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"For some, suicidal intent is a terminal illness"
August 5, 2013 7:54 AM   Subscribe

Suicide prevention has become a key focus of public and private mental health initiatives in recent years. And as we previously have seen, in many cases suicide is not an inevitable outcome for people experiencing suicidal ideation or even those who have made a suicidal attempt. Still, the question remains: is every suicide preventable?

Does the adoption of a "zero suicides" goal have the potential to continue the tendency to place blame on family members, care providers, and the victims themselves when prevention efforts fail? To make progress toward this goal, what sorts of systematic supports need to be strengthened or created for sufferers and their families and friends, beyond toll-free hotlines and PSAs, and even improved access to quality mental health care (PDF)?
posted by drlith (65 comments total) 28 users marked this as a favorite

 
To make progress toward this goal, what sorts of systematic supports need to be strengthened or created for sufferers and their families and friends, beyond toll-free hotlines and PSAs, and even improved access to quality mental health care (PDF)?

We live in a culture of fear that still, en masse, punishes vulnerability and restricts empathy between strangers. The only thing that will stop all suicide is when people can feel like they can ask for help without feeling weak or bad about themselves.

This will not happen in modern American societies for generations if at all.
posted by Talez at 8:12 AM on August 5, 2013 [19 favorites]


As a suicidal ideation sufferer myself, let me recommend the book Night Falls Fast to anyone who is even remotely interested in the subject.
posted by Weltschmerz at 8:39 AM on August 5, 2013 [9 favorites]


I think it's a misnomer to consider suicide a bad thing in every case. There is a small number number (that is still greater than 0) of people who should be able to decide how and when they want to go. So generalizing it under the "terminal illness" umbrella is probably poor syntax.

I'm still parsing through all TFAs. But generalizing this sort of thing like this isn't correct, and yet we're not to a point where enough is understood to categorize these things appropriately. Not sure we'll ever be... which just means that how we treat both the people who suffer from the ideation and those who succumb to the act of it quite differently than anything we've done in the past.
posted by Blue_Villain at 8:41 AM on August 5, 2013 [9 favorites]


...and even improved access to quality mental health care.

Someone forgot to tell my health insurer, Anthem, about this particular goal, seeing as how they've changed coverage for mental health services from a co-pay, to an out-of-pocket cost, greatly reducing the affordability (and, thus, availability) of regular mental health care, quality or not.
posted by Thorzdad at 8:44 AM on August 5, 2013 [4 favorites]


I think perhaps a better question is whether suicidal ideation is related to population pressure, and will it get any better until we are packed onto the globe a little less tightly.
posted by ackptui at 8:48 AM on August 5, 2013


I think that it probably isn't useful to use the same word for "suicides-that-ought-ideally-be-prevented" and "suicides-that-are-an-acceptable-response-to-appalling-circumstances." Using the same word is like calling abortions or executions "murders"--it's just muddying useful distinctions. We need a word for self-directed euthanasia (good, however sad its necessity) that is quite distinct from suicide (which we could reserve solely for those acts resulting from an irrational or ill-considered impulse).
posted by yoink at 8:50 AM on August 5, 2013 [12 favorites]


I think perhaps a better question is whether suicidal ideation is related to population pressure, and will it get any better until we are packed onto the globe a little less tightly.

Is there any evidence, at all, that suicide varies with local population density? Are suicide rates markedly higher in, say, India, than they are in, say, New Zealand? I suspect not.
posted by yoink at 8:51 AM on August 5, 2013 [3 favorites]


I think that there's another side to this... and I recently wrote this blog post on the subject...


I think that the State of Indiana should open up a new facility for those who wish to end their lives in a dignified manner. Someone wishing to die, would travel to this facility, get interviewed by doctors, psychiatrists, and a sitting judge rotated for a short term from their regular bench assignments. Those would serve to filter out people who really don't belong there for other reasons.

Once you passed admission criteria, you'd have a waiting period of at least 3 days, maybe a week or a month... whatever isn't entirely cruel... to stay in a hospice type atmosphere. During this time, you're free to leave for any reason, with no repercussions.

After your waiting period, you'd then be eligible for euthanasia, and burial in accordance with your wishes.
posted by MikeWarot at 8:57 AM on August 5, 2013 [3 favorites]


Interestingly, I think, the first 10 +/- Google hits on "population density suicide rates" all suggest the rate of suicide is inversely related to population density. Just reporting not asserting as I did not read the articles.
posted by rmhsinc at 8:59 AM on August 5, 2013 [1 favorite]


There were euthanasia facilities in Robert Chambers's The King in Yellow. We really haven't made much progress in how we deal with voluntary personal extinction since those days.
posted by Mister_A at 8:59 AM on August 5, 2013


At least in the U.S., suicide rates are higher in rural areas than in urban areas, for reasons that are suspected to largely relate to the easier access to the most lethal suicide method: firearms. And the highest rate of suicide on a national level (like, 3x the closest competitor, and 10x the average rate in the industrialized west) is found in Greenland.
posted by drlith at 9:02 AM on August 5, 2013 [3 favorites]


I am no expert, but 8/10 suicidal people I have known were rational. They were trapped in horrible situations that were very hard to avoid. It's an economic and political problem more than a chemical imbalance.

Comfortable people trying to talk them out of it (for a large fee) sound very much like "the poor have no bread? let them eat cake."
posted by EnterTheStory at 9:04 AM on August 5, 2013 [16 favorites]


seems like a good time to bring up this study.
posted by zenwerewolf at 9:09 AM on August 5, 2013 [5 favorites]


I am no expert, but 8/10 suicidal people I have known were rational.

I'm pretty confident that this is an area where anecdata are essentially meaningless.
posted by yoink at 9:10 AM on August 5, 2013 [2 favorites]


A friend has a family member with very severe bipolar disorder. After two suicide attempts, she is now taking so much medication that she moves around at 1/2 speed, stares out the window most of the day, can't tie her shoes, and goes days without speaking more than the most rudimentary sentences. Her doctors are afraid to reduce the medication lest she try to kill herself again.

I'm just saying that "no suicides" isn't always as utopian as it sounds. At least until much better treatments for mental disorders are discovered.
posted by the jam at 9:13 AM on August 5, 2013 [10 favorites]


If you watch commercial for pharmaceuticals, it's amazing how many of them list suicidal thoughts as a possible side effect. And we love our pharmaceuticals. I've always wondered if there's a connection there.
posted by girlmightlive at 9:14 AM on August 5, 2013 [1 favorite]


If a woman has a right to control her body, don't I have a right to control my own death? I need not justify to anyone else why I might want to die; it's none of their business.
posted by Chocolate Pickle at 9:14 AM on August 5, 2013 [34 favorites]


I'm personally not opposed to some very limited forms of suicide, but the biggest concern I have is normalizing it too much. Making it easy and acceptable in a wide range of areas. I've known people who attempted suicide, who now are very vibrant, interesting, productive, fantastic individuals. Where we would have missed them and their contributions had they succeeded, or had suicide been much more acceptable. Because, to be sure, their feelings and thoughts where entirely understandable and they may well have been rational in that moment, however "that moment", does not encapsulates the totality of a persons future existence.

I fear that too much normalization of 'suicide is ok" would lead to slowdowns and halts for research into better ways of dealing with and treating all manners on mental illness. It already is a struggle to overcome stigmatization, what if there was a socially acceptable way of not caring, even more, through the outlet of "it's ok, let them kill themselves and get it over with".
posted by edgeways at 9:21 AM on August 5, 2013 [6 favorites]


We live in a culture of fear that still, en masse, punishes vulnerability and restricts empathy between strangers. The only thing that will stop all suicide is when people can feel like they can ask for help without feeling weak or bad about themselves.

I'm not saying I disagree with your statement (I agree), and I think mental health care in this country is shamefully, appalling bad. But cultural changes would still not eradicate suicide.

I've had suicidal ideation before, but I have never acted on it. For contrast, I have a friend who finally succeeded in killing herself when we were both 25, after 12 years of constant crippling depression, anxiety, self-harm and regular hospitalization.

Without getting into a whole lot of details about somebody else's life and trials, I'll just say that over the course of our acquaintance, I realized that she was a quiet, sweet-natured person who was just in constant pain, every day of her life, since she was a small child. Who had been let down by the promise of new/different treatments so many times that she had no rational reason to ever expect she would feel better (and indeed, expectations for improvement were actually dangerous). At the end of the day, she just wanted to quietly stop hurting. That it took her so long to try that last time was, by her own words, because of friends who loved and supported her.

We could make her feel loved and cared for, but we couldn't stop her pain.

I still wonder what could have helped her. I turn over the details of her life over and over in my head: what I knew about her childhood, her family and romantic relationships.

I can postulate and accuse (and there are some choice places to point accusation)...but if I'm honest with myself, I just *don't know*.

I don't even know how to end this comment, now. It's been four years, and I still don't know what the take-away from this story is, other than just..."We don't know".
posted by menialjoy at 9:22 AM on August 5, 2013 [28 favorites]


As an addendum, for anyone interested in the discussion of how "rational" suicide is/isn't, I recommend the chapter on suicide from Andrew Solomon's Noonday Demon

I also recommend the entire rest of that book, cause...damn.
posted by menialjoy at 9:26 AM on August 5, 2013 [3 favorites]


Nor am I an expert on suicide but I was the Exec.Dir. of a comprehensive emergency psychiatric services agency ( 110 staff and 6,000 to 8,000 patients per year) for 20+ years and suicide is probably any and all the things that have been and will be mentioned--the risk factors are availability of lethal means, drugs/alcohol, depression, other mental illnesses, age, past history of attempts, family history, etc. I will go out on a limb and with reasonable comfort assert that all suicides can not be prevented. Some ( a few ) suicides are the result of rational thoughtful consideration, most suicides are relatively impulsive and some are accidental. The critical precipitating events tend to be overwhelming feelings/thoughts of hopelessness, unrelenting anxiety, availability of lethal means and the proximate use of alcohol/drugs.
posted by rmhsinc at 9:27 AM on August 5, 2013 [9 favorites]


If a woman has a right to control her body, don't I have a right to control my own death? I need not justify to anyone else why I might want to die; it's none of their business.

The majority of people who survive suicide attempts say they are glad to have survived. In many cases they begin the feel the regret the second their feet leave the bridge or the pills start to kick in. We attempt to reduce suicide, not to make the person attempting it suffer, but to let that same person five minutes later have the chance to be alive, which might have been taken from them against what is now their will.
posted by showbiz_liz at 9:28 AM on August 5, 2013 [9 favorites]


If a woman has a right to control her body, don't I have a right to control my own death? I need not justify to anyone else why I might want to die; it's none of their business.

The fact that you have a right to control your own death doesn't mean that it's "none of our business" when and how you choose to do it. You're confusing categories here. The fact that a woman "has a right to control her body" doesn't mean that we have no interest in offering her the option of birth control, in providing her counsel as to when is or is not a good time to get pregnant, in providing support to her during pregnancy and after childbirth etc. etc. etc. Similarly, the fact that you have a right to "control your own death" doesn't automagically mean that any decision you make in that area is a good one or that we don't have a moral obligation to do what we can to help you make as good a decision as possible.

The fact that there are times when death is the only good option open to you does not mean that every time someone successfully kills themselves was, in fact, such a time. And there is a very large body of evidence out there suggesting that the opposite is, in fact, the case. Most people who are prevented from suicide do not re-attempt and are grateful that they were prevented.
posted by yoink at 9:29 AM on August 5, 2013 [5 favorites]


need not justify to anyone else why I might want to die; it's none of their business.

If only that were true. The truth of the matter is, for every person who successfully commits suicide, he or she makes it plenty of people's business.

When a close friend of mine killed himself two years ago, it became all our business. His boss who found his body. Me, who got the phone call from the police because I was his ICE contact. His parents, who had to drive down for hours to clean out his apartment and get rid of everything he owned. All the family resentment that built up that I didn't even know about. And of course, the note he left that made us all just shake our heads.

There are many, many people that are forced to deal with the aftermath of someone's suicide, people who have no choice in the matter, and that is not at all comparable to a woman getting an abortion.
posted by girlmightlive at 9:34 AM on August 5, 2013 [10 favorites]


Nevermind that much of the always mentioned discomfiture is due to the entirely self-inflicted stigma we have against a planned death versus ... what, when the insurance company decides they cannot pay for your care any longer and they stop going through heroic extremely expensive measures to save you? People have heart attacks and someone still must find the body, another someone unavoidably gets a phone call, someone else still has to get rid of everything the deceased owned.

We are all going to die and it will almost invariably be inconvenient for somebody.

Mental note: distance self from friends and relatives, quit job, move out of town, close your Amazon account, pay off your credit cards, drop your stuff off at Goodwill, and then drown quietly in the ocean so as to not put anybody out.
posted by adipocere at 9:41 AM on August 5, 2013 [7 favorites]


I was driving when that NPR story aired and wound up crying in my car. It was kind of simultaneously off-putting and relieving that it seemed like they hadn't edited the story with an ear towards how it might sound to people who struggle with that topic daily.

They also had a report recently about physician-assisted suicide for terminally ill patients, and were talking to a wife about her husband's ongoing consideration of it. It was a long interview, with a lot of speculation on her part, but they never interviewed the husband (even though they could have), who clearly would have had the most interesting and applicable story to tell. That made me pretty angry because they either missed a great opportunity or the whole point, depending.
posted by Corinth at 9:43 AM on August 5, 2013 [2 favorites]


"Planned death" is a funny word for something that is almost always an impulsive and hasty decision which, again, would probably not have been carried out at all if the person had half an hour to think about it.

Suicide due to mental illness is so, so far removed from planned suicide for quality of life reasons that it's barely even comparable.
posted by showbiz_liz at 9:44 AM on August 5, 2013 [7 favorites]


The main thing keeping me time and again from attempting suicide is the thought that the few people whose opinions I truly value might think my suicide was irrational or ill-considered.
posted by Ice Cream Socialist at 9:46 AM on August 5, 2013 [3 favorites]


There is someone very dear to me who has experienced episodes in which he knows, for a fact, that if he'd had access to a gun he would have shot himself. Today he is treated, and he has a family, and he is generally happy, and the world would have been worse off without him. "Planned death" my ass, his death would have been a senseless tragedy by his own admission. That's like saying "let's not treat this cancer- his body wants to die, and who are we to deny its agency?"
posted by showbiz_liz at 9:46 AM on August 5, 2013 [1 favorite]


I'm still not sure my own suicide is preventable. I've struggled with suicidal ideation for a very long time now; even now while trying to work on fixing the various problems I have; while surrounded by friends and loved ones; nothing really seems to have changed.

I worry that my transition is never going to work out. I worry that my relationships will never work. I'm worrying that I'm just a terrible worthless piece of shit that shouldn't even exist and why am I here even wasting time writing this (that seems to go for all my interactions with people lately). And suicide is always there in the back of my mind, as the one easy way to stop worrying about all the goddamn things that *might* go wrong or how terrible I am for not being able to deal with any of it. That all of those goddamn intrusive thoughts that won't seem to fucking stop might be silenced for good.

I like to think I've been better lately. I don't really know. I've tinkered with lots of different antidepressants and medications; I quit my previous SSRI cold turkey a couple weeks ago because it was causing an absolutely intolerable side effect. I was crazy suicidal for like a week after that. Kept it mostly to myself. Avoided high anxiety situations. Still here.

I'm currently trying another antidepressant and supplementing that with stuff I shouldn't be supplementing it with. Killing myself accidentally actually seems kinda okay to me as a possible risk, if there's any chance at all some that anything is going to help make me feel better about myself, or something.

Who knows. I'm not even sure what I want out of an antidepressant or therapy anymore, or what's even wrong with me. I just don't want to want to die anymore. I wish I knew how.

And I always feel so dumb talking to my therapist about my suicidal feelings. I worry that someday she'll want to have me committed for being a risk to myself. I don't really think I am though. Even though I think about killing myself a lot, there hasn't really been an urge to actually ... follow through lately. Knowing there are things I need to see through first (my transition, the relationship I'm in) has given me things to distract myself with.

I don't know what will happen in the long run, after all is said and done.
posted by yeoz at 9:57 AM on August 5, 2013 [9 favorites]


On preview, I am not sure about writing this in light of yeoz's comment, but, I think that the fact that I believe in prevention over acceptance comes through.

I think the problem is for every case like the one menialjoy described, there are hundreds of cases like the one showbiz_liz is talking about. (This is based purely on anecdotes, so if there is any research on this, I would love to see it.) There are the people who have tried every single treatment, the people who nothing works for, people who are looking at a life of continuous pain. (I remember a friend of mine who has rheumatoid arthritis once told me that if she had not found a treatment that worked for her, she would have started planning her death. Luckily, the drugs for it worked and she is nowhere near that point.) For people in continuous pain, I think that the idea of ending ones life should not be thought of in the same way that it is looked at for those who are situations that will improve.

The problem with depression and other mental illness is that we just do not know if things will improve. Medications/therapy can help most and some of the more extreme therapies (ECT, TMS) can help a significant percentage of the rest (I am thinking of depression here, I don't know about schizophrenia). But some people are out of reach and there is no answer to the question of "when will this get better?" How long should we ask them to suffer in the hope that a treatment will be found that does work for them? Trust me when I say that depression can be more painful as a broken limb.

There is also the issue that suicide is almost always a spontaneous act. The British coal gas switch showed that. How much is owed to the fact that the person committing the act will most likely want to keep living in less than half an hour? Even if the suicide is contemplated for months before, the act itself is one of those cliched actions that cannot be undone.

I also do not know about how I feel about people who stop taking medications. I know that some of the anti-psychotics (if not all) really change how a person thinks, that they feel that they are no longer themselves. I have heard the same about some anti-depressants, but that seems to be less of a worry. How much should we respect the sense of self and ask people to change their own in order for them to survive in society? Do we have a right to demand that they change to (perhaps) a completely different person in order to make it?

Before writing that out, I tended to be, at best, bothered by people who quit taking medications that work for them. Now, well, I really am not sure.

I guess that I think that it may be the only way out for some people, but given the current knowledge of the brain, we have next to no way of truly knowing who this is true for. The person in pain is, ironically, perhaps one of the worst people to judge this. Until that can be determined (and I am not sure if it ever can), I think that trying to stop every suicide is the only way forward.
posted by Hactar at 10:13 AM on August 5, 2013 [2 favorites]


We live in a culture of fear that still, en masse, punishes vulnerability and restricts empathy between strangers. The only thing that will stop all suicide is when people can feel like they can ask for help without feeling weak or bad about themselves.
My brother was forced to receive therapy several times over the course of 15 years before he killed himself.Every time he was committed, he was put in the mental health ward of a nearby hospital with all the people who are mostly unglued from reality. Once released, he was treated just like anyone, crazy or otherwise, released from such an institution as far as the government was concerned. People don't ask for help because the system is mostly useless, and in his case, made his situation more difficult. Maybe if there were genuine help to be offered for people like him without social/legal penalties, they would ask for it.
posted by circleofconfusion at 10:24 AM on August 5, 2013 [7 favorites]


> The person in pain is, ironically, perhaps one of the worst people to judge this.

This is what horrifies me the most. Somebody in agonizing pain (physical or mental) can beg for release, and somebody else can say "no, your pain must continue: you cannot judge."
posted by EnterTheStory at 10:27 AM on August 5, 2013 [18 favorites]


What we actually really need is more fundamental research. Suicidality is a complex phenomenon that is part individual and part social, part disease and yet part symptom. It is politically correct to want to implement "solutions", but without even a good formulation of the problem, one that cuts through heavily-ingrained partialities and myths (and think I can detect a few even in this thread, which attests to our lacking an effective language and vocabulary to describe the problem in its fullness), efforts will be estrangingly piecemeal and random, and our era will go down in history as having been blind as those before us.
posted by polymodus at 10:39 AM on August 5, 2013


Except we're not just talking about suicide due to mental illness. We're specifically discussing all suicides. Not just some suicides, or suicides a few people find palatable, or the kind of ambiguous suicide that insurance companies loathe, but each and every one.

As a side note: every suicide is preventable, we have only to force the mass of humanity to kill one another. This fits the criteria but is hardly desirable to most.

What does suicide look like? It might be "tomorrow is Monday and I have a loaded gun" but it may also be as something as simple as keeping up your pack-a-day smoking habit. You know, you could probably go to the gym more often. When was the last time you had your prostate checked? Driving a little fast, aren't you?

I don't mean to bang on about it but we're not just discussing the impulsive or the "it gets better" suicide here. If we are, then "every" is a poor frame for the concept.
posted by adipocere at 10:51 AM on August 5, 2013


I think that the State of Indiana should open up a new facility for those who wish to end their lives in a dignified manner. Someone wishing to die, would travel to this facility, get interviewed by doctors, psychiatrists, and a sitting judge rotated for a short term from their regular bench assignments. Those would serve to filter out people who really don't belong there for other reasons.

Once you passed admission criteria, you'd have a waiting period of at least 3 days, maybe a week or a month... whatever isn't entirely cruel... to stay in a hospice type atmosphere. During this time, you're free to leave for any reason, with no repercussions.


Many people think those kinds of hurdles would be horrible to impose on people seeking abortions. I don't think suicide should be treated any differently if we're actually serious about letting people make their own decisions about their own bodies.
posted by cosmic.osmo at 10:57 AM on August 5, 2013


Many people think those kinds of hurdles would be horrible to impose on people seeking abortions. I don't think suicide should be treated any differently if we're actually serious about letting people make their own decisions about their own bodies.

Does it make any difference to you if the decision is made by someone who is mentally ill, not thinking rationally, and might not make the same decision in an hour? I think you're making a completely false equivalence.
posted by showbiz_liz at 11:01 AM on August 5, 2013 [2 favorites]


Many people think those kinds of hurdles would be horrible to impose on people seeking abortions. I don't think suicide should be treated any differently if we're actually serious about letting people make their own decisions about their own bodies.

False equivalence. They are treated differently because they involve different considerations.

Unlike pregnancy and abortion, the issue of suicide is tied heavily to issues of mental illness. Just as an abortion doctor would not operate on a patient who was intoxicated, obviously mentally ill, or in any way in a state rendering them incapable of giving knowing consent to the procedure, there need to be controls on suicide to ensure that it is a decision freely and knowingly made. Especially since it will be the last decision the person ever makes.

If you want to treat suicide as a medical procedure like abolition that people are free to choose, any medical procedure operates by these principles.
posted by Sangermaine at 11:11 AM on August 5, 2013 [1 favorite]


almost always an impulsive and hasty decision

I have lost a couple of friends to suicide, one very recently, and there was nothing impulsive or hasty about it. In fact, in the recent one, I thought "thank god he made it out of here!" He'd been trying everything else for years (therapy, religion/meditations, meds, diet, exercise, etc), and he wasn't a spring chicken. He put in a good college try, and if anyone earned a release from a lifetime of psychic misery, it was him.

This assumption that mental illness means you have no right to suicide is so disempowering & condescending that it makes me livid, as is my mom's version, which is that if you think of it, you're mentally ill and therefore can't make your own decisions. The ONLY non mentally ill decision, according to her, is to live as long as possible, no matter what. Does it get more circular?

The idea that you must live in misery for untold years until your body "naturally" releases you, so to spare your loved ones discomfort is a hell of a lot to ask of someone. I will never ask it of anyone I love. I will be sad when they go, and especially sad that their life was such that it was the only way out that they could figure out. I will not declare that my mental well being is their responsibility. I don't understand people who do that to the ones they love.
posted by small_ruminant at 11:24 AM on August 5, 2013 [23 favorites]


This thread illustrates one of the key problems with talking about suicide: there are so many different kinds, for so many different reasons, and we've got people talking at absolute cross-purposes depending on which kind(s) they're personally the most familiar with.

TBH I would bet the simplest, easiest way to do a broad breaking up of suicides into a bunch of categories would just be to categorize by age groups. I think most people would agree that suicide tends to be a very different animal when you're 20 than it is when you're 45, and even more of a completely different thing when you're 90. And trying to talking about one-size-fit-all policies, or even social attitudes, towards "suicide" when you're encompassing all of these things is impossible. Attitudes towards suicide-as-contemplated-by-90-year-olds that are totally humane and reasonable are simultaneously totally monstrous when applied to suicide-as-contemplated-by-teenagers.
posted by mstokes650 at 11:31 AM on August 5, 2013 [4 favorites]


If only that were true. The truth of the matter is, for every person who successfully commits suicide, he or she makes it plenty of people's business.

When a close friend of mine killed himself two years ago, it became all our business. His boss who found his body. Me, who got the phone call from the police because I was his ICE contact. His parents, who had to drive down for hours to clean out his apartment and get rid of everything he owned. All the family resentment that built up that I didn't even know about. And of course, the note he left that made us all just shake our heads.

There are many, many people that are forced to deal with the aftermath of someone's suicide, people who have no choice in the matter, and that is not at all comparable to a woman getting an abortion.


That is an extremely pernicious principle. If we establish the idea that everyone who is affected by any decision should get a say in making it -- then none of us would be free to make any decisions at all. We would all be slaves to public opinion and group consensus.

I have a right to do things others find unwise. If I lose that right, I lose all my rights because I would only be free to do things other say I may, and then I would be a slave.

If I were to die right now of a heart attack, I would leave behind a corpse, and my worldly affairs would have to be wrapped up, and those who know me would have to deal with the knowledge of my death. If I shot myself it would be the same. And if I keep living, that too will affect those around me. Every one of us affects others in everything we do; that's life.

In order for each of us to be free, we must accept that others are too. In order to have the right to act unwisely, we must accept that everyone else has the right to act unwisely. If we do not, we end up with a smothering nanny state, a place within which I don't care to live.
posted by Chocolate Pickle at 11:33 AM on August 5, 2013 [7 favorites]


In order for each of us to be free, we must accept that others are too. In order to have the right to act unwisely, we must accept that everyone else has the right to act unwisely. If we do not, we end up with a smothering nanny state, a place within which I don't care to live.

If I sink into a deep depression and try to kill myself one day, I hope that someone will stop me, free will and nanny states notwithstanding.
posted by showbiz_liz at 12:05 PM on August 5, 2013 [4 favorites]


Good for you. Part of freedom is that we are each able to give up our own freedom. But you don't have the right to give up my freedom.
posted by Chocolate Pickle at 12:23 PM on August 5, 2013 [3 favorites]


But what you're advocating for would remove my protection, as a mentally ill person, from violence by my own hand. I just can't see that as nanny-state-ism.

Honestly, I don't believe that every individual is always capable of making rational choices, and yes, they should be protected from ruining their own lives.
posted by showbiz_liz at 12:25 PM on August 5, 2013


But what you're advocating for would remove my protection, as a mentally ill person, from violence by my own hand. I just can't see that as nanny-state-ism.

Chocolate Pickle wasn't advocating for anything, they were warning that the principle some folks in this thread were using to justify preventing mentally ill people from committing suicide can be used, without any re-wording or stretching of it, to justify a lot of worse things, as well. And CP is correct. Everything we do affects other people; even a choice not to interact with other people affects them by denying them our awesomeness.

I am all for preventing the suicide of the mentally ill but here's the thing: justify it on the grounds that these people can get better and once they're better they will be able to make better decisions, which will likely not include wanting to kill themselves (but you know, maybe they will still want to kill themselves; what then?) Do not justify suicide prevention on the grounds that it "affects other people, so those other people should have a say" because that way lies madness.

It's also a troublesome thing to just automatically assume that suicidal equals mentally ill. Many suicidal people are mentally ill, but I don't think it's reasonable to automatically assume that anyone and everyone who's suicidal is necessarily mentally ill.
posted by mstokes650 at 12:39 PM on August 5, 2013 [3 favorites]


It's also a troublesome thing to just automatically assume that suicidal equals mentally ill. Many suicidal people are mentally ill, but I don't think it's reasonable to automatically assume that anyone and everyone who's suicidal is necessarily mentally ill.

In countries where physician assisted suicide is legal, don't they still have to go through a process to prove they're making a rational decision? I'm all for that.

Just, if we have to choose between keeping some people alive who'd legitimately rather be dead, and saving some people who would actually, on reflection, rather live, I just can't not side with the latter.
posted by showbiz_liz at 12:47 PM on August 5, 2013


I don't like the idea that the government, or the community, should be permitted to impose decisions on me "for my own good", whether I like it or not. Where does that end?

Can you force me to lose weight? Where do you stop meddling in my life, "for my own good"?

I will decide what is my own good. I neither need nor want your opinion. And I will fight to the death to prevent you from having the power to impose your opinion on me, whether about suicide, or weight gain, or anything else in my lifestyle that you may disapprove of.
posted by Chocolate Pickle at 12:58 PM on August 5, 2013 [1 favorite]


And if that means that some people kill themselves who, given time, might be glad they did not?

Some solutions are imperfect. Given an overall choice between freedom and a nanny state, I prefer freedom, and I accept that it has costs, some very tragic. The nanny state has costs too, and IMO they are much more tragic.

(And yes, I would still say that if it was someone I love who committed suicide.)
posted by Chocolate Pickle at 1:02 PM on August 5, 2013 [1 favorite]


Also, what if the mental illness isn't temporary? Do they have to be miserable for 70 years until they're finally able to die? My friend who suicided recently- he was depressed. Chronically & deeply, for years.

Another friend who suicided when I was about 30 was schizophrenic. The drugs that controlled it made his life not worth living, and living off of them wasn't an option for him.

Temporary insanity I can see controlling for, for people's own good, but chronic, long term illnesses, mental or otherwise? People need to have a choice, and taking my choice away from me (to make you feel better about yourself, generally) is no longer doing things for MY own good.
posted by small_ruminant at 1:02 PM on August 5, 2013 [6 favorites]


I made an account just to reply on this thread.

Suicidal ideation and intent are not themselves mental illnesses. Depression, bipolar disorder, etc. are mental illnesses. Suicidal ideation is a rational response to the experience of overwhelming pain and hopelessness.

Suicide in terminally ill patients is not a different animal from suicide in young people who are mentally ill. Society considers the former acceptable because on objective evaluation by a third party, there is no reason to think that quality of life will return to someone who is e.g. dying of untreatable cancer. On the other hand, in young people, it is more likely that not that the individual's suicidal tendencies will dissipate once they reach adulthood and escape their particular circumstances. LGBT youth who are bullied will often be able to find accepting communities; body dysmorphia can often be overcome through therapy, etc.

Some people reach adulthood and still suffer from mental illness despite all efforts to treat it. If someone has been suffering from a disease where there is no longer any reason to hope that quality of life can return, it is cruel and inhumane to deny them the right to end their suffering.

Again, suicidal intent is not a mental illness. Until modern medicine can provide effective lasting treatment for every mental illness, suicide prevention can not always be the right answer. There are people who deserve an end to suffering, and it would be awfully nice if providing a safe and painless means to those people with compassion and dignity and without stigma was a part of modern healthcare.
posted by sharktopus at 1:13 PM on August 5, 2013 [7 favorites]


And if that means that some people kill themselves who, given time, might be glad they did not?

Some solutions are imperfect. Given an overall choice between freedom and a nanny state, I prefer freedom, and I accept that it has costs, some very tragic. The nanny state has costs too, and IMO they are much more tragic.

(And yes, I would still say that if it was someone I love who committed suicide.)


I guess we just aren't going to be able to agree, then. I think I actually understand where you're coming from, but I just can't agree with you that it's preferable to live in a world like that. I only have a family because it's hard to kill yourself. I almost lost another dear friend because her birth control pills made her suicidal. I am so glad those people didn't have access to easy means of suicide, and so are they.
posted by showbiz_liz at 1:23 PM on August 5, 2013 [2 favorites]


chocolate pickle--to the best of my knowledge every State in the Union and country in North America and Western Europe have laws that give designated authorities/officials the right to intervene (without due process) on an emergency basis if a person is believed to be imminently dangerous to them self or others due to mental illness and for longer period of times with due process. While you may believe you have the right to solely and unilaterally make that decision it is only a belief rather than a right. Societies in general have determined that it is better to occasionally prevent rational suicide than to permit mentally ill persons to kill themselves without the option of State intervention. If you believe you have the right, under all conditions, to commit suicide then it is best done in private without any prior communication of intent. Whether the State has a compelling interest in private decisions that primarily only effect one's self is arguable but on this issue the argument has been almost universally settled as a matter of either administrative or statutory law.
posted by rmhsinc at 2:24 PM on August 5, 2013 [1 favorite]


While you may believe you have the right to solely and unilaterally make that decision it is only a belief rather than a right.

Large swaths of people believed they had the right to vote despite laws telling them otherwise, and eventually the courts, & therefore laws, came 'round to their way of thinking. I have hopes that this will happen in the case of the right to die as well.
posted by small_ruminant at 2:41 PM on August 5, 2013 [1 favorite]


Right to die legislation is fundamentally different from Statutory laws governing danger to self and others due to mental illness. I will lay you odds that when, and if, ( and I hope we do) have permissive laws regarding the right to die they will not void or significantly change the laws regarding danger to self/others due to mental illness.
posted by rmhsinc at 2:53 PM on August 5, 2013 [2 favorites]


RMHSINC, there's a difference between those kinds of laws and what seems to be proposed in the OP. Any time you start talking about "zero suicides", that cannot be achieved without gross violations of civil rights and privacy. You're talking about thought police.
posted by Chocolate Pickle at 3:02 PM on August 5, 2013


chocolate pickle--I agree with you although I would not choose the adjective "gross" and words "thought police" but that reflects differences in our political/ideological positions and not a disagreement on this specific issue.
posted by rmhsinc at 3:06 PM on August 5, 2013


RMHSINC, there's a difference between those kinds of laws and what seems to be proposed in the OP. Any time you start talking about "zero suicides", that cannot be achieved without gross violations of civil rights and privacy. You're talking about thought police.

But surely there's a middle ground between "no one can ever kill themselves for any reason whatsoever" and "absolutely everyone should be able to kill themselves, even if they'd immediately regret it."
posted by showbiz_liz at 3:14 PM on August 5, 2013 [1 favorite]


Liz, sure there is. And IMHO we're in it now. I'm OK with police trying to help someone standing on the Golden Gate thinking of leaping. But in terms of the OP, I don't think we need anything more than we already have, because on a political and cultural level the cure is worse than the disease.
posted by Chocolate Pickle at 3:49 PM on August 5, 2013


I listened to a radio program on a study of 515 persons who attempted suicide from the Golden Gate Bridge but were restrained. The upshot is that 90% of the attempters did not go on to kill themselves.

Study link:

http://seattlefriends.org/files/seiden_study.pdf
posted by Bearman at 4:55 PM on August 5, 2013


Not that thrilled about dismissing people's experiences with suicide as "anecdata".
posted by thelonius at 5:19 PM on August 5, 2013


Suicide is not the disease. Suicide is a symptom.
posted by mikurski at 5:23 PM on August 5, 2013 [2 favorites]


There are many, many people that are forced to deal with the aftermath of someone's suicide, people who have no choice in the matter

that's not a very good argument, because everyone has to die at some point, it's just a matter of timing: leave an aftermath now or in 30 years. if, in your final years, you spend a lot of money on medical services, it could more than offset what you gain from delaying the cost of death.
posted by cupcake1337 at 7:22 PM on August 5, 2013 [1 favorite]


Bearman- my computer doesn't handle pdfs well- is it possible that the people who allowed themselves to be restrained or even noticed are the ones who were in the waffling/cry for help category? I don't know how you'd figure that out, but I imagine someone knows how.
posted by small_ruminant at 7:50 PM on August 5, 2013


Re: The Golden Gate Bridge research: I have a suspicion that people who attempt suicide in such a public manner are making a desperate cry for help more than they're actually trying to kill themselves. I'd be really interested to see a similar study done on people who intentionally take massive overdoses, or attempt to shoot/slice themselves to death--my instinct (which may be incorrect) is that the numbers would be very different.

There are many, many people that are forced to deal with the aftermath of someone's suicide, people who have no choice in the matter...

Can you see the irony in this, though? You're saying that it's unfair to force someone to deal with the aftermath of someone's suicide--but in order to spare them that, you want to force suicidal people to deal with a life that they're not interested in living so that other people aren't inconvenienced or saddened. You're asking someone else to suffer--physically, mentally, whatever--for quite possibly the rest of their life. I can think of few things more selfish than someone saying "Hey, suicidal person, you shouldn't kill yourself, because it will make other people sad."
posted by MeghanC at 9:38 PM on August 5, 2013 [9 favorites]


When I hear the phrase "zero suicides," all I can think of is the phrase "necessarily inhumane."

"Zero suicides" is an open embrace of the wonderfully circular logic in mental health treatment that says: if you want to die, you are de facto irrational, and irrational people must be prevented (through the use of physical force, involuntary institutionalization, restraints, and/or forced medication, if deemed appropriate) from making decisions about the longevity of their own lives.

A goal of zero suicides can only be achieved by forcing people who do not want to live, people who are totally overwhelmed and sick of trying, to engage with a world that has lost its appeal to them to a degree so profound it's impossible to accurately describe it to anyone who has not felt it themselves. Those who are responsible for 5150 laws and assisted suicide bans cannot conceive of spending a solid quarter-century praying for death from above, of having had a suicide plan since you were five years old, of being moved to tears every single day when you are forced to realize that you are too much of a coward to try because you know very well what happens to people who don't succeed. It's heavy. It makes you so tired. It makes everyone around you tired, too.

"Zero suicides" means we must be prepared to accept the notion that even more people will be forced to drag themselves around with a perpetually aching heart and an exhausted mind, to beam out a ghastly rictus grin of civility and togetherness when the only thing they want out of life is to end it. "Zero suicides" requires a net increase of personal strife and suffering. It is an exacting and specific punishment to those who want nothing more than to stop feeling as though they are being unduly punished.

When it comes to those of us who have spent the majority of our lives twirling through the revolving doors of psychiatry, psychology, social work, therapy, and medication, when nothing has worked -- not years of talk therapy, not years of attempted pharmaceutical assists -- and we have come to the realization that something is fundamentally broken, why on earth do we need to stick around? If I could figure out a way to give my remaining years of natural life and moderately good health to someone who wanted it, I would make the handoff in a split second. If I could make sure no one would try to wake me, that I wouldn't leave a mess for someone to clean up (figuratively or literally), that I could tie up all my loose ends in advance and go away in a clean, quiet, respectful environment? It's the stuff of daydreams. I know it will never happen because society has decided that forcing permanently suicidal people to continue living, no matter how much pain they're in, is significantly more noble than allowing us to die with dignity, but I'm crossing my fingers for future generations.

No one wants to believe that true hopelessness exists because we are all so wrapped up in the idea that redemption is always possible, even when we must wield the long arm of the law to temporarily enforce it. As a species, we are obsessed with the notion of saving us from ourselves. As a result, the lived experiences of consistently suicidal people are often whitewashed; the world continues to view us through a lens that presupposes the universal possession of an unknowable, innate self-preservation mechanism. This behavior is meant to insist that our earnestly hypothesized, inherent, inextricable life force can only ever be shrouded by either "mental illness" or circumstance; it refuses to recognize any instance where it may have been extinguished outright. That's a fairly dangerous loophole, yet it is dismissed out of hand in nearly all cases.

It's cruel to force people to endure decades of bona fide psychic agony in order to satisfy others' requirement that all physically healthy people must continue living. It's cruel to insist upon labeling everyone who wants to die as "irrational" with the goal of enforcing ham-fisted, inelegant social norms and unnaturally prolonged lives of unremitting suffering upon those we have deemed to be such. Try touring a state-run mental hospital -- actually, try being locked up there against your will. You'll find that penning up and force-medicating desperately miserable humans into dazed complacency so no one has to feel bad about being unable to prevent their deaths isn't quite the curative it's cracked up to be.

For those who'd like to read up on it, Geo Stone's Suicide and Attempted Suicide is a great resource on the topic; it has lots of interesting, thought-provoking information and tons of statistics. Good discussion on this, MeFi. Very heartening.
posted by divined by radio at 10:42 AM on August 6, 2013 [12 favorites]


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