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.
Crisis response
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.
Available treatments
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.
Means restriction
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?
Related posts
- Barriers to Help-Seeking for Suicidal Ideation
- “Committed Suicide”: Suicide-Related Language and Word Policing
- Is Suicide a Choice? (Regardless, It’s Not Selfish)
- Suicide Attempt Survivors: Yes, We Do Exist
- The New York Times’ Take on a Suicide Forum – My Thoughts
- What a 988 Suicide Hotline Can (and Can’t) Accomplish
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.
There are so many unresolved questions about suicide that make any conversation difficult.
1. Is suicide sometimes a justifiable choice? Some societies honor those who sacrifice themselves in individual or mass suicide (think ritual suicide in Japan or Masada on the other side of the globe). Can it be OK for someone to say, “I’ve had enough, I’m done”? And not just when they are terminally ill.
2. What are the statistics about suicide? Honestly, we don’t know. Some police departments will still coverup less obvious cases to protect the reputation of families. How many gun accidents or car accidents are actually suicide? We know that for some, “death by cop” is in fact suicide, but is it counted that way? Do northern Canadian villages have higher rates, or are they simply more honest?
3. The cloak of confidentiality also obscures statistics. How many suicide attempts that medical professionals know about aren’t reported? Working in health insurance, my guess is that under-reporting is substantial.
4. Arguably, there are resources in many countries for those wanting to seek mental health treatment. However, there are also stigmas attached to seeking treatment, including financial penalties. Insurers won’t insure and employers may not hire. There is discrimination against those who have sought treatment, which ranks right up there with ageism and racism. In my experience, those who claim to be the most religious are in fact the most bigoted.
I don’t have a problem talking in confidence regarding any health situation with my clients, and I will connect them with help if they want and find an insurer who will cover them. It takes effort, but I’m happy to do it. However, other insurance people focus on volume, spending as little time as possible on each client in order to maximize commissions. And the government encourages that. CMS stipulates that for the insurance marketplace in the US (state and Federal), agents get paid $20 per month for servicing a client. I spend a lot more time than I get paid for, but I understand why others won’t. Consumers lose as a result.
The question of justifiability is an interesting ones, as what’s justifiable to one person may have nothing at all to do with what’s justifiable to the next person.
I agree that suicide statistics are only ever an approximation. Certain methods may be obvious as suicides, but others (like using a vehicle) are probably seldom counted as suicides when they actually are.
And yes, there’s definitely a lot of bias against those who have attempted suicide.
The old book, “The Martian Chronicals”, made a case that for each person there is an optimal time for exit, and that those who overstay are just as sad as those who die too young. Imho, the conversation is fundamentally entwined with Frankl’s notion of purpose.
Very good point.
You are a light in the blogging world Ashley. It hurts reading that your regrets were about surviving. At the same time, your perspective is super important and I respect the hell out of your honesty. Everyone is different and has different feelings. No matter what they are, they are valid.
I also agree wholeheartedly regarding what some of the biggest issues regarding suicide are. Language can be important. However, if people can’t be taken seriously or get proper access to Healthcare, then that is a much larger and serious issue. It is supreme bullshit that these life saving services are made so inaccessible for lots of different people.
This was a fantastic post. Thank you for sharing and this series that you have.
Thank you!
It’s interesting, I’ve come across people who’ve said/written that everyone regrets attempting afterwards. I have no clue what the proportions are around who regrets what, but there is no single experience that everyone has.
Greater accessibility is huge. It bugs me sometimes that so much emphasis is often placed on crisis lines, as they’re absolutely important, but effective and accessible mental health treatment is crucial as well.
I have never thought of it this way in whether this is an area to correct. I can see both sides that you raise, but thinking about it, its not an area I would get upset about. Even lets say I heard a medical professional say for example about my mum, “that she failed suicide.” It wouldn’t upset me, because I will be more upset about the situation.
Same with when I heard and seen that tweet of the one who died by suicide. I did not know this person and sadly only heard of this news, after it happened. Its sad to see that tweet of hers showing once again, those that really need the help and ask for it, but don’t get it, because they are not seen as suicidal enough.
The closest I have had personally myself, is I wasn’t depressed enough for counselling.
My upset I have more over is when people say “committed suicide,” rather than “died by suicide. “
Yes, certain situations are upsetting regardless of the words used.
I know a lot of people are bothered by “committed suicide”, but I don’t think the people using it associate the same connotation with it that the people who dislike it do. I tend to pay attention when I come across people using that phrasing, and it’s something quite a few mental health bloggers, including those who’ve attempted suicide, use.
Yes. I have seen it being used by mental health bloggers, including one who said they attempted suicide, but used the other phrasing I mentioned just before when talking about it.
I couldn’t agree more with this entire thing. There’s so much that needs discussed and researched. When I was teen and had multiple attempts, no one, literally no one, even bothered to see if maybe I needed some help.
Then as an adult, I was going through extreme panic attacks to where I started having suicidal thoughts to just get the panic attacks to stop because they were so bad. I had my husband drive me to our local military ER because I knew what was happening and I didn’t want that, I just wanted to panic attacks to stop. The staff was extremely friendly and caring towards me at the ER. I was sent to an inpatient facility in NY to try a different medication under supervision. Now this place wasn’t horrible, but man I can’t stress enough, from someone who has gone through a lot of stuff in life and deals with mental health issues, the basic cognitive therapy of telling myself I’m fine, is not a long term treatment solution. It’s the “faking it till you make it” kind of therapy in my own personal opinion. Instead of fooling ourselves, I think the issues with treatment for mental health need to start coming from the difficult conversations and the inner root causes. Whether that be from past hidden trauma or a physical health concern creating other health concerns. But why do we tell ourselves over and over we’re fine when we know deep down, our body is screaming “no you aren’t!”
So being at the inpatient place wasn’t all bad, but just seemed better for medication monitoring then anything because I can tell myself a million and one times I’m fine, but my deep rooted childhood trauma, wasn’t going anywhere.
I think part of that comes down to the common assumptions among health care providers that things happen in just one way or for just one reason, and that can blind them to the fact that we’re all unique individuals with very different histories. The last time in hospital, my primary nurse was frustrated that I wouldn’t tell her what I was angry about, because she thought I must have been angry about something to have tried to kill myself. I just figured she was batshit crazier than I was, but later realized that’s a very Freudian way of looking at it. No, we’re not all the same!!!
So true. That’s One reason I had left my former university for CMHC and switched elsewhere because I do not agree with the modernism one way view of things.
Yeah, trying to cram everyone in one box just doesn’t work.
Oooh – some really valuable points Ashley, and your candour is so important. I think sometimes the means of communication can effect the importance of using correct words. If you are having a face to face conversation in person, there are so many other aspects of communication that come into play – body language, attitude, eye contact, tone of voice, pitch, pace….etc. So sometimes the precise words you use might not be noticed as much as the overall message that is being delivered by numerous aspects.
If you are using solely written means, choice of words can really matter. In a telephone conversation, the warmth in someone’s voice can make a difference as well as their choice of words, and their pace.
But for me personally, I would always feel compelled to find the kindest, warmest, and most loving way of listening and reacting to anyone who was telling me they struggling.
It breaks my heart that some professional services sometimes completely miss the mark with some of those who are asking for help and send them off in a worse state.
Good points, and I think that in a more delicate situation like talking to someone directly affected by a loved one’s suicide or suicide attempt, kindness and warmth would be super important in word choices and paraverbal/nonverbal communication.
It really is heartbreaking that services miss the mark so badly sometimes.
Chicken or egg situation?
If we change people’s thoughts/beliefs, then language will change. But how do we change people’s thoughts and beliefs without first changing language? Language is how we communicate our ideas.
“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?” That feels like asking, should we use the pronouns for individuals that the individuals have chosen? Or should we focus on more important issues like the murder of people because they are not heteronormative? This seems like a false choice. We can do both. We get that energy is finite, and we want priorities. But as a movement, can’t we attempt multiple things.
I wasn’t trying to imply that we shouldn’t respect people’s own way of speaking about themselves. I was referring to people who attempt to dictate to others how to talk about a concept generally. When it comes to suicide, there are a lot of people issuing such general proclamation.
If I say that successful suicides are more common among men than among women because men tend to use more lethal means, and someone interprets that as me saying that suicide is a good thing because I’m talking about success, they’re free to interpret it that way. However, if they’re telling me and everyone else that we should never use that language, that’s something I see as a distraction from more important issues. The more language policing there is, the less dialogue there’s likely to be, and that’s a serious problem.
Someone could say conversion therapy is successful 0% of the time, and my issue wouldn’t be the word “successful,” but the fact that conversion therapy is even happening at all.
Now, we think we understand. These examples were helpful.
❤️❤️❤️
❤️❤️❤️
I think I only once seen expression ‘successful suicide attempt’. I don’t have problems with looking at it ‘from the person perspective’ – although how do we know what the person really wanted? I think everyone who is as desperate to try is not really thinking clearly.
What I have problem with in this expression is the fact that it is confusing. It seems to me like successful should be being rescued and then getting help as a result, the help that they actually needed.
I had one suicide attempt and, as I was swollowing one lorazepam tablet after the other I was not really thinking about whether I want to die or not. I was only thinking that I wanted to swallow them.
The box had 20 tablets snd I stopped when I thought I took 19 (it then later turned out I had 18), and only with time I realised that my attempt was actually me trying to ‘reset’ life rather than end it (this is due to my autistic instinct being in operation). That’s why I stopped before having ‘full course’ – my instinct expected I’m going to die if I took the full box.
The attempt was successful in this respect that I did as a result get help I needed. As much as I don’t advocate for this to be solution to any problem I actually see it, in hindsight, as the moment that was the beginning of the change for the better.
I’m glad you were able to get help.
First, I’m glad you failed and are still around (hopefully somewhat less depressed?). Second, I’ve grown to hate all language policing (thanks internet aholes) because it never fucking ends. We went from legit criticism of ethnic slurs to bitching about pronouns and calling migraines “headaches.” Eff these word-nannies! Third, I agree that it should be fine to use words according to their definitions. If you don’t succeed at a task, you failed. Example: I failed at marriage. As it turns out, I’m much happier single, so my failure was a good thing!
Failure at certain tasks can be the biggest success of all.
I’m good with referring to people they way they want to be referred to, but the internet has gone way overboard on the language policing.
I’m right there with you and the police presence. I had 4 officers show up on me with the crisis team. The crisis team basically told me I go with them to the hospital or they call the police back to make me go to the hospital. It was an awful experience.
Yeah, they certainly don’t make it easy. Involving police in non-violent mental health stuff is so wrong.
Definitely agree that the wording issue is a distraction, and strongly agree with this statement: “If hospitalization is so bad and dehumanizing that it’s a deterrent to seeking help for suicidality, that’s a problem.”
I have been hospitalized after attempting suicide — and the last time, was fortunate enough to know exactly what to say in order to get the hell out of the psych ward — even though I didn’t feel any damn better. (The providers there had incorrectly changed my meds and implied that my therapist was ill-equipped — not true.)
It does scare me to think that if I were to become suicidal again — and told Mitch, he might feel the need for hospitalization (not as a punishment, but as a last-ditch effort to save his wife): back to coloring books and being ignored until it’s time to administer meds.
More recently, I had a friend who contacted her local suicide crisis team. She was told that they had a “high call volume” and that someone would call her back. Weeks later, she’s still waiting for that call.
Fortunately, she reached out to friends she knew had resources to share, and has (thus far) been okay.
I also agree with your assessment that the health care industry is failing. It’s a business, and people are treated as raw material for profit.
My husband and I have relatively “good” health insurance — but this last year the company added a separate deductible addendum for mental health. So my first visit to my well-known psychiatrist cost us hundreds of dollars (that we didn’t have, and had to make payment arrangements on) — on top of the hundreds we have to pay out for our primary care needs.
Our co-pays on mental health care visits have also been pushed from a $20 co-pay to a $60 co-pay — financially restricting how often I can see my doctors.
The system is broken. We need more informed advocates — not politicians, but people who have actually been through this sh*t — to speak out and raise a ruckus. Unfortunately, most of us are just too damn busy trying to survive. 🤬
When my psychiatrist at the time was reading the discharge summary from my last hospitalization, he said it sounded like he was reading about a different person, which was because I had said whatever I thought I needed to say to get the hell out of there.
The whole insurance thing is messed up. It just seems so wrong that people’s ability to access care is dependent on dollars rather than what’s actually most appropriate for their health condition.
Ruckusing is definitely hard when surviving takes so much energy.
Maybe I’m missing something, but I think the language is a lot clearer with respect to outcome without the adjective modifier. For example, when I hear “committed suicide” / “killed oneself” / “completed suicide” / “died by suicide”, it is very obvious to me that the person attempted suicide and died as a result. When I hear “attempted suicide”, I interpret that to mean that the person attempted suicide but is still alive. (This is partly because I assume that if the person is not alive, one of the aforementioned descriptions of the event would have been used). The words “successful” and/or “failed” actually made the outcome more confusing depending on whose perception we’re talking about.
The other thing I don’t like about the success/fail language is that I feel like it makes a lot of assumptions. A person who attempted suicide and is still alive can characterize their experience however they feel is appropriate. But for someone who died following a suicide attempt, we have no idea what their final thoughts were. I have no idea what the last thoughts and feelings of my friend whom I lost to suicide were. I have no idea whether or not she regretted taking the steps to end her own life, or even if she felt that she was consciously making a choice or if her struggles had made the choice for her. I admit I have my own feelings factoring in as grieving friend that makes me uncomfortable with calling her suicide attempt “successful”, but there’s also the factual element that she killed herself when she was alone without witnesses, and we do not actually know what she was thinking or feeling.
Another thing I find confusing about the success/fail language is that the use of it means that suicide is a choice. I don’t know that I have an informed opinion in the “is suicide a choice?” debate, but it is contradictory to hold the opinion that suicide is not a choice and also use the language of success/fail when speaking about attempts. Success/fail language is only relevant if suicide is a choice.
Finally, I would like you to know that I, selfishly, am grateful that you “failed” in your suicide attempt, as I have enjoyed getting to know you through blogging. (I know you have your own feelings on the matter, but I wanted, selfishly, to share mine)
Thank you. xo
Merriam-Webster defines suicide as “The meaning of suicide is the act or an instance of taking one’s own life voluntarily and intentionally.” The CDC says “Suicide is death caused by injuring oneself with the intent to die.”
Depending on how one views choice, there is some element of choice in intentionality and voluntariness. A constrained choice, sure, but it’s not an automatic act.
Besides seeing it in various “what not to say” lists, I’ve most commonly heard the success/failure terminology to distinguish completers when referring to groups of attempters as an aggregate (e.g. females attempt more, but males succeed more because of a tendency to use more lethal means).
Fair point re: the voluntary and intent elements inherent in the definition.
Thank you for clarifying the usage of success/failure terminology in this context. It struck me as such odd phrasing that I couldn’t imagine who would be advocating for speaking about suicide in these terms. This makes somewhat more sense.
Excellent post, albeit somewhat difficult to reflect upon given my own slippery mental health moments. These conversations are important though, and I couldn’t agree more with your statement – “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.” Words matter…and so does care. 💕
Suicide in no joke. I have partially witnessed one…I heard the gunshot, but I didn’t see it. With my mental health, I go through the VA; sometimes they’re good, sometimes they’re not. I have thought about death myself; I have had a very bad close call once; I ask myself daily, “What if…?”. Things like this is why I keep giving the VA a hard time to make sure I can keep getting the help I’m needing at that time. I am tired of fighting, but giving up/quitting is not my style.
I’m very glad you’re still fighting.
As someone who has been there, I still talk about my failed attempt… I had always been told I could not live on my own, that I was to weak, stupid, limited, to ever succeed by myself. So when my marriage failed, my brain told me that I could not succeed so it would be best to stop living…
I took about 60 sleeping pills and fell asleep shortly after that. I felt at peace and thought it was OK.
When I woke up in a hospital I was angry, scared and confused… I really wanted to be successful at my attempt and was so angry that I even failed this simple task. 😔
3 years later I’m still here. And while life has been challenging for sure, the lobe Arwen gives me is really been my life saver.
But I still think my attempt has failed. And I understand how wording things differently may make it seem kinder, less harsh, and all that… For me, it is what it is. I didn’t call out for help at the time as I was sure of what I wanted.
That being said, I was only in the hospital for 2 days. They gave me meds, something I had been asking for years! With the meds, I was finally able to turn my way of thinking around…
So yeah, personally I don’t really mind how it is said, as long as we will be able to honestly and openly talk about it. There’s still a stigma on suicide here which makes it hard to talk about the problems. About failing health care, unaffordable health care, calls for help not being answered…..
I reblog this post in the afternoon! If you don’t mind. 😊
I suspect that part of why it can feel like a failure for some is that things don’t immediately get better afterwards and problems don’t immediately get solved. It seems like some people realize they didn’t want to die after all, but if that doesn’t happen, things are still just as shitty right after as they were before, and it takes time for things to get less shitty.
For me, that was true. I was battling severe depression, made worse by the way my divorce went. Lies, backstabbing, being forced to do things I didn’t want to do… But I felt like I had to. I had been used and replaced with someone better. Things of mine were kept away from me, things that were expensive or had memories I wanted to keep. Plus all my previous relationships, my exes always told me I’d not be well on my own. One of my shrinks said my “GAF score” (score on being dependent or self efficient, 0 being totally dependent, 100 being totally self efficient) was about 45, which only made that feeling of failure harder.
But the suicide attempt finally gave me meds that I had been asking for. I finally got some pills that helped my head feel a tad more rested and sorted, which helped me to think with a better mind… It still took me 13 hard months to come out of that depression and to finally be able to really start living again.
In that period, every major setback only acknowledged, for me, that my failure to end my life was something to be angry about. Every struggle where I had to ask for help, again and again, made me feel worthless and useless, making me think a lot about trying to end my life again. But with the meds and, mostly, my dog…. If I would not have had Arwen, I’m pretty sure I would have tried it again. That’s how beaten I’ve felt all those months after… 😔
I’m so glad you were able to get out of it eventually. Thank goodness for Arwen!
Yes! She was the reason I got up and dressed. I felt like I needed to give her the best I could. So while I was feeling like sh*t, crying about 70% of the time, I still did all I could for Arwen. The walks weren’t too long, for which I felt guilty. But I went outside. I bought food for her and myself. I cuddled her and dried many tears is her fur…. I truly owe her so much ♥.
Furbabies are so wonderful.
They truly are! I’m so very grateful to have her in my life.
I never know how to address the terms failed versus success with suicide. I know that saying failed to some who have tried is another reminder “I can’t do anything right” thought pattern. Thinking about it I say attempted I don’t know why. Another great got me thinking post. And I find Judi blog which I appreciate. It’s hard to be vulnerable and yet she’s doing it.
Yeah, she’s pretty amazing.