T.O. Walker argues that assisted suicide on mental health grounds will unfairly target people diagnosed with borderline personality disorder.
The issue of assisted suicide on mental health grounds seems to be everywhere I turn at the moment. I keep seeing discussions about it on social media, reading articles about people who have died this way, and hearing radio programs about it. In the last issue of Asylum, I saw a review of Undoing Suicidism, a book advocating assisted dying. I find it disturbing that books like this are being written and, although I agree with much of the review, I think a lot more needs to be said. I am also grieving a close friend who recently killed herself (in the UK), not long after her therapist suggested assisted dying to her.
Assisted suicide is currently available on mental health grounds in the Netherlands, Belgium, Luxembourg, and Switzerland. Canada also updated its law in 2021 to allow people who have what it calls ’grievous and irremediable’ mental illness to seek death at the hands of a physician, although the implementation of this has been postponed.
Assisted suicide isn’t currently being proposed on mental health grounds in the UK, although it is being proposed and backed by many on physical health grounds. In other places where assisted suicide/dying has been introduced on physical health grounds, it has often been followed by introducing it on mental health grounds. This terrifies me. I believe it will lead to more people needlessly losing hope, having the support they need withdrawn, and dying. It confuses me how people who claim to want bodily autonomy are arguing that the state and psychiatrists should make decisions about who, when, where, and under what circumstances people should be helped to die.
The people I’ve read about who have died via assisted dying are people like me and lots of people that I love. For example, they often have long histories of self-harm, feeling suicidal and attempting suicide. Like us, they have often experienced complex trauma and have one or more personality disorder diagnoses, alongside other diagnoses. They feel hopeless and despairing, often intensely and for extended periods of time. Like us, mental health services repeatedly have not helped them or have even made things worse. Like us, they have been told that they cannot be helped and/or given the impression that if psychiatry (or a particular service) can’t help them, then nobody can. When I read about these people being helped to die, I feel heartbroken.
I am heartbroken when a psychiatrist who was responsible for treating 25-year-old Zoraya ter Beek told her that there was nothing more they could do for her and that things would never get better. Beek says this is the point when she knew she would have to die. I am heartbroken when I read about Milou Verhoof, who was helped to die when she was 17. Verhoof had suffered a traumatic bereavement when she was 11 and then a sexual assault. Understandably, she became depressed and self-harmed, and unsurprisingly she was given a BPD diagnosis.
In all the cases of assisted dying I have read; the person had a borderline personality disorder (BPD) or other unspecified personality disorder diagnosis. People with these diagnoses are the people that mental health professionals do not like. We are the people they do not want as patients, and we are the people they don’t feel able or motivated to help. So maybe it isn’t surprising if we are the people they decide should be helped to die.
Twenty years ago, myself, my friend who recently killed herself, and other survivor activists produced a whole issue of Asylum criticising the BPD diagnosis (Asylum, Autumn 2004). We were concerned that understandable reactions to traumatic events were being pathologised and we were worried about the implications of this. We did not imagine that twenty years later the same women (it is mostly women who receive this diagnosis) would not just be pathologised and exposed to unhelpful or harmful responses, but would be told that we were incurable and then helped to die.
Having experienced complex trauma does not mean that you cannot and will not ever feel joy or love. If you feel hopeless and/or suicidal for long periods of time it can be really difficult or even impossible to imagine feeling any different. But people can and do go on to feel differently. This has been my experience.
When I was around five years old, I started hurting myself and throwing myself downstairs. From my early teens I took repeated overdoses. I felt utterly miserable and completely despairing for long periods of time. The child and adolescent mental health team I saw for many years acknowledged they hadn’t helped me and were not optimistic for my future. But there have been times in my life when I have felt joy and love; when I have felt hopeful and happy to be alive. I am very glad nobody offered to help me die.
This has been the experience of many of those I love, and other survivors I’ve heard about. I wonder if this could also be the experience of some of those who will die by assisted suicide. When I hear arguments for assisted suicide on mental health grounds, I hear people like us being told that there is no hope, and that we should kill ourselves. This feels dangerous and hugely disturbing.
When we feel hopeless and despairing, we need people (including therapists and mental health workers) to give us a sense of hope and a way to make things better. We need them to do this when we cannot do this for ourselves. To make assisted dying available tells us there is no hope, and things won’t get better. It is the exact opposite of what we need.
Recently, in the wake of my friend’s suicide, I’ve had to work really hard to look after myself and not self-destruct. When I hear arguments for assisted suicide on mental health grounds it chips a little bit more of my hope away. It’s painful and exhausting. When my friend went into therapy, one of the things she needed most was hope. Before she went on to kill herself, she told me how betrayed she felt when her therapist, whom she trusted, suggested assisted dying. She felt really hurt and rejected. It was the opposite of what she needed and wanted at a time of crisis. I cannot know for sure, but I think it’s probable that if the therapist hadn’t said this, my friend wouldn’t have killed herself and would have gone on to feel ok.
Assisted dying puts decisions about who can be helped into the hands of physicians and mental health professionals, many of whom would rather tell us that we are a hopeless case than admit that they don’t have the knowledge, skills, experience, or motivation to help us. I suspect this is what happened with my friend, her therapist suggesting assisted dying instead of admitting her own limitations and referring her on to someone who might have been able to help.
People argue that assisted suicide is about people having bodily autonomy, but this makes no sense to me. Realistically, services are not able to physically prevent us from killing themselves if we are determined to do this. I’m not the only person who knows someone who has killed themselves whilst in a psych hospital, or who knows people who have killed themselves whilst in community services. So, we do have autonomy. We can kill ourselves without the state and the medical establishment sanctioning and supporting it. Many of us (sadly) do this. Therefore, assisted suicide is not about us having the ‘right’ or the ‘autonomy’ to kill ourselves. It feels like the state and mental health workers sanctioning our deaths.
This is a sample article from the Autumn 2024 issue of Asylum Magazine (31.3). To read more. . . Subscribe to Asylum.