What If Aunt Francie Had Lived in Belgium?

Inside Out, the new Pixar movie, sets in motion the conflicting feelings that live within one eleven-year-old girl as she goes through a difficult move from a secure home to a faraway new city. Along the way, her islands of stability — Friendship Island, Family Island — crumble. The islands must be rebuilt, her equilibrium restored, with the help of all her traits working together, especially by the alliance between Joy, a relentlessly positive pixie, and Sadness, a galumph of a wet mop who nonetheless has the capacity for consolation.

But what if one’s islands cannot be rebuilt?

What if the helping arms of Joy, the empathic tears of Sadness, cannot reach out to save the child — or, for that matter, the adult?

In “The Death Treatment,” an article in the June 22, 2015 issue of The New Yorker, staff reporter Rachel Aviv writes about a Belgian woman in her early sixties, a life-long sufferer from depression who chose euthanasia when life became too difficult to bear. That she could make the choice is due to the doctor who euthanized her along with hundreds of others, Dr. Wim Distelmans, a staunch supporter of Belgium’s 2002 law that “permits euthanasia for patients who have an incurable illness that causes them unbearable physical or mental suffering.”

Distelmans is quoted as saying that the choice for euthanasia gives people a voice, his opinion set against the pain of the woman’s grown son, who had not been informed of his mother’s choice until after she had carried it out. One crucial voice is missing. We do not — cannot — hear from the woman herself. Her silence — the impossibility of knowing all that brought her to this final decision — has led me to think about someone I knew well: my incurably depressed Aunt Francie. Would this law, this policy, have helped her?

I can only guess, but my answer is a qualified yes.

Always troubled, her fragile self shattered when her husband Harry abandoned her. The aftermath was filled with suicide attempts, hospitalizations, electric shock therapy, medications that didn’t work. In the late 1950s, her doctors told her family — my mother and her three other sisters — that Francie’s case was hopeless; all that was left was “what we call a minimal lobotomy.” They said that Francie would be able to live alone, shop for herself, manage the basics of her life. “Without it,” the doctors said, “she’ll weep for the rest of her life.”

Aunt Francie after the lobotomy

It was true. After the surgery, Francie didn’t weep endlessly. She was able to live a minimal life, do a little shopping, make herself a TV dinner, indifferent to everything around her. The doctors said Francie was one of the fortunate ones for whom the operation had worked

Had it? When people weren’t looking, she would rifle through purses searching for an errant pill. As soon as she felt herself unwatched she would disappear into the bathroom. No one knew whether she had developed an addiction, or was still trying to kill herself, or whether she was trying to feel something — anything — that would let her know she was alive.

I think that Francie, given the choice, would have welcomed the chance to extinguish herself, in advance of an operation that erased her. But she might not have had the self-determination. Given her history of needing to be led by others, I think she would have consulted her sisters, who would have tried to dissuade her, and Francie would have listened to them. In other words, all the policy in the world wouldn’t have led inexorably to her death, no matter how much she wanted to die.

Admittedly, I am imagining all of this without taking into the account the difference between Francie’s mid-century Jewish middle-class life and that of a Belgian woman in the twenty-first century. But I am trying to examine not only Francie but myself, my own beliefs. I have spent the last decade investigating the lobotomies of two mentally ill members of my family. Let me be clear: I am all for assisted suicide. But I’m disturbed by the mechanistic aspect of Belgium’s policy, the inexorable cause and effect of its process: send in an application, have it reviewed by three specialists who determine whether your case is indeed hopeless and, if they agree, you get your wish. Belgium’s law doesn’t encompass the vagaries of one lone sad person nor the nexus in which the person lives. We still have no adequate means of dealing with sorrow, of definitively separating it from mental illness, of choosing to believe whether something is a temporary mood or an eternal unbearable state.

Twenty years after her husband had left her, Francie was in the hospital with terminal cancer. She had heard nothing from him all those years. One day my mother ran into Harry’s mother and learned he was in that same hospital.

“Francie,” my mother asked, “I want to tell you something. It’s about Harry. If you don’t want to hear it, say so.”

In bed, Francie said nothing, seemingly lost in the emotionless state of the lobotomized. My mother continued. “He’s here, in the hospital, on the fifth floor.”

Francie looked up and said that she wanted to be wheeled down to Harry’s room. She asked for a comb to fix her hair.

At his doorway, she looked at the jowly man she had married. Harry saw Francie, smaller, withered, the woman he had married. He tried for a little smile. Francie made a small dip of her head.

“That’s it, Harry,” Francie said, and asked to be wheeled back to her room.

Her lobotomy had not erased her. When she chose to see Harry, when she asked for that comb, she dug down into herself and found the person she had been. That’s it, Harry. Francie spoke her epitaph not as a lobotomized person but as a human being who understood something profound about making her peace. The tragedy of her life enlightens — if not her, then me, who has been left to tell her story. She has given me a new perspective on when death might most benevolently arrive for the mentally ill.

What I take from this is that we must do better: America, at a loss for what to do for the mentally ill; Belgium, attempting to solve the problem by creating a bureaucracy of extinction. The author of the article writes, “The laws seem to have created a new conception of suicide as a medical treatment, stripped of its tragic dimensions.” I say that we need those dimensions for our survival as a species, just as an individual needs the alliance of Joy and Sadness. Francie and my family would have been better off had she been able to choose a guaranteed death, but society and humanity would be diminished by it.


Janet Sternburg is the author of the forthcoming book WHITE MATTER: A Memoir of Family and Medicine (Hawthorne Books, Sept. 2015), a story about family secrets and mental health.


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