There are many different kinds of depression. To speak as though depression is a single clinical entity is to mislead.
If, for example, a psychotic is suffering from depression, he is not be held accountable for his actions. If he has s command hallucination telling him to jump off of a cliff we would not consider his suicide to be his own choice.
Such is the exception and exceptions do not make the rule. Most people who are depressed are not psychotic. Thus, they do retain a measure of moral agency.
Blogger Matt Walsh provoked a firestorm of critical commentary by suggesting that, while depression is an illness, suicide is an act.
In his words:
Your suicide doesn’t happen to you; it doesn’t attack you like cancer or descend upon you like a tornado. It is a decision made by an individual….
No matter how depressed you are, you never have to make that choice. That choice. Whether you call depression a disease or not, please don’t make the mistake of saying that someone who commits suicide “died from depression.” No, he died from his choice. He died by his own hand. Depression will not appear on the autopsy report, because it can’t kill you on its own. It needs you to pull the trigger, take the pills, or hang the rope. To act like death by suicide is exactly analogous to death by malaria or heart failure is to steal hope from the suicidal person.
In effect, Walsh is asserting that human beings have free will. To tell people that suicide is not a choice, but an inevitable consequence of a biochemical imbalance deprives them of hope.
If suicide is a choice, then you retain the option not to choose it. If it is not a choice, then you lose that option.
In point of fact, treating one's depression is also a choice. Unless the individual is subject to involuntary commitment he does have the freedom to choose whether to take his medication, to do his exercise and or to perform the cognitively-based homework exercises.
Walsh is trying to persuade people who have a choice not to commit suicide. He begins by claiming that all suicides are egotistical. They are self-serving, presumably to end psychic pain, but hurting other people:
In suicide you obliterate yourself and shackle your loved ones with guilt and grief. There is no freedom in it. There is no peace. How can I free myself by attempting to annihilate myself? How can I free something by destroying it? Chesterton said, “The man who kills a man, kills a man. The man who kills himself, kills all men; as far as he is concerned he wipes out the world.” Where is the freedom in that?
True enough, some suicides feel markedly egotistical. An individual who takes a step back and considers the impact his action will have on other people might well be less likely to commit suicide.
Unless of course he does it because he wants to hurt other people, as an act of revenge, for example.
We should not however dismiss the possibility that some individuals will make better decisions if they consider the effect their action will have on others.
I used the term egotistical because Walsh’s post reminded me of the great sociological study of suicide, written over a century ago by French sociologist Emile Durkheim.
Some suicides are egotistical, Durkheim posited, but others might be caused by altruism or anomie.
People who commit suicide for altruistic motives and sacrificing themselves to serve the betterment of others, whether the group or the family.
The military commander who leads his troops into a losing battle might fall on his sword, as they say, out of shame for his failure and because he does not want his soldiers to believe that they are responsible for their defeat.
I was reminded of this last night when Wall Street Journal reporter Lee Hawkins suggested that, financially speaking, Robin Williams might have been worth more dead than alive.
It was the case, Hawkins said, with Michael Jackson.
If Williams had financial difficulties—point that many have questioned-- his duty to provide for his family might have led him to imagine that he could best do it by committing suicide.
A disagreeable thought, but, if Durkheim is correct, then some people have altruistic motives for committing suicide.
A suicide based on anomie is yet another story.
If egotistical suicide is an attempt to hurt other people and altruistic suicide is an effort to help other people, with anomie the person is suicidal because he does not connect with other people.
Within this context examine the comment that many people made about Robin Williams, that he was always on, that he was always performing, that he could never turn it off.
People who met him in private settings were delighted to be entertained by one of the world’s greatest comic geniuses, but still when you are telling jokes you are not connecting with other people. You are on stage, in the spotlight, provoking laughter and pleasure in your audience… but you are still… alone.
There are no social niceties, no exchange of simple information, no schmoozing… no real connection.
Of course, people love you. They love you for making them laugh. And yet, they do not know you. They do not even care to know you. They are just waiting to hear another joke.
Perhaps Williams was bipolar, subject to mood swings between being a hypomanic entertainer and feeling alone and isolated.
And yet, bipolar illness is treatable, as are other forms of depression. And Williams, we know, had access to all of the best medical treatment.
Some have asked how it could happen that the psychiatrists did not succeed in treating him. Others have responded that the psychiatrists did well to help him to live as long as he lived.
Surely, medication can have a beneficial effect on the brain chemistry of someone who is depressed. And yet, feeling good while being disconnected might have a limited effectiveness. Being on medication might help you to make new friends, but, making friends is a skill. It is not the same skill as entertaining large groups of people.
How does a comic move from telling jokes, activity for which he is lionized, to chit chat?