His bewilderment, his emotional defeat, are commonplaces of the suicidal mind. Joel P. Smith, a man in Wisconsin who has survived multiple suicide attempts, wrote to me, “I am alone. A large proportion of depressed people I know are more or less alone, having lost their jobs and used up their families and friends. I become suicidal. My ultimate guardian—namely myself—has not just gone off duty, but, so much more dangerously, has become the advocate, the agent of destruction.”
On the day it took place, when I was twenty-seven, I understood and believed in the reasons for my mother’s suicide. She was in the late stages of terminal cancer. In fact, with my father and brother, I helped my mother kill herself and, in doing so, experienced a great intimacy with her. We all believed in what she did. Unfortunately, many who believe in rational decision making—including Derek Humphry, author of Final Exit, and Jack Kevorkian—seem to think that rational means “straightforward.” It was not easy to arrive at this rational decision. It was a slow, tangled, peculiar process whose convolutions were as madly individual as those experiences of love that can lead to marriage. My mother’s suicide is the cataclysm of my life, though I admire her for it and believe in it. It so distresses me that I mostly draw up shy of thinking and talking about its details. The simple fact of it is now a fact of my life and I will gamely share that with anyone who asks. The reality of what happened, however, is like something sharp that is embedded in me, that cuts whenever I move.
Activists draw an obsessively careful distinction between “rational” and all other suicides. In fact a suicide is a suicide—overdetermined, sad, toxic in some measure to everyone it touches. The worst and the best kind lie at either end of a continuum; they differ more in degree than in essential quality. Rational suicide has always been a popular and frightening idea. The narrator of Dostoyevsky’s The Possessed asks whether people kill themselves from reason. “Lots,” Kirilov replies. “But for prejudice there would be more; many more; all.” When we speak of a rational suicide and distinguish it from an irrational one, we are sketching out the details of our own or our society’s prejudices. Someone who killed himself because he didn’t like his arthritis would seem suicidal; someone who killed herself because she couldn’t bear the prospect of a painful and undignified death from cancer seems perhaps quite rational. A British court recently awarded a hospital permission to force-feed a diabetic anorexic and to inject her with insulin against her will. She was extremely wily and had contrived to substitute a mix of milk and water for the insulin that she was supposed to be injecting, and she soon reached a nearly comatose state. “Well, is that anorexia?” asked the therapist who was treating her. “Is that suicidal behavior? Is that para-suicidal? I think it’s obviously a very depressed and very angry thing to do.” What about people with miserable but not immediately fatal illnesses? Is it reasonable to kill oneself in the face of Alzheimer’s or Lou Gehrig’s disease? Is there such a thing as a terminal mental state, in which someone who has received lots of treatment and remains unhappy may commit rational suicide even if he is not ill? What is rational for one person is irrational for another, and all suicide is calamitous.
In a hospital in Pennsylvania, I met a man in his late teens whose wish to die I would be particularly inclined to honor. He was born in Korea and abandoned as an infant; when he was found, half-starved, he was put into a Seoul orphanage from which he was adopted when he was six by an American alcoholic couple who abused him. By the time he was twelve, he had been made a ward of the state and sent to live in the mental hospital where I encountered him. He suffers from cerebral palsy, which has crippled his lower body into uselessness, and speech is painful and laborious for him. In the five years he has lived full-time at the hospital, he has received every medication and treatment known to mankind, including a full spectrum of antidepressant treatment and electroconvulsive therapy, but he has remained bitter and anguished. He has made innumerable suicide attempts since late childhood, but because he is in a care facility, he has always been saved; and since he is confined to a wheelchair on a locked ward, he can seldom make his way to a situation private enough for his attempts to stand a chance. Desperate, he tried to starve himself to death; when he hit unconsciousness, he was fed intravenously.
Though his physical disability makes speech a struggle for him, he is perfectly capable of rational conversation. “I’m sorry to be alive,” he said to me. “I didn’t want to be here in this form. I just don’t want to be here on earth. I have had no life. There are no things I like or that give me joy. This is my life: upstairs in building number nine of this hospital and then back here to building number one, which is no better than building number nine. My legs are painful. My body hurts me. I try not to talk to the people in here. They basically all talk to themselves anyway. I’ve taken a lot of medication for my depression. I don’t think the medicine works for me. I lift weights upstairs with my arms, and I use the computer. That keeps my mind occupied and it distracts from what I have. But it is not enough. This will never change. I will never not feel like killing myself. It feels good to cut my wrists. I like seeing my own blood. Then I fall asleep. When I wake up, I say to myself, ‘Damn it, I woke up.’ ” Plenty of people with cerebral palsy lead rich and satisfying lives. This young man, however, is so psychologically bruised and so violently hostile that he will probably not encounter much love and would perhaps be unable to appreciate it if it were offered to him. He is moving to me and to some of the people who help to take care of him, but no heroic person who wants to give up a life to helping him has materialized; there are not enough selfless people on earth to devote themselves to all the people like him who fight against their own life every minute on this planet. His life is physical pain and mental pain and physical incompetence and mental shadows. To me, his depression and his wish to die seem untreatable, and I am glad that I do not have responsibility for ensuring that he wakes up every time he manages to cut his wrists, that I am not the one who inserts the feeding tube when he has deliberately stopped eating.
In another hospital, I encountered an eighty-five-year-old man in good health who, with his wife, took mortal doses of barbiturates when she began to develop liver cancer. They had been married sixty-one years and had a suicide pact. She died. He was revived. “I was sent in to cure this guy’s depression,” a young psychiatrist said to me. “Give him some pills and therapy so he won’t be depressed because he’s old, sick, in constant pain, his wife dead, suicide didn’t work. It’s been six months, he’s still in the same state, he could live ten years. I treat depression. What he’s got, it’s not that kind of depression.”
Tennyson’s poem “Tithonus” tells the story of such late-life despair. Tithonus was the lover of Eos, the dawn; she asked Zeus to give him eternal life. Zeus granted her request; but she had forgotten to ask for eternal youth. Unable to kill himself, Tithonus lives forever growing infinitely old and infinitely more old. He longs to die, saying to his former lover:
Coldly thy rosy shadows bathe me, cold
Are all thy lights, and cold my wrinkled feet
Upon thy glimmering thresholds, when the steam
Floats up from those dim fields about the homes
Of happy men that have the power to die,
And grassy barrows of the happier dead.
Petronius’ story of the Cumaean Sibyl, who was doomed also to immortality without eternal youth, was to form the despairing epigraph to T. S. Eliot’s The Waste Land: “When asked, ‘Sibyl, what do you want?’ she would reply, ‘I want to die.’ ” And even Emily Dickinson, living quietly in New England, came to a similar conclusion about the gradual descent into loss:
The Heart asks Pleasure—first—
And then—Excuse from Pain—
And then—those little Anodynes
That deaden suffering—
And then—to go to sleep—
And then—if it should be
The will of its Inquisitor
The privilege to die—
In our family, discussions about euthanasia began long before my mother developed ovarian cancer. We all signed living wills in the early eighties and talked at that time—entirely in the abstract—about how uncivilized it was that the euthanasia options famously available in the Netherlands were not available to Americans. “I hate pain,” my mother said casually. “If I reach the point at which I’m in nothing but pain, I hope one of you will shoot me.” We all, laughingly, agreed. We all hated pain, all thought that a quiet death was the best kind—in your sleep, at home, when you were very old. Young and optimistic, I assumed that we would all die that way at some point in the remote future.
In August 1989, my mother was diagnosed with ovarian cancer. During her first week in the hospital, she announced that she was going to kill herself. We all tried to shrug off this declaration, and she didn’t particularly insist on it. She was not at that time speaking of a considered agenda of terminating her symptoms—she had scarcely any symptoms—but was rather expressing a sense of outrage at the indignity of what lay ahead and a profound fear of being out of control of her life. She spoke of suicide, then, as people disappointed in love may speak of it, as a swift and easy alternative to the painful, slow process of recovery. It was as though she wanted vengeance for the snub she had received from nature; if her life could not be as exquisite as it had been, she would have no more of it.
The subject lay low as my mother went through an excruciating, humiliating bout of chemotherapy. When, ten months later, she went in for exploratory surgery to assess the chemotherapy’s efficacy, we discovered that the regimen had not been as effective as we’d hoped, and a second round was prescribed. After her surgery, my mother lingered for a long time in a resistance to consciousness forged out of rage. When she finally began to speak again, a flood of anger came out of her, and this time when she said she was going to kill herself, it was a threat. Our protests were thrown back in our faces. “I’m already dead,” she said as she lay in her hospital bed. “What’s here for you to love?” Or else she instructed, “If you loved me, you’d help me out of this misery.” Whatever meager faith she had had in chemotherapy had vanished, and she laid down as a condition of her accepting another round of punishing treatments that she would do it if someone would get her “those pills,” so that she could stop whenever she was ready.
One tends to accommodate the very, very sick. There was no answer to my mother’s rage and despair after her surgery but to say yes to whatever she demanded. I was living in London at that time: I came home every other week to see her. My brother was in law school in New Haven and spent long days on the train. My father neglected his office to be at home. We were all clinging to my mother—who had always been the center of our close family—and we wavered between the light but meaningful tone that had always been our mien and a terrifying solemnity. Still, when she had relaxed into a facsimile of her usual self, the idea of her suicide, though it had gained resonance, once more receded. My mother’s second round of chemotherapy seemed to be working, and my father had researched a half dozen more treatment options. My mother made her dark remarks about suicide on occasion, but we continued to tell her that there was a long time before such measures could be relevant.
At four o’clock on a blustery September afternoon in 1990, I called to check on some test results that were due that day. When my father answered, I knew at once what had happened. We would continue, he told me, with this therapy for the moment while we explored other options. I had no doubt what other options my mother would be exploring. So I should not have been surprised when she told me, in October, over lunch, that the technical details had been taken care of, and that she now had the pills. In the early stages of her illness, my mother, stripped of disguises, had suffered the loss of her looks as a side effect of her treatments, a ravagement so obvious that only my father could contrive to be blind to it. My mother had previously been beautiful, and she found the physical losses of chemotherapy intensely painful—her hair was gone, her skin too allergic for any makeup, her body emaciated, her eyes ringed with exhaustion and constantly drooping. By the time of that October lunch, however, she had begun to take on a new kind of pale, illuminated, ethereal beauty, completely different in its effect from the 1950s all-American appearance she had had during my childhood. The moment that my mother actually sought the pills was also the moment at which she accepted (perhaps prematurely, perhaps not) that she was dying, and this acceptance afforded her a radiance, both physical and profound, that seemed to me, at last, more powerful than her decay. When I remember that lunch, I remember, among other things, how beautiful my mother had become again.
I protested, as we ate, that she might still have lots of time, and she said that she had always believed in planning things carefully, and that now that she had the pills, she could relax and enjoy whatever was left without worrying about the end. Euthanasia is a deadline matter, and I asked my mother what her cutoff would be. “As long as there is even a remote chance of my getting well,” she said, “I’ll go on with treatments. When they say that they are keeping me alive but without any chance of recovery, then I’ll stop. When it’s time, we’ll all know. Don’t worry. I won’t take them before then. Meanwhile, I plan to enjoy whatever time there is left.”
Everything that had been intolerable to my mother was made tolerable when she got those pills, by the sure knowledge that when it became really intolerable, it would stop. I would have to say that the eight months that followed, though they led inexorably toward her death, were the happiest months of her illness; that in some obscure way, despite or perhaps because of the suffering in them, they were among the happiest months of our lives. Once we had all settled the future, we could live fully in the present, something that none of us had really done before. I should emphasize that the vomiting, malaise, hair loss, adhesions, were all relentless, that my mother’s mouth was one great sore that never seemed to heal, that she would have to save up strength for days to have an afternoon out, that she could eat almost nothing, was a mess of allergies, shook so badly that on some days she couldn’t use a fork and knife—and yet the excruciating business of the continuing chemotherapy seemed suddenly unimportant because these symptoms were permanent only until she decided she could take no more, and so the disease was no longer in control of her. My mother was an adoring woman, and in those months she gave herself over to love as I have never seen anyone else do. In A Short History of Decay, E. M. Cioran writes, “Consolation by a possible suicide widens into infinite space this realm where we are suffering. . . . What greater wealth than the suicide each of us bears within himself?”
I have since then read and been particularly moved by Virginia Woolf’s suicide note, so similar in spirit to the terms of my mother’s departure. Woolf wrote to her husband:
Dearest:
I want to tell you that you have given me complete happiness. No one could have done more than you have done. Please believe that.
But I know that I shall never get over this: and I am wasting your life. It is this madness. Nothing anyone says can persuade me. You can work, and you will be much better off without me. You see, I can’t write this even, which shows I am right. All I want to say is that until this disease came on we were perfectly happy. It was all due to you. No one could have been so good as you have been, from the very first day till now. Everyone knows that.
V.
Will you destroy all my papers?
It is an unusually sympathetic note precisely because it is dispassionate and so clear about illness. There are people who kill themselves because they have not yet found, or perhaps because they have not yet sought, an existing cure. Then there are those who kill themselves because their illness is genuinely refractory. If I had truly believed when I was ill that my situation was permanent, I would have killed myself. Even if I had believed that it was cyclical, as Virginia Woolf knew her complaint to be, I would have killed myself if the cycles seemed too much weighted toward despair. Woolf
knew that whatever pain she was feeling would pass, but she didn’t want to live through it and wait for it to pass; she’d had enough of waiting and time and it was time to go. She wrote:
Oh, its beginning is coming—the horror—physically like a painful wave swelling about the heart—tossing me up. I’m unhappy, unhappy! Down—God, I wish I were dead. Pause. But why am I feeling this? Let me watch the wave rise. I watch. Failure. Yes; I detect that. Failure, failure. (The wave rises.) Wave crashes. I wish I were dead! I’ve only a few years to live I hope. I can’t face this horror any more—(this is the wave spreading out over me).
This goes on; several times, with varieties of horror. Then, at the crisis, instead of the pain remaining intense, it becomes rather vague. I doze. I wake with a start. The wave again! The irrational pain: the sense of failure; generally some specific incident.
At last I say, watching as dispassionately as I can, Now take a pull of yourself. No more of this. I reason. I take a census of happy people & unhappy. I brace myself to shove to throw to batter down. I begin to march blindly forward. I feel obstacles go down. I say it doesn’t matter. Nothing matters. I become rigid & straight, & sleep again, & half wake & feel the wave beginning & watch the light whitening & wonder how this time, breakfast & daylight will overcome it. Does everyone go through this state? Why have I so little control? It is not creditable, nor lovable. It is the cause of much waste & pain in my life.
I wrote to my brother during my third bout of depression, before I knew how fast that one would pass, “I can’t spend every other year this way. In the meanwhile, I’m trying my best to hold on. I’d bought a gun which I had around the house, and I gave it to a friend to take care of because I didn’t want to end up using it in a moment of impulsiveness. Isn’t that ridiculous? To be afraid you’ll end up using your own gun yourself? To have to put it someplace else and instruct someone not to give it back to you?” Suicide is really more of an anxiety response than a depression solution: it is not the action of a null mind but of a tortured one. The physical symptoms of anxiety are so acute that they seem to demand a physical response: not simply the mental suicide of silence and sleep, but the physical one of self-slaughter.
The Noonday Demon Page 39