AT Tierney attempted suicide twice. On the second occasion he was successful. After the first attempt he was admitted to a mental hospital.
This in itself is not an unusual story. What is unusual is the different responses of the people he told and the manner in which his "suicide note" was published. Locked into these communications is a moral dilemma that we in Ireland may yet have to face.
Those who knew Pat (I did not, but I did listen to his reciting poetry on Grafton Street) will remember him as an articulate, well spoken young man, whose ability far outstripped his formal education.
He rose above every conceivable deprivation maternal election, institutional care, child abuse, living rough as a teenager, petty crime, life as a vagrant worker in the US, drug dependence, broken heterosexual relationships and finally the uncertainty of advancing AIDS contracted from a dirty needle.
Yet he chose to end his life and to wake a public, and, well publicised statement in doing so. That was his wish.
It is likely that he sought through his public persona what he did not have and never experienced as a child - love, respect and a sense of emotionally shared vision of future unfolding adult life.
Public recitation of poetry, the writing of verse, the production of his play and the publication of his autobiography may, at least in part, have been an attempt to gain publicly what was never his privately. Nevertheless, in his interview with the Sunday Tribune and as also related by Brenda Power on RTE radio's This Week yesterday, he did make salient points.
It is likely that, some suicides are not mentally ill. He believed that he was not. No one knows the proportion of suicides who are mentally ill, which in any case may not be constant in any society over time.
The given medical maxim in recent decades has been that all or virtually all are ill. This may not he so, however. A reading of history might lead one to think otherwise. Was Wolfe Tone ill when he cut his throat? I doubt it.
IN 100 consecutive suicides assessed through attendance at the Coroners Courts in Cork City and subsequently by speaking to relatives and others, it was found, by us, that whereas 80 per cent of women had been medically treated in the months prior to their deaths, only half of the men had received such. With young males aged 15 to 24, the situation was even more striking. Only one in five had received treatment.
What does this mean? It was possible that many were mentally ill but did not recognise it. Others may have been ill but did not seek treatment. Some may not have been ill at all. The reasons why and the proportions are presently being researched.
Pat Tierney, then, was right in his first point. Some of those who kill themselves are likely not to be mentally ill when they choose to do so. We do not know, however, whether Pat himself was psychologically ill at the time he ended his life. The fact that he arranged it meticulously does not prove that he was mentally well.
Many suicides who are mentally ill do just that. They outwit their relatives, friends, nurses and doctors usually in contrast to Pat through secrecy rather than the public way he did it. In classical times publicised suicides were much more common.
Suicide and attempted suicide, since 1993, is no longer an criminal matter in Ireland. One consequence of this may be that the law, and in particular the police, is limited in how it might intervene. This was not always so.
In the last century attempted suicides in London were often confined to prison as a preventive measure. This was largely on advice given by prison chaplains to magistrates. They believed that they could prevent occurrence by moral persuasion. They were not particularly successful and the practice gradually lapsed.
Recurrence remains a great problem, however, in spite of better trained doctors, psychologists, voluntary workers and effective anti depressants. For this reason the Suicide Research Foundation is endeavouring to develop new methods of treatment, where appropriate, and intervention.
Pat may have been wrong here, however. Most cases of attempted suicide do not go on to complete suicide. About 1 per cent do so in the subsequent year and between 10 to 15 per cent do so in the subsequent 10 to 15 years.
The importance of this is that Pat may have, unintentionally, provided a model for the suicidally ambivalent. Many would be suicides are just that. Will I, won't I? Let chance or fate decide. Many young impressionable suicides are copy cat. The figure is estimated to be one in five in the United States.
Most if not all human acts have a moral component how we buy, how we sell, how we drive, how we drink and how we communicate. How we die must be added to this list.
What Pat did was legal. If it calls others forth to die then morally this would be an undesirable consequence. Yeats was very conscious of this effect of his sacrificial writings, in later life. We can induce death by example.
This raises the issue of publicising individual suicides, including the methods used and the attendant circumstances. The consensus among suicidologists is that there is a relationship between the `dose' of publicity and the likelihood of imitation.
To be well known, to be seen as an icon, to be on the front page, to be given banner headlines, to be discussed on major news and television programmes may be an inducement to the vulnerable.
To be criticised publicly for the act, yet not rejected as a loved individual, which was the approach of Courtney Love to the suicide of her husband Kurt Cobain, may be protective.
The news media, however, must be ever conscious of their power for good and for evil. Last June another Sunday newspaper attributed, by implication, two suicides to the Leaving and Junior Cert examinations which were concurrently in progress. This was wrong headed. They associated a common experience, examinations, with an uncommon event suicide. It was also, in my opinion, immoral.
SUFFERERS from AIDS may experience many psychological symptoms. Dementia is one outcome as the illness advances, and depression is another which may occur at any time from learning of the positive blood test to the physical advancement of the illness. Pat was clearly not demented.
Whether he was depressed or not is another matter. In depression there are two sets of symptoms, objective, which include sleep disturbance, loss of appetite, a fall in weight, diminution of energy, daily variation in mood, and subjective.
The latter may be summarised as the future is hopeless, the world meaningless and the self worthless. He certainly saw the future as hopeless and for him the world had become meaningless. I do not know if he saw himself as less worthy or of less importance than when he had his full physical virility. The fact that he cheerily discussed his plans with Brenda Power does not mean he was not suffering from a depressive illness.
Many making serious suicide attempts will relate, afterwards, that once they had made up their minds the cloud lifted and they felt buoyant and almost elated in the knowledge they had decided to end themselves.
The importance of these possibilities relate to our moral responsibility once we know a friend or relative, is suicidal. Do we have a responsibility to intervene to prevent the occurrence? A person can be compulsorily admitted to a mental hospital if mentally ill and suicidal. The law however relates to the mental illness and not the suicidal behaviour.
Relatives of one patient in Ireland wished the person retained compulsorily in a mental hospital because they believed she was suicidal. The patient wished to leave. The doctors after careful examination and prolonged observation could find no evidence of illness. They felt obliged under the Mental Treatment Act to discharge her. She later ended her life.
It would have been better in my opinion if Pat Tierney had seen someone professionally before he, died. He might still have proceeded to kill himself. Yet we would know that some skilled professional person had assessed whether he was depressed or psychologically ill in any other way.
My mind goes back almost 30 years to a young highly intelligent Chinese philosophy student whom I treated in an emergency clinic at a psychiatric hospital in London.
She had made a serious attempt on her life and advanced many philosophical and social reasons why she should complete the event. I believed she was depressed and in danger of killing herself. She pleaded against compulsory admission, preferring to return to her lonely bedsit.
Agreement was reached. I reasoned that confinement would not protect her life in the long, term. She would give treatment a chance - anti depressants and counselling - before acting, against herself. She recovered. Subsequently she told me that philosophically she still thought life was not worth living. However, since her depression had lifted, she no longer felt like ending her life.
Finally, many in our society are physically sick with potentially fatal illnesses, whether cancer, AIDS, heart or lung disease. Up to a third of these may be depressed.
Because of this they see the future as hopeless. Once they are successfully treated, however, the darkness dissipates. Pat Tierney may have wished is private self to die because of untreated depression or depression that did not respond to treatment.
He wished his public self, however, even in the absence of heaven to continue at least for a time in the minds of his friends and those, like me, who were made aware of his tragedy.