I recently wrote a blog post about suicide. It wasn't about my own ideations, which have been pretty frequent of late, for reasons that I'll probably go into at some point in the near future. It received mixed reviews in some circles, varying from very positive from some, especially those whose ideations are fairly constant, to carpet-bitingly shrill howlings from others.

Some said that, as somebody who is a vocal advocate for mental health and suicide prevention, I was being irresponsible.

I'd be interested in discussing this a little. The psych and neuro forum doesn't really feel like the right place for this,because I don't accept the notion that suicidal ideation is but it's the best place we have here.

Still I'd be hugely interested in what people here think. I'm most interested in whether or not anybody can logically defend the premise that living is better than not living. The link to the blog post is below.

Note: I have zero appetite for conflict at the moment, not least because I'm going through some horrendous shit, and it's far from over, so I won't give any truck to screaming, and you can expect to be ignored. I'm also not interested in advice to seek help, because there is none for my issues, which are purely logistical at the moment. I don't need therapy, and I don't need to be sectioned.

Suicide Solution

hackenslash wrote:

I recently wrote a blog post about suicide. It wasn't about my own ideations, which have been pretty frequent of late, for reasons that I'll probably go into at some point in the near future. It received mixed reviews in some circles, varying from very positive from some, especially those whose ideations are fairly constant, to carpet-bitingly shrill howlings from others.

Some said that, as somebody who is a vocal advocate for mental health and suicide prevention, I was being irresponsible.

I'd be interested in discussing this a little. The psych and neuro forum doesn't really feel like the right place for this,because I don't accept the notion that suicidal ideation is but it's the best place we have here.

I'm unsure what you're saying there. Could you elaborate?

hackenslash wrote:Still I'd be hugely interested in what people here think. I'm most interested in whether or not anybody can logically defend the premise that living is better than not living.

I don't think so, not in an objective sense anyway.
As far as I can see and it is an admittedly vague and generalized view, as long as a persons's choice to end their life is not based on issues that can be remedied (for example: lack of friends/loved ones, bad luck in their financial life and or social security etc, they should be allowed to end or not end their life as they see fit.
(Even in the aforementioned temporary cases, I'd still think it's ultimately their choice, but would hope they'd try changing the situation first)

Thomas Eshuis wrote:I'm unsure what you're saying there. Could you elaborate?

Oops. That should have read "because I don't accept the notion that suicidal ideation is necessarily an indicator of poor mental health".

I don't think so, not in an objective sense anyway.
As far as I can see and it is an admittedly vague and generalized view, as long as a persons's choice to end their life is not based on issues that can be remedied (for example: lack of friends/loved ones, bad luck in their financial life and or social security etc, they should be allowed to end or not end their life as they see fit.
(Even in the aforementioned temporary cases, I'd still think it's ultimately their choice, but would hope they'd try changing the situation first)

Thank you, Thomas.

What I actually advocate most strongly is the notion that we should support first, and then explore whether there's anything that can be fixed to change the situation.

I've spoken to people whose lives have been filled with such atrocity that simply dismissing them as having mental health issues isn't just incorrect, but horribly destructive.

If I were to tell you, for example, of a woman I know who was passed around among her father's friends as a party favour until the age of 8, at which point her mother took her shopping to lingerie so she'd look sexier, or another woman very close to me who complained to her grandmother at the age of 5 about being repeatedly raped by all and sundry, only to be told that she should shut up, because this was her duty to her family, would you try telling them that living is better than not?

These are real-world examples of people I know and have counselled, and they're far from the 'worst' (setting aside that comparisons are asinine).

I should also add here a piece about giving advice, written some time ago. It highlights the many problems we have with the way we think about suicide, mental health, and how to support people.

Selfish! Weak!

I hardly think logic is a useful tool. This is an emotional decision.
It is very much society versus individual.

I think the individual can choose to opt out of living...I also think society has a duty of care to adult citizens to put up speed bumps ...time out if you like.
Suicidal thoughts, especially without duress from say a fatal disease diagnosis are generally considered symptomatic of mental distress if not mental illness and so subject to medical treatment ....
The question being can that treatment be imposed.

It would be if the person was a minor ....it could be viewed that it should be mandatory for all as a drive to go on living and avoid death would be the norm for any living being.

We have assisted suicide for those with terminal illness and a panel of medical personnel to oversee that.
I do not see the value to society of physically healthy but mentally distressed individuals given the same option.
My take is that treatment should be mandatory as suicide attempts being a clear symptom of mental illness.

We put up roadblocks to self harm in many ways - reducing access to drugs, firearms, even to a point booze so I see mandatory treatment of suicidal citizens in the same vein.

From society's standpoint ....expect justifiable active attempts at dissuasion if not little white men ....

My advice ..you've got enough mental acuity to turn it around and ask yourself if a valued friend was on this path what would you counsel ??

.......

Your examples are self justifying and those people need help..they are injured.

Macdoc wrote:My take is that treatment should be mandatory as suicide attempts being a clear symptom of mental illness.

I'd love to see some flesh put on this assertion, because this is the question before us. Is suicide ideation/attempt/completion necessarily a symptom of mental illness?

I reject this claim as unsupported.

Is living better than not? Can this be demonstrated?

It IS in the view of current society and the medical community.

I'd say you have to demonstrate it's not and is not harmful to society/others.

By undertaking the act you absent yourself from censure and leave others to clean up the splatter. Toilet training generally occurs earlier.

How willing are you to harm others?

The question weighs on me. This Thursday will be the 10th anniversary of my Dad's suicide, and I've spent many nights wondering what I could or should have done, or if I had a right to intervene at all. He was 82, and was ill but not terminal. He had Type 2 diabetes, was on injectable insulin, and doing the finger stick thing. He'd had intestinal cancer but it was successfully treated by surgery alone. But he'd spent the last 5 (at least) years of his life sitting at the table watching the boats go by on the intracoastal waterway. He didn't have any friends, any hobbies, he couldn't eat what he wanted, drink what he wanted, and he was physically incapable of doing the things he had always kept very busy with. Rebuilding antique cars, crewing a racing sailboat, living and working all over the world - that constant activity was, I think, his way of dealing with the black dog, who had followed him his entire adult life. Back in the 60s they'd even done the whole electro-shock thing to him. To top it off, my mom (rest her, too) was a strong woman. "Formidable", as my brother-in-law said when he met her. With the best of intentions she cosseted him, and he wasn't the sort of man to resist. Whether his actions were a product of the goddamn black dog or a rational decision taken by a rational man, I'll never be sure. I think maybe a bit of both.

I've come to terms with it, certainly took a while and it wasn't an easy thing to forgive. No, not forgive, that's a stupid word. There's no forgiveness necessary, he did what he felt was the best thing. The only thing, actually, because once you decide on that course of action you've exhausted all other avenues. That's the rub. One man's "exhaust all other avenues" is another man's "you're giving up without a fight". If you judge someone because you perceive them as weak, or selfish, then maybe you have to forgive them to move on, but if you can accept that for whatever reason suicide was their only rational choice then no forgiveness is required, only understanding and sorrow.

My advice to anyone thinking about it, though, is leave a goddamn note and explain yourself. Don't let your family wonder.

hackenslash wrote:

Macdoc wrote:My take is that treatment should be mandatory as suicide attempts being a clear symptom of mental illness.

I'd love to see some flesh put on this assertion, because this is the question before us. Is suicide ideation/attempt/completion necessarily a symptom of mental illness?

I reject this claim as unsupported.

Is living better than not? Can this be demonstrated?

The problem is differentiating the cases of mental illness driven suicidal ideation from other causes. The presumption is for mental illness. The question you pose is not relevant (eta: because there is no verifiable way to make such an assessment). The question is do “mentally healthy people commit suicide?”

Society and medical say no which I tend to agree with.

From a social perspective ...there is always harm.

From a personal perspective ....in some cases relief from present pain or known future pain ( certain cancers or conditions ) certainly can be supported.

In a healthy person ..nah..but then self destructive behaviour is nothing new.

hackenslash wrote:

Thomas Eshuis wrote:I'm unsure what you're saying there. Could you elaborate?

Oops. That should have read "because I don't accept the notion that suicidal ideation is necessarily an indicator of poor mental health".

I see and agree. I think the issue in current medical philosophy is that life is better than death, as well as the principle of 'first do no harm'.

hackenslash wrote:

I don't think so, not in an objective sense anyway.
As far as I can see and it is an admittedly vague and generalized view, as long as a persons's choice to end their life is not based on issues that can be remedied (for example: lack of friends/loved ones, bad luck in their financial life and or social security etc, they should be allowed to end or not end their life as they see fit.
(Even in the aforementioned temporary cases, I'd still think it's ultimately their choice, but would hope they'd try changing the situation first)

Thank you, Thomas.

What I actually advocate most strongly is the notion that we should support first, and then explore whether there's anything that can be fixed to change the situation.

So do I.

I've spoken to people whose lives have been filled with such atrocity that simply dismissing them as having mental health issues isn't just incorrect, but horribly destructive.

If I were to tell you, for example, of a woman I know who was passed around among her father's friends as a party favour until the age of 8, at which point her mother took her shopping to lingerie so she'd look sexier, or another woman very close to me who complained to her grandmother at the age of 5 about being repeatedly raped by all and sundry, only to be told that she should shut up, because this was her duty to her family, would you try telling them that living is better than not?

These are real-world examples of people I know and have counseled, and they're far from the 'worst' (setting aside that comparisons are asinine).

As I said, I agree that suicidal ideation doesn't necessitate mental illness, especially since there are people who consciously and of sound mind determine that they no longer have a desire to live on. Not only those who have, for example, crippling physical issues, but also seniors who've lived a full life.

I should also add here a piece about giving advice, written some time ago. It highlights the many problems we have with the way we think about suicide, mental health, and how to support people.

Selfish! Weak!

I've read that a while back, I believe. Both enlightening and recognizable.

Macdoc wrote:It IS in the view of current society and the medical community.

That's multiple fallacies in one sentence.

I'd say you have to demonstrate it's not and is not harmful to society/others.

That's shifting the burden of proof.

By undertaking the act you absent yourself from censure and leave others to clean up the splatter.

What a weirdly specific and graphic description. Are you unaware that multiple countries already allow assisted suicide?

Interesting topic for me, will have to come back later.

Just quickly - it might interest some to learn that in the world of psychotherapy, at least in the UK, there is no onus on therapists to stop a patient taking their own life, because autonomy is considered the most important factor. I myself have acted to prevent it, but only in cases where there were clear indications of uncontrolled mental illness. The nights I've had to sit tight wondering if my person was still here have been many, but my view is that it's not right to force life on a person who has considered all options (often with me, in a therapeutic setting), and comes to the conclusion that to not be is the rational choice.

I'd love to see some flesh put on this assertion, because this is the question before us. Is suicide ideation/attempt/completion necessarily a symptom of mental illness?

I would say it usually is, if you define severe depression as mental illness, which I don't. It is helpful to put that label on it in a medical sense, but I think severe depression can be perfectly natural and not something to be treated as such, so the label is a bit of a poor fit in my view.
It is of course not NECESSARILY so, since one can make a clear and logical choice that your life is complete and tomorrow is just going to be a burden, perhaps to others as well as to yourself.

By undertaking the act you absent yourself from censure and leave others to clean up the splatter. Toilet training generally occurs earlier.

I hope this was intended differently to how it appears to me, which is a callous dismissal of suicidal people and a horrible misunderstanding of what their reality can be at the time.

When seriously considering suicide the rest of the world can be completely irrelevant, "others" can be just part of the reality that has rejected you, your ties to those you cared about can seem absolutely false and meaningless. Concern for those left behind would be a recognition of a future that does not exist in your reality. Don't make the mistake of believing that someone on the brink of suicide is thinking in a way that you would recognise and could relate to or judge. It is fantastically unhelpful and wrong to judge suicide as an act of selfishness or cowardice, since at the time those concepts can be completely meaningless.

I mean, cancer is perfectly natural, but it's definitely an illness.

On Macdoc's point there, I'm not really sure what he means by absenting yourself from censure. On his second point, although people suffer greatly from losing a loved one to suicide, too much sorrow is caused in this world by putting others' needs and feelings before one's own. No one should be forced to suffer through hell because others will be affected if they go. Additionally, having heard the reasoning behind people's desire to end their own lives, a very common thought is that loved ones will be much better off without them. Sure they'll be sad, but they'll get over it in time. They think they're actually doing the best thing for the ones who will be left behind - it's not a clearly selfish act at all.

zulumoose wrote:

I'd love to see some flesh put on this assertion, because this is the question before us. Is suicide ideation/attempt/completion necessarily a symptom of mental illness?

I would say it usually is, if you define severe depression as mental illness, which I don't.
It is helpful to put that label on it in a medical sense, but I think severe depression can be perfectly natural and not something to be treated as such, so the label is a bit of a poor fit in my view.

But aren't many illnesses, both mental and physical natural?

zulumoose wrote:

By undertaking the act you absent yourself from censure and leave others to clean up the splatter. Toilet training generally occurs earlier.

I hope this was intended differently to how it appears to me, which is a callous dismissal of suicidal people and a horrible misunderstanding of what their reality can be at the time.

When seriously considering suicide the rest of the world can be completely irrelevant, "others" can be just part of the reality that has rejected you, your ties to those you cared about can seem absolutely false and meaningless. Concern for those left behind would be a recognition of a future that does not exist in your reality. Don't make the mistake of believing that someone on the brink of suicide is thinking in a way that you would recognise and could relate to or judge. It is fantastically unhelpful and wrong to judge suicide as an act of selfishness or cowardice, since at the time those concepts can be completely meaningless.

Fallible wrote:I mean, cancer is perfectly natural, but it's definitely an illness.

Not to go too far off topic here, but Cancer is a mutation, an invasion of the body by malignant cells from within.
It is only natural in the same way every disease is natural.

From my perspective (and I am not trying to force it on others, it is just my view) depression is more like going into shock, which can be fatal, and can be treated, but is often a natural and normal reaction to circumstances, and not always a sign that something is wrong with the body/mind makeup. Shock can be fatal but is not an illness. Cancer (although internal) definitely means something has gone wrong.

Wrong, sure, but not unnatural.

I don't agree with your contention about cancer, but cancer was just an example. Pick any illness from thousands - they're mostly natural.

From my perspective, you're not describing severe depression in a coherent fashion. It is NOT a normal reaction to circumstances - that would be feeing appropriate emotions and then when the circumstances have passed, a lessening, and an expression of new emotions in accordance with the new circumstances. Severe depression is when one feels severe sadness, lack of motivation, suicidal ideation, etc. when these feelings are not in response to circumstances. It is an illness. Its causes are many, and not fully understood, but there are many illnesses which are not understood. That does not mean we can define them any way we like. Severe depression is always a sign that something has 'gone wrong' - but again, this is a pretty nebulous phrase which does not necessarily entail the gone-wrongness being to do with 'mind makeup' (yet another nebulous term).

This puts me in mind of how mental illness continues to be the poor relation of physical illness. People just seem to feel fine about making up their own explanations for what it is or how it is. This in turn can lead to judgement. This in turn can lead to those suffering being ashamed or embarrassed. I haven't seen you judge, but as can be seen by Macdoc's comments, it happens. People are dying from severe depression. Is that a perfectly natural and normal normal reaction?

Thomas

What a weirdly specific and graphic description. Are you unaware that multiple countries already allow assisted suicide?

Do you actually read anything I wrote ??? or just knee jerk negative per usual?
This is what I wrote

We have assisted suicide for those with terminal illness and a panel of medical personnel to oversee that.

http://www.rationalskepticism.org/psych ... l#p2660038

In Canada it is a doctors duty of care to prevent self harm and there is guiding legislation as well supporting them.

Clinical assessment

The guiding ethical principle underlying a clinical assessment where risk of self-harm is a central issue is beneficence. Even if the patient does not want to be in the ER or to be assessed by a physician concerning these matters, physicians have a duty to act in the patient's interest and preventing harm to self is considered on its face to be in the patient's interest.

This is actual a good read on the ethical dilemma that some cases present - part of the education series by the Royal College of Physicians and Surgeons of Canada,
http://www.royalcollege.ca/rcsite/bioet ... arm-self-e

From that article

Mental health legislation that permits involuntary assessment and hospitalization is informed by the common-law doctrine of parens patriae—the notion that the sovereign (or, in our case, the state) has the authority to protect persons from themselves.

So yes, here there is the notion that attempted suicide requires intervention by the state as an underlying principle,

From the same section and the heart of the question in this thread

there are authors who have argued that persons should never be forced into hospital against their will—that the right to self determination is always more important than any interest that society may have in protecting people from self-harm. In other words, the question of whether people should be involuntarily hospitalized is a classic conflict between the ethical principles of autonomy and beneficence (acting in someone else's best interest).

In Canada, from a public policy point of view, beneficence has been deemed to be more important than autonomy in cases where people are at risk of self-harm. This is because it is believed that self-harm generally occurs in the context of mental disorder, and mental disorder diminishes people's abilities to act autonomously.

That would be my stance and clearly the stance of the medical community here.

The case study in the article raises good questions and provides insight into two different legislative approaches,

Is Sarah's capacity to make treatment decisions relevant to decisions about intervening in situations of self-harm?

Sarah's capacity to make treatment decisions is not relevant to decisions about hospitalization, except in Saskatchewan. In Saskatchewan, a person has to be incapable of consenting or refusing treatment for the disorder that is leading to the involuntary admission.
In all other provinces, the decision about hospitalization is made on the basis of self-harming behaviour or threats of self-harming behaviour. This is regardless of the person's capacity to consent to or refuse treatment, even treatment for the very disorder that is leading to the admission.

So in Canada there are speed bumps to self harm and even involuntary treatment or detention over riding individual wishes.
There are legal remedies a person in involuntary care can take ...but it takes time and other individuals which is the whole idea ...to allow treatment, re-consideration and the engagement of family and friends.

My first cousin's wife was involved as a career in suicide prevention and intervention and finally left the field due to the stress of dealing with such cases....both in dealing with the individuals attempting self harm and dealing with the damage to those close to the suicidal person.
No easy task.

OK I really don't want to go too far into semantics here, I did say it was just my opinion and others are free to disagree. I don't agree with what I feel is the common misuse of many terms. I think the terms Illness and disease are too often used to add medical weight to something that might otherwise be vulnerable to inappropriate dismissal by the public as just a personal issue. Ideally people should be able to give issues the appropriate weight without hanging labels on them.

Depression is a serious issue, whatever you call it, and I like the description you have used here to define when it has gone wrong, adds a nice degree of clarity to a murky subject:-

when the circumstances have passed, a lessening, and an expression of new emotions in accordance with the new circumstances. Severe depression is when one feels severe sadness, lack of motivation, suicidal ideation, etc. when these feelings are not in response to circumstances