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.