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More Evidence for Rational Suicide

with 6 comments

A letter in the upcoming January 2009 issue of the journal Psychiatric Services (Psychiatr Serv 60:126, January 2009) reports on the relationship between suicide method and past health care contacts. The authors of the letter report that people who commit suicide by charcoal burning (a method of carbon monoxide poisoning gaining popularity in Hong Kong and Taiwan) are significantly less likely to have had mental health care (or hospital visits for any reason) than people who commit suicide by hanging or solid or liquid poisoning. That is, there is an identifiable population of people who commit suicide using relatively painless means that require preparation, and this population is less likely to be mentally or physically ill than people who commit suicide using other means. These results are in line with past studies, and “corroborate findings from Hong Kong that victims [sic] of charcoal-burning suicide were less likely to have pre-existing mental or physical illness,” say the authors [emphasis mine; citations omitted].

The letter displays problematic logic in the interpretation of its findings. In relevant part, the authors say:

Our results support the point previously raised by researchers from Hong Kong that this new method may have attracted individuals who would otherwise not have considered suicide. Acute stress, particularly economic difficulty, rather than mental disorders may be the major precipitating factor of suicide in this suicide subgroup. Population-based prevention strategies to prevent charcoal-burning suicide that might be considered include efforts to destigmatize mental illness to enhance appropriate help-seeking behaviors, restrictions on access to charcoal (for example, by removing charcoal from open shelves and making it necessary for the customer to request it from a shop assistant), and guidance for the media on how to report on suicide events. [Emphasis mine; citations omitted.]

The authors’ perspective is that the availability of the method is what is causing the suicide. But isn’t it the individual’s choosing to commit suicide that is the proximate cause of the suicide? Is the “cause” of suicide the man or the gun?

The authors assume that suicide should not be allowed and that it is right to prevent it. Why should this be? No reason for or defense of this position is given. People committing suicide using the charcoal burning method are not likely to be mentally ill! Why shouldn’t they be allowed to choose to commit suicide in a relatively painless manner? Even forced life advocate Ezekiel Emanuel purportedly favors a “negative right” to suicide for rational people.

In addition, the authors’ proposed solution to the problem of non-mentally ill people committing suicide is: destigmatize mental illness. Huh? My interpretation of the data is that charcoal burning suicides are likely to be rational suicides – not the product of mental illness. How will destigmatizing mental illness help anything here? The authors also, predictably, recommend coercive suicide prevention methods (using the laughable tactic of restricting the sale of charcoal – no picnic barbecue for you if you look sad!) and media censorship.

There is little evidence that “destigmatizing mental illness” will prevent suicides in these cases. And even if coercive suicide prevention does prevent some suicides, they will be the wrong suicides. Take away the right to charcoal burning (not to mention the right to barbiturates), and you force people to choose between committing suicide by violent or ineffective means, or remaining alive in misery. And that is wrong.

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Written by Sister Y

December 30, 2008 at 5:26 am

6 Responses

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  1. Rational suicide is an interesting phrase – like ‘military intelligence’.There’s been recent debate on the mental nurse site about when it’s ok to commit suicide.One thing that stood out in the discussion is the actual decision – is it an intrinsically derived one or an externally imposed one?This may sound odd – that anyone who ‘takes their own life’ is simply acting alone. Yet when you review the causation of suicide, outside of disease or terminal illness, it is often found that the inner turmoil of the person was created from things in which they had no control – isolation, marginalised, coercive psychiatry, life status changes – all social welfare issues. On this basis, coercively preventing suicide is like rubbing salt in the wound and twisting the knife.“We don’t care enough to act to stop you feeling like killing yourself – but we will stop you killing yourself”.Why rational suicide cannot extend to those with mental illness tho aswell is another and more contentious issue. Mental illness does not always cause a permanent incapacity of rational thought and in lucid times, some may prefer to be dead than continue to live the enforced isolated, marginalised, low social status lifestyle that coercive psychiatry, and the society it serves, insists that they do.

    Mr Ian

    December 30, 2008 at 1:33 pm

  2. Well said. This:<>coercively preventing suicide is like rubbing salt in the wound and twisting the knife.“We don’t care enough to act to stop you feeling like killing yourself – but we will stop you killing yourself”.<>is an excellent way of expressing what I consider to be the core of my project.

    Sister Y

    December 30, 2008 at 3:49 pm

  3. Why is suicide a bad thing? The only conclusion I can come up with is because death is a bad thing, and suicide ushers in death. Death is to be avoided at all costs, including using force to prevent a person in bringing about his own death. Then why is birth a good thing, seeing that every birth culminates in a guaranteed death?As far as the term ‘rational suicide’ is concerned, I seem to be missing the absurd quality in the phrase that some find there. Why is it more rational to be dragged kicking and screaming into the inevitable cessation of life, often enduring gross insults to mind and limb along the way, than to ‘rationally’ choose the time that seems best to you to end it all?

    jim

    December 31, 2008 at 5:04 pm

  4. Almost every definition of “rational” I can think of – from pursuing one’s values, to maximizing one’s hedonic pleasure – is wide enough to, on occasion, include suicide.Jim – when people are talking about others who’ve committed suicide, they say things like “how could she have done that to her family/friends/people who cared about her?” But nobody says “how could her mother/father have put her through that hell by bringing her into being?”But that’s where the relevant blame should lie.

    Sister Y

    January 1, 2009 at 9:50 pm

  5. It seems that people consider happiness the default position of humankind. I see no evidence of this.

    jim

    January 3, 2009 at 4:51 am

  6. Yes – absent any mean-spiritedness, I think it is important for people to be encouraged to consider a sort of “null hypothesis” on human happiness – that perhaps not only is it not the default position, but it is also impossible to achieve. I think our social policy would be kinder if people genuinely considered this.

    Sister Y

    January 3, 2009 at 5:17 am


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