Terminal Mental Illness

Some years ago, the daughter of an acquaintance of mine died by suicide. While her husband and children were out, she lit a hibachi in their living room and died from carbon monoxide poisoning.

The obituary her parents wrote said, quite truthfully, that she had succumbed after a long illness.

The recent suicide death of Gregory Eells, head of the University of Pennsylvania’s mental health services, brought to mind my friend’s comparison of lifelong mental illness with a chronic and ultimately terminal disease. In suicide prevention work, we say that many suicides can be prevented. Many, not most or all.

For some people, the lifelong challenges of a mind that berates, undermines, and negates their value as a human being is ultimately unbearable. No matter their outward signs of success, love, or accomplishment, they “know” themselves to be inferior, undesirable, unlovable. No matter the support they have in the form of medication, talk therapy, and interventions, like the Safety Planning Intervention developed by Gregory Eells’ colleagues at U of P that is proving so useful to many people living with anxiety and depression, the illness thrives at the expense of their wellbeing and life force.

We’ve come a long way in our attitudes toward mental illness and its compatriot, addiction, but we have a long way to go.

Myself, I struggle to accept the choices of the terminally ill who seek self-selected euthanasia under plans like Death with Dignity. I’m inclined to a world view that says life is what it is and is ours to experience no matter what. But when I encounter deaths like Eells’, I understand the analogy to terminal disease, that the suffering of acute, unrelenting mental illness can become too great. The prognosis unfavorable and unchanging. The best option to “shake off the mortal coil.”

What is the counterpart, for those with unrelenting mental illness, to hospice and end of life care available to the physically terminally ill? I only know that its foundation is compassion. We can no more blame those who succumb to mental illness than we can those who succumb to terminal illness of the body. We need to start loving, listening, and accepting that we cannot know another’s suffering, nor can we fix it. Our good intentions, pep talks, and interventions may, in the long run, only add to the weight of depression and anxiety. Not only does our loved one feel that the world would be better without them, but they carry the extra weight of our implicit message that they should be able to do something to make things different. Instead, our responsibility is to stand in compassion and serve the best we can as witnesses of life’s various ways of being.

The metaphysical poet, John Donne wrote “No man is an island. . . Every man’s death diminishes me.” Each is a cause for grief and contemplation of our own fragile mortality. “To live in this world,” the late Mary Oliver wrote, “you must be able to do three things: to love what is mortal; to hold it against your bones knowing your own life depends on it; and when the time comes to let it go, to let it go.” For me, this is sage advice for those of us who bear witness to friends and family for whom life is an insurmountable struggle, to love each other’s mortality and to hold it as our own. Our lives depend upon it.

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