The Suicide Schism

The way in which the Western world has dealt with the phenomenon of suicide has been forever fraught with paradoxes and inconsistencies - it's been declared a criminal act, (akin to attempted murder), valorised and much imitated in the Romantic era by readers of Goethe's The Sorrows of Young Werther, adopted as a form of protest during oppressive political regimes and now apparently medicalised - the near-inevitable outcome of severe melancholic depression. But, hang on. If it's just symptomatic of an advanced state of an illness, why do many psychiatrists and their handmaidens, who usually treat their patients as sick and thus lacking responsibility for their condition, get so flipping mad when their patients try it?

In her penetrating but straightforward book Users and Abusers of Psychiatry, British clinical psychologist Lucy Johnstone describes the case of Linda Hart, whose award-winning memoir Phone at Nine Just to Say You're Alive recounts nine months spent in a psychiatric hospital. Despite an appalling childhood, Linda grew up to lead a full and active life before suffering the first of a series of breakdowns, resulting in numerous hospitalisations. During her last hospitalisation, feeling unable to ever overcome her severe and unrelating distress about her relationship with her father (a violent alcoholic whom she had found dead in the toilet when she was three, and whose voice now hurled abuse at her), Linda tried to hang herself. The response of the nursing staff was predictable, with many telling Linda that she was selfish and that they were angry at her, while others just ignored her completely. This behaviour fed into and exacerbated her feelings about her father, making her hallucinations even more abusive.

As an involuntary patient with an 'illness', Linda was considered to lack responsibility for her condition. Yet, at the very nadir of her 'illness', she was suddenly declared fully responsible for one of its 'symptoms', with her suicide attempt re-conceived as the act of a free agent, and a deliberate, calculating and manipulative one at that. For her trouble, Linda was moved to a locked ward, thus becoming even further entrenched in 'the system'.

It doesn't always work that way, of course. Often, a suicide attempt and the hostility it provokes will actually precipitate a patient's discharge, not only from the hospital or emergency room, but from 'the system' as a whole. Then what? Some would argue that this represents the most gross professional neglect, leaving the patient at risk of further suicide attempts, while others might argue that it's a blessing in disguise, since the patient's condition may well be largely iatrogenic. This is a possibility I'll discuss in a future post.