332 Comments
Jun 2Liked by Rupa Subramanya

The part of this article that is most disconcerting apart from the suicide aspect is the mention that she was diagnosed with autism at age 21.

One the two core characteristics in autism is challenges in social communication and interaction skills alongside restrictive and repetitive behaviors. Autistics struggle with restrictive thinking patterns. For those with Asperger’s /Level 1 this restrictive thinking can present differently leading the person to get stuck in a thought loop or pattern that can be devastating. A coexisting condition with Asperger’s/Autism Spectrum Disorders is anxiety and depression. The anxiety is aggravated tremendously by having to navigate a neuro-typical world that can be cruel but also difficult to understand as their brain processes the environment differently.  

Zoraya was diagnosed at the age of 21 which is not uncommon for girls with autism also extremely tragic. Very common for autistics with late diagnosis to have mental health issues. They have navigated life without a tool box for coping with autistic symptoms and meeting the needs that result from these symptoms. Zoraya seemed to have Asperger’s which is level 1 autism. Girls do not get diagnosed as often as boys with autism because they present very differently and they can camouflage their symptoms in ways that boys don’t.

This is the first tragedy regarding Zoraya she missed out on at least 18 years of interventions that could of helped her understand, cope and better meet her needs. I own a Center that provides interventions for autistics. It seems from the little information in the article that she was seeking help but was told there was no hope for her. She also had no family support. This affirmed her already restricted thoughts on coping with her condition.  Zoraya could have been helped to manage her anxiety and depression. She could of also benefited from cognitive behavioral therapy.

Cognitive behavioral therapy (CBT) is a type of psychotherapeutic treatment that helps people learn how to identify and change the destructive or disturbing thought patterns that have a negative influence on their behavior and emotions.1Cognitive behavioral therapy combines cognitive therapy with behavior therapy by identifying maladaptive patterns of thinking, emotional responses, or behaviors and replacing them with more desirable patterns.2

Learning self-care for managing the stressors resulting from the mental, emotional and physical energy required to continuously be adapting due to being in environments that can be hostile to their senses. Tragically girls and women with autism are misdiagnosed typically with mental health conditions first overlooking the source of the thinking or core characteristic that is leading to the anxiety or depression. Our thinking drives our behavior. At the Social Mind Center “Our focus at SMC is on thinking, not behavior. Thinking drives behavior.  To adapt our behaviors to the social situation, we must have social, emotional, and organized thinking”. Autistics struggle with disorganized thinking because they are typically placed under an enormously amount of stress leading to heightened anxiety which unmanaged can be extremely depleting leading to depression. If anyone of you has experienced high levels of anxiety you can sympathize that it is very difficult to have clarity or organized thinking.

With all the autism awareness campaigns globally there is still a significant failure is diagnosis and supports for the autistic community. You would think that with the rise in numbers there would be less Zoraya’s. Autistics have three-fold higher rates of suicide and suicide attempt than the general population.

Autism is very complex no two people on the spectrum are alike. There are recognizable patterns of behavior and thinking that should be identifiable by medical professions. Tragically I see this too often in autistics that have received a late diagnosis they are at a crisis point and the secondary symptoms are being treated and the core source is being overlooked.

REFERENCES:

Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A. The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognit Ther Res. 2012;36(5):427-440. doi:10.1007/s10608-012-9476-1

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While it is nice that you are so enthusiastic about the power of therapists to help people, I think you have rather jumped to the conclusion that the autism diagnosis is the be-all-and-end all of this case. It is interesting that one of the errors of thinking that CBT targets is all-or-nothing thinking. Holding that CBT or indeed any other psychotherapy is the solution for psychological problems or completely useless is all-or-nothing thinking. CBT helps a sizable number of people depending on the problem (high success for say panic disorder) but quite disappointing results for other problems (anger management helps but is not great). Depression while often helped by CBT is often a relapsing condition. The meta-analysis you cite confirms that CBT is quite effective with some problems and not very helpful with other problems and I am pretty sure that is true with all types of psychotherapy i.e. some people get a lot out of therapy and others not very much. A small number of people get worse with therapy. With this case/story we simply don't know the range of problems the person had. The information in the article is all what the person said to the journalists, for obvious reasons we don't hear from her treating psychiatrist. It is indicated that she also had a personality disorder but no further information. While it is true that treatments like DBT can be helpful for borderline personality disorder, it is also true that they only help a proportion of cases. Finally I would say we need to avoid being all or nothing about psychiatric diagnosis: it's not a worthless enterprise but nor is it like diagnosis in the rest of medicine i.e. it's power to predict what treatments will work etc is quite modest.

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Agreed therapists are not the end all be all. I can be guilty of living in a bubble with amazing compasisionate, gifted and humble professionals. I am aware of what you are sharing. The reason being that I got into this profession to help my own children through these struggles with anxiety and depression. There are many forms and types of treatment I was just highlighting one. Agreed that there is so much information missing from this article. However, I see this all too often from autistics they struggle to get the support they need. Most of the therapies that autistics encounter is more focused on attempting to make them more neurotypical. I agree with you on all your points. Depression is a relapsing condition especially in autism. In the last 15 years you would be shocked to know what I have seen make the most impact in our community at our Center is our brick club. Where we meet weekly to colloboratively build LEGO projects.

Also I did note that autism is a very complex and every individual with autism is extremely unique requiring individualized support. For my children who are now adults what has been most helpful is understanding their neurodivergence and acquring coping skills.

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Peter thank you for your feedback.

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Glad my comments made sense. Given the rather meager predictive power of psychiatric diagnosis and the huge gaps in our knowledge about how to help people with various psychological problems I am rather disturbed by the idea of euthanasia for mental disorders but perhaps that's just an emotional reaction.

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Yes I hesitated to read this article for that very reason. Suicide is a very difficult reality for me to process. This is a very disturbing idea. Yes, agreed on psychiatric diagnosis.

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"Society had given up on her"? What utter garbage! I expect better from FP than this victim glorification. The smug look on this young woman's face in the photographs that went around the world, surely much to her mentally ill mind's delight, speak of a deep soul sickness. Actually, I don't understand why euthanasia isn't yet the norm in the US, where the medical community CELEBRATES sterilizing and sexually mutilating physically healthy – mostly gay and autistic – youth. Straight from Hitler's cookbook. Canada is already calculating how much money killing their deplorables will save them in health care costs, plenty of recent stories on that.

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This is the most absurd pile of garbage ever. The woman was an adult. Her life belonged to her. NO ONE had the moral right to force her to live a life she found unbearable. Obviously she had other options. The simplest would be to jump off a building. But instead, others, who should have no say in the matter, insist that her death be frightening and painful for reasons that entirely escape me. The anti assisted suicide crusaders, with a few exceptions, stink of religion and other supernatural crap.

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May 31·edited May 31

You are right and you are wrong. You are right that there is no god. You are right that no one had the moral right to force her to stay alive. And yet you are wrong that her life belonged only to her. The suicide of a loved one is one of the most traumatic of losses a person can suffer. Her family will forever be affected by her act. She had the moral obligation to take it into consideration (and maybe she did, I don't know).

With all that, I am not an anti-assisted suicide crusader. I am an anti-physician-assisted suicide crusader. Once going to the doctor will have to begin to include the fear that "maybe the doc will suggest death" then the healing placebo effect, which often a major factor of getting better, will be lost. It is not supernatural crap, in fact is is one of the chief obstacles in doing placebo-controlled studies. Practicing by algorithm, which most likely her doctor did, and according to which "we" (i.e. the algorithm) had nothing else to offer to this patient, is only part of the practice of medicine.

Physicians should be on the side of life until the last moment. Now, the patient does have the right to get off the train. He can say "thanks doc, appreciate the effort but I think I'm done". At that point, some other profession, that I would call "thanatologists", would take over. Euthanasia is not a treatment. Physicians provide treatment. Period.

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Sorry, Herb. But you are wrong. There is a God. And your body isn't yours, strictly speaking. Suicide is one of the worst, and possibly the worst, sin against God. You can call it "stinky" and "crap" but it doesn't change the facts. I imagine that it's your special Jewish soul that makes you "protesteth too much"!

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What actual evidence do you have of the existence of this supernatural construct you call "God"?

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Evidence abounds, as I'm sure you know. You just don't find it convincing. Pity.

I believe that most people who subscribe to the construct known as "atheism" are looking for definitive proof. And that they - and I - are unlikely to get. But they aren't likely to get it in most areas of life either, and it doesn't stop them.

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"Abounds?" That's pretty funny! How about "none?"

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An atheist, a vegan, and a Tesla owner walk into a bar...

(I only know this about them because they'd told everybody in the place about it within the first 30 seconds)

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Her unspecified personality disorder was Borderline Personality Disorder according to other articles. Getting media attention for your assisted suicide might just be the most borderline thing a person can do.

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The idea that it’s justifiable because a doctor was consulted is ridiculous. Here’s the guidelines I copied from Wikipedia required to approve suicide:

-the patient's suffering is unbearable with no prospect of improvement

-the patient's request for euthanasia must be voluntary and persist over time (the request cannot be granted when under the influence of others, psychological illness or drugs)

-the patient must be fully aware of his/her condition, prospects, and options

-there must be consultation with at least one other independent doctor who needs to confirm the conditions mentioned above

the death must be carried out in a medically appropriate fashion by the doctor or patient, and the doctor must be present

-the patient is at least 12 years old (patients between 12 and 16 years of age require the consent of their parents)

How does a doctor (or anyone) decide what is unbearable with no prospects for improvement?

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May 30·edited May 30

I beg to differ with Subramanya's judgment that "the the society in which she lived had given up on a young person who had so much to live for and so many years ahead." First, it isn't giving up on the person to admit that there is no treatment for their disease. In fact, providing comfort care often becomes the only thing physicians can do for us. As to whether this woman had much to live for... only she can be the judge of that.

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There is a treatment for everything she had. It's just not quick or cheap, but killing her was.

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My son is a 23 yo Aspie with comorbidities of OCD and anxiety. I have begged him to seek inpatient treatment but he is very resistant for reasons he can't explain to me. Perhaps it's the stigma of being "institutionalized." He has suicidal ideation and has mentioned several times he would like to move to Canada where he could obtain assisted suicide. People that say "well if he wants to commit suicide then he can do it himself" don't understand that it's not that simple for the person suffering. HOWEVER, it's much easier if there's confirmation that it's an OK and acceptable thing to do when it is NOT! This whole story is so disgusting and sad. This is what happens when a society turns secular.

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This will become a fast-track. Of the doctors who are willing to enter this realm, only the most death-prone will remain. If a doctor develops a reputation for not recommending suicide (or scrutinizing suicide inquiries more carefully), prospective "patients" will simply avoid them and go to the doctors who are more apt to recommend suicide. And the suicide machine will accelerate.

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Don't Fear the Reaper. It's a sad consequence of going very public with these ideas and getting confirmation, adding to one's own confirmation bias, that the ultimate escape is a good idea. Life is full of pain and suffering, but it's how we grow. Bliss is boring. It's a tragic loss.

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I think you meant "fear" unless you're using a play on words I didn't "get!"

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Ha ha thanks, fixed it. I guess I need some more cowbell!

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The Slippery Slope of all slippery slopes. Hitler and company would be loving it.

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why cant people just commit suicide on their own if they insist? there is something sick about demanding someone else kill them.

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There's something sick about the fact others can legally help kill them.

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“Society….had given up on this young woman…”

Huh? Where is the author getting this from?

It seems like this is not a new law, and there are safe-guards in place, and this is something Dutch citizens and voters approve of. Where exactly did Dutch society fail this young lady?

If ending her life is what this young woman wanted (and nothing about this depiction suggests this to have been a rash response, spur of the moment reaction, or any sort of grave decision that had not been fully and duly considered by her), this seems far less barbaric than what her friend chose to do instead as a teen (ie jumping in front of a train).

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You should explain why is "barbaric" to jump in front of a train. The society did non fail this young woman, she failed herself. I'm not against helping die a person that is in real pain, but this young lady had nothing...she just did non want to live anymore, which is a perfect example of how empty can this society make someone's life; the point is that she did not have the courage to take her own life; yes, it take guts lots of guts to do so and I don't think I would have that courage myself, not because I'm afraid of death or so but because I think that there is always tomorrow and, more important, that there is always someone whose life is much worse than mine and do non have the fortune to be as bored as this young lady. Killing yourself is always a failure, but doing so because I'm bored and having someone else doing it for me I think is not right.

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It’s barbaric because you’re imposing a gruesome scene onto people who didn’t ask to be there….who were simply going about their day…or driving the train. It’s also selfish, cuz you’re imposing upon others.

How do you know she had “nothing”, and wasn’t in “real pain”? Were you there? Walked a mile in her shoes lately? Yeah, didn’t think so.

Yours is the typical paternalistic attitude of “you know her circumstances better than she does”.

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May 30·edited May 30

The key point is here: "Zoraya’s last treatment was in August 2020, after which she says her psychiatrist told her: “There’s nothing more we can do for you. It’s never going to get any better.”"

What an unconscionable, horrible, unforgivable thing to say to a patient! You NEVER say that to a psychiatric patient (Obviously things could be different for end-stage medical illnesses), never! There is ALWAYS something else that can be done, if not by the doc who ran out of ideas but by someone else with a fresh look. And who is this "we" that this unimaginative ethical dwarf claims to be talking?

Someone posted some defensive bragging about Dutch healthcare, but if that doctor is typical of the mainstream practice philosophies of that system, if that is what's considered to be "proper care" in that country, then it is to be ashamed of, not to be proud of!

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Of course we don’t know if the psychiatrist actually said what Zoraya stated. People’s memory of conversation is often not terribly accurate.

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I agree. I've gone through major depression and therapy. I also had an older brother who committed suicide.

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May 30·edited May 30

The original story is what convinced me to subscribe to TFP; outstanding journalism, disturbing as it is.

As for the decision of the Netherlands to both allow and actively abet the suicide of an otherwise healthy adult suffering from severe depression, I understand some see some nuance to the situation, but I can't understand it as anything other than genuinely evil.

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What a selfish woman. I feel so bad for her boyfriend.

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I have no pity for him, he was complicit.

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She wasn’t selfish, she was in severe emotional pain and didn’t see another way out. Autistic people tend to have black-and-white thinking, and unfortunately, the people around her encouraged the idea that there were only two options - suicide, or a life of unending pain.

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They treat this with the same importance as taking out the trash. As a doctor, I was trained to preserve life and sustain it. Will there be a new specialty with specific training? Instead of cardiology or orthopedics, we can call it MURDER by Experts.

It is incomprehensible that in this modern world that we could give up so easily; that these so called experts would be willing to extinguish lives so readily, like concentration camps on a miniature scale. Hippocratic Oath be damned!

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Bruce, I too am a doctor and horrified by this. We go through Herculean efforts to preserve life only to throw a 29 year old's away.

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