Identifying the Person as the Problem: Euthanasia for Mental Illness

It was a practice that is foreign to most us today: The victim was executed for a crime committed against her. In the case of sexual defilement in which the woman was the victim, the woman was stoned to death in order to keep her uncleanliness out of the tribe. It seems barbaric to our modern-day sensitivities.

But, what if a woman wants to be punished for something done to her? What if she sees herself as too defiled to enter into the community? What if she thinks she should be killed?

Today victims of child sexual crimes and sexual assault are not put in jail or executed for being dirty. The Enlightenment brought with it the idea of autonomy, and with autonomy comes personal responsibility. The just response to sex crimes is to have the perpetrator tried and convicted in a court of law. However, in our modern world, the community’s responsibility toward the victim is a bit hazy. Dealing with the aftermath of sexual crimes, in particular, tends to be private and personal.

The Dutch Euthanasia Commission granted a 29-year-old woman permission to die by physician-assisted suicide. She suffered from post-traumatic stress from childhood sexual abuse that occurred from age 5 to 15. Among her mental health co-morbidities (because people with PTSD tend to express several types of symptoms), she had what was deemed “untreatable” anorexia due to depression and anxiety.

The Psychological Damage of Sex Crimes

In the up-coming issue of Salvo (Issue 37), I wrote the Casualty Report on sex trafficking. In doing the research for this report, one of the key ways that traffickers and pimps maintain control of their victims is by making them feel worthless. By shaming their victims through abusive and degrading tactics, the victim will not only lose her will to fight back, but she will lose hope for a way out. This is how pimps “train their victims.” Once the cycle of shame has begun, the victim will stay in the abusive relationship because she doesn’t believe she deserves better. Even once she is out of the abusive situation, she will often engage in self-harm as a way to cope with her deep-seated sense of worthlessness.

In his book Shame Interrupted Ed Welch says that “any sexual violation brings shame on the victim…it should be bring shame on the perpetrator” (Welch, 14). Shame is something far deeper and more intense than guilt. It is dehumanizing. Welch defines shame as

[Y]ou were disgraced because you acted less than human, you were treated as if you were less than human, or you were associated with something less than human, and there are witnesses. (Welch, 2)

The 29-year-old woman was treated as something less than human for most of her childhood. When she was approved for physician-assisted suicide, she was treated as less than human then, too.

PTSD Is NOT Incurable

In an op-ed for TIME online, Joan Cook, a trauma psychiatrist, says that “No provider anywhere should ever tell a trauma survivor that their condition is incurable.” She points out that treatment can be hard and it can take a long time, but it is not incurable.

In a Huffington Post article by Jenni Schaefer, author and survivor of sexual abuse, she attests that she was not competent to make a rational and informed decision about physician-assisted suicide while in the throes of her mental illness. The feelings of hopelessness, she says, are part of the illness.

In The Netherlands, one of the criteria for approval for physician-assisted suicide is that the patient must be competent to make the decision. How can she be both rational and competent and have an “incurable” mental illness?

Jenni’s mentor and PTSD expert, Dr. Tim Brewton, said that it is the obligation of the therapist to instill hope. He says that from a clinical perspective,

I do not believe in ever giving up on an individual’s potential for recovery. In fact, I think it is the duty of a doctor or therapist to instill hope of improvement, particularly in a young person. One very important lesson that I have learned over the years is that I can never predict who will improve and who will not. I have been proven wrong too many times, and we cannot see the future. It is better to be present in the moment with patients and to do one’s best to help them sit with their discomfort and move forward in all ways possible.

Shame consumes a person until the person is completely gone. Welch points out that the deep logic of anorexia, which the woman suffered from, is that the person feels unworthy and deserves nothing, so she gives herself nothing and perhaps she can just disappear (Welch, 28). This woman felt unworthy of life and the Dutch Euthanasia Commission agreed with her.

Autonomy and Compassion

Sexual crimes violate the person, not only physically, but also mentally. It is the ultimate expression of treating another as an inhuman piece of meat, a means to an end. If the victim survives the attack, she is not free; she is in mental bondage. Her autonomy has been stripped from her. Killing her is not honoring her freedom to choose when and how she will die. It is honoring the perpetrator’s original intent, which is to consume and discard.

Our enlightened and progressive culture has a habit of “solving” the problem by getting rid of the person, whether it is the unborn, the disabled, or the mentally ill. The problem of suffering is solved by eliminating the sufferer. This is sanitized by calling it “compassionate” and justified by invoking autonomy. If Western countries, like The Netherlands, really do value freedom and autonomy, then true freedom means helping the victim out of her mental bondage by showing her the love and dignity that she doesn’t think she deserves.

Note: After writing this post, I came across this column by Clare Allen in The Guardian, (“The label ‘incurable’ is not a justification for ending a life”). In it, she makes several observations about mental illness and euthanasia including a point that should be more obvious than it apparently is: “It seems to me that anyone who has lived through 10 years of sexual abuse may benefit more from being listened to than labelled.”

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