Suicide is a Homonym

shutoff valve

Not long ago I found out a man I used to work with was diagnosed with ALS. In my day job, I help employees who have disabilities and need a leave of absence or help performing their jobs because of those disabilities. Naturally he called me.

He was the exact opposite of how I’d be if I just found out I had a protracted, terminal illness: calm, plan-full, laughing, resigned. Although, he did tell me a secret: “I have a wife and daughters, and I have to be strong for them. But when I’m in the shower, that’s when the tears come. I do my best crying in the shower.”

We talked about the company’s different leave of absence programs, medical plans, life insurance, and short- and long-term disability benefits. He told me he hoped he would realize when he was no longer able to work and “bring value.”

“I don’t want someone to have to force me to leave.”

Of course, I wondered what would I do if I were him. And the answer came to me without hesitation, like an eager understudy waiting in the wings.

I would commit suicide.

Not right away.

Not while I was still relatively healthy.

Not while I could still take care of myself.

But right before I felt like I was becoming a burden on my family.

Just before I felt like I didn’t have control over my life anymore.

I knew this because of the man I’d watched die a few years before.

A documentary called “The Suicide Tourist” featured that man. His name was Craig Ewert, and he had ALS. When I say I watched this man die, that’s exactly what I mean. He traveled to a clinic in Switzerland called Dignitas, and with his wife by his side, he drank a lethal cocktail of drugs followed by a chaser of apple juice. A few minutes later, he died.

John Zaritsky, the Canadian director, received a lot of flack for showing the actual moment of Ewert’s death. But he had a good reason to do so: “It would be less than honest if we were to make a film about the process and not actually be able to see the ‘hole in the hat’ as it were,” he said. “We would be left open to charges that the death was unpleasant, cruel or wasn’t even done willingly. People can judge for themselves.”

And I did.

Watching Ewert’s life end, seeing the exact moment he stopped living, was scary and intimate and heartbreaking. But it also seemed…right.

It made me think of my grandmother who had died of lung cancer more than twenty years before. When my parents cleaned out her dresser after she died, they found bottles of morphine in the bottom drawer. At the time I was horrified. I couldn’t imagine the amount of suffering she had been going through (or anticipating) that she would resort to taking her life.

But when I talked with my former co-worker that day in June, it all made sense.

Then Robin Williams happened.

And I realized “suicide” is a homonym.

People’s opinions of and feelings about suicide appear proportional to the person who took his or her life: a child or teen, an adult with mental illness or an adult with a terminal medical illness. It seems like most agree on the below:

1- Most human death is sad to someone, and those left behind experience varying levels of grief for hundreds of different reasons specific to each person’s life experience.
2- Teen suicide is probably the most tragic and the one that tends to stir up similar emotions in people. If you’re older than eighteen and still alive, then you’ve been a teenager and you know what that experience is like. What’s so agonizing about teen suicide is that they haven’t lived long enough to know from experience that things do get better, even if it’s just a minuscule amount. Like maybe they’re able to make it down one hall at school without getting called a name, or pushed or shoved, or they’re able to hang out on social media for one afternoon without being harassed, or maybe they learned one effective coping skill.

After those two premises and specifically as it applies to adults, suicides are not equal. There is a huge discrepancy in how people react even though the types of adult suicide have more in common than most people will admit:

People develop a condition and seek treatment.
Sometimes it’s successful, sometimes it’s not.
When it’s not, people suffer.
When their suffering reaches a level they can no longer bear, they do what they need to to end their suffering, either actively or passively.

But what’s most striking about adult suicide is the way people respond to the underlying factors that drive people to it.

In the days and weeks after Robin Williams’ death, there were thousands of people talking about mental illness and how important it is to ask for help, to seek treatment, to fight the dark demons that call you to take your life. Suicide hotline numbers were everywhere. People came forward and admitted how close they had come to becoming another statistic.

This happens every time someone well-known takes his or her life.

But where is everyone when your neighbor or your co-worker or your brother or your husband take their lives?

Where are the 5k runs, ice bucket challenges, Lollapalooza-sized concerts and colored ribbons before people kill themselves, while they’re suffering and struggling to get better?

It seems most of us can get our heads around people who have cancer or ALS wanting to end their life before their suffering is too much to bear. So why don’t we feel the same way about those with mental illness?

Let’s be honest. We’re furious with people with mental illness who’ve committed suicide because we think they were weak and didn’t fight hard enough, or they were cowards and took the easy way out, or they were selfish and didn’t consider those they left behind.

Would you say the same thing, aloud or in your head, about the cancer patient or the one with ALS?

Of course not.

And don’t you dare think that people with mental illness don’t know that.

People with terminal medical illnesses have options regarding ending their lives:

  • They can talk to family members and friends about their wishes and plans (even if it’s just declining further treatment).
  • They can address that elusive “why,” although it’s rarely necessary.
  • They can prepare their family members and friends for the inevitable even if the inevitable comes sooner than anyone had anticipated or wanted.
  • They can orchestrate their funerals and life celebrations.
  • They can make financial arrangements for their family.
  • They can check things off their bucket list as rapidly as they want without the worry of setting off alarms.
  • If they live in or travel to certain states or countries, they can have medical professionals help them to make sure everything is handled in a controlled environment.
  • They can surround themselves with their loved ones when they leave this world.

How many of those options exist for a person with mental illness intent on ending her life?

You can argue that people with mental illness aren’t in any state to make rational decisions, to think about the fathomless depth of the consequences of their actions. Katie Paul succinctly sums up many of those consequences in her raw post “10 Things You Should Know Before You Kill Yourself.”

But in the end, their level of rationality doesn’t matter because the world does not exist where they could talk about their desire to end their life. They don’t dare.

And if they do, what do they get for their honesty?

In many places, it’s a 72-hour hold in a psychiatric facility. With other people telling them what their options are. What they can and cannot do. Coercing them into treatments when in their bones they know the only “treatment” that will end their suffering is one they have to administer themselves.

With no one around them.

With no help.

With no ability to plan for all the contingencies or to ready their loved ones for the inevitable.

Without being able to say goodbye in a meaningful way or at all.

I think about Craig Ewert who left the living world surrounded by people who loved him and supported his choice to end his life when he felt it was the right time, even though they were crushed that they would soon be without him.

And then I think about Robin Williams.

Alone.

And I have to ask: Who are we to quantify a person’s suffering?

Can we really say that a person with a mental illness who wakes up every day and only sees more hours, days, months and years of agony is suffering less than a person with cancer who knows she has two months to live?

Really?

When we talk about people who are dying from a terminal medical illness, we talk about their quality of life. We understand and often even advocate for their right to say, “I’ve had enough.”

But when the conversation turns to people with mental illness, we talk about the quantity of their life, about keeping them alive for as long as possible because it’s the “best thing.”

For who?

Maybe if a world existed where people with terminal illnesses of any kind, including those of the psychological variety, were looked at in the same way it would be different. Yes, the Mental Health Parity and Addiction Equity Act has been around since 2008, but we still live in a society where if you can’t see a person’s illness then she must be faking it.

I cannot tell you the number of times in my job employees and supervisors have said to me, “She doesn’t look sick.” Is it any wonder with that type of attitude people remain silent? Until that thinking is annihilated, thousands of people with mental illness will continue to turn to palliative measures like illegal drugs, alcohol or suicide.

I know the medical community in general doesn’t consider mental illness a terminal illness, but that’s nothing short of negligence and denial. Look at the numbers. More than ninety percent of people who commit suicide have been diagnosed with mental illness.  And the number of people with a terminal or chronic illness who are diagnosed with mental illness is also high, anywhere from twenty-five to seventy-seven percent.

I’m not saying we shouldn’t offer help to those who want it.

We should.

But we need to listen to what kind of help the person wants. Even if that “help” means ending their life.

And why don’t we do that for people with mental illness? It’s because of the suffering we’ll feel when they’re gone, because of the fear we have imagining life without them, because we don’t feel strong enough to carry on.

Sound familiar?

But nobody thinks or says that the left-behind are cowards, selfish or weak.

This is the post I’ve been referring to in my last two “Over Coffee” posts (here and here). This is the one I’ve been scared to write, the one I’ve been avoiding writing because I’ve been imagining the reaction people might have.

I know it will anger some people. I know some will say I’m advocating suicide, that I’m being irresponsible for suggesting that it’s okay for people with mental illness to take their lives. I know people will say that if I lost someone to suicide I’d feel different. I might. I don’t think there is anyone who can say with a hundred percent certainty how they’d react to a specific situation if they hadn’t yet faced it.

I also knew that no matter how I prefaced this post, how much I tried to clarify what I meant or to explain my rationale, I wouldn’t be able to get it right for everyone. And I’m at peace with that.

Because some things are worth saying. And this is one of those.

question_mark_flat
So, what about you? How do you feel about the differences in people’s reactions to suicide? In what situations do you believe suicide is justified and when is it not? What would you want if you were a Craig Ewert or Robin Williams? What would you do if you were their wives or daughters or mothers?

26 thoughts on “Suicide is a Homonym

  1. What an amazingly powerful and thought provoking piece. The bravery you have shown to post it is inspiring.

    I keep going back and forth. First I think, “Yes I agree.” and then “Wait, no I can’t be okay with “healthy” people committing suicide.” but then, “Who am I to decide for others if they are “healthy”?”

    Like I said, extremely thought provoking. Thank you.

    1. Thank you Robyn! Depending on the day and my mood, I might even change my mind, but that’s what minds are for.

      This post has been brewing in me for quite some time. I’m glad I finally had the guts to push “Publish.”

  2. Kelly-
    This is too jam-packed with thought-provoking details for me to digest it without another read (or three). I’m going to be mulling it over and promise to post my reactions in a few hours.
    Let me say this: I admire you for putting this out there. Say what you believe. Stand by it. I’m proud to say I know someone with deep convictions who is not afraid to stand up and be counted (even if I end up disagreeing on some levels).
    Go girl!

  3. An excellent post. There is a line drawn in the sand it appears at times between people suffering with mental illness and those with another terminal disease in regards to their treatments and end game. In Oregon we have an assisted suicide law that is not used as often as you would think. I don’t know if mental illness would qualify for the law.

    1. Thanks for reading and for your thoughts, Haralee. I also watched a documentary about the law in your state, and I think you’re correct—it’s a small percentage of people who actually take the medication they’re given and you have to be free from any mental illness.

  4. Kelly-
    I appreciate your stance on this issue. Anyone who is willing to stand firm on a position has my respect.
    I love your argument that accepting suicide in the case of physical illness and rebuking it in the case of mental illness is a double standard. If there is no hope, there is no hope. Case well-stated and accurate.
    That said, I don’t believe suicide is ever the right choice. A few thoughts about this:
    Why can’t we accept that life doesn’t belong to us? We didn’t choose when, where, or how to be born and we won’t choose when, where, or how we die. To think we can have control over that is playing God. He is the one who breathed life into mankind in the beginning (and in the womb – Job 33:4). Why can’t we trust him to end it at the right time and in the right manner?
    I stood beside my mother’s bedside when she took her last breath. She had been diagnosed with a terminal disease 5 years earlier. The most recent treatments for it had robbed her of the energy to live life the way she envisioned. When the breaths sounded like window panes in the wind, I prayed for God to take her. He did – within minutes of my prayer.
    I believe she is with Him now. I respect that other people don’t share my beliefs. Does my faith take away the pain? No. I don’t know if it even eased it in the weeks before and after her death. Love is pain. It is also joy. Why do we believe we are entitled to the good without the bad?
    In reflecting on your post, I have written nearly 1800 words in a document called “Ramblings and Ponderings.” I was going to write a blog post and reference yours, but I don’t feel like my blog is the place for addressing this topic. It isn’t part of the brand I want to build.
    Thanks for being courageous. I hope people will be kind when they respond to your post. After all, we CAN disagree without being disagreeable.

    1. I LOVE that you gave it that level of thought, Sharon—it means a lot to me. I think there are probably quite a few people who believe like you do, at least I expected there would be.

      I have not yet had to face the death of a parent so I can’t even imagine what that’s like. But the experience with my co-worker along with another excellent article I read in The New Yorker when I was researching/writing this post made me realize there are conversations I want to have with my parents before it’s too late.

      Thanks again!

  5. As someone with severe lifelong depression, this touched lots of nerves. Thank you for writing this. Our society needs to address suicide as it is far more common than most people think.

    I have lost many friends to suicide. It sucks. But they were their lives. Ultimately we should have control over our own bodies or life is just slavery.

    I become rather upset when people bring up God and suicide. When my first female classmate suicided there were comments about how God will punish her for the act. WTF! The ones God should punish are the people in her congregation that were obviously not there for her, or were just as judgmental before as after her suicide when they were snarking about her “awful act.”

    Before I found a way to live happily with depression I spent years that were filled with torment, I thought about suicide. I was too chicken to do it. People who commit suicide aren’t cowards. It is horrifically frightening to face the act. It stopped me. I am alive because I am a coward, and I am glad I am.

    Just my two cents worth. Again, thank you for writing about this.
    Nancy Hill (@Nerthus) recently posted…Friday Find – Photo Watermark by IfuniaMy Profile

    1. Hi Nancy. I’m sorry to hear about the struggles you’ve had with depression. I’ve experienced my own episodes, but luckily there have been breaks in between, which have given me opportunities to surface and catch my breath. I can’t imagine a never-ending battle…

      This is a highly charged issue, and when religion is added to the mix to creates a nuclear bomb—there’s a lot of passion in religion, no matter what side of the fence you fall. People bring their entire worldview to issues like this and I wouldn’t expect anything else. I’m personally grateful religion doesn’t factor into this for me, but I know not everyone feels that way.

      I’m glad you’re still here too, regardless of the reason. I’m glad you found a way to live your life the way you wanted to despite your depression. I sincerely hope you’re able to continue to do so for a long, long time.

      Thank you for sharing your two-cents—I’m now richer for it. 🙂

      Take care!

  6. I’m with you. There’s something to be said about the quality of a life that must be weighed against the length of a life. If I were to become bed ridden or unable to care for myself, I would figure out a way to kill myself, simple as that. We live in a society where everyone wants to live to be 100, but I’d rather live to be 75 and healthy, than linger on into my 90’s without any energy or with a serious illness. Such a well written piece.

  7. Kelly it’s a wonderful piece! Very thought provoking. I want to think about it a little more. I’m coming from a weird place right now I’ve had both loses in my life within days of each other. My 41 year old BIL just passed away (last year) he had throat cancer and one of my best friends committed suicide days later (not related). You brought up some very good points. I’d love to have this conversation over coffee! I love that you would stand up and be counted for your beliefs. It’s terrific. Shared.
    Rena McDaniel recently posted…PT. 10 A YEAR WITH ALZHEIMER’SMy Profile

    1. Thanks Rena. I’m so sorry to hear about your losses…that’s a lot in a very short period of time. I’m glad you’re still standing, even if you do feel like you’re coming from a “weird” place. 🙂

      Take care of yourself!

  8. Not surprisingly, I’ve been digesting this and trying to figure out how I feel about it.
    I’m all for euthanasia, and I’ve told my family that if I am ever in a vegetative state to switch me off. The same goes for a chronic terminal illness — I’ll be getting out as soon as I can.

    But to me (and I’m not a doctor) depression is more like diabetes — there is no cure and it will kill you unless you have a system in place to manage it. I don’t think we’d be so accepting of people with diabetes refusing treatment in order to die … or maybe we would?

    The problem with depression is that is impairs a person’s ability to think rationally about the situation — it’s a disease that corrupts the decision making capacity of the brain. I’ve read about suicidal people who say they go into a fugue state and their grasp on reality disappears. Perhaps it’s not the suffering that flicks the switch but a real, tangible, chemical malfunction.

    I don’t know — I fear I’m waffling here.

    I’m angry that my husband died because it seems to me that he would still be here if he had got the right treatment. In my mind, he didn’t have a legitimate reason to end his life, because his suffering could have been easily alleviated. I guess it goes to the heart of the issue about stigma — I’m sure he felt too ashamed or embarrassed to ask for help.

    In the end, what I think or feel doesn’t really matter — he, and others like him, will continue to end their lives and I can’t do anything about it. The only person I can look after is myself.

    Thank you for bringing up this topic (and your link to my site). Thinking and talking is always a good thing.
    x
    Katie Paul recently posted…Writing from the Unconscious • Story is a State of MindMy Profile

    1. I’m so glad you read the post and commented, Katie. I was really hoping you would.

      Someone asked me yesterday what I thought about your post I linked to. This is what I told him:

      I’ve bookmarked that post and have referred to it many times. I’ve held onto it in case anyone I’m close to says that they’re considering ending their life so I could share it, which I would do in a heartbeat.

      I think it’s important for someone considering suicide to take a moment, even if it’s no longer than it would take to read that post or information like it, and realize what the loss of them might do to others.

      I’d share it not because I’d want to guilt them into staying alive, but because I think people make the best decisions when they have all the information they can, and I’d consider those 10 things important information to have.

      But I also believe in personal choice. I’d be devastated if they said they still wanted to go through with it but ultimately it would be their decision, not mine.

      Like you, I’d want the person with depression to try everything he could to get help and I think (although I have no data to back this up) a large portion of people eventually find relief. I’d want the same thing for the person with a terminal medical condition. But I agonize over the idea of asking or expecting anyone to continue suffering because of how I feel, regardless of what kind of suffering she’s going through.

      As long as the “crazy” stigma continues to exist, people with mental illness will not be treated the same way as people with terminal medical illnesses. And I fear in the end, we’ll lose them, some of them, one way or another.

  9. This is a lot to think about and the most challenging issues in our lives have few, if any, easy answers. I could comment one way today and probably reverse myself tomorrow. Thanks for saying this Kelly.

    The two primary suicides that have happened in my life were – a guy I knew (and dated once or twice) hung himself in his garage after serving in Viet Nam and my daughter’s fiance walked in front of a train. I felt the focus on both of these deaths was the dramatic way they took their lives, not the suffering that got them there.

    I wonder if some of our fear of ever considering that choosing death if death isn’t physically at our doorstep could be a viable option, might be based in our needing to cling to the concept that only God should take a life. Or did we create God being in charge of death as a way to monitor our own behavior? I know you aren’t advocating for suicide, Kelly, but I am pondering the topic from this perspective.

    I have lots of experience in dealing with a suicidal family member. To say her pain, when she is most fragile, is any different than someone dying of cancer is a total failure to understand what depression does to a person. And the added burden of secrecy is possibly the most unbearable piece of it. Think of it this way – if I was talking to you about a cancer patient, I might tell you what family member I am speaking of (not by name, but maybe as my sister, my mother, my cousin). However, I don’t share that information in any way here to protect her privacy. That all sounds well and good on the outside, but am I really protecting her identity because mental illness is so in the shadows…. a lot to consider in the early morning.

    1. Like you Ann, depending on the day I may very well feel differently. It’s the discrepancy between how these different types of illnesses are treated, in every place along the spectrum of the diseases, that angers me so. I don’t think my feelings will change, no matter how much progress takes place with mental illness because I don’t believe it will ever have the same level of support, understanding and care that physical illnesses are afforded. The stigma is too great, and the beliefs, and fear, people have about those with mental illness is deep-seated. And that makes me very sad.

      Thanks for reading and for your thoughtful comments.

  10. This is such a complicated issue – but the only way to start wading through it is for smart people like you to write and/or talk about it. There is too much “hiding” around mental illness. Depression runs in my family, and I have had two uncles commit suicide. Nobody ever wants to TALK about it – which makes me sad, because it is a disease that needs to be addressed. Thanks so much for this very thought provoking piece.
    Lana recently posted…Back to School BluesMy Profile

  11. As your post so aptly shows us, it’s a complex issues. People lash out at those who take their lives because we miss them, we don’t want them gone, they have value to us and we find it hard to believe they don’t see their value and would leave us. But, we don’t have that dark depression, not most of us anyway, so we have no idea what they face every single day. We don’t understand mental illness. My ex suffered lifelong depression and it was extremely hard for me to deal with his coping mechanisms. In his case they weren’t the healthiest (to say the least). But I did get to see close up what that kind of deep depression was like, as close as I could get without having it. It was horrible to see. I am so sorry for those who go through it and just can’t judge them if they decide to move on.
    Carol Cassara recently posted…Just trustMy Profile

Hit me with some comments:

Your email address will not be published.

CommentLuv badge