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Archive for the ‘rational suicide’ Category

Press: Traumatic Brain Injury Makes Suicide Rational

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From a story on a professional athlete who committed suicide, suspecting he had traumatic brain injury:

BOSTON — The suicide of the former Chicago Bears star Dave Duerson became more alarming Monday morning, when Boston University researchers announced that Duerson’s brain had developed the same trauma-induced disease recently found in more than 20 deceased players.

What is amazing about this story is this: there is no recommendation for greater mental health screening, detection, and services among former professional athletes. There are recommendations, however, to actually SOLVE THE PROBLEM that made the guy’s life hell in the first place.

Duerson shot himself Feb. 17 in the chest rather than the head so that his brain could be examined by Boston University’s Center for the Study of Traumatic Encephalopathy, which announced its diagnosis Monday morning in Boston.

In this case, the reporter seems to clearly accept the proposition that the former athlete’s suicide was caused by his traumatic brain injury – but NOT because his traumatic brain injury made him insane. Rather, it seems that his traumatic brain injury made his life bad enough that it’s impossible to completely reject the notion that he committed suicide rationally.

The medical model of suicide – the idea that suicide is a pathological symptom of a curable medical condition – has always been dubious, but it is clear from accounts like this that not even the media (repeatedly warned by well-meaning bullies to self-censor) fully buy the story. Everyone knows that there are good reasons to commit suicide. What few acknowledge is that most genuinely good reasons to commit suicide are not as easy to verify as this former athlete’s brain injury.

As David Foster Wallace describes it in Infinite Jest:

Think of it this way. Two people are screaming in pain. One of them is being tortured with electric current. The other is not. The screamer who’s being tortured with electric current is not psychotic: her screams are circumstantially appropriate. The screaming person who’s not being tortured, however, is psychotic, since the outside parties making the diagnoses can see no electrodes or measurable amperage. One of the least pleasant things about being psychotically depressed on a ward full of psychotically depressed patients is coming to see that none of them is really psychotic, that their screams are entirely appropriate to certain circumstances part of whose special charm is that they are undetectable by any outside party. [Emphasis mine.]

Written by Sister Y

May 2, 2011 at 5:17 pm

If Suicide is Caused by Mental Illness, Why Improve Working Conditions at Suicide Hotspots?

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In response to a high number of worker suicides at miserable Chinese iPad factories, the bosses are, apparently, giving the workers a raise.

The most common argument for forcibly preventing suicides is that they are brought on by irrationality, by mental illness. So what good is a rational incentive going to do in the face of elevated suicide rates?

People need to admit that suicide is rational, already.

Written by Sister Y

May 29, 2010 at 11:47 pm

"I regard this as justice"

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June Hartley of Lodi, California, was charged with “assisting a suicide” and “causing injury leading to death” for helping her brother to commit suicide. She recently pleaded guilty to a lesser charge of “being an accessory to a crime.” (I thought suicide was not illegal?)

Her brother, blues musician Jimmy Hartley, had suffered a series of strokes which left him bound to a wheelchair and in constant neuropathic pain. Prior to his death, at age 45, he had begged others to help him end his life.

Both Hartley’s lawyer, Randy Thomas, and the prosecutor in the case, Sherri Adams, expressed approval of the plea agreement.

“I regard this as justice,” Thomas said. “It sent two messages: The district attorney had an acknowledgement [sic] that the law was broken but also that it was a unique situation involving mercy.”

The prosecutor, Deputy District Attorney Sherri Adams, said the plea agreement was just. Adams said the District Attorney’s Office must scrutinize cases of assisted suicide, which are illegal in California, to prevent malicious killings that are masked as merciful.

Hartley’s actions, Adams said, were a genuine act of mercy.

“This case did not involve any ill will,” Adams said. “The defendant violated the law out of love and support for her own brother.” [Emphasis mine.]

Both Hartley’s attorney and the prosecutor seem to agree that this is the correct outcome for a case of assisted suicide.[1] Adams and Thomas recognize two kinds of harm:

  1. The harm of living in misery and not being able to die (hence the recognition that the act of helping a person to die can be merciful or compassionate, and that such a person should not be punished);
  2. The harm of a “malicious killing” (presumably a murder, but perhaps something else is meant) going unpunished.

The statement that the outcome in Hartley’s case is “justice” indicates that the correct balance has been struck between the two kinds of harm.

In fact, in this case the first interest – the right to choose death over suffering – is almost completely sacrificed at the expense of the second – punishing “malicious” killers. James Hartley’s interests, and those of people like him, are ignored. Adams is concerned with “malicious” killers disguising their work as assisted suicide. But what about all the people suffering in misery, who have a longstanding wish to die, but cannot die because anyone assisting them will face prosecution? The idea that June Hartley’s actions were “merciful” concedes that her brother had an interest in dying. Prosecuting people who assist suicides does nothing to protect that interest.

Also, as I have previously argued, prosecuting assisted suicides is an extremely poor way (in practical terms) to prevent malicious killings from being disguised as suicides. In Oregon and Washington, for example, it would be extremely difficult to make a murder look like an assisted suicide, at least a murder of a person ill enough to qualify for suicide assistance from a doctor. Since a comfortable means of assisted suicide is legal, with many safeguards to ensure that it is the true wish of the decedent, an “assisted suicide” by any other means would be unlikely and extremely suspicious. I assert that assisted suicide in Oregon and Washington is much harder to fake than in California – and, of course, the right to die is protected better there, as well. Both interests recognized by Adams and Thomas are poorly protected by the solution they claim is “justice.”

Elsewhere on the web, TGGP rips apart Frontier Psychiatrist‘s definition of rationality, in the context of suicide (“Life is a disease, so cut the bullshit please.”). Rationality in this context means that a decision is “characterized by reason or ‘makes sense’ to others,” FP claims. I manage to comment in both places without rolling my eyes or sighing deeply.

And Bryan Caplan wonders why so few terminally ill people kill themselves.


1. The term “mercy killing” is often used in cases such as Hartley’s. I think this term is misleading: “killing” implies that one person caused another person’s death – such as by smothering or shooting the person – without his permission. In Hartley’s case, she merely helped her brother achieve his own aim of dying. Helping someone to commit suicide who has a longstanding wish to die is not properly considered a killing.

Written by Sister Y

June 4, 2009 at 1:49 am

Disincentives, Time Horizons, and the Irrational Continuation of Life

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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

More Evidence for Rational Suicide

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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.

Written by Sister Y

December 30, 2008 at 5:26 am

Study: Having a Good Reason to Kill Yourself Increases Suicide Risk

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A study out of Oxford University has found that prisoners with a lot to lose upon entering prison – ones who are married and employed prior to being imprisoned – are more likely to commit suicide than unmarried prisoners who were unemployed upon entering prison.

This is the expected result if suicide is a rational decision. But, for some reason, the researchers recommend increased investment in mental health services (coercive suicide prevention) for at-risk (married, employed) prisoners. Huh? Because if someone has a good reason to commit suicide, and therefore is at higher risk for committing suicide, he must be . . . crazy.

Other results of the study include the fact that serving a life sentence also increases the risk of death by suicide, as does living in a single cell (the latter, presumably, not just because of loneliness, but because it makes committing suicide easier in practical terms).

Mental health services – generally a euphemism for coercive suicide prevention tactics and other ineffective, humiliating practices – are the wrong solution to the “problem” of rational suicide. The idea that “mental health services” are the right thing to do to reduce suicides is ubiquitous, but it’s important to point out failures of rationality like this.

Update: apparently chronic pain – especially head pain and pain in multiple areas of the body – also increases the risk of suicide.

Written by Sister Y

November 6, 2008 at 5:41 pm