Is suicide inherent proof of mental illness?

Great Debates
61

Dementia or other progressive neurological disorders. If a person chooses to live with such a condition, fair enough; I know we have at least one member of the Board who finds life well worth living even with early-onset Alzheimer’s. But I know that I, for one, could not abide the slow dissolution of my own mind. Yes, it would be physically painless. It would also be, technically, nonfatal - Alzheimer’s patients generally die of a secondary condition.

But it would also be utterly intolerable. There is something viscerally horrible in losing one’s sense of self. My grandmother has Alzheimer’s, and seeing her decline over the years has been profoundly disturbing. I don’t know if my father inherited a genetic predisposition to the disease, and I don’t know if I inherited it from him. But I decided long enough that I would never suffer from advanced Alzheimer’s disease; if diagnosed, I would continue living as long as my symptoms remained mild, and end the affair cleanly once symptoms threatened to progress.

This isn’t, btw, an idiosyncratic view - Terry Pratchett has been very outspoken in his belief that he should be able to legally end his own life before he loses his mind to dementia.

62

To throw another example in, how about a person who, through extreme negligence, causes the deaths of a dozen children? She finds she cannot live with herself, and becomes suicidal.
Is she mentally ill? Would it be more rational for her to be able to put it to one side and be able to laugh and smile and care about the minutia of life again?

Because humans aren’t really wired that way. What guides many of our lives much of the time, is caring hugely about the effect of our actions on others.
Are we all mentally ill?

63

Couldn’t one argue that it was a form of mental illness that led to such extreme negligence that led to the death of the children that resulted in her ultimate suicide?

64

Suicide is an escape mechanism. If viewed in that way, then it is not inherent proof of mental illness.

You’re Bernie Madoff in alternative dimension. You’ve been caught. Instead of going to prison, you put a gun to your head. Completely rational as a way of escaping punishment.

You’ve been kidnapped by foreign invaders and forced into the cramped quarters of a ship’s hull along with hundreds of other people. You have no idea where you are going, but you know it can’t be good based on the hell you’re already enduring. So you decide to leap off the side of the ship the first chance you get. Completely rational as a way of escaping pain and terror. Neither brave or cowardly…it’s a choice that defies judgment.

We’ve already covered health problems, both of the body and the mind. For the latter, I’m thinking of the torture of hearing loud, scary voices constantly. You kill yourself to get away from that, just as someone would kill themselves because of excruciating chronic physical pain. The proximate cause is a mental illness, but it’s not like the voices commanded you to commit suicide. You killed yourself to escape the pain that happens to dwell in your mind. Completely rational, though hard for some people to understand.

You accidently do something tragic, like driving a little too fast on black ice and mowing into a schoolyard full of kids. Or you leave something burning on the stove and accidently kill your whole family. The guilt is too much to bear and no amount of comforting from others can console you. You commit suicide because you feel like you don’t deserve to live anymore. I would say this is not rational, though the reaction is completely understandable. It is not a rational thought to believe that you don’t deserve to live because of something you did on accident. On purpose, maybe, but on accident? And everyone knows it and feels bad for you? But even though the thought itself is not rational, is this mental illness? I’m really not sure. A person can believe all kinds of irrational things (like that a supreme being is constantly watching them, despite the lack of empirical evidence) and still be mentally well.

Is it always irrational to hate one’s self? What if a person wakes up one day with tremenduous guilt for all the real horrible things they’ve done to others. Perhaps their meanness was motivated by a mental disorder or substance abuse, but the guilt or self-hatred would be an understandable reaction whatever the cause. So I could see someone committing suicide not due to a mental illness but because they finally have awareness of how they have negatively impacted people. They would be escaping the pain created by this realization. That would make it rational. So I guess this person is really no different than the accidental killer.

So the more I think about it, no, suicide is not inherent of mental illness. It is proof of pain, though. There may be a very tiny number of people who have committed suicide just for kicks, but I think pain is the underlying theme for all suicides. I guess it doesn’t make sense trying to categorize that pain. Though I still think survivors are free to feel whatever they want. If I commit suicide, I certainly wouldn’t expect everyone to understand or feel sympathy. And as I wouldn’t want to be judged for the feelings that drove me to my action, I don’t think it would be fair to judge others for theirs. Feelings can’t be helped.

65

So perhaps not all “mental illness” is truly irrational in it’s genesis then? If escaping the pain of physical illness is a rational reason for suicide, why is escaping the pain of mental illness not as well? I would categorize that person who suddenly awoke to the realization and guilt of all the wrongs he had done in his life, and the resulting mental anguish, as mentally ill. The mental illness may be a result of totally understandable, rational circumstances (accidentally killing a bunch of kids) but the resulting mental state IS in fact one of illness and a disruption of hormones and neurotransmitters in the brain (in the same manner that is present in historically “mentally ill” patients). So I would think that yes, necessarily suicide is inherent proof of mental illness.

66

I think that’s a pretty broad definition of “mental illness.”

I don’t think any and all mental anguish should be categorized as mental illness. That renders the term useless. I think that’s what makes mental illness different than physical illness and thus harder to understand. If I catch a cold, I’m physically ill, even though it is a mild and temporary state. But if I’m sad because my best friend is moving away, am I mentally ill? Or just experiencing a normal reaction?

I would say mental anguish that falls outside the realm of “normal” could be indicative of mental illness. For instance, I would think falling into a deep clinical depressive state because my friend is moving away would be a reaction that’s beyond two standard deviations of the normal response. Alternatively, if your friends and family corner you into an intervention of sorts about a life-long history of mean, selfish behavior and you realize, after listening to their tales of woe, that you really have been hurtful, I don’t think it would be unreasonable for you to feel such mental anguish that a suicidal response would be understandable, if not a rational way of escape. The fact that you would even need an intervention would definitely be abnormal, but I don’t think feeling remorseful after having one would necessarily be a sign of mental illness. The mean, selfish behavior precipitating it would, though.

67

I think monstro has said it much better than I’m going to be able to, but I feel that I should reply.

First of all your suggestion would broaden the definition of mental illness beyond any usefulness. We’re going back through the chain of events and finding something that is not even strictly a behaviour (negligence), and labelling that a symptom of mental illness. Why?
What precisely is mental illness, or are we just using it in an ad hoc way?

Secondly, you’ve somewhat missed the point of my hypothetical.
People tend to say that the thoughts of suicide themselves are inherently irrational and a product of mental illness. The point of the hypothetical is that this is not necessarily the case.
By scratching around for other things to call “mental illness” you’ve implicitly conceded the point that suicidal thoughts themselves may not be irrational, given a particular set of circumstances.

68

I have no doubt that suicide is probably indicative of pain in the vast majority of cases, but I don’t think we can say it’s absolute proof. There are other reasons to commit suicide.

Mr. Excellent mentioned Alzheimer’s. Alzheimer’s isn’t painful, but for him, living with severely compromised mental abilities is unacceptable.

In 2008, a 23-year-old rugby player had an assisted suicide at Dignitas in Switzerland. He had been paralyzed in a accident, and was unwilling to continue living in that condition.

A few years ago, there was a documentary about a healthy 80-year-old woman who committed suicide with the help of a right-to-die campaigner, simply because she’d had enough of life.

There have been cases of elderly couples committing suicide together when one became terminally ill, and the other didn’t want to continue life alone.

People attach varying degrees of importance to things like pain avoidance, independence, dignity, physical & mental ability, and purpose in life. To me, suicide is rational if it’s consistent with the individual’s personal priorities, if nonexistence is preferable to existence on the basis of whatever criteria that person values.

This is why it’s so problematic to try to judge someone else’s suicide rational or irrational. If someone says “I value X so much that I’m unwilling to live without it.”, it’s an incredible presumption to say “No, you don’t.”

(Not that you’re saying that, but there are lots of people in the world who do.)

69

I’ve often wondered if there is really a difference between clinical depression and depression. Clinical depression is classified as a mental illness treatable by drugs to elevate seratonin for example. As long as you are depressed you are ill IMHO, and it just might take a change in circumstance rather than a pill to recuperate.

70

I BELIEVE (i may be wrong) that clinical depression is depression (or depressed feelings) which lasts unabated for 2 or more weeks.

71

And I’m still thinking you’re an absolute relativist.

“Ow! I stubbed my toe! I can’t bear the pain! Time to die!”

Using your logic, this is rational because it’s consistent with a person’s priorities (apparently having a pain-free life). I say it’s not rational because a reasonable person would know that stubbing one’s toe causes temporary, non-traumatic pain and that the benefit gained by escaping this pain with a permanent solution like death is outweighed by the investment costs used to get that person to where they are now and where they COULD be.

A person who’s old and wants to die is suffering from pain. The emotional and physical pain that comes with old age, and the fear of that pain getting worse. I’m sure this person would not want to commit suicide using this rationale if they were 20 or 30-years-old and in tip-top shape.

A person who is diagnosed with Alzheimer’s and commits suicide is doing so because of pain too. The emotional pain that comes with the realization that their brain is gradually dying. They may feel fine at the present, but know that they have a small window of time before they can consciously “escape.” If it’s not mental anguish over their situation that is driving them to this decision, what is it? Joy? Contentment?

The elderly couples who commits suicide are motivated by fear of pain. The pain of grief and heartbrokenness.

Do I need to continue?

72

These are just straw men.
No-one has said “It’s all relative”. No-one has said “Every suicide is rational”.
I think Isabel8 distinguished her position very well from these extremist positions your arguing against.

Yep, how about someone who commits suicide for a strategic reason such as to highlight a political cause, or as part of a mission?
Is this necessarily irrational? Is it still about minimizing pain? I have an argument that follows from these examples, but I’d be interested to know how you’d answer those questions first.

73

:smack:

74

Well, there is a school of thought that holds that a life that contains any pain at all is worse than nonexistence. But I’m sure that 99.9% of people don’t subscribe to that.

For the rest, I may be misunderstanding your point, but it seems as if you’re overgeneralizing pain to include any vaguely negative thought or feeling. Thinking “Losing my physical/mental ability is unacceptable. I’m not willing to live through that” is not the same as feeling emotional pain.

How can you know this? If someone says “I have decided to commit suicide for X reason and I’m not in pain.”, what basis do we have for saying “No, you are in pain”?

I guess what I’m arguing is that it’s entirely possible for a person to judge unemotionally (or, at least, with no stronger emotions than one experiences when making any other decision) that being dead is in their best interest. I think suicide can be a mostly calm, intellectual calculation; it doesn’t necessarily have to be accompanied by pain or other very strong emotions (although I can conceed that in the majority of cases it probably is).

75

I think I get what you’re asking.

I don’t think suicide or suicidal attempts are necessarily proofs of mental illness. People can be faced with stressful life events (financial or relationship problems, grief etc etc) and if they do not possess adequate coping skills or networks, suicide can become one of the coping options. A stressed out person is not always the best decision maker and sometimes, suicide is the result of a poor decision. A person may have the resources to cope with financial loss, for instance, but may be unable to handle relationship problems. Not always mental illness.

Actually, I think the answer to your question lies in the definition of the term ‘mental illness’.

76

Do you think a person who would kill themselves for feeling pain, no matter how insignificant, is reasonable, healthy individual? Should their decision be respected, no matter what? What if their death has ramifications beyond grief? At what point, in your opinion, is it appropriate to judge someone’s decision to commit suicide?

I’m equating pain to mental or physical anguish. Strong negative emotion would count as pain. I do not think I’m the only person to use “pain” in this way.

Emotions don’t always accompany thoughts, but I would think a statement like “I’m not willing to live through this disease that I’m facing” would be motivated by a feeling of despair or hopelessness. “There is a fork on the table,” however, would probably be emotion-free.

I believe only a robot or a victim of brainwashing (a member of a cult) would take their life without any negative emotion motivating them. And yes, I would question the mental state of someone who would do such a thing. If someone says to me, “I tried to kill myself once by slitting my wrists, just to see what’s on the other side,” my first thought would not be, “Oh. This person seems mentally well.” No, I would be wondering how long they were hospitalized and if they received good psychiatric care.

77

So let’s review where we are then:

Suicide is irrational, and a product of mental illness.

Unless someone is in extreme, prolonged physical pain. Or mental pain. Or they are anticipating physical or mental pain in the future.
Oh, and obviously we’re omitting “strategic suicide”, like, say, a soldier who kills herself rather than let the enemy potentially obtain secrets, or someone who dies to save someone else, or to highlight a political cause etc.

Apart from all those very broad classes of reasons, all other suicide is irrational.

Do I need to point out the problem with this argument?

78

The only reason for us, as a society, to judge anyone’s reasons for suicide is for the purpose of deciding who should be allowed to and who shouldn’t be. So the real question is, which suicides should we allow and which should we prevent?

I’m ok with preventing the following:

[ul]
[li]People who are considered incompetent to make their own decisions, such as minors and those with dementia or severe mental retardation.[/li][li]People who are drunk, high or otherwise have compromised decision-making abilities.[/li][li]Suicides that cause danger to others or public disruption, like jumping from a building into a crowded street.[/li][li]Very impulsive suicides. If Joe wants to live at 12:00 and wants to die at 12:05, I’m think it’s safe to assume he hasn’t given it enough thought.[/li][li]People with dependent children, on the grounds that they have an obligation to support their kids. (This one is probably unworkable in practice.)[/li][li]People who voluntarily seek mental health care and ask to be physically stopped from harming themselves.[/li][/ul]
Essentially, I think that any adult who is considered mentally competent to make decisions generally, who expresses a consistent (over several days) intention to die, should be allowed carry out their wishes, provided they do so in a way that minimizes inconvenience to others. The reasons for their decision are irrelevant.

Look at it this way: We don’t require competent adults to justify other life decisions. People get married, have kids, buy/sell houses, change religions, make major medical and financial decisions without having to give “good” reasons. (Of course, we’re free to judge privately, but as a society we don’t interfere.) Further, we assume that adults are competent to make these decisions for themselves unless we have compelling evidence indicating otherwise. Why treat suicide differently?

We disagree on this. I think such a statement can be made calmly, particularly in the case of an older person who has seen their friends & family endure various diseases and has given some thought to their own future. It’s likewise possible, if less common, for a younger person to think through these issues and come to terms with them.

This goes back to the question of how to define mental illness. IMO, if we’re going to pin that label on people and then use it as justification for denying their autonomy, it needs to mean something more substantial than “any behavior or emotion we don’t approve of or can’t relate to.”

79

I ratify this list. This is a good list and reflects attitudes and philosophies of which I approve. Essentially they are exceptions. By default, one should be able to commit suicide without interference (and without involuntary psychiatrization for making attempts).

80

Actually you do. I see no contradictions in what I have posted. Just changes of opinion.

A person can change their minds in a thread, right?

Instead of believing that all suicides are irrational, I’ve come to the conclusion that most of them are not, since most of them are reasonable cases of people escaping horrific pain.

I define pain to be physical and mental anguish, or a realistic fear of experiencing such (what you might feel after being diagnosed with a terminal illness, for instance). Psychological pain does not need to be the result of a mental illness. It can be and often is, but it’s not necessarily.

I have also said that a person has the right to kill themselves. But just as they have the right to do this, other people have the right to their feelings about it. If I shouldn’t argue with a person that his reason for committing suicide is not valid (as Isabel seemed to be suggesting earlier), then it seems unfair to also harshly judge me for feeling whatever I want to from the aftermath. If I want to call someone a cuckoo for lunging off a building just for the hell of it, why is that so bad? From my perspective, they are (were) cuckoo. Me thinking that doesn’t take anything away from their suicide, because it’s already a done deal. I’m under no obligation to respect their choice, particularly if it affects me directly. Not all suicides are created equal. Some are understandable reactions to a life gone wrong. Some are just freakin’ bizarre (like the Jim Jones affair).

So…what am I saying that’s getting your panties in a wad, exactly?