Thursday, April 3, 2008

The Last Psychiatrist: "But I Wanna Kill Myself!"

on The Last Psychiatrist:

An Open Letter to The Last Psychiatrist, from a guy who hasn't actually read my blog, because if he had, he'd realize I agree with him.


He writes:

...Just for kicks and giggles, try this out for a second: imagine you live in a world where there are no lawsuits. I know this is hard for you, as your profession is almost entirely shaped by the fact that there are.

Is it even remotely possible, then, in this world with no lawsuits, that there are people who don't have a "disease" and aren't delusional or out of touch with reality who have thought through all their options and decided, clearly and rationally, that they no longer want to live in this world? Is it possible that some people would be better off ending their lives then continuing on in endless pain?...

...Even in a world with no lawsuits, would you still insist he be kept alive? If so, why? So he would continue to pay your fees? In which case, who are you really helping?

In a world with lawsuits, does it help the patient any to continue to stay alive just so you can collect money and not get sued?

Knowing the answer, is it any wonder that so many people in "treatment" continue to kill themselves anyway?

Suicide is always a choice. Whether it is rational or not is a case by case question. It isn't always irrational (what's euthanasia?) and it isn't always well thought out (obviously.)

1. The answer to your question, "would you keep him alive even if there were no lawsuits" is, yes, almost always. I say "almost always" because there is always the chance that some situation may arise, but I can't imagine it, and it hasn't happened. Lawsuits hardly ever drive my practice, lawyers are rarely on my mind. (see #4.)

What I take issue is that people attribute suicidal thoughts to externalities which are at best mitigating. Zoloft doesn't make you suicidal. Period. It may help, it may make you more emotional, but the act itself is yours. Own up.

2. Can a person have perfectly rational reasons for killing himself? Sure. Does that matter? No.

Here's the reason. No one in George Clooney's America will agree with me, I'm sure, but I am certain they are wrong. "Under perfectly rational conditions, why can't a guy consent to kill himself?" Because your own happiness or misery is a secondary issue, secondary to your existence. Why? Because your life is not yours. It's mostly yours, but to the extent that it affects other people in any way, you have a responsibility to them. Maybe to help them, but at least not to harm them. Your life is a publicly traded company. You may have majority ownership, but you still are subject to a Board and to your shareholders. If you want to kill yourself, everyone you have touched in any way gets to vote. Good luck.

In these posts I am trying to make a very subtle distinction. It is the duty of the psychiatrist to try to do whatever necessary to keep you alive; but it is not his fault (short of gross negligence) if you succeed. Neither is it Zoloft's fault, mania's fault, alcohol's fault, capitalism's fault, your ex's fault...

"You know, if you kill yourself, it puts that option on the table for your kids when they hit your age." Get it?

Let's all hear this at least once: you did not get to choose to be born, neither will you choose to die. If you care nothing about your own life, so be it. But you have a responsibility to improve the lives of those around you-- I don't mean good samaritan style, I don't mean person by person, I mean that your life has a net positive effect on the people in your life, in general. Some people need to get punched in the face, I get that, it's not a nice thing to do, but I'm sympathetic. But overall, miserable or not, you have to leave the world better off than you came into it, to the best of your ability. Miserable or not, painful or not, like Prometheus you will bring fire to man and take from man the expectancy of death, and you will stay chained to the rock.

Mistake me not; I would not, if I might,
Change my misfortunes for thy vassalage.

Lo, I am rockfast, and thy words are wave
That weary me in vain. Let not the thought
Enter thy mind, that I in awe of Zeus
Shall change my nature for a girl's, or beg
The Loathed beyond all loathing-with my hands
Spread out in woman's fashion-to cast loose
These bonds; from that I am utterly removed.

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