With the emergence of modern medicine in the 19th Century, the meaning of suicide changed again and it is this understanding that prevails today. Suicide is now generally thought of as the result of mental illness. If a person wants to end their life, then they must be sick (a psychiatric illness, with depression the usual diagnosis). The appropriate response, therefore, is medical treatment and prevention (in the form of psychiatric counselling and/or anti-depressant medications).
At Exit International, we question this view of suicide that automatically links a person’s decision to die to depression and mental illness. Are we seriously postulating that the suicide bombers of the Middle East are depressed? Rather, the act of suicide is better seen as context dependent.
For example, a person who is very elderly and who is seeing friends die around them on a weekly basis and who must be wondering ‘am I next?’ is going to have a very different outlook on dying than the young person who has their whole life in front of them. When serious illness is present, planning for one’s death helps put the person back in control and may help alleviate their existential suffering. A person’s attitude towards death must be understood in the context of that person’s situation.
In Oregon, for example, where physician-assisted suicide (PAS) is legal, one study found symptoms of depression to be present in 20 per cent of patients who request PAS. At Exit, we believe that feelings of sadness (as opposed to clinical depression) are a normal response to a diagnosis of a serious illness. You don’t need to a degree is psychiatry, however, to understand that this might be a normal response to an extraordinary situation. To assume that suicide amongst the elderly or people who are seriously ill is, necessarily, the result of depression or other psychiatric illness, is to adopt a biomedical way of seeing the world. People’s decision-making about when and how to die is more nuanced than this.