The Dictatorship of Hope

"How could I know - how could anybody know - that her death wish was not a sign of her psychiatric disease? The fact that one can rationalise about it, does not mean it's not a sign of the disease," says psychiatrist Dr Frank Koerselman, one of Holland's most outspoken critics of euthanasia in cases of mental illness.

He argues psychiatrists should never collude with clients who claim they want to die.

"It is possible not to be contaminated by their lack of hope. These patients lost hope, but you can stay beside them and give them hope. And you can let them know that you will never give up on them," he says.
The troubled 29-year-old helped to die by Dutch doctors

While the idea that every life is precious is laudable, I do think that it's worth asking, "Why?" at times. Aurelia Brouwers decided, after some 17 years of severe mental illness and distress, that there was no end in sight (or over the horizon), and that she wanted to end the pain herself, by taking her own life. Dr. Koerselman believes that this was the wrong choice. Which I don't have a problem with, but I'm curious about his reasoning. If the presence of mental illness renders others unable to truly understand the patient's interior life, why decide that they don't actually want what they say they want?

What I find interesting was his statement that "It is possible not to be contaminated by their lack of hope." This casts hopelessness as being a pathology itself, and perhaps that explains a lot. If you view hopelessness as a disease, then of course a wish to die becomes a symptom. When I first heard the story of Pandora, Hope was characterized as the one good thing in her jar of evils. But as I grew older, I encountered different versions of the story, in which Hope was the last of the evils.

"Like people with diabetes, psychiatric patients are also treated for years, but this is not an argument to stop treatment.

"It's very well known that after the age of 40 things might go much better for people with Borderline Personality Disorder - their symptoms might become much milder."

Aurelia Brouwers was 29 when she died, after suffering from mental illness for 17 years. Doctor Koerselman felt that she should have held on for another 11. Not because he could actually assure her that he, or anyone else, could do something for her, but out of hope.

The problem that I have with positing hope as a requirement is that it's one-sided. That hope may never be borne out - and it's the very real possibility that nothing will come of it that makes it hope in the first place. Therefore, to treat hopelessness as a disease or a contaminant is akin to saying that there is pathology in refusing to invest when there is no visible path to any sort of return.

There is, I think, a certain amount of irony in positing life as too precious to belong to the person who has to live it, because there is a risk that if one person is allowed to say that they don't want it anymore, that this will become the new default position. Because one wonders who life is precious to, if not the person who has it.