Opportunity Cost

Sitting in an economics class, listening to passionate discourse about the role of cost-benefit analysis and opportunity cost in forming economic policy, noticing the salt and pepper beard's motion and the sexy laugh lines around his eyes. I turn my head ever so slightly to move my gaze out the window and start performing my own little cost-benefit exercise quietly in my mind. Prowler gave a cold and accurate summation of his opportunity cost analysis regarding suicide to Dr. Sudak once. She was discussing some health action or another, I can't remember exactly what, and said "If it helps, do it! I mean, the alternative  right now might be suicide and what good does that do anybody!?" I think she meant it to be a rhetorical question, but that kind of assumption is only made by people untouched by suicide. Prowler looked her straight in the eyes and said "What good? Suicide is ultimately an effective way to end the pain."

But other respected professionals argue the opportunity cost analysis to be more three-dimensional, and we, as a system, get that. So what are the benefits of suicide?
1. effectively end pain and suffering
2.
3.

I can't think of any others. What are the costs of suicide?
1. The years unlived, which might have been meaningful but most definitely would have included pain.
2.
3.

I once did an activity with my students, trying to get them to understand economic opportunity cost analysis. I had a tray of "prizes" and asked for 10 volunteers to come up in front of the class. I started at the front of the line and held out the tray and told them each in turn to choose a prize, any prize, no strings attached. The prizes were jolly ranchers, mechanical pencils, stickers, post-it notes, and extra credit coupons. You could watch the students' faces quickly calculate the cost-benefit of the items, especially as the tray got to them and their choices might have changed due to the first students' choices. Every now and then a student would exclaim "Darn! I wanted that!" as the last jolly rancher was chosen, or "I got what I wanted!" if the pencil they wanted remained. Once all students had a prize, I asked the first student, who chose a jolly rancher, what the cost of the jolly rancher was to them.

 "Nothing."

I dug deeper. "Jolly Ranchers are free?"

"Well, no, maybe a couple cents."

"So, you paid a couple cents for that?"

"No! I didn't pay anything. It was free."

"Anyone have a different idea of what the Jolly Rancher cost Johnny?" I asked the class. No one had any ideas. They were engaged....I do this kind of thing a lot, ask questions and they try to figure out the 'right' answer and so often I have a little surprise at the end of it all. It's a fun and effective way to teach a concept, almost a kind of game, and they like it.

"So," I ask Johnny, "why did you pick the Jolly Rancher and not the mechanical pencil? Sue was fourth in line and she grabbed the pencil and was happy about it."

Johnny had a quick answer. "I don't need a mechanical pencil. I don't need anything in the tray, but I wanted a Jolly Rancher so I took it."

"Sue, why did you take the mechanical pencil?"

"I just lost mine this morning. And I like pink. I hate Jolly Ranchers and I have an "A" in this class so the extra credit was pointless."

"What did the pencil cost you, Sue?"

"Nothing. It was free. You gave it to me."

Someone from the class blurts (I'm ok with "participatory blurts") "The pencil cost the other stuff in the tray."

Bingo! That's the concept. I went on to explain that the cost of the Jolly Rancher to Johnny was the post-it notes, or the mechanical pencil, or the extra credit points. He made a choice based on his needs and wants. His opportunity cost was different from Sue's, who also made a choice based on needs and wants. Sue needed something different than Johnny, and so her cost-benefit analysis was based on that.

What does this have to do with suicide? Suicide is a deeply personal decision, and as such most likely confounds the individual who has no need for it or who has a life framework from which to operate that doesn't include suicide as a choice 'in the tray of prizes' so to speak. But suicide is in my tray. It's got a neon sign over it, with red arrows flashing on it. The other choices are dim comparatively. I can't think of why I would need or want extra years....The cost of suicide is unclear. Perhaps there is meaning in the future, perhaps some laughs, some children's lives improved as they enjoy a class....I'm glad my family and friends find me worthy of life, find some benefit in being around me, but that is their choice. The cost of suicide to me, personally, is years unlived and those years may or may not be meaningful/joyful/peaceful. The benefit of suicide is most succinctly stated by Prowler, an effective end to suffering. It's beautiful in its simplicity, and as far as I'm concerned unarguable. The other choices in the prize tray have held promise over the years - psychological treatment, psychiatric treatment, Buddhism, sex, drugs, dissociation. But either their effectiveness has waned or their cost has become too high. When Sue lost her pencil, getting another one was her dominant need. When I suffer psychological pain, ending the suffering is mine.

The psychiatrist I spoke with during a recent hospitalization once said "Take pictures of yourself happy. Take video of yourself having fun and laughing. Watch them when you are suicidal. Depression sucks a person in and they feel that suffering has always been and always will be. But despite how it feels, it's not true. I hate to see a depressed person kill themself when relief is a day away." I guess he was trying to add 'hope' to the prize tray. What's the cost of hope? Endless suffering.....endless suffering is the cost of hope.

Trust

A doctor stands over a trauma patient, unsure of what the exact wounds are. They have been covered in layers of bandages, scabs, scars, and dried blood. To know how to heal the patient, the doctor has to remove bandages, move limbs, ask questions. It's a nearly impossible task, as he doesn't know for sure which bandages will come off easily and which ones will tear away vital scabs causing bleeding, possible fatal bleeding. The patient, sometimes conscious, sometimes not, can only effectively answer a part of the time. Other questions are lost in the pain of old wounds made fresh, broken limbs moved so that the nerves are all pinched, and terror in the face of death.

I'm trying to answer your questions. Your words are the touches of the doctor, and almost every word hurts. I'm so raw even your glance feels like a stab in my soul. It feels like a violation.

I hear your explanation to those around me, the explanation about how Luke didn't mean to tear open the wounds. I hear you explain that the intention is not to violate or abandon. What difference does it make, what his intention is, if it feels like violation and abandonment? The guy who carried the trauma patient into the ER to the doctor didn't mean to hurt the patient, but in his amateur handling he caused so much more pain, opened old wounds, it might as well have been the original trauma. So what difference does his intention make to the suffering of the patient?

You discuss hope, share a vision of what tomorrow might feel like, and next week, possibly next month. You ask me to trust you in so many words. I do. We all do, except LA. What you're asking feels like a violation to her. In order to heal, that bandage has to be taken off and it causes bleeding just to move the bandage, just to touch the bandage. Your words are the doctor's touch, and LA is the patient. The bleeding might be fatal. It feels that way. To her, it seems there are only two choices - violation or abandonment. She cannot make the choice so we make it for her - we will always choose violation and we always have. Your words feel like violation. To trust you feels like you're violating us. I don't know how our action (to trust) can feel like you're taking an action (violation).

I hate that I trust you.