A suicidal mind is often one caught in the temporary throes of delusion and irrationality, even if it comes from internal wiring going haywire instead of external substances.

Preventing someone from killing themselves is in their best interest most of the time for that reason. Suicidal impulses are most often fleeting relative to normal lifespan.

My wife tried to kill herself a few times when we were younger - I wrestled knives from her hands and had to get a safe for pills (which she agreed to in her better states). With therapy and medicine, she is very, very happy to be alive now.

If it isn't someone you are personally willing to take some responsibility for, as you did with your wife, then I think it is wrong to insist they live.

I'm quite open about my long history of being suicidal and the various underlying reasons why. People on the internet often want to tell me "chin up, tally ho, here's a suicide hotline number." They generally don't want to do anything whatsoever to help with any of the actual underlying problems.

In fact, they usually make me feel like they are merely using me as their "good deed for the day" to make themselves feel like good people. It generally pisses me off and makes me feel crapped all over.

I'm pro right to die, but this article casts light on how very complicated the issue is. I would be horrified to learn that "I got raped and now want to die" is some new standard for helping women kill themselves. I just can't even begin to come up with the words for how mixed my feelings are about this girl's story.

Exactly. People, even kids, kill themselves because of "lack of perspective". Lack of a (reasonable) future. Lack of any reasonable hope for change. People aren't stupid and mental illnesses (the non-medical ones) don't actually prevent thinking. That means the first thing to realize is that a desire to kill yourself isn't illogical. Maybe it's a mistake but maybe it isn't.

Which of course is terrible and of course absolutely not what society expects of help. Here's this kid. She's broken. Find the miswire in her brain, cut it or something, and bring them back fixed. And then you read the story of the kid. Was "diagnosed" with Autism by a teacher with no psychological skills whatsoever. From that point on systematically increasing repression was used against this kid, and of course as a psychological/social worker you cannot change their situation. That, youth services will not let a psychiatrist do. They need to be fixed and accept whatever "help" other people feel the need to provide, decided by whoever gets put in charge by the government (they "just happen" to never ever be the people who actually take responsibility for the child). That's your only function. Oh and by the way, if you can't do it in 6 weeks (can be up to 16), the kid will be violently taken away by the police, in cuffs, and someone else gets that job. Oh, and if they commit suicide in your clinic, they'll bankrupt you and maybe you'll go to jail. Good luck !

So the problem in this girl's case is not just that her conclusion, that there was no perspective on a better life ... well let's just say it wasn't a particularly stupid or obviously wrong assessment of her situation. The things she didn't have control over weren't getting better over time. And she tolerated being treated like that "for her protection" for at least 3 years ... Do you really feel you'd last that long ? Kids are actually far more resilient than adults when it comes to being suicidal, but enough punishment ("help" provided involuntarily, like in the case being discussed here) will get the better of them soon. Every 3 months you get moved somewhere else, in cuffs, and the next thing is tried on you. That might be good, it might also be 12 weeks in an isolation cell. You just don't know. Hell, because they just take whatever is available right at the moment they move you (because your current placement ends you have to leave, doesn't mean they have somewhere else for you to go). So the social workers, your parents, even the juvenile judge also doesn't know, except perhaps a day or so in advance. Good luck feeling optimistic about your future.

So of course youth services itself was the cause of the lack of perspective. "Safety" for the child, imposing safety on her is what killed her. Escalating to heavier and heavier repression every time. As soon as she worsened in care someone should of course have pressed the abort button, EVEN knowing she was cutting herself or suicidal. Send her home and say she can stay there unless she chooses otherwise. Why ? To prevent doing more damage. To make it clear that her home was still there, and that the situation really is salvageable. But if you as a social worker or psychiatrist take that chance, and the result is that it was too late, and the kid does commit suicide (or worse: their parents or someone they're exposed to back home takes advantage of the situation), you'll be eaten alive by society. So nobody does. Everybody avoids responsibility, and thus taking chances on not treating kids is barely ever done. The odds are actually in favor of doing this. Even people who've tried to commit suicide, only 3% actually follow through with it, meaning the symptom disappears in 97% of cases, which is far better than treatment accomplishes.

About 400 kids are placed (which means locked up against the will of parents and child) "for their safety" for every 1 case of actual abuse in the Netherlands. Social workers build cases against these kids that aren't checked for accuracy (it is an actual policy for them to write down everything they hear, and to never check), there is no defense possible, there are children's rights, but no way to sue child services if they are violated, so there might as well not be. There is no actual appeal process against the youth court (technically there is, but whatever "protection measure" they put forth is always immediately executed, appeal or not, nor is it canceled on a succesfull appeal, it is re-evaluated by the original judge (after, of course, another waiting period). This heavily punishes appeal since if an appeal is filed, no adjustments (such as visitation by your parents, or a friend, or more phone numbers you get to call, or ...) are possible until the appeal is heard, sometimes years later)

It is very clear that at this point the system damages many more kids than it helps.

BUT there is money being handed out. For example, if you have a handicapped kid, and you need help paying for a wheelchair, this is done through youth services, with "pgb" (meaning money that "follows the kid"). Parents can even use this money to pay themselves (very badly I might add, but it's something) for watching the kid if the care required is heavy enough that the kid can't be left alone. Or to get them after school lessons for free. Or ... Also schools, institutions, even things like children's farms can get extra money through the system, if they get "problem" kids assigned to them, and so kids are being forced into it, sometimes by their own parents. But where the real damage is done is where social workers are both being made responsible for deciding on care, and paid for providing care.

The perverse incentive is of course that one can easily see that institutions', schools', social workers', ... optimal strategy is to "treat" kids that are normal to begin with, diagnose them with something like "autism", and "treat" them. How many social workers, how many schools, how many institutions do this ? Hopefully not too many, but it's equally obvious that it's rather unlikely to be zero.

This has resulted in that apparently a solid 11% of Dutch kids have a serious psychiatric problem necessitating professional aid in any one year. Internationally, it's not even 3% (and that number is over 18 years). That number is rising. Just for autism, 2.5% of Dutch kids are diagnosed with it, whereas international numbers are between 0.6% and 1%.

It's so scary to see that our systems are full of misaligned incentives, a classic economics problem. The fucking textbook agent-principal dilemma. And nothing changes. (Or just so very slowly.)

The other aspects, about issues of the system, are of course also valid.

I was raped at age 12. It took me two decades to recover, and I got vastly better support than her.

Lots of tape victims seem to never really get over it. Most of the world seems to not know how to heal that kind of trauma.

I cannot imagine that a single dose of a drug has any hope of fixing something like that. If you cannot trust anyone around you because of a long standing track record of mistreatment of you, taking happy pills to make you happy with this horror show sounds like a really bad idea to me, one that would reduce your ability to adequately self advocate in a dangerous social setting.

I also live with an incurable medical condition that is classified as a dread disease because it so negatively impacts your life.

On the upside, I am getting healthier when the entire world says it cannot be done. As my physical health improves, my suicidal tendencies are trending down because I'm not so extremely miserable 24/7.

On the downside, basically the entire world is openly hostile, openly attacks me for talking about that, openly dismisses me as a lunatic who is making that up, openly discriminates against me over that -- for example, I've had moderators on multiple forums tell me I'm the problem when I got attacked in violation of the rules and I got thrown off instead of the people attacking me -- and on and on. That alone is enough to make things look pretty damn hopeless.

There is no winning here.

And that's for someone miraculously getting well when that's supposed to be impossible. If I actually was facing the steady gruesome decline my condition is supposed to cause where life is horrible torture today and you can count on things just getting steadily worse for all of your tomorrows, I would have killed myself ages ago. There is no fucking way I would fight to survive with such a prognosis.

Many people need solutions for torturous health issues or torturous social problems rooted in the bad behavior of other people. For such people, seeking to tweak their brain chemistry like they are the problem that needs to be fixed is part of the problem.

The trouble is when this idea becomes circular, e.g. "anyone who would choose to kill themselves even though their life doesn't seem that bad to me must be in the temporary throes of delusion and irrationality."

In other words, to apply your proposal would require determining whether someone is "in the temporary throes of delusion and irrationality" without knowing or factoring in whether they are suicidal. That's probably easy enough in the two obvious examples you listed, but accidental deaths due to intoxication or recklessness are already a less tricky issue than what we normally refer to as "suicide."

But I think you're saying a week isn't enough to determine things for sure? If so, you need to read what I said more closely.

I said a week is a basic filter, that can figure out an urge is temporary most of the time. It won't tell you an urge is not-temporary. It either says "temporary" or "unsure".

Why do you make this assertion that a rational person can't be suicidal? DFW was definitely a very rational person, for instance. I'd recommend reading Good Old Neon for an insight into his character, and a good depiction of both a suicidal and rational character[0]

> Suicidal impulses are most often fleeting relative to normal lifespan.

Key words there are 'most often', but I'm curious to know your evidence for this assertion.

> With therapy and medicine, she is very, very happy to be alive now

This is a great result for her, and you.

[0] http://sdavidmiller.com/octo/files/no_google2/GoodOldNeon.pd...

Don't you believe that such cases exist? Presumably there are also people who want to die, no matter what. But there are also people who just go through periods of depression. I also had the issue as a youth. It sounds to me as if you are hellbent on denying the OP's point by pointing to the extreme examples of suicidal people. What's wrong with trying to save at least the people who may only have a temporary attack of suicidal thoughts?

It only takes a fraction of a second to pull the trigger, if a gun is at hand, or to jump off a bridge. Then you can't reconsider anymore.

I'm in sympathy with the OP's post (the one with the DFW quote). The post I was responding to, seemed to suggest that people who are suicidal should generally not be taken seriously - that they arrived to their ideations by delusion - without acknowledging the other possibility.

I'm positing a counter-claim that not all people that are suicidal are also irrational, and I provided one example that I don't think so extreme, that was referenced in the OP's post. Robin William's case is another example though his decision was spurred by physical ailment[0]. Keith Flint (singer of the Prodigy) is a better example, he claimed his own death to be 'a positive thing'[1] (have no special love for the band, just a good example)

These examples could be outliers, I don't deny the possibility, but I must at least acknowledge that they exist - which was my whole point. I'd go further to say that we under-estimate how many people are both suicidal and rational.

[0] https://www.theguardian.com/film/2015/nov/03/robin-williams-... [1] https://metro.co.uk/2019/03/04/im-done-kill-keith-flints-bru...

edit - mistaken claim about post/grammar

If I sign a DNR, it isn’t the place of anyone else to say “but he didn’t mean it like that”. Same for (what are assumed by observers to be temporary) suicidal ideations.

This strikes at the very core of personal autonomy.

What I am speaking of is of a person plainly expressing their own intent, perhaps to the contrary opinions of medical professionals, family, legal professionals, et c.

Obviously if that expression of intent was coerced, there is a question of legitimacy of the expression of intent itself. But that is not really what we are discussing.

There is of course room for legal opinion on whether or not the documentation of the intent is valid or not. But the intent itself cannot morally be questioned by any second party for any reason, on any grounds. Our bodies are our own.

If they lack the ability to do so for some reason should they be assisted?

Is that should a moral imperative?

Obviously the best thing to do is to minimize the numbers of people who end up in such situations by addressing root causes. But that is something society has proven unwilling to deal with at scale. There will always be some people who have intractable suffering, with no tolerable outcome possible, and they deserve a peaceful way out.

Assistance is a whole ‘nother ballpark. I don’t think it’s a moral imperative for anyone to do anything for a second party that the first does not fully consent to.

If someone is not able to sign a DNR it must be because they have no autonomy over their medical care at all at that point. Which of course happens regularly but needs precise controls and protocols, and of course is rife for abuse.

Generally the presence of an intervention versus choosing not to intervene provides a clear dividing line. In this case, the choice not to force feed someone who is refusing food is why this is not euthanasia.

I think for example if someone has a previously executed DNR, I would say a valid medical proxy would not be able to override it. I’m trying to recall an instance when I filled out such a form for my wife before a procedure, I seem to recall there even being a section on resuscitation and whether the appointee could make that call?

The examples you give are in the order of hours. Fair enough.

What if someone is in this state of despair for a week? A month? A year? Ten years? When do you draw the line of temporary?

The day I kill myself it will be a long thought out choice.

Not many people can handle that without disrespecting the perspective, or worse, wanting violence applied against my will.

The arrogance of some people to think they know best for me is amazing.

P.S. I'm not suicidal now, it's a family condition that will mean (likely) one day I'll be deteriorated to the point I will want to check out.

As a psychologist what I've grown outraged by is the hypocrisy of current approaches to suicide, in that they are all focused on stopping suicide, but not the pain that drives it.

We talk about taking away guns and pills, putting up fences around parking ramps and bridges, monitoring social media, and so forth and so on. But we do nothing to address the psychosocial ills that drive the suicidal person to their state.

Labeling the suicidal as "mentally ill" does nothing but allow the living to wash their hands of the accumulated insults that drive someone to where they are, to feel good and then walk away from the most difficult issues to address. It places the blame on the person who is suicidal. It's not about protecting the suicidal, it's about protecting the living from guilt.

Sure, there are many people who obviously suffer from some sort of biological insult, but there is also a large grey area of those who have some kind of handicap, who are then thrust into horrific circumstances on top of that. And there are those who just get a bad lot in life.

These issues are spilling over into euthanasia in a way that's starkly highlighted by this case.

I'm not saying healthcare professionals should be forced into something they see as murder, or murkily close to it. What I'm saying is that as a society, our focus should be less on preventing people from accessing the means of suicide -- or euthanasia as the label may be -- and more on the sources of pain that drives them to it.

Sartre was a believer in absolute freedom, and that suicide was a choice among many others that a person could make (and indeed, Sartre eventually did).

Camus, on the other hand, believed that suicide was the rejection of freedom. Once you commit suicide, you are no longer free to make any further choices. I tend to be more sympathetic to this view: I have an eternity to be dead, but a short time make choices good and bad.

(Note: way beyond social contract.)

“Remember that the door is open. Don’t be more cowardly than children, but just as they say, when the game is no longer fun for them, ‘I won’t play any more,’ you too, when things seem that way to you, say, ‘I won’t play any more,’ and leave, but if you remain, don’t complain.” (Discourses I.24.20)

“Has someone made smoke in the house? If it is moderate, I’ll stay. If too much, I exit. For you must always remember and hold fast to this, that the door is open.” (Discourses I.25.18)

https://howtobeastoic.wordpress.com/2016/04/05/epictetus-on-...

I think this is a better summary than what you can get from a random comment in hacker news: https://www.youtube.com/watch?v=xVdF0k4DN1U&t=197s

The Myth of Sisyphus is the name of Camus’ book about suicide, and Sisyphus’ plight is its central metaphor.

- The universe has no innate meaning, and if causality exists (which is still an honest debate in metaphysics) it is unknowable to us. Camus calls this condition the Absurd.

- In an absurd world, our choice is limited. We can make decisions with an outcome in mind, but that outcome is by no means guaranteed.

- Ultimately, a person’s purpose in life is created by the individual as a means of escaping existential despair (which Sartre calls ennui) as a response to an absurd world.

- But within this purpose, there are always choices. Sisyphus has limited choices in his situation: his purpose in life (or afterlife in this case) is to roll the boulder up the hill for eternity. He is free to choose not to roll the rock up the hill — but this would invalidate his purpose.

- If Sisyphus chooses to not role the rock up the hill, it is akin to suicide in that he has given up his purpose. If humans have any purpose in life (which isn’t certain in the case of a deterministic model of causality), it is to define our own purpose in life. This isn’t a choice we can avoid, and the meaning we assign to life ceases to have meaning as soon as we die.

Existentialism is an intensely personal philosophy. It makes no assumptions about other people or societies writ large; only that people are free act in accordance with their chosen (and some would say arbitrary) purpose. It was a reaction of Camus and Sartre’s experiences in Nazi-occupied France — a situation where choices were extremely curtailed, but required the individual to make them nonetheless.

TLDR: there is always hope, even in an absurd world. The world is largely arbitrary and meaningless, so your choices only matter insofar as they define your existence. Or as I like to define it, when you stare into the void of nihilism you see only your own reflection.

If a mentally ill person is effectively treated the desire to kill themselves will generally subside, and at that point we know that it wasn't a rational choice but a biological symptom. The case here is much more difficult than say, assisted suicide for a terminally ill, old and frail patient.

it's not that they owe their life to us, but that we owe it to mentally ill people to care for them until they are in a state of mind in which we can be sure their decision to end their lives is not just an accident of brain chemistry. For a 17 year old girl the chance that her condition improves, even if treatment resistent at the current point at time, is actually still plausible.

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.)

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.

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.

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.

And ... separating brain chemistry from rationality is an error. If her current state is 90+% determined by her brain chemistry, and our medicine and other treatments can't reverse it, then it's a rational option to solve it by giving up on that brain with its chemistry and all.