Don’t ask me, if ‘I am suicidal’

“Are you suicidal?” This is one of the questions that people and organisations ask persons whom they think are at risk of suicide. It is also a question which is to get people to pick up the phone and get help. Does it work? I don’t know. But I really don’t like it.

A disclaimer is needed here. This blog only addresses the form of the question. It is not meant to undermine the activities in suicide prevention, which I admire. If anything, I would hope, I might be helpful. For this reason I also decided not to put links to the suicide prevention websites I visited. I do not want to suggest in any way that their work is not valuable.

Let me start with something which is now quite obvious and accepted. In psychiatry and in psychology clinicians no longer say things like: “You are schizophrenic.”, “You are bipolar.” (at least I hope they don’t). They prefer saying “You’re diagnosed with…”. This is because the diagnosis (the label, if you wish) does not define the person. The ‘schizophrenic’ might also be a man, a professor, a father, and indeed a judoka.

There is another reason, though, often raised by the critically-oriented clinicians. The label ‘schizophrenic’ or ‘schizophrenia’ reduces quite a range of complex experiences into one single label. Indeed, the psychiatrist Jim van Os recently wrote an article under the telling title of Schizophrenia doesn’t exist.

So, what about the question “Are you suicidal?”? You might argue, of course, that it is not the same issue. After all the word ‘suicidal’ does not refer to a diagnostic category. Well, true, but not exactly. There are already reports of ‘anti-suicide’ medication (surely, one takes medication for an illness), and the American Psychiatric Association is considering making suicidal behaviour a disease.

But all that is not really an issue for a linguist (which should never stop linguists from making a point, obviously). The linguist asks the following question. What does:

 “Are you suicidal?”

mean? Yes, what does it exactly mean? For example, does it mean that you want to kill yourself? Or perhaps that you think of killing yourself? Or, does it mean that you have plans how to do it? Or perhaps that are already preparing to do it? If you look at suicide prevention pages, you will find that all these questions are asked when the issue of “Am I suicidal?” is explored. Sometimes all at once, sometimes only some of them, sometimes even more questions are asked. For example, there are questions of how sure you are about killing yourself, or the reasons for wanting to do it. And others.

So, the linguist in me asks: when you ask me whether I am suicidal, what exactly do you mean? Which question do you ask me? Is it enough to ‘have suicidal thoughts’ to consider yourself ‘suicidal’? But if so, which suicidal thoughts do you have in mind? Once again, I bring Justyna Ziółkowska and my article which shows that ‘suicidal thoughts’ are far from a homogeneous category. Or what about planning? Is it enough to have a plan? And yet, Brand and colleagues show that having a suicide plan might, in fact, alleviate suicidal distress.

But what really bothers me in the question “Are you suicidal?”, goes way beyond the fuzziness of the adjective ‘suicidal’. It bothers me that the question changes actions into characteristics; doing is changed into being. And so, instead of acknowledging that people think, plan, want or do, the question asks what they are like. And this is something which I find very unhelpful.

Let me give you an example. Let’s imagine that here and now you are driving a car too fast. Shall I comment on it by saying “You’re driving too fast.“ or perhaps “You are careless.”, or better still “Why are you careless?”. What my question does, is to shift attention from what you do, to what you are. From what might be a unique (and single) action in a particular context (you might be driving fast to a hospital), I made it your characteristic, and the linguistic form suggests it is quite timeless. You don’t like it? Tough.

Or let me put it in a different way. What if a patient says: “I don’t want to take this medication”. Is it OK to say that the patient is ‘uncooperative’, forgetting that the medication makes them sleepy? No? Is it then OK to ask a question like “Are you delusional?”. Not, either? So why is it OK to ask whether a person ‘is suicidal’?

No, I don’t think there are ‘suicidal people’, or I can ‘be suicidal’. I might want to, think about, plan, wonder, prepare, write about suicide, and do all sorts of other things. But that does not make me ‘suicidal’, it does not give me a characteristic, which puts me into a category of ‘suicidal people’. I actually resent this!

There is a catch here, though. When I was looking for instances of ‘are you suicidal?’ online, Google did suggest phrases such as “I am suicidal, I need help.” There is no way of knowing, whether this is only the suggestion of an engine, or whether people actually do write this. And what is the source of such phrases. As a linguist I tend to think that, if anything, people write this, because they saw it written – they adopted the label, even though it might not have been theirs.

Thankfully, one of the websites had what appears to be a quote:

 I felt cloudy, confused, detached…I decided I had to contact….

Is that ‘being suicidal’ or not? Incidentally, this strikes me as something a real person might actually say. The problem is that none of the checklists for ‘being suicidal’ mentioned being cloudy or confused. And yet, the person phoned…S/he phoned because people put their experiences in many different ways, often without using the s-word. And that, indeed, might be a problem. What if my story of how I feel, does not contain the s-word? Does it mean, I don’t need to phone?

Often when I talk or write about such things, people ask me what I would do. What kind of question would I ask? The answer is not easy at all. There are all sorts of contexts to consider, among others, prosaically, how many callers a question is likely to generate. Or is our priority to mention the s-word in the question? I cannot speak to such contexts – I have never worked in organisations trying to prevent suicides.

Whatever the choice, it should, however, be written in the language people understand.  You know, I would never say to anyone ‘I am suicidal’, but I would say: “I’ve had enough’, ‘I want to die.’, ‘I want to kill myself.’.  Let’s then first listen to the stories people tell, let’s ask questions on the basis of these stories.

But, no, don’t ask me, if ‘I am suicidal’.

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