the thought of suicide....

[posthuman]

SUICIDE AS A MORAL ISSUE


by


Thomas S. Szasz, M.D.


"Suicide is an event that is a part of human nature. However much may have been said and done about it in the past, every person must confront it for himself anew, and every age must come to its own terms with it."
--Johann Wolfgang von Goethe (1749-1832)


Behind Goethe's simple statement lies a profound truth: dying voluntarily is a choice intrinsic to human existence. It is our ultimate, fatal freedom. That is not how the right-thinking person today sees voluntary death: he believes that no one in his right mind kills himself, that suicide is a mental health problem. Behind that belief lies a transparent evasion: relying on physicians to prevent suicide as well as to provide suicide -- and thus avoid the subject of suicide -- is an evasion of personal responsibility fatal to freedom.


Not long ago the right-thinking person believed that masturbation, oral sex, homosexuality, and other "unnatural acts" were medical problems whose solution was delegated to doctors. It took us a surprisingly long time to take these behaviors back from physicians, accept them comfortably, and speak about them calmly. Perhaps the time is ripe to rethink our attitude toward suicide and its relation to the medical profession, accept suicide comfortably, and speak about it calmly. To accomplish this, we must demedicalize and destigmatize voluntary death and accept it as a behavior that has always been and will always be a part of the human condition. Wanting to die or killing oneself is sometimes blameworthy, sometimes praiseworthy, and sometimes neither; it is not a disease; it cannot be a bona fide medical treatment; and it can never justify deprivation of liberty.


Increasing life expectancy, advances in medical technology, and radical changes in the regulation of drug use and the economics of health care have transformed how we die. Formerly, most people died at home. Today, most people die in a hospital. Formerly, patients who could not breathe or whose kidneys or livers or hearts failed to function died. Now, they can be kept alive by machines, transplanted organs, and immunosuppressive drugs. These developments have created choices not only about whether to live or die but also about when and how to die.


Birth and death are unique phenomena. Absent celibacy or infertility, practicing birth control -- that is, procreating voluntarily -- is a personal decision. Absent accidental or sudden death, practicing death control -- that is, dying voluntarily -- is also a personal decision. The state and the medical profession no longer interfere with birth control. They ought to stop interfering with death control.


Practicing birth control and practicing death control as well as abstaining from these practices have far-reaching consequences, for both the individual and others. Birth control is important for the young, death control, for the old. The young are often entrapped by abstaining from birth control, the old, by abstaining from death control.


As individuals, we can choose to die actively or passively, practicing death control or dying of disease or old age. As a society, we can choose to let people die on their own terms or force them to die on terms decreed by the dominant ethic. Camus maintained that suicide is the only "truly serious philosophical problem." It would be more accurate to say that suicide is our foremost moral and political problem, logically anterior to such closely related problems as the right to reject treatment or the right to physician-assisted suicide.


Faced with a particular personal conduct, we can approve, facilitate, and reward it; disapprove, hinder, and penalize it; or accept, tolerate, and ignore it. Over time, social attitudes toward many behaviors have changed. Suicide began as a sin, became a crime, then became a mental illness, and now some people propose transferring it into the category called "treatment," provided the cure is under the control of doctors.


Is killing oneself a voluntary act or the product of mental illness? Should physicians be permitted to use force to prevent suicide? Should they be authorized to prescribe a lethal dose of a drug for the purpose of suicide? Personal careers, professional identities, multi-billion dollar industries, legal doctrines, judicial procedures, and the life and liberty of every American hangs on how we answer these questions. Answering such questions requires no specialized knowledge of medicine or law. It requires only a willingness to open our eyes and look life -- and death -- in the eye. Evading that challenge is tantamount to denying that we are just as responsible for how we die as we are for how we live.


The person who kills himself sees suicide as a solution. If the observer views it as problem, he precludes understanding the suicide just as surely as he would preclude understanding a Japanese speaker if he assumed that he is hearing garbled English. For the person who kills himself or plans to kill himself, suicide is, eo ipso, an action. Psychiatrists, however, maintain that suicide is a happening, the result of a disease: as coronary arteriosclerosis causes myocardial infarction, so clinical depression causes suicide. Set against this mind set, the view that, a priori, suicide has nothing to do with illness or medicine, which is my view, risks being dismissed as an act of intellectual know-nothingness, akin to asserting that cancer has nothing to do with illness or medicine.


The evidence that suicide is not a medical matter is all around us. We are proud that suicide is no longer a crime, yet it is plainly not legal; if it were, it would be illegal to use force to prevent suicide and it would be legal to help a person kill himself. Instead, coercive suicide prevention is considered a life-saving treatment and helping a person kill himself is (in most jurisdictions) a felony.


Supporters and opponents of policies concerning troubling social issues -- such as slavery, pornography, abortion -- have always invoked a sacred authority or creed to justify the policies they favored. Formerly, God, the Bible, the Church; now, the Constitution, Law, Medicine. It is an unpersuasive tactic: too many deplorable social policies have been justified by appeals to Scriptural, Constitutional, and Medical sanctions.


The question of who should control when and how we die is one of the most troubling issues we face today. The debate is in full swing. Once again, the participants invoke the authority of the Bible, the Constitution, and Medicine to cast the decisive ballot in favor of their particular program. It is a spineless gambit: persons who promote particular social policies do so because they believe that their policies are superior to the policies of their adversaries. Accordingly, they ought to defend their position on the grounds of their own moral vision, instead of trying to disarm opponents by appealing to a sanctified authority.


For a long time, suicide was the business of the Church and the priest. Now it is the business of the State and the doctor. Eventually we will make it our own business, regardless of what the Bible or the Constitution or Medicine supposedly tells us about it.

 

[posthuman]

STRAIGHT TALK ABOUT SUICIDE
by

Thomas S. Szasz, M.D.

Straight talk about suicide. Ideas on Liberty, 52: 34-35 (September), 2002.


Suicide -- like accident, illness, death, poverty, persecution, and war -- has always been with us and has always been regarded as a part of life. Believing that a person's life belongs to God, not himself, the Jews declared it to be a grievous sin, and Christians and Muslims followed suit.

Enlightenment thought did not overtly repudiate this position. Instead, it supplemented it with a secular version of it. Suicide, declared the mad-doctors ("psychiatrists"), is due to a disease of the mind, which it is the duty of mad-doctors to prevent (by imprisoning / "hospitalizing" the madman / "patient"). The mainstream media and most people accept this ostensibly scientific doctrine as truth.

Although we now have more so-called rights than we have ever had -- such as welfare rights, disability rights, patients' rights, the right to choice, the right to treatment, the right to reject treatment, ad infinitum -- we have no right to suicide.

In the immediate aftermath of the attacks on the World Trade Center and the Pentagon, President Bush - with his disarmingly gauche use of language -- called the act "cowardly" and the terrorists "cowards."

That characterization of our Muslim enemies was quickly abandoned in favor of our "scientific" cliches: brainwashing and mental illness. Declared George Will: "And although Americans are denouncing the terrorists' ‘cowardice,' what is most telling and frightening is their lunatic fearlessness."

William Safire opted for brainwashing. He explained: "A more powerful weapon [than surprise] of radical Islam is its ability to erase from the brains of recruits the basic will to live. The normal survival instinct is replaced with a pseudo- religious fantasy of a killer's self-martyrdom leading to eternity in paradise surrounded by adoring virgins."

One of the effects of the September 11 attacks on the World Trade Center and the Pentagon was that every politician and pundit suddenly became an expert about the fine points of Muslim theology. "This perversion of the world's great faiths," pontificated Safire, "produces suicide bombers. How to build a defense against the theological brainwashing that creates these human missiles? That is the challenge to Muslim clerics everywhere... "

How wrong can our most respected pundits be before we begin to view their expertise as we regard the expertise of the Enron accountants? The Muslim suicide bombers are a challenge to their victims, not to their teachers and paymasters. Any other interpretation is our collective folly, serving to indulge our love affair with a misguided concept of multiculturalism.

Are brainwashing, cowardice, and lunacy our only choices? Surely, it is not difficult to see an Arab youngster training to become a suicide bomber and becoming a celebrated patriot and martyr as engaging in what he considers a rationally motivated series of actions. From the point of view of the future terrorist, his family, and his society, his actions are just as rationally motivated as are the actions of a young American engaged in going to college, studying medicine and becoming surgeon.

I maintain that, from the point of view of the suicidal actor, planning to kill himself and carrying out the act is also rationally motivated. However, we regard this interpretation as so flagitious -- so indecent -- that, for most Americans, it is as good as taboo. The only socially acceptable view is that suicide is a "cry for help," uttered by a person who has a mental illness (depression) and denies that he is ill.


Caused by Depression?


A large, multi-story shopping mall in Syracuse -- the Carousel Center -- has become one of the favorite places for young men and women to jump to their deaths. Every time this happens, the newspapers present the story as if the act were a symptom of -- that is, were "due to" -- the subject's mental illness. "Suicide jumpers often disordered," was the headline of a long report on the suicide of a young woman in April. "[She] had been battling the disease [depression] for several years," her father said. The rest of the long, double-headed article -- the other title was "Suicide-prevention counselor says barriers to jumping should be considered" -- was devoted to telling the reader that (most) people who commit suicide, or think of doing so, suffer from "bipolar illness"; explaining that the disease is genetic and chemical in origin; and that it usually responds well to treatment with drugs. This and other newspapers never mention that persons suspected of being "suicidal," or who try to kill themselves and fail, are routinely incarcerated in prisons called "mental hospitals."

Muslim clerics engage in theological brainwashing. Does the mainstream American media -- not to mention organized American psychiatry -- engage in therapeutic brainwashing? Of course not. We call this "educating people about mental illness" and "eradicating the stigma of mental illness."

Kay Redfield Jamison -- professor of psychiatry at John Hopkins University Medical School -- is America's poster girl for suicide as a preventable and treatable illness. She advertises herself "As someone who studies, treats and suffers from a severe mental illness--manic depression"; preaches the psychiatric mantra: "Suicide is due to mental illness and mental illness is treatable"; and explains: "I drew up a clear arrangement with my psychiatrist and family that if I again become severely depressed they have the authority to approve, against my will if necessary, both electroconvulsive therapy, or ECT, an excellent treatment for certain types of severe depression, and hospitalization."

Well and good. Does Jamison approve of other persons, similarly afflicted, having the right to reject psychiatric coercion and kill themselves? Certainly not.

We are so blind to the essentially human (non-"pathological") nature of voluntary death that we deny the reality of what people throughout history viewed as "heroic suicide." "Of all the ‘isms' produced by the past centuries, fanaticism alone survives," declares memory-champion Elie Wiesel. "We have witnessed the downfall of Nazism, the defeat of fascism, and the abdication of communism. But fanaticism is still alive."

Our political-ideological prejudgements prevent us from acknowledging Zionism as the reason why some Palestinians choose to kill themselves for political reasons. Our psychiatric-ideological prejudgements prevent us from acknowledging the slings and arrows of outrageous fortune as the reason why some Americans choose to kill themselves for personal reasons.

We are as squeamish and superstitious about suicide as people used to be about demonic possession and witchcraft. And we will remain so until we begin to take seriously how we talk about it.

 

[posthuman]

The thought of suicide is a great source of comfort: with it a calm passage is to be made across many a bad night. -Friedrich Wilhelm Nietzsche