The trigger warning is (obviously) in the title.
You know how people write posts with admonitions against suicide and lists of resources? Those posts are valuable, but this isn’t one of them. It’s basically just my thoughts about it all in general, plus a whole heap of questions. You should definitely avoid this post if suicide is a painful trigger, but for the rest of the world, suicide should not be taboo. There’s little hope of preventing it if the reaction to it is fear, anger or evasion. I intend to play devil’s advocate as far as possible.
When the house is finished, Death enters. —Arabic proverb
This isn’t about David Foster Wallace, though all but one of the quotes I’ve used are by or about him. He didn’t write about his own illness, but the words he gave his fictional characters are incredibly expressive.
It’s difficult to explain to a neurotypical person (and I do know that the term is problematic), just how painful the pain is, when it’s invisible pain. The following quote is possibly the most cogent and succint description I’ve read thus far.
A level of psychic pain wholly incompatible with human life as we know it
a double bind in which any/all of the alternatives we associate with human agency — sitting or standing, doing or resting, speaking or keeping silent, living or dying — are not just unpleasant but literally horrible
a nausea of the cells and soul
David Foster Wallace Obituary | Longread article**
Suicide is on my mind today, because a local guy (we’ll call him Leon) attempted suicide last night. I say ‘attempted’, but right now things don’t look good. Leon is bipolar; he was hospitalised fairly recently to sort out his meds. He tried to hang himself in his garage a few years ago. Last night he overdosed, vomited while unconscious and inhaled some of it. He’s in hospital and on a ventilator now. He is not close to me, he is friends with my neighbour and I’m not even sure whether I’ve ever met him or not. I feel that, although you probably know it, I ought to say that simply taking an overdose of your medication is highly unlikely to kill you outright, but can cause other truly horrible issues. Do not imagine a peaceful and painless journey to oblivion and death.
‘Disorder’ was, of course, not always a medical term. As a noun it means a state of confusion, and as a verb, a disruption of order. The clinical definition is equally logical, it’s an illness that disrupts normal physical or mental functions. Some people think it’s all psychosomatic and that, apparently, is an adequate reason to dismiss it. Either way, whether or not you agree with the semantics, the suffering is real, and as we know, ‘mental’ problems are measured by the suffering they cause.
I’m not incredibly glib, but I’ll tell what I think the Bad Thing is like. . . . Imagine that every single atom in every single cell in your body is sick . . . intolerably sick. And every proton and neutron in every atom . . . swollen and throbbing, off-color, sick, with just no chance of throwing up to relieve the feeling. Every electron is sick, here, twirling offbalance and all erratic in these funhouse orbitals that are just thick and swirling with mottled yellow and purple poison gases, everything off balance and woozy. Quarks and neutrinos out of their minds and bouncing sick all over the place.
David Foster Wallace
Treating manic depression is a nightmare for both doctors and patients; there’s just no formula for it. What is ailing and needs treatment, is the entire spectrum of human moods, plus some extra extremes/intensity. I’m simplifying a lot, but I don’t want the details to detract from the topic at hand. In order to attain the goal of euthymia, both mania and dysthymia need to be treated at various levels of severity, and that requires numerous different drugs, plus proactive lifestyle adjustments and strategies. What works for one person may not work for another; what does work is almost guaranteed to become ineffective at some point. What is certain, is that the meds cause unpleasant side effects that may or may not be bearable. Electro Convulsive Therapy is an option too, but there’s no guarantee there either. Some people are simply treatment resistant.
“It’s like they’re throwing darts at a dartboard,” he complained to them about his doctors. They went with him to an appointment with his psychiatrist; when the doctor suggested a new drjug combination, Wallace rolled his eyes.
Given the facts that bipolar takes an average of 10 years to diagnose, and is a progressive, recurring and chronic condition, if the form of disorder experienced is a severe one, the outlook can be frightening. Potential consequences of brain damage, early onset dementia, increased risk of heart disease from excessive cortisol production are disheartening to. In the USA, the suicide rate of people with bipolar disorder is quadruple that of the national average. No matter which way you look at it, the outlook of serious manic depression is grim.
… he considered suicide “a reasonable if not at this point a desirable option with respect to the whole wretched problem.”
David Foster Wallace
It’s a given that suicide while the mind is disturbed is not based on rationality, but if the mind is seriously disturbed for a long time (years, in some cases), what is the alternative (there are always alternatives)? The alternative is to stay alive without a cure or any definite prospect of remission. If death is not an option, we must logically find better palliative solutions. Waiting for big pharma to produce meds with better results and fewer side effects is highly likely to be a very long process indeed. Natural remedies, yoga, routine, exercise, regular sleep, healthy social interaction, CBT and so forth are helpful, but not helpful enough. New strategies would need to be found there too. And what else is there?
The problem lies in the gray areas, those points between issue and illness, illness and emergency. Here, our “thin red lines” make themselves known. The drinker concerned about his very occasional binge, and now worrying about his possible alcoholism, doesn’t have the support of a recovering addict, but he sure as hell can’t wait two weeks to see a specialist. The bipolar depressive awake for the third night in a row on a manic streak doesn’t have time to reconnect with a distant psychiatrist, but also might not feel their situation warrants an “emergency” call. So what are these fringe cases to do? How do they get the treatment they need on time if they fail to fit neatly into the commonly understood categories?
There is absolutely no doubt that suicide is tragic and causes enormous grief, but without hope, is it really empirically wrong? And if there are no loved ones to be damaged by it, is it wrong then? If it is wrong purely on moral grounds, isn’t it also cruel? Should it be possible for someone to specify, in rational circumstances, that in the event of certain circumstances/factors, s/he might very well commit suicide (or get assisted suicide where the law allows it)? Has society made the judgment that a mentally ill person is never capable of rational thought? If it’s possible to keep fighting, it’s wrong, because hope and determination can carry the day – but not always. Leaving the concept of suicide as wrong is potentially a major extension and intensification of suffering and therefore, the suffering must be alleviated. We are all stakeholders, so what exactly should we be advocating for and researching? We cannot leave it to pharmaceutical companies and academics; they haven’t found a solution in the 5,000 or so years since bipolar was first documented. We definitely need better access to healthcare. What else can you think of?
Options! Allow suicide, or at least condone it. Legalise assisted suicide. Find a shorter and safer path to remission. Find a cure. Which is the most compassionate solution? How do we best facilitate and support the process we want?
This is what kidsaregifts, who tragically lost her (bipolar) son to suicide has to say:
From where I am standing, I can see no good reason for anyone to end their life as many people along with me are hurting deeply as a result of it. The sufferers of the illness have a different perspective on it and rightly so.
Footnotey type things:
* I may have invented the bipolar brigade, idk. I did it for the alliteration. Spose I’ll be up all night sewing uniforms for them now :/
** The longread about DFW is a very, very worthwhile read. I can’t stress that enough … I hope you read it.