More sermon prep.
Jun. 23rd, 2010 11:49 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
rivkaMy sermon draft is already 2000 words long and I'm just developing the religious theme now. I've decided to carry it through to the end and then make drastic cuts, instead of trying to shorten it as I go. There's a lot that I know and believe and think that doesn't need to make it into the sermon. I'm pretty sure I'll have to get all of it said before I can figure out which pieces are sermon-shaped.
I'm going to keep posting bits. Feel free to disagree or ask questions or, you know, flounder with the issue; it helps me formulate my thoughts. At this point it's probably not useful to tell me what you think I should leave out or to comment on matters of style. I'm not there yet. I'm just getting it all out.
2. David Kissane and therapy for the dying.
I’m going to admit straight up that I didn’t know what I was doing when I worked with Ray. I knew how to treat depression, but I didn’t know how to do it without the promise of a better life afterward. Ray lived much, much longer than the doctors predicted – perhaps because he willed himself to; I don’t know – but I couldn’t do all the things I knew how to do: entice him with visions of useful work, fun, social relationships, romance, once the shadow of depression was lifted. Even when he was better he was still dying. Ray and I had to grope our way through that without an instruction manual.
A year or so after Ray’s death I went to a conference about psychosocial aspects of cancer care and I heard a presentation by an Australian psychiatrist named David Kissane. Dr. Kissane identified a set of symptoms that are common among persons with terminal illness: hopelessness, the loss of a sense of meaning in life, a feeling of powerlessness, fear of loss of dignity, fear of burdening others. He called these symptoms "demoralization syndrome:" loss of morale on the profoundest level. These feelings of hopelessness and powerlessness, he said, inevitably resulted in a desire to die or to commit suicide.
These feelings of demoralization – hopelessness, powerlessness, fear of losing dignity – may seem to some to be intrinsic to the process of dying. Of course, if you’re dying, why wouldn’t you be demoralized? But in fact, not everyone is. And second: Dr. Kissane was able to develop a psychotherapy that successfully treated demoralization syndrome. It was specifically designed to help people reflect on the meaning of their life and on their legacy – and we’re not necessarily talking about anything huge; I remember that he said, "for some people, it’s that they have a really good borscht recipe, one they want to hand down to their family." He would help people craft a sense of their legacy, his assistants would write down what they came up with, and they’d make it into a beautiful little book and present it to the dying person, so they could share their legacy with their families and friends.
And the thing is: repeatedly, he found that this kind of psychotherapy cured people of the desire for assisted suicide.
3. So...
So it turns out that terminally ill or severely disabled people who want to commit suicide aren’t actually different from anyone else who wants to commit suicide. They are suffering. Their suffering is responsive to treatment. And when they receive appropriate treatment, they lose the desire for suicide.
What does this mean for the assisted suicide movement?
And why did it take so long – some thirty years after the assisted suicide movement began – for anyone to study ill people who wanted to die and figure out what was wrong with them, and what could help them want the time they had remaining? Why weren’t those obvious questions from the start?
4. Things I know about suicide.
I started talking around in my social circle about this sermon I was going to give, and someone said to me very earnestly: “Rebecca, what you may not realize is that I’ve talked to some of these people and they do genuinely want to die. They have logical reasons.”
I don’t think she knew what I do in my work life. I’m not a licensed psychologist – I do clinical research instead – but over the years I have talked to many, many suicidal people, and they always have reasons. Their reasons are always compelling to them, and sometimes they are persuasive enough that they sound pretty compelling to me too. It was for good cause that psychiatrist Aaron Beck said in his famous treatment manual for depression that if you ever find yourself agreeing that your client’s situation is hopeless, it’s a sign that you’ve gotten sucked into their irrational thinking.
I know some things about suicidal people. One of the things I know is that you will never meet a suicidal person who is completely unconflicted, completely lacking in ambivalence. That’s because people like that are already dead before you have a chance to meet them. Anyone who lets another person know that they are suicidal, however certain they may sound, is ambivalent. There’s a part of that person – perhaps just a small part, a weak part – that wants to live. There’s a part of that person that wants to be rescued.
My job, when I meet a suicidal person, is uncomplicated. It is my job to stand with the part of the person that wants to be rescued.
I say “uncomplicated” although of course sometimes actually carrying out that job can be enormously complicated. What is uncomplicated is the part about knowing where my allegiance should be. I don’t try to wade into the person’s situation and figure out whether their problems are in fact hopeless. I don’t try to figure out, from what they are able to tell me about their prospects, whether their life is really worth living or whether they would be better off dead. The law, my professional ethics, my experience, and my personal values all tell me that my allegiance must be with life. That part is uncomplicated.
5. Suicidal dying or disabled people are different.
When the issue of assisted suicide comes up, I talk about the suicidal people I have known. "How come no one says my patients should be allowed to kill themselves? People who are mentally ill, people who are overwhelmed by horrifying life events – where is the assisted suicide movement for them?" Then people get annoyed with me: "Terminally ill and disabled people are different."
How are they different? Why is it that there is literally no disaster, no tragedy, no collection of problems so severe that our society argues that a person ought to be allowed to die rather than suffer them – EXCEPT for physical disability, physical helplessness? What makes being seriously ill or disabled different from every other bad thing that a person could possibly experience?
I’m going to give you a minute here to struggle with that question.
I'm going to keep posting bits. Feel free to disagree or ask questions or, you know, flounder with the issue; it helps me formulate my thoughts. At this point it's probably not useful to tell me what you think I should leave out or to comment on matters of style. I'm not there yet. I'm just getting it all out.
2. David Kissane and therapy for the dying.
I’m going to admit straight up that I didn’t know what I was doing when I worked with Ray. I knew how to treat depression, but I didn’t know how to do it without the promise of a better life afterward. Ray lived much, much longer than the doctors predicted – perhaps because he willed himself to; I don’t know – but I couldn’t do all the things I knew how to do: entice him with visions of useful work, fun, social relationships, romance, once the shadow of depression was lifted. Even when he was better he was still dying. Ray and I had to grope our way through that without an instruction manual.
A year or so after Ray’s death I went to a conference about psychosocial aspects of cancer care and I heard a presentation by an Australian psychiatrist named David Kissane. Dr. Kissane identified a set of symptoms that are common among persons with terminal illness: hopelessness, the loss of a sense of meaning in life, a feeling of powerlessness, fear of loss of dignity, fear of burdening others. He called these symptoms "demoralization syndrome:" loss of morale on the profoundest level. These feelings of hopelessness and powerlessness, he said, inevitably resulted in a desire to die or to commit suicide.
These feelings of demoralization – hopelessness, powerlessness, fear of losing dignity – may seem to some to be intrinsic to the process of dying. Of course, if you’re dying, why wouldn’t you be demoralized? But in fact, not everyone is. And second: Dr. Kissane was able to develop a psychotherapy that successfully treated demoralization syndrome. It was specifically designed to help people reflect on the meaning of their life and on their legacy – and we’re not necessarily talking about anything huge; I remember that he said, "for some people, it’s that they have a really good borscht recipe, one they want to hand down to their family." He would help people craft a sense of their legacy, his assistants would write down what they came up with, and they’d make it into a beautiful little book and present it to the dying person, so they could share their legacy with their families and friends.
And the thing is: repeatedly, he found that this kind of psychotherapy cured people of the desire for assisted suicide.
3. So...
So it turns out that terminally ill or severely disabled people who want to commit suicide aren’t actually different from anyone else who wants to commit suicide. They are suffering. Their suffering is responsive to treatment. And when they receive appropriate treatment, they lose the desire for suicide.
What does this mean for the assisted suicide movement?
And why did it take so long – some thirty years after the assisted suicide movement began – for anyone to study ill people who wanted to die and figure out what was wrong with them, and what could help them want the time they had remaining? Why weren’t those obvious questions from the start?
4. Things I know about suicide.
I started talking around in my social circle about this sermon I was going to give, and someone said to me very earnestly: “Rebecca, what you may not realize is that I’ve talked to some of these people and they do genuinely want to die. They have logical reasons.”
I don’t think she knew what I do in my work life. I’m not a licensed psychologist – I do clinical research instead – but over the years I have talked to many, many suicidal people, and they always have reasons. Their reasons are always compelling to them, and sometimes they are persuasive enough that they sound pretty compelling to me too. It was for good cause that psychiatrist Aaron Beck said in his famous treatment manual for depression that if you ever find yourself agreeing that your client’s situation is hopeless, it’s a sign that you’ve gotten sucked into their irrational thinking.
I know some things about suicidal people. One of the things I know is that you will never meet a suicidal person who is completely unconflicted, completely lacking in ambivalence. That’s because people like that are already dead before you have a chance to meet them. Anyone who lets another person know that they are suicidal, however certain they may sound, is ambivalent. There’s a part of that person – perhaps just a small part, a weak part – that wants to live. There’s a part of that person that wants to be rescued.
My job, when I meet a suicidal person, is uncomplicated. It is my job to stand with the part of the person that wants to be rescued.
I say “uncomplicated” although of course sometimes actually carrying out that job can be enormously complicated. What is uncomplicated is the part about knowing where my allegiance should be. I don’t try to wade into the person’s situation and figure out whether their problems are in fact hopeless. I don’t try to figure out, from what they are able to tell me about their prospects, whether their life is really worth living or whether they would be better off dead. The law, my professional ethics, my experience, and my personal values all tell me that my allegiance must be with life. That part is uncomplicated.
5. Suicidal dying or disabled people are different.
When the issue of assisted suicide comes up, I talk about the suicidal people I have known. "How come no one says my patients should be allowed to kill themselves? People who are mentally ill, people who are overwhelmed by horrifying life events – where is the assisted suicide movement for them?" Then people get annoyed with me: "Terminally ill and disabled people are different."
How are they different? Why is it that there is literally no disaster, no tragedy, no collection of problems so severe that our society argues that a person ought to be allowed to die rather than suffer them – EXCEPT for physical disability, physical helplessness? What makes being seriously ill or disabled different from every other bad thing that a person could possibly experience?
I’m going to give you a minute here to struggle with that question.
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no subject
Date: 2010-06-24 04:02 pm (UTC)A capable person who expresses a wish for suicide gets mental health treatment. Forced, if necessary. It's only for disabled people that we entertain the notion that perhaps they have the right to kill themselves. With approval and help.
no subject
Date: 2010-06-24 04:06 pm (UTC)no subject
Date: 2010-06-25 11:00 am (UTC)1. Most suicidality is not rational, although some cases may be rational.
2. If some suicides are to be socially/legally permitted or assisted, there will need to be some method for determining whether or not the suicidal person is making a rational choice.
3. There's no way to make that determination objectively; the process would inevitably be contaminated by prejudices and assumptions about what makes a life worth living.
4. So the only safe ground is to say that we won't permit anyone to commit suicide.
5. Some people will be determined enough to do it anyway, but at least this way we're not putting a stamp of social approval on the idea that lives like theirs have no value.
no subject
Date: 2010-06-25 11:12 am (UTC)no subject
Date: 2010-06-25 11:27 am (UTC)no subject
Date: 2010-06-25 11:35 am (UTC)no subject
Date: 2010-06-25 12:56 pm (UTC)For psychosocial and medical problems, or just medical ones?
no subject
Date: 2010-06-25 01:00 pm (UTC)I'm not going to be able to continue this today because I'm getting more sucked into my prodromal labour so I can't give it the thought it needs.
no subject
Date: 2010-06-29 04:43 am (UTC)In one sense, this is one of the stronger arguments *against* assisted suicide. It creates a situation in which compassion and a desire to end suffering says "so, let's kill this person," instead of "let's figure out what we can do to help this person."
Then again, I also know that there are situations in which there's an ugly mix of things. If there's no time for anything fancier for pain relief, it's possible that opiates sufficient to kill the pain will also depress respiration enough to cause death.
But I'd rather have a doctor trying to stop the pain and hasten death, rather than explicitly trying to hasten death to stop the pain.
no subject
Date: 2010-06-24 06:33 pm (UTC)Wow. Yes. We (UUs especially) want so desperately to rely on reason and independence in this issue, but we can forget all about the subjectivity of it.
[sorry, random self-disclosure ahead...]
I've been really struck lately with how context laden my feelings about my own life are. A few months ago I was driving when I had to avoid a car suddenly and a totally unfamiliar thought flew through my mind: "Careful!" it said. And it was like the word was wrapped in a bubble of something I don't remember ever experiencing before. I felt valuable. I felt like I had to be careful with my life because my life has value now that Lyn is pregnant and there are babies on the way. I don't mean to be melodramatic or weird by saying this, but this is a sentiment that I literally do not remember ever having before. Ever.
And yet there have been hundreds of moments in my life when I felt like my life wasn't worth anything; that my absence was worth more than my life. If someone—anyone—outside of myself had been right there saying "yeah, you're right about that," there's zero chance I would be alive right now.
The thing is those moments almost always FEEL rational. It feels like math: I am worth X, not dealing with my shit is worth Y, it's a simple equation. When I have stopped myself it's because some part of me understood that—if not for me, at least for others—X might be a little bigger than Y. I think having Final Exit there would be like taking a math test and writing X is less than Y, being in the middle of checking my work and having the teacher take it out of my hands and give it back to me with an A on it.
(But ask me again when I'm in the midst of a depressive episode, and I'll say something pretty different. Our minds are more elastic than we believe.)
By the way: I don't know if I've said to you in person how glad I am that you're doing this. It's led me to challenge my own assumptions and think about this issue in a far deeper way than I ever have. Thank you.
no subject
Date: 2010-06-24 09:03 pm (UTC)The thing is those moments almost always FEEL rational. It feels like math: I am worth X, not dealing with my shit is worth Y, it's a simple equation. When I have stopped myself it's because some part of me understood that—if not for me, at least for others—X might be a little bigger than Y. I think having Final Exit there would be like taking a math test and writing X is less than Y, being in the middle of checking my work and having the teacher take it out of my hands and give it back to me with an A on it.
Yes, exactly this. This is such a clear way of putting it. I know you really understand the fragility and ambivalence of that moment, and how easy it would be to push someone in the direction of death.
(By the way: your value is approximately 643 zillion, by my calculation. Even without Lyn and the babies depending on you.)