The Absence of Suicide from Obituaries

Suicide, assisted suicide, and our continuing discomfort with mental illness

My father was an avid reader of obituaries. Once, when I was a teenager, I told him that his habit of reading them every morning with his cappuccino was weird. At the time, I considered anything I didn’t understand weird, and the word “morbid” wasn’t part of my lexicon. My father, never one to take the bait from his occasionally irksome son, explained that reading obituaries was an excellent way to learn recent history.

Now, at about the age he was when we had that conversation, I am an obituary devotee. I most enjoy reading obituaries about people whose names I recognize but know little about them. A discomfiting fact about obituaries (as well as the Wikipedia pages of the deceased) is that they usually include a cause of death. We seem to have a macabre, voyeuristic, fascination with how people died.

Last week I read two obituaries that I can’t get out of my head. One was about a person who had taken her own life. The other was about person who might have. The columns tell us a great deal about how we think about mental illness and assisted suicide and made me wonder if obituaries in the future will read differently.

I heard about the death of a classmate’s child and read the young person’s memorials. It was devastating. From the articles, this twenty-something was a vibrant and beloved friend, family member, and gifted student. It did not seem like the person had been ill. No cause of death was provided. Given the individual’s youth and life history I assume the cause was suicide or overdose.

Like in the 1980’s when the obituaries of scores of young men only said “he died after brief illness,” it seems to me rare that suicide (or overdose) is named as a cause of death. I know of no systematic data that proves this point. It is only the sense I get as a daily reader.

I would never encourage a family to share anything they are not comfortable making public. There is absolutely no reason my curiosity needs to be satisfied by learning the cause of a stranger’s death. I only comment because, in a sea of obituaries about people losing their brave battle with cancer, we seldom hear about people losing their fight with depression, or schizophrenia, or opioid use disorder. This shows how far we are from accepting mental illness the way we accept medical disease as a tragic fact of life.

Last week I also read the obituary of Betty Rollin. I am embarrassed to admit that I had not heard of her. She was an amazing person, a network news correspondent, and a memoirist. I write about her not because of her accomplishments but because the second paragraph of her obituary began: “The cause was voluntary assisted suicide, at Pegasos, an assisted dying service…”

Of course, this struck me for the public acknowledgment of suicide. I had also recently listened to a stunning episode of This American Life in which Amy Bloom tells the story of accompanying her husband Brian, who was suffering with Alzheimer's disease, to assisted suicide with Dignitas, another Swiss dying service.[i]

Although rarely acknowledged in obituaries[ii], assisted suicide is not rare in the US. It is legal in eleven states and recent numbers suggest that at least 1300 people ended their life in this way in 2021. Ms. Rollin was an advocate of sorts. She had written about helping her mother end her life and belonged to Compassion & Choices, an advocacy group that supports expanding access to end-of-life medicine. I expect, but do not know, that she had a hand in including her cause of death in her obituary. I wonder if she, recognizing that all suicide so often goes unreported, hoped to give it more of a public face.

Maybe, at some point, we will become comfortable enough to share this information in death, and this will make people more comfortable with it in life. Comfortable enough to seek treatment. Comfortable enough to have insurance coverage of mental illness and commensurate to what we have for physical illness.

The approach I am imagining Ms. Rollin took reminds me of Harvey Milk. He believed that if people were more open about their sexuality, we would recognize the diversity in those closest to us. It is hard to be homophobic when you know that your friends, colleagues, and family members are gay. Milk was quoted in a San Francisco Examiner article after he was killed.

“I cannot prevent anyone from getting angry, or mad, or frustrated. I can only hope that they'll turn that anger and frustration and madness into something positive, so that two, three, four, five hundred will step forward, so the gay doctors will come out, the gay lawyers, the gay judges, gay bankers, gay architects ... I hope that every professional gay will say 'enough', come forward and tell everybody, wear a sign, let the world know. Maybe that will help.

I am not calling on families, during what I am sure are the most difficult times, to do anything that might make their pain greater. I myself am confounded by the issue of assisted suicide. Although I feel it should be legal, with significant protections, I also do not believe doctors should be primarily involved. This is personal for me. I did not go into to medicine to be an active participant in the end of my patient’s lives, even if that is what they desperately, and rationally, desire.

A pithy conclusion to a meandering post? Not likely. If my sense that suicide as a cause of death is generally kept hidden from the public, I believe that reflects our longstanding problem with accepting the normalcy of mental illness. Maybe this failure of acceptance applies to well-considered assisted suicide as well. I expect that as we become more comfortable with mental illness being “just another disease,” we will read about people “finally succumbing to their depression.” Maybe having more people as brave as Betty Rollin will get us their faster.

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[i] A film that I think does a wonderful job with the complexities around assisted suicide in dementia is the movie Still Alice.

[ii] I recognize a bias here. I read obituaries in the New York Times and assisted suicide remains illegal in New York. It is legal in California, Colorado, The District of Columbia, Hawaii, Montana, Maine, New Jersey, New Mexico, Oregon, Vermont, and Washington.

Attached photo by K. Mitch Hodge