The Land of the Cold-Hearted

brown wooden armchair on brown sand during daytime

Hard times create strong men, strong men create good times, good times create weak men, and weak men create hard times.

The Dutch are hitting again!… I thought that my previous article, A Way Out, which was quite extensive, has covered a lot about euthanasia. I didn’t expect to write again about the same subject in less than 3 months but this theme annoys me for various reasons and the case that I’ll be discussing below reaches new lows and has some political, medical and ethical aspects that are worth considering.

First, the facts. I typically avoid giving details and be too specific but I guess that those interested can identify the person and the story widely available on the internet. We’re talking about a 28 years old woman which is scheduled to be euthanized in a couple of days, at the beginning of this month. The details relating to the way she has planned her death are available online and are quite disturbing, so I won’t share them here again. The idea is that she is in a loving couple with her boyfriend 12 years her senior, she has two pet cats and seems to be okay financially and socially. By the average standards of this world taken as a whole, she is doing fine (that is, you calculate the average standard also considering the lives of those in Africa, parts of Asia and Americas, not only the average of the so-called civilized world, which is roughly about 20% of the world population). However, she is struggling with mental health issues, namely depression, autism and borderline personality disorder. Being tired of her struggling with depression and after several treatment failures, and since her psychiatrist has told her that “there is nothing more we can do for you” and “it’s never going to get any better”, she has decided to euthanize herself and she finally got the okay from the Dutch government. These are the facts.

From a political standpoint, one can argue that in the current European situation where the countries are struggling with low population replacement indexes, with few baby births and an increasingly aging population, giving the green light for a 28-year-old to lawfully commit suicide is not the wisest move. I mean, look at Japan or South Korea, countries that are completely powerless in front of a huge decline of the young population and rampant suicides… Do you think that Europe is any better at this chapter?! Germany has invited more than 2 million migrants (and still counting) to come to live and work and correct the deficit in the workforce and the aging population trend, and despite the catastrophe that ensued (which I won’t cover here), there are still not enough children being born. So, in this dire circumstances, the Dutch government (under the supervision of a well-known individual still acting as prime-minister, who apparently can’t get enough power and now wants even more at the NATO level) doesn’t care about this “social hemorrhage” of people committing suicide. Apparently, the reason for this euthanasia is “life fatigue”, as the woman is not bedridden, in the final stages of a terminal physical illness, or anything like this. And one question arises: Is the discomfort caused by a mental problem sufficient to accept it as a lawful way to end someone’s life? Anyway, at political level, the entire situation, despite perhaps being “sold” as a sign of civilization/progress, is nevertheless a loss for the Dutch nation and for the European population as a whole. We need the traditional family and the resulting children so as to rebalance the births deficit on one hand… and on the other hand we do the opposite and let people die… It is not coherent!

Now, from a purely medical and ethical viewpoint: I am constantly shocked by the competence (or the lack of thereof) of the Dutch doctors. Autism is often a manageable issue and the autists are never exceeded emotionally so as to ask to be euthanized (this goes contrary to what autism is, by definition). Then, the borderline personality disorder is definitely a difficult situation to live with, but to end up an accomplice for a patient that is manipulating you so as to make you accept her projected lack of solution and finally accept to declare that “nothing can be done”?! Come on! You can’t see the forest because of the trees! Depression is definitely the hardest diagnosis of the three that have been stated, but to go along the lines/wishes of a suicidal patient instead of stopping her from killing herself… this is revolting from the perspective of someone who is also a psychiatrist! I mean, we do our job to prevent suicide; we don’t facilitate it! Or has psychiatry changed in the meantime and I wasn’t aware!?! Are we still the guardians of life? Or have we “graduated” so that we’re also the facilitators of death!?!

Emotional inner void is probably what is forcing this woman to euthanize herself. I understand. It is extremely painful. You typically don’t see it on her face, on her clothes or in her behavior, but the void hurts. The void and the fatigue typically belong to the borderline disorder. The autist doesn’t care whether she is full of emotions or not, and the depressive patient can be literally drugged with several antidepressants (that is, psychiatric medication) until she gets out of her depressive episode. The only problem is with the borderline disorder, because you can’t get out of your own dysfunctional personality (you are who you are, at a specific moment in time), and if there is emptiness and meaninglessness in your soul, you have to live with that. I understand this, I had my patients who struggled (and still struggle) with this and it’s very nasty. But why would some psychiatrist, who is sane in his or her own head, convey to a patient that “there is nothing more we can do for you”? The main treatment for borderline personality disorder is psychotherapy, not psychiatric medication. This means that you give medication only when the patient is passing through a depressive episode or an anxiety disorder, or when she’s suicidal. Otherwise, you work on the relationship and support the psychotherapy work, which typically lasts for years. This is written in most serious books of psychiatry or, to put it bluntly, “it’s in the manual, in the guidebook”. One needs to read the manual of psychiatry… at least the Dutch colleagues. So, it is extremely disturbing to fail to give the proper medical recommendation: it is true that for borderline disorder the medical treatment has its limits, but there are still a lot of resources in the psychotherapy realm. So, the patient needs to be focused on re-parenting, on emotional training, on attachment issues and all the other typical issues related to the borderline disorder, issues that are discussed in a psychotherapeutic setting. Yes, it’s hard, but there are psychotherapists specialized in borderline personality disorder and the patient has the right to see them and fight for her life with their help. Yes, I know that statistically, in the textbook, it is stated that the borderline disorder is likely to last for the rest of one’s life, but are we doing statistics or are we managing individual cases!?! Are we managing “diseases” or are we managing “individual patients” or “individual human beings”!?! What if this soon-to-be-euthanized patient actually belongs to that small cohort of patients that will heal and not die with the disease!?! My Dutch colleagues have let their preconceived ideas and their statistic-infested convictions cloud their judgement and have sentenced this lady to death. And it is regrettably for me to be in the position to witness this…

Another problem with my Dutch psychiatry colleagues is that they have become too voided themselves of any compassion and common-sense… They probably have a mechanistic view of the human psyche and they see the patients just like cars that need fixing with chemical molecules (with drugs, with pills). This is the so-called biological psychiatry, a viewpoint that sees the human being mainly as a body and the human psyche as a by-product, an epiphenomenon of the brain activity. The biological psychiatry gives little importance to relationships, to emotional regulation, to aspects linked to an existential (humanistic) attitude that emphasizes concepts such as acceptance of the burden of this life, commitment, and – why not? – courage to live one’s life. From a biological standpoint, nothing can be done for this woman (the chemical receptors in her brain don’t work satisfactory and the medication is ineffective); from the standpoint of the social psychiatry or of psychotherapy in general, there is still a lot to be done…

Another sign of, unfortunately, incompetence – and I mean affective incompetence or lack of emotional intelligence – is the fact that the psychiatrist has stated that “it’s never going to get any better”. A patient comes to a doctor (a psychiatrist) searching for a solution but also seeking hope (you expect the doctor to tell you that your life is salvageable, that you will survive or your functionality can be improved). It is inhumane to take away that hope. It is inhumane (read cruel or cold-hearted) to tell someone that “you’re never going to be better”. For terminal cancer patients for instance, it is perhaps fair to convey this message of irreversibility in a delicate form, but when talking about mental issues, it is not. One never knows the future. One makes a mistake to state something about things that haven’t happen yet. I always pronounce myself on what I see in front of me, in the present, and I might have an expert opinion about what happened. But I never comment about what might happen or about what will happen, in my opinion (although I might have a personal opinion, but I keep it for myself). Why? Because the future didn’t happen yet and it might be different from what I imagine. How on Earth can you be so low in emotional intelligence so as to tell to a patient that there is no hope!?! I fail to understand what those psychiatrist are doing in a profession in which empathy and tactfulness should be paramount…

Following the verdict of the psychiatrist – actually his or her own projection versus the probable future of the patient – the woman decided to do what any sane person would do when dealing with a dark, negative prognosis: take her life in her own hands. So, euthanasia there is! The law – politicians, judges, legislators, etc. – are not psychiatrists; they are not experts, so they have an excuse. They accepted the verdict of the doctor. If the psychiatrist says that there is nothing to be done, they will follow the expert’s advice. So the woman is now free to kill herself.

Now, I would like to go a bit in depth: there is an epidemic of euthanasia deaths that has begun for some months in the West. There is also a new epidemic of drugs in the US and it begins in the Western Europe as well. One can argue that this woman has a borderline disorder and she has successfully manipulated her psychiatrist and the judicial system so as to let her die. But from a different perspective, her case is not singular. Borderline patients are plagued with void and life fatigue, but this is only half of the story. The other half is a society that offers nothing but meaninglessness and emotional deprivation in various forms. Many people believe that the West is in a serious moral or spiritual crisis because it has left the traditional values, heavily tested on many generations before, and has embarked in a rationalistic (not rational) adventure that aims to describe reality only from a purely materialistic and thinking perspective, excluding the emotional, the mythological and the transpersonal. The result of voiding the human being of its numinous essence is embodied by this woman who will soon die: she has everything from an outside perspective (boyfriend, pets, physical health, finance, etc.) but something is lacking. And that thing that is lacking makes life unworthy of being lived.

When you live in an emotional desert, you tend to do two things: collectivization and atomization.

Collectivization is when you tend to socialize but the emotional bond doesn’t exist. Put some people in a room today, do something – anything – and see if relationships develop. People are polite, they are trained to properly socialize, but they typically fail to create a bond, to create a community, a common spirit, a common story. Some don’t know how to do it, some have forgot how to do it and some are simply too vulnerable to open up and risk a connection. As a result, people remain alone inside the group. It’s like mixing sand with water: you can’t, they remain separate. The suicidal woman has probably lived her entire life as a collectivized being: nobody within her social group will tell her now to stop killing herself, they will all be “sufficiently polite so as to respect her choice”, maintaining a politically correct attitude of non-involvement. Since there is no bond, nobody will step in and tell her that she is wrong and she will be missed, including members from her own family (which is also collectivized). She is superficially socialized, she has a social network of some kind, but she is, in reality, emotionally alone. Nobody cares about her. Her place in the social network will be taken by another person and life will go on. No feelings got ever involved.

If you love your boyfriend, you don’t go to be euthanized because you want to maintain the bond and you don’t want to see him suffering because of your disappearance. Yes, love has an amount of possessiveness in it, although some might argue the contrary. But if each of you has his/her own life, you respect the other, you occasionally have intimate relationships with that person (that’s sex), but you remain two separate entities that fail to mix. This is called atomization. Each in the couple is an atom, a particle: we meet, we spend some time together, and then we go our separate ways. No deep feelings involved. No sign of belongingness, which often happens to be the cement that keeps people together and prevents euthanasia. Nothing like this, only limitless respect for one’s decision but nothing personal whatsoever.

A society plagued by collectivization and atomization is a society that is disintegrating. It is dying. Mark my words!

The quote at the beginning of the article is something worth pondering on. All has begun by being hard in the West, then things have improved because people got tough. But then, good life invited superficiality, lack of spiritual depth and many other signs of decay. Good life made people soft and shallow. And shallow people are, in a way, weak people. They can’t face properly the same degree of adversity their ancestors had to deal with. However, life’s challenges have remained the same, and the borderline disorder has remained unchanged throughout history. The only difference is however that today’s people are less able to manage situations that were dealt with easier in the past. And this is how we arrive at the current time, when weak people have created a dysfunctional society that is unable to advise correctly from a medical viewpoint, and offer healthy interpersonal bonds that prevent people from asking to be euthanized.

The time has come for people to become strong again. Are you in?