On logical suicide

I was at an internal medicine grand rounds talk one day when a colleague started speaking about “logical suicide”; as in suicide that does not seem like the irrational choice we all have come to believe it is. Experience, philosophy, or science, have taught us that a human being’s overriding desire in life is to live. If we deviate from this, if a person wants not to live, then that human being must be ill or evil. But are there ever situations when suicide can actually be thought of as logical? It takes a little bit of tearing down of our usual norms to even contemplate this, but I was curious to explore this further.

A life worth living

In medical ethics circles you’ll often hear the terms “a life worth living” and “quality of life” banded around. What is a life worth living? Most of our lives. We have our basic physiological needs met; we have freedom to think, decide, and act accordingly; and we have (most of us, I mean) the physical capabilities to transform our desires into acts. But, then, just what is a life not worth living? You could say that it is a life that lacks those things we spoke about before, but that’s not true. You may lack any, a few, a lot, most, or all of your physical abilities and yet still consider your life worth living. The important thing is that decision on the ‘worthiness’ of your life is made by you, the owner of that life and body.

A life not worth living

The medical profession and some societal groups, though, have decided on certain broad aspects of a human being’s existence which, if lacking, deem that person’s life a “life not worth living”.  Things like if a person’s brain lacks measurable electrophysiological activity, or if the person requires constant support in their nutrition, hydration, breathing, etc. Of course, the problem with a third party deciding which life is worthy and which not worthy of living is a very fearful one. The Nazis, for example, conceived a concept of “a lifeunworthy of life”. Initially, they considered it a socially useful tact to destroy peoples who were brain dead, brain impaired, mentally retarded, or psychiatrically ill to the extent that they could not survive without the assistance of others. It was considered that these people weren’t worthy of life and in fact were unaware of what life meant, therefore, eliminating them from society (by purposely killing them) was totally acceptable. We are now all very aware that the Nazis’ category of “life unworthy of life” eventually extended to some very broad groups of people and resulted in mass killings without a logical rationale. I, am, however, now digressing…

Suicide

Why do people suicide? That is a question psychologists, scientists, doctors, religious people, and a lot of us ask every day! What do people who suicide tell us (in their last writings or after a “near miss”)? That they did it to end to the pain, that they could see no other options in their life, that they no longer wanted the mundanity of life, that they had failed beyond what they considered remediable, that they had succeeded enough that anything further would be a downhill decline which they didn’t want to face, that they had nothing left to live for, that they had more to gain in death and the afterlife, that they didn’t want to be a burden on others around them that supported them in their existence, etc., etc. People’s reasons for dying are as complex as those we live for. And yet, for most of us, living just seems like the right thing to do. Most of us don’t even question it. And when we become ill or our life is threatened in any other way, our instinct is to try to preserve it. Then what is wrong with people who want to die? People will often quote you that up to 95% of people who commit suicide have a mental illness, for example, depression. But I’ve always wondered about the other 5%. OK, OK, 4% didn’t have a diagnosed mental illness but were intoxicated with drugs or alcohol, acted impulsively after a sudden change in life circumstance, or suicided “accidentally”. But what about the remaining 1%?

Logical Suicide

I’ll start by acknowledging that I’m playing devil’s advocate here just to explore this question further. My colleague who spoke of logical suicide was in fact speaking of one of our patients. It’s not that he disliked this patient and wanted him to die, he was just saying that if this patient decided to suicide, it wouldn’t be considered a totally irrational thing to do. Of course, there were a gasps of disbelief in the room and a few chuckles thinking he was purposely trying to bring up a taboo for a few laughs. How could he speak such preposterous ideas? Because he knew the patient was very aware of his own conditions. The patient did not suffer an intellectual impairment and he knew what he had been through with his condition and that it was only going to get much worse for him. He was in constant pain and discomfort. He was still physically able to act so as to procure his own death and he was not depressed or suffering any other mental illness. Would he want to face further suffering and physical deterioration? If he didn’t, would his opinion be irrational? If he suicided, could you consider his decision illogical? What happened in that room with our colleague having raised this, is that the conversation quickly changed topic. It is still taboo to speak of these things, apparently.

Now, consider a person who, like most of us, has set an agenda for his life, something he would like to achieve and this is what motivates him day to day to keep living. For some of us this is doing a particular job, helping others, marrying the person you love, competing in a sporting race, raising your children, making music, self-expression, visiting a particular place on earth, caring for your parents, etc. These are things worth living for, for you, at least. Now, let’s consider, for example, a person whose sole motivating thing in life is to get married and have children. He wants that more than anything else in life, and that would make his life happy and complete. He is not unhappy without it, however, but he is just existing with the purpose of achieving his dream. What if he was born with a physical impairment that meant he was completely dependent on someone else to care for him and as a result wasn’t able to meet any women to have potentially fall in love with him, marry him, or have his children? He reaches 20 and hasn’t met anyone yet, online or in person. He reaches 30 and he is still in the same predicament. He reaches 40 and his parents, who are his only source of real meaningful love (but not of romantic love, which he desires), are becoming elderly and still his predicament hasn’t changed or improved. He isn’t any more likely now to a) become free of his illness, b) prevent his own physical deterioration, c) find a new overwhelming desire/purpose for his life, or d) fulfil his own self-designated mission in life. What is he living for? How does he answer that question to himself if he isn’t a religious man? Is he living to wait for his death one day?... Well, if this man suicides thinking he has nothing of value to him to live for, could you honestly say his suicide was not logical?

Living

When someone speaks of suicide, of contemplating it, we often see ourselves come up in defence of “life”. We tell the person that they should seek treatment for a mental illness, or we “remind” them how wonderful life is, or we tell them how missed they will be and how many people love and care for them, or we say that perhaps soon medical science will come up with a solution to what discourages them from life, or we tell them to think of how much they will hurt others if they go through with what they’re contemplating… We’re actually pretty good advocates for life! However, perhaps what we should be doing instead of telling others how to feel or what to think, is ask some questions of how they’ve reached their conclusions. The person most likely to convince you of something, even living, is yourself. And hearing back your own arguments for life vs. death is perhaps the only way to have a person change their minds on suicide.

Until recently we still spoke a lot on suicide prevention, but that lead to a lot of people (family, friends, religious ministers, health professionals, etc.) feeling guilty. They were feeling guilty because suicide was being discussed as purely “preventable”, which mainly implied that it could and should be prevented, and if a person succeeded in suiciding then it meant that someone (or everyone) had failed this person. The emphasis is now shifting to raising ‘suicide awareness’, to be able to recognise those at risk of suicide. Most of these people can be helped. The others we may not be able to prevent from suiciding, but we can equally help while they’re living. You don’t need to be anyone special or especially-trained to do this, all you have to do is be a human being and engage the attention of another human being. Who knows, they may just help you too.

On teen suicide... and living

A few months ago when Declan Crouch, a 13 year old boy, went missing, his disappearance was likened to Daniel Morcombe’s. However, after some time it proved that the age of the boys and the fact that they were reported as missing persons may have been all they shared in similarity. The fate of both boys have become more clarified in the recent months and it’s not my intention here to rehash the news. But I do want to rehash a thought I once had on teenage suicide.

I read a book by Udo Grashoff called ‘Let me Finish’. It’s a copy of and study on a series of suicide letters. One of the interesting findings is that the suicide letters written by teenagers are the most mysterious, confusing, and give the least detail on motive. They're often very profound philosophically and spiritually. They list their motives not in terms of their personal struggles, but rather about the plight of humanity in general. For example, a child who is being bullied or is being subject to abuse from their carers actually rarely writes about their personal experience and their circumstance. Their suicide letters tend more to be filled with their insights into humanity, the negative aspects of our society in general, and they often conclude with a wish for us who remain alive to be well. To an external party looking at their case we may see a child who was suffering due to abuse and become so stressed that they choose to end it all. What the children themselves tell us is that it is not dissatisfaction with their own circumstance, but rather with our society and our world in general.

One of the things often said of suicide is that it’s a permanent solution to a temporary problem, and in the case of adolescents you could even argue that their decisions are made on generalizations about the rest of the world based just on their personal negative experience of it in their microcosm, for the short time of their lives that they’ve had to experience it. However, having said that, isn’t it true that our world is, in fact, a lot like a typical adolescent’s microcosm? The ‘popular kids’ with money and power (corporate types and politicians) set the trend for the majority of us. The majority of us are here just to do what they’re meant to do to survive (the ‘working class’), and trying to behave so as not to piss off the popular kids or those in power, like our parents and teachers (law and government). And no-one really wants to get in trouble with these people (jail-time, fines, oppression, getting fired, etc.)! When teens suicide, we as adults think, 'but they have so much more to lose by dying', but it's almost as if they leave us saying 'we have so much more to gain via death'. And compared to more mature adults, their decision to die seem to be more definitive. They hesitate less.

Is there something adolescents see about our society that makes them so sure? Before I get onto that, I just want to acknowledge that we already know that the human brain’s prefrontal cortex, which is tasked with making our ‘mature’ and ‘rational’ decisions, isn’t fully developed until about the age of 21 years. Of course, people “mature” at different rates and it is said that females will reach this stage before males do. It is also not a yes-no type of separation between maturity and immaturity. Possibly since before the age of 2 years a child can make decisions based on preference (of colour, taste, texture), etc. Gradually, as a child matures, different aspects of a particular choice creeps into their decision-making process (e.g. immediate and long-term consequences, cost, effect on self and others). So what I am trying to say is that I acknowledge that an adolescent is not ‘fully mature’, but taking a look into their thought process is definitely worthwhile, especially given that a teen who suicides is making a very significant and conscious choice.

What, in signing off ‘I have so much more to gain via death’ does a teen aim to achieve? An older adult may see in the teen potential in terms of years of life remaining, in abilities that can be developed, and in knowledge to be gained. But it's almost as if the teen turns around and says, 'I can see where this is going and I'm not interested'. What exactly about our world are they seeing? I suggest that a teen may be rejecting a world they perceive as being unjust or incoherent. Now, I already mentioned that they may be overgeneralizing their particular situation to the whole of the future and the whole of society, but let’s pose for a second that they aren’t exaggerating in their perception. Let’s consider. for example, what the “adult world”, the “real” world is like.

As a child when I didn’t get my way, I cried and threw a tantrum. As I grew older I learnt to hold back the tears and the rage (things I instinctively want to do when I don’t get my way), to accept that things aren’t always going to go my way. Now I was considered mature. Yet the same reality was still true: I lost! As adults we always have a choice, though not all options necessarily produce equally ego-syntonic results: to accept things as they are, or to act so as to change them. The truth, however, is that most people live in stagnation, we get too used to accepting injustice; trying to change things is too hard. That’s the reality and cowardice a lot of people live/exist in. A lot of adults in our society become docile little cogwheels, indifferent, accepting of injustice (to ourselves and other human beings), dampening our true feelings and passions, working the jobs we have rather than the ones we want – always at the bequest of the ‘popular kids’ and in fear of punishment. How is that living? Really? What really is the difference in between an existence like that and death? I can see how to the teen this inaction may look remarkably close to death already.

And yet having said all this, you’d think I’d be petitioning for us all to suicide! In fact I’m petitioning that we all instead start living, deciding our own fates. Every revolution is fought by individuals, and we are all qualified. No-one ever asked permission to start a revolution. So why not start living as if we were actually alive?