Depression Marathon Blog

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Diagnosed with depression 19 years ago, I lost the life I once knew, but in the process re-created a better me. I am alive and functional today because of my dog, my treatment team, my sobriety, and my willingness to re-create myself within the confines of this illness. I hate the illness, but I'm grateful for the person I've become and the opportunities I've seized because of it. I hope writing a depression blog will reduce stigma and improve the understanding and treatment of people with mental illness. All original content copyright to me: etta. Enjoy your visit!

Monday, March 2, 2020

May we discuss suicide?

I've been wanting to write this post for awhile, but I knew it would take a lot of energy, and I just haven't had it. I also knew it would take a long time and prolonged sitting, which hasn't been doable since my hip surgery. But it's time to give it a try. 

Here's the question. Is it okay to have a discussion about suicide? Is it possible, especially as someone whose depression has tried to take my life more than once, to have a frank discussion about suicide without panicking those around me? And is there anyone out there willing to have that discussion anyway? I've broached the subject with my doctor and at least one friend, but not to the depth I've wanted. I guess this post is my attempt to get the discussion going even if it's not face to face.

I began thinking about suicide more objectively during my last severe depression relapse. I began wondering, when is it okay for someone with a chronic mental illness to decide to take their life? Is it ever okay?

In November, as my psychiatrist was endeavoring to admit me to the hospital, I repeatedly said something to the effect of, "It's my life. It should be my choice. I should have the right to make this decision." She, of course, informed me she felt that was my depression talking and sent me off to the hospital. In that moment she was correct. It was my depression talking. But this question, the right to die on one's own terms, has been on my mind ever since.

It's interesting. As soon as this question niggled my mind, I began seeing the issue everywhere I turned. First I came across the movie, The Bridge. The Bridge is a documentary about the Golden Gate Bridge and follows the stories of several people who decided to jump.

This documentary drew me in. In graphic, painful detail I watched with compassion and empathy as one suffering person after another stood at the edge and contemplated their last moments. I viscerally understood their desperation in those moments. I could feel the depth of their pain and hopelessness. I've been there. It was so familiar. I got it.

Unfortunately, many of the survivors who were interviewed didn't seem to get it. They didn't get it! Despite warning signs, statements, and downright knowledge that their loved one was suffering and contemplating suicide, many survivors were cavalier, cold, and detached afterward. I heard dismissive statements downplaying the depth of their loved one's suffering. I heard blaming statements. Consistently, the thing I didn't hear was a sense of empathy. It was frustrating and maddening. And I didn't understand.

Shortly after viewing The Bridge I came across this graphic. It was shared on Instagram by The Depression Project.

Wow. How true is this graphic? Take a moment. The "Suicidal" side of the graphic is what I saw and heard in the documentary, The Bridge. It is what I often see and hear in healthcare professionals; yes, even mental health professionals. And certainly this is what I frequently see and hear among the general population.

I experienced "No one believes they'll ever do it" when I attempted suicide at 17, despite the fact I had told multiple people of my desperation and intention. The most troubling truth I see in this graphic, however, is "Everyone feels irritated." I don't understand that. Besides sharing it, I'm not sure how to change the reality of this graphic. It is a powerful illustration. Ironic that I came upon it while still digesting my feelings about The Bridge.

The niggling didn't stop at this graphic, though. Recently I came across an article in Outside Magazine which also dealt with suicide. It was an article about a couple who lived in remote Alaska. He was an artist. She had MS. They had been married for years and were considered by all who knew them to be soulmates. She didn't want to live through the ravages of MS. He didn't want to live without her. They put their affairs in order, left their home, and died together somewhere in the wilderness. It was exactly how they wanted to end their time on earth, and they believed they were headed to a higher spiritual realm together.

As with most Outside Magazine articles, this one was thorough and interesting and made me think. I found myself feeling supportive of their decision. I respected how thoroughly contemplated and planned their decision seemed to be. They left nothing to be managed in their wake. They believed they were headed to a better place where they would be content, together, forever. Of course, I didn't personally know this couple. If it were one of my family members or close friends, would I feel the same support? If the circumstances were equal, I think so. But I'll likely never know.

I believe it is the right of any person with a chronic condition to end his/her life. If the pain or debility is such that life is no longer worth living, I believe we as humans have the right to die. We have a right to choose. That is what I believe.

But here's the question. Is it ever okay for a person with chronic depression to decide to commit suicide? If they are unable to live a life worth living, if they are unable to participate in the quality of life they desire, if their illness is treatment resistant and they've tried everything, and if they can't deal with the pain of another relapse, is is okay? Is it more okay if the decision is made outside of a severe depressive episode? Is it understandable? Forgivable? Is it their right, ever? That is my question.

I'd love to hear your thoughts.


Paul Lamb said...

How is chronic, debilitating depression (I've been there) different from a physical illness that debilitates and steals dignity? If suicide is a reasonable response for the latter, why not for the former?

I think the taboo about suicide is an unexamined "rule" in our culture. We're raised to "know" it is wrong. I was raised knowing it was a "sin." That god had given me my life and through some non sequitur sophistry I was persuaded that it was only his/her/its choice to take it. This was drilled into my brain in overt and subtle ways until I no longer thought about it any other way. The "why" of it is never considered. Only the "what" of it gets discussed. ("it's wrong!") I think it is an easy fallback position to the question. It saves people the trouble of thinking for themselves about a difficult matter and coming up with their own conclusions. Rather than think hard about something, people eagerly grasp a quick and easy answer, generally sent down from an "authority." I think the same sort of thing is true about the lack of empathy among survivors. Rather than think they might have done something or should have paid closer attention, they can feel indignant and insulted instead. It protects their ego.

I think Aristotle was among the first to discuss the problem of suicide, and his argument against it was that when slaves did kill themselves, they were robbing their masters of their labor. (Early capitalism!) The privileged master class had no misery-inducing complaints. Similarly with the various church teachings. If too many miserable/oppressed people make their exit, there will be no one left to plow the fields or fight the wars or add their pennies to the collection plate each Sunday. Suicide is wrong because it reduces the work force, but we'll dress it up as a sin so there can be no arguments about it.

I take your point one step farther. I believe I was born with a quit-claim deed on my life. As an adult, I can end it whenever I want for whatever reason I want. If I am bored. If I am disgusted with the state of the world. Or if I am sick. (Yes, there are temporary situations that seem permanent at the time, and yes, children probably can't make such an informed decision.)

etta said...

@ Paul: Thank you. I knew I could count on you for thoughtful insights.

As for your first point, my doctor argues that the difference between depression and other chronic illness, at least in my history, is my depression relapses have always ended. So at what point is it okay to pull the plug? She makes a valid point. I still feel I have a right to make the decision, but with that history in mind maybe I'm able to hang onto hope for a bit longer than I would otherwise. Perhaps thinking about or deciding where that ending point would be while I'm WELL would make tolerating the relapses a bit easier. Maybe I wouldn't daily struggle with overwhelming thoughts of suicide (tortuous in and of themselves), when I'm SICK, if I'd already decided what constituted my breaking point. It's an interesting thought.

I love your summary of the religious objections and the, "It's wrong," fall back position. It allows us to avoid the inconvenience of introspection and thought. It keeps the taboo subject taboo because there's no discussion, no attempt to understand. It's just wrong. End of story. That's too easy, in my humble opinion.

And I had no knowledge of the Aristotle viewpoint! Very interesting. Thanks for that.

Nathalie said...

Etta and Paul, what an interesting discussion. I hate the stigma around suicide. I think it is a subject that if discussed more openly and in depth may help those who lack empathy to perhaps gain more understanding of those who experience such mental anguish that in fact there is no ‘choice’ it’s the only way to end the pain. I also have frequently recurring episodes of severe anxiety and depression during which I struggle with the tortuous suicidal ideation, always terrified that I may one day follow through on those thoughts and feelings. It’s not the fear of the act so much as the fear of devastating my loved ones who are left behind.I find that when I am well I have hope and no longer think of suicide, yet that can lure me into thinking that maybe I won’t suffer another episode, which somehow feels like a kind of ‘trick’ because deep down I know I will.
I know I am being subjective and this is more of an objective discussion, I respect and admire people as in your example Etta, who having lived their lives in the way that they chose out in the wilderness and made their choice to die together for the reasons they gave leaving none of their responsibilities for those left behind to have to deal with. Equally I so understand and empathise without judgement those who complete suicide while feeling that terrible sense of desperation and despair, (without forward planning and organisation).
I agree with Paul’s first question /point. At the same time your psychiatrists viewpoint Etta that ‘it’s the depression talking’ is valid as you say. Also your response is thoughtful and courageou. You are realistic about possible future episodes of illness whereas I avoid confronting the reality under the guise of ‘hope’. .

etta said...

@ Nathalie: Thank you so much for participating in our discussion! This is exactly what I was hoping for, a discussion.

I've been where you've been, Nathalie. The fear of devastating those I would leave behind has occasionally, I think, been the only thing that kept me alive. And maybe that's a good thing? Probably.

I have to admit I would have missed out on a lot of life if I had been successful in my suicide attempt (or more recently would have followed through with a plan). I value and cherish the experiences I've had, the people with whom I'm surrounded, and the beauty in this world. That statement alone should inform those around us who "don't understand" the oppressive enormity of the pain and hopelessness we experience; so enormous, so oppressive, it obliterates the beauty, cancels the relationships, and overrides the experiences we cherish. It leads us to the conclusion of suicide instead.

Nathalie said...

I am aware that I am being subjective rather than objective by perhaps focusing on my own experiences rather than being objective with more of a philosophical response. However I am hoping that the one will have relevance for the other.
Etta and Paul, I was thinking about what you have written and the points you have made in this discussion about suicide. Very interesting and meaningful. I was sitting in my car in the almost deserted car park of my local McDonalds at about 11pm UK time. Why do I mention that detail? Well because it has been my ‘achievement’ of the week to go to my small local supermarket at night in the dark for a few groceries to somehow keep me alive. Then to buy myself my first hot ‘meal’ of the week. You see I am in the midst of yet another suicidal episode of anxiety/depression precipitated by the death of my darling precious 13 year old rescue dog Molly. A lab/collie x. I was immediately tipped into that terrible dark place -profound suicidal depression. Since she died on Nov 18th I have barely left my bed; rarely showered; hardly eaten. I feel ashamed. Such behaviour would possibly have been viewed as self sabotaging by the local community mental health team. I am 72 years of age (younger in spirit when I am well) living in an (assisted)/independent living complex where there is plenty of company in the surrounding apartments; except I can’t engage. I feel I have this ‘secret’ - mental illness which people might gossip about if they knew. So I withdraw completely....Ironically I know this behaviour feeds into the ‘stigma’ that I am so against perpetuating....especially if it was ‘known’ that I have suffered since childhood with increasing severity and apart from during young adulthood have been treatment resistent at the mercy of months long episodes once or twice a year. I am thinking ‘how can it help
my mood to betray my own beliefs in this way. The same might apply to my betrayal of my beliefs during Molly’s final hours. I have tortured myself with the thought of how much she must have suffered before I was brave and decisive enough to ‘let her go’. For around 18 hours I went against everything I believe in by not making the decision to end her suffering with earlier euthanasia. My desperate anxiety obliterated my decision making powers. Unless a human being was unconscious they would have a voice and be able to say ‘please do it’....animals rely on us humans to be their voice. How could I be so cruel as not to speak out on Molly’s behalf to my lovely caring competent vet at the animal surgery/hospital?.In this case my false and remote hope that she might recover was totally inappropriate. Animal euthanasia is universally legal unlike assisted human suicide. This furthers my guilt at behaving inappropriately and betraying my strong beliefs. I am hoping that when I recover I can forgive myself and be able to focus on our happy memories together during which times Molly gave me such joy, an emotion that is replaced by numbness and despair during the months long episodes of this chaotic mental illness which nowadays happens sometimes up to twice yearly.

Nathalie said...

Paul I was interested to read your point about Aristotle (early capitalism) as I like to learn new (to me) information. His argument - practical...though a little harsh? ...the ‘I’m alright Jack attitude of the privileged! I have to say I wonder how our privileged (uk) politicians in government can really fully understand about the struggles/ challenges of ordinary people without privilege. But maybe I should steer clear of politics? I understand that access to the (UK) welfare benefit, universal credit has been improved. The (potential and actual) destitution that has until more recently been caused to individuals and families by difficulty in accessing this ‘new’ benefit’ that has been ‘rolled out’ to replace the very complex previous benefit, has in fact caused some people to attempt and complete suicide. I have read that it may not be fully realised statistically the extent of these tragedies.
I have found your cultural and religious points very interesting too, Paul and am in agreement.

Etta, I found your paragraph relating to your valuable and cherished experiences of life that would have been missed out on, had your suicide attempt been successful, mirrors my own experience. As does my experience of the anguish and agony experienced when episodes of illness crush and destroy any joy and peace we may have known previously, filling us with terror and leading us to feel we have no choice to go on living. There is only one way. Suicide.

etta said...

@ Nathalie: I am so sorry for your loss. Remember, you did the best you could at the time, and that's all we can do. Regretting the past, in my experience, has not been good for my mental health. Allow yourself to grieve. Losing a pet is so difficult, yet having a dog has been (and is) one of the greatest joys of my life. Grieve. The memories of joy will return.

Anonymous said...

Thank you Etta

Nathalie said...

Thank you Etta

I hope your physical healing is prgressing....

Katy said...

I wanted to let you know that you have certainly helped me through some hard times. I have had times when I left to go on a run or a walk, stopped in the middle of my run to check your posts, then I let you know I did do the run. You being there helped me on those days. I think that you are helping more people than you know. Even when I'm super busy like right now because I have to figure out how to teach 6th graders online, you are on my mind. You are helping defeat the stigma with this blog. I just found about the group: Still ; Run (Still I Run). The semicolon is the "I" which goes with the semicolon. I certainly don't have the answers to the questions you posed. I don't really think any of us truly do. I just wanted to take the opportunity to thank you for what you have done for me. By helping me, you also helped my husband and my daughter, Ana, who is 13 and my son, Eli, who is 11 and may have generalized anxiety disorder (this is what they call depression/anxiety in kids). He has a great therapist. I try to be honest with him about my depression. We also go exercise together as a family every morning right now. This morning exercise is key for helping our mental health. It helps us start out the day. Anyway, love from New Orleans!

Anyway, my family is certainly counting on you to be there because you are improving our quality of life daily. That is really powerful. Thank you!

etta said...

@ Katy: Thank you so much for these kind words. I appreciate what you said, because I can understand stopping mid run to look for motivation or connection from afar. In fact I'm sure I've done it myself. I'm honored to have been that connection for you. Humbled and honored. Thank you. Your comment helped me today.