Re: Suicide

Left Field by Patricia Nell Warren

What can we learn by looking at the social context around this “taboo” act?

A friend of mine recently phoned me, devastated, to share her news that a gay male friend of hers had just quietly, suddenly, without any warning, committed suicide. He had been living with AIDS and ARV treatment for a number of years; evidently he had reached the point where the drugs were no longer delivering that “quality of life” promised by the FDA and the pharma industry. So, rather than suffer through the inevitable decline, to the very last day and hour, he had decided to take control and end his own suffering quickly.

AIDS suicide has become part of the epidemic’s vast global texture—whether it’s the seemingly out-of-the-blue death like that of my friend’s friend, or the ceremonial planned exit dramatized in the now-classic 1996 film It’s My Party. Indeed, six degrees of separation means that many of us have been touched in some personal way by AIDS suicide. But its ubiquity, and its long-lastingness as an issue, hasn’t made it any easier to deal with.

My friend’s phone call moved me to review some of the literature on AIDS suicide. A routine Web search under “AIDS suicide” dredges up a lot of studies, editorials, and pronouncements from the 1980s and early nineties. They mirrored the fact that suicide is not only deeply taboo with many in our country—viewed as a “sin against God,” but also viewed as one of the most deeply taboo expressions of a taboo disease. During that early period when AIDS was still universally defined as a “death sentence,” AIDS and suicide often went hand in hand. In one study of 207 New York City women, forty-two percent of them attempted suicide within the first month of being diagnosed with HIV.

But an unsettling fact emerged from my review. After the introduction of AIDS drugs, the dark shadow of that “death sentence” was supposed to be lifted for good—not only physically, but emotionally, spiritually and mentally. Replacing it was the pharmaceutical rainbow promise of many years of managing AIDS as a chronic disease—meaning relative good health, activity, and happiness. So thanks to the drugs, AIDS suicide was supposed to disappear. But it didn’t.

Judging by a 2010 article in American Journal of Psychiatry, titled “Elevated Suicide Rate Among HIV-Positive Persons Despite Benefits of Antiretroviral Therapy,” the experts appear to be somewhat surprised that the suicide rate among people living with HIV/AIDS is still a towering three times higher than that among the general population. Some experts are convinced that AIDS suicide is never a rational action—that a person has to be driven by what the article calls “comorbid psychiatric conditions” in order to even seriously consider “suicidal ideation,” i.e., thoughts of ending his or her own life. (Experts do make an exception for depression and dementia that result directly from physical and chemical changes in the AIDS-afflicted body.)

According to the statisticians, more men than women commit AIDS suicide. But regardless of gender, the PWA is made to feel that if he or she is patient enough and long-suffering enough, and adheres to ARV treatment obediently enough, he or she will somehow reach that golden shore—those sunny years of improved quality of life that the drugs supposedly confer. For those who aren’t proving to be courageous enough, or obedient enough, the experts feel they must rush to do relentless routine screening, and psychiatric-level treatment and, yes, more drugs, (i.e., psychiatric drugs) to keep them from harming themselves. This way, society hopes it can keep that PWA from becoming yet another taboo statistic.

Why, in spite of all the drugs, is suicide still around? To paraphrase a question from the film Titanic, which the young hero asks after he saves the girl from jumping off the ship: “What could have happened to these people with AIDS to make them think they had no way out?”

Surely we have to start answering this question with the fact that the drugs don’t necessarily work forever. Sooner or later, owing to growing resistance of HIV strains to the drugs, a person’s health may finally fade. This can be a shattering moment for a person’s psyche. This is what may have happened to my friend’s gay male friend.

So is AIDS suicide really the result of “psychiatric illness?” Or can it be a rational action? Can we look for additional reasons why a sick person might look for a “way out” in the toxic social atmosphere that still looms around this disease? AIDS-phobia was already bad enough in the 1980s—and now, after a brief period of improvement, it’s suddenly worse than ever—fed by the mean-spirited religious judgmentalism sweeping the country. Some conservatives feel that AIDS treatment should be reserved for the “innocent victims,” namely children who are infected through “no fault of their own,” or adults who might have been unknowingly infected by a blood transfusion or philandering spouse. But the individual who was infected through drug addiction or “illicit” sexual activity does not (in the opinion of many conservatives) deserve any consideration…or any taxpayer funding for care.

What happens when that individual life is personally and screamingly overrun by drug failure, or social stigma, or unbearable pain, or denial of access to treatment, or the combined devastation of AIDS and AIDS-related infections…or all of the above, coming all at once?

Pain alone is worth looking at. American society is so obsessed with the moralistic notion of preventing drug addiction that we are reluctant to deal with the stark need for palliative and hospice pain relief in chronically ill and dying people. In the wake of the Michael Jackson doctor trial, the federal government is pushing investigations of pain-management prescribing all across the country. No doubt it’s important to prevent “doctor shopping” by people who are really addicted. Yet where is the balance needed here? In a recent Journal of the American Medical Association, an article by author Joan Stephenson is headlined, “Experts say AIDS pain ‘dramatically’ undertreated.” And palliative and hospice care is expensive enough that it is now falling victim to budget cuts. Example: a twenty-year program in Marin County, California, that was axed in 2009, leaving hundreds of seriously ill PWAs adrift. The bottom line: Someone with a low pain threshold can feel that fierce untreated AIDS pain is reason enough to look for a way out.

So it’s predictable that AIDS suicide is starting a slow uptick again, as the national cutbacks in treatment access are slashing ever more deeply into the nation’s HIV-positive population. Likely we will see most of these suicides among middle- and low-income people, as well as the indigent—specifically, those vulnerable members of society who are the most threatened by race phobia, age phobia, homophobia, transphobia, homeless-phobia, or other types of moral elitism.

Once upon a time, there were socially conscientious American church people who were ready to leap into the breach, with private-sector relief for everyone who needed it. Compassionate folks like this created everything from Depression Era soup kitchens to big hospital systems. But today we’re seeing a new breed of cold-hearted church-owned politicians who have come up with the astonishing notion that the Bible prohibits government healthcare. But these pols aren’t doing any compassionate private-sector replacement of the public HIV/AIDS services that they’re so avidly destroying by their funding cuts. Ironically, some state and federal cuts are even targeting suicide prevention programs.

In the current climate of religious callousness, AIDS suicide is surely going to flourish. The politicians and church leaders who create this climate will bear some blame for these deaths—the very ones that they have the nerve to call “sins against God.”

Author of fiction bestsellers and provocative commentary, Patricia Nell Warren has her writings archived at Reach her by e-mail at [email protected]

Copyright © 2012 by Patricia Nell Warren. All rights reserved.

March 2012