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The roster of failed suicide-prediction tests that Will Stephenson explores in his essay [“The Undiscovered Country,” Miscellany, August] reminded me of a time in the mid-Fifties when an eager nursing student suggested I take an attitude test. I was a teenager who didn’t believe in the order of things and who tended to hold negative opinions—conditions that prompted psychological evaluation.

The test was straightforward: draw a stick figure family of three. I drew the stick figure child between the two parents. Each parent held the child by the hand.

The psychologist who analyzed my drawing was astonished. What I produced wasn’t what she had expected. And even then I knew what she expected from me: an image of alienation, perhaps even child abandonment; some evidence of trauma that could have explained my hardened worldview.

From my experience, psychologists and psychiatrists then believed that people like me must have some hidden internal reason for feeling as we did about the world. The world itself could not possibly be at fault.

At a group therapy session that I attended in the Sixties, a participant attributed her psychological breakdown to her controlling husband. The psychiatrist leading our session was a powerful man at the university who held regressive ideas of feminine behavior. He replied: “Well, you know, it has always been this way.” That he had nothing good to say about me I now take as a compliment.

What was not understood then is that a Panglossian attitude leads to disappointment for anyone with empathy and observational skills. The guru at the end of the article has it right: the meaning of life is life, and what you can make of it. Even at my advanced age, I remind myself regularly that I’m alive, and that it is a privilege not everyone has.

Doris Wrench Eisler
St. Albert, Alberta


While exploring the implications of suicide prediction, Stephenson asks a stirring question: Are we all suicidal, albeit in a dormant way? He notes that a person might not know he is going to kill himself before he does it. This has implications for the researchers whom Stephenson profiles, people who are working to construct a predictive science of suicide.

The potential outcome of the prognostic work is so obvious that perhaps Stephenson feels no need to state it: If we know people are going to attempt suicide, we can stop them, we can save them. And if we can, then we should.

But who wants to be saved? As a writer and producer who has written extensively about health care and right-to-die bioethics, I wish Stephenson had considered longer-standing suicidal impulses that follow years of suffering, and that are more tangled than the deaths to which Stephenson alludes: violent and impetuous, the product of false hopelessness and despair.

In March, the Canadian parliament voted to expand the country’s law on physician-assisted death to eventually include certain patients who are physically well but suffering from a “grievous and irremediable” mental illness, such as chronic depression or PTSD. Canada’s expanded law will serve a very different kind of patient from the one Stephenson describes. It will apply to people who want to die and plan to die and who tell us so, very clearly.

Critics of such legislation have asked how medical providers can know whether a psychiatric condition is incurable. They argue that patients with severe mental illnesses are incapable of making life-and-death choices. They insist that treating suicidal patients’ lethal longings as medically reasonable, and then helping them to die, is akin to collaborating in suicide—or at the very least, that it confuses the symptoms of mental illness, like despair, with clearheaded expressions of free will.

Several European countries already consider mental illness a valid criterion for physician-assisted death in a limited number of cases. Indeed, certain European medical professionals speak of assisted death as a kind of harm reduction. Some patients are just going to kill themselves; this way, they won’t die alone or in pain.

When I visited the Flanders region of Belgium, I heard euthanasia described in exalted tones. It was proof, people said, of Belgian enlightenment—secular humanism and freethinking winning out over religious superstition and cheap taboo. In Antwerp, one doctor told me that he initially refused to assist a patient with a personality disorder who wanted to die. After he turned down her request, she stepped onto the street and set herself on fire. Today the doctor assists such patients.

The new Canadian law assumes the existence of a death impulse motivated by mental illness but nevertheless rational. Activists speak of “rational suicides” in contrast to suicides that are sometimes called “deaths of despair” (which, to be clear, are most suicides). Rational suicide presumably operates less like impulse and more like cost-benefit analysis, with sober calculations about dying and living. I wish Stephenson had taken the time to explore what suicide prediction might mean for those suicides, too.

Katie Engelhart



Sensual Flow

In her review of Roger Deakin’s Waterlog [“Writ in Water,” Review, August] Leanne Shapton claims that the book “might be the most romantic swimming memoir ever written.” I had previously forgotten the romance of water stories. Shapton’s review reminded me that it’s everywhere: the swims chronicled in The Iliad, The Odyssey, and Beowulf; the mythical pleasure of entering ponds, streams, and oceans with unfathomable depths in Charles Sprawson’s Haunts of the Black Masseur. Books such as Waterlog beckon us to dive in headfirst, Ledecky-like, with joy in our souls.

Jeffrey Susla
Woodstock, Conn.

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October 2021

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