Suicide

My second class tonight featured a woman whose husband had committed suicide. She made many philosophical errors in her subsequent advocacy but made a few courageous stands. Her first act of sheer bravery was to tell her children that their father had committed suicide after it had happened. Society would generally tell her to hide it from them and reveal it when they were older. However, given my experience with adoption and my parents telling me (not the same, but the reveal could be just as powerful or traumatic), that this was an amazing decision! My parents were counseled to do what they did. She made her decision on her own (or as she says, through god). And I'm willing to bet that if she had consulted a mental health professional, slaves to traditionalism as we are, we would uphold the social order and tell her to lie to her children until they were older and ready to handle it.

The second act of courage is also where she starts running into philosophical problems. She became and advocate for survivors of suicide (the term for those grieving a completed suicide) as well as suicide prevention. She stands athwart school districts who would rather pretend that suicidal and parasuicidal behavior do not exist, and is working to introduce an educational curriculum into school districts in the suburban Virginia area. However, when I asked her about the sociological impact of introducing that campaign, she seemed only to grasp that her program might reduce suicide. She furthered that sentiment by implying that she would like to eradicate suicide. I asked her if by talking about suicide and putting it out into the open, she might be normalizing suicide, making it less taboo of a subject. This would certainly lessen the shame of survivors and the idiotic blaming of the survivors for the suicide (hello, just world fallacy). I didn't want to push the subject because from the tone of her voice and body language, she was visibly upset. But it was scary to me that she wouldn't have thought of these implications, since she is trying to affect social change and that implies a shift in ideas. Just as harm reduction and rational drug education programs can help those who choose drugs to do so more safely, they also make it less taboo for drugs to be used. It's not the intended effect, though a positive one (I believe), but it nevertheless exists.

I have some other issues with things she said, but I don't want to ridicule the woman. She obviously found a very positive way to cope with a terrible scenario and did so in a way that questioned the proper behavior for a survivor.

Now, onto the meaty theoretical discussion on why suicide is neither good nor bad. My professor made the terrible mistake of trying to stake out a middle ground between all suicides are bad (or are fomented by mental illness) vs. suicide is neither good nor bad. She intimated that she held some sympathy for those who were chronically physically ill and made the rational choice to end their lives, rather than go through months of torture and pain. This was perhaps acceptable to her, but those who are "mentally ill" and make the same calculations must be saved from themselves. Why?

She made a comment and the words are escaping me, but they belied the most heinous of value judgments. Who decides whether a person's life is worth living? If you have a patient who is severely depressed and has exhausted all of his or her treatment options, why is it wrong for them to conclude that suicide is preferable to life? You don't know their life. You can only glean from their statements how they feel on a daily basis. How can a clinician ethically judge another's life worthy objectively and unilaterally?

Speaking of objectivity, how can a clinician in my placement judge a person's logic to be not right? If I were some of my patients, I'd be suicidal, too. There is no way I'd want to live with Dissociative Identity Disorder and Borderline Personality Disorder among several dozen diagnoses. How can you say she would be better off slogging through her life instead of letting go of it?

Bringing this again into my practice and my thought, is it right for a social worker to advise a suicidal person on the least harmful/most peaceful means of committing suicide? There are resources, however unused, on how to kill oneself including a manual called the Peaceful Pill Handbook (now a website). Apparently, there is also the Hemlock Society which advocates for the rights of those who wish to commit suicide and provides some community support. Grief textbooks can be reverse-engineered to create a way for the person to inform their families of their intentions, allow them to say goodbye, and understand the reasons they are ending their lives. In the invention of the suicide note, it seems as if it is important for the person committing suicide to convey their reasons and feelings. This may lessen the families ambiguity following the death, as well. Furthermore, by becoming educated on the methods of suicide, they may choose to end their lives in the least gruesome way, lessening the trauma on the family even further.

These methods and resources may (and I stress may) be congruent with harm reduction methods. They are certainly consistent with the person's autonomy, dignity, and free will. Social workers cannot ethically act in a paternalistic manner towards their clients, and respecting their wishes, no matter how incomprehensible, must remain paramount.

I suppose that I should make it clear that none of my patients are in danger of having me tell them or help them commit suicide. These are merely my ideas and while they may have philosophical import, they may be wrong and may harm others. I cannot act on them.