Suicide is Painless

This essay was written with Nina Power. It was originally published in the August-September 2023 issue of The Critic under the title In a world without God, what does suicide mean?

If life becomes unliveable, who would you turn to? A friend? A doctor? A priest? Today we no longer imagine ourselves God’s creation, with all the concomitant demands to look after ourselves that might entail. On the contrary, we belong only to ourselves, and can dispense with ourselves as we see fit. No more bonds, duties, or higher values. No more worrying about eternal damnation, but no reason to be grateful for the gift of life either: when pain outweighs pleasure, why not simply disappear?

We live in the era, not only of the fully administered life, as Max Horkheimer put it, but of the total bureaucratising of death. In this vision of the world, suicide becomes simply one more thing to check off the list.

In his 1974 critique of modern medicine Medical Nemesis, Ivan Illich declares that “In every society the dominant image of death determines the prevalent concept of health.” What today does death resemble? A lonely pill.

If we might still idly dream of a gentle death in bed, at home, surrounded by loved ones after a life well-lived, today the reality of death contains an unbearable coldness: unfamiliar surroundings, an over-worked nurse, the thin light fading into indifference while a machine slides from beep to flat tone. 

A culture that promises a frictionless “solution” for all ills in the form of a pill regime or a lifestyle to emulate, but little in the way of any collective rituals for coming to terms with human suffering, turns every individual into a self-administrator involuntarily contracted out by the state. We have lost the recognition, and have forgotten to tell our children, that to live is to suffer, and that suffering, like life itself, unfurls its own peculiar truths.

In this world, suicide might appear as an adamant, if self-defeating, final assertion of autonomy. As Al Alvarez in his great 1971 study of suicide, The Savage God, puts it:

For suicide is, after all, the result of a choice. However impulsive the action and confused the motives, at the moment when a man finally decides to take his own life he achieves a certain temporary clarity. Suicide may be a declaration of bankruptcy which passes judgement on a life as one long history of failures. But it is a history which also amounts at least to this one decision which, by its very finality, is not wholly a failure. Some kind of minimal freedom — the freedom to die in one’s own way and in one’s own time — has been salvaged from the wreck of all those unwanted necessities.

While it is still possible to die by one’s own hand, with all the grief, anger, horror and futility this causes for those left behind, suicide too has now become just like everything else. There’s an app for that.

Today, three per cent of Canadian deaths are by assisted suicide. On paper, the protocol and conditions appear robust and reasonable, stipulating that MAID (Medical Assistance in Dying) is only offered to individuals suffering from a “grievous and irremediable medical condition” who “experience unbearable physical or mental suffering”.

But in a society where death itself is a lifestyle option, “unbearable mental suffering” becomes a very broad and very dangerous category indeed, because among the many reasons why people feel sad are poverty, loneliness or the feeling of being useless, all factors that can be ameliorated from the outside. In Canada, medical practitioners are permitted to suggest euthanasia to patients even when they had already refused such offers. The suggestion that one is nevertheless better off dead, especially repeated by someone in authority, might start to sound like the least bad option.

State-assisted suicide is, among other things, a class issue. It’s also a memetic issue. Suicide is contagious, if complicatedly so. The Werther Effect, named after Goethe’s anti-hero whose fictional suicide is said to have prompted a wave of poetic self-annihilation among European youth of the late eighteenth century, may not be provable, quite, but there are plenty of non-fiction examples to sadly share.

In 2007-8, Bridgend in Wales saw 26 suicides of people aged 13-17, with many parents blaming media glamorisation. The Samaritans claim that the suicide of the American actor Robin Williams contributed to a nine per cent spike in self-inflicted death in the US in following months. They urge reporting on suicide to avoid any mention of method, to avoid glamorisation, and to promote the idea that suicide is preventable and that help is always available.

But in many ways, we are long past the romantic idea of death. What frightens most, instead, is the fear that there is nothing outside of the state. MAID, where death is a product, brings to mind the final scene of 1973’s Soylent Green, set in 2022, where Malthus’s worst nightmares have come true, and rampant overpopulation has generated a secret state-run ouroboric food chain in which people can only eat processed others to survive.

Edward G. Robinson plays the elderly Sol, who was in real life dying of bladder cancer. Finally deciding to rest forever, he attends a large, bright hygienic “Thanatorium”. Lying down, having drunk a fatal last solution, as music by Tchaikovsky and Beethoven flood the room he is treated to footage of an extinct world — deer, flowers, sunset — cinema being the only way any of these things have been preserved. 

While liberal states promise, if not to take care of you, then to end the need for you to care altogether, elsewhere serious and troubling questions regarding risk and responsibility are raised.

In 2018, the 20-year old Bristol University student, Natasha Abrahart, took her life following a mental health crisis prompted by the prospect of a public assessment in her physics course. Natasha suffered from severe anxiety and struggled in the months before her death. She was receiving limited specialist NHS mental health care and the university’s student support teams had her enrolled in schemes that would, in principle, help her navigate the challenges of university life. Tragically, these safeguards failed.

At three deaths per 100,000 students, suicides among undergraduates are rare in comparison to the general population of the same age. But each death leaves family and friends with painful questions. And because universities are a strange middle ground between the childhood home and independent life, Abrahart’s parents wanted to find out what the University of Bristol, which was host to 10 other suicides in only two years, could have done differently.

A trial in 2022 confirmed that the university had no general duty of care towards students that would, for example, involve monitoring their private lives off campus. But the judgement decided that Bristol failed Abrahart by not making reasonable adjustments to accommodate her severe anxiety which, in the court’s view, amounted to a disability under the Equality Act.

Yet, there is no straightforward protocol by which a student with a mental health condition would be so classified by a university, or even the NHS. Abrahart didn’t self-identify as “at risk” and it’s hard to know who among her peers, family, or tutors could have known just how much distress she was in. The court, however, erred on the side of caution and decided that the university should have picked up on the signs and offered Natasha adequate support, thus preventing her death.

The University of Bristol is appealing the judgement to clarify how an institution may be expected to comply with such an obligation in the future. A group of bereaved families, meanwhile, is urging a change to the law that would see universities formally charged with the duty of care for students. Their proposals were debated in Parliament in June after a public petition gathered nearly 130,000 signatures.

If suicides are preventable, who would be responsible for preventing them? Who could be relied on for the power and skill, duty or even the authority to turn an individual away from a dark choice? In a society that shares no consensus on the value of life, these questions have no answers and attitudes to suicide are thus rife with evidentiary, ideological, and moral contradictions. And so, the Westminster debate took predictable lines: Labour, broadly, welcomed the idea that an administrative process could be deployed to reduce harm. Conservatives wanted to highlight the role of family and friends. But both appeared to understand that the solution was not in their gift. We can no more rely on “the system” to save lives on UK campuses than for it to facilitate suicide in Canadian hospices. And even in the past golden age of “community”, suicides were not uncommon. What if some deaths are, in fact, not avoidable? 

Like Abrahart, many young people who commit suicide today make no explicit pleas for help. This reality is at odds with young people’s reputation for being “snowflakes”, fragile creatures constantly demanding recognition for an increasingly baroque array of mental health conditions. 

The demand for psychological health services for young people has soared since the pandemic. One doesn’t need to follow the sarcastic social commentary of Twitter, where footage of disturbed individuals is routinely shared for “likes”, to understand that the “mental health crisis” among the under-30s is quite real.

But the performative aspects of Gen Z and Millennial fragility bizarrely appear to be working for them: these generations are, in reality, killing themselves at lower rates than their predecessors did at the same age. In 2000, the most likely victim of suicide was a man in his 30s living in Northeast England. Today, it’s the same man, just 20 years older. The grin-and-bear-it attitude to adversity which much of Gen X embodies turns out to be a less effective defence mechanism than the public displays of vulnerability of their successors.

The real suicides of middle-aged men – and it’s men who account for more than three-quarters of all suicides in the UK – sit uneasily alongside the claims of trans activists that there is an epidemic of suicide among so-called trans children. While numerous polls show that gender-troubled young people – confused by who, or what, you might well ask – experience high levels of suicidal ideation, there is thankfully no evidence that such ideas are carried out. Even the NHS’s flagship gender clinic agrees that “suicide is extremely rare”.

The obsession with suicide risk is a symptom of a culture that feels responsible for a loss but doesn’t know how to mourn it. Bereaved families of students seek to leave no stone unturned: who wouldn’t want to make sure that the needless death that plagues them is the last? Meanwhile, trans activists push – dangerously – the idea that to be trans is to be suicidal, no doubt as a way of making their political demands feel more urgent. A collective understanding that life, and especially puberty, is difficult, seems to be a now-fading twentieth century idea. Just as for those who apparently wish to die, so to for the still living body – a medical “solution”. Instead of embracing tragedy, as a society, we store it up by other means.

In 2017, the Church of England ended its ban on full church funerals for those who have killed themselves, with the Bishop of St Albans remarking at the time that “public attitudes had changed markedly by the second half of the last century as understandings of mental health had developed.” Suicide destroys not only the person who commits it, and it seems callous to disallow those who mourn to mark the death of someone they loved. Charities and bodies like universities or museums seek to fill the gap where meaning seems absent, presenting themselves as “life-sustaining”. But as religion’s authority over the matters of death has waned, these civil institutions’ claims on it are equally elusive.

Suicide, then, is at once a state-run business, a sad fact for which no one can bear responsibility and a highly-politicised threat. Those that today shout the loudest about it nevertheless seem to be least prey to its cruel allure. The natural refusal to demand an account of the opportunity cost of saving young lives, perversely, gives way to a wholly instrumental approach to the life of older generations. And the bigger picture slides from view: in a world without God, the state will step in with a solution, if not exactly an answer, to matters of life and death. Suicide will become not just painless, as the theme from M*A*S*H had it, but bereft of all meaning whatsoever. Would we want to live in that world?

Image: George Hodan