MONSTER INSIDE ME
Why this physically healthy 23-year-old woman is fighting for the right to die as soon as legally possible
KELLY is 23 years old. She is a bright and thoughtful young woman with an attractive smile that flits across her face occasionally as we spend several hours discussing her background, her family and her short life. With her long, tousled, chestnut hair and short, checked red dress, she looks like many of the 50,000 cheerful students who throng the bustling Belgian city of Leuven, home to the country’s biggest university.
Yet there is a big difference. For this friendly woman sitting on the sofa beside me – someone younger than both of my own children – is telling me an anguished tale of deep personal torment.
‘When I look in the mirror, I see a monster,’ she says at one point, although dark rings around her eyes are the only outward sign of her struggles. ‘I really don’t like what I see.’
Such words do not seem to match the person speaking them. But Kelly is plagued by mental health problems that she describes as being like a knife plunged in her chest – and we are meeting to discuss her determination to die.
‘It won’t hurt so I don’t see the problem,’ she says. ‘It is like going to sleep and for the first time in my life it will be quick. I won’t be lying in bed waiting for it to come.’
In almost every place on the planet, this would be a huge problem. But Belgium is one of three countries that permit such euthanasia, making no distinction between ‘unbearable’ physical and mental pain. The other two are Holland and Luxembourg.
Yet even in Belgium – which, 17 years ago, became the world’s second country to sanction euthanasia and the first to legalise it for children – psychiatric cases remain controversial, especially when they involve someone as young as Kelly.
Mental health patients account for about 3% of the 17,000 people killed since the law was changed in this country of 11million citizens. There were 2,357 deaths last year – 10 times as many as in the first year euthanasia was legal in Belgium – and most involved elderly people.
Many psychiatrists and most Belgians oppose extension of euthanasia to mental health cases. Some experts argue diagnosis is subjective, unlike severe physical illness, and insist the lives of distressed younger patients can improve with time, therapy and medication.
Yet Kelly, whose birthday is this week, plans to die as soon as legally possible so has no time for such arguments. ‘It feels like discrimination,’ she said. ‘It makes me angry. It’s just not fair. They don’t understand the pain.
‘People look at me and see someone so young but I feel bad inside all the time. It is not the age that is important but the suffering of the person.’
This woman – open and yet obviously troubled – highlights the complexity of this issue as societies face growing pressure from some patients and politicians to permit doctor-assisted death. Opponents argue legalisation is a slippery slope.
Kelly lives with her family near Leuven – yet incredibly had not told her parents, identical twin sister or younger sibling of her plan. She was due to break the news to them four days after our discussion, something she admitted she was dreading. ‘It is not going to be easy to tell them. I think my sisters will understand more than my parents. But it will obviously be very difficult, especially for my twin sister.’
The reason for her failure to tell her family soon becomes clear. She is fond of her father, a salesman, but said her relationship with her mother, a former cleaning lady, was very difficult, leaving her feeling unloved and insecure at home.
Her parents had a fractious relationship and her mother was extremely unstable, liable to explode in anger and storm out of the house for hours at the slightest upset. ‘I was afraid of my mother,’ said Kelly. ‘She would suddenly be shouting and crying and throwing things around the house, so I’d have to get away from her. Anything could trigger these events. But as a child I did not understand what was happening’.
Her stresses were fuelled by crippling shyness. This was intensified by living in the shadow of a more extrovert twin sister – which allowed Kelly to withdraw into a shell – and frequently changing schools as the family moved between rented homes.
The twins were often identically dressed, even as teenagers, although their parents made some efforts to encourage their individuality. ‘My sister did everything, such as making friends for us, so I never really had to do these things for myself. It felt like we belonged together, although I now see we were very different. But we were always together. Then when we were separated at school, I found it difficult.’
Kelly focused her efforts on
It won’t hurt so I don’t see the problem. It is like going to sleep
working hard and trying to pleaseher teachers. But she says shealways felt lonelyand unhappy–and even when she did bond withnew friends, it seemed as if theywerethen‘stolen’by her vivacioussister.
‘I tried telling her once how I felt,that it feltlike she stolea way myfriends, but nothing changed. Idon’t think she understood.’
I asked if she had ever been to aparty? ‘Yes, I went once and itwas awful,’ she replied. Shetried asking a few friends to her housefor asleep over around the sametime,when she was 16. ‘But onlyone came so I felt rebuffed.’
These are , of course,standardsocial anxieties form any teenagers .And for all her doubt sand in securities , I found Kelly tob every affable and straight forward–despite evident anger beneath the surface – once she began to relax during our discussion .
Yet trust is clearly an issue after her disrupted upbringing . So despite pouring out her up setting life story in detail , she was scared to tell mes he had a diagnosis of border line personality disorder for fear that it would change my opinionof her . It old her it washard to understand such psychiatric trauma for those that do not suffer .‘ It is like physical pain ,’ Kelly replied, holding both tightly clenched fists to her heart .‘ It feelslike I am breaking apart.'
Things began to spiral out of control at the age of 18 after the death of a beloved grandparent combined with a feeling of betrayal by a female psychologist she had grown to trust. `I could not go to classes. I would sit in the toilet all day crying.'
Kelly attempted suicide, was hospitalised, suffered eating dis-orders and started to self-harm. 'It was easier to feel the pain from self-harm then the pain in my head. At least the pain from self-harm goes away, unlike the pain inside that is always there?
She decided to apply for eutha-nasia after learning it was lawful and possible from a psychologist in the hospital. 'I felt "yes",' she said, pumping her fist as she recalled the moment. `I immediately went and looked up all the information I could find.'
To win the right to die, Kelly-who has been unable to work since leav-ing school beyond a bit of babysitting - needs backing from two psychiatrists and one other doctor. They must agree her mental pain is unbearable and untreatable.
She applied seven months ago and is being assessed by Joris Vanden-berghe, a local professor who has helped draft stricter rules for psy-chiatrists amid concerns that some patients died despite treatment options being available.
In the end, only her father attended the meeting on Fri-day with her doctor to break the news. 'My father was very shocked, he cried and I grabbed him. I was almost crying, too. It was very moving but also painful to see him like that,' she said.
Vandenberghe declined to discuss Kelly's case. But Vandenberghe recently wrote an academic article admitting Belgium's policy was `highly controversial and raises dif-ficult ethical and clinical issues'.
He argued its laws failed to ensure `sufficient checks and balances to promote reluctance to act on a patient's death-wish', concluding that more investment in mental health care could prevent some, but not all, of the demand for eutha-nasia from distressed patients.
Last year it emerged that three Flemish doctors, including a high-profile psychiatrist accused of being behind almost half the cases of euthanasia for mental health disorders, were being investigated on suspicion of 'poisoning' a woman who had autism.
Kelly attends a fortnightly group session with five others under goingthis vetting process where shemet her boyfriend Bregt, 44, afather-of-two who grew up in-an-abusive and dysfunctional household, leavinghim suffering post traumatic stress disorder.
‘I have always felt Idon’t be long,that I don’t want to be here. I try toconform as wanted by society but itdoes not work,’ he said. ‘There isthisconstantfeelingofbeinganalien,afreak.’
The pair have discussed whetherthey should die together if theygainconsent,butareconflicted.Bregt, a former social worker,fearshewillnothavethestrengthtowait.Kellyadmitsthatwhileshewould like to ‘do it’ together itmightupsetherfamily.
‘Idon’twantmyfamilythere.Ihavefeltsolonelyforsolong,whyshouldIhavepeoplewithmewhenIdie?I’mjustgoingtosleep–woohoh!’sheaddedwithasmile.
The group sessions are run byAnn Callebert, a psychologistwhohashadherownmentalhealthstruggles, including feelings uicidal.Shesaid:‘Myaimistoshowlifecanbebearable,tofindways to enjoy life, sincethey havethe feelingit is toopainful.’
She admit sit is difficultwhen patientsgoon to bekilled byeuthanasia– and thatKelly, theyoungest tojointhegroup,has got underherskin.‘Icanfeelhersuffering.Iwouldnotwant to be inherhead.’
So doesCallebert wantKelly to winconsent to die?‘Thatisdifficult.On one sidethereistheconstanthope shecanmakesomethingfrom life,somethingtogivemeaning. ButthenIcanseeherdaily fight and Iwouldlovetofindawaytotakeawaythepain.’
She says Kellyis ‘a tough girl’.
Itwasdisturbingtotalkinsuchanopen manner about the possibledeath of someone so friendlyandphysicallyintheirprime.Butequally,herintensementaldifficultieswerecleartosee.
Kellyhascontemplatedwhatshewilldoifdeniedeuthanasia.‘FirstI will try to find another doctorbutifthatdoesnothappenthenIwillgiveup.Thatmeanssuicide.’
Last year I interviewed a Belgianwoman with autism left seriouslytraumatised after being locked upin psychiatric units duringchildhood .She had wont he right to die but since being granted control over her death had stoppedthinking about suicide.
So could this happen to you, Iasked Kelly? Could you possiblyfind any happiness in the future?She shakes her head in response,before saying quietly: ‘Happydays in my life? Never, seriouslynever.Iwantthisalltoend.’
As she left with Bregt, I gaveher a big hug and hoped that shewaswrong.
Why have my family there when I die? I have been so lonely for so long