I’ve written before about the issues with language policing, but this is probably one of the more controversial areas where I believe that words matter less than people might think. We aren’t “supposed to” talk about successful suicide or failed suicide attempts. Sara of Surviving Sara brought this up recently, and I told her it’s not something I have a problem with. Still, I thought it would be a good topic to chat about, because I think there are bigger failures in relation to suicides that we need to be talking about.
How we talk about attempting
The reason that we’re not supposed to talk about a successful attempt/suicide is that it implies that it’s a good thing the person died. Also, talking about a failed attempt implies that it’s a bad thing that they didn’t die. I get that, and I can see why people prefer not to use that phrasing.
The reason I don’t think it’s especially useful as a target for word policing is that it seems like it’s more about shifting the frame of reference that’s used rather than changing how people feel about suicide. Usually, if we’re talking about succeeding or failing at something that someone is attempting, the frame of reference that we use is what that person was trying to do, not what we’d like them to do or wish they had done. If I completed a task I was trying to do, I succeeded at that attempt. If I didn’t achieve the outcome I was aiming for, from my frame of reference, I failed at that attempt.
Changing how we talk about success/failure in terms of suicide shifts the frame of reference away from the person who was doing the attempting. Instead, it takes the perspective of the onlooker to decide what is success/failure. I don’t have a problem with that at all, but I’m not sure how likely it is that pushing other people to make that perspective shift will change their beliefs about suicide and attempted suicide.
My own experience
Here’s perhaps an even less popular thought, but it is what it is. I’ve had a few suicide attempts, and I viewed them as failed attempts. I was trying to die. Whether that’s a good or a bad thing, that was what I was trying to do. I did not succeed at what I was aiming for. My story was very different from someone like Kevin Hines, who jumped off the Golden Gate Bridge and immediately regretted it. My regrets were about surviving.
What has really failed?
Regardless of whether an attempt resulted in a death or not, if things have gotten so dire that someone feels compelled to take their own life, there are most likely various things outside of the individual that have failed in the lead-up to that point. I think those failures are a lot more important to get people talking about than wording choices.
The health care system
The mental health care system fails people all the time. It can be hard enough to get a GP, much less a psychiatrist. Now with COVID, you might be really sick and have to deal with some bullshit telephone assessment. The phone can be convenient for some things, but a solid psychiatric assessment, especially of someone in crisis, is not one of them.
For some people, insurance coverage limits what treatments they can access. Even in countries with public health care systems, there’s often limited coverage for psychotherapy. Wait times can be significant for therapy that the public system does cover. When people aren’t doing well, the possibility of accessing therapy many months down the road (or more, if your referral gets conveniently lost) just isn’t good enough.
For some of us, disclosing suicidality in the community opens up the possibility of police showing up and hauling us off to hospital, quite possibly in handcuffs. If we want to destigmatize mental illness and suicide, stop getting the damn police involved. Mental illness is not a crime.
Very often, hospitals suck. If hospitalization is so bad and dehumanizing that it’s a deterrent to seeking help for suicidality, that’s a problem.
Then you’ve got ERs that will happily turf people for being “not suicidal enough.” Or, in the case of the NHS’s Serenity Integrated Mentoring program, you may have had an attempt, but A&E will refuse to treat you because you’re on a SIM shit list. You might even end up in jail, because that’s how fucked up SIM is.
This poor girl wasn’t taken seriously by health care providers, and a successful suicide was the result (this was her last tweet before she died). If only it had been a failed attempt. The fact that it came to that at all is a massive failure. Sadly, there were a few colleagues I worked with over the years that I can imagine saying this kind of thing.
With the current crop of available treatments, there are a fair number of people with treatment-resistant mental illnesses. They continue to have symptoms (which can include suicidal ideation) despite getting treatment and trying their hardest to get the illness under control. We need more research to find better answers.
Social safety net
People are living in poverty, with difficulties meeting basic needs. There’s a lack of affordable housing. In certain communities, significant social problems and a lack of opportunities can translate into high suicide rates. An example of this is very high suicide rates among youth in Indigenous communities in Canada’s North. If communities in Canada have some of the highest suicide rates in the world, that’s a systems-level fuck-up.
Mentally ill people with guns rarely kill others; they kill themselves. The easier it is to get guns, the easier it is for suicidal people to access lethal means. Means restriction can contribute to lower suicide rates.
So what is success or failure?
My concern is that if we worry too much about getting people to change the frame of reference and wording when talking about attempted suicide, it’s a distraction from the real failures that we need to be talking about.
As long as people are getting the boot for ER because they’re not suicidal enough, we’re failing. As long as crisis teams are minimizing patients’ suicidality, we’re failing. As long as people can’t get a proper assessment, we’re failing. As long as (effective) treatment seems to be just a pipe dream, we’re failing. This is the shit we should be getting worked up about.
In my mind, success is when people can “reach out” and there’s something there to reach for that can actually help them.
Do you think efforts to change people’s language use regarding failed or successful suicide are helpful? Or are other issues more important to focus on?
The Straight Talk on Suicide page has crisis and safety planning resources, along with info on suicide-related topics from the perspective of someone who’s been there.