There is no one untouched by crises of mental health. And yet, when you or someone you love is going through it, it can often feel like you’re alone in the dark, searching for a light. In honor of World Mental Health Day, we are publishing a series of essays, starting today and running through the weekend, that tackle this topic through a personal lens. We hope these essays offer a little insight into the many ways that people struggle, and how they can come out the other side with dignity and grace.
I’m sitting alone on the couch, held in place by a weighted blanket my husband’s grandmother gave us. The living room is dark except for the light coming from the TV. An episode of X-Files is playing at a low volume.
My sister has been staying with us for a week this time.
Perhaps she comes to me when she’s in trouble because I’m older. Maybe it’s because she doesn’t have to hide who she is when she’s around me. I don’t judge her when she spends long hours asleep. I don’t try to rationalize her paranoia or challenge the delusions that come from a combination of her schizoaffective disorder and drug use. Then again, it could be that my guest bedroom is a lot better than the rooms she’s stayed in at psychiatric hospitals and drug rehab centers.
The bottom of her pajama pants had been folded underneath her feet when she’d shuffled to bed hours earlier. But I suspect she is still awake. Even with 15 feet and a wall between us, I can sense her insomnia like I sense my own. The meds she takes to quiet her mind don’t always work. (Approximately one-third of patients diagnosed with a major depressive disorder are categorized as treatment-resistant, defined in resources offered by Johns Hopkins as “lingering depression symptoms in patients who have taken multiple antidepressants or antidepressant classes.”)
I fill a small glass with tap water and tip-toe to the end of the hallway. I knock lightly on the door. I don’t wait for a response before I push the door in slowly, a manifestation of my role as big sister, always taking charge and professing that I know how to fix things.
The small TV in the room is on, but no sound is coming out of it. The black garbage bags she’d quickly stuffed with clothes, shoes, makeup and bent pictures are ripped open, the contents strewn across the floor.
“I’m heading up to bed. Can I get you anything?” I always want to make her feel cared for in a way I fear she never does.
“I’m ok,” she says.
I push the door all the way open and kick mismatched socks to the side. Some water splashes from the glass as I navigate across the messy floor and sit down on the bed. I nudge her body, buried under blankets, to make room for me.
“I’m glad you’re here,” I say. “You should just rest now. We’ll have plenty of time to figure everything out.”
She pauses a second and then turns to me, “Jen, I think we should look into Death with Dignity.”
***
The Death with Dignity Act invokes a sense of pride for most Oregonians. The physician-assisted suicide law passed in our home state in 1997. It was written by the Oregon Right to Die Political Action Committee and petitioned by a former nurse, a doctor, and a man whose wife suffered from an incurable and painful heart condition. It would be more than a decade before other states followed. Washington enacted its own law in 2008, after which eight more states and Washington D.C. passed similar medical assistance in dying laws. In 2021, New Mexico became the latest, and bills are being considered in several other states including New York, Pennsylvania, Michigan, and Delaware.
My sister didn’t suffer from the kind of physical fatal diseases that have led many people to seek out a means to end their lives. But she was suffering. All the prescribed drugs in the world couldn’t cure my sister, so she often resorted to whatever was available. I never judged her drug use. Legal or illegal, I just wanted her to feel better. To me, the antipsychotic meds that gave her Tardives Dyskinesia, a neurological disorder that made her eyes and mouth twitch uncontrollably, seemed almost as damaging as the meth that she sometimes snorted or smoked.
Nowhere in the United States is medical assistance in dying allowed for those who are suffering mental conditions. That’s because, according to existing law, the patient must be capable of making the decision without impairment, which is definitely difficult when you are suffering from a mental disorder. In Canada, however, where a federal program exists to assist those who wish to end their lives, there is a movement underway to consider mentally ill patients. There is an argument, as outlined by the professor of philosophy Clancy Martin in The New York Times last year, that “the difficulty of understanding extreme psychological suffering is in fact a reason to endorse a prudent policy of assisted suicide for at least some psychiatric cases.” Paradoxically, the logic is that the possibility of doctor-assisted suicide may actually save lives. As Martin summarizes: “If you know there is no medically sanctioned way out of your mental pain, you may be likely to take matters into your own hands.” Intervention —even ostensibly aimed to assess the possibility of doctor assisted suicide—could potentially expose patients to resources that could help them live.
***
I tell her I don’t think they do that for mental illnesses.
“Then will you do it?”
She sits up to look me straight in the eyes. Her bottom lip starts to tremble the way it does when she begins to cry.
“Jen!” she says loudly, uncontrollably. “I’m scared. All the time. My head hurts and I can’t think straight. If we do it this way, you could be with me.”
Everything goes silent, and a high-pitched ringing rips through my ears. The room is filled with the smell of fresh laundry. No matter her circumstances, she always has clean clothes and they always smell good.
I picture myself injecting her with something that would end her life and her illness at once. My stomach flips violently and I think I might throw up, but I maintain my stillness there on the edge of the bed.
It wasn’t the first time she asked me to save her, but this time was clearly different. Before, she’d wanted me to rescue her from bad men, on the street or in bars where danger was present. But this time it’s not my safety I fear, it’s my inability to survive her.
“We can find you some help,” I say, as if I don’t understand that those kinds of statements feel empty to her in her times of despair.
She’d attempted suicide for the first time when she was 14, but she is 27 now and right here in my guest room, proving she can keep going. My hope blinds me to reality, that the fact she fought before doesn’t mean she will fight forever. Tonight she is telling me that she is done.
I hear my husband’s feet stop behind me at the bedroom door and immediately wonder how much he’s overheard. I turn quickly, like I’ve been caught in the act.
He is a sweet and generous man. “No regrets,” he told me on our first date. Something only 20-year-olds say. We’d grown up together in the way you do when you marry young. If you’re lucky enough, your tangles intertwine around each other.
“We’re good,” I say too fast. “I’ll be up in a minute.”
He steps through the doorway anyway. “Am I missing the party?” he says with a grin.
“Not right now, babe. I’ll be up in a minute.”
No matter her suffering, I can’t allow myself to consider playing a role in her death. Five years older, I’d been there for all of it, from her childhood night terrors to fleeing abusive men she thought she could please. She’d been sick for a long time. But surely, there is hope. Surely, the right med cocktail, the right living situation, the right doctor, support systems—surely, she can find a better life.
She lays back down and turns away from me, defeated. She pulls the fluffy down comforter up around her neck, the way she does when she desperately needs sleep and wants to be left alone.
I linger there for a few minutes, on the edge of the bed with my hand on her hip, before I get up. I bend over and move her hair back away from her face. I kiss her on the side of the head as if she is a little girl and say, “I love you, we’ll talk more tomorrow,” and I go upstairs to bed.
***
While I didn’t know what the next day might hold, I held fast to the belief that I could save her. Somewhere deep down, somewhere intensely emotional and not at all practical, I believed I could make the difference. These beliefs came from a place of denial and desperation: denial that her illness was as severe as it was and desperation for help and acknowledgement of our struggle. I went to every length possible to prevent the inevitable, all the while thinking I had some sort of power that none of us ever have. In that anguished hustle that so many families of the mentally ill know well, I was alone.
My sister and I would go on to fight her illness together for 13 more years before she died by suicide at the age of 40. I still commemorate the anniversary of her death every year. She found her own dignity through her incredible strength in the face of so much adversity. I will forever remain in awe of her fight.
If you or someone you love is suffering, please seek help.