4 ms·

How do you define when the suicidal ideation is irrational, though? Let's say you're having a persistent depressive episode, and have had suicidal urges and po

How do you define when the suicidal ideation is irrational, though? Let's say you're having a persistent depressive episode, and have had suicidal urges and possibly even attempted it in the past. Let's further say that you've been attempting treatment consistently from multiple approaches, for extended time intervals, and none of them have yielded improvement. Is there a point at which the suicidal urges should no longer be considered irrational? There's a viable argument that their urge to end themselves is a direct result of their condition (e.g. if we removed the condition, the desire would evaporate), but there's also a viable argument that their urge is an increasingly rational response to extended suffering with little hope of improvement. Unfortunately, while I'd like to say the answer to this is more objective ways to quantify prospects for improvement, I don't currently know of much research on the horizon that would enable this, as too much of how our psychiatric care works is currently guess-and-check, and we don't even know where we'd look if we had good near-realtime monitoring for neural interactions. (The above hypothetical does not reflect my life experiences - I've never been at risk of self-harm for the lovely malaise of depression that pervades my mind, but a few years ago, I was given a treatment which, for a little while, made me much closer to neurotypical functioning - but it stopped working after a few months, not because I had stopped receiving the treatment, and having acute memories of how pervasive this problem was, and how much nicer life could be, is probably the closest I've been to that particular precipice.)

Barrin92 7y ago
I would agree that there is potentially a point where a mental illness could be so severe and life-draining and incurable that it would be an option to end that life, but I think even in that case it's hard to argue that the person in question is even in a position to make that call, because we cannot distinguish why they're feeling the way they do. And in particular when it comes to young adults there is a significant possibility that treatment resistant mental illness improves or sometimes vanishes, often in the late twenties or early 30s. In the case of a 17 year old girl I think precaution dictates that we stay on the side of treatment. I think to end the life of a minor without terminal illness is very hard to justify. And I thankfully never suffered from depression, but have a family member who did. She came very close to ending her own life, and explained to us repeatedly that she did not want to live. When it took a turn for the worse we had her hospitalized against her will, and now several years later she is thankful for the fact that we did. And I think I'd feel the same way. Mental illness can change the perception of people so much, it really seems to hard to me to take these wishes just at face value or see them as personal choice.
- candiodari 7y ago
  The problem is the alternative. Or rather the total lack of alternative. Because the state won't actually pay for personnel in mental facilities (even for kids), the only option is the isolation cell. Constantly. Obviously without glasses or books, both of which provide options for suicide. Suicidal patients are never let out (because doing that is, of course, an extremely stressful thing to do that necessitates large amounts of staff) You know what you don't get in an isolation cell ? An optimistic outlook on life. Even in those circumstances patients often figure out how to commit suicide anyway with the very limited tools they have there. There's plenty of examples of patients that figured it out after 2 months or so. Of course there's also examples people who haven't figured it out after years, but I doubt anyone who's seen that considers it a good outcome. You have to realize that you're choosing between 2 alternatives. You cannot just choose against something. What I've described here is the only alternative, and yet I feel like the vast majority of people would give these people an alternative, even if it was suicide. I don't think you'd really consider 10 years of this a better alternative to suicide if you were to go and see one of those patients. And of course, there is the alternative "provided": get the staff angry enough (damage a few of them permanently for example, systematically attack them psychologically and pester them), and there is a point where they will throw you out (will make things worse in the short term of course). That's another thing that can't be prevented. And I get it. There are other problems. Who judges these people ? Because obviously there's problems there. Who decides if a request is sincere and not forced ? Who executes such requests ? But still allowing suicide is not the worst thing to do.
- pas 7y ago
  Why are we condemning people to live so many brutally bleak and desperate years just in the hope of maybe it'll be better? Are we running out of people? Can we make life bearable for them? No, and alas not really. Sure, we offer drugs, and counseling, and whatever, but sometimes those amount to nothing, because you can't give them what they need/want - kinship, family, love, a loving mother/father, a better childhood, etc. I'm not saying life is not precious. I'm saying, that exactly because life is precious because it allows you to experience the journeys, pursue happiness, find joy, retrospect, and go out knowing it was precious. But if none of these happen, if none of these are available, if you can't give any of these to these people, then their life is not a life.

Barrin92 7y ago

I would agree that there is potentially a point where a mental illness could be so severe and life-draining and incurable that it would be an option to end that life, but I think even in that case it's hard to argue that the person in question is even in a position to make that call, because we cannot distinguish why they're feeling the way they do. And in particular when it comes to young adults there is a significant possibility that treatment resistant mental illness improves or sometimes vanishes, often in the late twenties or early 30s. In the case of a 17 year old girl I think precaution dictates that we stay on the side of treatment. I think to end the life of a minor without terminal illness is very hard to justify. And I thankfully never suffered from depression, but have a family member who did. She came very close to ending her own life, and explained to us repeatedly that she did not want to live. When it took a turn for the worse we had her hospitalized against her will, and now several years later she is thankful for the fact that we did. And I think I'd feel the same way. Mental illness can change the perception of people so much, it really seems to hard to me to take these wishes just at face value or see them as personal choice.

candiodari 7y ago
The problem is the alternative. Or rather the total lack of alternative. Because the state won't actually pay for personnel in mental facilities (even for kids), the only option is the isolation cell. Constantly. Obviously without glasses or books, both of which provide options for suicide. Suicidal patients are never let out (because doing that is, of course, an extremely stressful thing to do that necessitates large amounts of staff) You know what you don't get in an isolation cell ? An optimistic outlook on life. Even in those circumstances patients often figure out how to commit suicide anyway with the very limited tools they have there. There's plenty of examples of patients that figured it out after 2 months or so. Of course there's also examples people who haven't figured it out after years, but I doubt anyone who's seen that considers it a good outcome. You have to realize that you're choosing between 2 alternatives. You cannot just choose against something. What I've described here is the only alternative, and yet I feel like the vast majority of people would give these people an alternative, even if it was suicide. I don't think you'd really consider 10 years of this a better alternative to suicide if you were to go and see one of those patients. And of course, there is the alternative "provided": get the staff angry enough (damage a few of them permanently for example, systematically attack them psychologically and pester them), and there is a point where they will throw you out (will make things worse in the short term of course). That's another thing that can't be prevented. And I get it. There are other problems. Who judges these people ? Because obviously there's problems there. Who decides if a request is sincere and not forced ? Who executes such requests ? But still allowing suicide is not the worst thing to do.
pas 7y ago
Why are we condemning people to live so many brutally bleak and desperate years just in the hope of maybe it'll be better? Are we running out of people? Can we make life bearable for them? No, and alas not really. Sure, we offer drugs, and counseling, and whatever, but sometimes those amount to nothing, because you can't give them what they need/want - kinship, family, love, a loving mother/father, a better childhood, etc. I'm not saying life is not precious. I'm saying, that exactly because life is precious because it allows you to experience the journeys, pursue happiness, find joy, retrospect, and go out knowing it was precious. But if none of these happen, if none of these are available, if you can't give any of these to these people, then their life is not a life.