Being diagnosed with a mental illness is a little like being drafted into the military: one never asks for it, it’s often very unpleasant, and it involves fighting an enemy that cannot be reasoned, negotiated, or bargained with.
Sadly, compared to other medical conditions such as cancer or diabetes, most mental illnesses (particularly mood disorders like depression and bipolar disorder) are seen as far more trivial. It’s not uncommon for those unfamiliar with the nuances of mood disorders to write off a depressed individual as merely being sensitive and/or whiny. Those who do choose to put an end to their suffering through suicide are often seen as cowardly and selfish.
In the wake of Robin Williams’ tragic suicide, many have sought to reopen the discussion on the way we as a society view depression and suicide, and rightfully so; the comedian’s death illustrates the complexity of depression and how the stigma associated with it leads many to suffer alone.
While the need to rewrite our cultural opinion of suicide is indeed a pressing one, there are those who seek to take things a little too far: suicide, they claim, is a sign of a terminal mental illness, in that individuals are so burdened by their condition that they feel compelled to end their lives. Suicide is not a choice, such people say, but a compulsion caused by a sort of cancer-of-the-mind.
Speaking as both a Cognitive Science minor and an individual diagnosed with bipolar disorder (formerly known as manic-depression), I feel justified in saying that such an outlook on mental illness is irresponsible, illogical, and quite frankly insulting.
It’s true that suicide is commonly associated with mood disorders and that suicidal tendencies occur at a neurophysiological level; depression, for example, is often associated with decreased levels of dopamine and serotonin (two neurotransmitter chemicals associated with mood and emotional regulation) and increased levels of norepinephrine (a neurotransmitter produced under stress that is associated with the fight-or-flight response). Deficiencies of dopamine contribute to the lack of motivation, loss of interest, and decreased sex drive found in many cases of depression. Low levels of serotonin are correlated with low self-esteem and negative emotions. Elevated levels of norepinephrine lead to anxiety and obsessive behavior.
Severe instances of these chemical deficiencies lead to what is known as suicidal ideation: that is, the extreme feelings of misery and dread that may become so unbearable to a depressed individual as to make their lives feel meaningless to the point that suicide feels like the only way to end their suffering. So yes, there’s some truth to the argument that suicidal tendencies are on some level bodily in nature.
That said, while the feelings that lead to suicidal behavior in depressed patients have physiological roots, the very act of terminating one’s life does not. The samurai of feudal Japan believed that ritual suicide was a perfectly acceptable (even honorable) way to die; thus, suicide was for them a cultural phenomenon, rather than something directly caused by chemical imbalances. Although most suicides today are the byproduct of suicidal ideation, there’s still an important distinction to be made between the feelings that drive a person to suicide and the act itself.
The relationship between brains, minds and consciousness is so complex that biochemistry is only one component of it. Mind and consciousness are emergent in nature; they are built upon multiple modular systems that operate independent of each other. Decision-making, for example, is a unit of neurological activity that is controlled by a different part of the brain than emotion and motivation. Although our moods can affect our choices, they aren’t bound by them because they’re processed differently. You can feel like killing yourself and yet choose not to; this is why crisis hotlines, support groups, and psychotherapy exist.
Subscribing to the belief that mental illness can be terminal is problematic for two reasons: on one hand, such a belief implies a far more negative outlook for those diagnosed with mental illness. It undermines and devalues practically everything we know about how the brain and mind operate, not to mention at least three of the four basic principles of medical ethics: autonomy (a patient’s right to choose or refuse treatment), beneficence (acting only in a patient’s best interests) and non-maleficence (refusing to act against a patient’s best interests). Promoting a terminal prognosis for mental illness could potentially lead to an obscenely boneheaded psychiatric philosophy that encourages evaluating patients on a cursory level that fails to consider the patient as an individual. From an ethical, psychological and scientific standpoint, the label of “terminal mental illness” has terrifying ramifications associated with it.
Also, the idea that a mental illness is terminal fails to do justice to those who have, in the face of adversity from both society and their own central nervous system, refused to give up and surrender. In my personal experience with both depression and hypomania, I’ve had multiple experiences wherein suicide might have been an option, yet every time the thought of killing myself so much as crosses my mind, at least two or three reasons not to kill myself arise simultaneously. Like so many others before me, I’ve made my diagnosis work for me by striving to find meaning in it through a number of outlets, such as this column. All of my hard work and accomplishments are made meaningful because I had the option to give up, but decided not to. I chose to stand my ground, and this has led me to a number of personal victories.
As is the case with any conscription, there’s a choice to be had when it comes to having a mental illness: You can run away or stand your ground and fight for what you believe is right. The choice, as always, is yours. But keep this in mind: we have a word for those who take the second option, the road less travelled by: Heroes.
Why should the fight against mental illness be any different?