Abortion and Suicide: A Spurious Link

In South Dakota, it is now legal to require doctors to tell women seeking abortions that they are putting themselves at risk for suicide.

This move is brilliant from a PR standpoint. Unlike banning certain types of abortions entirely or, say, forcing women to undergo invasive screenings that are medically unnecessary, this seems completely apolitical when you first look at it. Don’t people deserve to be informed if they may be increasing their risk for suicide? Don’t we all agree that suicide is a Bad Thing?

However, something tells me that this is actually another attempt to scare women out of (what should be) a normal, socially acceptable medical procedure.

First of all, the inconvenient truth here is that credible research consistently shows little or no link between abortion and poor mental health. One 2008 study reviewed the literature and found that the only studies that seemed to show such a link had very flawed methodology, whereas the studies that were well-designed showed no links. (Damn liberal academics!) And here’s another study that showed no such links. And here’s a thorough debunking of a study that did claim such links:

Most egregiously, the study, by Priscilla Coleman and colleagues, did not distinguish between mental health outcomes that occurred before abortions and those that occurred afterward, but still claimed to show a causal link between abortion and mental disorders.

In other words, that study actually tried to use mental health pre-abortion to confirm a hypothesis about mental health post-abortion. This is simply not how you do science. And it’s especially bad here, because according to the American Psychological Association, guess what the best predictor of mental health post-abortion is?

Across studies, prior mental health emerged as the strongest predictor of postabortion mental health. Many of these same factors also predict negative psychological reactions to other types of stressful life events, including childbirth, and, hence, are not uniquely predictive of psychological responses following abortion.

That’s right. Shockingly enough, the best predictor of mental health is, well, past mental health. And poor mental health predicts poor response to all sorts of stressful events, of which abortion is only one example. Another one being, for instance, childbirth!

Compounding the bad science here is that, unlike physical side effects,suicide isn’t something that just happens to you suddenly and without warning. People don’t just suddenly wake up one morning and decide to kill themselves. Suicidality is a complex process that involves factors like genetics, family history, environment, social support, mental illness, and life circumstances. For instance, here are some things that, according to research, actually increase one’s statistical risk for suicide:

As you can probably surmise, not all of these correlations are also causations. While mental illness and drug addiction can actually cause suicidal behavior, being intelligent and being LGBT probably cannot. In the latter case, the causative culprit seems to be (surprise surprise) institutionalized discrimination and homophobia. Before I get too off-topic, let me point out the irony in the fact that, despite this well-known risk faced by LGBT youth, I don’t see any of these pro-lifers advocating for an end to homophobia.

That’s why something tells me that nothing about this court ruling actually has anything to do with suicide prevention.

Although the court’s ruling does at least acknowledge that abortion probably doesn’t cause suicide, it nevertheless states that “conclusive proof of causation is not required in order for the identification of a medical risk.” This is probably true, but it only makes sense from a physical health standpoint. If studies show that people who get a certain elective medical procedure are much more likely to, say, experience headaches or nausea or numbness, you don’t necessarily need a causative study to conclude that there’s a reasonable chance that these symptoms were caused by the procedure (assuming, of course, that there was no illness present that might be causing them). Furthermore, there’s a difference between saying “This procedure may cause you to experience cramps and headaches” and saying “This procedure may cause you to kill yourself.”

The truth is, mental health doesn’t work that way. A person who gets an abortion might experience mental side effects because of the stress of having gotten pregnant accidentally and been forced to decide what to do, perhaps without the support of a partner or family. Furthermore, any invasive medical procedure can be stressful and worrying for many people–especially one like abortion, which is consistently portrayed as more painful and dangerous than it really is.

And this is all made even more complicated by the fact that the faulty studies in question were actually studying mental health before the abortion. Perhaps a person with poor mental health is more likely to seek an abortion in the first place–say, if they feel that they aren’t mentally capable of raising a child at the moment.

Ultimately, decisions about what to tell a patient should be left up to the people who know most: doctors (with, of course, a reasonable amount of regulation to prevent malpractice). If a doctor can tell that a person seeking an abortion is going through a lot of mental distress, then that doctor may want to gently recommend counseling and perhaps give out some hotline numbers–and training doctors to recognize signs of mental health troubles is always a good thing.

But doctors should not be mandated to fearmonger to their patients. They should especially not be mandated to serve a pro-life agenda.

Depression is Not Sadness

[Content note: depression, suicide]

Yesterday I came across the story of Junior Seau, an NFL linebacker who committed suicide on May 2. He shot himself in the chest and was found in his home by his girlfriend. Although little is known of Seau’s mental health leading up to his death, he had apparently suffered from insomnia for the last seven years of his life.

Sportswriter Chris McCosky wrote a beautiful column in the Detroit News about Seau’s death and continuing ignorance about depression and suicide. In the column, McCosky shares his own experiences with depression and suicidal thoughts and laments how difficult it is to explain them to people. He notes, as I’ve noted before, that one common reaction that non-depressed people have is to wonder what the hell we have to be so sad about. He writes, “It’s almost impossible to talk about it to regular people (bosses, spouses, friends). They can’t fathom how somebody in good physical health, with a good job, with kids who love them, who seems relatively normal on the outside, can be terminally unhappy.”

The unbearable frequency at which McCosky and I and probably everyone else who tries to talk about depression get this response could be a testament to the fact the most visible symptom of depression is usually sadness. So that’s the one people latch on to: “What do you have to be so sad about?” “Cheer up!” “You have to decide to be happy!”

Because of the sheer obviousness of our sadness, we’re often forced to try to use it to describe depression. We say that we’re just extremely sad, or unhealthily sad, or a different kind of sad. It’s sadness that never goes away like sadness is supposed to. It’s sadness that’s out of proportion to the troubles that we face in our lives. It’s sadness that we can’t stop thinking about. For those of us with bipolar or cyclothymic disorder, it’s sadness that comes and goes much too quickly.

And it is. But the truth is that sadness actually has very little to do with depression, except that it is one of its many possible symptoms.

Based on the diagnostic criteria for depression, you don’t even need to be chronically sad to be considered “depressed.” Anhedonia, which means losing the ability to feel pleasure from things that you used to enjoy, could be present instead. Under the formal DSM-IV definition, you must have at least five of nine possible symptoms to have major depression–and one of the five must be either depressed mood or anhedonia–and only one of those symptoms involves sadness. (If you so some very basic math, you will notice that this means that two people, both of whom officially have major depression, might only have one symptom in common. Weird, huh?)

So, even if your particular depression does include sadness, it’ll only be one of many other symptoms. The others might be much more painful and salient for you than the sadness is. Some people can’t sleep, others gain weight, some think constantly about death, others can’t concentrate or remember anything. Many lose interest in sex, or food, or both. Almost everyone, it seems, experiences a crushing fatigue in which your limbs feel like stone and no amount of sleep ever helps. Then there are headaches, stomachaches, and so on.

So, depression doesn’t necessarily mean sadness to us. (And, a gentle reminder to non-depressed folks: being sad doesn’t mean you’re “depressed,” either.)

Depression is not sadness; it’s an illness that often, though not always, involves sadness. No amount of happy things will make a depressed person spontaneously recover, and, usually, no amount of sad things will make a well-adjusted person with good mental health suddenly develop depression. (Grief, of course, is another matter.) And sadness, on its own, does not cause suicide.

We need to start talking about mood disorders as disorders, not as emotional states. McCosky writes:

Junior Seau wasn’t sad when he pointed that gun to his chest. He wasn’t being a coward. He wasn’t being selfish. He was sick. I wasn’t sad when I thought about swerving into on-coming traffic on Pontiac Trail some 20 years ago. I was sick.

What he’s saying is that people don’t kill themselves because they’re sad. They kill themselves because they have an illness that, among other things, makes them feel sad. It also makes them feel like their life is worthless, like they’re a burden to others, like death would be easier, and all the other beliefs that lead people down the path to suicide.

There is a tendency, I think, to assume that people are depressed because they are sad. A better way to look at it is that people are sad because they are depressed. That’s why, even if we could “turn that frown upside down!” and “just look on the sunny side!” for your benefit, it would do absolutely no good. The depression would still be there, but in a different form.

Junior Seau did not leave a suicide note, so nobody will ever know what he was thinking when he died. I would guess, though, that he was thinking about much more than just being sad.

What You're Really Saying When You Say that Suicide is "Selfish"

I’m still thinking about the Chet Hanks suicide thing from last week and the various responses to it that I saw online. Specifically, I cited two comments that referred to suicide as “selfish.”

“Selfish” has to be one of the most common adjectives people think of when thinking about suicide. Those of us who are involved in mental health advocacy could probably rant at you for hours about how this word perpetuates the stigma that mental illness and suicide carry in our society, how useless and counterproductive it is to accuse a suicidal person of being “selfish,” and so on. In fact, if you get nothing else out of this post, I hope you reconsider using that word to describe suicide if you’ve done so before.

But I can understand where this sentiment comes from. While everyone loses loved ones at some point in their lives, relatively few people experience suicidality first-hand. For this reason, people understand the latter situation much less than the former. Faced with the thought that someone you love might kill themselves and put you through all the resulting grief just because of some inner turmoil that you can’t see or understand, it makes sense that you might feel that suicide is selfish.

At the same time, though, conceptualizing suicide as a “selfish act” sends the message that people somehow “owe it” to their loved ones to stay alive despite immense emotional pain. When you say that suicide is “selfish,” you’re implying–even if you don’t mean to–that the individual’s pain, as well as their potential to improve, isn’t what matters. What matters is how they’ll make the people around them feel.

I don’t mean to discount the grief that people feel when someone they love commits suicide–that’s real, valid, and deserves attention. And, obviously, I believe that people should not commit suicide. But I believe that because I also believe that people can recover from the pain that’s causing them to consider suicide, not because they owe it to others to live.

What all of this comes down to is that most people do not (and perhaps cannot) understand what actually goes through a suicidal person’s mind. Maybe they assume that suicidal people are just sad the way all of us sometimes get sad, except maybe a bit more so. (I honestly don’t know how mentally healthy people think about suicide because I haven’t been one for a while.) It would indeed be rather selfish to put your friends and family through so much pain just because you felt sad one day.

But that’s not how suicide works.

The way I see it, the tragedy of suicide is not (or is not only) the fact that an individual’s suicide also hurts others. Rather, it’s that the individual could have found a way to heal, be happy, and live out the rest of his or her life. Calling suicide a “selfish” thing to do erases that latter tragedy and implies that our primary purpose in life is not to create a meaningful and worthwhile life for ourselves, but to keep our friends and family happy at all costs.

Our first priority should be to convince those who want to take their own lives that those lives are intrinsically valuable and should be preserved for their own sake. Only when they’ve accepted that premise can they even begin to think clearly about their obligations and interactions with other people.

Telling a suicidal person that suicide is “selfish” only reinforces the guilt they already feel. People should choose to live because their lives feel worth living to them, not out of a sense of obligation towards others.

Note: Since this is quite a sensitive topic both for me and probably for many readers, please try to be especially careful with your comments. I reserve the right to delete any comments that I feel may trigger people, even if they’re completely on-topic.

Chet Hanks, Victim Blaming, and the "Weakness" of Suicide

Chet Hanks, son of Tom Hanks and a student here at Northwestern, has this to say about victims of bullying:

Chet's tweet: "Ayo I don't condone bullying but anyone who offs themselves cuz they got picked on is weak."

Credit: Gawker

And then, perhaps in response to people who responded to him (including yours truly), Chet tweeted these followups:

“I say real shit and I always speak my mind if you don’t like it I could give a fuck less.”

“Lol…Haters: I am sorry I do not cater to your demographic: shlubby dudes that don’t get laid enough it’s ok go back to your Internet porn”

“G’head check my feed, all the people hatin are mediocre Lames and cute girls show me love #whatdoesthattellyou

How mature.

Sometimes I wish someone would invent a technology that allows you to connect to someone else’s brain and actually feel what they feel. Because language is a poor substitute.

Maybe if we had such a technology, people would finally understand that mental illness and suicide do not happen to people because they are “weak.”

However, since we don’t have such a technology, the best we can do is educate ourselves about other people, something that college provides a great opportunity to do. It’s too bad that Chet Hanks seems not to be taking advantage of it.

Some of the comments on the Gawker piece I linked to, while generally dismissive of Chet Hanks, are hardly any better:

His expression of emotion is misguided and a bit douche-y, but I second the sentiment. Suicide is a horrible option to exercise as a bullying deterrent. It’s a permanent solution to a potentially temporary problem. It exchanges the pain you feel for the pain of those around you who love you and is essentially a selfish act.
Suicide is selfish and hurts people who care about you, but calling people who are potentially thinking about doing it weak is only going to make things worse. He could have expressed this sentiment in a way that was constructive and helped people, instead of highlighting what an asshat he is.

It’s probably true that some people are psychologically more susceptible to suicide than others, but that difference has nothing to do with “strength” or “weakness.” It also has nothing to do with “willpower” and “selfishness.” To put it broadly, suicide is what happens when a person no longer wants to live–which isn’t necessarily the same thing as wanting to die.

Tragically, most people who commit suicide do so at least in part because they don’t feel like anyone will miss them, and contrary to what the self-righteous commenters above seem to think, not everyone does have friends or family who care about them. It’s also worth noting that, with the exception of people like me who were bullied for being nerdy, kids who get bullied tend to already be marginalized by society in numerous ways–because of fatness or ugliness, mental or physical disability, perceived or real homosexuality, noncompliance with gender roles, and so on. Sometimes, these are the very children who are least likely to have supportive parents, siblings, teachers, and friends cheering them on through their trials.

What Chet seems to miss is that the causal relationship between bullying and suicide isn’t just that a kid goes to school one day and gets called a fag and comes home and tries to kill himself. Bullying is almost never a one-time thing; it can continue over months or years. It’s a constant wearing down of an individual’s self-worth and belief that he/she belongs in this world. Bullies don’t simply call you names and beat you up–they convince you that nobody wants you here.

While supportive friends and family can alleviate these tragic effects somewhat, as I mentioned, not everyone has supportive friends and family. And even if they do, that may not be enough. Children don’t have the freedom that adults have–they’re completely powerless to escape the situation by moving or dropping out of school. The only recourse they generally have is telling an authority figure at school, and that tends to do nothing at best or backfire at worst.

But of course, pretty much everyone reading this blog probably already knows all that. What they probably don’t know is how it actually feels to seriously consider suicide, and how little it has to do with concepts like “weakness” and “selfishness.” If you’d like to hear about it from someone who knows of what she speaks, feel free to ask me personally. Otherwise, I’d recommend this amazing book.

After we read about Chet’s tweet, some of my friends and I started talking about the whole concept of victim blaming and how pervasive it is in our society. Although it’s usually talked about in the context of sexual assault, there really isn’t a single shitty human experience that doesn’t routinely get blamed on its victims: mental illness, bullying, poverty, racism, sexual harassment, you name it. If you have depression, it’s because you’re just not looking on the bright side of life. If you’re getting bullied, it’s because you stick out too much or “react” too much. If you’re poor, it’s because you’re too lazy to get a job. If you’re fat, it’s because you eat crap and don’t exercise. If you feel discriminated against, it’s because you’re “too sensitive.” If you’re getting harassed on the street, your skirt’s too short. And so on and so forth.

(In fact, as Barbara Ehrenreich notes in her brilliant book Bright-sided, even cancer, that ultimate of tragedies, is increasingly getting blamed on its victims. Why? Because they didn’t “think positively” enough.)

Sometimes, it’s really difficult and unpleasant to acknowledge the fact that, even in our pull-yourself-up-by-the-bootstraps, when-there’s-a-will-there’s-a-way sort of culture, sometimes life just screws people. Sometimes it just does.

It’s easier to blame the victim than to make the sort of cultural changes we would need to make sure that people get screwed over as little as possible. Much easier than to figure out how to teach compassion to kids, how to eradicate racism, how to get people to realize that there’s never an excuse for raping people.

But just because we may not yet know how to do those things does not mean we should just throw up our hands and say, “Yeah well, if they off themselves, it’s just cuz they’re weak.”

The more I study psychology, bullying, and the many challenges faced by people that society continually marginalizes, the more I think: If only it were that simple.

*edit* Also, here’s an awesome blog post about this from my friend Derrick.