Doctors, Patients, and Suicide: Symptoms of a “Sick” Society

The content of this post is written by a friend of mine. It’s a paper proposal for a conference. It’s academic in tone but still very accessible. I asked permission to share it here as I think the ideas are brilliant as well as original and anyone who cares about the issue of suicide would do well to think about the points that are brought up in this proposal. I look forward to the completed paper.

The proposal:

The topic I wish to explore and present is the social construct of suicide and what it can tell us about our values in society in regards to autonomy, choice, social responsibility, and mental and physical illness. I wish to write this from the unique perspective of a person who both embodies chronic, congenital physical disability (Cerebral Palsy) and as someone who was more recently psychiatrized into the mental illness industry/mental health care system (labeled Bipolar I disorder) in 2008.

The paper will look at physical/mental intersections of the American construct of suicide. The first perspective is of suicide as something to be avoided at all costs, as a reason for detaining/hospitalizing someone against their will, and, in almost all instances, an automatic “mental illness” label, either one applied prior to the attempt, or one applied in retrospect (ie: you often hear peers say, “I attempted to take my life, and was hospitalized and diagnosed as Bipolar”). In this construct, doctors are “heroes” by saving lives and preventing suicide.

The second perspective is the construct of suicide as it applies to physically disabled or ill people. In this instance, we have “physician assisted suicide”, where the heroism is the mirror opposite (and, to be fair, hotly contested). If a person has a physical disability and wishes to end his/her life, it is, in contrast to most instances noted above, not automatically assumed that this is an irrational choice or mental illness. When it comes to people with physical disabilities, especially “extreme” ones, the “choice” to die, and more than that, to engender a physician to help one die, is considered a rational choice by large numbers of the public and medical professionals. A psychiatric evaluation is often done (generally by an able-bodied psychiatric “expert”) to ensure that the disabled person’s decision to die is not due to mental illness, and more often than not, the conclusion is, “this person is in their right mind to want to die, given the state they’re in”.

At first glance, these may seem to be completely opposite constructs in nature, but upon reflection, an interesting commonality emerges. In both instances, no thought is truly given to actual life situations why a person might be feeling despair, hopelessness, and a willingness to end his/her life. In the case of psychiatric suicide, a person is provided “life-saving drugs” and sent away, generally with no inquiry as to the trauma, abuse, poverty, or injustice they might be experiencing and no other services or supports provided. The defect is found within the person, and the drugs fix it. In the case of physical disability, there is generally no thought or effort given as to what supports would help this person to desire life, such as attendant care, more independence, and more social connection. Again, the defect is in the person, but we can “help” the person die, to solve the defect.

Thus, the way suicide is conceived of and treated in American culture allows us to avoid actually looking at social dynamics and power imbalances, while appearing on the surface as though we are “saving lives” (even if “saving” means “ending” for the physically disabled).

There is also a third construct I may work in, and that is of physician suicide (doctors who kill themselves). On any paper written on this topic by psychiatrists, mental illness is not cited as a reason why doctors kill themselves – rather, stress, burnout, psychosocial reasons are attributed. Doctors, seeing themselves as rational, competent beings, see that they have “life situations”- whereas everyone else has “mental illness” or some disability so horrid (in the doctor’s mind) that it only makes sense to die. This third construct is important because doctors/physicians have such a key role in people with disabilities’ lives, their suicide and euthanasia decisions, and of deciding courses of labeling and treatment. They seem to be given the final word on should this person be “allowed to die” or be “saved”? when, in fact, we would do well to listen to other voices in the community (such as the disabled themselves to weigh in on solutions that truly value life and quality of life.

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