Jack* is a former client in my therapist practice who suffered from chronic, severe depression. He was a creative, bright, funny, and thoughtful young man frequently plagued with long stretches of dark thoughts and demonic images. He was often lonely, and longed for a friend.
Jack’s father brought him to see me, hoping I could help sort out his depression. During our initial visit, I asked Jack if he was ever suicidal. He replied, “No, not right now, but I have been in the past.” I press into these kinds of responses, so I went through my standard therapist line of questioning, asking him to explain.
“I’ve thought about killing myself. I’ve been that depressed many times. Just wanting it to all stop,” he said. I explored his answers until I felt confident he wasn’t in immediate danger, and told him I’d be checking in with him to make sure he was safe.
Over our time together, Jack and I spent many hours working through various parts of his painful past, while developing coping skills to help build up his self-worth and live his values. One day, during one of our more lighthearted sessions, we were talking about television shows, and I mentioned in passing that I watched “Stranger Things.” Jack perked up as though I’d said something remarkable.
“You know the Upside Down in the show? That’s what depression looks like, and feels like,” he said. “Nothing feels right. Nothing looks right. Nothing is pretty. Everything is wrong, and you can never escape it no matter where you go.” To give readers some context, the “Stranger Things” Wiki website describes the “Upside Down” this way:
The Upside Down is an alternate dimension existing in parallel to the human world. It contains the same locations and infrastructure as the human world, but it is much darker, colder and obscured by an omnipresent fog. The Upside Down is devoid of human life, instead being overgrown with ropy, root-like tendrils and biological membranes covering practically every surface.
The Upside Down isn’t where anyone wants to spend any amount of time. So when Jack told me this is what it feels like when he’s depressed, it was at once vividly descriptive, and heartbreaking. No one would ever want another human being to suffer like this.
As a therapist, family member, or friend, it’s incredibly painful to watch someone you love go through this kind of anguish day after day, month after month, sometimes for years. But if Jack came up to me one day and asked me to support him taking his own life to end his suffering, I would unreservedly say, “No.”
Elevating a Disorder Above a Human’s Worth
Setting aside the many ethical and moral problems, supporting suicide as a solution is in effect elevating Jack’s disorder above his own worth as a human being. It’s giving power to his mental illness, and conceding defeat when there is still hope.
This is the exact opposite of what we do as therapists. People are not defined by their mental disorders. They are not powerless, they do have personal agency to live full, meaningful, value-driven lives amid depression, anxiety, or any other mental illness. None of these disorders precludes living a fulfilled, dignified life.
Furthermore, electing to take one’s own life while suffering from a mental disorder certainly presupposes that person is unfit to make rational decisions regarding his or her personal welfare, or at the very least about major life decisions, under which assisted suicide would definitely fall.
Not everyone, however, shares such ideals on treating mental disorders. In fact, Belgium and the Netherlands roundly disagree. Leading the way in euthanasia for the mentally ill, these two nations are at the forefront of progressive policies on assisted suicide for people with non-terminal disorders. In 2016 in the Netherlands, 60 individuals with severe psychiatric problems were euthanized, four more than in 2015. There have even been controversial cases including a woman who suffered from severe tinnitus, a ringing in one’s ears.
Killing People Just Because They Feel Sad a Lot
The most recent tragedy was the euthanizing of Aurelia Brouwers, a 29-year-old female who, according to her blog, “has Borderline Personality Disorder, chronic and complex PTSD, addiction, anxiety disorders and many more mental issues.” Brouwers fought for eight years to be euthanized. Her blog posts go as far back as 2012 and tell a beautiful, sad story about a very complicated young woman in a lot of pain.
She shared about being in and out of institutions, and how her many disorders isolated her and caused her to feel lonely and misunderstood. She expressed very little hope that her condition would improve. In one post she quote Meatloaf’s “The Future Ain’t What it Used to Be”:
I never knew so many bad times
Could follow me so mercilessly
It’s almost surreal all the pain that I feel
The future ain’t what it used to be
Some days I feel so numb and empty
And those would be the good days for me
But all her writing wasn’t steeped in sadness. Some posts were rather sweet stories about her interests and hobbies. In one she shared about a group of women she met at a knitting workshop to learn how to make gloves. She even set a goal for herself to learn how to knit a complicated pattern.
Reading through her posts, one can’t help but think whatever her pain—and there was a great deal of it—she had a tremendous vibrancy. She was gifted, valued, and a beautiful woman who was so much more than her illness, her suffering or agony.
Euthanasia for individuals like Aurelia is literally overkill. Her mental illness was not fatal. I’m not sure what type of pharmacological or psychotherapy she was receiving, but if an intervention isn’t working, the answer is try something different, it isn’t end your life. As Andrew Walker argues in National Review, this kind of extreme solution is an invitation for other more dangerous problems:
Cases in the Netherlands show the most troubling reality of euthanasia laws: their widening use based on subjective criteria. Euthanasia is advertised as ‘dignified death’ for those suffering from a terminal illness. But the euthanizing of a young woman on grounds that she suffered from a mental illness shows the false advertising of the ‘death with dignity’ movement. When an apparently healthy young adult can legally end her life because of her mental illness, it raises legitimate questions of where that trajectory ends.
Many People Change Their Minds After Good Care
There are some very appropriate concerns about where euthanizing the mentally ill can and will take a civilized society. To say this is a slippery slope would be incorrect. It’s a cliff. The American Psychiatric Association (APA) found the practice so troubling they issued a position statement in December 2016, stating: “The American Psychiatric Association, in concert with the American Medical Association’s position on Medical Euthanasia, holds that a psychiatrist should not prescribe or administer any intervention to a non-terminally ill person for the purpose of causing death.”
This declaration is mostly a symbolic gesture, because assisted suicide for the mentally ill isn’t legal in the United States, but the overture isn’t lost on the international discussion. As Charles Lane reports from the Washington Post, “Most important, the statement implies the basis for a possible direct organizational protest by American psychiatrists to their Belgian and Dutch colleagues, the logical next step in the APA’s welcome assertion of what should be a global ethical principle.”
Mental health practitioners here in the United States need to follow the APA’s lead and corporately reject the practice of euthanasia for the mentally ill. The American Psychological Association has yet to make a formal statement on this matter. The nearest they’ve come is a resolution in August 2017 on Assisted Dying and Justification, in which they acknowledge end of life issues are complex, and many individuals will “rescind their requests for assisted dying when they receive palliative and comprehensive care,” and clinical depression is “frequently unrecognized and undertreated, which can lead to suffering that may result in requests for assisted dying.”
This resolution assumes neither an affirmative or negative position on assisted suicide. In fact, note they don’t even refer to it as suicide. As a resolution, it’s a lukewarm. The resolution does, however, recognize mental disorders be addressed before assisted suicide is considered, so both organizations agree that individuals suffering from mental disorders are not mentally fit to make sound decisions regarding their welfare.
Having a unified position will become more important as more countries, like Canada, start exploring the practice of euthanizing the mentally ill. To show the world that we value and support the dignity of our citizens suffering from mental illness by refusing to abandon them to the option of death, I encourage the American Psychological Association to partner with the APA in issuing an equally strong statement, in plain language, simply stating: “Psychologists should not be involved in any intervention to a non-terminally ill person for the purpose of causing death.”
(*The client’s name and certain details have been changed to protect the client’s identity.)