Oh, Canada: Exploring attitudes up north

Two big surprises came up when I went to Canada this week for its national conference on suicide prevention. One was the number of attempt survivors who addressed the conference, with humor at times and a welcome lack of nervousness from the crowd. The other was a difficult, sometimes emotional session on what role the Canadian Association for Suicide Prevention should play in the growing issue of assisted suicide. I’ll write this in two parts below.

Part one: I’ve been to two national conferences in the U.S., and they seem more somber and less intrepid now. One example: When the American Association of Suicidology had its first-ever plenary session on attempt survivors in 2010, with just one attempt survivor addressing the full conference, the mood was deeply serious and careful. That’s not wrong, and it was a historic move after decades of AAS conferences, but sometimes deeply serious and careful can be a barrier to faster change.

In Canada, the attempt survivors loosened up their session by passing out chocolates. That’s what they do in support groups when things get emotionally intense, they explained. The woman behind the original groups for attempt survivors is Yvonne Bergmans, who spoke with me months ago about the work she’s doing. During the session, she was blunt and informal, just like everyone else. “Quite frankly, if you don’t want to work with this kind of clientele, then don’t,” she said of fellow therapists and others. She shared feedback from professionals who work with attempt survivors who have gone through the support groups: “The conversations are very different. The conversations are no longer, ‘I want to die.’ It’s now, ‘I don’t feel safe.’ When you tell professionals you want to end your life, it scares the shit out of them. They panic and run. We try to change the language so you will be heard.”

Most of the attempt survivors in the session have worked with the support groups as peer facilitators. “I sit on both sides of the desk,” said Allan Strong, who leads the Skills for Safer Living support groups in a community about an hour’s drive from Toronto. “Oftentimes we look at the lived experience and clinical experience as separate silos. Our intent is, it’s not an either-or, its and and-both. One can give voice to the other. I could easily have been a member of the group as a facilitator.” The average number of attempts that group members have is seven, he said, with a high of 25. The groups’ approach is not talking about methods and focusing on keeping people safe.

“All of us are really open talking about it,” he added. “We schmooze our buns off.”

Cathy Read-Wilson, who also spoke with me earlier this year, gave a lively presentation of her own suicide attempts and her work as a peer. “I never anticipated that a suicide attempt would get me a job!” she began. She read feedback from one formerly skeptical member of a support group: “When my psychiatrist referred me to this group, I thought, ‘Great, another group to tell me to think of my kids, my husband, think happy thoughts, endless useless suggestions. BUT I WAS WRONG.'”

Cathy later ended a description of one suicide attempt by saying, “The cops found me, and I like to add that they were damn good-looking. The ambulance attendant was even better!” The audience fell apart laughing. “I joke because it’s the sense of humor that gets me through,” she said. “We need that. We need that reality in life.” At the end of her story, she returned to her role as the session’s moderator, turning to the next speaker and asking, “Do you need a PowerPoint?”

Attempt survivors spoke at sessions scattered throughout the conference, and listeners didn’t shrink away. At the closing session, a young woman, Alicia Raimundo, stood up and introduced herself as an attempt survivor. She also told the audience about meeting a woman in a psychiatric ward who told her, “You’re gonna need this” and gave her a necklace with the word “Hope.” What she didn’t realize, Alicia said, was that the woman was in a manic state and was giving away all her possessions. Finally the woman’s sister came over and asked, “Can I get this back?” It was, the audience agreed, pretty funny.

(I later watched her earlier TED Talk online, where she explained the anecdote fully, and it turns out that moment became a turning point in her recovery and her decision to be open.)

Part two: It seems the issues of suicide and assisted suicide are usually treated as separate worlds. The Canada conference included a fascinating session that tried to bridge them. A recent court case in Vancouver that struck down the country’s ban on physician-assisted suicide was the cause.

“We’ve ducked these issues for a long time, and for a good reason,” Adrian Hill, a former president of Canada’s association for suicide prevention, said to open the session. “Maybe our hands were full already.” But he argued that the association now needs to have a voice. “We no longer have the luxury of leaving the discussion of assisted death to others.”

His argument was personal. His mother had been in a wheelchair since her 50s. “My mom was terrified of ending up in an institution where she couldn’t kill herself,” he said. “She wanted to die before she was institutionalized, and she did. She sent my father out of town so he would not be charged. She researched on the Internet the best way to kill herself with a firearm. And she did. And my father came home and found her.” Later, he realized that if his mother had been in a place with assisted suicide, she would have lived longer. “She would not have to secretly have this pact with my father, for this act that scarred us.”

He pointed to a recent survey in heavily Catholic Quebec, where a majority of people said they wanted a right-to-die option. “If Canada is on this road, with this right to die, I think we damn well better be on that bus,” he said. “And if we don’t, it will look like we don’t care. We’ll look like we don’t know. Like it isn’t important to us. Like a turf war with people who won’t share what we know.”

The association’s current president was in the audience. A panel of ethicists and clinicians began the discussion, and they were open about saying this is a difficult issue. When people say, “I want to be able to control my death,” what does that mean? Isn’t suicide the same? How do we tell the difference between a death that can be prevented and one that can’t? What does it mean if assisted suicide is OK but the suicide prevention community says, “These cases are never good!” Who should be part of the decision-making process? How could an option that shortens life be a better option than one that prolongs it? Does someone want to die, or do they not want to suffer unbearably? Can you imagine something worse than death for yourself?

“Certainly in both cases, somebody’s dead. And we always grieve people dying,” philosophy professor Michael Stingl said. “But we can say in those situations (of assisted death) we’ve done the best we can. … In suicide, we can’t. That person died in isolation.”

He continued, “There may still be difficult cases in the middle. And they need to prompt discussion of whether we need to put in one camp or the other. But we classify most cases in one camp or the other. And if we succeed in doing that, we’ve made some headway. And we can pursue suicide prevention in good conscience.”

Dr. Anne Woods, a palliative care expert, ended the discussion with a comment from one patient. “One woman said, autonomy is naming the limits of her own suffering.”

And the Q & A session began. One woman in the audience said she had had one friend die by suicide and another die by ALS. The friend with ALS had plenty of conversations with friends about suicide, with no shame attached, she said. It was a very rational discussion. She then choked up when she turned to the friend who died by suicide. “We didn’t know she was suffering. It was stigma and shame. We are an emotion-phobic, death-phobic, mental illness-phobic society.”

I stood up and asked: If we are told that mental illness should be seen and even treated as any physical illness, that there should be no stigma, why is assisted suicide closed to people with mental illness? Can they not name the limits of their own suffering? I told them I was a suicide attempt survivor and that I had asked experts this question in the past. Again, the audience murmured.

“This has haunted me for years, this question,” Hill said.

“It’s actually the central question,” Woods said. “We don’t know about suffering … not sure how to quantify it.”

The questions continued: Why did a veterinarian deal with a family’s decision over a terminally ill cat so much better than doctors did over the fate of a mother with dementia and physical complications? If a parent with dementia says in a rare moment of clarity, “I don’t want to be here,” where does that fit in? Again, there were no clear answers.

“Right now, physicians and nurses are asking the question, how do we keep being human?” Woods said.

And Hill said, “One of my enormous regrets is that my mother died alone. I’ll be damned if someone else will.”

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