Some time ago, my Twitter timeline included another language poll. This time, the author asked for views on replacing the phrase ‘threatening suicide’. In this post I comment on my involvement in discussing the poll. The post might be controversial for some.

And so, when I saw the poll, I did not vote, but responded to the tweet. My response was two-fold. First, I said that people did (more or less often, doesn’t matter) threaten to commit suicide. A blanket ‘ban’ on the phrase makes no sense and contributes to euphemising suicide away. The time before suicide can be very dramatic and rendering it by ‘considering suicide’ makes no sense at all. My second point was that institutions or healthcare professionals (HCPs) have no right to impose a perspective on my experience. If I threaten suicide, I don’t want to become considering it or in danger of it.

The response was as predictable as it was significant. But ‘threaten suicide’ is stigmatising and can put professionals ‘on edge’. In the rest of the post, I want to consider the response.

The most significant aspect of the response is that in the brief Twitter exchange, it was made very clear that it is the HCPs’ perspective which trumps all else. In other words, I can threaten suicide all I like, if they don’t like it, it is tough…. for me. My perspective pales away in the presence of the possibility that an HCP might be put ‘on edge’.

I must admit I am not particularly surprised by this. I have always thought that this whole kerfuffle around patient-centred ‘all that is medical’ (here is my earlier post on my scepticism of patient-centred communication) is just for show. It’s a way for medicine to pay lip service to something it invented and decided we, patients, should all want it. But I never thought I could get such a clear answer. No, the person doesn’t matter. What matters is that the HCP  not be put ‘on edge’. And I keep going back to the question of what happens when the person does threaten suicide. Should ‘we’ just pretend that they don’t? Does it matter?

It’s like we should not really put ambulance crews ‘on edge’ and ask them to put the siren on, should we? Or is it just suicide that puts people on edge? I’m starting to feel more and more guilty for having a heart attack and reporting to hospital. Someone might have been put ‘on edge’. And we wouldn’t want this, would we?

The second point made to me was that ‘threaten suicide’ is stigmatising. I must admit that I am increasingly tired and suspicious of claims of phrases being stigmatising. Yes, threatening something is probably negative, but is threatening to drive too fast stigmatising of driving too fast? I would suggest that you can sensibly say something like:

He threatened to study hard all week!

and yet, I doubt very much such a sentence is stigmatising of studying hard. So, I am suspicious.

Still, regardless of the phrase, no doubt suicide at least can be stigmatising. What irritates me no end, however, is the mantra that it is so and therefore all efforts should be made to make it less stigmatising. I wrote it already in an earlier post (here is a link to the post on growing acceptability of suicide), but perhaps it is worth reiterating that stigma might have its uses. In other words, do all the stigma warriors not worry that removing stigma from suicide will make suicide more accessible? That more people will be committing suicide? After all, it will be a normal, unstigmatising thing….Well, I do. And I continue thinking that suicide should not be euphemised away from our medical and social reality because mentioning it and suggesting that it might be dramatic might offend some sensitivities.

But the story with the poll is not over. It had an interesting ending. As expected, all who voted, voted to dislike ‘threaten suicide’. The alternatives were all OK, just ‘threaten suicide’ causes offence. Interestingly, the arguments went beyond those that I mentioned above. The phrase ‘threaten suicide’ implies choice, potentially also menace. And yes, it does. But is it really beyond the realm of what’s possible to think that people might actually be doing just that? For example, people who killed themselves wrote suicide notes such as

“You killed me.”

“You have what you wanted. “

“I’ll haunt you forever.”

Those, and other notes, are full of blame, bitterness, and yes, there is menace in such notes, too. Are we really saying that they don’t count? We should not mention them? They are too dramatic and might put you ‘on edge’? Well, tough. Reality is way more complex than thinking that all people who are about to kill themselves are just calmly ‘considering suicide’. And quite frankly, it offends me when I read that, as one of the respondents to the poll said, that people about to kill themselves are not ‘in control of their thoughts’. Now, that’s really stigmatising for me. But hey, it’s stigmatising the right way, innit?

When reporting the poll results, its author said that as many as 376 people disliked the phrase ‘threaten suicide’ and one liked it. The one, obviously, is me (but my identity was preserved, wink, wink). When I read it, my jaw dropped. As ever I am the bad monster who doesn’t to learn to talk proper. In favour of all the bad things, including putting HCPs on edge.

And I despair. I despair because I hoped that it was obvious that I really don’t care about the phrase ‘threaten suicide’ or any other phrase for that matter. I do care about people’s right to self-describe. I reject the right of one shrink, even with 376 others, to tell me how to speak. I reject the domination of the medical perspective over the lived one. I reject your right to shove me into your frame, just because you can. The phrase ‘threaten suicide’ is irrelevant. What I am interested in is what stands behind its use or its absence. But I guess making me into a person who likes ‘threaten suicide’ is easier.