A DrHurd.com reader sent me a clip of an article that ran in the Northwest (Illinois) Herald on November 13, 2010. It’s written by the Reverend Jim Swarthout, rector of St. Paul Episcopal Church in McHenry, Illinois.
The reader suggests that if someone believes that alcoholism is a disease, then the ideas presented in the article are a logical corollary to that.
Below are excerpts from that article, followed by my comments.
Reverend Swarthout: Anatomy of suicide requires examination ‘ A letter written to me by a young lady during her treatment says it all. ‘The pain of severe depression is quite unimaginable to those who have not suffered it, and it kills in many instances because its anguish can no longer be borne. The prevention of many suicides will continue to be hindered until there is a general awareness of the nature of this pain ‘ And for the tragic group of those who are compelled to destroy themselves there should be no more reproof attached than to the victims of terminal cancer,’ she wrote.
Dr. Hurd: The letter Reverend Swarthout cites represents the common view of suicide. People are referred to as ‘victims’ of suicide. The unspoken premise is that something or someone external led to their deaths.
Note the comparison with cancer. This person goes so far as to say that suicide is literally like cancer. How can this be? Terminal cancer is, by definition, an illness that will lead to death. Medical science cannot stop it, nor will actions or efforts on the part of the patient. Is that really the case with suicide? Many suicides are botched. Many who fail in their attempt to kill themselves later reflect that they’re glad their attempt failed, and they’re glad to be alive. A terminal cancer patient, by contrast, has no such prospect. The illness will run its course and certainly result in death. For the suicidal person, all kinds of interventions are possible. These include the intervention of the suicidal person himself botching or aborting the suicide because of a desire to live.
Whatever is true of suicide, it’s not the same as terminal illness. The reasoning of the person who claims otherwise goes like this:
Premise: Severe depression is emotionally painful. (True)
Premise: Emotional pain eliminates the capacity of free will. (False)
Conclusion: The suicide, for a depressed person, was inevitable. (Inaccurate)
The conclusion follows from the two premises, but the second premise is false. Emotional pain does not determine the outcome. Sometimes emotional pain passes on its own. Sometimes a thoughtful conversation with a significant other gets one past the suicidal impulse. Sometimes the suicidal person himself, whether out of fear or not wanting to emotionally harm a loved one, ‘sucks it up’ and refuses to kill himself even though problems remain. None of this is to minimize the fact that people experiencing the emotion of despair have real problems. However, none of these problems make death inevitable.
Reverend Swarthout: Suicide is an illness, not something freely chosen. A person who dies by suicide certainly, in most cases, dies against his or her own will. Suicide is death by illness, not something someone wills.
Dr. Hurd: Wrong. Suicide is an action. It’s the culmination of what many refer to as the illness of depression. But it’s not an illness itself. Suicide is caused by emotions within a person’s consciousness. These emotions are ones of despair and depression. Also—and most people don’t know this—there are emotions of anger. The anger can be directed at particular people, but they can also be directed at existence itself. (For a religious believer, they can be directed at ‘God’ rather than existence or reality.) For those who attempt suicide, the dominant emotion is often ‘I’ll show you,’ or ‘The hell with you.’
All of these emotions come from ideas, perceptions and beliefs that the suicidal person holds. The rationality of these beliefs is usually questionable. A depressed person is not in a rational state of mind. A suicide survivor will often say, in the hospital or even once released, ‘I don’t know what I was thinking. That wasn’t the answer.’ Does this mean the previously suicidal person is no longer depressed, unhappy or angry? No, usually not. It’s just that she can now acknowledge that her feelings and emotions at the time were distortions or exaggerations of how bad things really were.
Suicide is a choice; usually an irrational choice as a means of handling strong emotions based on distortions, exaggerations or false beliefs. Just because the choice to commit suicide is rarely made on the basis of rational ideas doesn’t change the fact that it’s a choice. Keep in mind that not all depressed people commit or even seriously consider suicide. Most, in fact, do not.
Reverend Swarthout: For those of us left behind, we should not spend undue time and energy second-guessing, ‘What might I have done?’ ‘Where did I fail?’ ‘If only I had responded and reached out when I had the chance!’ Suicide is the emotional equivalent of cancer, a heart attack, or a stroke, and all the care and reaching out in the world cannot, at times, save a loved one from dying from these diseases.
Concluded in tomorrow’s column.