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: 2010-06-25 04:50 pm (UTC)Let's say every moment of my life was a rain drop and I had three buckets to store the water in: subpar, par and superpar. In the subpar bucket are the raindrops of every moment I felt severe pain, hopelessness, depression or injury. In the superpar bucket are the raindrops of every moment I felt affirmation, joy, love or triumph. In the par bucket are the raindrops of all the moments that don't belong in the other two buckets.
Now, I know it's true that I've got plenty of water in each of the three buckets. But at any given time, it's difficult for me to accurately distinguish how much water would be in each bucket because the moment of that discernment has its own place in one of the buckets. If that moment of discernment is a moment in the subpar bucket, it's difficult to see the levels of the other buckets from there. Similarly with either of the other two. Honestly, when I'm in the superpar bucket, I may be aware that there are other buckets, but damned if I can accurately tell you how full they'd be. When life is awesome, it's very difficult to remember the moments of real suffering with all their contours and emotional textures. And the same goes for suffering. When I'm in deep emotional pain, remembering the joyful moments of my life is like trying to decipher fine print through a rainy windshield. It's like a language I know I used to know, but can't for the life of me remember how to read or speak.
Every time I've been stuck in the subpar bucket, I think I'll never see the superpar bucket again.
Assisted suicide requires the suffering individual and the assistant to make a judgement about not only the level of each of the three buckets, but the future rainfall due to each of them. For the sufferer, this judgement usually comes from the perspective of the subpar bucket. But for the assistant (and, incidentally, let's not ignore the power dynamic when the assistant is a doctor) this judgement may come from a totally projected and self-constructed view of a virtual subpar bucket with little or no awareness that there are two other buckets. Or, rather, that there ARE two other buckets, but now that the sufferer is dying/injured/disabled/broken, etc., the universe has put lids on the other buckets.
Let's say for sake of argument that there will come a point in my life (after a car accident? when Alzheimers sets in? while standing on a bridge? when the chemo doesn't work?) when every future moment of my life will fall into the subpar bucket. And let's say I was given the foreknowledge that this was the case. I think it's true that with that knowledge, I might want to choose to die.
What if I was given the foreknowledge that every moment between that point and my own death would drip into the subpar bucket except five drips that would go into the superpar bucket? Five drips. Five moments of joy or love or triumph. Would that be enough? How many drips into the subpar bucket would be a worthy price for those five moments? What if it was just one moment? One moment of feeling loved. How many moments of pain would make me want to miss out on that one moment of love?
I don't know the answer to that question. I'm not so naive to think that it doesn't have an answer. It does. There is a number at which point I would rather die. I know that's true. But I have no idea whether the answer is five or ten or a hundred or more. I can't know that. And if I can't know that, with total foreknowledge of what will come, how could I possibly know without any knowledge of what's to come? I would have to guess. And because guessing would necessarily have to be done from the context of one of the buckets, it would always be skewed one of at least three ways.
It might be the case that I have every right to choose to die. But I don't think it's possible to make that choice objectively, meaning that having the right to choose to die is sort of like giving part of me the right to kill the whole me. And that doesn't seem right either.
no subject
Date: 2010-06-28 09:27 pm (UTC)Every time I've been stuck in the subpar bucket, I think I'll never see the superpar bucket again.
Having suffered from depression and anxiety, I've found this to be so, so true and cannot be underestimated.