Language About Suicide
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Language about
Suicide (Part 1): The Power of Words “Committed Suicide” vs. “Died by Suicide” It is not at all uncommon to hear someone say, or to read in a news account, that someone commits suicide. This is a pervasive term. Yet the word “commits” often has negative connotations. Think of what else the word “commits” is used for. Somebody commits murder. Or commits rape. Or commits robbery. What is the common denominator? The word “commits” in combination with a noun often signifies a crime or another act of wrongdoing, such as “adultery.” A person who attempts suicide or dies by suicide is experiencing deep emotional pain, hopelessness, or mental illness – or all of the above. Such pain does not make someone a criminal. But the word “commits” makes suicide sound like a crime. For this reason, in this blog I will use the term “died by suicide,” a neutral, factual term. “Completed Suicide” Some suicide prevention activists use the term “completed suicide” instead of “committed suicide.” This term is problematic for several reasons. First of all, it is not a phrase that comes naturally. If I say “he completed suicide” to somebody outside the suicide-prevention community, they are not likely to understand instinctually. And when they do understand, they are not likely to use the term themselves, because they want to be understood by others. The other problem with the term “completed suicide” is that “complete” typically is associated with success. “I completed a project.” “She completed graduate school.” “Now I am complete.” Suicide is not a project to be completed. From a suicide prevention standpoint, I would much rather this undertaking remain unfinished, a quality that usually is undesirable, but not in this case. Rather than “she completed suicide,” it is fitting to say, “She died by suicide.” “Successful Attempt” and “Failed Attempt” I often will hear people say “she attempted suicide and failed” or “it was a successful suicide.” Again, connotations are important. Success typically is good. Failure typically is bad. From a suicide prevention standpoint, in this case “success” is profoundly bad, and “failure” is a gift. We certainly do not want someone who survives a suicide attempt to then feel like a failure. For this reason, I avoid the terms related to success and failure. Instead, I will say somebody survived an attempt, or died by suicide. Alternatively, I sometimes refer to a nonfatal suicide attempt. Sensitivity to Language All in all, the key is to be sensitive
about what we say and about any other meanings our words
might have. If you are not active in the suicide prevention
community, you might view these guidelines as another form
of political correctness. Perhaps they are. Sometimes,
political correctness is good, especially when it helps, in
whatever ways possible, vulnerable people and those who love
them. Language about
Suicide (Part 2): Who are Suicide Survivors? Suicide means to die a self-inflicted death, so how can anybody be called a survivor of suicide? Of course, nobody survives their own death. The term “suicide survivor” – or “survivor of suicide” – is reserved for those left behind. It is used in the same sense that an obituary will say, “The deceased is survived by ….” The person who died by suicide is gone. Those who remain are survivors. But Wait – What About People who Survive a Suicide Attempt? In recent years, more and more people who have attempted suicide and survived have shared their stories publicly. They often are referred to as “suicide survivors,” which can get more than a little confusing. Suicide Survivor vs. Suicide Attempt Survivor It helps to keep in mind that there are two types of survivors – people who survive the suicide of a loved one, and people who survive a suicide attempt. So, more accurately, somebody who attempts suicide and lives to tell about is a suicide attempt survivor, not a suicide survivor. For More Information As this site develops, I will write more about suicide survivors and about suicide attempt survivors. In the meantime, I have listed some good resources below. For more information for and about survivors of suicide, check out these sites: www.survivorsofsuicide.com For more information for and about survivors of suicide attempts, this pioneering site is excellent: attemptsurvivors.com/ Source: www.speakingofsuicide.com/2013/04/14/language-about-suicide-part-2-who-are-suicide-survivors/ Please Stop
Saying 'Committed' Suicide Thankfully laws have changed, but our language has not. And the residue of shame associated with the committal of a genuine crime remains attached to suicide. My brother did not commit a crime. He resorted to suicide, which he perceived, in his unwell mind, to be the only possible solution to his tremendous suffering. If I was telling you about a friend or loved one who actually did commit a crime, chances are I’d feel at least a little embarrassment or shame on behalf of that person. But I don’t feel even the tiniest bit of shame about how Jeff died. Of course, I wish with every fiber of my being we’d been able to successfully help Jeff and that he was alive today. But shame, nope, I don’t feel that about my brother. I focus on how proud I am of who he was in his life – passionate, thoughtful beyond words, brilliant, determined and braver than most people I know for enduring his pain as long as he did. Yes, Jeff Freeman was a brave, brave man. As is any person who grapples with deep emotional distress day after day, year after year. So to say that someone “committed” suicide feels offensive to me, and I’m not easily offended. The offense is in the inaccuracy. With that said, I don’t judge people for using this expression – until August 17, 2007, I did the same. But now I don’t. And I humbly ask that you consider the same. When you have occasion to talk about suicide, please try to refer to someone dying by suicide. By shifting our language around
suicide, we have the power to reduce some of the massive
shame carried by survivors of suicide. If you feel scared or
helpless about what to say to someone who’s lost
someone to suicide, take comfort in knowing that, by
changing your language about suicide, you’re offering a
countercultural act of kindness. It might seem small but the
interpersonal and political impact is nothing but huge. Are You
Thinking of Killing Yourself? Instead of giving you superficial reassurance, I am going to ask you some important questions. I invite you to consider them thoughtfully, and to sit with your answers. They may surprise you. Have You Tried Everything that Can Help? You obviously feel tremendous pain, hopelessness, or other problems that are causing you to want to die. Have you tried out everything possible to alleviate those problems? If you are depressed, have you tried every different type of antidepressant medication out there? (At last count, there were 30). Even if a few types of antidepressants haven’t worked for you, that doesn’t mean that none of them will. Have you tried therapy? Research indicates that various therapies, such as cognitive behavioral therapy and dialectical behavior therapy, can help to reduce suicidal thoughts, improve depression, and strengthen coping skills. Have you increased your exercise? Exercise can be as effective as antidepressants in relieving depression, and it helps reduce anxiety, too. If you are experiencing a life situation with devastating consequences – perhaps you are being bullied or facing jail time – can you consider the possibility that the situation may change, or that it may become more bearable in time? If you are hearing voices telling you to kill yourself – perhaps the voices say that you are a bad person or that you do not deserve to live – can you consider that the voices simply are wrong? Can you talk back to the voices? Have you tried every type of antipsychotic medication there is? (There are at least 18, not including mood stabilizers.) Might the voices come to a stop, or change what they tell you, or become less believable with time? Similarly, if you are plagued with thoughts of worthlessness, hopelessness or unlovability, can you entertain the possibility that those thoughts are not true? You do not need to believe everything that you think or feel. I have heard the saying before (though I forget where) that many people have a prosecutor residing in their head, and they lack a defense attorney. You can learn to defend yourself against self-condemning thoughts and to feel better about yourself and your life again. (Cognitive behavioral therapy especially helps with these types of problems.) Whatever you are dealing with, can you consider that you still can craft a purpose for yourself in life in the months and years to come, whatever that purpose may be? What Would You Say to a Suicidal Person in Your Situation? Compassion and suicideThink of everything that is going wrong in your life. Think of all the reasons you have for dying by suicide. Now imagine that someone you care about very much came to you with the same problems, the same reasons, the same desires to die. What would you tell them? Would you say to this person you care about, “You’re right, you should kill yourself”? If not, why? What Are Your Reasons for Living? (Or What Were They?) Something has kept you alive this long. What has kept you going? Reasons for livingWhat have you lived for in the past? Is it possible that you will want to live for those same things again in the future, if this crisis passes? Here are common reasons for staying alive that people provided in a study by Marsha Linehan and colleagues:
Other reasons might include pets, dreams of traveling, love of the mountains – you name it. Whatever keeps you here may well be worth staying for. Do any of the above reasons apply to you? If not, could they in the future? Where Is Hope? Hope and SuicideThe antidote to suicidal thoughts is hope, and conversely, hopelessness is their accomplice. What do you hope for yourself for the future? What can you do to help you survive long enough for those hopes to be realized? Are there things you hope for immediately, like a chocolate bar, a good night’s rest, a day off from work? What are the little things that you hope for that might not be getting your attention during this time of crisis? Have you lost all hope? If so, think back on what gave you hope in the past. When did those things stop fueling your hope? Could they again? Maybe you are thinking “Things will never get better” or “I have nothing to live for. ” Can you be certain your thoughts are correct? More to the point, even though it is painful to have such thoughts, is it possible you are wrong? Remember, some conditions – like extreme stress, or depression – can cloud a person’s thinking, making hope invisible. People with these conditions may be unable to remember the good things in their life and unable to tap into the good things that may come. But hope does not really die. It just hides. Even amid a terrible storm in the head, it is still there behind the clouds, just like the sun. Think of Other People – Or Not Family and suicideI would like to ask you to think of people who would suffer from your death. But I know that thinking of other people can be very complicated. Some people are angry at those they believe have failed them. They may feel, often rightly so, that their suicide will cause guilt in those they left behind, and for a small number of suicidal people, this may be a fate that they welcome. In this context, suicide takes on a vengeful quality, whether that is the primary purpose or a byproduct of suicide. Other people may feel convinced that they are a burden on their loved ones, and that their suicide would be a way to spare their family and friends. Even more common, perhaps, are the people who are suicidal precisely because they have no one who cares (or believe that to be true, even if it is not). I also know that when the pain and desperation become excruciating for a person considering suicide, the love and support of others becomes only a small solace. Even parents of young children die by suicide, not because they do not love their children and not because they disregard the pain it will inflict on their children. No, for many people who are suicidal, their pain is so great that they desperately want to escape it. Even though they know their death will bring great pain to those left behind, a more frightening scenario for them is having to continue enduring their own pain, day after day. I recognize that sad reality. So the question of who your death will hurt might not be relevant to you. But if it is relevant, please do consider that those who care about you will be devastated. Remember the saying: “To the world you may be only one person, but to one person you may be the world.” To which people are you the world? Whose world might you become in the future, whether or not you have met that person yet? What people might you help, whether professionally or personally? How Have You Coped in the Past? Think of another time when you really struggled in life. Perhaps you did not think of suicide, but you felt extremely sad, or angry, or hopeless. How did you get through that? What helped you? Who helped you? If you have ever experienced this kind of despair and suicidal thinking before, what stopped you from killing yourself then? What did you do, feel or think then that you might be able to repeat now? Is It At All Possible that Things will Change? Hope change and suicideCan you know for certain that your problems will never improve, or that you will never learn to cope with them better? Even though it does not feel like it now, there is hope for change. The horrible situation you are in might get better, or it might become more bearable. The pain you feel may ebb, or you may develop techniques for coping with it. Hope may return. Goodness may come. Consider that among people who survive a suicide attempt, about 90% do not eventually die by suicide. Even these people who made the decision to die find reasons to live again. Can you know for certain that you won’t rediscover reasons for living, or reconnect with those that already exist? Maybe not now, but there may well come a time when you look back on your suicidal state of mind and are glad that you did not die. There is a good saying: Don’t quit five minutes before your miracle. Similarly, I have a piece of artwork on my wall that says, Any moment can change your life. You just have to be there. This applies to you, too. It applies to everyone. Finally, What If You Survive a Suicide Attempt with Serious Injuries? Sadness regret and suicide attemptThis is a tough question to ask, and even tougher to answer. Consider that you might survive your suicide attempt. Would the injuries you inflicted on yourself make your problems even worse? You could suffer permanent injuries from jumping, trying to hang yourself, or doing other bodily injury to yourself. Consider what happened to Kristin Jane Anderson, who attempted suicide by lying down on railroad tracks when a train approached. She lost both her legs. (See her excellent, inspirational book, Life, In Spite of Me, about rediscovering hope and purpose in life in the years that followed.) If you shoot yourself, you may still survive. Some people who shoot themselves do permanent damage to their face, experience severe brain damage, or become paralyzed. In another book by an attempt survivor, David Wermuth describes the ordeal of becoming blind from shooting himself in the head. Some people who survive an overdose damage their kidneys or liver in the process. A transplant is sometimes necessary. Some others suffer permanent brain damage. I said this is a tough question to ask, because I do not want to challenge you to come up with a foolproof method for killing yourself. Instead, I want you to consider that things don’t always go as planned. Whatever problems you struggle with now could be made even worse with a suicide attempt. In Closing: Suicidal Thoughts as a Symptom Many people think of suicide from time to time. The philosopher Camus noted, “There is but one truly serious philosophical problem and that is suicide.” The philosopher Nietzsche said, “The thought of suicide is a great consolation: by means of it one gets through many a dark night.” To seriously consider suicide is a sign that something is wrong. Our natural instinct in life is to survive. People endure unimaginable horrors in order to stay alive – as but one example, just think of the man who cut his arm off with a pocket knife in order to liberate his body from a boulder, having been trapped beneath it for five days and seven hours. If your instinct to survive has become weakened, it is a sign that you need help. Please seek that help, whether from a trusted friend or family member, clergy, physician, therapist, or some other supports you have. What can you do now, right now, to help yourself or to let someone help you? Resources For a list of resources you can contact immediately, via hotlines or online, click here. If you are in danger of acting on suicidal thoughts or are in any other life-threatening crisis, please call emergency services in your area (9-1-1 in the U.S.) or go to your nearest hospital emergency room. The National Suicide Prevention Lifeline is open 24 hours a day, every day. Services are also available for veterans, and for Spanish speakers. The Trevor Project 866-488-7386 – a hotline for LGBT youth Trans Lifeline This is a hotline for transgender people. The volunteers and staff are themselves transgender. U.S.: (877) 565-8860 Canada: (877) 330-6366 International Hotlines The above hotlines are based in the U.S. You can find a list of international suicide hotlines here. It is compiled by the group suicide.org. Here’s another
list, in case you don’t
find one there. This one is maintained by the
International
Association for Suicide Prevention What is a
Suicide Gesture? “…A suicide gesture is like a one person play in which the actor creates a dramatic effect, not by killing or even attempting to kill himself, but by feigning an attempt on his life.” In another definition of suicide gesture, “a person leads others to believe that he has just made a suicide attempt in order to communicate that he is in distress or to influence the behavior of others in some way.” Still another definition: “an unusual but not fatal behavior as a cry for help or to get attention, or a suicide gamble, when patients gamble their lives that they will be found in time and that the discoverer will save them.” What is Wrong with the Term “Suicide Gesture?” There are several problems with the terms “suicide gesture” and its cousin “suicidal gesture.” Especially in the clinical world, the terms are sometimes used interchangeably with the term “suicide attempt.” In some clinicians’ eyes, a suicide attempt in itself is a suicide gesture, because the person survived. Equating a suicide attempt to a “gesture” inherently diminishes the gravity of a suicide attempt. It is dismissive. It is even pejorative. It doesn’t take seriously a person who is experiencing serious pain or other problems. This is especially true when you consider one of the dictionary definitions of “gesture” at www.oxforddictionaries.com: “An action performed for show in the knowledge that it will have no effect: I hope the amendment will not be just a gesture.” So, calling a suicide attempt a “gesture” is just another way of branding someone as manipulative and attention-seeking. After all, their apparent suicide attempt (supposedly) was not an attempt at all, just an action performed for show in the knowledge that it would have no effect. The dictionary also notes that, in the general sense of the word, “gesture” usually applies to a movement of the head or hands to express an idea or meaning. Even this benign definition suggests that a person who attempts suicide was trying to convey something to others – not to die. Misrepresenting Suicide Attempts, Misrepresenting Risk Calling a suicide attempt a gesture is not only dismissive. It is also potentially dangerous. The term can mask the true danger of suicidal behavior. In an article titled “The Problematic Label of Suicide Gesture: Alternatives for Clinical Research and Practice,” Nicole Heilbron and her colleagues note that calling suicidal behavior a “gesture” can understate the person’s suicide risk: “Labeling of an individual’s behaviors as gestures to family members also may communicate a dismissive stance that may lead to a false sense of security regarding the individual’s safety and needs for monitoring.” What About “Suicide Attempts” That Are Not Really Suicide Attempts? Sometimes, a person does something that appears to be a suicide attempt, but without any intent to die by suicide. Non-suicidal self injury occurs for a great many reasons. Some people hurt themselves without intent to die because it helps them to discharge stress, to penetrate numbness, to punish themselves, or to achieve some other aim such as an adrenalin rush. These are clear cut cases where there is no suicidal intent, and so the act is not a suicide attempt. Yet it is also true that some people who hurt themselves with the specific goal of actually feigning a suicide attempt. Usually people with these feigned attempts have a specific objective in mind, like to get removed from the general population of prisoners in a jail (though a great many people who attempt suicide in jail or prison do so out of a genuine, painful desire to die). For others, an apparent suicide attempt may actually be a “cry for help,” though it’s important not to dismiss self-harm as manipulative. (I write more about this complex topic here.) The Reality of Suicidal Behaviors Sometimes, as I explain in a journal article, we just don’t know whether someone who appears to have attempted suicide really wanted to die. Even people who do intend to die may be ambivalent about dying. They may be afraid of dying. They may even be tormented by the idea of dying. But for whatever reason, to at least some degree death seems preferable to their current situation. Even when people engage in self-harm to cry out for help or effect change in a situation, they are still engaging in dangerous, potentially deadly self harm that goes beyond “just” a gesture. Most individuals have healthy ways of solving problems or receiving attention. Using the appearance of a suicide attempt to effect change represents a dramatic, life-threatening gap in coping skills. The person may not actually be suicidal, but their behavior could still kill them. Alternatives to the Terms “Suicidal Gesture” and “Suicide Gesture” There’s no need to use the term “gesture.” If somebody hurts himself or herself with at least some intent to die, then that is a suicide attempt. If it is clear that the person had no suicidal intent when injuring himself or herself, then that is non-suicidal self injury. If somebody truly and unequivocally feigns a suicide attempt, then the non-suicidal self injury can simply be described with precision rather than labeled. For example: “The client is homeless and sought admission to the psychiatric hospital during the blizzard. When he wasn’t admitted, he pulled out a knife and said he would kill himself unless someone gave him a warm place to stay.” Whatever the case, there is no need to
minimize suicidal behavior by calling it a mere gesture. We
make gestures with our hands and head – not with
suicide. Language
Matters: Committed Suicide vs Completed Suicide vs.
Died by Suicide Suicide is bad, yes, but the person who dies by suicide is not committing a crime or sin. Rather, the act of suicide almost always is the product of mental illness, intolerable stress, or trauma. To portray suicide as a crime or sin stigmatizes those who experience suicidal thoughts or attempt suicide. This stigma, in turn, can deter people from seeking help from friends, family, and professionals. As Susan Beaton and colleagues note in their article, “Suicide and Language: Why We Shouldn’t Use the ‘C’ Word”: “Suicide is not a sin and is no longer a crime, so we should stop saying that people ‘commit’ suicide. We now live in a time when we seek to understand people who experience suicidal ideation, behaviours and attempts, and to treat them with compassion rather than condemn them.” “Completed Suicide” vs. “Died by Suicide” Warning: I am a word geek. I love language, and I also love discussing its intricacies. Some will deride this discussion of suicide terminology as political correctness gone awry. But language has power. If changing our language can help suicidal people to feel safer asking for help, then changing language can save lives. With that said, I prefer the term “died by suicide” because it avoids the judgmental connotations of “committed suicide.” Some people advocate for using the term “completed suicide” instead. I urge people not to use the term “completed” suicide. I explained my objections to the term in this post, and they bear repeating. What’s Wrong with the Term “Completed Suicide” Think of the sense of accomplishment you feel when you complete a big project. Then think of the disappointment you feel when you don’t. Completion is good, and suicide isn’t. To complete something conveys success; to leave something incomplete conveys failure. In fact, at universities, if a student receives an “incomplete” in a class and doesn’t complete their remaining requirements on time, the “I” converts to an “F.” Some suicide prevention advocates use the term “completed suicide” because they view it as an acceptable alternative to “committed suicide.” Not all suicide prevention advocates agree, of course. The State of Maine’s Suicide Prevention Program, for example, states on its website, “Both terms (committed and completed) perpetuate the stigma associated with suicide and are strongly discouraged.” The term “completed suicide” is especially popular among academics. A search on Google Scholar yields 470 articles where “completed suicide” is used in the title. Here are just a few examples:
Those examples actually bring me to a different complaint about the term “completed suicide.” When “completed” is used as an adjective for suicide (instead of a verb), it is redundant.
More about the Term “Died by Suicide” The Associated Press dictates the standards for appropriate language in most mainstream newspapers and magazines (but not academic journals). The AP changed its style book recently to discourage the use of the phrase “committed suicide.” Instead, it recommends alternative terms like “killed himself,” “took her life,” and “died by suicide.” I have no objections to any of these terms. As a direct substitute for “committed suicide,” I prefer “died by suicide.” I’ve heard only a couple complaints about this term, and none is that it perpetuates stigma against people who die by suicide, as the term “committed suicide” does, or that it portrays the act of suicide as an accomplishment, as the term “completed suicide” does. The first complaint is that “died by suicide” is a little clunky. Usually, we say somebody died of something (like, “she died of cancer”) not by something. Suicide is different, I guess, because the term “died by her own hand” also is in the vernacular. The second complaint I’ve heard from folks, especially my students, is that “died by suicide” is an unfamiliar term and hard to get used to using. It doesn’t roll off the tongue. Over time, the more you substitute the term “died by suicide,” the more natural it becomes. Likewise, over time, the more you say “died by suicide,” the more the term “committed suicide” will hurt your ears. And if you’re like me,
“completed suicide” will hurt your ears even
worse. So please, I urge you, say something else. |
