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Issue 2
Racism, ageism -- but not ableism
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 Attempted Suicide, Completed
In December, national media noticed
what Not Dead Yet has been saying for years -- that most of those who died at Jack Kevorkian's hand were women who were disabled, not terminally ill. The significance of that fact, however, escapes them.
They're not understanding evidence before their eyes. They cannot see it because they cannot or will not ask the right questions.
The Woman Problem
That the vast majority of those who died by Kevorkian's hand were women has been reported since the beginning. Dr. Kalman Kaplan, a professor of psychology at Detroit's Wayne State University who has been writing about Kevorkian for years, says the gender ratio among Kevorkian's deaths resembles the attempted suicide rate in America rather than that for completed suicides (researchers have long known that suicide patterns vary among groups and that some groups -- elderly people, African-American youth, Native Americans and women -- have a significantly higher risk of suicide attempts than do working-age white men -- see sidebar). But none of the researchers seems to have a viable theory about the gender disparity in completed suicides.
In America, the overwhelming majority of successful suicides are committed by males -- however, three to four times more women than men attempt to kill themselves. Few of those studying the problem have any real explanations. Some suggest that since women are weaker than men physically, psychologically, or both, their suicide attempts are weaker as well; but this fails to take into account that such things vary by individual and that suicides by pill or firearm need no great strength. A more reasonable explanation for the suicide gender disparity says that women's suicide attempts come from the oppressive conditions of our lives; that many of the women who attempt suicide do not want to cease living altogether so much as to cease living under the conditions that prevail in their lives.
Oppression takes two major forms, external and internal. A woman can be a soldier but cannot serve in combat, which provides the greatest opportunity for advancement. She can have a career in the military but is not allowed to achieve the success of male counterparts. In other endeavors, the glass ceiling, though less formal, is no less real.
Women find our choices circumscribed not only in the large issues of life but also in the choices we make on a daily basis. The harassment a woman could face might make her take a longer route to avoid passing a construction site. This costs her not only in extra time she must plan into her schedule, but also in psychic energy. The purpose of such harassment is to make public space hostile to women -- and it works.
External oppression savagely limits the choices women have in American society. Despite decades of the women's movement, women still earn 30 percent less for the same job and suffer exploitation, rape and domestic violence at rates that would never be tolerated in a truly egalitarian society.
Women with disabilities face even more oppression. They are less likely to be employed, to be married, or, if divorced, to have custody of their children than are non-disabled women. We are less likely to receive disability benefits, and receive far less than disabled men, if we do manage to qualify. Too many disabled women live impoverished lives in dehumanizing institutions. These conditions lead to the despair from which suicide attempts arise -- yet, just as with non-disabled women, they arise more from wanting to change circumstances than from a profound wish to die.
Those of us who acquire disabilities in mid-life come to the experience with ableist baggage, and with few coping skills. Those of us who have lived with disability over time find coping strategies breaking down with increasing impairment and the failure of the kinds of support systems that are often women's lot. It is no surprise that 72 percent of those who died from Kevorkian had a recent decline in health status.
While becoming disabled isn't easy for anyone, certain aspects of it are harder for women than men. Women's sense of self-worth is still closely tied to their body image. Having one's body change in unexpected, radically devalued ways makes women believe they are less physically and sexually attractive.
Women who have themselves been "caregivers" find it particularly hard to face the prospect of becoming recipients of care. Kaplan found that over half the women who sought Kevorkian had been employed in a "helping type job." For those who worked in institutional "caregiving" the prospect of ending up on the other side of the equation would understandably be terrifying. But it seems women fear facing the prospect of having even a family "caregiver"; they fear becoming a burden to their families.
Long and deeply held beliefs about self-sacrifice being a feminine virtue combine with these other issues to make it likely that disabled women who seek suicide are operating from the same impetus as non-disabled women, greatly intensified under the added oppression of ableism.
Perhaps the worst effect of sexism is internalized oppression. Sexism is often so pervasive that it seems natural. Women are often the first to tell other women and girls to behave in socially acceptable ways -- to conform their behavior to the "natural" reality of sexism. Girls are taught by mothers and aunts to avoid the construction site or look demurely downward when catcalls begin.
The combination of external and internal oppression causes far too many women to find themselves in situations to which they see no alternative but death. They, however, have a deep current of wholeness that creates ambivalence when they "decide" to die.
Some researchers think women who attempt suicide have fantasies of rescue -- the childhood stories of Prince Charming, Rapunzel, and Snow White tell women to await rescue by a valiant prince -- and rescue fantasies help to create ambivalence in suicide attempts.
Women's attempts at suicide often fail because they are responses to and products of a particular kind of oppression. These attempts are deeply ambivalent and too often done in hope that this desperate cry for help will motivate someone to rescue them. Women with disabilities are no different. Unless, of course, they meet a Kevorkian.
Attempts Completed
Who were those who died at Kevorkian's hands? They were predominantly women who were alone and had experienced a recent decline in health and social status. When we examine their lives, we see disturbing stories of abuse, abandonment, isolation and threatened or actual institutionalization. All were clearly oppressed by ableism, living as disabled people in a society that hates disability. None had any apparent contact with the disability rights nation.
That they would be desperate and depressed, that they would talk about suicide or even attempt it is not surprising. But for these people the path from talk to death was shorter than it ought to have been.
One can easily imagine these people expressing internalized oppression by telling a friend or relative that they no longer saw much purpose in life. Their suicide talk was taken seriously. But, unlike a non-disabled person whose suicide talk is taken seriously and then helped, thereby prevented from suicide, these people met with a particularly virulent form of ableism -- the "better dead than disabled" variety.
In at least two cases, there is convincing evidence that those who may have initially requested death changed their minds. Both Hugh Gale and Thomas Youk -- both men -- tried to stop the process after Kevorkian had begun. Their protests were ignored. Once the process was set in motion, ambivalence became irrelevant. Kaplan notes that Kevorkian ignored clear ambivalence in these and other cases.
The reason that Kevorkian's statistics look like those for attempted suicide rather than completed ones is that they should have been attempts. In a less ableist world they would have been attempts, only attempts.
The only reason that these "suicides" were completed is that Kevorkian invalidated all ambivalence, took away all uncertainty. The victims' internalized ableism made them unable to see or choose alternatives. This, combined with their family's and friends' ableism and Kevorkian's virulent ableism, took ambivalent feelings and made them into certain deaths.
On their own, these people might have attempted suicide. Many would have failed, but the safety of failure was taken from them.
In a world where ableism was taken seriously, experts examining Kevorkian's record would find this conclusion obvious.
Social isolation, unemployment, change in social or health status, and institutionalization are all factors known to predict suicide. And these things are all factors that affect people with disabilities to a much larger degree than other groups.
The loss of social status, disintegration of support systems, unemployment and social isolation are ubiquitous parts of the "process" of becoming disabled. Many people, due to lack of attendant services or inaccessible housing, cannot return to their former residence from rehab; all too many are dumped in institutions where isolation and unemployment are part of the package.
Yet these experiences of disabled people are "naturalized": being dumped in a nursing home is assumed to be a natural outcome when one has a disability; a minor issue compared to the disability itself. It is not seen as a devastating expression of social oppression.
The "mainstream" model of disability doesn't admit ableism, and therefore doesn't see that the unemployment, social isolation and institutionalization that we fear or face is not a necessary part of disability but an artifact of oppression.
Those who do not recognize ableism or who naturalize it cannot see that the actual problem is that physician-induced dying both reinforces and is part of the ableism that permeates society.
The opposite of Kevorkian is not abandonment and isolation in a "rat-infested nursing home warehoused by Nurse Ratched," as Kevorkian attorney Geoffrey Fieger put it, but life as a strong, proud disabled person. This is what our people deserve. This is what those of us in Not Dead Yet demand.
Racism, ageism -- but not ableism
Elderly people, Native Americans and African-American youth have higher suicide rates than the national average. Yet few who are not virulent racists would blame members of racial minorities for the desperation that leads them to believe that change is impossible and that they cannot live without change. Conditions that cause their desperation are well documented and widely known. In a society oriented to youth where the experience of age is disregarded and disrespected, the desperation of the elderly is acknowledged as well. Our society recognizes that racism and ageism are not natural or inevitable parts of the world; that the oppression which drives members of these groups to desperation and suicide is very real, but not necessary. But the existence of ableism isn't even acknowledged, so its role in suicide goes undetected.
-- W.C.C.
Screening problems Virtually all stories about the Kevorkian deaths note the few victims who had no discernible illness; most reporters use these cases to show that Kevorkian didn't screen his "clients" well. Perhaps they don't realize it, but what these stories are also saying is that having an illness -- a disability -- made one an appropriate candidate for Kevorkian. And that isn't questioned.
-- W.C.C.
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