Who Is To Blame For A Suicide?

Yesterday I was driving around in my hometown and listening to the radio. The DJs did a segment on the suicide of Jacintha Saldanha, a nurse in a hospital where Kate Middleton was being treated, who was pranked by some radio DJs and tricked into giving out Middleton’s medical information.

The DJs on my hometown station put a caller through and asked for her opinion. She said that it’s not at all the DJs’ fault that Saldhana clearly had issues and that they shouldn’t have lost their jobs because of what happened. Furthermore, it was “irresponsible” of Saldhana to kill herself and leave this whole mess behind.

Lesson one: never listen to the radio in Dayton, Ohio.

Lesson two: people have a lot of trouble with grey areas and blurry lines.

(Of course, I mostly knew both of these things already.)

It seems to be very difficult for people to form an opinion on this tragedy that isn’t extreme. Some say that the DJs were just doing their jobs, the prank was completely harmless, just a bit of fun, and Saldanha was messed up and crazy. Others say that the DJs are terrible people and should be blamed for Saldanha’s suicide. The latter seems to be the minority opinion.

I don’t think that the truth always lies between two extremes. In this case, though, I feel that it does.

Suicide is a complex phenomenon and the suffering that causes it–and that is caused by it–makes it even more difficult to comprehend. A particularly painful fact that the friends and families of people who kill themselves sometimes have to face is the fact that suicide often has a trigger. Sometimes, that trigger is other people.

I remember reading a young adult novel called Thirteen Reasons Why a few years ago. The novel is very serious for a YA book, and the premise of it is that a teenage girl, Hannah, has killed herself and left behind a set of audio recordings in which she explains to every person who was implicated in her mental troubles what it was that they did.

One was addressed to a guy who found a poem she wrote and spread it all over the school. Another was to a guy who took photos of her through her bedroom window. By the end of the book you get a picture of a girl who was just completely used and marginalized by almost everyone she interacted with.

And yet–this is the part that some readers, judging from the reviews, didn’t get–Hannah is not supposed to be a wholly sympathetic character. You’re meant to feel sorry for her, but her actions are meant to make you uncomfortable. The tapes she leaves behind seem a bit vindictive. And at the end you learn that two of the major triggers for her suicide were that she failed to stop a rape at a party and that she allowed her friend to drive drunk–and hit and kill someone.

So, who’s to blame for Hannah’s suicide? Her classmates were cruel, yes. But they didn’t know what she was going through. And she could’ve saved herself a lot of guilt had she intervened and stopped the rape and the car accident, but can you really expect a terrified teenage girl to do that?

The point of the book, to me, is this: you can’t blame anyone. It’s comforting to think that you can, but you just can’t.

Similarly, the Australian DJs who pranked Saldanha could not have known what would happen. In fact, even now we don’t really understand. Although she reportedly left a suicide note, we don’t know what it says, and we don’t know what kinds of personal struggles she might’ve had leading up to her death. To their credit, the DJs have said that they’re heartbroken and sorry.

But blaming Saldanha is sick and cruel.

And while I don’t blame the DJs for her death, I still think they shouldn’t have done it.

The thing is, we live in a world that presumes that everyone is “strong” and mentally healthy and capable of dealing with whatever life throws at them without falling apart. This is why people like Saldanha are blamed and exhorted to “just work on their issues,” even after they’ve died.

We assume that people are always capable, for instance, of refusing repeated sexual advances, ignoring social coercion and proselytism, dealing with mental health issues without ever being taught how, overcoming pervasive racial inequality, facing the humiliation (and, sometimes, terror) of street harassment, suffering through targeted online hate campaigns, refusing to believe it when magazines tell them they must be thin, and so much more. We expect them to do all this without anger, because anger is “counterproductive.” So, of course, is mental illness.

We expect people to conform to an ideal that includes emotional strength, confidence, and resilience, and we refuse to concede that few people are able to live up to this ideal all of the time. How much do we expect a person to bravely, stoically handle? I’m not sure there is a limit.

The DJs assumed, whether consciously or not, that Saldanha would either see through the prank or be able to deal with the international attention she would receive for falling victim to it. As it turned out, she was not.

At The Daily Beast, Kent Sepkowitz writes:

With the recent focus on bullying sparked by suicides of young people who were hectored as outcasts, a new or newly articulated risk factor for suicide has gained currency: humiliation. Though certainly related to hopelessness and to real or threatened financial embarrassment, humiliation is its own very private experience, with its own equally private triggers. How and why certain events might brutally transgress honor and dignity in one person yet the same events barely touch the next, remains inscrutable. In this particular tragedy, it seems a sense that she was being publicly ridiculed—humiliated—somehow pushed Ms. Saldanha over the edge, an edge previously defined and maintained by her tremendous pride in her work.

Why do we expect people to deal with public humiliation for our own entertainment?

I would hope that rather than limiting the discussion to what these particular DJs should or should not have done, we expand it to talk about the exploitation and degradation that modern media thrives on. That these DJs would even think to go through such trouble to obtain someone’s private medical information is ridiculous. That there is a market for that information is ridiculous. I’ve long believed that celebrity gossip is unethical, but when it sets off a chain of events that ends in a suicide, that becomes even more apparent to me.

Not only is it impossible to blame any individual person in this awful story, but to do so would be to miss the point. Something in our culture–in the ways we relate to each other and in the ways we expect each other to be strong–is broken.

If I absolutely had to lay blame on something, it would be that.

Who Is To Blame For A Suicide?
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The Trivialization of Mental Illness

I’m reading a very interesting novel called The Four Fingers of Death. It’s somewhat science-fiction, with a distinctly Vonnegut-esque tone to it–very sarcastic and cynical. The story takes place in the 2020s, and the author, Rick Moody, gives several hints as to the general milieu of the future. Few people have cars as gas is very hard to come by, India and China are dominating the world, and paper books are mostly a thing of the past. One little detail that the narrator mentions several times–a detail that most readers would skim over, but that the author undoubtedly meant to make a point with–was the 8th version of the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Currently the DSM is in its fourth version–DSM-IV–but the DSM-V is in the works. However, in the world in which Four Fingers takes place, the DSM-VIII has medicalized all sorts of everyday issues, such as a disdain for hygiene (“aggravated hydrophobia with hygiene avoidance”), opening a game of chess in an unusual way, being rude to waitstaff, and speaking unusually (“conversational pseudo-uremia”). What completely got me, though, was when the narrator diagnosed a new friend with “mixed caffeine obsession with chronic caffeine dependence” when–get this–the friend suggested that they meet up at a coffee shop!

The author’s point, of course, is easy to see. It’s a satire of the supposed overdiagnosis of mental disorders even today, and of the presence of useless and non-clinical “disorders” in the DSM. As in, hahaha, at the way things are going, soon we’ll call not showering a mental disorder! To this point, the narrator of the story mentions that everyone has been diagnosed with a mental disorder these days. The way he talked about the DSM–“I flip through it looking for symptoms I have yet to contract”–makes this attitude even clearer. Through his satire, Moody implies that mental illnesses are not something to be taken seriously.

Forgive me for making a big deal out of a (probably insignificant) novel, but this mindset right here–that mental disorders are just some sort of farce invented by people yearning for attention for their minuscule problems–this is what’s responsible for one of the biggest threats to adequate mental healthcare in America. I’ll attack this mindset point-by-point.

First of all, contrary to popular opinion, “everyone” does not have a mental disorder these days. I’m sure you’ve heard someone comment, perhaps after hearing of another person’s diagnosis with a disorder, something to the effect of, “Oh, lord, everyone’s popping pills for something these days!” No. Everyone is not popping pills for something these days. Many people do, at some point in their lives, take medication for a mental issue. But most psychotropic medications are meant as temporary solutions while the person works on their problems in therapy or on his/her own. People aren’t meant to take them for their whole lives.

And even if every single person in this country does, at one point or another, take psychotropic medication, that doesn’t mean much on its own. Almost everyone takes drugs for colds or headaches at some point, but nobody seriously advocates against this. I use the word “seriously” carefully here–a radical diet book I came across recently, Skinny Bitch, claims that we should basically never take medication for anything. It says, “Yeah, getting cramps totally sucks. It’s supposed to. Every month you endure cramps (without medication), you are preparing for the physical pain of childbirth. So suck it up. Stop interfering with Mother Nature.” Pardon my coarseness, but I actually nearly crapped myself when I read this. What?!

Most of us are glad that with things like modern surgical techniques, dentistry, drugs, and diagnostic tools (like x-rays and blood tests), we now live happier, healthier lives. Before these things were developed, people had 40-year lifespans and got all kinds of gruesome illnesses. Similarly, back in the good ol’ days, people with mental disorders either spent their lives in misery, got committed to mental asylums, or simply offed themselves, depending on the nature of the disorder. If we can prevent that by having “everyone pop pills,” so be it–at least until we can find a better solution.

Second, the fact that some mental disorders may be overdiagnosed does not mean that every diagnosis is illegitimate. Some parents, for instance, push for their children to be prescribed medication for ADHD in order to help them get ahead in school, even if they do not actually have ADHD. It should be noted that there are standard screening procedures for this disorder that ensure that people are diagnosed correctly. If a parent gets their child to somehow cheat the screening tests, or if an unscrupulous doctor prescribes medication even though the child doesn’t fit the diagnostic criteria, well, guess what–these people are being unethical. That does not mean that ADHD isn’t a legitimate disorder that many people–adults included–legitimately suffer from.

Furthermore, although some people probably do “imagine” their disorders and seek treatment in order to get attention, I should point out that this can only be a minority. There is nothing at all pleasant or fulfilling about spending hundreds of dollars, taking medications that give you really crappy side effects, and telling a complete stranger about the most shameful aspects of your life. This is not fun. Anyone who invents a mental illness and seeks treatment for it as a way to entertain themselves is an idiot.

I should also point out that even though some people do falsify their problems and some psychiatrists do overprescribe, this is a general trend that you can’t really apply to individual people. Unless you are a psychiatrist, you are simply not qualified to judge whether or not a particular person’s problem is “real” enough to merit treatment. Everyone told me there was “nothing wrong” with me and that I should stop being a crybaby, until it got so bad that my daydreams changed from imagining that cute guy from class asking me out to imagining which method of suicide is most effective. Don’t be the person who trivializes someone else’s illness. Just don’t do it.

Third, Moody suffers from the mistaken assumption–shared by many people–that the trend in the field of mental health is for increasingly insignificant and non-clinical problems to be classified as mental disorders. With this view in mind, it’s easy to see how the author could come up with the hypothesis that in 20 years, a disinclination to take showers could be considered a clinical disorder.

However, if there’s any trend here at all, it’s in the opposite direction. For instance, premenstrual dysphoric disorder–more commonly known as PMS–was in the DSM until the revision of the DSM-III in 1987. Much earlier, in the 19th century, women who suddenly showed a strong desire to have sex were labeled with the diagnosis of “hysteria.” The cure? An orgasm. (This diagnosis was also a catch-all term for any medical complaint made by a woman. Obviously, it’s not longer considered a disorder.)

Finally, I’m pretty sure that nobody who has this author’s opinion of the DSM has actually looked at one. I’m no DSM expert, but I’ve looked through it a number of times, and I can tell you that very few of the disorders listed in it seem trivial to me. (There are disorders that shouldn’t be there, perhaps, but for different reasons. For instance, gender identity disorder, which refers to a very strong feeling that one has been born into the wrong sex, is probably in the DSM because psychologists have assumed that it leads to a lot of distress and problems for the person who has it. Before it was possible to change one’s biological sex, that was probably true. But today, it has become clear that if a person who’s “suffering from GID” is able to change their sex, things get better. The remaining problems are caused more by society’s lack of acceptance for trans* people than by their psychological makeup.)

However, Moody is echoing the prevailing cultural sentiment that mental disorders are nothing but insignificant little problems that people have in their daily lives. If this were true, popping pills to solve these problems would indeed seem pretty silly. However, it’s not true, and unfortunately for those of us who have to struggle to find adequate mental healthcare and to get friends and family to accept and understand that struggle, people like Moody are busy spreading this misconception around through various media–in this case, a satirical novel.

Contrary to what Moody seems to think, recognized mental disorders cause significant problems in daily living, relationships, and work. Some involve hallucinations or delusional beliefs. Some involve uncontrollable episodes of panic, which are said to feel somewhat like heart attacks. Some cause people to be unable to experience pleasure from anything they do (this is called anhedonia). Some cause people to become so preoccupied with cleanliness, order, and performing particular rituals that they are literally unable to go through the day without taking care of these things. Some keep people from getting a good night’s sleep–ever. Some cause people to try to throw up every bit of food they eat, or stop eating altogether. Some cause people to want to kill themselves.

Do you see anything trivial here? I don’t.

The Trivialization of Mental Illness