Suicide Prohibition: The Shame of Medicine

6. Envoi

104 6 Envoi In “The Myth of Sisyphus” (1942), Albert Camus famously declares, “There is but one truly serious philosophical problem, and that is suicide.”1 Seventy years later, everyone knows that suicide is a psychiatric emergency, not a philosophical problem. Ostensibly, contemporary discourse about suicide concerns understanding the individual who says he intends to kill himself or, perhaps more often, the individual to whom such intention is attributed by others. In fact, its true subject is the imperiled professional identity of the psychiatrist as bona fide physician, contingent on his presumed medical competence and legal duty to “save lives,” especially the lives of persons who do not want to live. Understanding a person and coercing him are mutually antagonistic and incompatible functions and roles, and we all know it. I have long objected to the social expectation that the psychiatrist be both consensual healer of souls and coercive controller of misbehaving persons and to the psychiatrist’s willingness to play both roles. The moral dilemma of double agency is built into psychiatry and will not go away. Honest psychiatrists cannot help but confront it. Hapless patients are doomed to be injured by it. That medicalization forms an integral part of the modern zeitgeist is obvious. Some fifty years ago I coined the term therapeutic state and suggested that coercive psychiatric suicide prevention is Envoi • 105 one of its defining emblems. Opposing this revered ritual may be a thankless task, but is a worthy goal. “The time is out of joint—O cursed spite, / That ever I was born to set it right!” soliloquizes Hamlet (1.5.188–90). For the lover of liberty and responsibility, the time always seems out of joint. The individual who assumes the task of setting such dislocations aright runs the risk of being destroyed in the process. I bless my stars for protecting me from that fate, and thank my family, friends, and colleagues for helping me protect myself from it. Appendix Notes Bibliography Index ...