Suicidal Tendencies Should Be Treated Like a Terminal Disease

Suicidal Tendencies Should Be Treated Like a Terminal Disease

Thirty-seven percent of U.S. adults who experienced a major depressive episode in 2016 did not receive treatment.

SourcePeter Griffith/Getty

Why you should care

When a loved one has cancer and decides to stop treatment, we understand that they need to end their suffering. Isn’t the same true of suicide?

No longer able to bear her tormented mind, Cornelia Geerts asked her psychiatrist to kill her. And on Oct. 7, 2014, he did. Geerts, 59, had been suffering from mental illness for most of her life, and in Belgium, where she lived, assisted suicide is legal for people with psychiatric illness.

It’s a highly contested law, as is a similar rule in the Netherlands. The Termination of Life on Request and Assisted Suicide Act allows doctors to end the life of a patient experiencing “unbearable suffering.” That includes mental suffering — as it should.

Most of us have experienced sadness, grief and apathy. But for those with major depression — that’s nearly 7 percent of the U.S. adult population, according to the National Institute for Mental Health (NIMH) — those feelings are near constant and far more intense. NIMH also found that nearly 40 percent of American adults who experienced a major depressive episode in 2016 did not receive treatment.

They’re trying to get out of completely intolerable circumstances.

Dr. Julie Cerel, president of the American Association of Suicidology

Yet when a loved one commits suicide, an early reaction is often anger. We believe they chose to take their own life — that they were being selfish or “took the easy way out.” But consider this: If a family member has a terminal illness and decides to stop treatment to end their suffering, we’re far more likely to understand. Sure, it might be upsetting that they don’t want to keep “fighting,” but ultimately, we agree that ending their suffering is more important.

We should think of suicide the same way.

Many people who end their lives have been suffering from depression for years. They may have tried every form of therapy and medication available. If they’ve run out of options for healing, we shouldn’t blame them for wanting to end their life, the same way we shouldn’t blame those suffering from a terminal illness who want to stop treatment.

The difference though, says Dr. Julie Cerel, director of doctoral programs at the University of Kentucky and president of the American Association of Suicidology, is that some people who die by suicide haven’t had access to the right kind of treatment. “We need to know more about what really helps people,” says Cerel, who advocates for more mental health resources and better training for mental health professionals.

For now, physician-assisted suicide is only legal in seven U.S. states and the District of Columbia. It’s mandated by law in Colorado, Hawaii, Oregon, Vermont, Washington and Washington, D.C., and is mandated by a court ruling in California and Montana.

But Cerel thinks the culture around suicide in the U.S. is starting to shift. For example, the American Psychological Association no longer uses the word “commit” when referring to suicide. Instead, “died by suicide” is now used. “‘Committed’ really connotes that someone committed a crime or committed a sin,” Cerel says. “It’s very pejorative.”

And that’s the thing. We shouldn’t look at those who die by suicide as bad, selfish or sinful. Of course, it’s devastating to lose someone you love, and it’s normal to be angry. But we need to try harder to put ourselves in their shoes. If every day is unbearable and death is the only way to relieve the pain, perhaps we shouldn’t think of suicide as a choice.

“I think more people are realizing that those who are suicidal aren’t making a choice to end their lives,” Cerel says. “They’re trying to get out of completely intolerable circumstances.”

Last year, the assisted suicide case of 29-year-old Aurelia Brouwers in the Netherlands drew attention because of the patient’s young age and because she was one of few people euthanized for a mental illness in the country in 2017. That year, 83 out of 6,600 assisted suicide cases in the Netherlands were for people with psychiatric disorders. But according to friends and family, as well as Brouwers’ posts on Facebook, she was very happy about receiving approval for the procedure. One of her friends, Toon Krijthe, told The Guardian at the time, “I was glad for her because I knew this was her only option — and I knew if it wasn’t a yes, she would find another way.”

The primary focus, of course, should remain on suicide prevention, and this, says Cerel, is sometimes simpler than it seems. She suggests that we all help with “caring contacts” interventions — simple texts or phone calls with people experiencing depression can be very effective at preventing suicide. “We know that people are kept alive by simple human contact,” Cerel says.

But reframing how we view suicide can be helpful for everyone — those who struggle and live, those who choose to die, health care professionals and loved ones alike.

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