At a Bare Minimum, How About We Make Euthanasia a Choice that Precludes Doing a Ton of Media About Your Choice to Die by Euthanasia?
An article that basically was written by the time I wrote the title.
1The Frontier Psychiatrists is a newsletter. This will be a quick one. The day prior’s article was about the problem of borderline personality disorder existing, and being under recognized. Among the things that are recognized less? The very positive prognosis for people with borderline personality disorder.
Probably because I clicked on it, my social media feeds are blowing up with more stories about the young woman in Netherlands who has chosen to die by euthanasia to relieve her psychiatric suffering.
I probably made it clear that I think this is a bad idea, but I want to make a straightforward recommendation for the entire world. if you're going to have euthanasia that is state-sanctioned, and you're going to conscience the murder by physicians of the mentally ill?
Don't give people endless attention for the choice. Exhibit A:
This practice reinforces the behavior. Do we want to fund endless state-sponsored suicide? Well, by allowing people to do viral internet blitzes about their suicide, it reinforces the behavior, as this academic paper points out:
It concludes that: 1) attention may be a strong positive reinforcer for any behavior upon which it is contingent, 2) attention may serve as a reinforcer regardless of the intent of clinicians' verbal statements which accompany it, and 3) clinician attention affects group behavior and patterns of peer reinforcement.2
Classroom teachers and their associated researchers have know this for years:
The results indicated that the effect of a contingency may be determined not only by the specific response reinforced but also by the behavior that immediately precedes that response.3
Reinforcement of behavior is complicated. Humans are good at learning—even lessons we don’t intend. In the world of suicide research, we have a specific name for this phenomenon: Contagion.
Research continues to demonstrate that vulnerable youth are susceptible to the influence of reports and portrayals of suicide in the mass media. The evidence is stronger for the influence of reports in the news media than in fictional formats.4
I have written about this topic before. It’s the reason I think Pamela Wibble, M.D.’s promotion of death by suicide to sell her micro practice consulting services is unsavory.
When we call attention to suicide, when we pay attention to suicidal behavior, we get more death by suicide. This article, in a moment of grim irony, risks some of the same consequences. I’m going to mitigate that risk by highlighting hope, and that recovery from thought of suicide is the norm, not the exception.
BPD Gets better over time:
Radical acceptance is a lifesaving gift:
And humor can be powerful medicine, in the dark night of the soul.
Thanks for reading. If we are going to provide physician assisted suicide, maybe we can consider reasonable limits on how people can promote their choice to other vulnerable people?
A daily health-themed newsletter written by Owen Scott Muir, M.D., DFAACAP, among others.
Moore, J. C. (1979). An Analysis of the Reinforcing Function of Clinician Attention. Language, Speech, and Hearing Services in Schools. https://doi.org/10.1044/0161-1461.1002.93
Kazdin, A. E. (1977). THE INFLUENCE OF BEHAVIOR PRECEDING A REINFORCED RESPONSE ON BEHAVIOR CHANGE IN THE CLASSROOM1. Journal of Applied Behavior Analysis, 10(2), 299-310. https://doi.org/10.1901/jaba.1977.10-299
(2003). Media Contagion and Suicide Among the Young. American Behavioral Scientist. https://doi.org/10.1177/0002764202250670
I have an incredible amount of empathy for the suffering this girl has been through. Treatment- resistant depression is one of the most devastating to witness even as healthcare providers!
Thank you Owen. Perhaps one day someone will square the circle with respect to how, among some members of the medical profession, the notion of suicide prevention can coexist with the notion that doctors are there to help others end their life in that very manner.