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  • Writer's picturecocodensmore

Life, liberty, and the pursuit of happiness.

January 12, 2024

Chronic mental illness is a horrific disease. It obliterates hope, it robs you of your dignity, your ability to function, and any semblance of quality of life. It’s a horrible way to live; it’s a living death. For some, it’s an unsustainable existence. Is chronic mental illness curable? I don’t believe it is. The condition can be managed, people can experience remission for extended periods of time, but I do not think the disease ever completely resolves.

I recently saw Anderson Cooper and Ashley Judd talking about Naomi Judd’s suicide. Naomi had used a firearm. Ashley was with her mother at the end, holding her as she passed. She told Anderson, “Even when I walked in that room and I saw that she had harmed herself, the first thing out of my mouth was, ‘Momma, I see how much you've been suffering, and it is okay... I am here, and it is okay to let go.’”

We are living in a time when there is more awareness of suicide prevention than ever before. And it’s important that we, as individuals and as a society, value human life. But the issue is much bigger than the sanctity of life. I’m not advocating suicide, not by any stretch, but it cannot be assumed that requiring a person to remain living and in the world is necessarily always what is best and good and right. There are quality of life issues that in our haste as a society to address the suicide epidemic, we may not be taking into adequate consideration.

I just read a New York Times article titled Should Patients Be Allowed to Die From Anorexia? It outlines the use of palliative care as a final treatment option for those suffering from chronic mental illness. It’s the first time I’ve ever seen this particular philosophy explored in detail.

In the article, psychiatrist Dr. Joel Yager explains how he came to embrace the idea of palliative care for those with chronic mental health conditions who had not responded to multiple rounds of treatment over extended periods of time.

“He came to think that he had been impelled by a kind of professional hubris — a hubris particular to psychiatrists, who never seemed to acknowledge that some patients just could not get better. That psychiatry had actual therapeutic limits. Yager wanted to find a different path. In academic journals, he came across a small body of literature, mostly theoretical, on the idea of palliative psychiatry. The approach offered a way for him to be with patients without trying to make them better: to not abandon the people who couldn’t seem to be fixed. ‘I developed this phrase of ‘compassionate witnessing,’ he told me. ‘That’s what priests did. That’s what physicians did 150 years ago when they didn’t have any tools. They would just sit at the bedside and be with somebody.’”

There is a common belief that someone who is mentally ill is not capable of making rational informed decisions. Yager explores that assumption in the article and explains it does not hold true in all cases. Perhaps someone who is mentally ill may not come to the same decision as someone who is not mentally ill, but that doesn’t mean their decision is irrational or uninformed. The majority of people with chronic mental illnesses are capable of competent decision-making. If that were not the case, vastly more people with mental illness would be found innocent of their crimes due to insanity.

Furthermore, to rob a person of the privilege of making decisions about their own lives robs them of their humanity. It’s cruel.

“Even a very mentally ill person, he [Yager] thought, was allowed to have ideas about what she could and could not tolerate.”

There are many countries where passive or assisted suicide is legal. After reading the article, I am a solid supporter of psychiatric palliative care under specific circumstances. I would go even further and advocate for passive suicide under very stringent criteria. It’s interesting I’d draw the line there, and not advocate for assisted suicide as an option. I wonder why. Perhaps it’s because if I were provided the means, it would be up to me to make the choice, and I could decide against suicide at any point.

During my psychiatric hospitalization during the summer of 2017, I wrote:

I wonder, on the quality-of-life spectrum, does the right to suicide exist? I'm not talking about end of life suicide, or those who opt not to live out a terminal illness. I'm talking about depression suicide. Is the option to end one's life a matter of personal freedom? Life, liberty and the pursuit of happiness. If you feel you'd be happier dead, aren't you acting within your rights?

I have made the decision to persevere. It’s a decision I made long ago, and I make it often. I choose to live. I continuously cling to the hope there will be a better day. And I can do that, I keep on doing that, because no matter how bad it is, those better days always come.

I suffer from chronic mental illness, and I am not in remission. Every day I choose to aggressively manage my condition. With the recent change in my living circumstances, I’m feeling much better. But still, there are afternoons I sit at my desk in front of the living room windows in this lovely apartment, gazing out on my busy Northeast Portland neighborhood, and tears stream down my face. “Why am I sad?” I ask myself. And I have no answer. There is no reason. Sometimes I am just sad. Incredibly sad. And sometimes I feel joy. Incredible joy.

Through it all, I Persevere. I choose to Persevere. Every day, I make that choice anew.



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