Don’t Give Up, Adam!

In an argument on behalf of assisted dying for the mentally ill, a young man named Adam Maier-Clayton, 26, of Windsor, Ontario, explains why he is in favor of it. He thinks he should be able to end his life because of the mental pain he has endured for the past few years.

He was well until he was in college, when the anxious and obsessive-compulsive symptoms he had experienced earlier began to return. On top of that was “psychosomatic pain,”which got worse and worse. ”You know when you touch your toes, and you feel that burn at the back of your legs,” he told a reporter. “It’s like that in my face, in my back, in my head, and it doesn’t stop.”

He became psychotic, and some caregiver gave him the diagnosis of “dissociative disorder,” which used to be called “multiple personality disorder.”

He now describes himself as being “neurobiologically doomed,” sees no hope and believes he should be able to end his life.

Hold on here.

First of all, our hearts go out to this sad, hopeless young man who is experiencing the symptoms of severe depression. A star athlete who is now an emotional cripple, this should not have been permitted to happen in a country that prides itself on its up-to-date health-care system. At the human level, he deserved better.

He has somehow fallen between the cracks in the system of psychiatric care, and has spent the last decade accumulating these fragile psychiatric diagnoses, as though he had a medical illness and his doctors first told him he had mumps, then heart disease, then liver cancer.

While one cannot make a definitive diagnosis of Adam’s plight owing to the lack of detail, there are medical illnesses he could have that might produce all this pain, though much of it is mental in nature (yet nonetheless real). If he turned out to have such an illness he could be treated for it and given back his life.

But his symptoms are not inconsistent with psychotic depression. He believes that he is not depressed, based on the fact that “I don’t hate myself.” But that doesn’t rule out depression.

What steers the observer towards psychotic depression is this pain theme. He’s enveloped in it. And here again, at the human level one can only commiserate. A life bathed in pain is a life in hell. Yet pain is one of the primary symptoms in psychotic depression. (See Psychotic Depression. Conrad M. Swartz and Edward Shorter. Cambridge University Press, Cambridge 2007) And it seems to stretch endlessly across his future horizon.

This sheer cheerlessness – called anhedonia -- is another characteristic of serious depression: the annihilating hopelessness these patients experience. There is no source of joy – no sunray of happiness – left in life. It seems like a miserable plod to what they hope will be a quick end.

But, Adam, don’t do it! You apparently have not been well looked after. He’s tried everything he says, psychoanalysis, numerous medications, even “acceptance and commitment” therapy. Unsurprisingly, all have failed.

What he has apparently not tried is electroconvulsive therapy (ECT), which is actually the therapy of choice in psychotic depression. These patients, for whom other treatments generally have the status of placebos, usually respond very well to ECT.

So this is a disheartening comment, not on the travails of this unfortunate young man seeking to end his life, but on the health-care system that he found himself enmeshed in and that has failed him. ECT must be available in Windsor. It’s a big industrial city. Did he fall into the hands of the Freudians (who hate ECT)? Or did all of his friends cry, “No no no, they’ll burn your brains out!”

The answers to these questions are unclear. Clear is that he’s ended up on the front page of the “Life and Arts” section of Canada’s national newspaper, a poster person for allowing euthanasia in depressed psychiatric patients.

For sure, many of these patients want to kill themselves – and some do. But when they’ve been successfully treated and are back to their families, their jobs, their dogs and their sports careers, they recognize psychiatric euthanasia as a profound waste of life and a shocking breach of medical ethics.