yourself". I think he was referring to negative thoughts.

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  17. I would like to thank the person who wrote this of whom has encouraged and enlightened me to the decision I am going to take. Thank you. God bless you all.

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  18. Everyone is entitled to their own lives and choices. I am still angry with my brother for killing himself, though. No, I do not believe he had a right to do that. I vehemently disagree.

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  19. This is the stupidest thing I've read about suicide. Plainly put if someone wishes to end their life and the pain that comes with it that's their decision. Attempting to shame, guilt trip, or other means is completely uncalled for. When you're looking at life from the other person's perspective their life is so tragically skewed from years of mental, physical, and sexual abuse there is no other way out of the hell you alude to. This world and the people in it, good and best intentions all, have already taken it to hell and we're already burning. We treat others with such disdain, cruel intention, and hatred then tell that person to "man the fuck up and get over it" WITHOUT being given the chance to speak their mind or act out aggression in healthy forms. Thusly, the feelings of inadequacy are suppressed more and more and more and more till there's nothing other way out but death.

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  21. Does your organization support tracing of some phone calls?

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