How to ask a question about suicide?

Here is an article which asks a crucial question: “How to ask a question about suicide?”. I want to respond to the linguistic part of the article.

So, the question that the authors start wondering about is the following:

In the past (1) _____ have you had (2) ____ thoughts about (3) _____?

(1) Several days; 2 weeks; 1 month; 12 months; 2 years

(2) Any; serious; frequent; uncontrollable

(3)Being better off dead; going to sleep and not wanting to wake up in the morning; not wanting to live; dying; just giving up; life not being worth living; killing yourself; harming yourself; hurting yourself; dying by suicide

In a nutshell the core of the question is:

Have you had thoughts about…?

And before I continue with my analysis, I would like to make sure that it is clear how ironic the question is. Despite the psy-disciplines banging on about how important it is to ask ‘open questions’ (I’ve written about such instructions), the basic question with which to ask about suicide is, yes, you guessed, closed! And I still want to repeat that any such directives make no sense.  Interestingly, however, a recent study by Rose McCabe puts an interesting twist to language analysis showing the difference between negatively phrased and positively phrased ‘closed’ questions. Let me add that McCabe’s research is rare in experimental psychology in that it analyses questions in their actual conversational context. And, I’m loath to admit, it actually does contribute to understanding language as it is used in clinical settings.

Now, the authors of the editorial are aware that there are many ways in which one can ask the above question. Indeed, they focus on three options of adverbials and that’s great. The problem is that these ‘permutations’, as the authors call them, focus exclusively on the contents of the question. Two weeks or three weeks, serious or frequent are about, to oversimplify, what information to seek.

And, let me repeat it again, with some desperation, language does not only carry content. It does it through a form. Put differently – whatever is said/written, has a form. Moreover, the form carries meaning. For us, linguists, these are all truisms, but somehow, we seem to be incapable to impart these truisms. And despite the fact that the following two sentences:

Would you please leave?

Get the f…out!

carry just about the same content, their form makes them very different. The difference, importantly, isn’t only accomplished by the use of the ‘f-word’, but through the use of the interrogative mood in the first sentence and the imperative mood in the other. It’s obvious, isn’t it?

But is it? The options the authors list for the variety of asking the questions somehow do not concern the word ‘thought’. Let me put it differently – for some (actually fairly explicable) reasons psychologists and psychiatrists want to ask about thoughts and not about thinking. But it is, again, fairly obvious that

Have you had thoughts?

is quite different from

Have you thought?

The former asks about some clearly identifiable objects, the other about the process of thinking. Interestingly, ‘we’ tend to talk about thinking not about thoughts. In other words, we, normal people, use verbs.

Once again, how many of declare love by:

There is love.

instead of

I love you.

Do psychologists and psychiatrists really speak like that? If not, why ask about people’s thoughts and not about what they think?

Now, there are two issues here, I think. One is about speaking ‘my language’. I’m not a medic, but I quite firmly believe that clinicians should speak to me in a language which I understand. For me it’s commonsensical. When my mother asks me what kind of research I do, I could say, for example:

I study discursive constructions of experience of people diagnosed with depressive episode (ICD F32-33).

but I don’t. My mother is unlikely to understand that. So I say something like that:

I’m interested in how people with depression talk about it.

And when I say this, my mother engages and asks me about it.

When you ask me about ‘thoughts’, don’t you wonder how I will understand what you’re talking about? Interestingly, the authors do understand the issue. They write:

Of course, we do not know whether our patients under-stand that these are meant to be synonymous, especially if they interpret a question about self-harm to refer to what otherwise would be labeled as NSSI.

Somehow understanding can only mean certain phrases, but it doesn’t mean how you talk to me. And I would think and think and think what it meant if, for example, my child told me there is love. Obvious? For psy-disciplines, somehow it’s not.

The second point is the source of such questions. I can’t remember how many times I heard that ‘everybody’ in psychology and psychiatry understands that ICD is not to be taken directly and must be transformed into clinical communication. And yet, I actually think that the questions about thoughts do not come from the clinicians, so to say, but they come from the diagnostic manuals which ask about ‘suicidal thoughts’. It’s probably more complex, with suicidological research exploring suicidal ideation, still it’s clinical communication which is underpinned not by patient experience but by, shall I call them, elite discourses. And, to make matters worse, I actually don’t think the authors and their disciplines understand it.

So, let me repeat, ad nauseam. Language has form, form matters. Language has form, form matters. Language has form, form matters. Language has form, form matters. Language has form, form matters. Language has form, form matters. Language has form, form matters. Form also means. It really does. There is no clinical communication without reflection on and understanding of the form of what you say.





1 Comment
  1. I remember being in the hospital getting stitches for self-harm back in the 90’s. The doctor asked me “were you trying to hurt yourself?” I had no idea how to make sense of that question. I guess it was a euphanism for suicide but I took it literally and didn’t know how to respond.

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