Over the last few days I have been following the tweets from the congress of the International Association for Suicide Prevention. As ever, I‘ve seen tweets about language which matters, so I want to make a contribution to the ‘language matters’ discussion. I would like to suggest that suicidology stop talking about suicide ideation.
Let me make my case by referring to an example Justyna Ziółkowska and I discussed in our article on experience of suicidal thoughts. Below you will find a translation of a fragment of a clinical encounter in which suicide ideation was discussed.
- D: Now, please, tell me what these suicidal thoughts consist in?
- P: Reluctance to live. I feel like either hanging myself or, I don’t know, I think that I will pour water into the bathtub and drown myself. I can’t switch the gas on because I don’t have it in the flat, but when I lived in the old one such thoughts appeared sometimes.
- D: You look for means?
- P: I look for means, yes.
The patient’s account of her thinking about suicide is far from uniform. She speaks of reluctance to live, feeling like hanging herself, thinking of drowning in a bathtub. Linguistically, these are three different constructions of suicidal thoughts. The initial mention of suicide is done by an impersonal use of a noun ‘reluctance’ (Polish niechęć). The patient is talking about a state of mind which is not predicated of anyone in particular, including herself. It is as if there is this ‘reluctance’ to live, existing in its own right. The other two explications of the suicidal thoughts are done personally – with the speaker taking ‘ownership’ of what happens. And so, she speaks of ‘feeling like’ and of ‘thinking’. Again, these two actions differ from one another: one refers to the sphere of volition (probably like the negative ‘reluctance’), the other to cognitive skills. Note also that the psychiatrist completely ignores the story, going for risk assessment.
This extract showcases the main issue. Regardless of what people ‘have in their heads’ to which we have no access, accounts of ‘suicidal thoughts’ show that they are not a homogeneous kind of thinking, but, in fact, they refer to various activities that cannot and probably should not be subsumed under one general category. It’s also worth stressing that we have no access to any suicide ideation. What we do have are accounts, stories. Those accounts could be made in the form of a narrative, like above, or could be highly constrained, like in a questionnaire. Either way, research into suicide ideation is about discursive representations of thinking. Nothing else. And yet, suicidology insists on talking about suicide ideation, which suggests, through nominalisation (i.e. rendering actions and processes as things), that suicide ideation is more objective, almost universal, as if when John, a farmer in England, thinks about suicide, it’s exactly the same when Agnieszka, a businesswoman in Poland, does it.
I would go as far as suggesting that the phrase ‘suicide ideation’ is a sleight of hand. Its main purpose is misdirection. Instead of talking about what people do, that is to say, about people telling stories, we get to hear about this suicidological object of inspection. Suicide ideation becomes readily available for brave researchers to identify and describe. And so, for example, not a single thought given to the fact that when you talk about themes in suicide ideation, you actually talk about nothing of the sort. If anything, you talk about themes in stories of suicide ideation and believe you me, these are not one and the same at all! Suicidology’s offers a reductionist and oversimplified view of suicide ideation (and suicide in general), as it constructs it as outside any temporal or social context.
Now, I would like to make it clear that, no, I don’t think for one second that suicidology will even spare a thought, let alone entertain the idea of dropping the phrase ‘suicide ideation’. Of course, it will not. It will continue using it, as the phrase fits well with how it sees suicide and suicide ideation. Dropping the phrase would mean undermining thousands of studies in which suicide ideation is examined by suicidologists across time and culture.
So, you might ask why I am writing this then. First, no, I am not writing this because if we drop the phrase, somehow, we shall start thinking differently. Of course, we’ll not. The common assumption in mental health stories that changing words will change how people think is simplistic to say the least. So, second, I am writing this post because I want to show a particular discursive practice in academia. I’m trying to show a practice that is likely to have consequences in how a particular kind of narratives are studied (because, no, you do not study any thinking!). The phrase (as many others) helps researchers construct a field for their study. This in turn has consequences for how you can report on your research and also on how you do it.
But do indulge me and imagine that suicidology suddenly does realise that the phrase ‘suicide ideation’ is too reductionist and starts rejecting research which assumes such reductionism. All of a sudden research suggesting that suicide ideation is X, or suicide ideation predicts X will not be published. You will need to talk about what people say and how they say it. And that would require a different kind of study. That would be a revolution. And one which will not happen.
Finally, I would also like to say that ‘suicide ideation’ is not exactly the bane of psychological/suicidological research. No, we’ll be fine. However, it does reinforce the dominance of a particular kind of suicidology. It’s a suicidology of the kind that you can see at such major conferences. It’s a suicidology that will continue pushing its own agenda, as it continues to be concerned about not being able to predict anything. And so, it will continue finding another 50 risk factors (or 150 if need be!) about which it will write another 5000 articles. Its royalty will continue repeating platitudes that it’s OK not to be OK…. And I’d better stop here.