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"Harnessing the Power of Friendship"

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Facebook is “harnessing the power of friendship” so suicidal people can get “help” – that is, it’s ordering users to call the police when any user mentions suicide, so that such users are (a) denied the opportunity to talk about suicide, and (b) forcibly prevented form committing suicide.

To get an idea of what the euphemism “help” refers to, see, e.g.:

Please don’t help enforce unethical laws or policies like Facebook’s.

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Written by Sister Y

March 8, 2011 at 8:28 pm

It Might Get Better

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It is dishonest and cruel to prime children to expect better things from the future than the future in fact holds.


From itgetsbetter.org:

Many LGBT youth can’t picture what their lives might be like as openly gay adults. They can’t imagine a future for themselves. So let’s show them what our lives are like, [sic] let’s show them what the future may hold in store for them.

The It Gets Better Project is a creative, non-coercive suicide prevention project directed at gay youth, who are at a highly elevated risk for suicide attempts. Folks are invited to make a pledge:

Everyone deserves to be respected for who they are. I pledge to spread this message to my friends, family and neighbors. I’ll speak up against hate and intolerance whenever I see it, at school and at work. I’ll provide hope for lesbian, gay, bi, trans and other bullied teens by letting them know that “It Gets Better.” [Bolded emphasis mine.]

Dan Savage, the creator of the project, says:

‘When a gay teenager commits suicide, it’s because he can’t picture a life for himself that’s filled with joy and family and pleasure and is worth sticking around for,’ he declared.

‘So I felt it was really important that, as gay adults, we show them that our lives are good and happy and healthy and that there’s a life worth sticking around for after high school.’

I find many things to be supportive of here:

  • It acknowledges how sucky life is for many gay kids;
  • Non-coercive methods are advocated;
  • It’s pro-gay and pro-freedom;
  • It’s kind of heartwarming and encourages people not to be ashamed of something it’s stupid to be ashamed of.

However, as much as I approve of these aspects of the project, I would not be able to make the above-printed pledge. “It gets better” is an empirical statement, and it is one I don’t think can responsibly be made so unequivocally. I think there is a great deal of evidence that it does not, in fact, get better. It is dishonest and cruel to prime children to expect better things from the future than the future in fact holds. We do it, I think, to feel better about the wrongs we allow or commit against children, both as parents and as a society that can only function with a high rate of reproduction. We are here told to tell the gay kids and the bullied kids that it gets better. But what we need to ask first is: does it get better?

For Kristin and Candace Hermeler, the Australian twin sisters who attempted to carry out a suicide pact (with limited success) in Colorado, “it” does not seem to have gotten “better.” An article in the New York Times indicates that the 29-year-old sisters were bullied as children, and chose to die at a shooting range in Colorado because of its proximity to the site of the Columbine massacre. For the Hermeler sisters (no word on their sexual orientations), being bullied in high school was not, apparently, followed by a happy life of contentment and adventure. It was followed by a mutual wish to die.

One question we need to answer empirically is whether gay suicide attempts in fact decrease dramatically with age. If they do, that’s some evidence that youth is just a tough period to get through. I haven’t dug up any data either way (let me know if you find some); the only study I’ve seen found that “first attempts” tend to cluster at young ages, but I don’t think that has anything to say about later-in-life suicidality.

“It Gets Better” makes the assumption that children are committing suicide because they irrationally think life is crappy and won’t get better. Many attribute the high rate of teen gay suicides to bullying and homophobia:

Beth Zemsky, director of the University’s Gay, Lesbian, Bisexual and Transgender Programs Office, said [a 1998 study indicating an increased risk of suicide for gay youth] is consistent with previous research. She also said our culture’s intolerance of homosexuality, which can often be violent, leads many to take their own life [sic].

“Suicide attempts are often caused by the stress of a homophobic society,” said Zemsky. “The study is in line with the American Psychiatric Association. People are not killing themselves because they are gay, but because they are dealing with a society that discriminates.” [Bolded emphasis mine.]

I have never seen the evolutionary psychology side of things considered with regard to the high rate of suicide among gay kids, but that nasty idea seems to require serious consideration here, if only to make better models to understand suicide. This may help us understand why gayness is a risk factor for male suicide attempts, but not female. (Personally, I took way more crap in high school for being a cheerleader and being on the math team than I ever have for being bisexual.)

The idea that youthful suffering is short-lived is an empirical proposition. There is some evidence that as people age, their ability to cope with life’s suffering increases. But not always. If the organizers of the It Gets Better Project cared about intellectual honesty, they’d call it the “It Might Get Better Project.”

But that wouldn’t be as catchy.

Written by Sister Y

November 22, 2010 at 8:55 pm

Is "saves" really the right word here?

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When someone makes a very serious suicide attempt, like jumping from heights, should we be glad when that person is . . . “saved”? Is that a “miracle”?

From that cultural pillar, USATODAY:

Dodge Charger, or a miracle, saves man from suicide attempt

The New York Daily News says 22-year-old Thomas Magill jumped 39 stories from a West Side apartment building, and ended up landing in the back of a red 2008 Dodge Charger. He broke both of his legs and is in critical condition, but survived the fall.

Some witnesses laud the car he fell on for saving his life. Some say it’s a miracle from God. But is it even a good thing?

Often, people who make very serious suicide attempts and are “rescued” say they are glad. Their incomes tend to go up, too. But this is at great cost to autonomy. Perhaps the would-be suicide will wake up and give the culturally appropriate response: “I’m so glad to be alive; I never wanted to die.” (N.B.: if he wants to get out of the hospital, this would be advisable.) Perhaps he will wake up and curse God and demand to be allowed to die (the dignified route, but the one that will keep you hospitalized).

Regardless, it’s nothing but cruel to this poor guy to praise Jesus (or a Dodge Charger) for “saving” him. People who do not want their lives should be free to discard them, without having to break their fucking legs in the process.

Written by Sister Y

September 1, 2010 at 9:48 pm

Is High IQ a Treatable Medical Condition?

with 18 comments

I have argued for a right to suicide grounded in personal freedom and dignity; I have argued that there is, in addition, no right to forcibly prevent people from committing suicide. My views on this extreme example of patient choice still apply; but what about less extreme solutions to suffering?

The predominant view of medicine seems to be a doctor-controlled, paternalist one. We must all get a doctor’s permission to access most drugs; most people apparently do not find this to be a serious intrusion into privacy and dignity. I think a better view of medicine is that of a doctor as a consultant, who assists the patient with medical knowledge and advice, but does not ultimately control the patient’s treatment.

What is the purpose of medicine? (Please feel free to answer this below – it’s not just rhetorical.) Is it to relieve suffering? To enforce proper behavior? To extend life? Certain definitions of medicine’s purpose (like that last one) rely on idiosyncratic values that perhaps should not be forced on others. A fairly radical, but I think value-neutral, definition of the purpose of medicine might be: to assist patients in maximizing their own values by providing knowledge of human biological systems and applying available medical techniques as chosen by the patient.

One of these might be a prescription for Nembutal.

But another of these “available medical techniques” might help a patient reduce his general intelligence in various ways if it is a burden to him.

The DSM-IV definitions of diseases tends to include the rider that the symptoms “cause marked distress” to the patient. Perhaps it is time to consider whether conditions thought to be desirable that “cause marked distress” should also be treatable.

High intelligence is clearly treatable with a variety of substances and treatments, from ECT to antipsychotics to medical cannabis. If, say, extremely good memory or other symptoms of high intelligence are a burden to the patient, shouldn’t he be entitled to use available technology to eliminate them? And why not have a physician’s advice on how to do it in a manner that maximizes the patient’s other values?

Is it different from suicide?

Written by Sister Y

October 1, 2009 at 6:44 pm

Disincentives, Time Horizons, and the Irrational Continuation of Life

with one comment

Social science researcher David Phillips was a pioneer in the theory of suicide contagion. His research has also focused on other fascinating correlates of suicide (and other fatalities), such as day of the month, public holidays, and birthdays.

As these last few professional interests suggest, identification of dates has been important to Dr. Phillips. A 1988 paper * focused on potential difference between deaths from suicide and the suicidal acts or injuries that preceded them. A significant difference in date of suicide attempt and date of death would, of course, be relevant to Dr. Phillips’ studies on how date affects suicide rates.

The motivation for the paper is a 1985 study on a San Diego population that found a whopping 22% difference between date of injury (suicide attempt) and date of death in cases of suicide. The San Diego study analyzed 204 cases of suicide; its findings cast doubt on whether date of death was a good proxy for date of suicidal act.

Phillips and Sanzone, however, studied a much larger sample – 42,698 suicides throughout California – and found that 92.6% of suicide deaths occur within one day of the precipitating suicidal act. In terms relevant to my project, that means that only 7.4% of people who commit suicide have to suffer more than a day before dying.

7.4%. About one in fourteen.

To a potential suicide, this is terrifying – not least because these are the people who succeed. This doesn’t even include the suffering of those who attempt suicide but fail – and are left miserable, with grievous injuries, trapped in a life worse than the one they attempted to leave.

If life is so bad, though, wouldn’t it be worth the risk?

The problem is a possibly irrational time horizon perceived by the potential suicide.

When we decide whether to commit suicide (to shoot ourselves in the head, say, or mix up some community-endangering hydrogen sulfide gas), the risks and benefits of suicide should, rationally, be weighed against the risks and benefits of continuing to live. But “continuing to live” for how long? One rational-sounding candidate would be “continuing to live out one’s natural life span.” Indeed, for most of us, continuing to live our natural life span is unthinkably horrible – much, much worse than the considerable risks of a careful suicide attempt.

But one’s natural life span is difficult to consider. The more tempting, and probably irrational, option – one I find myself preoccupied with – is to weigh the risks and benefits of a suicide attempt with the risks and benefits of living another day or week. Perhaps next week drugs will be legalized. Perhaps next week one will die in an automobile collision or be diagnosed with a fatal illness. Living another day, another week, another month, even six months, is certainly no worse than the alternative – risking extremely serious harm from a suicide attempt. As Dr. Phillips and others demonstrate, even the ones who succeed risk extreme and prolonged suffering.

This is yet another way in which the suicide prohibition encourages irrationality. This is neither just nor compassionate.


*Phillips, David, and Anthony Sanzone. “A Comparison of Injury Date and Death Date in 42,698 Suicides.American Journal of Public Health 78:5:541 (1988).

Rich, Charles, Deborah Young, Richard Fowler, and S.K.S. Rosenfeld. “The Difference between Date of Suicidal Act and Recorded Death Certificate Date in 204 Consecutive Suicides.American Journal of Public Health 75:7:778 (1985).

Written by Sister Y

April 7, 2009 at 3:42 am

Force Feeding and Respecting Values

with 8 comments

Is it morally right to force-feed anorexic patients? To interfere with a suicide attempt? I think the better question is not whether it is always acceptable or always unacceptable. Better that we ask, when is it morally correct to intervene in the potentially lethal action of another?

Zarathustra at Mental Nurse wrote a piece in September about using degrading, humiliating, coercive means to force patients with eating disorders to eat. He is extremely candid about the reality of force feeding, detailing the force-feeding protocol:

The protocol for serving a meal to an eating disorder patient is a no-holds-barred affair. She’s made to come to the table with her hair tied back and wearing short sleeves, wearing no watches or jewellery, so that there’s nowhere to secretly stash food. She’s then made to eat everything – everything – on the plate with a nurse watching her like a hawk. No excuses are tolerated. No “that’s got a bit of gristle on it” or “but that’s just a crumb”. The plate has to be completely cleared. Afterwards she’s made to sit resting for a full hour so she can’t go off and purge or exercise.

If she fails to complete the meal, or doesn’t complete the rest period, then she’s ordered to drink a nutritional supplement milkshake. If she refuses to do that, then she’s restrained while a nasogastric tube is passed up her nose and into her stomach to force-feed her. Nasogastric feeding is so unpleasant that few of the girls have to have it done more than once. As coercive psychiatry goes, you don’t get much more coercive than this. [Emphasis mine.]

At the end of this litany of horrors, though, Zarathustra wonders – if it saves the girl’s life, what’s so wrong with that?

The short answer is that, for many people, there are things that are more important than life.

I have written in the past that it is sometimes permissible to save a person’s life against his will. I propose two criteria for this:

  1. Because of a condition that clearly destroys the person’s ability to act in his own genuine interests, such as an acute confusional state in a person who is otherwise lucid, the person is not acting in his own interests (note that I mean his own interests, according to his own values, not his “best interests” as defined by others); and
  2. there is substantial evidence that the person, in his lucid state, values his life more than he values being free from the kind of intrusion that would save his life.

I think it was Dr. Maurice Bernstein of the Bioethics Discussion Blog who said that, faced with an anorexic patient who was refusing to eat and would die without intervention, but still said she wanted to live, he would opt to force-feed. This actually accords well with my model of a time when it is appropriate to intervene: when it accords with the patient’s ascertainable values. (I am not sure my first prong is met – anorexia nervosa seems to be more of a life-long condition rather than a sudden-onset break with reality. This is the hardest prong to define and apply[1].)

But if an anorexic patient values her bodily inviolability, her dignity, more than she values her life – then it is morally wrong, and damaging to her as a human being, to stick a nasogastric tube down her throat. There are some things that are more important – to her – than her life. How can it be right to ignore her values and humiliate her in furtherance of protecting her life from damage she herself may do to it?

A similar model may be helpful in determining when it is appropriate to interfere with a suicide. Some people who attempt suicide really want to die, and coercive suicide prevention is a horror that they would rather die than accept (Group 1). Some people who attempt suicide genuinely want to die but fail to be in a lucid state when they make the attempt; they are forcibly “rescued” and treated, and when more lucid are grateful for the indignity of forced treatment (Group 2). And some people who attempt suicide do not really want to die at all – they have bought into what I have termed the dangerous fantasy of rescue, and count on being saved from their suicide attempts through coercive means (Group 3). (In “Attempted Suicide as a Signal,” I have articulated the way in which a policy of always interfering with suicides actually harms people who don’t wish to die – because it sets up an incentive structure that rewards them for engaging in lethal behavior.)

In my view, it is permissible to interfere with the second group’s suicide attempts if the two prongs of my test above are met – the person is experiencing an acute state of mental confusion or delusion (I don’t think DSM-IV depression qualifies here), and according to the person’s own value system (when lucid), remaining alive is more important than the humiliation and suffering involved in the proposed coercive intervention.

Group 3, suicide attempters who clearly lack a sincere intent to die, seem to me to present the easiest case. Under our current system, rescuing them – following through with the fantasy they have been fed – is the morally correct option. However, as I mentioned above, it would actually be better for them if there were a well-known public policy of not interfering with suicide attempts, because under such a system, they would have no incentive to make a potentially harmful, insincere attempt in the first place.

It is never morally permissible to coerce people in the first group to remain alive.

But, on the bridge or in the ER or on the bathroom floor of the apartment, how do you tell the difference? How can you tell whether the person belongs to Group 1 or Group 2 or Group 3? How do you know whether the bleeding, half-conscious person’s values allow for interference with his suicide attempt?

Many people fail to ask this question at all. They assume without question (a) that anyone who would attempt suicide is in a state of mental confusion sufficient to render his actions and judgment valueless, and (b) that everyone places his own life above all other values – that any humiliation or insult to dignity or loss of liberty is worth it if it saves one’s life.

I think it is true that many people hold the belief in (b), but I don’t think it’s controversial to say that not everyone values his own life over all else. If it were true, I think our race would be a race of cowards. But it is not: people are willing to die for their political and religious beliefs, and for other people, demonstrating that one’s own life is not the supreme value for everyone. And for some of us, dignity and bodily inviolability are values we hold above even life itself.

But we can, and ethically must distinguish between the two groups (Group 1 above – those who value dignity over life – and Groups 2 and 3, who want to live despite any indignities that might entail). I have previously articulated a proposal for distinguishing between these groups, with two options, as follows:

  • Radical option: Cease automatic interference with suicide attempters, and publicize this policy, to destroy the dangerous “fantasy of rescue” that might cause many people who do not genuinely want to die to make a suicide attempt, and
  • set up a procedure for medically assisted suicide (a prescription for a lethal dose of, say, barbiturates to a competent adult requester) that would be unlikely to be used by anyone not extremely serious about suicide, and
  • allow people who value their lives over any possible indignities to enter contracts while lucid to allow them to be “rescued” or forcibly treated should they become suicidal, refuse to eat, etc., as with medical advance directives;
  • Minimal option: or, as an alternative, at a minimum, establish an “opt-out” policy that would allow a competent person to execute a legally enforceable document, revocable only by the person it concerns, that would exempt him from coercive suicide prevention “treatment” and from medical “rescue” in the case of his suicide

Regardless of whether the radical or the minimal option is enacted, the following criteria would apply:

  • the suicide procedure (or execution of the opt-out document) could have a waiting period, like gun purchases or marriage or divorce, and even require multiple requests
  • requesters, to be competent, must understand the nature of death and be able to articulate a non-delusional reason for wanting to die
  • a DSM-IV diagnosis of Major Depressive Disorder would not suffice to render someone incompetent to request suicide assistance

Some things are more important than life. But life is important to many – for some, it is the most important thing. A policy like the one I have outlined would respect everyone’s values.

Thanks to mysterious, modest commenter failed poet for inspiring probably the only thinking I’ve done in weeks, which thinking led to this post.


1. If my neighbor wants to lose weight, and values losing weight, but doesn’t have the will power and determination to achieve it, would it be morally right for me to kidnap my neighbor, feed him only health food, and make him run on a treadmill two hours a day? Of course not – unless, perhaps, his values were such that the humiliation of being kidnapped and forced to run on a treadmill was nothing compared to the value of losing weight. He may hate it in the moment – people sometimes feel this way about their hired trainers or physical therapists – but if his deepest, truest value is losing weight, then I think the action is permissible, and he would probably agree. In this way, it all comes down to value – no mental illness/acute mental confusion prong is even necessary. (The only problem comes in judging which of several “selves” is speaking one’s true values. And it is tempting for a listener to assume that the “self” that articulates values close to one’s own is the true self.)

Written by Sister Y

January 6, 2009 at 1:20 am

Coercive Treatment: It’s Not Worth It

with 6 comments

mentalnurse.org.uk is one of the only sites I’ve seen that allows the serious consideration of the possibility that allowing suicide can be morally correct, and that forcing people to stay alive through coercive “treatment” is often a moral disaster.

In a post by Mr. Ian, the experience of a commenter known as “Squawk” is related: she was subject to coercive psychiatric treatment, was “cured” and came out the other side, but, like me, she does not feel that it was worth it and continues to suffer from feelings of violation:

Was the coercive treatment worth it? Was going through utter hell every day for more than a year worth it? No. I love my life now, I’m not remotely suicidal, and I hope I do good things for the world. But even for everything I have now, the threats and the heavy meds and the tubes and the completely destroying *everything* I was 5 times a day every day day after day for more than a year – no, it wasn’t worth it. Nothing could be worth that. Not my first boyfriend, or getting my degree, or the first time a patient with PMLD recognised me and smiled when she’d only ever done that to her Mum, or being able to help the people I’m now volunteering full-time with who would otherwise have nothing, or eight years of a bloody fantastic life with ups & downs & friends & adventures & fun. Another eighty years, winning 5 Nobel Prizes, and being the first person to walk on Mars wouldn’t be worth going through a severe ED & treatment. Nothing could be. [Emphasis mine.]

I am sorry for her experience and agree wholeheartedly about the after-effects of coercive treatment.

Some people, of course, are forcibly treated and are later glad about it; I suspect that these are people without a strong sense of personal dignity.

Written by Sister Y

January 1, 2009 at 9:36 pm