It is not uncommon today to hear someone express the idea that everyone has a right to suicide. Sometimes the speaker is thinking primarily of the terrible pain and decrepitude of fatal illnesses. As I noted in my introduction, for someone in agony because of a fatal disease, it may be inappropriate to think of self-administered death as suicide; rather we might think of it as the way that person has chosen to manage the death that cancer, for instance, had made inevitable. That is not what this book has been about. This is an important difference to keep in mind, because fierce antagonism exists between those who would allow suicide in extreme illness and those who hold a belief—generally based in religion—that no tampering with life is permissible. The extreme position of those who would prohibit all suicide sometimes has the effect of pushing those on the more tolerant side of the argument to a broader stance, perhaps inspiring them to defend suicide for people who are healthy but sad, or fed up with life. At the very least we need to notice that these are two different issues that deserve to be adjudicated separately, each on its own terms.
Some people argue for a right to suicide because having the option to end their lives gives them some solace. Nietzsche wrote that the thought of suicide got him through many a bad night. Sometimes when a person is feeling very bad and perhaps very scared, it can be a comfort to know that if she ever comes to a place where the pain is too much, she would have an out. I have no wish to deprive anyone of consolation, especially since most people whom the option would comfort are unlikely ever to follow through with the act. If a person is faced with a terrible fear—of losing a child, say, or of being brutalized in a particular way—that person might take solace from thinking, “I can dismiss worrying over this unlikely suffering because should it come to pass, I will end my life.” Maybe such thoughts are harmless, but maybe they are not. Would it not be better, and more useful, for that fearful person to comfort herself by remembering that the intelligence and strength that got her through past trials are apt to get her through further trials as well? It is crucial to see that deciding against the principle of suicide creates its own practical strengths: it commits one to the human project and to one’s own life in a way that gives rise to solidarity and resilience. And when one speaks of such commitment to living, others may be encouraged to live and to find the resources to survive pain.
Of course, there are times when a person suffers from despair so intensely and for so long that it can seem merciful to let him or her end life. Perhaps there is a level of constant emotional anguish that is more reasonably considered alongside painful fatal illness in regard to the appropriateness of suicide. There are many things that we say are wrong that yet have some exceptions. I think it is right to say, along with many incisive thinkers throughout history, that suicide is wrong. I believe the vast majority of people who think about suicide are tortured by their suicidal thoughts and wish to be rid of them. It can be a tremendous comfort to learn that great minds have concluded that no individual need wonder whether his or her life is worth living. It is worth living.
Three modern philosophers have some useful thoughts on this subject, and though each has been seen as having written in support of suicide, their approaches are more nuanced than is often suggested.
The first, Romanian-born French philosopher Emile M. Cioran (1911–95), is important because of his thoughts on vacillating between the desire to kill oneself and the desire to live. Cioran wrote, in The New Gods, “The obsession with suicide is characteristic of the man who can neither live nor die, and whose attention never swerves from this double impossibility.”1 Cioran’s use of the word “obsession” helps provide a strong vision of the person whose “attention never swerves” both from imagining death and from rejecting it. Zilla Gabrielle Cahn has written of Cioran that “throughout his work one finds this refrain: I cannot live, I cannot die.”2 Cioran speaks of this vacillation as intensely painful in itself and sympathizes with others in his situation. Camus joked that most of us are in this situation, writing that “just as one does or does not kill oneself, it seems that there are but two philosophical solutions, either yes or no. That would be too easy. But allowance must be made for those who, without concluding, continue questioning. Here I am only slightly indulging in irony: this is the majority.”3 Like Camus, Cioran seems almost morbid in his willingness to speak about death and suicide so openly, but it is essential to note the philosophical distinction between accepting suicide and accepting thinking about it. Living can be too hard, and we can find ways to refuse to do it, at least in the ways that we were taught it had to be done. But though we may refuse a version of life, we must also refuse voluntary death. Cioran is much more interested in suicide than popular culture’s purveyors of life-affirming sentiments, but he does not actually advocate suicide.
The modern philosopher who most clearly does countenance suicide is the French savant Michel Foucault. Foucault defends the right to suicide and even seems to celebrate it. To him it seems a grand act of self-determination. He considers modern suicide to be somewhat less grand than the “moral and political form of behavior” Montesquieu cited for the “Roman suicide,” but he does not idealize the ancient suicides. Rather, he seemed to exalt in a kind of suicide precisely not in the service of the family or the state.4 Foucault attempted suicide as a young man in 1948 and several times afterward. His school doctor attributed the early attempt to homosexual guilt, but it was probably a more complicated suffering.5 Throughout his career Foucault shocked people with his sympathy for suicide. In a short essay of 1979, “The Simplest of Pleasures,” Foucault wrote that he was not attempting to legalize suicide or make it moral, saying that “too many people have already belabored these lofty things.”6 His intention, he explained, was instead to contradict the humiliations and shady doings that the detractors of suicide have associated with it. He advocated a world that was amenable to the potential suicide and allowed him to take his time, openly choosing his method and moment. Foucault spent his life decrying the suppression of social deviancy that he felt characterized medicine, psychiatry, and law. He fought for the freedom of a host of behaviors that are policed in modern society, and within that context it makes sense to see his championing of suicide. I find much of Foucault’s writing very persuasive, but I question his conclusion on this particular subject. It is one thing to try to free the human being from social constraints and to defend difference of all types; it is another thing to help usher people into the grave.
Finally we must consider the psychiatrist and philosopher Thomas Szasz (1920–2012). Szasz famously argued that there is no connection between mental illness and suicide, and that no mental health professional ought to consider it her natural duty to step in to prevent suicide. Szasz argued that people should be able to choose when to die at any time, with no intrusion by medicine or the state, just as with contraception they are able to choose when to conceive without medical or state interference. He cites suicide as one of the most fundamental rights. In 1963 Szasz coined the phrase “therapeutic state.” The therapeutic state responds to unwelcome activities, opinions, and feelings by repressing them—or, as representatives of the viewpoint would put it, curing them—through an alliance between psychiatry and government. Thus suicide is considered to be a sickness that needs to be treated, along with unusual religious beliefs, unhappiness, anxiety, shyness, sexual promiscuity, overeating, gambling, smoking, and illegal drug use. Szasz disagrees sharply with this control and considers all these behaviors choices made by sane people who should not be interfered with. These are dramatic claims against the backdrop of our state laws and social rules, and these dramatic claims are what people think of when they consider the work of Szasz. It is crucial to note, however, that Szasz believed that anyone who did not want to die should by all means avail himself of whatever help he could find in keeping himself from committing suicide. Szasz wrote, “Let me state that I consider counseling, persuasion, psychotherapy, and other voluntary measures, especially for persons troubled by their own suicidal inclinations and seeking help, unobjectionable and indeed generally desirable interventions.”7
Szasz’s opposition is to coercive measures that would prohibit a person from committing suicide, even after the onset of a horrible disease. Szasz points out that no doctor would institutionalize a patient for not taking his medicine or otherwise not acting in his own best interest, even to the point of death, but suicide attempts routinely result in such action. His ideas got a considerable hearing, and he has influenced modern thinking on the subject. His theories have also inspired a robust counterargument. In defense of intervention, his opponents have argued that the urge to suicide is often relatively brief in duration, that it presents itself within the fluctuations of depression, and that it is often deeply ambivalent.8
Here we are not primarily concerned with the amount of control doctors legally have over people who say they intend to kill themselves. Rather, we are looking at those through history who have counseled people against suicide, and we are doing so with the particular aim of nudging secular philosophy toward a robust rejection of suicide, and of nudging individuals too. As we have seen, one can advocate all sorts of liberties for humanity and still try to convince people to draw the line at self-murder.
Some might argue that counseling others against suicide is not our business, as private citizens, that antisuicide advocacy might better be left to mental health professionals. But a recent study showed that worldwide relatively few suicidal respondents had received treatment, from 17 percent in low-income countries to 56 percent in high-income countries.9The researchers’ conclusion was that “most people with suicide ideation, plans and attempts receive no treatment.”10 The dominant reason given by respondents was low perceived need. So one reason we need a more pervasive cultural argument against suicide is that many people do not have therapists or others in a professional capacity looking after them. Health care professionals are not the only ones whose responsibility it is to protect individuals from self-harm. A social and philosophical argument has the potential to take up different space in the culture and act, on its own, as a gatekeeper. Ideas have force and can dramatically reshape behavior and societal norms.
Consider the anguish and turmoil of the person considering suicide. Consider the terrible aftermath of a completed suicide. Consider the tremendous numbers of people that death affects. We as a society do very little to save the lives of people suffering and contemplating suicide. Isn’t it time for us to try a little harder to save these lives? To save our own lives?