Twenty-year-old Michelle Carter was convicted last week of “involuntary manslaughter” for encouraging the suicide of her friend Conrad Roy III, in July, 2014. While I’m not surprised by the outcome, I’ve always wondered if anyone should be held responsible for another person’s actions, up to and including suicide and murder.
The law says they should. Psychiatrists, in particular, can be held liable if their patients–present or past–kill themselves or anyone else. A mere hint of “suicidal ideation” in an emergency room is enough to get someone committed to psychiatric hospitalization, at least for an observation period of up to 72 hours.
That homeless people, alcoholics, drug addicts, and those escaping the law or outside enemies use this ploy to obtain “three hots and a cot” on cold or stormy winter nights is common knowledge in the medical world. There are also the drug seekers, who hope to receive controlled substances to alleviate their pain. While others want to blame the patients, I look to the crazy-making system itself. Those who learn to “work the system” are only doing what they believe is necessary for survival.
The professional’s challenge and dilemma is always to determine intent to act. Psychiatric evaluation is meant to assess the seriousness and immediacy of the threat. It includes questions about access to weapons, past attempts, serious stressors (like medical diagnoses, relationship breakups, financial crises, for instance), level of intoxication (if any), mental stability (such as psychosis) and other possible contributing factors to the person’s distress.
In most cases, a 24-hour hospitalization is enough to alleviate the symptoms and allow a person to be discharged safely. By morning, most people have changed their minds, at least until the next time. Those who are truly suicidal can remain in the hospital for weeks, months, or even years, although this is becoming rarer. Psychiatric hospitals are so crowded that there’s constant pressure to discharge as soon as possible, or at least as soon as insurance coverage ends.
Bottom line is potential suicidality is taken very seriously in the medical and psychiatric world, and each case is different. Although it is an ethical no-no for psychiatrists to diagnose or analyze people they have not personally examined, I deduce from news reports that there were a number of factors playing into the Carter case, including the un-examined belief that anyone can prevent anyone from doing what they intend to do.
News sources say Mr. Roy had attempted suicide four times in the past. Ms. Carter met him in 2012, had emotional and mental problems of her own, and needed to be needed. She fancied herself a helper, and up until the last two weeks of his life, she tried to convince him not to kill himself. Then she suddenly changed tack and began encouraging him to act on his threats. She even ordered him back into the carbon-monoxide filled vehicle when he became scared and got out. Most of this was done long-distance, say the reports.
Witnesses for the prosecution claimed her motive was attention, as she was communicating various moves in this two-year dance to a variety of other people. It’s not clear whether anyone intervened or tried to break up this dangerously destructive dynamic. Was this so-called need for attention a desperate cry for help by Ms. Carter herself? Apparently Ms. Carter at one point encouraged Mr. Roy to seek professional help, but did she consult anyone herself about this problem? Chronically suicidal people can be exhausting, even for professionals, when they begin to manipulate for sympathy, attention, or to control the relationship. At what point does the helper give up and say (or think), “Quit talking about it and just do it.”?
I don’t mean to excuse Ms. Carter for her actions. She apparently gave a lot of bad advice over a long period of time, and she was way out of her depth. Who can ascribe motive? For all anyone knows, Mr. Roy may have killed himself sooner if not for Ms. Carter’s friendship. I happen to believe suicide is a personal choice. I don’t recommend it, but I also believe we all choose our time to die, on some level. We only differ in how we do it.
katharineotto 