Why NOT commit Suicide? -
Medications and the Wisdom of Albert Camus
March, 2004, by John Tennison, M.D.
According to the
Nobel Prize website, Albert Camus won the Nobel Prize in Literature 1957
"for his important literary production, which with clear-sighted
earnestness illuminates the problems of the human conscience in our times"
"always refused the existentialist label with which he is usually
associated," 1 the word “existentialist” has become
inextricably associated with him. His
resistance to the word's usage is understandable, in that its usage amounts to
categorical thinking, which causes the uninformed to think in terms of
stereotypes and assumptions about what Camus believed or wrote, rather than take
the time to search out the uniqueness of his personal perspective and
experiences. This same discomfort
is felt by many patients who have DSM’s (Diagnostic and Statistical Manual of
the American Psychiatric Association) 2 simplistic
"diagnostic" labels applied to them, at the expense of their
individuality being taken into account by clinicians.
DSM allows 1 of the 5 of 9 criteria required for a "Major Depressive
Episode" to be "recurrent thoughts of death (not just fear of
dying)" or "recurrent suicidal ideation without a specific plan."
Thus, even the preoccupation with suicide is enough to be considered
"pathological" by modern psychiatric nomenclature.
Yet, it was precisely a preoccupation with suicide that Camus considered
the most fundamental question of philosophy. Rather than taking
the unsophisticated stance of modern psychiatry, which assumes, almost
universally, that even considering suicide is irrational, Albert Camus turns the question
around by essentially asking, "WHY should we NOT commit suicide?"
In the 1955 Preface
to "The Myth of Sisyphus, and Other Essays" (translated by Justin
O'Brien) 3 , Camus wrote,
subject of "The Myth of Sisyphus" is this: it is legitimate and
necessary to wonder whether life has a meaning; therefore it is legitimate to
meet the problem of suicide face to face. The answer, underlying and appearing
through the paradoxes which cover it, is this: even if one does not believe in
God, suicide is not legitimate. Written fifteen years ago, in 1940, amid the
French and European disaster, this book declares that even within the limits of
nihilism it is possible to find the means to proceed beyond nihilism. In all the
books I have written since, I have attempted to pursue this direction. Although
"The Myth of Sisyphus" poses mortal problems, it sums itself up for me
as a lucid invitation to live and to create, in the very midst of the
desert." -- Albert Camus, PARIS, MARCH, 1955 3
In his essay,
"An Absurd Reasoning," Camus wrote, "There is but one truly
serious philosophical problem, and that is suicide. Judging whether life is or
is not worth living amounts to answering the fundamental question of philosophy.
All the rest— whether or not the world has three dimensions, whether the mind
has nine or twelve categories—comes afterwards." 3
concludes that suicide is "not legitimate," that is, it is not a
desirable thing to do. Camus
instead embraces the absurdity of the human condition, and finds meaning by
becoming "a great sensualist for whom sun, sea, sex, football, and theatre
were the answer to life's absurdity." 1
How each of us finds meaning, is, of course, an individual choice.
Thus, one role of psychiatry should be to help patients find there own
sources of meaning, a process that can often have significantly greater lasting
effects than those that result from the knee-jerk prescribing of the latest
patented and often expensive medication(s).
I am not trying to
suggest that medications don't have a role in finding meaning.
In fact, I propose that psychiatrists use the word,
"absurdolytic" to describe medications that can increase one's sense
of meaning. Clearly, some medications can accomplish this effect better
than others. These medications
appear to have their "absurdolytic" (lessoning one's sense of
absurdity) effect by activating the dopamine system.
In particular, those that are used in ADD (attention deficit disorder)
(Also known as ADHD) can have this effect.
Dopamine activation, (or "agonism" as it is known in
pharmacology) is often described as being associated with activating the
pleasure or reward centers of the brain, but for the intellectually-minded, this
activation can be experienced as an increase in meaningfulness, rather than an
increase in pleasure per se. This
increased meaningfulness, in turn, is able to keep the attention of quick minds
that would otherwise become easily bored.
In terms of DSM
terminology, the "anhedonia" which can qualify a patient for the label
of "Major Depressive Disorder" (MDD), is often experienced more as a
sense of "meaninglessness" by the intellectual, rather than as a loss
of sensual pleasure. In fact, DSM
does not require the presence of a depressed mood to qualify for the
"diagnostic" label of "MDD."
That is, "anhedonia" along with other symptoms can qualify one
for the label of "MDD." Although
having a "depressive" disorder label without being having a
“depressed” mood is an illogical use of the English language, knowing of
this contradiction can be of assistance to the clinician who is under pressure
from insurance companies or other institutions to pigeonhole his or her patients
into DSM "diagnostic" categories.
In summary, as is the case in most areas of psychiatry, the greatest therapeutic result is likely to occur as a result of combining psychotherapy with medication. Although it is often under-emphasized in modern psychiatry, an existential approach to psychotherapy (emphasizing a search for sources of meaning) combined with dopamine agonism can have a very high-yield outcome.
Introducing Camus, by David Zane Mairowitz and Alain Korkos, 1998, by
DSM-IV-TR (the Diagnostic and Statistical Manual, Fourth Edition, Text
Revision), 2000, by the American Psychiatric Association
The Myth of Sisyphus, and Other Essays, by Albert Camus, (translated by
Justin O'Brien), 1955, by Vintage Books, a Division of Random House
to the Psychiatric Journal Home Page