Loneliness, Depression, and Euthanasia

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Loneliness is part of the trifecta of modern angst (along with boredom and fragmentation).

A recent study published in JAMA Psychiatry looked at physician-assisted suicide (PAS) cases in Belgium that were approved because the patient had an unbearable psychiatric illness. The study found that in more than half of the cases, the patient declined treatment that could have helped. Often the patient sought approval for euthanasia after visiting with a doctor for the first time, some patients even visiting a mobile clinic that is funded by a euthanasia group. Forty-six of the 66 cases were women. Importantly, loneliness was cited as a common theme.

You can read the research article here, available by subscription, and the New York Times article here.

Last year, Rachel Aviv wrote a poignant and insightful article in The New Yorker on euthanasia for non-terminal people in the Netherlands. In it she recounts the story of Tom whose mother suffered from depression and eventually elected to undergo euthanasia. Tom did not know about it until after the fact and was angry that he was not called so he could talk to his mother. His mother died with three photographs in her pocket: one of her holding Tom as a baby, one of her feeding her granddaughter ice cream, and one of her and her daughter in a field. She had just broken up with her boyfriend and was estranged from her daughter. Tom and his wife could visit her sometimes, but career and children took much of their time. Furthermore, her lifelong struggle with depression and inability to form close relationships contributed to her isolation. She was lonely and she elected to die alone.

Loneliness is pervasive. This is not the idea of someone being by themselves. Many people can be alone and not be lonely. Also, many people can go to parties, have friends, and still feel utterly alone. As social commentators have pointed out, loneliness is part of the trifecta of modern angst: loneliness, boredom (hyperboredom) and fragmentation. Greg Monbiot in an insightful column in The Guardian dubs our time as the “Age of Loneliness.” One of the Dutch psychologists mentioned in Rachel Aviv’s article says that euthanasia for psychiatric disorders is a response to the nihilism pervasive in the Dutch culture. He says that people ask “What is life worth when there is no God?” or “What is life worth when I am not successful?”

In Japan, the incidence of dying alone, and sometimes not being discovered for weeks, has become so common that the Japanese have a word for it: kodokushi. There is an entire industry dedicated to cleaning after the discovery of someone who has died a lonely death with no friends or relatives. In Japan, many of these lonely deaths are men who had dedicated their lives to their jobs only to be laid off or forced into early retirement. They had no relationships outside of work. Their jobs were the essence of their identity. Without it, they were lost.

A 2014 report showed that loneliness has greater negative health effects than obesity, and a Washington Post article from this past January reported more studies on the health effects of loneliness. In sum, scientists have found that loneliness leads to physiological changes and is more damaging to one’s health than cigarettes, diabetes, and obesity. Studies have shown a correlation between loneliness and early death, onset of Alzheimer’s and dementia, and increased risk for cancer and heart attacks. This is likely due to increased activity in genes that cause inflammation coupled with decreased activity in genes that produce antibodies.

Canada recently legalized physician-assisted suicide, and in the U.S., California recently joined Oregon, Vermont, Washington, and Montana as states where PAS is legal. Most of these places have stringent guidelines for who qualifies for euthanasia. The U.S. laws specify that the patient have a terminal illness and some of them require that the patient have less than six months to live. While “slippery slope” arguments can sometimes be spurious, in this case, we do have two examples of what happens when suicide is medicalized and re-framed as a dignified death. Belgium and The Netherlands continue to open up euthanasia to more and more people. They are not required to be terminal and the age limit continues to decrease with some advocating for no age limit for qualifying for euthanasia.

But, if loneliness is a pervasive problem in our culture, medically-endorsed suicide does little to help and may contribute to the sense of isolation. There was a time when suicide was a cry for help. Now, for the depressed and lonely, it affirms their fears that they are unwanted. Mother Teresa is quoted as saying that “the biggest disease today is not leprosy or cancer or tuberculosis, but rather the feeling of being unwanted, uncared for and deserted by everybody.” Rather than trying to care for people who are struggling, doctors are helping lonely people to end it all. Suicide is not a “solution” for someone struggling with a mental health issue. It is abandoning someone in their time of need.

See also:
Dutch Treatment: A Eureka Moment for Holland’s Medical Ethics
Daily Killings: Euthanasia Grows in Deepest Darkest Belgium
Dr. Phillip Nitschke and the Reinvention of Assisted Suicide

What Does Death Have to Do with Having a Happy Holidays?

Two Christmas stories that have stood the test of time are Charles Dickens’ A Christmas Carol and Frank Capra’s It’s a Wonderful Life. Both stories invite the main character to suppose he were dead. In A Christmas Carol, the ghost of Christmas future asks Scrooge to look at how people will talk about him once he has died. In It’s a Wonderful Life, George Bailey is taken to an alternative world in which he sees how things in his town would be different had he never lived.

Additionally, both main characters must look into the face of death, confronting their own mortality, before they are ready to see that their problems originate in their own hearts. In A Christmas Carol, before Scrooge faces his own death, he encounters Marley’s ghost who warns Scrooge that if he continues in this path, he will end up like Marley, chained to his idol.

In It’s a Wonderful Life, George sinks into such deep despair that he ends up standing on the edge of the bridge considering suicide, but instead rescues another jumper from the bridge. Incidentally, the other jumper was Clarence who, similar to Marley, was once alive but now is dead, and whose mission is to help George live a better life. Scrooge and George Bailey are vastly different characters, yet both are miserable because of the same seed of discontent growing within them, and both are cured through similar means.

Interestingly, what is different about George Bailey and Ebenezer Scrooge is telling. Scrooge is the lonely wealthy man who seeks to rob others of joy because he cannot feel it himself. George is the sympathetic family man who begrudges his tender-heartedness because it has left him poor and stagnant. Both the rich man and the poor man struggle with discontent, and both the rich man and the poor man believe that money is the key to their happiness.

Both men are plagued by the same disease, discontent. When a person is discontent in poverty, he does not see the mercies and blessings he has been given, but only his lack. Puritan writer, Thomas Watson, points out that a man who is discontent in this estate will think even bitter things taste sweet. We see this when George Bailey considers compromising his standards and partnering with Mr. Potter, the town tyrant.

When a person is discontent in wealth, he can never accumulate enough to satisfy his true needs. Scrooge hoarded his wealth as a kind of security. Marley warns that rather than a security it is a fetter. The discontented wealthy man can never acquire enough, and we see this in Scrooge’s bitterness. He left his loved ones to pursue wealth, but wealth proved to be a burden rather than a companion.

By the end of the story Scrooge and George Bailey are not in a different place than they were when they faced their supernatural reminders of their mortality. Yes, George got the lost money back, but his town didn’t change, his house still had the broken bannister, and he still had four children to feed.  Scrooge still lived in the same dark house and Bob Cratchit was still his employee. What changed was their state of mind. And that is the lesson. Contentment is a state of mind, not some perfect combination of annual income, a home’s square footage, stock investments, luxury car, or vacation experiences.

George Bailey and Ebenezer Scrooge may not be characters in our time and place, but their lesson applies now as it did then. Ours is a culture that thrives on us never having enough. There are noble things that we should not be content to endure, like children dying from leukemia, or grandparents whose mind has been ravaged by Alzheimer’s, or diseases that destroy the body and injuries that result in loss of function.

However, wanting to rid the world of innocent suffering is not the kind of discontent that haunted George Bailey or Ebenezer Scrooge and it is not the kind of discontent that is endemic in our own time. Ours is a discontent that says “You deserve the best.” It is a discontent that comes from a sense of entitlement and a lack of thankfulness.

Many people blame our cultural sense of discontent on commercials that tell us that you will be happier driving a particular car or technology industries selling newer and better products before the warranty is out on your old one or magazines with air-brushed models sporting impossibly perfect bodies. But George Bailey and Ebenezer Scrooge didn’t have Cadillacs, iPhone 6s, or Photoshop. These industries are not the problem; they just make a profit from it. The problem is as old as human nature. We are dissatisfied with what we have and instead of addressing the root of our dissatisfaction, we would rather strive for more and more like Scrooge, or sink into despair like George Bailey. Their lesson strikes a chord with us because we are like them, and perhaps, like them, our focus on our lack robs us of our joy in what we have.

Girls and Guys, Getting [It] Together; Some Observations on Double Standards

(Surprise, surprise, Intern 2 has a bone to pick with cultural attitudes on sexuality and the sexes)

Recently my friend Barnabas mentioned that another (male) acquaintance of ours had once written a story whose implausible content “revealed his virginity.” The tone was not complimentary.

Due to the setting we were in, I chose not to mention that I too was wrestling with a scene in my own work-in-progress, one key to the characters’ emotional trajectory, that suffered from my lack of firsthand experience. But if I had, I know my friend would have vocally distinguished my situation from our classmate’s. There were other reasons (my actual presence, for one) that my lack of experience could be denoted the more respectable, but I’ve long suspected that chief among them would be the fact that I was a girl.

Say what we will about the pervasively decadent quality of popular and academic culture, but the secular world is still remarkably kind to female virgins. We have our detractors, (Jessica Valenti comes first to my mind), but they are generally not disdainers. It is frequently argued that women are harmed or restricted by abstinence, but not that there’s something innately wrong with a woman who abstains. The prevailing mindset does not suggest that a woman who has not engaged in sexual conduct is any less of a woman for it. (If your evidence or experience says otherwise, by all means post a link/tell us your story, and join the conversation.)

This is not the case for abstinent men, and men and women alike bear the responsibility to face the injustice.

Surely it is a point of agreement for all reasonable people that men’s promiscuity ought not to be excused and even praised while the same behavior is denigrated in women. I do not believe that this, which many feminists hold as the capital-D-S Double Standard (see also; “Stud/Slut Dichotomy”), is nearly so prevalent now as it was many decades ago, but this new double standard that excuses women’s virginity while denigrating men’s (we can call it the “Nice Girl/Nice Guy Dichotomy”) seems to have sprouted from the same root. The difference might have come with the shift of mainstream sexual mores. As pre-marital abstinence, rather than sexual activity, becomes the frowned-upon behavior, so do men, rather than women, become the chiefly frowned-upon participants.

This is not progressive thinking. This merely inverts our old thinking. The new double standard operates from the same false premises as the old. It still presupposes that men are passive victims to their all-consuming sexual desires (so, if a man has not had sex by a certain age, he must be either completely undesirable to women or otherwise suspect in his manliness). It still presupposes that women do not struggle with sexual desire at all, or only to a degree that is easily controlled (so, if a woman has not had sex by a certain age, that is an understandable decision on her part.) Just like the old double standard, this discredits both men’s and women’s capacity for strength in virtue.

It may be easier in this cultural climate for me, as a woman, to openly discuss my moral choices than it is for my male friends and counterparts. But I propose that even so, in such contexts that are appropriate and in such terms that are constructive, we all put these choices into open discussion. We, men and women together, bolstering the required courage, should calmly explain ourselves and defend each other.

Had it come to that, I could have reminded Barnabas, who does know better, that being male or female was not really a relevant factor in the conversation about twenty-something virgins trying to write what they don’t know. He would have listened. So would many others.

As we strive together toward the same fixed and unchanging standards, let us be confident, assured, and transparent* in our striving. Let us strive together so that others may see and understand, and may begin to strive alongside us.

I remain, sincerely yours,
Intern 2

*But tactful, and not obnoxious or boastful. Discretion, valor, better part, etc.

On Bradbury, Part 1: Middle School

(This is Intern 2. She is a twenty-something liturgical Christian with two degrees related to literature. Every so often during her tenure at Salvo, Intern 2 will post some observations on subjects that strike her as relevant, pressing, or just of interest. She will attempt to keep these snappy and effective, and appreciates all critique and discussion alike. Today, in her two-part first outing, Intern 2 freely associates on an author she had long hoped to meet in this life.)

Public school, like any human institution, has its flaws. For me, these flaws were particularly apparent in our eighth grade English curriculum. One time, our class was assigned a project on “Heroes and Sheroes,” a “shero” being so called because “heroin[e] is the name of a dangerous drug.”

I could go on in this vein for a long while. To do so, would be uninteresting and worse, unjust. Our eighth grade public school English class, for all its problems, was adorned with some distinctly, even vitally positive aspects.

It’s true that this English class had been, somewhere among the higher-ups at the middle school, deemed the assessment test/study habit/career path class, all of which took time and focus away from, well, English. But still there was grammar. Still there was vocabulary. Still we could identify a direct object and use the word “assuage.” We may have even diagrammed a sentence or two. And there was more.

To actively interest fourteen-year-olds while teaching them may be one of the toughest challenges God gave man, but when this class rose to it, it rose. My classmates enjoyed and responded to the fiction and poetry we read and discussed. We engaged in experiences outside of our own little suburban middle school worlds, as should be a main goal of good literature and good literary education.

If I may slip for a second into Old Guard Conservativese, we had many opportunities to stimulate our moral imaginations. I can recall no opportunity so vividly as reading Ray Bradbury’s The Martian Chronicles.

Please do yourself a favor. If your experience with Bradbury extends only to having been assigned Fahrenheit 451 (in which books are illegal and their owners sometimes burned along with them) during the Dystopia Unit in high school, then get yourself to the library (or library website) as soon you can. If you feel so inclined, stop reading this post, ignore the following, and go now.

Whatever your impression of Fahrenheit 451 itself and how it was taught to you, please take the plunge into any and all of Bradbury’s other work. We all know that he passed away last week. Now, if you haven’t already, is a good a time to discover him as ever.