Yesterday I learned that this man that I knew, Paul, killed himself last week. This is the second person I have personally known this year who has decided that the best decision was to end this life journey. Although one was several years older than the other, both were relatively young by today’s standards. It appears that both were fearful of living with an acute, chronic illness and did not want to wait for “nature” to take its course. Although the one did not leave a note it appears that she may have decided that a reasonable response to recent diagnosis of stage 4 cancers was to be more intentional about when and how she would finish this journey. She took a gun and shot herself in the head in the back yard of her home. The second who had lived with what was thought to be a serious bipolar depressive illness and addiction became fearful that the “voices” which were increasingly present in his head and which made it difficult for him to tell the difference between so called reality and non-reality, apparently decided he could not live with the isolation and inability to function as he wanted to function. He and his wife had separated because of her fear that the children would find him dead or be traumatized in some other way by his inability to be intentional about his behavior.
Although it makes me very sad that each of these people were feeling so alone during the last stage of their life, I do not feel as if I am in any position to say that their respective decisions were wrong or immoral in any way. In the case of the young man who shot himself to death last week, I knew him to me a man who desperately wanted to be able to consistently be the kind, loving man that he was. There were many times when he tried to explain his internal angst by blaming others or he used anger to push people away because he feared his own behavior. He also, at times self medicated which often led to behavior which only left him with feeling more guilt ridden and, at times, self loathing.
In our culture, many have a very negative response to suicide or assisted suicide. Yet, many continue to support the death penalty and the right for both police and private citizens to use lethal gunshots in response to a danger or perceived danger. Many also support the use of a variety of lethal or potentially lethal bombs and other weapons of destruction to stop or destroy whoever we decide is the enemy. We label people as criminals, which then gives the city, county, stage for federal government to treat them as “bad” and “less then”. As a nation we continue to give away billions of dollars to other nations when we have, as a country, an enormous deficit.
Our inability as humans to be able to agree on what is logical or illogical leads to confusing definitions of mental illness, insanity or mental health. We now have a new version of the diagnostic manual approved by the American Psychiatric Association and which is used by insurance companies and courts to determine the “mental health” of individuals. Sadly it does not include a diagnosis system for communities, states or nations. The newest version of diagnostic manual, the DSM 5, defines mental illness as:
"A mental disorder is a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above."
This new definition attempts, among other changes, to insure that diagnosticians are more culturally competent and do not confuse mental illness with a behavior which is acceptable and/or even valued in some cultures. It attempts to insure that such behavior, as homosexuality is not labeled a mental disorder. On the other hand, it hedges when it continues to talk about deviant behavior. Deviant has, for most people, a very negative connotation. The DSM 5 also continues to diagnose certain behavior of “children” as oppositional defiant or a conduct disorder. The delineating criteria for this diagnosis is:
Oppositional Defiant Disorder
• A Disruptive, Impulsive-Control, and Conduct Disorder marked by a negativistic, hostile, and defiant behavior toward authority figures persisting for at least six months
• Developmental progression to Conduct Disorder; it often co-occurs or precedes a diagnosis of Conduct Disorder, but many ODD never develop Conduct Disorder
• ODD often manifests through excessive stubbornness, revenge-seeking, compositionality, and blaming of others for wrongdoing
• Verbal aggression and outbursts common, but do not include aggression toward people or animals, or destruction of property
• Symptoms begin round preschool years and most often present around family members
• Wide estimates of prevalence rates (1 to 11 percent). In childhood, boys more likely than girls to have ODD; gender disparity diminishes by adolescence
• Linked to inconsistent, neglectful, or overly harsh parenting, temperament. Possibly neurobiological markers.
• High comorbidity with Attention-Deficit/Hyperactivity Disorder
Increased risk for anxiety, depression, antisocial behavior, and substance use disorders.
I have often seen children who had been treated by my colleagues for this disorder who I thought were exhibiting a healthy response to an unhealthy environment. If one, for examples, listens to talks by such folks as Anne Lambert, one is quickly reminded that the alcoholic family in which she was raised engendered symptoms, which are listed above. She and her siblings knew something was terribly wrong and were reacting to that family “dysfunction”. Often I have seen families in which the child had been identified as the family “problem” when in fact the child was the healthiest member of the family.
Another debate centers on the question of whether mental illness even exists as a disease. There was a book by a psychiatrist, Dr. Thomas Szasz that was very popular when it was published in 1961entitled, The Myth of mental Illness: Foundations of a Theory of Personal Conduct. In this book Dr. Szasz maintains that: “…the concept of mental illness is not only logically absurd but has harmful consequences: instead of treating cases of ethical or legal deviation as occasions when a person should be taught personal responsibility…”
Personally I never did understand the distinction between mental illness and other forms of illness. It seems to be that all illness are physical although many factors including genetics, environmental, nutritional, emotional, and physical can affect the ability of all parts of our body to function including our ability to have what is considered in a particular culture a cogent thought. All of these factors affect the firings in the electrical system of the brain which in tern affects how one perceives the world, how one stores and retrieves words and thoughts and ultimately whether one can distinguish between the chatter in one’s brain and an agreed upon reality.
Given the reality, as my two friends perceived it at that time suicide was, in my opinion, a very logical choice. Of course, I, given my selfish interest in having them continue to be a part of my life journey, would like to believe that given the “right” treatment both could have lived for a long time. Obviously, I have no idea of this is true or not. I do know that they were good people and made what, for them, was a very logical decision. I suppose I might also question the choice of methods but then who am I to say how is right or even moral in this respect either.
For all of us, I am again reminded that life is very brief; that I know very little about how our mind functions; the distinction between mental illness and mental health; what the God of my understanding thinks about suicide or about much of anything else. I do know that I my life is richer because of individuals such as these two. Thanks.
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