Selfish Acts?

Reality Requires a Rethink

A lot of the posts on here have, to lesser and greater degrees, dwelt on my experiences with suicidal impulses. I wouldn’t blame anybody for having had quite enough of that. But recent events have caused me to have a serious rethink about what has been going on in my psychology. So for those prepared to stick it out I’m going to try and work through some of that here. Bear with me.

A good place to begin is the common phrase that “suicide is a selfish act”. For many years I really despised this expression. It always struck me as something that only somebody who had never wrestled with suicidal thoughts could find plausible. I understand what is meant by it: that the emotional impact on loved ones is so horrendous that a person who kills themself must only care about themselves, hence is being selfish. But this completely fails to understand the mentality of somebody who is suicidal. To the person who wants to kill themselves, suicide is not selfish, but something like the opposite. Think about it: if you don’t consider your own life worth living, then it seems obvious that nobody else could value it either. Sure they might be sad in the immediate aftermath of your death, but they would move on and forget you. More than this, their life would in fact be better off without you there polluting it (as they too would come to see). You would be doing everybody a favour by getting out of the way. Hence, not a selfish act.

For many years this is how I saw matters in terms of how the suicidee feels. But in the immediate aftermath of my accident I understood for the first time what motivated the notion of suicide as a selfish act. As I read through the dozens and dozens of cards sent to me, and reflected on the bravery and skill of the climbing partner who saved my life that day, and of the scores of medical professionals who worked tirelessly to keep me alive afterwards, and of the friends who visited me whilst still unconscious, and of my parents who had moved to Glasgow to spend every day with me until I finally woke up from a coma - well it suddenly seemed indisputable that giving up was not an option. I simply owed too many people too much: I now had to fight and choose to stay alive, come what may. Given how much had been done for me - how much love had been shown by others - for the first time I genuinely felt I simply had no right to end it all. Choosing to quit would indeed be a selfish act.

This new mentality lasted for the best part of a month. Unfortunately, due to the endless grind of living in a hospital, unable to feed myself or go to the toilet like an adult, with nothing but time to reflect on how catastrophic my injury really was, I sank further and further into the deep depression with which I’m still wrestling. In the process I flipped back to something like my old stance: how could it be selfish to want this nightmare to end? Indeed, surely it was the other way around. I wasn’t the selfish one for wanting to die, it was other people who were being selfish in forcing me to live. Whatever grief they thought they might experience should I die must surely pale into insignificance compared to the mental suffering of my daily existence. Furthermore, how could it be selfish to cease being an emotional and financial burden on my friends and family, as well as a black hole of NHS expenses? Let me go, you selfish bastards. I want out.

Or so I have felt for the last four or five months. But recently something happened that has forced me to reconsider once more.

About four weeks ago a new patient arrived here in rehab, a gentleman in his late 70s, who was assigned to the bed three meters to my right. Truth be told he rubbed me up the wrong way. The reasons for this are not important, and don’t amount to anything more than the kinds of mutual irritations you would expect to occur amongst random people suddenly thrown into close proximity, for 24 hours a day, through one of the most stressful periods it is possible to imagine experiencing. (Although if I’m honest I was probably also envious of him. His injury was at a similar level of his spine but less severe than mine, and he could do things I am desperate to achieve, such as functionally using his hands and going to a regular toilet.) However I grudgingly made my peace and opted to simply ignore him as much as I could, with the exceptions of the times he crashed his wheelchair into mine through carelessness. At least, I thought, he was quiet in the evenings and therefore better than some of the other people who inhabit the ward.

Then last Sunday he died.

I did not witness what happened, being in the day room and watching the Arsenal-Liverpool FA cup game whilst he was in bed. From what I have been told, however, he likely suffered either heart failure or the catastrophic results of a blood clot. The hospital staff did all they could, but there was nothing to be done. After reviving him once and evacuating him to the ICU, he continued to deteriorate and could not be saved.

I knew that evening that his bed had been taken out of the ward, and he was in ICU. The next morning I was told that he hadn’t made it. I cannot deny that the news affected me. For several weeks I slept 3 meters away from a living human being, a centre of consciousness, one with many decades of subjective experience: a particular vista onto the world, with hopes and dreams and cares and anticipations. And now that source of subjectivity simply no longer existed. Not as part of some introspective fantasy, but for real. Gone. Over. Done.

But even more affecting was seeing how the death of this man impacted others. Many of the nursing staff were visibly shaken. After all this is a rehab unit and people who are admitted here are expected to be discharged and live on in the world outside. Death here is rare.

Likewise, those patients who interacted with him more than I did were understandably shaken. Counselling has been offered, although I’m not sure anybody has actually received any. Particularly affecting was watching the senior nurses clear away the man’s possessions. As they explained, they did not want the man’s family to have to come in and sort through his affairs themselves, in the full gaze of patients and staff. He was regularly visited, and it pained me to think that when his family said goodbye to him on Saturday, none of them knew they were saying goodbye for the last time.

It might seem ridiculous that it should take a real death for me to interrogate more deeply my own hypothetical one. But that has certainly been the result. I have spent much of the last week confronting my much professed desire to die. The reality of death, taking place so close to me, has forced me to be more honest with myself.

There is an important distinction in psychology between suicidal ideation and full-blown suicidality. The former involves ruminating extensively about death and imagining ways one might die. The latter involves taking actual concrete steps to go through with it. For simplicity’s sake we can say that whilst the person suffering from suicidal ideation is very good at mentally torturing themselves, they are not at risk of physical harm. They are not actually going to try and die. By contrast the person who is actively suicidal is a genuine risk to themselves. So which am I?

If I introspect honestly on this question, I think I am firmly in the camp of ideation not actuality. I have taken no concrete steps to bring about the ultimate end, not just now but at any point in my life before, no matter how depressed I have been. If I’m completely honest with myself, I don’t think I am actually ever going to do it.

So why on earth do I go on about it so much, to the point of even begging friends and family to help me die? The answer I think is precisely because I know they can’t (and won’t). What I’m really trying to communicate is how much mental suffering I’m experiencing. It is a cry for help, of trying to tell people how bad I feel in the hope that somehow they can make me feel better. Similarly, it serves as a form of coping mechanism. If I tell myself that soon I’m going to die, then I reassure myself that I have an escape route. That I am not trapped. That if things ever really get so bad that I genuinely cannot cope anymore, then I can in the end make it stop. This, paradoxically, keeps me going one more day at a time.

Another way to put the point (and as a friend recently said to me) is that there is an important distinction between losing the will to live and actively wanting to die. It is true that it has been many months since I have seen much point in being alive. But this is not the same as actively choosing to die. And what is more, desires can change. As friends and family have repeatedly told me, I need more time in order to allow this possibility to happen, rather than simply assuming that it can’t. Deep down I think I know they are right. I just wish I could hit fast forward.

In the meantime don’t pay too much attention next time I sink into the pit of despair and start wailing, which I almost certainly will. Just bear with me as I struggle through, and don’t take me too literally.