Choice

I'd been thinking about this topic off and on and, up until now, there were two things that hadn't come together. One was knowing what I'd want to say about it. I've seen a lot of opinions out there, and it seems like it's a question a lot of people feel very strongly about. I also wasn't sure where I cane down on it, and I'd at least need to be clear on that. The other thing was the willingness to potentially upset some folks with my opinion. Well, as recently I seem to have been struck with hoof-'n'-mouth disease, it seems like as good a time as any. So, here we go. The topic for today is choice and how it relates to suicide.

Before I get into it, I want to start with a disclaimer. I know that some people who get really caught up in this question are the ones who're dealing with losing a loved one to suicide. In that case, they've got a total pass on it in my opinion, at least for however long they're dealing with the loss & grief. They're not the ones who I have a harder time dealing with. I get how those questions don't leave folks alone, how there's that burning need to know, one way or other, if choice is the deciding factor. It's other folks who I have a harder time dealing with around this issue.

Some people say that it's certainly a matter of choice. People choose what they do (or don't do), what they say, where they go. Our legal system is based on that, that people are responsible for what they choose and do. That's why, at least technically, suicide is the one crime for which someone simply CANNOT be charged if they pull it off, but theoretically could be charged if they tried and failed. That idea of choice is why it takes going through a rather intense process to get someone involuntarily committed to a mental institution, at least for any length of time, or to be force-medicated. There's some evidence to back up the idea that choice is certainly involved in suicide, like the following:

• People decide how they're going to kill themselves (or at least try), and they choose different means. Some of it depends on what they can get access to. However, almost everyone has access to a sharp knife/blade, a length of wire or rope, and chemicals or drugs that are highly toxic, especially if taken internally. People in similar circumstances don't always take the same approach. Ergo, there's an element of choice.
  
  
• Maybe the strongest piece of evidence has to do with how long folks who attempt or commit suicide were depressed and hurting beforehand. While with some it's an impulsive, spur-of-the-moment act, with most there's some degree of consideration and deliberation. Despite feeling hopeless, they hang in there for awhile before acting, sometimes for a long time. The reasons they do so vary, but regardless it points to the choice to act or not act.

Other people say that it's not a matter of choice; it's a matter of mental illness. Research over the last several decades has shown substantially higher rates of suicide in those with major mental illnesses, such as major depressive disorder, bipolar disorder, schizophrenia, and some of the personality disorders. There's a reason those are called “major mental illnesses.” People say and do things they wouldn't ordinarily when they suffer from those conditions. There is a legal defense of insanity that points to the idea of someone who's suffering from severe enough mental illness not knowing what they did. There's also evidence for the idea that it's about mental illness:

• As mentioned above, the suicide rates are dramatically higher for those who're diagnosed with serious mental illness. In some cases, going back and reading over journals or correspondence suggests that people who hadn't been diagnosed with major mental illness likely would have been. For example, there's been some studies suggesting people with borderline personality disorder have suicide rates roughly 400% that of the “average” people.
  
  
• One of the symptoms of depression is a sense of pessimism and hopelessness, the idea things just won't get better. That goes along very well with the concept of suicide, where it's taking a permanent exit from one's circumstances or life. People usually value at least some things in their lives enough to stay around for, even in hard circumstances. Getting to the point of not valuing anything enough to keep trying is pretty outside of what's considered “normal.” And that's part of how mental illness is defined.
  
  
• When treatment for major mental illness is provided and followed through with, the rates of suicides and suicide attempts go down significantly. That's been seen enough times to be able to say that it's not just a fluke or accident. There's something to it.

So, there's evidence on both sides of this debate. Which one wins? How hard do people press their points, either reinforcing their evidence and position or undermining that of the “other side”?? Some people get pretty...intense about this. I think a lot of that's because people either have personal investment in it, or see the money tied up in it....or both. Regardless, the arguments/discussions get pretty heated at times, and on both sides there are people who are insisting they have The Right Answer!

The problem is, I've been coming to believe that they're asking the wrong question.

I don't think it's a black-and-white, yes-or-no kind of issue. Is suicide chosen or not? I think that's the wrong question. I think that it's more an issue of how much of choice and how much of mental illness play in...and how they interact. Is it possible to choose to not act toward ending one's life? I think so. However, that doesn't say anything at all about HOW HARD THAT CHOICE CAN BECOME. I think that's where the mental illness comes in. It makes it harder and harder to see the options that might be there, or to believe they'll help/work. For anyone who's experienced significant pain over an extended period of time, they'll also get it how that just wears a person down, saps energy and resolve, slowly takes the color out of the world. It's one of the reason why prescription pain medications are some of the most widely abused drugs; people get to the point where they're willing to do damn near anything to make the hurting stop. In that case, it's a continuum of things people might do to get it to stop, with the ultimate end being suicide. 'Cause there's no coming back or other options after death. At least not in this life.

One of the things it helped me to do, when I accepted both are involved, was have more compassion for her pain and more respect for her strength. I'd gotten to read some of her journal files, the ones that weren't massively encrypted, and found out how long she'd been depressed and hurting. How long that had been weighing on her, dragging her down. And I also got to see how long she had gone on and chosen to keep going. She was thorough and thoughtful enough about killing herself, that there had to have been a good stretch of time where she was thinking about it AND DECIDING NOT TO DO IT, at least not then. And that kept getting more difficult. And she kept choosing to stay around, as long as she could. And when it finally hurt too bad to keep choosing to stay, it was because of the depression and anxiety and anger and everything else that robbed her world and her life of comfort, of color, of worth. Of hope.

Like I said in the beginning, I get how those who're still hurting and grieving focus on the one or the other. When you're hurting and empty and confused and scared and angry like that, it's too hard to look at bigger, more complicated questions. But it's ultimately not as simple as a yes-or-no, this-or-that kind of issue. Both play into it. And until we figure out how to deal with both, it's going to continue to be a problem that isn't going to change.

For me, being able to accept that I'd been asking the wrong question was another leg of the journey. A little farther down. A little closer to the way out.

Rules Break Down

One of the things I've felt and heard from other widows and widowers is feeling like we're falling apart, like we're going crazy. It comes up in regard to a lot of different things: paying bills, going to work, talking to friends, trying to have fun, watching movies or TV, trying to (and often having a hard time with) sleep, listening to music. Things we used to be able to handle just fine are suddenly...different. We can't handle them the same. We have reactions to things that, at least at the time, don't seem to make sense. Intellectually, we know we're grieving and dealing with a catastrophic loss, but on a more visceral level, we wonder just what the Hell is wrong with us.

One thing has been coming to mind lately for part of why that is. See, growing up we all learned certain rules. They're the rules we use to get along in the world, to negotiate dealing with others, to take care of our responsibilities. They tend to be pretty universal, though the extent to which we buy into them can vary. They're often so simple we hardly ever think about them. Take your turn. Say “please” and “thank you” and “excuse me.” Work hard and you'll do well at your job. Treat people nicely, with at least respect if not kindness, and you'll be able to get along. Be a good boy/girl, with the usually unspoken implication that if you do things will go well. Do a good job. Don't hit people, even if you really want to or it seems like they really deserve it. Things we generally haven't had to consciously think about since they were first taught to and impressed upon us. With all of them, there's an implicit expectation that if we follow them, things will be well and we'll get to be happy. At first, we probably learned to follow them to avoid getting punished. Over time, most people move beyond just following them to avoid punishment to see the reasons why they're good rules. They generally do lead to good outcomes for us, which is what pretty much everyone wants (though the ideas of what “good outcomes” might be do vary).

When someone you love dies, whether it's suddenly or not, then it suddenly seems that at least some of those rules are suspect. They didn't work. Even when the death is natural causes there's suddenly a not-so-good outcome. When it's the result of an accident, it's a little worse. When it's the result of someone else's choices and actions, worse yet. In the case of suicide, when it's the actions of the person who died that brought it about, it's even worse. The rules seem to have broken, because they didn't result in what we'd come to believe they should do.

For me, one thing I've come to realize is I'd had a rule I'd been following that I hadn't even consciously realized or been aware of. It was another one that, on the surface of it, seems to make a lot of sense. If you love someone and commit to them, in my case through marriage, then you take care of them. The implicit piece of it was the expectation that they'd take care of you and you'd both get to be happy. Sounds good, doesn't it? And, in truth, it worked for quite awhile. That made it hard to deal with how things changed, when her depression and anxiety and anger had her withdrawing and being more sullen and less able (yeah, I know, some think that should probably read “willing,” but that's a post for another time) to do things for me. The rule had worked before, dammit, so if I kept following it, it should pay off again. Right? At a level below my conscious awareness, at least at the time, that was how I saw things.

And then she killed herself. The rule hadn't worked. I'd cared for and taken care of her, and she hadn't done the same for me.  Not at the end.

All of a sudden, a fundamental part of the world didn't make sense anymore. It'd be something like suddenly waking up to find out that what's defined as “left” and “right” would change at random intervals throughout the day. Think that doesn't sound like much? Imagine trying to drive, with the laws and rules we have set up about what kind of turn you can do when and who has the right of way, and suddenly not being able to know which is which for sure. If you're really paying attention, you'll get some scares and close calls. Odds are, you're likely to end up in some fender-benders, and be shocked to find out that it was your fault.

And when one of those fundamental rules breaks down, it brings with it some fear that maybe the others aren't as solid as they'd previously seemed. It suddenly makes the world seem like a scarier place. It'd make anyone question how well they're able to be in touch with reality, to deal with even normal, day-to-day stuff, much less bigger things. Suddenly there's a lot more conscious attention and energy being focused on rules that previously operated at pretty much a reflex level, and that's exhausting. Think it isn't? Try tying your shoes while paying conscious attention to EVERY MOVEMENT OF THE LACES AS YOU DO SO. Not just what you're doing at the moment but what it's setting up to do. Doing something that you've done on autopilot for years (or more) with that kind of conscious effort and attention isn't so easy, and it's tiring. Want another example? Think about shaving, but with your OTHER hand (I'm not recommending this, mind you; I put it out there as a mental exercise). What'd previously been automatic and required only slightly more focus and concentration than standing up or putting on pants becomes something much harder and more involved.  And, if you make a mistake (which is more likely), it's gonna hurt.  Now think about having to function the same way almost all the time. Think that might wear someone down, make them wonder about and doubt themselves, make them feel broken?

In time, we get settled with the rules again. It's likely we eventually get to where a fair number of the old rules still apply and go back to reflex level. Others, however, end up having to change. And we get to go through the process of having to pay that conscious attention and put in that focused effort to get them down to that level again. And it's not a linear process. When we're stressed or tired or distracted, we sometimes go back to old habits, even if on a conscious level we know they don't work or apply anymore. That doesn't do much good for the ol' self-confidence, either. It's not a short or easy process. It requires patience and perseverance, even if sometimes that means making time to sit down and cry and feel hopeless or overwhelmed for awhile....and then getting back up and getting going again. Sometimes, that's all we can do, and it's good enough. It fits with an old Chinese proverb: Be not afraid of moving slowly, only of standing still.”

The "Oh, SHIT!!" Response

I hope y'all will bear with me in this entry. I'm starting with some of the stuff I've been reading about that's made some more sense of things for me. I'll get to the more personal, applicable-to-real-life stuff in a little bit. Hang in there, OK?

As human beings, we've essentially got three brains crammed into our skulls. The first one I'd call the “Amoeba Brain.” This is the oldest part, the one that's responsible for keeping us alive. It does things like make sure that our hearts keep beating, we keep breathing, we absorb nutrition and get rid of waste, etc. Any living thing that has anything like a nervous system has this part. If this part breaks down, well, we're done. Pretty immediately, too. The next part that evolved is what I've heard called the “Puppy Brain.” This is the part of the brain that focuses on things like knowing to be afraid of dangerous things, getting angry to deal with threats we don't need to run away from to survive (or can't run away from), and to want to have connection and interaction with others of our kind, and dealing with more than just making copies of ourselves. Among other things, this is where emotions live and do their things. This kind of brain is present most obviously in mammals, though some of those functions can also be seen in some other animals. The newest part of the brain is the “Person Brain.” This is where we actually think about things, we compare memories of how things were to what's going on now, to consider the possible outcomes and consequences of potential courses of action. When people say that you should “use your head,” this is the part of the brain they mean.

The piece I've been thinking most about lately is the “Puppy Brain.” We developed those functions and parts because they'd give us an edge with regard to survival. If we hang out together, we tend to have better odds of surviving. Groups can handle bigger threats better than single individuals. It's also more likely that our young will survive and grow. It also means that we don't have to have everything hardwired into our DNA. See, that emotional stuff lets us learn things from others. When we're young, we pay attention to others around us. If they get scared by something, we learn to be scared of it, too. It makes us more flexible and adaptable than, say, plants, which have to have all of that stuff coded into the genetics. Incidentally, it makes sense out of why plants in general have so many more genes than we do. And that part of the brain keeps on learning throughout our lives. That way, we can continue to adapt to and deal with novel circumstances and situations.

Where it can get problematic is when the “Puppy Brain” creates what I call the “Oh, SHIT!!” association with something. See, that response makes sense in regard to real threats to our survival, like suddenly walking up on a tiger. When a threat's that strong, that emotional coloring gets stamped hard onto those cues and memories. The problem for us is twofold. One is that a lot of stuff we deal with in day-to-day life isn't really that serious of a threat. There's actually relatively few things we run into as we go along that's likely to kill us quickly. Not like when we were still hanging out in the trees or living in caves, anyway. So having that permanent stamp on there isn't as adaptive as it used to be. It's especially problematic when it's not just that specific set of circumstances that evoke that response, but things that we see as similar enough to remind us of them. The second part of the problem is strongly related to that. No other animal really thinks about what's going on the way we do. So those “Puppy Brain” responses are only based on what it's got going on around it at the time. Our ability to think and remember, though, means that it's more likely a wider range of things can spark off that “Oh, SHIT!!” response. Seeing or hearing something that reminds you of a particularly intense crisis can be enough. For me, one time it was seeing someone in an airplane who, at least at first glance, looked just like my late wife. Suddenly my heart was pounding, I was sweating, my muscles were shaking and my guts tied themselves in knots...all the same things that physically get the body ready to either run from or fight off a real danger. She was about two-thirds my size and didn't even know I was there. She was no danger to my continued life. But the “Puppy Brain” reacted anyway.

That leads to two points. One of them is that trying to be rational and reasonable doesn't work in dealing with those responses. Look on the Internet and it's easy to find videos of puppies and kittens freaking out over their reflections. Now imagine trying to intellectually explain to a small animal about the principles of reflection to get them to calm down. Yeah....good luck with that. Well, guess what? We've got that part of us, too. And, when it sparks off the “Oh, SHIT!!” response, trying to intellectually explain things is just as useful. To me, that makes a lot more sense out of some of the reactions I've had that have made me wonder sometimes if I've been losing my mind. Walking through a grocery store she and I had gone to twice suddenly sets off panic. Well, my “Puppy Brain” got reminded of losing a critical connection, which it interpreted as a threat to survival, and suddenly I'm caught halfway between a panic attack and a psychotic episode. And much though people around me care and want to help & be there, it's not always easy to get it that the usual, rational way we talk about and deal with stuff just isn't going to make a difference.

The other point is that it's made a lot more sense out of some of the things I'd found myself doing over and over again. It seems we all have them, even though they vary from person to person. The common ground in them all is they bring a sense of safety and comfort. There's good reason why some things are called “comfort foods.” They're the ones that have associations of safety and good times for us. Just the taste and texture is enough to evoke that feeling that things are OK. Not the thought that things are OK, but the feeling. The “Puppy Brain” doesn't get thoughts, but it does get feelings. Same with sitting on the couch watching TV or staying in bed under the covers and reading. For some folks it's shopping. For others it's going to the gym and working out. Yet others find it in getting to talk to people, especially those who'll listen and validate what we feel. That's why sometimes we just need someone to hear us out; no advice or fix-it required. Depending on the severity of the crisis, it can take a long time to get the “Puppy Brain” calmed down again. Making the time and space for those things can be critical.

In walking through Hell, we don't just face challenges and barriers that come from outside of ourselves. Some of the torments are driven by parts of who and what we are. To the extent we don't know and understand and accept ourselves, those parts can be turned against us. “Accept” doesn't mean “like.” It just means acknowledge what's there so we can know what it is and how to deal with it. So it's one less thing in the way as we walk down to get out.