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.
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?
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.”
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.
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.
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.
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?