Book:  Every Cradle Is a Grave:  Rethinking the Ethics of Birth and Suicide

Author:  Sarah Perry

Type of Book:  Non-fiction, philosophy

Why Do I Consider This Book Odd:  Pretty self-explanatory.

Availability:  Published by Nine Banded Books, you can get a copy here:

You can also order a copy directly from the publisher.

Comments:  Sarah Perry wrote this book from a place of philosophical intellectualism and factual integrity.  She exhaustively researched the hows and whys of suicide and procreation and makes a very compelling case for making suicide accessible for people who do not want to live and for considering whether or not it is ethical to continue to create new humans whose lives may be more a burden to them than a gift.  As she deftly picks apart the arguments against suicide and antinatalism, she bestows upon mankind a dignity and respect for self that anti-suicide and pro-birth crusaders deny us as we are asked to suffer and to mindlessly recreate ourselves because of tyrannies of tradition and religious mores.

I very much want to discuss this book in a bloodless manner because the subject matter is so fraught with emotional reaction, much of it knee-jerk, that makes the topic hard to discuss in an intelligent way.  When you speak to people whose loved ones killed themselves, you hear them speak of the cowardice and selfishness of suicide.  When you talk of people who did not have children, you all too often hear others dismiss ethical childlessness as selfish, or insist that if only one had a child, one would know, really know, what true love means.  To approach a counter to such topics with emotion is pissing in the wind because the very basis for avoiding suicide and encouraging procreation is steeped in emotion.

But given my personal history and recent events in my life, I can only approach these topics – especially suicide – from a place of emotion and personal anecdote.  I hope that as I write from my id I do this topic justice.  This book really is a paradigm changer, and you don’t have to adopt an antinatalist world view for that to happen.  It is a book that argues against some of the most deeply ingrained habits of human existence – to remain living at all costs and to spread one’s seed far and wide – and it makes the case that our reason and self-awareness are not entirely a great gift and that possession of them should permit us to control how we decide to die rather than be used as a manipulative tool to keep us living.

And there is no way to discuss the entirety of this book.  Know that I will be unable to discuss large amounts of this book and that you need to read it yourself.  All I can do is discuss what I experienced when reading this book and how it relates to my life.

Perry begins her treatise with an analysis of Bryan Caplan’s theory of “free disposal.” Caplan, an economist, through analyzing current trends in suicide, makes a facile case for how it is that the mass of people consider life a great gift.  Caplan states that since it is so easy to end one’s life, that there are so many options available to the suicidal person, the fact that so few people avail themselves of suicide proves in itself that life is valuable to us all.  For Caplan, because there are so many tall buildings one can leap from, and because one doesn’t have to worry about cleaning up the mess one leaves behind, that proves, economically, that even though the “cost” of suicide is cheap, people choose not to commit suicide not because it is hard to do but because we as human beings really value living at all costs.

Without the rancor that would accompany my own dismissal of such an argument, Perry neatly tears apart Caplan’s economic view of cheap suicide.  The costs of suicide are steep, Perry explains. People are not free to do with themselves what they want.  The very nature of the secrecy of planning suicide proves that one is not free to take one’s life because the secrecy is necessary to prevent people from stopping you from dying.  You have to plan to die in secret because it is illegal for anyone to help you and if you fail you may find yourself locked up in a psych ward, your will thwarted and your future in the hands of people you do not know.

But Perry goes beyond just the basic economic analysis Caplan offers.  Suicide is hardly a situation of “free disposal” because anyone who thinks about committing suicide knows full well the social burden suicide brings with it.  Someone will have to find your body and it’s appalling to think of a family member or friend encountering such a thing unprepared.  Suicide with drugs is risky and prone to failure but more effective methods are messy and one does not want to think of one’s mother or husband cleaning brain matter off the wall.  Then we have to face the knowledge that our loved ones will feel utterly betrayed because we crept around behind their backs in order to die and they are left holding the bag, second guessing themselves, wondering if they could have saved us, wondering what they did wrong.  Did they miss the signs?  Could they have gotten us help?  Or worse, they may be angry at us for being cowardly, for not fighting to stay alive at all costs.  There is nothing free about suicide in this world.  If it costs us nothing when our bodies hit the floor, the loneliness of planning a covert suicide and the reactions of those surviving us have a cost that many find too dear to pay.

Most interesting to me was Perry’s analysis to support the notion that most suicides are not caused by a person feeling out of options or that life is too hard.  Temporary despair seldom fuels suicide. Most suicides are committed by people who feel like they lack connections to others, or are tired of being burdens or fear becoming a burden.  Virginia Woolf did not drown herself because she could not endure another depressive episode.  She drowned herself because she could not see putting her family through the effects of another depressive episode.  It is in this moment when the self-awareness that is supposedly a gift to human-kind is most evident, a realization of one’s limitations and endurance and our impact on others.  In order to work around that self-awareness, we’ve imbued suffering with meaning, a religiosity that guilts us into remaining alive and to creating more living beings, ensuring that no amount of personal or inflicted misery can ever be seen as a legitimate reason for dying because our suffering evidently ennobles us.  It teaches us lessons.  It gives us meaning that makes the suffering seem worth enduring.

*****

I now know there are ways you can tell a person is getting ready to die.  Gradually failing appetite.  Distaste for being touched.  Mood changes.  Agitation. Much of what marks a person beginning to die can also be markers for depression except for one:  seeing and speaking to dead loved ones.

My mother confused me for her mother on the phone a couple of times before she died in January of this year.  My grandmother died in 1981.  She was also convinced my grandfather was in her home, pacing the hallways, looking over her.  He died in 1994, and he indeed haunted her.

My grandfather shot himself in the head, dying in a hospital when life support was removed.  He shot himself because he was 78 years old and his health was beginning to fail him. I don’t know the details but he wasn’t fatally ill.  He was just an old man who did not like being an old man because he had been so strong in his youth and middle-age.  His family was long-lived and he was the baby of his family.  His own mother, a vile Irish hag, lived with him and my grandmother when she was old.  She more or less turned my aunt into a nervous wreck and wreaked havoc on my very sensitive grandmother.  My mother claimed the evil old woman didn’t bother her much but Mom never copped to any mental or emotional weakness, at least not around me.

My grandmother suffered for decades before she died in her early 60s and my grandfather was her primary care-taker, even as he worked as a rancher.  He loved her dearly and did not resent his role but it is undeniable that my grandmother’s severe illness changed their marriage.  He was unable to save much money, he spent much of his life caring for his elderly mother and then his sick wife, and it all left a mark. My grandfather married a widow after my grandmother died and lived in her home because he had been a sharecropper (share-rancher is more accurate) and owned nothing but his truck. My mother thought my grandfather remarried because he didn’t want to be a burden for her or my aunt, but either would have loved to have had him come live with them.  But he didn’t want any of that.  He’d seen how that worked out for him, his wife, his children.

My grandfather had spoken of his older brother Tom, who in his 90s was a dementia patient in diapers.  He could see years and years of failing health with indignity after indignity heaped upon him.

He didn’t want to be a burden on anyone.  He hated not having financial independence.  He didn’t want to sit by idly as his body failed and his mind left him.  He didn’t want to wait around for the worst to happen.  So he took care of it himself.

It shocked everyone.  My grandfather was a deacon in his Baptist church.  He had strong ties to his community and was in his way a pillar of the community. He was quite literally the last person anyone would think would kill himself.  Well, he was until you looked at it logically.

In the last year of her life my mother was so bitter towards her father.  She told me many times she planned to confront him in Heaven, to tell him off for what he did and demand an explanation.  She said he could have lived 20 more years had he not killed himself.  I asked her why, as a Christian, she could not forgive him.  I asked her why she wanted him to stay on Earth in a body that was failing, in an emotional state that hurt him.  She would look away when I asked her these questions, never answering.

I know the answers now.  She couldn’t forgive him because he planned it and no one knew.  She was angry because she could not prepare.  She was angry because she could not say goodbye before he left.  She felt abandoned by him, like he had made a craven choice to leave her behind without a single word of warning.

So she was haunted and spent the last year of her life in misery because she didn’t understand and felt angry.  I wonder if at the end she began to understand why he did it.  I know I do now.

And I wonder how different her last year would have been had my grandfather lived in a culture where impoverished, elderly men who were tired of life and rightfully afraid of what was to come could end their lives in the presence of those who loved them, preparing people for the end rather than planning covertly, going in quiet dignity rather than blowing their brains out in their backyards.  She would have had more peace as her own body failed her.  She would have been able to remember how wonderful a man her father had been.  She could have planned to meet him again with an open heart rather than angry demands for answers.  She would not have been haunted by him pacing the hallway, nervously awaiting her arrival.

*****

One of the elements of Perry’s analysis that stuck with me the most is the notion that we human beings exchange suffering for meaning.

Rather than eschewing all suffering, individuals frequently accept some degree of suffering in pursuit of other rewards – either in the form of meaning or in the form of pleasure.  The mountain climber or medical student affirmatively chooses to suffer for the purpose of future experiences, pleasurable or meaningful.  Others, looking back on times of suffering, say they are glad to have had such experiences.  When making decisions for ourselves, there is no moral problem with trading off suffering for pleasure or meaning; it appears to be a social fact that people do not minimize suffering in their own lives.

She goes on to make note of the fact that even though acceptance of suffering is evidently a part of human decision calculus, we really don’t have the right to actively inflict suffering on others so that they can later interpret it as a meaningful experience.  This is an element of thought important in creating new human beings – when we have children we are effectively asking these beings who had no say about coming into existence to participate in this exchange of misery for meaning, and Perry questions whether or not we have the right to do this.

This question also comes up for me when a person is no longer possessing higher consciousness.  We imbue suffering with meaning because of our higher consciousness and self-awareness but how moral is it to ask a person stripped of any sort of sentience to continue to suffer when such a personal exchange is no longer possible?  Well, we tell ourselves that life is sacred and we cannot deprive anyone of life, no matter how little they experience life or how quickly they know they will be facing the end of their natural life.  Life has assumed the role of an ultimate good and because we cannot inflict suffering on others we cannot help them achieve a pleasant death, even if refusing that death is itself the infliction of suffering.  Worse is the use of other people’s suffering for our own interpretation of meaning.  We tell ourselves that terrible things happen for a reason and that if we learn a lesson, then it was all worth it in the end, and that’s a very callous way to process suffering that we don’t have to experience first-hand.

All of this has led us to a very sorry end. What do we do when we know suffering no longer has any experience-value for the person suffering?  The answer is:  not much.

*****

For close to fifteen years my mother had suffered and the last year of her life was spent in complete misery as her conditions became terminal.  I can’t even begin to describe what happened to her and the last six months she was alive were torture, the sort I know I simply could not have endured. She had many things going wrong with her body, all of them painful, all of them complex.  But of all the things we thought would kill her, a brain hemorrhage was not on the list.

She was already in the hospital for a fall brought on by hepatic encephalopathy and suffered the hemorrhage in the middle of the night, and because the hepatic encephalopathy made her sleep heavily, the nurses didn’t notice anything was wrong until she had already lost all her higher brain function. It was not until late the following morning on January 2, 2015 that a scan showed she had suffered complete death of her cerebral cortex and her cerebellum.  Had the doctors detected the bleed the moment it happened there would have been nothing they could have done – her blood was unable to clot so surgery was not an option.  We just had to wait for her to die on her own as the swelling in her brain reached her brain stem.

The hospital, which had no facility for hospice care, didn’t bother to arrange hospice transfer immediately because they were so sure she would die quickly.  They eventually put her in a room on the sixth floor and the vigil began.  The doctors said my mother could feel no pain so no genuine palliative care was offered – they called what they did “comfort care” and very little of it seemed comforting.  She was given anti-seizure meds, which we later learned didn’t prevent seizures but rather prevented the seizure from manifesting physically and upsetting us.  She also was given an anti-inflammatory drug that would help slow the swelling in her brain.

We were waiting for the swelling to reach her brain stem so she could finally die. Why did they give her anti-inflammatory drugs via IV?  That inexplicable action prevented her brain stem from herniating and she could potentially have stayed in a coma for years.  However, my mother had refused a feeding tube before the hemorrhage, so even though her heart kept pumping and her lungs kept breathing unassisted, eventually death would come in the form of dehydration and starvation.

And that was okay, in a perverse way, because if her cerebral cortex and her cerebellum were completely dead, as we had been told, she wouldn’t need morphine.  The hospital didn’t really take care of her much – they unhooked her from all monitors and didn’t bathe her until she had been in her coma for six days and my aunt and I told the nurses we could smell an infection in her skin.  But she didn’t feel any of it.

But then a nurse told my mother’s husband that she could probably hear us, spoke of a pamphlet  (that never materialized) that she promised would prove that hearing was the last sense a person suffering brain death lost and we should talk to her and hopefully she would respond.  I came into the hospital room one day to see her husband asking her to squeeze his hand if she was okay with elements of her funeral planning.  I know now that people who are dying who seem unresponsive often can hear everything around them, but my mother was not temporarily unresponsive while dying.  She had suffered complete death of all higher brain function.

I said, “If she can hear us and can respond via grunts or hand movements, then she can probably feel being unclean, she can feel herself starving, she can feel thirst, and she can feel pain.  If they are telling us to talk to her, then they need to give her plenty of morphine.”  That didn’t happen but suddenly the posturing common to brain damage patients seemed like communication with a still sentient, self-aware human being. I know my aunt and my mother’s husband needed to think she could hear them and I spoke to her as well. Otherwise I was sitting in a dark, fetid room watching what was left of my mother refuse to die.

But I also needed to believe she lost all higher brain function and could sense nothing because otherwise I stood by and did nothing as my mother was starved to death, as she felt pain and fear.

When my mother’s carcass didn’t shuffle off this mortal coil fast enough, Baylor Irving finally decided to force her husband to either take her home to die, which was impossible since there would be no way to afford the nursing care, or to pick a hospice, any hospice, pick it now or else, and no, she might not survive the transfer but since she’s pretty much a corpse anyway who cares, right? Besides, my mother was taking up a valuable bed, one of the two pieces of shit masquerading as social workers told us.  She was taking too long to die and they needed the bed and they said this at the foot of that bed while my mother was still in it.

Finally my mother did make it to hospice on January 9.  She was taken care of by an excellent end-of-life staff.  They noticed my mother was making facial expressions as though she was experiencing pain so they gave her morphine.  She died not long after her second bag on the 10th.  I know deep in my heart what happened – the morphine depressed her nervous system so that her body could die along with her brain.  She had had no fluids outside of IV-bags of meds, she had received no food for nine days and the morphine helped end it.

But the hospice could not say this.  They could not say, “This has gone on too long.  She has been gone for over a week – the woman you loved is no longer in this body.  This is killing all of you.  This has to stop, so we are going to give her morphine until she dies.”  That is illegal in Texas.  So they had to tell my mother’s husband she was in pain, that it was possible she was in pain the whole time, in order to do what can only be called the most ethical thing.  And no matter how much I know that my mother was gone, really gone from her world of pain and misery as of January 2, I am still afraid she suffered.  That she was in pain.  That the woo-slinging nurse was right and she could hear, that the excellent hospice wasn’t reacting to brain stem grimaces so that they could ease her out of life.  That she felt, heard, smelled and experienced every goddamned minute of it.

Why is it death is so feared that even the most hardened atheist and humanist slips into magical thinking when faced with it.  We tell ourselves a brain stem medically prevented from herniating is a sign of a sick old woman’s stubbornness and willingness to fight, to rage, rage against the dying of the light, as if that’s a good thing, to suffer and suffer because to die is far worse.  Even Christians who believe in the celestial kingdom of eternal life after death mindlessly fight against the mechanism that sends them to their Lord.  We see death as worse than suffering, and we give our suffering human attributes of spunk, of strength, of sanctity, because we are too chickenshit to face the reality that sometimes death is better than life.

And since we are too afraid to face death, how the hell can we speak openly and honestly about how suicide can so often be better than continuing to live.  Sarah Perry was unspeakably brave to write this book.

I finished a pre-publication version of this book right before my mother began her final spiral in November and it changed how I processed my mother’s death.  I had little patience for any of it because I could not justify the suffering my mother may have endured and that we, her family and friends, endured.  In a sane world, when a terminally ill woman suffers complete higher brain death, we don’t ask what remains of her to starve to death.  We let her go and we let her go quickly and we do what is needed to help her leave.

You don’t have to subscribe completely to the notion of antinatalism to realize that our modern beliefs that life is the ultimate good in every situation infantilizes us and forces us to engage in cruelty in the name of life, even if we know the life is untenable.  I don’t know exactly where I stand on the subject of antinatalism but I can say this: There is no moral force in this world that can ever convince me that a suicide entered into sanely is somehow more immoral or irrational than what happened to my mother.

People have told me that I learned something from this, that I am stronger for having endured it.  They can go fuck themselves because my mother’s death was not mine to learn from.  The only thing I walked away from that experience knowing is that if I ever become that ill, I will not wait for the inevitable end.  I will not ask anyone to grow from the experience of watching me die.

*****

I am focusing so much on the suicide part of this book because aside from some maternal rumblings when I graduated from college, I never really wanted a baby.  I couldn’t have had one even had I wanted one, so it all seemed very neatly put together – lack of desire coupled with physical inability. I thought about foster care a few times and even that seemed a bad idea.  I suffer from cyclical but major depressive episodes and there was no way then and no way now to justify putting a child through it. Suicide and death are what I know.  Babies and regeneration are not a part of my world.

Because I am a depressive, I seem to know all too well the burdens of being alive but I also know the burden that my own suicide attempt had on those who love me.  Sarah Perry discusses this carefully in the book as she flays Bryan Caplan’s insistence that we have a “free disposal” society where suicide is concerned.  Our ties to others often makes suicide difficult, if not impossible, even for those with a strong will to die.

…people do not exist as individual units separate from human relationships and groups.  A great deal of the cost of committing suicide faced by a person wanting to die is social and empathetic: it is resonant in the loneliness and grief that his death will cause, or at least hasten, among parents, children, siblings, a spouse, or friends.  As social creatures, we begin forming bonds at least as soon as we are born; these bonds, while often no more voluntarily chosen than our own births, are powerful motivations.

[…]

The suicide of a close associate is usually regarded as much more than the event of such a person moving across the country and losing touch, even though the deprivation is similar in either case.

Some social costs are artifacts of the prohibition.  The suicide must act in secret, sneaking and hiding to avoid detection and unwanted rescue.  But who will discover his dead body?  It will be especially traumatic for a relative or close friend to happen upon the dead body of a suicide.

But for me the most interesting prohibition for those seeking death that Perry discusses is the threat of intervention before death and its repercussions.  If you survive a violent attempt at suicide, you will be left in a wrecked body with even less quality of life than you had before you attempted suicide.  If they find you before the drugs stop your heart, they will bring you back to consciousness and you will likely find yourself in a mental hospital for a time determined by people who do not know you and for whom the reality of your life will never be clear because they have a single mission: to make your mind better so you won’t attempt such a thing again.

And then you have to face everyone who suffered because of your actions.

Caplan’s attempt to apply free market economics to suicide is actually one of the stupidest things I’ve ever read, now that I think hard about it.  Only a man who has never heard the song could so effectively mangle the tune.

*****

After reading this book, I went back and reread sections of my old blog wherein I discussed the before and after of my own suicide attempt.  I went psychotic due to really inappropriately prescribed pharmacology and ended up in a mental ward on Halloween of 2008.  It was bizarre reading those entries because even though I can barely remember much of that time, I also know that what I wrote in my blog were hardly the words of someone completely in the throes of psychosis.  I asked Mr Oddbooks about it and he explained that there were long stretches in late September and October when I was completely lucid.  Then a light would switch off and I would become incoherent and violent.

But as I read my account of the hospital, I was struck by how distant I was in my recounting of it.  It was horrible.  It was far worse than the suicide attempt on both of us, my husband and me.  I was completely deprived of will and so was he.  A doctor whose own diagnosis of me was completely off the mark was responsible for determining when I could leave and, once I knew that, I marched to her tune and did and said what I had to do to get out, including submitting to a pharmacological regimen far worse than the one that had landed me there in the first place.  Initially the drugs seemed to help but eventually I developed something called toxic psychosis from being on Wellbutrin, Prozac, Klonopin, Valium, Xanax, Trazedone, Ambien and Provigil.  I was on all of these at once, after having been prescribed the anti-psychotic that landed me in the hospital in the first place.

I’ve talked about my suicide attempt on this site before.  But I seldom discuss the aftermath of the hospitalization.  I was fucking insane.  I attempted suicide at least two more times and both times Mr Oddbooks did what he had to do to both save me and keep me out of the hospital because the hospital had made it all so much worse.  I am often scared to share this element of my recovery because I fear that someone who is suffering who may not have a genuine will to die may read this and think that not seeking help is in their best interests.  But the fact remains that most forms of help available to me during that time invariably made everything so much worse.  Nothing got better until I detoxed from all those drugs I was on.  And I was too scared to go to rehab to get off those drugs (and insurance denied it anyway), given my experiences in the loony bin.  From September 2008 through the end of September 2009  I lived in hell and my husband did, too.

But here’s what I want people who read this to understand:  drug-induced psychosis is not a valid will to die.  Now that I am drug and alcohol-free, my life is strange to me at times but I am very glad I am alive.  But my happiness to still be here is not proof that suicide is a great moral harm.  It just means that what happened to me is not universal.  Once I was drug-free I never attempted suicide again and never again had a definite and clear urge to die.  It would have been very regrettable had any of my attempts succeeded.

But that is the caprice of life, is it not?  We regret a lot of things.  And due to that potential for regret we’ve decided that we can dictate to a cancer patient in terrible pain, a brain tumor patient who does not want to bankrupt her family in exchange for a few months of life, a person with MDD who simply cannot face another episode, that the possibility of someone somewhere making a bad decision means they cannot make a decision.  Your regret, my regret, your best friend’s brother’s regret are not everyone’s regrets.  The potential for regret doesn’t prevent gun sales.  It doesn’t prevent divorce.  It doesn’t prevent the purchase of mid-life crisis Corvettes that get wrapped around utility poles.  It is puritanical and disingenuous concern that causes our potential regrets to condemn this specific choice.  Concern trolling, as it were.

That doesn’t mean that you don’t want to help a fifteen-year-old kid who is facing turmoil due to transgender status or terrible home life.  Such a being is not in clear mind – that person needs intervention, as I did as I was not in my clear mind when I tried to die, even if the help was not particularly helpful.

What you should do is stop using the worst case scenario – a young person making a bad decision or a middle-aged woman in a psychotic haze making a mad decision – and using it to make public policy to prevent people whose lives are a misery to them and will never improve from exercising their will to die.

But it has to be said:  though I recall very little of that year of my life, I do know that if I ever, for any reason, decide to take my life, I won’t attempt an overdose.  I will use a far more more violent and effective method because the aftermath of suicide was far worse for me than the act itself.  I know for a fact that Caplan is wrong.  There are many, many costs to disposal.

*****

Ultimately, at heart, I am not an antinatalist.  Part of my reluctance to adopt such a philosophy is that I don’t know how self-aware and conscious many people are, how much their life is dictated by reason and how much is dictated by instinct.  We are animals, albeit animals with a bit more strategic capacity.  I think I am too pessimistic about the human condition to be an antinatalist because I just don’t think that the mass of humanity really think through their life choices.  And I’m not patting myself on the back here – had we not suffered from infertility there is every chance Mr Oddbooks and I could have brought a child into the world based on whim, tradition, a misplaced desire to make someone else happy, a belief that a shiny new person could heal old scars.  The will that guides me is not always what happens.  Human beings are remarkably preprogrammed in many ways.  At its heart, despite the innate pessimism in seeing mankind’s self-awareness and advanced consciousness as a curse, antinatalism is a philosophy that if made active requires optimism, hoping that human beings can put their higher consciousness to work in a manner that eliminates current and future suffering.  I don’t think we all have such nobility of character.  I’m just not that hopeful.

But Christ this book made me think.  It’s extraordinarily well-written, well-researched and well-reasoned.  It was elegant at times.  And it helped me deal with the death of my mother in a way I had not expected.  I didn’t have to dwell in platitudes.  I didn’t have to deny what was happening to us all watching her slowly starve to death.  I could say that what was happening was morally wrong, and I was surprised when a few others agreed with me.  I am very grateful to Sarah Perry for that.

Highly recommended.