Blame the famous for their suicides?

When someone dies, especially at their own hand, they leave a trail of grief in their wake. When a star such as Anthony Bourdain dies, it’s more of a comet tail whose intensity gouges a black hole in the lives of a legion of friends and fans. Some of them are angry.

“Anthony I am so mad at you,” wrote friend and MeToo activist Rose McGowan in an impassioned Twitter post after the celebrity chef’s shock suicide. It’s less anger than anguish, but in the subtext there’s an accusation often buried in the aftermath of suicide.

Could the deceased have been the deliberate author of his or her own death and, if so, can we blame them for it? And in the case of celebrity suicide, where harms are measured not just in the personal toll of bereavement but in the spike of copy-cat suicides that follows, is there any conceivable place to assign posthumous guilt?

The very short answer is no. On some estimates, more than 90% of suicides are linked to mental illness, often depression, the Svengali-like effects of which unravel perspective and stamp any decisions with the unendurable weight of pessimism. Agency is lost to a treatable illness that is an intense focus of suicide prevention efforts. Facts are sparse but some suggest Bourdain may, tragically, have been in this category.

There is, however, a harder answer, which points to a rarer class of suicide in which the actor retains rationality. If this seems unlikely, recall that many jurisdictions, including very recently the Australian state of Victoria, have legalised physician-assisted dying. The Victorian legislation specifies the person must be competent to make the decision and be battling a terminal illness with less than 12 months to live.

These statutes carve the imprimatur of democracy on two contentious ideas. The first is that individuals can autonomously choose to die. That means they do so rationally and voluntarily, in full possession of the facts and in accordance with their own, carefully considered values.

The second is perhaps harder for some to digest. It’s the reality that death can be a good for the one who dies. In the face of intractable pain and with no hope of survival, death can sometimes be the preferred option.

That realisation, however, places an open can of worms on a decidedly slippery slope. If death can be a good, why so only in the presence of terminal illness?

This is a question tackled by Meera Balasubramaniam, from the Department of Psychiatry at the New York University School of Medicine, in a May article in the Journal of the American Geriatric Society. Balasubramaniam describes a 72-year-old man who had been successfully treated for bowel cancer and told a nurse that, rather than undergo repeat surgery or end up in a nursing home, he would consider suicide, “while I’m still doing well.”

The man had no cognitive impairment and, writes Balasubramaniam, “he was not found to meet diagnostic criteria for any mood, anxiety, or psychotic disorder”.

The author says geriatricians are seeing more cases like this and posits a number of reasons why. Ageing baby boomers, she writes, might be endowed with a more ferocious autonomy forged in a Woodstock era of burgeoning sexual freedom, experimentation with drugs and a general attitude of flipping the bird to authority.

But while rational suicide might seem to elide effortlessly with the cult of the individual, other Western obsessions put it in a more sinister light. Our media-fuelled youth fetish drags down the brand of age and, indeed, negative stereotyping of older people as decrepit and incompetent is not only well documented but something many will take on board subconsciously.

Philosopher Andrew Sneddon has argued that “deep” autonomy is set back when the very values that ground our decisions have been tainted in this way, raising the question of whether any suicide could be rational if the actor were, in fact, enacting suspect values conferred by an elder-hating society.

While Bourdain was in the baby boomer age range, there is nothing to suggest any of the above applied to him. To the outsider, he was on the crest of a wave of popularity, hailed by foodies around the globe as a fearless, if sometimes caustic, thinker and an intrepid venturer into the underbelly of world cuisine.

It may never be known if the chef was, in fact, gripped by a psychic pain that flew under everyone else’s radar. Moreover, as psychiatrist Steve Ellen, based in Melbourne, Australia, has noted, studies of people who survive suicide by mere chance show final moments before the attempt are often chaotic and marked with indecision, impulsivity and ambivalence.

At least one psychiatrist, however, has raised the possibility of suicide as a rational response to intractable mental anguish. Writing in the Canadian Journal of Psychiatry in 2014, Angela Ho noted some clinicians liken chronic mental suffering to that of a terminal illness.

“Desire to escape unendurable suffering, regardless of aetiology, could then be seen as a rational response,” she writes.

Could such a rational response conceivably entail blame? If it could, might it act as a disincentive to the rational-yet-suicidal actor? 

The stakes are high, as a February article in the journal PLOS One makes clear. It found a spike of 1841 excess suicides in the months after the death of actor Robin Williams. It may be an example of the so-called “Werther effect”, after Goethe’s iconic enlightenment era novel, which triggered a spate of suicidal mimicry across Europe following its publication.

The cause isn’t clear, but on one theory, glorification of an idol’s death by the media can act as a reward that reinforces suicide as a desirable solution.

Here, the question of blame would seem to cut two ways. If a person ends his or her life deliberately, in full understanding of the consequences, it seems more than likely they do so cognisant of the harms to others. But the very rationality that supports such a conclusion might also suggest that their response, like that of the person with intolerable physical illness, is proportionate, even considering those harms.

Either way, should feelings of anger and betrayal migrate to blame, it would seem at best a subsidiary concern, and probably belongs with the jumble of other emotions with which those left behind struggle.

Meanwhile, the default for any person thinking of self-harm is that the underlying causes are treatable, help is available and every effort must be made to connect them with it.

If this story has raised any issues for you or someone you love, please call these numbers:

In Australia, Lifeline: 13 11 14

In the US, national Suicide Prevention Lifeline: 1-800-273-TALK [8255]

In the UK, Samaritans: 116 123

In India, Lifeline Foundation: +91 33 2474 4704

In Canada, Canadian Association for Suicide Prevention: (613)702-4446, or for a list of regional contacts: https://suicideprevention.ca/need-help/