I am telling you now, upfront, this post is in no way a cry for help. As you read this post, be aware of your reactions to what I am discussing and share your comments accordingly. We have a very dysfunctional relationship to death in this culture. I am seeking to tear down some of that dysfunction here.
I want to talk about suicide, euthanasia, and death. Please note your reaction. Is it "how morbid!" Is it, "Oh, I hope he's ok." Is it, "I don't want to hear about this."
I have been on medication for anxiety/depression for about eight years now and probably could have used it much earlier than that. My mood ebbs and flows--at times with enough caffeine on board I have some clearly manic episodes. I also have times where I am down. This isn't one of them.
As a single person in America, I am constantly subjected to the cultural expectations that people are to be coupled and the silent and not so silent questioning of what is wrong when someone remains single. When I am down it almost never has to do with being "alone." (cue the dramatic music)
About two years ago I was meeting with my psychiatrist. I basically have a 15 minute appointment every six months to touch base and get my prescriptions refilled. I had finally felt brave enough to bring up my thoughts of suicidal ideation--fancy words for contemplating suicide.
What he said that day has stuck with me more than anything else he has said. Essentially he said that part of depression - part of being neurotic - is having experiencing those emotional states as our comfort zones. Our brains - our subconscious - works then to keep us in those emotional states because that is where we are comfortable.
Think, for example, of someone you know who always seems to be in a crisis. You might even say they spend their lives bouncing from crisis to crisis. That person essentially only knows how to function when they are on high alert/crisis mode. That is his or her comfort zone. Some will go so far as to create crises in order to maintain that zone.
In my case though, the regular punitive sh*t we feed ourselves doesn't work. This would be the "I'm a bad person because..." kind of thoughts. I'm a bad person because my house isn't clean, I'm a bad person because I yelled at my kids. I'm a bad person because I didn't recycle. Think of that as a first line of attack by our sub-conscience to keep us in that comfort zone of feeling bad. As I said, in my case that stuff doesn't carry water any more. I am able with the help of my medication to shut that voice down most of the time.
This is where Dr. Miller's thoughts really hit home. He suggested that in my case, my brain has had to be more creative to try and push me back into that zone, and it does so by having these taboo thoughts creep into my daily musings. They can be musings on suicide or sexual perversity or violence. Once I have those thoughts, the punitive voice kicks back in. "I'm a bad person because I'm thinking about..." Thankfully, I am mastering control of this strategy as well in my fight to battle depression.
I believe it is a zen concept to remember that our thoughts do not define us. They are like a monkey in a cage, rattling the bars, trying to escape. This in conjunction with Dr. Miller's advise keeps me out of the dark place.
However, clearly suicidal ideation is a cultural taboo. We don't want to hear about it. We don't want to talk about it. We start to panic when someone does.
I am fairly certain that when the appropriate time comes, I will choose to die at my own hands. Once again, please note your reaction. Is it, "Oh my God!" Is it, "You lie!" Is it, "Oh, you're just being dramatic." Is it, "Are you sure you're ok?"
I have mixed feelings with how Hollywood has dealt with the subject over the years. There is the tragic end to The Children's Hour in which Shirley MacLaine's character hangs herself after admitting that she is a lesbian. There is Ruth Gordan's character in Harold and Maude, who takes her own life on her 80th birthday. Having survived the concentration camps of Germany, she simply decided she would enjoy life to the fullest and check out on her 80th. In both of these films, the suicide comes at the end as an essential moment in the film's climax.
On rare occasions, the suicide is a central theme of the film. For example, Javier Bardem portrays the real life struggle with assisted suicide of Ramon Sampedro in The Sea Inside. Ramon Sampedro lived for many years as a quadriplegic, fighting unsuccessfully for the right to end his life.
Lastly, is the Robin Williams' movie What Dreams May Come. This movie is mostly set in heaven after a series of tragedies befall one family. First they parents lose their children in a car accident. Then, months later, Robin Williams is also killed in an accident, leaving the bereft mother all alone. The remainder of the film centers on Robin Williams' experiences in heaven where he learns that his wife has committed suicide.
I remember discussing the movie with my mom and she was very troubled by the message put forth. The wife is ironically trapped in a hell-like prison of her own creation because she chose to end her own life. Robin Williams' eventually manages to free her from this purgatory. However, the message is that you will be punished in the afterlife for your action if you choose suicide.
This, of course, is the Christian tradition. Suicides were not to be buried in sacred ground. The grieving families were instructed that their loved one was now beyond reach in hell for their mortal sin. Even today, the Roman Catholic church still forbids the removal of feeding tubes and the withdrawing of life support.
I have worked in health care for nearly twenty years now. I have seen up close what it looks like when death wins over medical intervention. Too, too often we - the patient, the family, the doctors - cling to life at all costs...to what end?
Perhaps I will choose hospice over aggressive treatment of cancer. Perhaps I will find a way to end things on my own if faced with a diagnosis of Alzheimers. Perhaps I will live into my nineties and all my friends will be gone and I will decide that it is time. It is my hope that long before I reach that point, society will have improved on how we deal with death and end of life issues and there will be a formal process I can follow. Rest assured that when the time comes, it will not be an emotional, rash decision.
However, it will be my choice and my decision...unless a wayward logging truck gets me first.
I want to talk about suicide, euthanasia, and death. Please note your reaction. Is it "how morbid!" Is it, "Oh, I hope he's ok." Is it, "I don't want to hear about this."
I have been on medication for anxiety/depression for about eight years now and probably could have used it much earlier than that. My mood ebbs and flows--at times with enough caffeine on board I have some clearly manic episodes. I also have times where I am down. This isn't one of them.
As a single person in America, I am constantly subjected to the cultural expectations that people are to be coupled and the silent and not so silent questioning of what is wrong when someone remains single. When I am down it almost never has to do with being "alone." (cue the dramatic music)
About two years ago I was meeting with my psychiatrist. I basically have a 15 minute appointment every six months to touch base and get my prescriptions refilled. I had finally felt brave enough to bring up my thoughts of suicidal ideation--fancy words for contemplating suicide.
What he said that day has stuck with me more than anything else he has said. Essentially he said that part of depression - part of being neurotic - is having experiencing those emotional states as our comfort zones. Our brains - our subconscious - works then to keep us in those emotional states because that is where we are comfortable.
Think, for example, of someone you know who always seems to be in a crisis. You might even say they spend their lives bouncing from crisis to crisis. That person essentially only knows how to function when they are on high alert/crisis mode. That is his or her comfort zone. Some will go so far as to create crises in order to maintain that zone.
In my case though, the regular punitive sh*t we feed ourselves doesn't work. This would be the "I'm a bad person because..." kind of thoughts. I'm a bad person because my house isn't clean, I'm a bad person because I yelled at my kids. I'm a bad person because I didn't recycle. Think of that as a first line of attack by our sub-conscience to keep us in that comfort zone of feeling bad. As I said, in my case that stuff doesn't carry water any more. I am able with the help of my medication to shut that voice down most of the time.
This is where Dr. Miller's thoughts really hit home. He suggested that in my case, my brain has had to be more creative to try and push me back into that zone, and it does so by having these taboo thoughts creep into my daily musings. They can be musings on suicide or sexual perversity or violence. Once I have those thoughts, the punitive voice kicks back in. "I'm a bad person because I'm thinking about..." Thankfully, I am mastering control of this strategy as well in my fight to battle depression.
I believe it is a zen concept to remember that our thoughts do not define us. They are like a monkey in a cage, rattling the bars, trying to escape. This in conjunction with Dr. Miller's advise keeps me out of the dark place.
However, clearly suicidal ideation is a cultural taboo. We don't want to hear about it. We don't want to talk about it. We start to panic when someone does.
I am fairly certain that when the appropriate time comes, I will choose to die at my own hands. Once again, please note your reaction. Is it, "Oh my God!" Is it, "You lie!" Is it, "Oh, you're just being dramatic." Is it, "Are you sure you're ok?"
I have mixed feelings with how Hollywood has dealt with the subject over the years. There is the tragic end to The Children's Hour in which Shirley MacLaine's character hangs herself after admitting that she is a lesbian. There is Ruth Gordan's character in Harold and Maude, who takes her own life on her 80th birthday. Having survived the concentration camps of Germany, she simply decided she would enjoy life to the fullest and check out on her 80th. In both of these films, the suicide comes at the end as an essential moment in the film's climax.
On rare occasions, the suicide is a central theme of the film. For example, Javier Bardem portrays the real life struggle with assisted suicide of Ramon Sampedro in The Sea Inside. Ramon Sampedro lived for many years as a quadriplegic, fighting unsuccessfully for the right to end his life.
Lastly, is the Robin Williams' movie What Dreams May Come. This movie is mostly set in heaven after a series of tragedies befall one family. First they parents lose their children in a car accident. Then, months later, Robin Williams is also killed in an accident, leaving the bereft mother all alone. The remainder of the film centers on Robin Williams' experiences in heaven where he learns that his wife has committed suicide.
I remember discussing the movie with my mom and she was very troubled by the message put forth. The wife is ironically trapped in a hell-like prison of her own creation because she chose to end her own life. Robin Williams' eventually manages to free her from this purgatory. However, the message is that you will be punished in the afterlife for your action if you choose suicide.
This, of course, is the Christian tradition. Suicides were not to be buried in sacred ground. The grieving families were instructed that their loved one was now beyond reach in hell for their mortal sin. Even today, the Roman Catholic church still forbids the removal of feeding tubes and the withdrawing of life support.
I have worked in health care for nearly twenty years now. I have seen up close what it looks like when death wins over medical intervention. Too, too often we - the patient, the family, the doctors - cling to life at all costs...to what end?
Perhaps I will choose hospice over aggressive treatment of cancer. Perhaps I will find a way to end things on my own if faced with a diagnosis of Alzheimers. Perhaps I will live into my nineties and all my friends will be gone and I will decide that it is time. It is my hope that long before I reach that point, society will have improved on how we deal with death and end of life issues and there will be a formal process I can follow. Rest assured that when the time comes, it will not be an emotional, rash decision.
However, it will be my choice and my decision...unless a wayward logging truck gets me first.
16 comments:
"I am fairly certain that when the appropriate time comes, I will choose to die at my own hands."
It is interesting that that is actually a very vague statement--it could be everything from "choosing hospice" to "not being intubated," to active suicide.
(And before anyone reading this thinks I am toying with you, let me add we have had many discussions about this in an academic sense ever since the time of Lee D's death.) We both have a habit of talking dispassionately about the taboo--it may be one of the occupational hazards of working in health care. It sounds callous, but we are actually being very thoughtful.
I only have one issue with people who actively commit suicide--and it has more to do with my personal opinions that we are not solely on this earth for ourselves, but also for others. Not necessarily "our brother's keepers" in a codependent sort of way, but more like "our sibling's siblings."
Active suicide generally does not consider the feelings of those left behind--the loss felt by others. I would argue it is the incredibly rare situation that everyone close to us would support actively killing ourselves. Passively, as a natural course of the end stage of disease is another situation entirely. Or, as I've often said, "I've never been to a funeral where the person killed themselves and everyone said, 'I'm glad they're dead'."
Most of the terminally ill who consider suicide simply want to escape the physical pain of terminal illness. People who commit suicide as a result of depression or another mental illness are generally not able, b/c of their illness, to discern how others would feel, or their pain is so great it simply is no longer on the radar screen.
So what I would say is this: To hear you discuss this right now doesn't bother me, b/c I perceive you are simply dispassionately discussing it. If I felt you were profoundly depressed, I would be concerned that you (or anyone else) are, at that point, too impaired to consider all the options, and thereby I would have more concern about that choice as "reasonable." Then my duty on the planet as the world's sibling gets in the way!
Why should when a person decides they are done be treated differently then why a person takes a promotion across the country or decides to divorce with children? If we are to be completely selfless in everything and never hurt people in our lives with our decisions...how do we make any significant changes in our lives?
I sense a bit of nervousness in all your bravado, Maria. I am in earnest, I'm not just striking a pose and waiting for reactions. As I stated, I also am not crying out for help here.
I find it interesting that a person cannot be seen as a rational adult and decide to end one's life merely because it is time - in the absence of terminal illness or depression.
I realize that Harold & Maude is just a movie and not completely valid, but what is your take then on Maude's decision? She has lived what she considers a full life after surviving the Holocaust.
I finally remembered the other cinema suicide that plays an essential role in a movie plot - that of Edward G. Robinson in Soylent Green. He too decides that he is done and acts on his choice.
I hear you, Renz. I actually think about this quite a lot. I've watched too many people hang on to EXISTENCE, not life.
I have no interest in living into my dotage. I'm not afraid of death. I am much more frightened of old age, pain, and being alone than I am of death. I can see deciding that it's time to go. And, as you note, there are many ways of getting to that point.
I do agree with Maria that deliberate suicide is almost always traumatic for families. That's the toughest part. Been there, came close to doing that--and very glad now that I didn't.
Dear Friend feels VERY strongly about assisted suicide in the context of Alzheimer's. His father died of it, and he is terrified of developing it. He talks often about how I am to give him "the Kool-Aid" if he begins to show signs. I've told him that, even as much as I love him and want to respect his wishes, I can't do that.
For one thing, I would look awful in an orange jumpsuit. ;-)
But for another, I do think that, for those of us who fear illness and suffering more than death, the biggest part of our fears has to do with losing what we consider the essential part of ourselves (e.g. our minds or our mobility) and our independence. I sincerely struggle with whether this is an issue of pride--and with whether or not we need to accept the help and service of others as part of our sojourn here on earth?
My views on this were shaped by watching my grandfather's long, slow descent into dementia. He would have HATED that--but my grandmother cared for him as lovingly as the two of them had cared for each other through their long marriage. I know it was terribly difficult for her---but she loved him dearly, and was truly devastated when he died, even though he had been senile for 10 years and bedridden for 6 by that point.
There is a line in one of my favorite novels, Zora Neale Hurston's Their Eyes Were Watching God, that had a big impact on how I see this issue. The protagonist, Janie, ends up killing the love of her life, who has been bitten by a rabid dog, in self-defense:
"Janie held his head tightly to her breast and wept and thanked him wordlessly for giving her the chance for loving service."
That line about "loving service" hit me like a ton of bricks, and I've never forgotten it. I still don't know how to process what my obligation to others is, but I do wonder...
Pax,
Doxy
My parents maintained throughout my adolescence that they would prefer suicide rather than suffer a prolonged painful death. I remember publications from the Hemlock Society in our home. This did not shock me - in fact it made sense to me.
When my parents started deteriorating, they both dealt with the concommitent issue of Alzheimer's Disease. I know from the letters they wrote to each other, conversations overheard that they firmly believed that I, in particular, and my siblings were trying to kill them - with each pill they took they truly believed I was poisoning them. So much so that my mother managed to get into a wheelchair on her own with a broken hip, and wheel up and down the hall warning patients that they pills were going to kill them.
We made a painful choice to discontinue oxygen and a feeding tube when my mother finally lapsed into non-being. They hadn't even bothered to write out a Living Will, or put a DNR order into place.
I honestly believe it is each individual's responsibility to make their wishes known, to write them down, and, if need be, to execute them.
I pray that I do not die a death similar to the one either of my parents did - with no dignity, tubes keeping them alive, and an overwhelming fear of dying.
I think that those of us who have suffered a major depression have less fear of death - not because we are planning it, but we know that, at times, we are dead even as we live. I find your feelings remarkably similar to mine, Larry, and remarkably reasonable.
Maria, I've reread your comment and take back what I said about nervousness/bravado. Your qualification was in regards to concern over interpretations of your comment not mine. My apologies.
Doxy/Kate - the really radical thing I am proposing is that there is no other necessarily as in fear dementia more than death. I truly believe that one day I will wake up and realize it is time. That I am finished. That I have done what I wished to do. Accomplished what I have wanted to accomplish. From that day forward I will make appropriate arrangements for any surviving animals. I expect my parents will have been long gone by the time I reach this point. If I were to reach it much sooner it would likely only be as a result of prolonged chronic illness and pain and then they would be included in my plans.
Doxy - if you haven't seen The Sea Inside rent it - it is very moving and thankfully I knew Javier Barden before he played the monster killer in No Country For Old Men...
You're correct about the nervousness being "how what I say will be interpreted" rather than what I say.
The other problem I always struggle with in the suicide scenario is what a friend once told me with regards to his thoughts once about jumping off a bridge. He said, "What if, halfway down, I change my mind? It's too late!" I said, "Well, if you were thinking that, you really were not wanting to kill yourself, you were just wanting the pain to stop."
The most common reason for suicide is for a pain to stop--physical pain from terminal cancer, emotional pain from depression, etc. Doxy's points are well taken. If one can't even get a loved one to write a living will, the "conditions for a reasonable suicide" seem to be a chasm to get most people to even articulate. I wish I had a dollar for every person who told a relative, "Just don't let me suffer," but could not explain in vivid detail what defined suffering for them.
i resonate with so much of this talk of attempted or contemplated suicide that it's almost like listening my own inner 'siblings'. experience does yield a certain objectivity, so i don't find anything scary about the talk.
the question is: once you're not afraid of leaving this side, what if the fear of pain is what we came here to deal with in the first place? what if we come here over many lifetimes to find and work out our fears, and fear of pain is one of those things to be learned & overcome? I grew up baptist & taught in a catholic school [not as scary as the baptist landlady who warned me daily about being careful around ''those papists!"] i remember vividly scoffing at the catholic notion of a ''mystery of suffering.'' now i wonder if there's more to it.
i had an odd semi-awake dream experience of total paralysis-- felt a weight holding me down-- and felt a brief panic, and then a presence with the single word 'endure'... then knowing that the part of me that really mattered was okay, that this ''being held down'' would pass. if the thing is to learn from dealing with fear of pain is trust, or obedience, or endurance, or all three, i can see how it was one way of learning it.
i don't know if that adds anything to the discussion, but it is affirming to find that the discussion is going on! thanks.
I admire those who find life precious under the most heinous circumstances. But everyone has a right to determine what, if any meaning, there is in having been born. I daydream about setting up clinics where those who believe they are done living---for whatever reason--can be counseled, confirm their decision in the presence of loving individuals, work out their affairs, and be terminated painlessly. Part of the service, paid for through life insurance policies that allow for this, is grief counseling and legal help for those left behind, if any.
Renz--I'm sorry if you read my comment as setting conditions for you (or others) or arguing with you. I believe I understand your point, and share it to a certain extent--though I have to filter my feelings on this subject through my concerns about what active suicide would mean for my children. (Something I couldn't do when I was severely depressed.)
Duck--I think that is an excellent question. It makes me really uncomfortable, which means I need to wrestle with the point you raised....
Doxy - sorry? for what? I didn't find anything wrong with your comment at all - not in the least argumentative. I found it very representative of folks' reaction to the topic. Keep commenting, babe, I love it and appreciate the recognition. It keeps me from feeling like I'm screaming in the wilderness. :-)
Doxy: "though I have to filter my feelings on this subject through my concerns about what active suicide would mean for my children. (Something I couldn't do when I was severely depressed.)"
I think right there you've explained what is the most defining thing for me about the difference between "not depressed" and "depressed."
A depressed person is simply unable to filter what anything means to anyone else other than through the lenses of their own pain. A depressed person is unable to filter their own feelings about their job, money, etc. They are unable to filter anything that has to do with their own feelings. It's like a mute button on their soul. Sometimes I wonder if when depressed people kill themselves, if they simply desired to feel something--even if the something was death.
Sometimes I wonder if when depressed people kill themselves, if they simply desired to feel something--even if the something was death.
In my own case, it was entirely the opposite. I was exhausted from feeling TOO much. I just wanted to rest....
I wonder why it is that we have come to accept that there will be physical pain that is untreatable and therefore an acceptable condition for considering hospice and euthanasia. Yet we do not allow that there is emotional pain that may be untreatable. Why is emotional pain considered to be universally fixable?
I think it stems from the still existing prejudice against mental illness buried deep in our cultural psyche. Either you are "mad" and therefore incapable of making a rational decision or you just need to get over it, here take this pill and buck up...
Seriously...if a man with worsening rheumatoid disease and barely controlled pain (I am actually thinking of a former patient of mine here under different circumstances) decided to take an overdose in order to achieve peace, our reaction would be very different than if the same man had been fighting a losing battle with depression for the same time period.
Yet we do not allow that there is emotional pain that may be untreatable. Why is emotional pain considered to be universally fixable?
Because emotional pain CAN BE transitory. Mine was. Change the situation (or the medication) and the pain might very well go away. But if you've killed yourself.... (I'm sure you've heard that old saw "Suicide is a permanent solution to a temporary problem.")
That's not to say that ALL emotional pain is fixable. But I think the recognition that some emotional pain can be extremely intense, but transitory, is why some people react negatively to the idea that suicide is a viable option for emotional distress.
Doxy, you're taking the opposite tack again - I don't deny what you have said. However, people tend to act as though ALL emotional pain is treatable.
I'm not saying that 2 months into a bleak depression it's time to check out.
However, there are people who never get beyond their depression. I am one of them. I will always be fighting depression/anxiety. I am fortunate that I respond well to my medication.
What I was suggesting is that there is a double standard when it comes to intractable, untreatable pain - physical vs. emotional.
I think it comes from a cultural belief that deep down the emotional pain is not real and if we just tried hard enough it would disperse.
I agree wholeheartedly with you that much depression is very transitory in nature.
What I was suggesting is that there is a double standard when it comes to intractable, untreatable pain - physical vs. emotional.
And I *do* agree with you! I was just answering your question about why people MIGHT see emotional pain as "fixable," when they are willing to grant that physical pain may not be...
Are you LOOKING for a fight on this one, Renz? ;-)
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