Making progress in compassion

Progressives in Belgium have begun to argue for the right of individuals with mental illness to decide their own fate. Last year, three per cent of euthanasia cases in Belgium were for people with psychiatric conditions. In the last month, a highly publicised decision will allow Laura, a 24-year-old woman, to receive a lethal injection to end her psychological pain. Laura, who is otherwise physically healthy, has depression. She reportedly told Belgian newspaper, De Morgan, ‘Life, that’s not for me.’

It is not a new idea that psychic pain can be rationally addressed through suicide. The cornerstone of the anti-psychiatry movement, brought to prominence by figures such as Thomas Szasz, was to emphasise the ever-present sanity in people with all kinds of mental illness, however florid the psychosis, however dark the depression. Taking away people’s power to choose their own path – life or suicide, hospitalisation or remaining at home, radical treatment or a Caribbean holiday – was paternalistic and unhelpful.

There remains a thread of progressive thought which dismisses the role psychiatry can play. Medications are akin to the soma depicted in Brave New World, ways to shut off pain without addressing its real source. Psychic pain emerges when it is useful for an individual to feel it. The mental health system is a form of Foucauldian bio-power, a kind of neoliberal conspiracy to make people work more and harder and forget the cost. Feeling exhausted and sad just means you’re paying attention.

I know these views well. They were mine. So, one winter, it seemed natural to stay in my room to avoid the cold. The food outside was disgusting because it was preservative-laden gloop, the landscape turned grey and soulless because it was part of my personal aesthetic, gravity more powerfully weighed me down because Bush was still President.

One day though, I sought a solution in the medical system.

It was here that the issues of the world were bracketed and neurotransmitters became the target for treatment. Even in therapy, some strands of which explore the role of one’s autobiography and relationships, the issues that pressed me were not pressed. Why is it that mental illness has become so ubiquitous? What is it about the intersections of my life and those of so many others that have become so toxic? Is the disconnection I feel with society mostly real or mostly imagined?

I paid the money for the appointments and the pills (even with Medicare, the quest for mental health is easier for those with a lot of economic capital). I was a compliant patient, a conduit for which my doctors’ theories of good living could be corporally realised. Following their instructions sometimes meant having to compromise my own better judgement (Go salsa dancing! Try theatre sports!), and sometimes it meant talking about parts of myself which I accept but they found wrong. There were many smiles but unspoken threats, implicit in the power psychiatrists hold: to change or withhold medication, to put stigmatising labels on your file, and in extreme circumstances, to force you into hospitalisation. It was a constant humiliation.

It would be wrong to say that psychiatry helped me gain an autonomous sense of wellbeing. That work is far more idiosyncratic and ongoing. What psychiatry did do, though, was keep me alive for long enough to see wellbeing as a possibility. Not everyone is saved in kind – neither the Belgians with a mental illness where the spectre of euthanasia is an enticement, nor the approximately 2500 Australians who take their own lives each year.

Death may be a rational choice in certain situations. It may also be part of a wider system that kicks you while you’re down. Services, in short, suck; and perhaps even more significantly, there isn’t much compassion for those undergoing inner turmoil – both at an interpersonal level and towards oneself. It’s not simply a matter of being in pain, but also a matter of feeling burdensome because of that pain.

In an article for the New Yorker by Rachel Aviv which explores euthanasia for mental anguish in Belgium, academic Herman De Dijn cautions that as death becomes a widely available and socially acceptable option, views about what kinds of lives and experiences are worthy begin to narrow. He says, ‘human dignity should include not only respect for personal choices but also for connectedness to loved ones and society.’

The anti-psychiatry movement has lent consumers some semblance of dignity, but it gives up addressing mental illness as it exists across individual, interpersonal and cultural contexts. It also gives up the possibility that our lives are still worth living even if we’re unsure.

On a pragmatic level, compassionate progressives should campaign for better mental health funding, even if they don’t believe in the system. At the moment, the system is the only possible band-aid in a society that is proving to be more and more difficult for people to want to live in.

Ideologically, a change in attitudes would go far. Progressive people who feel ambivalent about the medical system would do well to see psychiatric euthanasia as a symptom of a complex and intangible social disease which values people not on their intrinsic worth but their propensity to be happy, productive citizens. It should also be remembered that a difficult life is still a worthy life. We cannot always know if another’s pain is ultimately tolerable – it is not possible to make that judgement for another. But we can embrace their experiences as a manifestation of human diversity, and try to temper suffering through compassion.

Erin Stewart

Erin Stewart is a writer based in Canberra. She tweets at @xerinstewart

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  1. I sympathise with your concerns about the situation in Belgium, and hold similar concerns when people in my profession – psychology – wish to administer ‘rational’ euthanasia here in Australia. Under current economic conditions of scarcity in public health, there can be little doubt that ‘rational’ euthanasia would result in killing patients as a result of resource pressures. Examples like this from the Gold Coast show that some elements of the mental health system are not far from such a position as it is:
    On the other hand, I’m sceptical about the claims of this being the fault of ‘anti-psychiatry’. Firstly, this movement barely exists anymore, and has evolved into the more nuanced ‘critical psychiatry/psychology’ movement, which does not seek to deny help to the suffering, but wants to do so outside of existing paradigms. One needn’t be ‘progressive’ to critique mental health practice, since there are strong ethical and epistemological grounds for doing so in any case.
    Secondly, mainstream psychiatry is already Szaszian. Szasz said that illness is biological or non-existent, and the DSM, NIMH and others agree with him, assuming every ailment of subjectivity to have a biological cause. Reductionism and appeals to (perceived) scientific authority remain the order of the day.
    Finally, mental health services are being cut all over the place, but does anybody seriously believe that this is because (largely conservative) politicians have had some Damascene conversion to Foucault, Deleuze or anarchist theory? Is it not rather because the prevailing economic orthodoxy is one of ‘user pays’, ‘personal responsibility’, radical individualism, etc? And is not this orthodoxy inscribed into mental health treatment itself, from the haphazard use of medications, to the attempts at subjective micro-regulation via CBT, DBT, ‘anger management’, ‘positive psychology’ and the rest? Frankly, medication is the least sinister, coercive and ideological of these interventions.
    The properly Foucauldian point, IMO, is not that madness and subjective suffering are non-existent or fictitious. Rather, it is that the diagnosis and treatment of these conditions operates more on the basis of social control and normalisation than to any subjective desire. It is power laundered as science. And that’s why an uncritical call for more of the same in mental health resembles nothing so much as a call for bigger prisons and more wardens.

  2. As you say Erin, ‘services suck’and where they exist very often practice methodologies of humiliation. Psychiatry kept you alive, which is a good thing and I guess you perhaps had some reserves to make the most of what little the services you encountered offered. And all power to you for doing that. David’s right on the deleterious influence of neoliberalism, but the left hasn’t exactly done a sterling job in enunciating critiques of regimes of mental health either. Various strange materialisms have ruled the day for the most part, and what constitutes inner life gets pushed into a corner. Maybe one reason is because so many of the loudmouths on the left have been men.

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