Welcome to Richard Ziegler's blog. I am an Ottawa writer and the author of
Reclaiming the Canadian Left and The Cults of Bosnia and Palestine. Information on those books is
available at my website (www.richardziegler.ca). This blog focuses on economic equality and human rights. I can be contacted via my website.

Contents
 

Economic Inequality and the Politics of Suicide Prevention - 29 August 2013
Mobilizing the Unemployed - 28 June 2013 

The Americanization of Canadian Politics - 11 December 2012

The Poverty of the Anti-Poverty Movement - 29 November 2012

Why Does Canada Still Have Food Banks? - 28 November 2012
The Inauthentic Concern Over Inequality - 28 November 2012

The Canadian Left Needs a New Party - 28 November 2012

The Myth of the 1 Percent - 28 November 2012
Canadian Leftwing Academics - Defenders of Economic Inequality? - 7 November 2012

Economic Inequality and the Politics of Suicide Prevention

                                                                   Posted 29 August 2013

Thus we hear that suicide is the most cowardly of acts, that only a madman would commit it, and similar insipidities; or the senseless assertion that suicide is ‘wrong’, though it is obvious there is nothing in the world a man has a more incontestable right to than his own life and person.¹  Arthur Schopenhauer

Suicide is a fundamental human right…Society does not have the moral right to interfere, by force, with a person’s decision to commit this act.²  Thomas Szasz

The prevailing approach towards suicide is that it is a health and social problem and that suicide prevention is laudable. This article states a dissenting position on suicide that is expressed less frequently, namely, that suicide is not a societal or health problem but is a human right and a solution to a problem, that suicide is usually a political act and that suicide prevention, when it involves the use of force, is social control.

Suicide, when it occurs without any concomitant killing of others, is usually considered a political act only in those relatively few cases in which those who kill themselves have expressed the political motive for their voluntary death - such as the IRA hunger strikers in Northern Ireland who starved themselves to death in prison in order to protest British rule in Northern Ireland, or the Buddhist monks in Tibet who immolated themselves in public to show their opposition to the government of China. However, these examples of political suicides are vastly exceeded by other suicides which are not normally regarded, but which deserve to be, as political suicides. There are three categories of suicide that are political.

First, there are those who take their lives not to convey outrage over the actions of their political rulers but to have an impact on other people with whom they are in close relationships. If political acts are broadly defined as all those that involve the use of power over other people, then those who kill themselves with the intention of altering the balance of power in the relationships between themselves and others are engaging in political acts.³ However, the characterization of these suicides as political is clearly discomforting for those whom the suicide intended to impact because the latter may feel that they were implicated in those deaths; hence, the proclivities of those who closely knew the suicide to disown any responsibility for the act, to stress their non-involvement by referring to themselves as aggrieved survivors of suicide, and to declare that the suicide was suffering from a purported mental disorder or illness. Suicide, even if it is done without an attempt to influence or modify the behavior of others, is nevertheless passing an unfavorable judgment on those who knew the suicide. As Jacques Peuchet noted, “And, if the act of suicide accuses someone, it is usually those remaining behind, because in this crowd there was not one person for whom it was worth staying alive.”⁴     

Second, there is a form of political suicide that is not directed against specific individuals but is rather a protest against society, and this variant of suicide is not relegated to political prisoners who refuse to eat or to monks who burn themselves to death in public. These suicides hold the state or society to be at least partially responsible for the unbearable situation that induces the suicides. This type of suicide is habitually carried out in private and the reasons for the suicide may be undeclared to the public or even to the suicide’s closest associates. The permanent withdrawal from society is also an indictment of it, and frequently a declaration that the individual’s disavowal of society was preceded by society’s abandonment of the individual.⁵ There is a lengthy Western tradition of suicide as an affirmation of one’s identity and dignity that society has trampled upon, and which is also an undermining of authority and institutions, a rejection of the established order and a deviation from the dominant norms and beliefs.⁶

There are many reasons that account for people taking their lives in order to protest the actions of the state or society, and the repudiation of the society that has rejected me is common in suicide caused by economic misery. It is well-known that chronic involuntary poverty or unemployment can reduce or destroy the will to live. There have been dramatic public suicides in the past several years that were motivated by poverty or unemployment.⁷ However, most people who kill themselves due to lack of money or employment refrain from doing so in public. These suicides, although performed in private are political, although they are rarely acknowledged as political acts of defiance.⁸ If all of those who committed suicide to liberate themselves from economic horrors were indeed engaging in acts of political protest, then why didn’t they all inform others that their acts were political statements and why didn’t they kill themselves in public to indicate the unambiguous political nature of their suicide? The answer is that they preferred methods of suicide (frequently asphyxiation, hanging or overdose of pills) that could not be performed in public without high risks of intervention, or they desired a less violent death than the methods of public suicide - shooting, setting oneself on fire or jumping off buildings - necessitate.  Moreover, those who leave life due to intolerable economic hardship may have been unable to specify who or what was responsible for their suffering and they may have been unaware that poverty and unemployment have political causes.   

Society often refuses to regard the suicide of those who were experiencing financial deprivation or any other ordeal as political acts because this acknowledgement would imply some degree of societal culpability. The three groups most opposed to suicide and the most supportive of suicide prevention - the medical profession (above all psychiatrists), politicians (notably those of the government) and religious leaders - typically refer to suicide, regardless of the cause, as a result of an illness and as a blight that the state has an obligation to prevent. The opposition of religious leaders, particularly those of the major monotheistic religions, to suicide is readily understandable, as the voluntary withdrawal from the world is hardly a complement to any alleged deity responsible for the world;  Arthur Schopenhauer observed that religions denounce suicide in order not to be denounced by it.⁹ The opposition of governments to suicide is easily explainable, since suicide is a brutal denunciation of society; consequently, government politicians are reluctant to acknowledge the political motives behind suicides and are eager to promote suicide prevention. However, it is the psychiatric perspective on suicide that holds sway in society, and the pronouncements of many religious leaders and politicians, as well as those of most journalists, on suicide are often replications of the psychiatric claims that suicide is, in the vast majority of cases, a product of a mental disorder or illness and that suicide is a public health problem.

The psychiatric depiction of suicide as indicative of a sickness depoliticizes, delegitimizes and medicalizes suicide,¹⁰ and transforms it into a health problem that the medical profession asserts is their duty and prerogative to combat. The medicalization of suicide occurred primarily in the 18^th and 19^th centuries.¹¹ The tendency of psychiatrists to consider suicide as almost invariably a result of an alleged mental disorder or illness,¹² a habit that Ian Marsh labeled the ”compulsory ontology of pathology,”¹³ removes individual volition from suicide, obscures or dismisses the underlying motivations behind it and conveniently absolves society and governments of any blame for the act. Despite the frequent claim by psychiatrists that psychiatric diagnoses are based on objective scientific criteria that are devoid of undue social or political biases, those diagnoses are intrinsically political.¹⁴ The medicalization of suicide has resulted in physicians regarding suicide not as an act of protest but as behavior committed by ill people who are hapless victims. The sociological explanations for suicide also tend to deprive suicides of agency by considering them as being subjected to overwhelming impersonal forces.¹⁵ The medical profession has transformed many other behaviors besides suicide into medical conditions.¹⁶

Medicine, including its psychiatric component, has been criticized as being an institution of social control.¹⁷ Suicide prevention is social control when it involves the use of coercion in an attempt to alter the emotions or behavior of those who are suicidal or who attempt suicide. Suicide prevention becomes social control when attempts to verbally dissuade people from suicide, efforts that are morally acceptable but of dubious efficacy, are superseded by the use of outright force - incarceration in a hospital or mental institution, involuntary drugging, electroshock or lobotomy (euphemistically called psychosurgery) and other methods.¹⁸ These involuntary measures are more aptly termed punishments or cruelties than treatments. It is extremely improbable that, of the physicians who have killed themselves, more than a handful voluntarily utilized the means to prevent suicide that they had the right to inflict upon others.

The designation of suicide as symptomatic of an illness obviates any need to rectify or even examine the economic conditions of those who willingly die, but it is the economic circumstances, not suicide, that is the problem; suicide is a solution to economic misery. Robert Burns rightfully praised death as the poor man’s friend.¹⁹ In Ontario, the maximum monthly payment to single persons who are receiving social assistance is slightly over $600. This pitiful amount, well below the poverty level, is designed to deliberately produce hardship and suffering, although not to the point where the recipients will want to kill themselves. Unsurprisingly, there are those on social assistance, who, tired of the daily humiliations, degradations, deprivations and frustrations of poverty, regard death as liberation and kill themselves. 

As poverty is caused primarily by wealth, and as poverty and unemployment result from society’s refusal to insist upon the requisite sharing of income and work, the characterization of suicide as indicative of a sickness is self-serving because it exonerates the wealthy, of which the medical profession is an element, from any role in the economic nightmares that provoke suicides.²⁰ The salaries of doctors are in stark contrast to the incomes of those who commit suicide due to economic wretchedness.²¹ Thus, there is the ironic, if not farcical, situation in which the physicians of a social class that contributes to the economic causes of suicide masquerade as being devoid of any complicity in the suicide of the poor and even state that they care about the poor and want to save the poor!²² However, as Lisa Lieberman noted, “What does it say about a society when its members choose , in ever-increasing numbers, to die? Is it not an indictment of the existing order and, if so, don’t those who benefit from the status quo deserve a share of the blame?”²³ Doctors have vested financial and political interests in the conceptualization of suicide as a medical problem rather than as a political one. Doctors, despite their professed concern for the poor, belong to a class of which the overwhelming majority desires only insubstantial social and economic changes.²⁴ Physicians seldom judge the economic system to be a cause of suicides, and they rarely propose radical economic and social changes to society in order to prevent suicides because those alterations, and the attainment of a much more egalitarian society, would result in a diminution of the doctors’ income, power and status.²⁵

There is a third type of suicide that is a political act. The values of those who are opposed to suicide and partial to its forcible prevention are underpinned by philosophical assumptions and considerations. There is, in the Western tradition, a longstanding religious and secular view that life is good, worth living, a gift for which people should be grateful and a duty to be preserved under almost all conceivable conditions because people have obligations towards others. However, there is another strain of Western thought which is often called philosophical pessimism, although its proponents have included not only philosophers but also dramatists, poets and novelists, that expresses a different and less sanguine attitude towards life. The philosophical pessimists share several or more of the following beliefs: it is better never to have been born; life is suffering; consciousness is vastly more of a burden than a gift; life is irrational, absurd, meaningless, cruel and futile; the human condition cannot be fundamentally changed by any melioration of society; happiness is an undesirable or even inauthentic response to the human condition.²⁶ Friedrich Nietzsche summarized this attitude: “Concerning life, the wisest men of all ages have judged alike: it is no good.”²⁷ The philosophical pessimists consider suicide a rational response to the human condition, and this outlook has been famously expressed by Albert Camus:

There is but one truly serious philosophical problem, and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy….Dying voluntarily implies that you have recognized, even instinctively, the ridiculous character of that habit [of living], the absence of any profound reason for living, the insane character of that daily agitation, and the uselessness of suffering.²⁸

Those hostile to philosophical pessimism commonly decry it as an elitist philosophy that inexorably leads, if not to suicide, then to resignation, defeatism and political detachment. This criticism is largely gratuitous because philosophical pessimism is not necessarily incompatible with political engagement or simply remaining alive.²⁹ Moreover, the majority of the philosophical pessimists did not kill themselves, and despite the pessimists’ bleak assessment of the human condition, the writers of pessimism have usually refrained from an overt recommendation of suicide; notable exceptions to this position include Hegesias, who did advocate suicide,³⁰ and Eduard von Hartmann and Philip Mainlander, who called for the collective suicide of humanity at some future date.³¹  

Philosophical pessimism, especially if it results in suicide, is a rebellion against the human condition often termed metaphysical revolt.³² This form of suicide may occur without any outstanding grievance against society, but may also be accompanied by intense hostility or hatred towards society, and it is often impossible to disentangle disgust with existence from disgust with society; some suicides are a rebellion against the perceived injustice of existence and an unjust society. Politicians, religious leaders and psychiatrists habitually loathe philosophical pessimism because it is a flagrant challenge and threat to their existential values. The notion that a person would commit suicide simply out of philosophical disdain for existence is difficult for many psychiatrists to accept or tolerate.³³ Psychiatrists are fearful that the acceptance of suicide based on philosophical reasons would encourage people to question the value of life. Psychiatrists occasionally try to discredit suicide due to philosophical reasons by attributing it to a mental impairment or at least to a defect in personality or character. It is highly improbable that many psychiatrists are familiar with the works of the pessimistic writers,³⁴ and their lack of knowledge about philosophical pessimism contributes to their predilection to conceive of suicide only as a medical or social problem. Psychiatry supports and enforces philosophical optimism, a doctrine that maintains that existence should be affirmed and that people should accept their situation in life because there is always hope, but philosophical pessimism is a repudiation of individual and collective hope.³⁵ The use of psychiatric coercion to prevent suicides resulting from metaphysical rebellion or even from a disenchantment, disillusionment or weariness with life, is also social control.

Psychiatry’s invalidation of suicidal feelings is only one example of the psychiatric regulation of emotion. Western psychiatry attaches great importance to the desirability of what it often refers to as the positive emotions, notably happiness. The philosophical pessimists’ criticism of, if not contempt for, happiness is an assault on a major premise of psychiatry.³⁶ Philosophical pessimists consider that people should have the right to be unhappy, sad, miserable, wretched or suicidal without any attempt by the mental health movement to utilize force in order to ensure emotional correctness.³⁷ The belief that the purported negative emotions should be minimized or banished often implies that they are destructive and that people are involuntarily subjected to those feelings, and this view differs from philosophical pessimism which considers those feelings as deliberately chosen.³⁸ The state’s desire to have its citizens, including those whose economic and social conditions are hideous, be happy is a transparent attempt to defuse any anger that could be directed against the state.³⁹

In consideration of the political nature of suicide, endeavors to prevent it should be limited to voluntary counseling and to addressing the underlying social and economic reasons that lead to suicide.  There are four reasons why the state should actually ensure that adults who want to die have access to the means to suicide.

First, society’s inability or unwillingness to provide all of its citizens with the minimal requirements for a dignified existence imposes an obligation on society, as a compensatory measure, to provide all adults with the means to depart from life. However, those who would choose suicide because of society’s neglect or indifference would be highly unlikely to request assistance from the state to help them die, and would demonstrate their independence and scorn for society by dying in the circumstances and by the means of their own choosing. 

Second, society encourages, or at least does not discourage, its citizens to reproduce. Yet birth exposes one to the human condition and all of its sufferings.  Suicide is a human right and efforts by the state to use force to prevent suicide are wrong because individuals find themselves, because of birth, in a situation in which they did not ask but from which they must be allowed to depart; to prevent suicide by force is to condemn people to a life sentence. Parents, unlike certain pessimistic philosophers, do not consider that by bringing life into the world they have committed an immoral act⁴⁰ for which they are required to atone by ensuring that their offspring have the means to suicide. Thus, the state must assume the responsibility for providing all adults who want to die with the means to kill themselves. Moreover, people should not have to justify to authorities or physicians their reasons for wanting to end their lives; this position is neither extreme nor novel, and Pieter Admiraal noted that there was a historical precedent for such a policy in ancient Greece:

Plato and Socrates regarded suffering as a result of painful disease to be a sufficient reason for stopping life through suicide. We all know that Socrates died by taking hemlock, not because of a painful illness, but for a noble reason, to uphold the very rule of law that had condemned him to death. Plato’s and Socrates’ views on the matter diverged from those of Aristotle, who argued that suicide was not courageous and was an offense against the state.  Pythagoras and Epicures also condemned suicide.  Yet in some city-states of Ancient Greece, suicide was approved.  Magistrates kept a supply of poison for anyone who wished to die.  Perhaps it was against this widespread acceptance that the Hippocratic physicians took an oath to “give no deadly drug,” as they were part of a reform movement of physicians influenced by Pythagorean ethics.⁴¹

The fear that unrestricted access to the means to suicide would be a subtle pressure on those who do not have a fatal illness but who are nevertheless suffering to take their lives needs to be balanced against the current situation in which those people are already often under pressure by their significant others to prolong their suffering.⁴² The removal of any obligation to justify one’s decision to die would contribute to the demedicalization of suicide because the involvement of the medical profession with suicide would be limited to that of being responsible for the provision of the lethal means.

Third, the access of all adults to state-assisted suicide would result in the democratization of the right to a painless suicide. The access to prescription medication that guarantees a speedy, certain and painless death remains restricted to health care professionals and to those who are fortunate enough to be able to procure such medication; everyone else, including the poor and those confined to institutions (sometimes even under surveillance) are constrained to utilize means that are painful or problematic (jumping, hanging, drowning, shooting, stabbing, non-prescription medication, refusing to eat and other methods) and which may result in failure and physical harm that would make future attempts impossible.⁴³ The unrestricted access to a pain-free death would end the current injustice whereby physicians have access to, and occasionally employ, the means to a non-violent death that many others do not possess. Thomas Szasz noted the hypocrisy of the medical profession’s desire to prevent suicides, “The fact that physicians commit suicide more frequently than do lay persons ought to unmask their claims about suicide prevention as self-serving propaganda.”⁴⁴ It is uncertain whether universal access to state-assisted suicide would increase the prevalence of suicide because simply knowing that a suitable way out always exists may postpone or even deter suicides.

Fourth, ensuring that all adults have access to a state-assisted death would not merely benefit those who want to die, but would be of potential value to everyone, including those who are vociferous opponents of an unrestricted right to die. The vicissitudes of life are such that nobody in love with life today can be assured of wanting to live tomorrow.⁴⁵

 

Notes

1.       Arthur Schopenhauer, ”On Suicide,” in Essays and Aphorisms (New York: Penguin, 1973), p. 77.

 2.       Thomas Szasz, The Untamed Tongue: A Dissenting Dictionary (LaSalle, IL: Open Court, 1990), pp. 250-51.

3.       David Lester states this idea and uses this definition of politics which was employed by R.D. Laing. See his article for an elaboration of the idea. David Lester, “Suicide as a Political Act,” Psychological Reports 66:3 (1990) : 1185-1186. <http://www.amsciepub.com/doi/pdf/10.2466/pr0.1990.66.3c.1185>

4.       Jacques Peuchet, in Marx on Suicide, eds. Eric A. Plout and Kevin Anderson (Evanston, Ill: Northwestern University Press, 1999), p. 50. Translated by Plout, Anderson and Gabrielle Edgecomb.

5.       Lisa Lieberman, Leaving You: the Cultural Meaning of Suicide (Chicago: Ivan R. Dee, 2003) p. xii. She refers (pp. 36-37) to this motivation as behind the suicide of Jean Amery but it is at the root of many suicides:  “The only way of taking back his [Jean Amery] dignity and regaining his power, of belonging once again to himself, was by deliberately turning his back on the society that had reduced him to a thing. But in abandoning the world he made the point that the world had first abandoned him.”

6.       See the first two chapters in Lieberman for the Western tradition of suicide as political revolt.  The political manifesto “Suicide, mode d’emploi” emphatically declares that suicide is a political protest. See Claude Buillon and Yves Le Bonniec, Suicide, mode d’emploi: Histoire, technique, actualité (A. Moreau : Paris, 1982).   

7.       For recent examples of public suicides, attempted or completed, due to economic suffering, see: Yaniv Kubovich, Ilan Lior, Jalila Nesher, “Israeli Man Sets Himself on Fire During Tel Aviv Social Protest.” Haaretz. 14 July 2012. <http://www.haaretz.com/news/national/israeli-man-sets-himself-on-fire-during-tel-aviv-social-protest-1.451041>; Nick Squires, “Greek Man Shoots Himself ‘Over Austerity Measures’.” The Telegraph. 4 July 2012. <http://www.telegraph.co.uk/news/worldnews/europe/greece/9185498/Greek-man-shoots-himself-over-austerity-measures.html>; Nigel Davies, “Spain Promises to Spare Needy from Eviction after Suicides.” Reuters. 12 November 2012. <http://www.reuters.com/article/2012/11/12/us-spain-evictions-idUSBRE8AB0GY20121112>; “Suicide by Self-Immolation a Rising Trend in France.” France 24. 15 February 2013.  <http://www.france24.com/en/20130214-france-suicide-immolation-welfare-economy>

8.       For an example of a non-public suicide due to poverty, see Sonia Poulton, “British People are Committing Suicide to Escape Poverty. Is this what the State Wants?” Mail Online. 20 March 2012. <http://www.dailymail.co.uk/debate/article-2117718/British-people-committing-suicide-escape-poverty-Is-State-wants.html>

9.       Arthur Schopenhauer, “On Suicide,” in Studies in Pessimism: A Series of Essays (London: Swan Sonnenschein & Co., 1893), p. 49.

10.   For the medicalization of suicide, see Thomas Szasz, “The Medicalization of Suicide.” The Freeman.  October 2010. <http://www.szasz.com/3medicalizationofsuicide.pdf.>;  Saxby Pridmore,  “Medicalisation of Suicide,” Malaysian Journal of Medical Science 18:4 (October- December 2011) : 78-83. <http://pubmedcentralcanada.ca/pmcc/articles/PMC3328934/>

11.   For the history of the medicalization of suicide, see Michael MacDonald, “The Medicalization of Suicide in England: Laymen, Physicians, and Cultural Change, 1500-1870,” The Milbank Quarterly.  Vol. 67, Supplement 1. Framing Disease: The Creation and Negotiation of Explanatory Schemes. 1989. Pp. 69-91. <http://www.jstor.org/stable/pdfplus/3350186.pdf?acceptTC=true>;  Rob Houtston, “The Medicalization of Suicide: Medicine and the Law in Scotland and England, Circa 1750-1850,” in Histories of Suicide: International Perspectives on Self-Destruction in the Modern World, eds. John C. Weaver, David Wright (University of Toronto Press, 2009), pp. 91-118.; Maria Teresa Brancaccio, Eric J. Engsrom, David Lederer, “The Politics of Suicide: Historical Perspectives on Suicide before Durkheim,” Journal of Social History 46:3 (March 2013) : 607-619; Ian Marsh, “The Uses of History in the Unmaking of Modern Suicide,” Journal of Social History  46:3 (March 2013) : 744-756. 

12.   The long-standing debate over whether what are called mental illnesses or disorders are actually biological conditions or simply psychological states is encapsulated in Jamie Doward, “Medicine’s Big New Battlefield: Does Mental Illness Really Exist?” The Observer. 12 May 2013. <http://www.theguardian.com/society/2013/may/12/medicine-dsm5-row-does-mental-illness-exist>; Sharon Jayson, “Books Blast New Version of Psychiatry’s Bible, the DSM.” USA Today. 12 May 2013. <http://www.usatoday.com/story/news/nation/2013/05/12/dsm-psychiatry-mental-disorders/2150819/> There are still no biological markers that would clearly indicate that what are labeled mental illnesses or disorders are actually bodily illnesses.  For a critical examination of the DSM, see Gary Greenberg, The Book of Woe: The DSM and the Unmaking of Psychiatry (Blue Rider Press, 2013). For books that challenge the psychiatric premise that what is commonly called depression (which psychiatrists claim is a disorder from which most suicides originate) is an illness or condition that necessarily requires intervention, see  Irving Kirsch, The Emperor’s New Drugs: Exploding the Anti-Depressant Myth (Basic Books, 2010); Gary Greenberg, Manufacturing Depression: The Secret History of a Modern Disease (Tantor Media, 2010); Paul Keedwell, How Sadness Survived: the Evolutionary Basis of Depression (Oxford: Radcliffe Publishing, 2008); De-Medicalizing Misery: Psychiatry, Psychology and the Human Condition, eds. Mark Rapley, Joanna Moncrieff, Jacqui Dillon (Houndmills, Baringstoke: Palgrave Macmillan, 2011).

13.   See Marsh who employs this expression.

14.   See Joanna Moncrieff, “Psychiatric Diagnosis as a Political Device,” Social Theory and Health 8 (2010) : 370-382. <http://www.palgrave-journals.com/sth/journal/v8/n4/abs/sth200911a.html>

15.   Lieberman, p.7.

16.   For the medicalization of conditions and behaviors, see: P. Chodoff, “The Medicalization of the Human Condition,” Psychiatric Services 53:5 (May 2002) : 627-8.; Ben Goldacre, “The Medicalisation of Everyday Life.” The Guardian. 1 September 2008.  <http://www.guardian.co.uk/business/2008/sep/01/pharmaceuticals.drugs>; Peter Conrad, The Medicalization of Society: On the Transformation of Human Conditions into Treatable Disorders (Baltimore: The John Hopkins University Press, 2007).

17.   For psychiatry as social control, see Andrew Scull, “Psychiatry and Social Control in the 19^th and 20^th Centuries,” History of Psychiatry 2 (1991) : 149-169.  <http://hpy.sagepub.com/content/2/6/149.full.pdf+html> For critiques of medicine as social control, see Irving K. Zola, “Medicine as an Instrument of Social Control,” The Sociological Review 20:4 (1972): 487-504.; Peter Conrad, “Medicalization and Social Control,” Annual Review of Sociology 18 (1992) : 209-232. <http://www.annualreviews.org/doi/pdf/10.1146/annurev.so.18.080192.001233>

18.   The demarcation between acceptable and immoral means in suicide prevention is not clear-cut. Michael Cholbi, for instance, characterizes methods such as an increased training for physicians to detect suicidal thinking and the creation of suicide hotlines as benign and morally permissible ways to prevent suicide. He contrasts these methods with what he terms “morally problematic” means such as incarceration or the obligatory use of medication. However, the methods that he judges as harmless could be, and sometimes are, devices to identify suicidal people who are then subjected to state or medical coercion. See Michael Cholbi, Suicide: The Philosophical Dimensions (Peterborough, Ont.: Broadview Press, 2011), pp. 116-117. For a critique of suicide prevention, particularly when it involves psychiatric coercion, see Thomas Szasz, Fatal Freedom: The Ethics and Politics of Suicide (Praeger Publishers: Westport, CT, 1999), pp. 45-62. For criticism of some of the common assumptions of the suicide prevention industry, see Stephen Killeary, “Submission to Suicide Inquiry: Social Stress and Male Suicide.” 9 November 2008. <http_aphref.aph.gov.au_sentate_committee_clac-ctte_completed_inquiries_2008-10_suicide_submission_sub113.pdf>  Martin Innes provides a useful definition of social control: “the purposive mechanisms used to regulate the conduct of people who are seen as deviant, criminal, worrying or troublesome in some way by others.” Marin Innes, Understanding Social Control: Deviance, Crime and Social Order (Maidenhead, Berkshire: Open University Press, 2003), p. 3.
 
19.   Robert Burns, “Man Was Made to Mourn. A Dirge,” in Poems of Robert Burns (London: Penguin Classics, 2008), p. 30.

O Death! The poor man’s dearest friend,
The kindest and the best!
Welcome the hour, my aged limbs
Are laid with thee at rest!
The great, the wealthy fear thy blow,
From pomp and pleasure torn
But Oh! a blest relief for those
That weary-laden mourn! 

20.   See the earlier entries in this blog that discuss the causes of poverty and unemployment: “The Poverty of the Anti-Poverty Movement” of 29 November 2012, and “Mobilize the Unemployed by Demanding the Sharing of Work and Income” of 28 June 2013. Peuchet’s observation (pp. 68-69 in Marx on Suicide) that legally enshrined economic rights will not prevent suicides unless those rights are implemented is as relevant now as when his work on suicide was published posthumously in 1838: “It is easy to proclaim constitutions on parchment guaranteeing every citizen’s right to education, to work, and above all, to a minimum subsistence-level existence. But it is not enough to put these magnanimous wishes on paper; there remain the essential task of bringing these liberal ideas to fruition through material and intelligent institutions.”

21.   For the incomes of Canadian doctors, including psychiatrists, see André Picard, “How Much are Canadian Doctors Paid?” The Globe and Mail. 23 January 2013. <http://www.theglobeandmail.com/life/health-and-fitness/health/how-much-are-canadian-doctors-paid/article7750697/>

22.   The class to which physicians belong is not solely responsible for the existence and perpetuation of poverty and unemployment. See the two entries in note 20, and other ones, for the deleterious role the middle class also plays.

23.   Lieberman, p. x.

24.    The Canadian Medical Association appears to have belatedly realized that poverty is one of the social determinants to health. See André Picard, “Bold Calgary Plan Aims to Cut Poverty in Half.” The Globe and Mail. 30 May 2013. <http://www.theglobeandmail.com/news/national/bold-calgary-plan-aims-to-cut-poverty-in-half/article12282219/> For the social determinants of health, see Juha Mikkonen and Dennis Raphael, Social Determinants of Health: The Canadian Facts (Toronto: York University School of Health Policy and Management, 2010). <http://www.thecanadianfacts.org/The_Canadian_Facts.pdf>

25.   For articles that blame the economic system for suicides, see Paul Street, “Anti-Capitalism as Suicide Prevention.” Zspace. 23 March 2009. <http://www.zcommunications.org/anti-capitalism-as-suicide-prevention-personal-worth-against-exchange-value-and-corporate-thought-control-by-paul-street>; Les Leopold, “Is Cutthroat Capitalism Pushing a Growing Number of Baby Boomers to Suicide?” AlterNet. 10 May 2013. <http://www.alternet.org/hard-times-usa/cutthroat-capitalism-pushing-growing-number-baby-boomers-suicide>

26.   For books that provide good overviews of the pessimistic view of life, see:  Radoslav Andrea Tsanoff, The Nature of Evil (New York: Macmillan, 1931); J. F. Dienstag, Pessimism: Philosophy, Ethic, Spirit (Princeton University Press, 2006). For works of three pessimistic philosophers, see Arthur Schopenhauer, The World as Will and Representation (New York: Pearson Longman, 2008); E.M. Cioran, The Trouble with Being Born (Paris: Gallimard, 1973); Eduard von Hartmann, Philosophy of the Unconscious; Speculative Results According to the Inductive Method of Physical Science (Westport, Conn; Greenwood Press, 1972). 

27.   Friedrich Nietzsche, Twilight of the Idols, in The Portable Nietzsche (New York: Penguin, 1982), edited and translated by Walter Kaufmann, p. 473. Sophocles stated “Not to be born is the first choice, the prize beyond any other. But once he has seen the light, the next best is to go back to that dark place from which he came as soon as possible.” Sophocles, “Oedipus at Colonus” in The Theban Plays (Baltimore: The John Hopkins University Press, 2009), p. 117. Translated by Ruth Fainlight and Robert J. Littman.

28.   Albert Camus, The Myth of Sisyphus and Other Essays (New York: Knopf, 1975), pp. 3, 5, 6. Translated from the French by Justin O’Brien.
 
29.   Dienstag makes this point and notes the political engagement of Albert Camus as an example. His book is a welcome correction in countering a common misunderstanding about philosophical pessimism. See Dienstag for the position of Camus, Cioran and Miguel de Unamuno on suicide. Another political activist who was a philosophical pessimist was the famous American lawyer Clarence Darrow. For his philosophy of life, see Clarence Darrow, “Pessimism: A Lecture by Clarence Darrow.” Rationalist Education Society. 11 January 1920. <http://darrow.law.umn.edu/documents/Pessimisim.pdf> 
 
30.   See Wallace I. Matson, “Hegesias: The Death Persuader; or, the Gloominess of Hedonism,” Philosophy 7 3:4 (October 1998) : 553-557.

31.   For an analysis of Philip Mainlander’s book The Philosophy of Redemption, see Tsanoff. Emile Cioran’s The Trouble with Being Born contains passages that counsel suicide while others advise against suicide.

32.   This term is associated with Albert Camus. See Albert Camus, The Rebel: an Essay on Man in Revolt (New York: Vintage Books, 1956).

33.   The longing for death prompted by merely being alive was expressed in A. E. Housman, The Collected Poems of A.E. Housman (Jonathan Cape: London, 1966), p. 151.

Some can gaze and not be sick,
But I could never learn the trick.
There’s this to say for blood and breath,
They give a man a taste for death.

 34.   Many psychiatrists have undoubtedly read some of the works of Albert Camus. They may also possess minimal awareness about Arthur Schopenhauer and Eduard von Hartmann since these writers influenced Sigmund Freud, but are unlikely to have ever read the books of those philosophers. The psychiatrists who incorporate philosophies such as stoicism or existentialism into their practices would probably have had a greater exposure to philosophical pessimism.   

 
35.   The rejection of individual and collective hope was powerfully expressed by Eduard von Hartmann:

Were there no hope in the world, despair would be the order of the day, and notwithstanding the instinct of self-preservation and the fear of death, we should have to record innumerable suicides. Thus hope is the necessary auxiliary instinct of the self-preserving impulse; it is that which alone renders possible for us poor fools the love of life in defiance of our understanding….its [hope’s] function is just to dupe us, i.e., to make fools of us, in order only that we may endure to perform our yet uncomprehended task….It is not , however, the golden age that lies before us, but the iron; and the dreams of the golden age of the future prove still more empty than those of the past. As the burden becomes heavier to the bearer the longer the road on which he carries it, so will also the suffering of mankind and the consciousness of its misery increase and increase until it is insupportable….The illusions are dead, hope is extinct; for what is there still to hope? The dead-tired humanity drags along its frail earthly body wearily from day to day. The highest attainable were ineed painlessness, for where is positive happiness still to be sought? In the vain self-sufficiency of the knowledge that all is vanity, or that in the contest with those vain impulses reason now usually remains victor? Oh, no; such vainest of all vanities, such arrogance of the intellect has long been surmounted!

Philosophy of the Unconscious. Chapter 3 - Metaphysic of the Unconscious Continued X111 - The Irrationality of Volition and the Misery of Existence, pp. 71-72, 116-117.

Although most other pessimistic philosophers have not gone to this extreme in their consideration of hope, they share a belief that humanity must relinquish its false hopes. See Dienstag for the pessimists’ treatment of hope.  

36.   Books that assume the desirability of happiness vastly outnumber those that question whether happiness is even a worthy goal. For the story of how the West became obsessed with happiness, see Darrin M. McMahon, The Pursuit of Happiness: A History from the Greeks to the Present (London: Allan Lane, 2006). For a critique of happiness, see Eric G. Wilson, Against Happiness: In Praise of Melancholy (Farrar, Strauss and Giroux, 2008).

37.   See, for instance, Lesley Hazelton, The Right to Feel Bad (Ballantine Books, 1985).

38.   For a book that discusses the benefits of what are normally labelled negative emotions, see Miriam Greenspan, Healing Through the Dark Emotions: the Wisdom of Grief, Fear and Despair (Boston: Shambhala, 2004).

 
39.   See Brendan O’Neill, “Like the Rebel in Brave New World, I am Standing Up for ‘the Right to be Unhappy’.” The Telegraph. 13 April 2011. http://blogs.telegraph.co.uk/news/brendanoneill2/100083597/like-the-rebel-in-brave-new-world-i-am-standing-up-for-the-right-to-be-unhappy

40.   Arthur Schopenhauer, Emile Cioran, Philip Mainlander and David Benatar, author of Better Never to Have Been: the Harm of Coming into Existence (Oxford University Press, 2006), are among the philosophical pessimists who have argued that human reproduction is a moral wrong. 

 
41.  Pieter Aadmiraal, “Euthanasia and Assisted Suicide,” in Birth to Death: Science and Bioethics (New York: Cambridge University Press, 1996), eds. D.C. Tomasma, T. Kushner, p. 210. A proponent of the right to state-assisted suicide on demand is Ludwig Minelli, the head of the Swiss organization Dignitas. See Steve Doughty, “Suicide on Demand for the Healthy; it’s a Marvelous Possibility for All.” Daily Mail. 3 April 2009 <http://www.dailymail.co.uk/news/article-1166620/Suicide-demand-healthy-Its-marvellous-possibility-says-Dignitas-boss.html>

42.   In the debate concerning the consequences of an extension of the right to assisted-suicide, Margaret Battin notes that the members of vulnerable groups are already under pressure to go on living. See Robin Marantz Henig, “The Right to Die vs. a Will to Live.” The New York Times Magazine. 22 July 2013. <http://www.nytimes.com/2013/07/21/magazine/a-life-or-death-situation.html?pagewanted=1&hp&_r=4&pagewanted=all&>

 
43.   For a lengthy list of gruesome and painful methods that people have employed in order to kill themselves, see Karl A. Menninger, Man Against Himself (New York: Harcourt, Brace & World, 1938), p. 61. Petra de Jong, head of the Dutch organization Right to Die – NL, notes the inability of some people to kill themselves, and the violent nature of some suicides, as reasons to establish a clinic for those who want death. See Anja Krabben, “Petra de Jong Believes in Clinic for Termination of One’s Life.” Relevant. February 2011. <http://www.nvve.nl/nvve-english/pagina.asp?pagkey=146455&metkey=449>
 
44.    Szasz, Fatal Freedom, p. 62.

45.   The possibility that one will kill oneself in the future as a reason for refraining from interfering in the suicides of others was expressed in the celebrated poem by James Thomson. James Thomson, City of Dreadful Night (Edinburgh: Canongate Classic, 1993), p. 65. First published in Great Britain in 1880 by Reeves & Turner & Dobell. 

The mighty river flowing dark and deep

With ebb and flood from the remote sea-tides
Vague-sounding through the City’s sleepless sleep,
Is named the River of the Suicides;
For night by night some lorn wretch overweary,
And shuddering from the future yet more dreary,
Within its cold secure oblivion hides.

One plunges from a bridge’s parapet,

As by some blind and sudden frenzy hurled’
Another wades in slow with purpose set
Until the waters are above him furled’
Another in a boat with dreamlike motion
Glides drifting down into the desert ocean,
To starve or sink from out the desert world. 

They perish from their suffering surely thus,

For none beholding them attempts to save,
The while each thinks how soon, solicitous,
He may seek refuge in the self-same wave;
Some hour when tired of ever-vain endurance
Impatience will forerun the sweet assurance
Of perfect peace eventual in the grave.