When It Comes to Being "Shrink-Resistant", Toronto Universities Lead the Way

Whatever you may think about it -- and different people have dramatically different assessments -- most Canadians are acutely aware that the University of Toronto is a central hub for institutional psychiatry, with CAMH (Centre for Addiction and Mental Health) being one of its most famous research institutes as well as one of its mega teaching hospitals. Did you know, however, that Toronto universities are likewise famous for what is transparently the opposite -- that is, for cutting edge critiques of psychiatry? And in the latter, let me suggest, we seekers of social justice can truly take pride.

Some history: The very first course on working with traumatized people anywhere in the world that operates from an antipsychiatry perspective was introduced over 15 years ago in the ever radical Adult Education and Community Development program at Ontario Institute for Studies In Education (OISE), University of Toronto. Called "Working with Survivors of Trauma", it is still going strong, students scrambling every year to get into this highly popular course. What is especially exciting about this course, beyond that the type of engagement being upfronted is fully consensual -- an absolute must -- the course operates totally outside of psychiatric frames (e.g., no use of psychiatric diagnoses or language). Moreover, unlike every other trauma course in the world, instead of psychiatry being conceptualized as a "resource" for traumatized people, it is framed as a traumatizing institution which presents a danger to them precisely because it acts as it does, moreover, precisely because is widely accepted as the ultimate “resource”. By the same token, just as students gain cutting edge skills for helping traumatized peoples and communities "work through", "expand their coping repertoire", and on a more political level, resist, one of the skills acquired in this course is how to help traumatized folk and communities become adept at protecting themselves precisely from psychiatric and other intrusion by "professionals", irrespective of whether or not such intrusion is called "help".

Speaking of radical reframing!

A slightly later but related development was kickstarted at Ryerson University (located in central Toronto). At the instigation of mad history specialist Dr. Geoffrey Reaume (now a long term faculty member at York University), it introduced the world’s very first Mad History course. This development, I would add, occurred shortly after Reaume had proposed just such a course to University of Toronto, only to find it rejected offhand -- and in this, U of T's lack of foresight is evident.

The inclusion of this course in Ryerson was quickly followed by the introduction of a Mad History course in Disability Studies at York University (also located in Toronto), again courtesy of Dr. Geoffrey Reaume. Soon with the aid of scholars like Reaume (York University), David Reville (Ryerson), and Dr. Jennifer Poole (Ryerson), Mad Studies became a highly recognized academic area in Canada. And before long Mad History and Mad Studies courses more generally spread to Wales, Scotland, the Netherlands, and other parts of the world (see http://www.universityaffairs.ca/features/feature-article/mad-studies/). It remains at the same time a Canadian stronghold, as seen by the appearance of such stellar Mad Studies tomes as Brenda LeFrançois, Robert Menzies, and Geoffrey Reaume (2013).

What is exciting about such courses and areas is that the perspectives explored are not those of professionals but rather those of folk deemed mad. Herein we have what philosopher Michel Foucault (1980) so aptly calls “the insurrection of subjugated knowledge”. 

A further Toronto university breakthrough: In 2010 in cooperation with leading antipsychiatry group Coalition Against Psychiatric Assault, Adult Education and Community Development at OISE/UT mounted the historic PsychOut Conference (see http://ocs.library.utoronto.ca/index.php/psychout/index/index). This was the first conference ever whose focus was strategic resistance to psychiatry. Widely attended, it culminated in printed proceedings (see http://individual.utoronto.ca/psychout/papers/lehmann.html).

It likewise inspired Bonnie Burstow's, Brenda LeFrançois's, and Shaindl Diamond's (2014) book on the subversive art of crafting resistance to psychiatry.

Yet a further development of note happened in 2014 -- again at University of Toronto. People came from far and wide to OISE/UT to take a series of workshops on how to use a radical approach to research called “Institutional Ethnography” to investigate aspects of psychiatry. The purpose of the workshops was nothing less than to help attendees learn how to trace seemingly individual personal problems to the workings of institutional psychiatry, together with the power conglomerates of which it is a part. The upshot of these workshops were the formation of research teams. Composed of psychiatric survivors, academics, and activists, the teams proceeded to employ this radical methodology to investigate hitherto relatively unexplored nooks and crannies of psychiatry. The product is the soon-to-be-released book “Psychiatry Interrogated” (see http://www.springer.com/fr/book/9783319411736). 

And then there is the pièce de la résistance -- which it has been my pleasure to be integral to.

But days ago -- so this news is “hot off the press” -- yet another important breakthrough materialized, once again at OISE, University of Toronto. For the first time anywhere in the world an antipsychiatry scholarship was set up. Known as the Dr. Bonnie Burstow Scholarship in Antipsychiatry, it is a matching scholarship in which I am slated to match up to $50,000 dollars in donations from others. And it will be awarded annually in perpetuity to OISE students doing theses in the area of antipsychiatry.

To understand the significance of this scholarship, witness these words by leading psychiatrist/psychiatric critic Dr. Peter Breggin:

I am Peter R. Breggin, MD and I am a psychiatrist. As a professional long heralded as the conscience of psychiatry, it is my pleasure to endorse the newly formed Bonnie Burstow Scholarship in Antipsychiatry. Science is demonstrating that psychiatric diagnosis and drugs, electroshock, and involuntary treatment are doing much more harm than good. We desperately need critical scholarship aimed at stopping this epidemic of demoralization, dehumanization, and brain damage. 

Likewise backing the scholarship, in her written endorsement, Ontario MPP Reverend Cheri DiNovo draws attention to the scholarship's long-run potential to help address inequities faced by psychiatric survivors.

Zeroing in more pointedly on the social movement dimension, Toronto activist extraordinaire Don Weitz explains the significance of the scholarship thusly, “It's time antipsychiatry is officially and widely recognized as a legitimate and growing international movement. This Scholarship will help make it happen.”

Correspondingly, survivor/activist/academic Dr. Lauren Tenney pinpoints with rigour multiple ways in which the scholarship is significant, bringing in intersectionality in the process, elegantly asserting:

How radical!  How timely! We are so fortunate to have [here], a visionary with a commitment to exposing psychiatry, and assisting people making their way into the field, to not have to fight for a right to hold an antipsychiatry position. State-sponsored organized psychiatric industries target children, women, people of color, seniors, and people from oppressed groups. The opportunities such a scholarship program presents are enormous for the growth of research that will hold psychiatry accountable. The important feminist, anti-racist work that can be accomplished from an antipsychiatry framework is significant, not only for those awarded this new scholarship, but for those working with and near those in slated positions designed to allow people to honestly speak out about the damages psychiatry creates. This brilliant move by Burstow is a game-changer that will further solidify the growing field of antipsychiatry in North America, and around the world. If you are able to support this effort, please do so, today.  -- Lauren Tenney, PhD, MPhil, MPA, Psychiatric Survivor.

As these endorsers are well aware, as the scholars involved in every one of the cutting edge endeavors outlined in this article too are aware, as the throng of students benefiting from such developments are likewise aware, it is precisely in breakthroughs such as these that we see universities at their best -- not acting as the regimes of ruling (which they unquestionably are) but daring to step away from vested interests to promote truly liberatory scholarship. Not that any of this happened without struggle. 

Insofar as we have such breakthroughs, it is because radical scholars itching for universities to be real sites of liberating education pushed and keep on pushing against the conservativism and the inherent intransigence in universities. May the struggle continue!

Hopefully, we will see many more such developments not only at Toronto universities -- but at sites of learning throughout this nation and beyond. My own personal wish list for the near future is; the public mounting of hard-hitting debates on the timely subject of psychiatry; the creation of departments of Antipsychiatry and Mad Studies, and last but hardly least, the integration of antipsychiatry into such currently (and woefully) psychiatry-dominated fields as psychology and social work (for a discussion of psychiatry's wholesale colonization of psychology and social work in North America, see Bonnie Burstow, 2015).

Correspondingly, I look to the day when every university will consider their mission of advancing social justice and radical scholarship at least somewhat incomplete without creating a space for demystifying psychiatry, for promoting mad voices and "mad literacy", and for the co-development of antipsychiatry strategies. Can you imagine how society might change if our universities truly prioritized pedagogies of the oppressed in such ways? By the same token, can you imagine what would happen if a good part of the populace got behind such a transition? -- a vital question that I put to the reader, for despite how impressive are the inroads made to date, without abundant and radical community involvement, universities will only change so far. Or to phrase this positively, we get what we make happen.

That said, to end by highlighting the scholarship at hand, for those wanting to learn more about this exciting new development and/or eager to become part of what Tenney has so aptly dubbed this game-changing" move, this history-in-the-making, go here (http://www.oise.utoronto.ca/oise/About_OISE/Bonnie_Burstow_Scholarship.html). For queries that you might have, write: burstowscholarshipcommitee@gmail.com.

References

Burstow, B. (2015). Psychiatry and the business of madness. New York: Macmillan.

Burstow, B., LeFrançois, B, and Diamond, S. (Eds). (2014). Psychiatry disrupted. Montreal: McGill-Queen's University Press.

Foucault, M. (1980). Power/Knowledge. New York: Pantheon.

LeFrançois, B., Menzies, R., and Reaume, G. (Eds.) (2013). Mad matters. Toronto: Canadian Scholars Press.

The Bonnie Burstow Scholarship in Antipsychiatry

After a seven and a half year struggle to make something like this happen--terrific news--a scholarship in antipsychiatry has just been established at University of Toronto--a wonderful breakthrough for besides that this area is of monumental importance, there are no such scholarships anywhere else.  The scholarship is available to thesis students at Ontario Institute in Studies in Education at University of Toronto conducting antipsychiatry inquiry. For details on the award, including its significance and how to get involved, see http://www.oise.utoronto.ca/oise/About_OISE/Bonnie_Burstow_Scholarship.html

“Invisible” Resistance: Taking Charge in the Face of Difficulty and Institutional Rule

The context in which this article is penned is rule by institutions which are functions of the state, in particular those deemed services; the ways in which these interconnect to create a veritable trap; contrary to current hegemony, the ease with which they can substantially harm those that they “serve”. Pivotal in this article is the “mental health system” and the psychiatric dangers that it presents (for an extensive demonstration that psychiatry intrinsically harms and lacks validity, see Burstow, 2015). Likewise figuring prominently are the educational system and the social services—which, despite their comparative validity are themselves centralized sites of social control, and as such, also wreak havoc in people’s lives.

At the centre of the discussion are two stories, each involving individuals competently attending to their own needs and/or the needs of their loved ones precisely by keeping one or more of these institutions at bay. These particular stories were chosen because of my intricate knowledge of each, also because of the contrast between them (they take place in very different eras, and very different modes of resistance are involved). Questions explored with respect to them include: What problems do the stories bring to light? Would the complications encountered in the first story have been better or worse if some semblance of these events played out today? What attitude do they suggest that we should take to the various apparatuses of the state? What do they tell us about resistance? And insofar as the solutions arrived at by the central protagonists might be thought of as instructive, what do they alert us to, open up as possibilities, or prefigure?

Story One:  Ottawa, 1950s.

A younger me is the central protagonist of this story, age 12-13. My family had just moved from Winnipeg Manitoba to Ottawa Ontario, and both in Ottawa itself and in the new school that I attended I found myself encountering a level of anti-Semitism which I had not previously experienced. Badly thrown, for better or for worse, I did not share these conundrums with my folks for my dad had just suffered a major heart attack and parents were in such dire financial distress that it is all they could do to put food on the table. What I did is stop going to school. A truant officer was summarily dispatched to our flat to drag me to school. Eyeing this menacing looking figure approaching the door, I locked it, whereupon he yelled, “If you know what’s good for you, you’ll unlock the door pronto.” As I did not respond, he eventually departed. This left the school in a tricky position for what was happening here blatantly broke the rules. What was their solution to this interference with standard operations? To insist that I must be “mentally ill” and force me to see a psychiatrist – a framing which “solved” their immediate problem.

For the next year and a half, I saw a psychiatrist thrice a week. He began by administering an ink blot test, then asking follow-up questions. Whence began an extended conversation, which in no way touched on any of my conundrums. Now one day I inquired what would happen to me when I was out of answers to his queries. He never responded, from which I surmised that my safest course of action was to keep the conversation going. Now I did indeed wonder whether or not I might be “mentally ill”, as almost everyone beset by psychiatry does—for we are primed to do so. However, he soon made a critical error that signaled to me that he had not a clue what he was doing.  He told my folks and the school authorities that it was okay that I had left school for I had not the intelligence to pass out of grade 7. Well aware that I had just heard something preposterous, I made my own assessment of the assessor and his tools, and I continued to bide my time. Meanwhile, knowing that I would be seriously disadvantaged in life with nothing but a grade 6 education, I took a part-time job at the National Art Gallery of Canada—and I stayed alert to whatever “possibilities” arose.

One day my family announced that we would be moving back to Manitoba, more particularly, to the small northern town of Churchill—for my dad had landed a job there. Here was my moment! I intuitively knew that whatever anti-Semitism awaited me there would be in a range that I could handle. I immediately told my parents that I wished to return to school. They nodded. Taking a deep breath, I continued, “but I don't want to go back to grade 7. How about if I go to the grade I would’ve been in at this juncture had none of this ever happened –y’know, grade 9.” Without soliciting any further explanation, again my parents nodded. The question, however, was how to pull off a coup of this proportion given that no school would knowingly permit such a major violation of their rules. Indeed, as we were all aware, such a request would not even “compute”. My father’s brow knit as if he were lost in thought. Then he responded, “I'll assure them that you passed out of grades 7 and 8 and that I have sent for the records and they simply have not yet arrived.” 

My parents looked at me, knowing that I was the weak link for I had (and yes, still have) a passion for truth. I also knew that we were up against an unbending power and this was a critical moment–for here was my opportunity to get my life back on track. So I took a deep breath, then returned their nod. And without a word from anyone, the die was cast.

We moved. I spent the summer hitting the books so that I could handle grade 9. Then the school year commenced.

For the next several months, my father stalled the principal, who kept calling to inquire about my records from Ottawa. Come the end of the first term, I took the interim exams and came in top of my class. Then circumstances landed us in Winnipeg, where I subsequently took the departmental exams. The successful completion of the departmental exams meant that I could now “officially” enter grade 10.

I continued on, completed high school, attended a number of different universities, where I acquired four different degrees, included a doctorate, and received numerous awards (e.g., the Russell Gold Medal in Philosophy). Then I resumed teaching in universities (which I had begun after my first masters). In the fullness of time, I became a world famous scholar who had published extensively. All this, by a person, note, “officially” without sufficient intelligence to pass out of grade 7.

Discussion of Story One

Students being forced to deal with pernicious racialization is a common plight in schools. As a 12 year old who was thrown by a level of it that I had not previously witnessed, I dealt with it as best as I could. Clearly, the solution itself was less than ideal. At the same time, getting distance from the daily assault on my dignity was a reasonable course of action given that there was nothing in the system which even allowed for the possibility of such difficulties existing. Hence the decision to absent myself (the first act of resistance). Once I acted on this decision, two of arms of the state—the educational system and psychiatry—entered in to rectify a breach of their rules that could only be conceptualized institutionally as something over which they needed to reassert control. I was now trapped at least seemingly between two unacceptable outcomes—being dragged back into an oppressive learning environment or falling prey to psychiatry. 

To the best of my ability I proceeded to keep both institutions at bay. I kept the school system at bay by going along with their insistence that I see a psychiatrist. And I kept psychiatry at bay in essence by engaging in a kind of mindless chatter that might best be characterized as stalling. Anguished though I was, the task which I set myself was competently performed, in other words, and the tactic was successful.

Likewise competently exercised and sensible was the decision to return to school once I had reason to believe that I would be entering a safer environment. By the same token the decision made by my entire family—for me to skip two grades and for us all to lie to the principal—also made sense. Lest it strike you otherwise, let me invite you for a moment to consider the alternative: Had we played by the rules, not only would I have been unnecessarily stuck in a class with students two years younger, having received the relevant documents from Ottawa, instead of approaching me as a bright and promising student, the school officials would have instantly turned to pathologizing. And indeed we were all of us acutely aware of this, and as such, our response constitutes “critically aware resistance”.

Herein, let me suggest, the fact that we were working class served the family well. The point here is that working class families, like most other oppressed groups, harbour an inherent distrust of the establishment, have a standpoint which, while hardly foolproof, uniquely positions us to see through the official line. What we understood, quite simply, is that the system is not our friend. And what is mere dishonesty in one situation is self-protection in another. Not that sheer luck did not likewise come to our aid.

That said, to return to the various institutions themselves, what was wrong with what each one did—beginning with the educational system? Besides that the educational system allowed an atmosphere of anti-Semitism to flourish in the first place, it activated institutional responses which were ill advised, insensitive, and punitive. And capturing even themselves up by their rules, they turned a situation which called for listening, respect, and creative problem-solving into one which allowed for only two possible interpretations and two possible courses of action—both of them injurious—EITHER the child was “derelict” and therefore should be manhandled into returning to school OR the child was “mentally ill” and therefore should be forced into the psychiatric system.

What did psychiatry in turn do wrong? It uncritically accepted its role as the correct handler of the situation. It failed to share information. It prioritized its own dubious tools over human relating. Correspondingly, as an agent of the state, the psychiatrist proceeded to come up with an assessment that not only made no sense but was transparently political. The point is if “the child” was both “mentally ill” and “intellectually incapable”, the broken rules became far less of a problem for the other arm of the state—the school. Moreover, psychiatry’s “owning” of the situation was guaranteed.

Now as it happens, only two arms of the state directly figure in this saga, and in both cases, significantly, contrary to their own sense of themselves, they were problem-creators, not problem-solvers. Nonetheless another arm of the state might easily have entered in, and had it done so, it too would have been a problem-creator. To wit: What if the family had been less skillful in pulling off this ruse and the deception and collusion became evident? In accordance with the boss texts which determine its operation, the school would have been obliged to call in Child and Family Services. Expertly applying their own texts, the Child and Family Services officials, in turn, would have “determined” that the welfare of the child was at stake, that the parents were badly negligent at the bare minimum, and that the removal of the child from the home was mandatory. At which point, “the child” would not only have lost her home, her foundation, and her one true ally but in all likelihood, would once again have been facing the danger of the psychiatric system (theorized as help). Moreover, the family as a whole would suffer.

Now it might be argued that this happened eons ago and things would have played out in a better way today. Let me suggest, however, that racialization in schools remains a fact.  Moreover, if we assume even a vaguely similar beginning and a vaguely similar set of circumstances, the outcome today would be every bit as bad and arguably considerably worse. How so?

There is now a far closer relationship between the educational system and the psychiatric system. Moreover, there has not only been a “drug revolution” but a specific honing in on the child market (see Whitaker, 2010 and Burstow 2015). Ergo, “the child” would almost certainly have ended up on psychiatric drugs, with all the brain-damage which this entails—a course of action that would have likely commenced the moment that she stopped attending class.

Nor would the escape route that opened up later exist. The point is, unlike in 1950s, subterfuge of that particular nature is impossible under the current circumstances for the problematic records would follow the child electronically wherever she went. Moreover, even were it possible, were the subterfuge ever discovered, not only would the social services still remove the child (see http://web2.gov.mb.ca/laws/statutes/ccsm/c080e.php), and not only would psychiatry similarly summarily be called in, the psychiatry called in would be modern psychiatry –that is, one duly armed with toxic drugs.

.

Story Two: Toronto, Current Times

The major protagonists in this story are: a woman whose husband had recently died (pseudonym: Nel), her children, and her mother-in-law (pseudonym: Lisa).

A year ago, as a well known antipsychiatry therapist whose opinion she respected, Lisa called me to solicit my advice about how to help her daughter-in-law. The backstory? Nel was overwhelmed, was having enormous trouble coping. And she would every so often start screaming at her children. The children in turn were frightened of their mother. What had Lisa already done with respect to her family? Something remarkable. She had supported both the children and their mother. She had also begun advocating on Lisa’s behalf, arranging for nonintrusive counseling and stopping psychiatry’s relentless attempt to push psychiatric drugs on Nel. Having been asked what she might do now, I naturally  applauded Lisa’s efforts to date and urged her to continue on in the same vein. I likewise suggested that she spend as much time as possible listening to Nel, helping her mourn, and brainstorming solutions with her (and I gave her ideas how to do this), that she support the children similarly, that she provide the children with a place to which to retreat, as needed, moreover, that she encourage the family to hold meetings where everyone discussed the problems in the family and explored ways to support one another.

What next I heard from Lisa, besides having enacted all my suggestions, she had also in effect taught her family all that I had taught her. Additionally, she had masterminded an agreement whereby when Nel was having a bad day, she would shut herself in her room to spare the children, and on the children’s side, they would let their mom know that they needed to take off now and would return when “the storm had blown over.” Which they all accomplished without involving authorities and without incident.

What happened in the fullness of time? The pain, needless to say, did not disappear. Nonetheless, Nel began getting control over her life. The family became good at handling its problems together. The children ceased being afraid, confident that they were loved, knowing, moreover, that everything could be discussed and everything handled together.  Correspondingly, the family unit stayed in tact.

Discussion of Story Two

The institutions involved here or which threatened to become so are two of the very ones that figured so prominently in the first story. However, a very different dynamic played out, with the institutions totally kept in line—with one, additionally, drawn on as needed—and by someone with a keen sense of how to advocate.

That psychiatry posed an imminent threat to Nel is transparently obvious. Lisa's calm and effective resistance, however, prevented anything untoward from happening. What Lisa did is gently but persistently block the intrusion at hand and successfully lobby instead for the provision of empathic psychological counseling while reassuring everyone by her steady ongoing involvement. By the same token, once again we have a situation in which Child and Family Services would normally have been called in, and had this happened, once again, in all likelihood the children would have been removed—and everyone thereby harmed. The persistent, skillful, and loving help which Lisa provided prevented this from happening, moreover turned the entire situation around, leaving all family members and the family as a whole in a far better place.

What particularly strikes me about this story, I would add, is how incredibly better Lisa responded than oh-so-many mothers-in-law would. The point is that a situation like this in a patriarchal culture is a setup for a mother-in-law in grieving and who is naturally worried about her grandchildren to fall into pathologizing and/or vilifying her daughter-in-law, perhaps even encouraging social services to remove the children, placing them in her custody instead. This might or might not be accompanied by her urging that the daughter-in-law be “afforded” psychiatric “care”. How wonderful that Lisa was so clear-sighted and giving that instead of sacrificing the daughter-in-law, she safeguarded her, while helping the entire family.

In so doing, I would add, she prefigured how families and community members might handle problems in the better type of society that I would like to see us build (for details, see Burstow, 2015, Chapter Nine).

Summation/Conclusions/Suggestions

This article has laid bare a number of the intricate, insidious, and profound ways that institutions which are arms of the state individually and collectively control people, in the process substantially injuring and/or endangering them. It likewise has made visible everyday acts of skilled resistance. Correspondingly, it has demonstrated the utter necessity of such resistance. Had I chosen stories involving other institutions, I would suggest, as long as psychiatry or the criminal justice system were one of them—and to an appreciable degree, even were they not—similar dynamics would have materialized.

The primary lessons to be gleaned from the forgoing are: While for sure there are times when certain institutions serve us, we can ill afford to simply place our faith in any institution, much less any institution embedded in the state, this, note, despite the fact that society “dictates” otherwise.  We need to be aware of the connections between all major social institutions, to see how they can work together to the enormous disadvantage of human beings caught up by them. We need to prioritize people over institutions. We need to keep our eyes peeled for instances when resistance is in order. And we need to know how to resist.

In ending, some concrete recommendations that readers might consider:   

·      Nurture a healthy skepticism about all the arms of the state, including, and perhaps especially, ones theorized as “help”.

·      Albeit it may well be that psychiatry (and I would personally add others) is the sole arm of the state totally lacking in validity, be aware that an analysis restricted to psychiatry is insufficient. Safety lies in having an analysis of all regimes of ruling, having a sense of how they interconnect, and acting accordingly.

·      Get into the practice of noticing how power operates.

·      Step back from the worldview created by regimes of ruling so that you are in a position to truly assess both what is happening and what the institution or the institutional network is likely to do. A good beginning is distancing yourself from their discourses (see Burstow, 2013).

·      Touch base with and respect your own knowledge and that of your community—for irrespective of how the institutions may frame things, you surely do have knowledge.

·      Take note of the institutions currently governing your actions or those of your loved ones and/or community, with an eye to determining what problems might arise, what steps you can predict, and how, if necessary, you might work around them.

·      Observe how seemingly separate institutions connect together in ways which entrap individuals.

·      Study not only the routine operation of institutions but the permutations that occur when they connect with racialized communities, with women, with the very young, with the very old, with the disabled, with the LGBTQ community.

·      Remember that “experts” and their “knowledge” are themselves institutional products.  

·      Be willing to reach out as helpful; be equally willing to keep your own counsel as necessary.

·      Negotiate and advocate where helpful.

·      When facing the power, contradictions, and circular reasoning of institutions, be prepared to sabotage and to do so skillfully.

·      Study resistance strategies, investigating what works and under what circumstances.

·      Try to navigate life in ways that maximize the likelihood that everyone’s welfare is safeguarded, community is supported, and a decentering of power occurs.

Finally, never forget that children are far more resourceful than adults realize, moreover, while they may be at a loss to explain themselves, they have unique insight into their own needs. Correspondingly, if you find yourself dismissing their behavior as misguided, as simply bad, or worse yet, as evidence of a fictitious disease like “oppositional defiance disorder”, reach back to the time when you were a kid—then think again!!

References

Burstow, B. (2015). Psychiatry and the Business of Madness. New York: Palgrave Macmillan.

Burstow, B. (2013). A Rose by any Other Name. In Mad Matters. ed. Brenda Lefrançois, Robert Menzies, and Geoffrey Reaume. Toronto: Canadian Scholars Press, pp. 79-93.

Whitaker, R. (2010). Anatomy of an epidemic. New York: Broadway Paperbacks.                              

The Liberals’ Assisted Dying Bill: Reflections on a Cop-Out

When it comes to the issue of assisted dying, there is fresh pain and understandable outrage in the country right now because, as most readers are aware, a bill was recently tabled in parliament that, as it were, pulls the proverbial rug out from under the feet of a huge constituency who have been counting on something better. "It’s mean," states Linda Jarrett. "There’s going to be a lot of unnecessary suffering," objects Rachel Phan (http://www.dyingwithdignity.ca/advocates_speak_out_against_new_legislation). Correspondingly, a huge anti-bill lobbying effort has mobilized.

What in a nutshell has happened? The prelude is—and a highly welcome prelude it was—after years of activist struggle—the Supreme Court declared Canada’s criminalization of assisted suicide unconstitutional and it unequivocally stipulated that legislation must be passed whereby people with severe and irreversible agony, should they competently so choose, could receive assistance from doctors to end their lives (Carter vs. Canada). Enter the Liberal government, who sounded like they would comply. Now to their credit, they indeed did introduce assisted dying legislation. However, what they have tabled -- Bill C-14 -- falls seriously short of the Supreme Court ruling. Ergo, the stunned outrage.

What is wrong with the bill? And what can we do about about it?

The problems largely arise from the restrictive nature of the conditions that have to be satisfied. The most worrisome of these is spelt out in section 241.2  (2d).  Earlier sections specify that the person must be capable, have requested the service, have given informed consent (all unproblematic), be at least 18 (please put a marker here), be eligible for Canadian health services, and have "a grievous and irremediable medical condition". [241. 2 (2c)] Then comes 241.2 (2d), which stipulates that the condition must be so advanced that "their natural death has become reasonably foreseeable."

Note the vagueness in the stipulation above. Just what is meant by "reasonably foreseeable"?  And exactly how advanced and close to "natural death" must a person be? Question: Would an ALS sufferer who is told that she probably has only 6 months to live qualify? Would the stalwart Sue Rodriguez qualify -- the woman, after all, most responsible for helping Canadians begin to seriously grapple with these issues? And if not, should that not worry us? And if no one knows for sure whether or not they would qualify, should not that likewise worry us?

Worse than the lack of clarity, much like American legislation in this area (for an overview of relevant American legislation, see Stefan, 2016), the bill is intrinsically connected to the concept of imminent death. To qualify for assisted suicide, according to this bill, the person must be close to death—this, despite a Supreme Court ruling that made no such stipulation.

Herein we find a blatant contravention of the Supreme Court ruling for the assistance available was not to be restricted to people whose death is imminent or even those whose malady is terminal -- no minor difference. In the very process of veering from the Supreme Court ruling, moreover, the bill disqualifies a huge number of people, leaving them without the assistance which they may desperately need. Note in this regard, not all horrid suffering is connected with imminent death or indeed with terminal conditions at all -- a reality which does not make the suffering in question an iota less severe or the person less in need of relief.  

On top of which, the bill in essence makes the relief unavailable at any time for people with certain conditions, given the double binds created by the combination of restrictions.

Take the person in early stage dementia. At this early juncture, they would not qualify (despite having a serious and grievously deteriorating condition) for they are not yet near death.  And so they must wait. Eventually they will indeed satisfy condition "d"—for death will be "foreseeable". However, by the time they satisfied that criterion, they would no longer be able to satisfy the competence criterion. Which in short means: People suffering from one of the most humiliatingly debilitating conditions with which anyone is ever afflicted -- a condition that may rob them fundamentally of who they are -- are in effect totally excluded from exercising even the highly limited rights which that statute makes available to other Canadians. Which makes the bill inherently discriminatory, and indeed, frighteningly so.

This is not equality. This is not adequate. This is not the compassion and the dignity that we owe Canadians in difficulty. Ergo, the Liberals should seriously amend the bill, which amendments should include but not be limited to removing both the "foreseeable death" and the terminal criteria and allowing for advanced directives.

My invitation to Canadians is to urgently push the Liberals to do just that. Sign petitions; contact your member of parliament; talk to senators; let them know that we expect more from them; and urge them to vote against the bill unless the necessary changes are made. And if all this fails, gear up for a Supreme Court challenge.

That noted, to date, I have focused on problems with this bill that have already received considerable attention. Well and good. However, I cannot in good conscience end this article without drawing attention to various other problematic features -- ones of special significance to people who are likewise being shortchanged by this bill yet who are but seldom mentioned by commentators. The point here is that there is a not-so-hidden dividing line between people that the average Canadian is comfortable seeing included in such legislation and ones that the average Canadian is not -- and unless we actively grapple with the latter, fairness is unlikely to prevail. 

To begin with psychiatric survivors, here we see yet another very clear violation, for the Supreme Court stipulated that mental anguish was to qualify. Moreover, the parliamentary committee established to advise on this bill specifically stated that "mental illness" should qualify. The recognition evident here is that this suffering too can be grievous and it too can prove to be irremediable.

Question: Why has this deviation not been taken up by the public with equal fervor that others have? Quite simply because the average citizen is uncomfortable with psychiatric survivors and their misery qualifying. Understandable, perhaps, but let us look at the issue more carefully.

Now it goes without saying that like everyone else, there are psychiatric survivors leading lives of meaning to them -- and thankfully, this is the vast majority. And like everyone else, there are survivors who do not.  Of the latter, some opt to kill themselves, and as with everyone else, in many of these instances, such a decision seems premature to most, and regardless, the condition in question fails to meets the threshold of irremediable. There are survivors, nonetheless, who have struggled for decades, who have tried one measure after another, and whose agony has only grown worse -- in some cases exponentially so -- survivors, moreover, who have made a clear and measured decision to die. Are they to remain either trapped or forced to die alone? Moreover, in response to readers who are certain that exclusion is in order, whether because they believe that a termination-of-life decision by a member of this population is likely to be a product of their "mental disorder" (a concept and a conviction, note, unsupported by the evidence) or for any other reason, I would ask this: Given that the identical safeguards would apply, given, for instance, that psychiatric survivors seeking physician-assisted dying would also have to be competent to make the decision in question, given they too would have to wait the requisite period of time to ensure that the decision is not in any way impulsive, and given that the condition would have to be seen as advanced and irremediable, is not denying this population what we allow other Canadians tantamount to discrimination? And is that truly what we want this country to stand for? 

Herein, let me suggest, our biases get in our way. Moreover, our sense of compassion and responsibility toward people we see as vulnerable badly skews our judgment. The point is that while vulnerability is a reason for making extra help available, it is not a reason to deprive people of their rights (albeit we habitually act as if it is). And robbing people of their rights is ultimately neither the compassionate nor the responsible thing to do.

Finally, to end with the age restriction, the Supreme Court was clear that "mature minors" should also have access to assisted dying services -- and yet this bill manifestly excludes them. Now I doubt that anyone would disagree that extra safeguards are in order here. For example, there may be reason to look into issues of neglect or of undue influence. That is different, however, than the across-the-board exclusion found in this bill. Once again, irrespective of intention, this smacks of discrimination. And here once again, paradoxically, our desire to protect the vulnerable gets in our way and in effect leads us to shortchange and to violate.

In ending, I invite readers to grapple with these issues. While without question, we need safeguards and criteria -- and most of the ones already stipulated make perfect sense -- and while without question, we must ensure that such measures are never used as an excuse for cutting back on services for people who in any way want help to live, cannot we not be less restrictive? More compassionate? More respectful? And what better time than now when legislation is on the table and the Supreme Court has provided the requisite signal?

References

Stefan, S. (2016). Rational suicide, irrational laws. New York: Oxford University Press.

A “Hot-Potato” Topic and a “Rational” Book: Burstow Reviews: Rational Suicide, Irrational Laws

This year Oxford University Press and renowned scholar Susan Stefan (2016) released a very thoughtful book on one of the most controversial subjects with which any tome could ever deal—the question of suicide and the laws and public policies surrounding it. A long book of 540 pages, it is called Rational Suicide, Irrational Laws.

This is without question an excellent book. It is highly comprehensive, including an examination of a vast number of related laws and issues. While focusing on the US, it has international scope and provides a critical overview, for example, of assisted suicide laws throughout the world. It explores the criminalization and decriminalization of suicide. It analyzes laws by which “mental health” professionals and organizations are held accountable or “liable”. It exposes horrific contradictions in how laws are applied, particularly problematizing the assumption that people who kill themselves are suffering from a “mental illness” which makes them “legally incapable”, also the legal contradiction of mental health professionals deeming people capable when they go along with the professionals’ wishes while assessing these very same people as incapable otherwise. It weaves throughout real cases and the plight of very real people. Moreover, the underlying research includes at once depth analyses of statutes and legal journeys, and personal interviews with a large number of different folk, including health professionals, and what is especially gratifying, including people who have tried to kill themselves—a group arguably with the most relevant expertize and yet one which recognized “experts” on the topic characteristically sideline.

Finally, it is at once a compassionate and an intelligent book, written by a researcher who listens intently and who is trying to do justice to a complex issue about which she deeply cares. All of which is obvious right from the introductory remarks.

As the title of the book suggests, the story which Stefan tells and the analysis proffered is largely one of “rational” suicide and “irrational” laws and processes. Positions arrived at/articulated include: The state has an interest in preserving life and as such, a balance between the interests of the state and those of the person need to be struck. The vast majority of people who opt to end their life, including psychiatric survivors, have the legal capacity to make this choice and should be treated accordingly. The state should be getting rid of suicide magnets such a bridges with no barriers and should require the safe lockup of personal firearms. We should be moving away from an emphasis on detection and the immediate stopping of suicide to addressing the systemic issues that incline people toward suicide. A full range of help options should be made available to people, including safe houses, peer counseling, even long term 24 hour wrap-around services. While there are some who are “suicidal” for whom short term involuntary confinement is necessary given their lack of capacity, contends Stefan, in most cases, this is not so. It is critical that people who are considering killing themselves be able to talk about it freely—without the threat of being apprehended (an outcome traumatizing in itself and which increases the likelihood of suicide). What goes along with, so that professionals are not predisposed to avoid the topic of suicide or call 911, laws should be changed making “mental health professionals” not liable for the suicide of their non-committed clients.

Assisted suicide should be legal, Stefan goes on to state, but only if a number of stringent conditions are met, including the existence of capacity, the fact of having no more than 6 months to live, and having considered one’s options carefully. Correspondingly, she makes a sharp distinction between “assisted suicide” and “euthanasia” and regardless of whether or not euthanasia is actively solicited by the capable person themselves, wants it utterly prohibited and treated like ‘homicide”. And optimally, neither strangers nor family members should be allowed to “assist”.

Do I agree with all of the above? Decidedly not. However, before I touch on disagreements and what I see as problems (some of them major), let me say, there is much in this book that makes me want to stand up and cheer. The deep awareness of problems caused by trying to control people would top that list. Stefan is understandably horrified by the ease with which police are summoned, with vulnerable people concomitantly cuffed and dragged to “hospital” simply because they have mentioned suicide. As part of countering this expectable reaction, correspondingly, Stefan recommends legal, policy, and educational changes so that therapists, for example, stop focusing on control and start focusing on connection. Correspondingly, she is crystal clear that the status quo generally makes the suicidal person’s plight worse. Consider in this regard this thrilling passage:

People who are struggling with a reason to stay alive don’t want to be “assessed”. They don’t want to be asked endlessly if they have a plan, if they have the means, if they will contract for safety.  They want to talk about someone who cares, about hope, about solving the problems that seem insolvable, about how to get through the night (309).

Or consider this one:

The most skilled mental health professionals doing their best work must necessarily take risks that their patients will commit suicide. The journey to a life that a suicidal person considers meaningful and worthwhile must carry some risk. To increase the quality of life and the absolute number of lives saved, we have to be prepared to tolerate the reality that some people may kill themselves, We cannot continue creating unnecessary misery, increasing costs, and reducing both the availability and the quality of treatment to nurture the myth that all suicides are preventable. They never have been and never will be. (277)

She opines, correspondingly, that there would be considerably less suicide if we put less emphasis on controlling people and more on connecting with them.

In this last regard, while our opinions are far from identical on this issue for I place greater emphasis on freedom and personal autonomy than Stefan, let me share a bit of my own professional history for it solidly supports Stefan’s point: As a therapist, for well over three decades my specialties have been adult clients who: a) self-injure; b) are psychiatric survivors; c) have been profoundly traumatized; d) live with alternate realities; and e) want to kill themselves. As a matter of principle, I am clear with clients right from the start that I will not prevent them from killing themselves, will not call 911, so they have no need to censor themselves. Bottom line positions for me are that people desperately need to be safe to talk about “suicidal” thoughts, that we should not presume to know what is best for others, nor make decisions for them, moreover, that people in dire distress need to connect, and to deny them the possibility to do so safely is ultimately to make counseling and therapy unavailable to those in the most dire distress. What is significant in this regard, while no doubt some degree of luck has been involved, in all these decades, despite my having a specialization that makes the suicide of my clients a statistically strong possibility, not a single client of mine has ever killed themselves. As such, I am highly aware that there is wisdom in what Stefan is alleging and recommending here.

More generally, what this book does well is introduce us bit by bit to the legal territory, and the place of culture in determining what conceptualizations are viable. Praiseworthy and major contributions similarly are the author’s insistence that whatever laws are created, psychiatric survivors must not be discriminated against, must be treated like everyone else; the sharp distinction that she draws between adults and children; the argument that we should prioritize addressing the systemic problems that commonly underlie people’s desire to kill themselves (e.g., in the case of children, bullying); the push toward less control and more connection/compassion; the highlighting of psychiatric contradictions; the unmasking of so many current practices in this area as illegal and/or irrational; the downplaying of medical solutions as well as the recognition of how causal they can be in suicide; the recommendation that society consider the different types of suicide and find ways of providing the various types of help needed; and finally, what goes along with this, the caution against the advent of assisted suicide becoming just another way of letting society “off the hook”.

Which brings me to the problems.

From my perspective—and I suspect most people would critique Stefan from the opposite perspective—the author seriously understates the problems caused by psychiatry, and in no way touches on the invalidity or the inherently damaging nature of all its biological “treatments”. As such, while she wants to protect people’s rights as far as they are “legally capable” and while she remains very critical of psychiatry, she still sees a place and a privileged place for psychiatry. More generally, while she would greatly reduce it, she ultimately accepts the “need” for involuntary psychiatric detention—and no, I do not.

What relates to this, while once again being critical, Stefan accepts a view of incapacity that would still have a huge number of people declared incapable (albeit far less than are so deemed today). For example, she sees as obviously incapable people who are “floridly psychotic” and as such, would have no compunction over 911 being called on them, if, for example, they are actively suicidal. What this position invisibilizes is that there are people with such different ways of processing that they are automatically seen as lacking reason. As demonstrated in Burstow (2015, Chapter Nine), this failure to comprehend is largely a limitation of the “sane”, as well as a deficit—and indeed correctable deficit—in our education systems. Correspondingly, society’s failure to understand people whose minds work differently does not per se make such people “incapable”.

An example pertinent to the issue at hand: A client of mine that at once dwelt in an alternate reality, was “suicidal”, and who would certainly have been seen by most as ‘incapable” announced one day she was going to kill herself forthwith in order to join the trees. To the average person, it would look as if she had lost her power of reasoning and so could not conceivably be competent. An understandable reaction, sure, but what this view leaves out is that she was literalizing a metaphor. What she was saying, in “sane parlance”, is that she wanted to return to nature, to dust, as it were. That is, finding life meaningless, she wanted to rid herself of the existential burden of being a separate and cognizant being. Now I can well understand why a situation like this gives us and indeed must give us pause. Nonetheless, is not a variant of this position held by most people considering ending their lives—including those, I would add, that the average person would “recognize” as “capable”? Indeed, to step totally outside pathologizing frameworks (always a good thing), is not her question a variant of the ultimate existential question that philosopher Albert Camus (1975) sees facing all of us? To be clear, I am not suggesting that anyone “support” her decision. However, how in good conscience can we uphold a framework which would not only thoroughly invalidate it but would inevitably lead to her apprehension?

Less obviously but more fundamentally problematic is the statist framework which Stefan uncritically employs. Note, while I well understand the need to balance community rights with individual rights, weighing the needs of the individual against “the interests of the state” (in this case in “preserving life”) which the author is advocating, is a different matter altogether. To be clear, while I am decidedly “on board” with wanting to improve society and people’s situation for a variety of reasons, including so that fewer end up feeling that they have no recourse but to kill themselves, not one of those reasons is that the “state” “has an interest in preserving life”. By the same token I see as inherently problematic concepts like “suicide prevention” so rampant in this book and indeed, the very conceptualization of people “committing suicide”. Note, in this regard, “committing suicide” is a concept tied to the state. And as institutional ethnographer Dorothy Smith (1983) so astutely put it decades ago, while people indeed end their lives, “no one commits suicide.” While shifting a framework this hegemonic is hard, I appreciate, and runs directly counter to legal training, attempts to bring about a more humane approach, I would suggest—are minimally jeopardized by statist ways of thinking and statist problem-solving. By the same token, while I applaud the author for wanting and pushing for better services, I question the degree of improvement possible in our current statist arrangements, for states have their own interests, as do their representatives—note, the very people in whose hands lies the state’s parens patriae powers—ergo, the power (and responsibility) to commit and to intrude (see Burstow, 2015).

Finally, we come to Stefan’s positions on assisted suicide and euthanasia (issues with which, I would agree that as things currently stand, we need to involve the state).

To put this simply, people in dire distress and who rationally choose to end their lives often need more than either decriminalization or assistance to live, significant though both are. As a society, of course we need safeguards and of course we need standards, and of course, contrary to how we currently act, we need to prioritize doing whatever we as a community can to help improve the quality of everyone’s lives. And of course, having the right to end one’s lives does not automatically translate into having the right to assistance with this—far from it. Nonetheless, let me suggest such assistance is often in order. 

On a simple level, no one wants to die alone; most people would greatly prefer having the peace of mind that comes from knowing that the procedure will not be botched.  Correspondingly, allowing assistance of this ilk only in those cases where the person has but six months to live (one of Stefan’s provisos) is woefully inadequate. What for example, about the person who is not in the least terminally ill but is in terrible pain that cannot be stopped, that in essence cannot be “made comfortable”. Take the person who has advanced arthritis, together with exceptionally severe gastro-intestinal problems along with such a dire case of multiple chemical sensitivity, along with a body with such low intolerance that no pills will alleviate her suffering, for no medication whatever, however introduced, can be tolerated. Imagine further that she has spastic conditions that will not allow her to tolerate even seemingly non-intrusive measures like acupuncture or mindfulness or indeed any of the other options in the medical repertoire. Do we as a society really want to say to such a person that while we will not stop her from ending her life, unless she has but six months to live, we will neither help her nor allow others to?

Enter the author’s recommendation for how assisted suicide might work. Understandably worried about the involvement of doctors, Stefan recommends that persons with six months only to live enter a hospice, whose operator in turn gives them a voucher which allows them to receive a fatal dose of medication from a pharmacy. To go back to the previous example, which as it happens is not a hypothetical but a real situation with which I am highly familiar, besides that the person in question would not be eligible—for she has way more than six months to live—she is unlikely to be able to enter a hospice for the presence of everything in it would instantly make her vilely ill. Moreover, the medication is highly unlikely to be something her body would tolerate. And it is hit-and-miss with injections or other like solutions. Nor would starvation (a method suggested in this book) be endurable for her body reacts even worse to food deprivation than to eating.

Which brings me to the question of euthanasia. Stefan unequivocally rules it out and equates it with homicide even where the person in question actively requests it, waits the required amount of time, carefully considers their options. To be clear, of course far more stringent oversight is needed if we allow direct second party involvement, and of course, we need to keep in mind what has been called “the slippery slope”, but at the bare minimum people’s peace of mind in dying can at times be greatly enhanced by making more direct assistance possible. Again, take the person referenced earlier.

With solutions that work with others habitually backfiring with this person, do we not want her to have a medical expert there to deal with physical reactions that might suddenly happen, that might make an otherwise seemingly uncomplicated procedure unworkable and/or tortuous? Or do we want to leave what happens to her to chance? Correspondingly, are we okay leaving as one of the only options that does not leave her trapped or feeling guilty (the latter because of a route that involves legal jeopardy for potential helpers), the lonely and indeed frightening option of crawling away and shooting herself?

The point is clear. Society has been moving to assisted suicide because we do not want people in agony stuck with such dilemmas. However, we cannot provide what is needed without considering the real dilemmas that real people in extremis face. Correspondingly, we cannot just accept models that might work for many. Any model that places anyone in such dilemmas is unacceptable. 

Time for greater clarity on the example at hand: In short, what I have done here is draw on several of my own conditions, while leaving out the vast majority of disabling but nonterminal physical conditions I have (e.g., inability to sit, to eat more than 4 specific foods, to travel at all, to see anything without significant distortion, to treat a single ailment, to be around sounds louder than a hush, etc.). Factor in all of these and the need for active help to be available is even more apparent.

To be clear, I am 71 years old. I have a wonderful life, continue to be highly productive, work with awesome students and fellow activists, am a professor at a leading university, have just become head of my program; and I have no intention whatever of retiring any time soon, never mind killing myself soon—if ever.  However, if things got so bad that life was no longer tolerable irrespective of the help offered, a society that could only push “solutions” at me that would make my plight worse and/or would in any way penalize anyone who helped me bring my life to a peaceful conclusion would surely be failing me—not to mention the helpee. And mine is just one set of circumstances.

Who knows what worse circumstances others and indeed younger individuals might be facing? Bottom line, the criteria for qualifying for assisted suicide stipulated in this book, together with the dismissal of more active help, seriously “misses the mark”.

Two final observations: While there are unquestionably people, including doctors, whose “help” in this area qualifies as undue influence and/or borders on criminal negligence, moreover, others where it is downright murder—both of which are “beyond unacceptable”—at this point in history, that is hardly typical; and processes and laws that operate as if it is are themselves sadly wanting. Moreover, often people, including doctors and including family members who go “the extra mile” do so because individuals who are by conventional standards demonstrably “capable” want them to—are clear that they urgently need them to. Question: Can we not find better processes and ways of distinguishing what is happening? And cannot we not respond accordingly? As for bone fide helpers who cross the still-to-be-negotiated line, let us deal with that for sure, but in a way that factors in their predicament and society’s inevitable role in this.

And finally: Like Stefan, like virtually all disability activists, I too consider “beyond unacceptable” any slippage whereby states start using assisted suicide as the ultimate solution to their “problems”, as a cost-effective and convenient way of ridding themselves of whatever or whoever they see as burdensome. Correspondingly, as I too see a danger here and as I want better, not worse services, I personally would favour a policy whereby for every penny that a state spends on the combination of assisted suicide and requested euthanasia, an equal amount has to be added to the coffers supporting programs intended to help people in difficult circumstances live—that is, to help them lead lives of meaning to them.

Closing Remarks

As I stated at the outset—and I would reiterate it at this juncture—Rational Suicide, Irrational Laws is a ground-breaking, brilliant, indeed courageous book; and I encourage people to read it. There is information, analyses, wisdom to be gleaned from it. What is also important, it is written by someone who is clearly highly ethical. And reading the reflections and considered opinion of those who are guided by a strong sense of decency is in itself good for the soul.

My invitation? Pick up the book, engage with it, where you find yourself agreeing, ask yourself why, similarly for when you find yourself disagreeing, and continue thinking about the issues raised. Through the lens of suicide and societal responses to it, it implicitly asks what kind of society we want, and as such, it holds significance for all of us, addressing in the detail it does issues that cannot but touch each of our lives. At the same time, it holds special significance for psychiatric survivors, for survivors of childhood trauma, for lawmakers, for therapists, for educators, for people who are sick or dying, for anyone who has themselves or whose loved ones has ever seriously entertained killing themselves—hence my particularly drawing your attention to it.

In ending, additionally, I would say this to the author: I hope that some of what I have written holds meaning for you, including where we agree, including where we disagree.

And regardless, Susan, thank you for penning this book.

References

Burstow, B. (2015). Psychiatry and the business of madness. New York: Palgrave.

Camus, A. (1975). The myth of Sisyphus. New York: Penguin.

Smith, D. (1983). No one commits suicide. Human Studies, 6, 309-359.

Stefan, S. (2016). Rational suicide, irrational laws: Examining the current approaches to suicide in policy and in law. New York: Oxford University Press.