On growing acceptability of suicide

In a recent article, the sociologist Julie Phillips raises the issue of the change in acceptability of suicide. Her argument is that taboos around suicide have loosened and, in the process, it’s become more socially available. In this post, which is likely to be controversial, I want to some comment on acceptability of suicide.

Phillips says that in the United States suicide has become more acceptable, for example as a reaction to terminal illness, but also to life setbacks.  The share of Americans who accepted the right to kill oneself in the case of incurable disease rose from 46.9 percent to 61.4 percent in the last 30 years or so. It is perhaps more troubling that also acceptance of suicide in the case of being “tired of living and ready to die” rose from 13.7 percent to 19.1 percent.

Phillips continues her argument by linking the rising acceptability of suicide with its destigmatisation. She writes:

Reducing stigma around suicide can be positive — if it means that distressed people become more likely to seek help, for instance. But when and if the belief spreads that the act is acceptable under some conditions, even terminal illness, that may have ramifications we don’t fully understand. We need more research to figure out what messages destigmatize suicide in the good sense, opening the doors to life-saving conversations, and which ones normalize it as a response to crisis, with deadly consequences.

I am in complete agreement with what Phillips says, in fact, 18 months ago, in the post about the verb ‘commit’,  I wrote:

Has someone actually considered whether dropping the phrase makes the act more acceptable and, in the process, more accessible? The discussion about how to refer to suicide is for the most part based on acontextual claims about ‘commit suicide’. But what if, however unlikely it might be, the phrase is protective.

I underscored this point by reference to, research by John Oliffe and his colleagues. They suggest that men’s wish to avoid the stigma related to suicide can actually be protective. In other words, some men do not ‘commit suicide’ because they do not wish to cause the pain both of the act and of the stigma attached to it. Is it possible that by banning the phrase ‘commit suicide’ this protective factor is removed for those men?

Such arguments keep being ignored. Rather, I recently read about 99 per cent of people who avoid ‘commit suicide’ and prefer to say ‘die by suicide’. As ever, no evidence is provided for such claims which make a clear assumption that the latter phrase is so obviously superior.  Is it though?

The undoubtedly well-meant fight to save us from ‘commit suicide’ includes, as I wrote in an earlier post, such wild claims as the Samaritans’ research had apparently found that using the phrase ‘commit suicide’ stops people from seeking help. I contacted the Samaritans, they denied the existence of such research. What next, I would ask, after blatant lying?

There is a reservation I would like to make here. No, I don’t think that changing one phrase has resulted in the change of attitudes. No, it’s the entirety of activities, from the change of references to suicide, the range of these changes (even the CNN started writing ‘die by suicide’), the “It’s OK to feel shit” (a real campaign), together with much advocacy/activism that are all likely to have had a significant effect on how people perceive suicide.

Now, it’s time for a couple of comments.

1. First, the message constructing suicide as non-stigmatising is overly simplistic. While I can understand the arguments for campaigning against the phrase ‘commit suicide’ (I disagree with them), they must come with understanding what and why it should be replaced with. I have written many times that the phrase ‘die by suicide’ is problematic as it positions suicide as something merely happening and not being completed by an (unfettered) actor. Such arguments keep being ignored. ‘We’ know better, after all.

2. Second, one of the reactions to the abovementioned article I saw on Twitter was (genuine, I think) surprise that people do not do as they’re told. No, you’re not supposed to kill yourself more readily, the tweet seemed to say, you’re supposed to do what we want you to do. Well, it doesn’t work like that. You cannot decree that the stigma of suicide will only be reduced in areas in which you wish it. Suicide has become more available socially. In a way, the genie is out and it will be very difficult to put it back in.

3. Suicide and its stigma concerns at least 4 groups of people:

  • those who did commit suicide
  • those who experienced the suicide of their close one
  • those who attempted suicide
  • those who are thinking about it.

In my view, the activities attempting to counter the stigma resulting from suicide assume that reducing the stigma mean roughly the same thing to all those groups. In other words, all those people will see suicide and the (potential) harm it does in a similar way and will (or will not) act accordingly.

This is unlikely to be the case. And what might be protective for the bereaved families, might not work for those with suicidal ideation (as John Oliffe’s research suggests). Context seems to rule supreme and there seems to be no escape from its nuance.

So, what do we do? Well, I don’t know. More research is needed – more research, however, and not assumptions, however well-meaning they are. We need more research bringing understanding that the interests of the four abovementioned groups might actually be contradictory. For example, should we prevent suicide from happening or should we ease the suffering of those who remain? Perhaps there are strategies that can achieve both at the same time. But what do we do if there aren’t?

Needless to say, I have no answers at all. I can barely muster the courage to pose such questions (and I suspect I will get some stick for it) and there are questions I daren’t write down. I also think ‘we’ need a serious debate about suicide, its meaning, acceptability, and availability. In my view, this debate is yet to happen but, importantly, there seems little interest in it. Suicide remains constructed as a highly homogenised act, as if suicide is just suicide. That is, in my opinion, a very simplistic view (as I cautiously explored in this post).

The final question to be asked then is whether such debate will happen. My answer is: no, it will not. And I am not brave enough to write why.

  1. Weighing into this again as I did when you brought this up before: and agreeing with you again: “died by suicide” makes it sound almost involuntary- with a suggestion of, if not exactly inevitability, then at least of a lack of agency. I think that this can contribute to perceptions of suicide being just what can happen to people in certain circumstances: what does this mean for suicide prevention? For some people bereaved by suicide the thought of a loved person having been in such pain that they committed the act of suicide may be so unbearable that expressing it in passive language (“died by” rather than “committed”) helps, by in some way almost denying that this was their real intention, their commitment. Because if it wasn’t their real intention, if they didn’t fully commit to kill themselves, then maybe their pain was somehow also less than it appears. Or if it just happened in some sort of logical conclusion to a particular and understandable (understandable because we know there are well studied and generally agreed upon risk factors) set of circumstances. In protecting the bereaved in this way though we risk denying the level of suffering resulting in and attending suicide, and the significance of someone committing to self annihilation. I don’t know. But my sister committed suicide and if I were to say she died by suicide, I would feel like I was letting her down in some way: her suicide was not just “dying”- it was an act of violence against herself and an uncompromising communication of feelings of overwhelming pain and powerlessness, and I feel that I have to recognise that both for her sake and for what it means for suicide prevention more generally. I think we need to face the full horror of suicide as an act (whether that act was meticulously planned
    or a moment of anguished impulse) so that we can look at prevention not just in dry academic terms of socio-economic, psychological or psychosocial risk factors, but through the distorted and bloody, but real and living prism of human anguish.

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