Many of this site’s readers send me angry emails or texts. They post challenging comments. Some are so passionately opposed to suicide prevention that they resort to harassment. I have received threatening missives and phone calls from numerous people. Some urge me to kill myself.
A common argument is that people should be free to die by suicide without intervention by others, no matter what:
“For some people there is little to be done sadly and if they want to exit life then I completely understand and I believe they should be helped: either by medical personnel or at least by giving them access to pain-free means. This is the humane, moral and decent thing to do and it respects their autonomy and human dignity…”
That comment, by a reader named Zara, raises good points. It is just one comment among many that have caused me to question myself:
By advocating for stopping people from suicide except in the context of terminal illness, am I wrong?
Why don’t people, regardless of terminal illness, have the right to end their own life, without anybody interfering, interrupting, or otherwise intervening?
What if the suicidal person’s mental or physical suffering truly is intolerable and with no end coming soon, if ever?
Is it inhumane to stop a suffering person from ending their life?
Why?
Why not?
The Most Difficult, if Fleeting, Question
People who long for suicide typically want to escape unbearable torment. They experience deep emotional or physical pain, or existential malaise, or fear, or trauma, or psychosis, or material hardships like poverty, or something else so powerful that it snuffs out the biologically ingrained will to live.
They feel hopeless that things will ever change. Indeed, they do not simply feel hopeless. They are convinced their situation is hopeless.
People intent on suicide often want to end their lives for very compelling reasons.
I think of all this, and a troubling question settles on me. I dedicate my work to suicide prevention, but even I wonder, if momentarily:
Why not let them die by suicide?
Suicide Prevention and the Greater Good
In preventing suicide, yes, we are trying to help the suicidal person. We know, based on years of research about suicide attempt survivors, that even intensely suicidal people are likely to regain the desire to live. As I describe in the post “Where Are They Now?: The Fate of Suicide Attempt Survivors,” most people who survive a suicide attempt do not later die by suicide.
But we are not only helping the suicidal person by working hard to prevent suicide. We also are helping people who care about the suicidal person.
Suicide hurts the living. We strive to prevent suicide not only to save the suicidal person from dying prematurely and unnecessarily. We also strive to prevent suicide to save children from losing parents, parents from losing children, partners from losing love, and communities from losing valued individuals.
As Jennifer Michael Hecht wrote in her book, Stay: A History of Suicide and the Arguments Against It: “The whole of humanity suffers when someone opts out.”
In seeking to prevent one person’s suicide, we also seek to prevent even more suicides. People who lose someone they love to suicide are at higher risk for suicide themselves. One suicide can lead to another, what is called “suicide contagion.”
Please let me be clear: In describing the harm that suicide does to others, I am not blaming the suicidal person. Rather, I blame the forces that lead to suicide, just as the blame for a person’s death to cancer belongs to the cancer, not to the person who died. In this regard, the person who died by suicide is suicide’s victim – but not the only one.
A World Without Suicide Prevention
Some people lament that suicide prevention measures deprive people of the ultimate liberty – that is, the freedom to die on one’s own terms.
Consider the alternative: A society where people are not stopped from dying by suicide. Where parents and children and friends and lovers watch, without recourse, as tragedy unfolds. Where there is no pathway for keeping a suicidal person safe without the person’s consent, even though the chances are very high that the person will recover the will to live if given the chance. Where friends, family, and professionals are not allowed to prevent what might be preventable.
A society that tries to prevent suicide sends the message to people who suffer, and to those who love them, that their lives matter. That suicide is not the answer. That people care and can try to help. That things have a good chance of getting better.
No doubt, we need to do more as a society. On a large scale, people need more resources and more reasons to want to stay alive. If society treated people better – if there were more jobs, better access to health care, and less violence, for example – fewer people would want to die.
Society needs to do more for suicidal people besides keep them alive and miserable. But letting people kill themselves without providing any means for prevention isn’t a solution, either.
Questions In Search of Answers
More emails from strangers will come to me, missives full of challenges, perhaps even anger. I know this. I anticipate some of the comments:
You are selfish. Why should one person suffer so that others don’t?
Why should people stay alive to help society when society doesn’t provide enough help to people who stay alive?
Who decides what is best for the suicidal person? For society?
Those are good questions, and maybe I will tackle them in future posts.
What are your answers?
Copyright 2018 by Stacey Freedenthal, PhD, LCSW. Written for SpeakingOfSuicide..
Dr. Freedenthal, first I want to follow up my previous comment with an apology; I know your heart is in the right place, and as long as there are individuals who are still reachable, your website is a goldmine.
After having read more information on your site, you have inspired me, and I love your idea for a “hope box”. I would like to create one and pay your idea forward.
One thing that keeps me putting one foot in front of the other (which doesn’t happen every day) is knowing that I still have something useful to contribute to the world, even if I haven’t found that precise something yet. All of us do, even if it’s just connecting with others in similar situations. Not a single one of us is alone. It is so, so important not to isolate, but most of the time, I still do. I thought I would snatch this opportunity to take a small step forward.
Contemplating how to dig out from the bottom of a deep well of sorrow is overwhelming, and when one doesn’t know how, it seems impossible. I think a good place to start is knowing that as long as most of us are all still breathing, there is more right with us than there is wrong, and then build upon on the next right thing, and the next, in manageable, bite size pieces.
The “forces of suicide”? Bipolar I was not forced on me. There are no known cures for bipolar disorder. None. Not diet, not exercise, not therapy, and especially not religion – superstition is contraindicated to bipolar. My condition is disabling and I will be on medication forever – at least until I become treatment resistant. “Regain the desire to live”? I would never want to relive the rest of my life as I have spent it so far, and I never have. It has in no way been “desirous”.
My conditions may not kill me, but they are terminal and I will eventually die with them. In that respect, if and when I decide that I have exhausted my treatment options, I deserve to end my life just as any individual who is terminally ill with a physical condition.
Yeah, if I committed suicide, people would be hurt, but people who hurt over the deaths of loved ones hurt for selfish reasons. A few empathetic individuals might be glad that their loved one’s lifelong suffering has finally ended. And so it should be with people who have battled lifelong mental torment – I bet these people have subjected much of that torment onto loved ones, just as I have so unwittingly done.
Please get real.
Having a loved one commit suicide causes pain, but so does having to stay alive for other people. And not every suicidal person even has other people to stay alive for them. At the end of the day, a suicide prevention “expert” considers themself the savior of suicidal people but is actually their jailor.
I think it’s a huge mistake to lump all suicidal people into one category.
Teen suicide should always be prevented, nearly all of the time things are going to get better for that person just by default. The same is true of nearly any young person. Life at 35 is completely different and often better than life at 22. Most acts of suicide at those ages are impulsive acts.
I read a story a few years back about a 13 year old who killed himself because he lost his iPad, and of course there are the stories of people who were being bullied. That stuff is tragic. Of course it should be stopped.
I would try and stop that by cracking down really hard on bullies, myself, rather than working on suicide prevention… but I’m getting off topic.
Anyway, I’d be willing to bet that the vast majority of the success stories regarding depression revolve around that age group.
Then you’ve got people over 40 and the elderly.
By the time you’re 40, you pretty much know how your life is going to turn out. If you’re not well established in a career by 40 you probably never will be. Likewise for romance, money, etc. Those people, not all of them but a higher percentage, have been depressed for a long time, many of them have been slowly withdrawing from the world for years. The life of a 40+ year old, unless there are some acute stressors causing their lives to be bad, is NOT going to get better by default. And they know it.
I’d like to see the numbers on people who have been in a state of depression for 2 years or longer, and who are over 40. I bet they’re abysmal. Even if they don’t kill themselves, they’re just chugging along in no-mans land, contributing little and with no notion of why they’re really on this Earth. A lot like a ghost – a faded entity which resembles the person they once were, but in most respects not here anymore.
(I can talk so harshly about that group, since I am one of them)
Stacey, be honest… you’ve been practicing a long time. What percentage of those types of people who walk into your office, the older long term depressed people, are living meaningful lives free of depression within 2 years? I ask that knowing you do your best, but still, there are cases where you can’t draw blood from a stone.
As for elderly with chronic conditions and a low quality of life, and the terminally ill… I think it’s horrifying that people are trying to fight against THEIR right to die as they wish. By all means, you can have your opinion on it but don’t tell someone with stage 4 cancer, who is likely in terrible pain, what they should and shouldn’t be doing. That’s a very personal decision IMO and it should be. Arguing to deny that is akin to telling someone they can’t practice their religion – and oftentimes, people arguing against such things are motivated not by caring but by religious dogma.
In general I think most efforts to prevent suicide are cynical, like people who talk passionately about helping children in Africa but who would never even dream of actually going to Africa and helping them themselves. It’s a knee-jerk response which makes people feel good and tells the rest of society that, “Yes, I care about life”, or “Yes, I’m saying what Jesus would say”.
People listing the suicide hotline number kind of make me angry for that reason, even though I’m sure they mean well. To me it comes off as insincere, a lot of it does, and I really hate insincerity especially in a topic like this.
Paul,
Those are good questions. I can say that I’ve worked with, and also know personally, people over 40 who did come out of severe depression and find hope and meaning in life again. But I agree with you that suicide prevention needs to be different for different age groups. The issues are different, and the approaches to (possible) solutions also need to be different.
I wish to clarify a couple things, and one day I’ll write a post about this: I don’t tell people whether or not to die by suicide. But if they come to me for help about their suicidal thoughts, I try to help them stay alive. If they come to others for help about their suicidal thoughts, I think others should be free to help them stay alive. If they involve others in their planning or are found after a non-fatal attempt, I think others should be free to help them stay alive, too. What people do in private about their life or death is their choice. This is why we have almost 50,000 deaths by suicide in the U.S. each year. I know, commenters on this site have criticized me for holding a view that prohibits suicidal individuals from being able to freely discuss their suicidal thoughts without fear of intervention, and thus being forced to die alone by a method that method that might not actually kill them but instead make them worse. I struggle with that. I do. But, so far, I haven’t come up with an easy answer. I don’t think it’s fair to loved ones to force them to do nothing; it’s human nature to want to save a life, not (necessarily) out of some love for Jesus or sanctimonious belief in the sacredness of life, but out of a blend, I think, of compassion and instinct.
For the record, I do support physician-assisted suicide in cases of terminal illness where the condition is irreversible.
Thank you for sharing here, Paul. I appreciate your letting us into your thoughts and beliefs about this sensitive topic.
I appreciate your efforts to prevent suicide. As a disabled person, a disability rights activist, and an advocate working against physician-assisted suicide, I also appreciate many of the points you make in this article regarding the societal and ethical dimensions of suicide prevention. In particular, it is important that we continue to have robust discussion and action about these dimensions, and what more could we be doing as a society to prevent suicide, without blaming or shaming. You mentioned a few – that society should be devoting more resources to improving the quality and availability of employment (including widespread low-cost and no-cost training options and good-paying jobs), violence reduction (including restorative justice), and healthcare services. The latter needs to include not just universal access to healthcare generally (including palliative care), but also universal access to behavioral health services. Behavioral health services need to include ample counseling options (individual counseling, couples counseling, group counseling, etc.) as well as medication and other options. (A disproportionate amount of behavioral health resources and research are unfortunately spent on medications instead of counseling options.) Moreover, we need to redouble our efforts to increase opportunities for all (including the areas of employment, housing and transportation) and to eliminate social stigma and prejudice. The latter especially includes eliminating stigma and prejudice directed against disabled people (including people with “mental illness”) and the barriers which discourage an open and honest discussion and resolution of problems associated with the devaluation of disabled people in our society. Social devaluation of disabled people (especially against mentally disabled people) has an enormous cost to our society in many ways, not the least of which is how it results in the social isolation of disabled people. Lastly, suicide prevention programs and services need to be open and available in a nondiscriminatory way to everyone, regardless of disability status. I hope that you and other professionals devoted to suicide prevention will continue and strengthen your efforts, and to actively seek alliances with disability rights activists working to increase opportunities for disabled people in our society. Thank you.
You have recommended solutions to many of the side-effects of unfortunate situations which induce people to commit suicide, but you fail to consider the situations themselves, many of which are beyond solution. Consider people with renal failure, for example, who have a very high suicide rate, since dialysis requires them to waste the entire day on treatment one day and then the entire day recovering from the exhausting effects of treatment the next day. This is not a life but a living death, and since the availability of transplants is so low, only a tiny fraction of patients ever escape this horror by getting a new kidney. Similarly, what is your solution to things like people going blind, becoming paralyzed, being utterly abandoned by friends and relatives, losing a cherished career forever, becoming bankrupt, having a stroke that leaves you largely brain dead, countless things leave people in intolerable circumstances with no possible solution except escape.
Oscar,
I understand the point you’re trying to make, but I want to point out, not only for you but for other readers, that a great many people who have experienced renal failure, blindness or paralysis live meaningful, fulfilling, and happy lives. Same with people who lose a cherished career, go bankrupt, suffer abandonment by friends and relatives, and so on.
One of the great mysteries of suicide, to me, is how some people experience grave physical, financial, and emotional hardship but do not want to die, while others experience no outward source of suffering and might be affluent, successful, and well loved but do want to die by suicide. Of course, it’s not either/or; some people with external sources of suffering want to kill themselves, while some people with affluence and success don’t have suicidal thoughts. But it’s simplistic to believe that any one thing causes suicide.
Thanks for sharing here. Your comment adds to the complexity of the discussion.
Stacey, I just don’t see how you can, in good conscience, say that the people who don’t find that new lease on life under those circumstances should simply be trapped, with no way out. You seem like a compassionate person, and I cannot see how you reconcile that nature with the knowledge of the fates to which you are condemning innocent people, a certain proportion of whom will not change their perspective to match yours. Just imagine still being quite young and feeling trapped with no way out, with a great long future of suffering stretched out ahead of you with almost nobody advocating on your behalf.
We wouldn’t be allowed to inflict on the worst criminals the types of fates to which we are abandoning a certain proportion of suicidal people who never get the happy endings. If we started actively putting people in the positions that we are trapping suicidal people in, it would be decried internationally as an abominable human rights abuse.
Michael,
I’m not actually saying what you think I am. Of course I don’t want people to be trapped in endless suffering (and thank you for acknowledging I seem like a compassionate person). My challenge is, how do we know that someone’s suffering is endless? I’ve worked with countless clients who were convinced they were trapped, hopeless, and better off dead, and who no longer feel that way. The damage caused by suicide is so great, and the people can be so bad about predicting their future, that I try to stand on the side of hope, not hopelessness. There are very few circumstances (though I concede there are some) where a person’s life is completely incapable of changing for the better.
You state, “Just imagine still being quite young and feeling trapped with no way out, with a great long future of suffering stretched out ahead of you with almost nobody advocating on your behalf.” Many, many young people have felt trapped with no way out, felt certain that a great long future of suffering awaited them, and been wrong. The question then becomes, who should mental health professionals help: the part of a person that is convinced things are hopeless, or the part that is seeking help and trying to change?
These are big questions with no easy answers. Thank you for making your points here and for the constructive, thought-provoking conversation.
This makes me sad. Because I wonder what will happen when I try see the damage I’ve caused to myself. I don’t want to know. For if i know, and it’s hopeless, i won’t keep to the side of life. Yet if I keep to the side of life now, then find out the damage I’ve caused, then what?
The real question is, why resist suicide if it is the easiest, quickest, and most certain solution to horrible life circumstances? If you strip away the remnants of religious mysticism which say ‘God owns your life; you may not take it yourself,’ then there is no reason not to treat your life as the inconvenient rock that holds your misery in place, the strategic force which does not let you escape your troubles . My recommendation is that keeping life or just getting rid of it should just be regarded as one more step in the practical improvement of our lives, and that life should not be regarded as something sacred against the interests of its owner.