Suicide terminology

Suicide
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Historically, suicide terminology has been rife with issues of nomenclature, connotation, and outcomes,[1][2] and terminology describing suicide has often been defined differently depending on the purpose of the definition (e.g., medical, legal, administrative). A lack of agreed-upon nomenclature and operational definitions has complicated understanding. In 2007, attempts were made to reach some consensus.[2][3][4][5] There is controversy regarding the phrase "to commit suicide" as some view it as implying negative moral judgment and having an association with criminal or sinful activity.

In 2020, a meta-analysis of studies on the effects of media coverage of suicide found that "Reporting of deaths of celebrities by suicide appears to increase the number of suicides by 8-18% in the next 1-2 months, and information on method of suicide was associated with an increase of 18-44% in the risk of suicide by the same method."[6]

Terminology

Ideations

Suicidal ideation is any self-reported thoughts of engaging in suicide-related behavior.[2] Subtypes of suicide-related ideations depend on the presence or absence of suicidal intent.

To have suicidal intent is to have suicide or deliberate self-killing as one's purpose.[7] Intent refers to the aim, purpose, or goal of the behavior rather than the behavior itself.[3] The term connotes a conscious desire or wish to leave or escape from life, and also connotes a resolve to act. This is contrasted with suicidal motivation, or the driving force behind ideation or intent, which need not be conscious.

Suicide-related ideation with no suicidal intention is when an individual has thoughts of engaging in suicide-related behavior but has no intention to do so. When an individual is unable to clarify whether suicidal intent was present or not, the term undetermined degree of suicidal intent is used. Suicide-related ideation with some suicidal intent is when an individual has thoughts of engaging in suicide-related behavior and possesses suicidal intent.[4]

Communications

Suicide-related communications are any interpersonal act of imparting, conveying, or transmitting thoughts, wishes, desires, or intent for which there is evidence that the act of communication is not itself a self-inflicted behavior or self-injurious. This broad definition includes two subsets:[4]

A suicide threat is any interpersonal action, verbal or nonverbal, without a direct self-injurious component, that a reasonable person would interpret as communicating or suggesting that suicidal behavior might occur in the near future. Type I is a passive or active threat with no associated suicidal intent; Type II is a passive or covert threat with an undetermined level of intent; and Type III is a passive or covert threat with some degree of suicidal intent.[4]

A suicide plan is a proposed method of carrying out a design that will lead to a potentially self-injurious outcome; a systematic formulation of a program of action that has the potential for resulting in self-injury. Type I is the expression of a definite plan with no suicidal intent; Type II is a proposed method with an undetermined level of intent; Type III is a proposed method with some suicidal intent.[4]

Behaviors

Suicide related behavior is a self-inflicted, potentially injurious behavior for which there is evidence either that: (a) the person wished to use the appearance of intending to kill themselves in order to attain some other end; or (b) the person intended at some undetermined or some known degree to kill themselves.[4] Suicide-related behaviors can result in no injuries, injuries, or death. Suicide-related behaviors comprise self-harm, self-inflicted unintentional death, undetermined suicide-related behaviors, self-inflicted death with undetermined intent, suicide attempt, and suicide.

Self-harm is self-inflicted, potentially injurious behavior for which there is evidence that the person had no intent to die. Persons engage in self-harm behaviors for its own sake (e.g., to use pain as a focusing stimulant, or due to a condition like trichotillomania), or when they wish to use the appearance of intending to kill themselves in order to attain some other end (e.g., to seek help, to punish themselves or others, to receive attention, or to regulate negative moods).[4] Suicidal gestures are suicide-related behaviors that are carried out without suicidal intent. It is considered a controversial term.[8]

Self-harm type I and Type II result in no injury and nonfatal injury respectively, while Self-Inflicted Unintentional Death, often called accidental suicide, is self-harm that has resulted in death. It is defined as from self-inflicted injury, poisoning, or suffocation where there is evidence that there was no intent to die. This category includes those injuries or poisonings described as unintended or accidental. Undetermined Suicide-Related Behavior is self-injurious behavior for which the person is unable or reluctant to admit positively to the intent to die, which have resulted in no injuries, for Type I, and injuries, for Type II.[4]

A suicide attempt is defined as a self-inflicted, potentially injurious behavior with a nonfatal outcome for which there is evidence of intent to die. Type I has no resultant injuries, regardless of the degree of injury or lethality of method, while Type II has resultant injuries. Self-Inflicted Death with Undetermined Intent is self-injurious behavior that has resulted in fatal injury and for which intent is either equivocal or unknown A suicide is a self-inflicted death with evidence of intent to die.[4]

Attitudes and oppression

Suicidism is currently used in two meanings;

  • "the quality or state of being suicidal"[9]
  • "... an oppressive system (stemming from non-suicidal perspectives) functioning at the normative, discursive, medical, legal, social, political, economic, and epistemic levels in which suicidal people experience multiple forms of injustice and violence..."[10][11][12] Suicidal people can experience discrimination, stigmatization, exclusion, pathologization, and incarceration. They may be hospitalized and/or drugged without their consent, and have difficulties in finding jobs or housing, and have their parental rights revoked. Suicide is not seen as a positive human right, or suicidal people seen as having potentially valuable messages to convey.[13]

"Committing" suicide

According to Fairbairn in his philosophical study of suicide published in 1995, "The most common way of speaking about suicide is to talk of its being 'committed'."[14] An article published in 2011 stated that, although committed suicide or similar descriptions continued to be the norm in the English language, the term committed associates death by suicide, or more accurately, death by mental illness, with criminal or sinful actions.[15] Research has pointed out that this phrasing has become so entrenched in English vocabulary that it has gained "a naturalness which implies a deceptive harmlessness."[15] Per reportingonsuicide.org,[16]

Certain phrases and words can further stigmatize suicide, spread myths, and undermine suicide prevention objectives such as "committed suicide" or referring to suicide as "successful," "unsuccessful" or a "failed attempt." Instead use, "died by suicide" or "killed him/herself."

While common, Lebacqz & Englehardt argue that referring to suicide as an act "committed" is hazardous to ethical clarity.[17] Others have also argued in favour of alternative language regarding suicide, both in the interest of moral and ethical precision,[18] as well as scientific and clinical clarity.[2][4] A United States Navy report urges against the use of the term committed suicide on similar grounds, asserting that "suicide is better understood when framed objectively within the context of behavioral health."[19]

The lack of clarity in English suicide terminology has been attributed to the connotations of crime, dishonour, and sin that suicide may carry.[20][21] Common language has been described as "[portraying] suicide as a 'crime' to be 'committed' as is, for example, murder."[17] This is despite the fact that suicide is largely no longer a crime,[18][22] and that, as noted suicidologist Samuel Wallace wrote, "all suicide is neither abhorrent nor not; insane or not; selfish or not; rational or not; justifiable or not."[23]

Canadian suicide prevention activist, P. Bonny Ball, commented that the alleged criminal implications of suicide are a carryover from the Middle Ages when suicide was considered "both illegal and sinful by the laws and religions of the time."[24]

Since "committing suicide" was akin to committing murder or rape, it has been argued that they continue to be linked in some languages.[15]

Various alternatives have been proposed to alter the language regarding the act of suicide from a variety of sectors – including government, journalism, community mental health advocates, and the scientific community. Terms such as death by suicide have been suggested to be more objective.[19] The World Health Organization has agreed that these terms "are more accurate and less open to misinterpretation."[25]

As it applies to a direct clinical context, the widely cited Beck Classification of Suicidal Behaviour exclusively uses the terminology of complete suicide.[26] This classification was revisited in a number of notable documents (such as the Operational Classification for Determination of Suicide, the 'Tower of Babel' nomenclature, the WHO/EURO definitions, the Columbia University suicidality classification, the Centers for Disease Control and Prevention self-directed violence surveillance system, and the Denver VA VISN 19 MIRECC self-directed violence classification system).[27]

Advocacy groups have suggested a variety of guidelines for suicide terminology.[28][29][30][31][32][33] As it concerns media reporting of suicide, a key indicator of guideline influence on language as it is practiced in that context reports including one by the Annenberg School for Communication's Public Policy Center at the University of Pennsylvania suggests that there is "evidence of a change in reporting practices following the release of the new media guidelines".[34]

References

  1. ^ Archives of Suicide Research, 1997, vol. 3, pp. 139–151
  2. ^ a b c d O'Carroll et al. (1996). Beyond the Tower of Babel: A nomenclature for suicidology. Suicide and Life-Threatening Behavior, 26(3), 237–252.
  3. ^ a b Silverman MM, Berman AL, Sanddal ND, et al. Rebuilding the Tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. Part 1: background, rationale, and methodology. Suicide Life Threat Behav 2007; 37:248–63.
  4. ^ a b c d e f g h i j Silverman MM, Berman AL, Sanddal ND, et al. Rebuilding the Tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. Part 2: suicide-related ideations, communications, and behaviors. Suicide Life Threat Behav 2007; 37:264–77.
  5. ^ Posner K, Oquendo MA, Gould M, et al. Columbia Classification Algorithm of Suicide Assessment (C-CASA): classification of suicidal events in the FDA's pediatric suicidal risk analysis of antidepressants" Am J Psychiatry 2007; 164:1035–43.
  6. ^ Thomas Niederkrotenthaler; Marlies Braun; Jane Pirkis; Benedikt Till; Steven Stack; Mark Sinyor; Ulrich S Tran; Martin Voracek; Qijin Cheng; Florian Arendt; Sebastian Scherr; Paul S F Yip; Matthew J Spittal (18 March 2020). "Association between suicide reporting in the media and suicide: systematic review and meta-analysis". BMJ. 368: m575. doi:10.1136/bmj.m575. PMC 7190013. PMID 32188637.
  7. ^ Leenars, A. A. (2004). Psychotherapy with suicidal people. West Sussex, UK: John Wiley & Sons.
  8. ^ Heilbron, Nicole; Compton, Jill S.; Daniel, Stephanie S.; Goldston, David B. (2010-06-01). "The Problematic Label of Suicide Gesture: Alternatives for Clinical Research and Practice". Professional Psychology: Research and Practice. 41 (3): 221–227. doi:10.1037/a0018712. ISSN 0735-7028. PMC 2904564. PMID 20640243.
  9. ^ "Suicidism". Webster's 1913 Dictionary. Archived from the original on 13 June 2017. Retrieved 30 December 2020.
  10. ^ Baril A (2020). "Suicidism: A new theoretical framework to conceptualize suicide from an anti-oppressive perspective". Disability Studies Quarterly. 40 (3): 1–41. doi:10.18061/dsq.v40i3.7053. Archived from the original on 12 December 2020. Retrieved 2 January 2021.
  11. ^ https://temple.manifoldapp.org/projects/undoing-suicidism
  12. ^ https://www.suicideinfo.ca/resource/suicidism-a-new-theoretical-framework-to-conceptualize-suicide-from-an-anti-oppressive-perspective-2/
  13. ^ https://templepress.wordpress.com/2023/05/31/a-qa-with-alexandre-baril/
  14. ^ Fairbairn, Gavin J (1995). Contemplating Suicide: The Language and Ethics of Self-Harm. London: Routledge. p. 34. ISBN 978-0415106061.
  15. ^ a b c Olson, Robert (2011). "Suicide and Language" (PDF). Centre for Suicide Prevention. InfoExchange (3): 4. Retrieved 15 May 2013.
  16. ^ "Best Practices and Recommendations for Reporting on Suicide" (PDF). reportingonsuicide.org.
  17. ^ a b Lebacqz, K. & Englehardt, H.T. (1980). "Suicide and covenant". In Battin, M.P. & Mayo, D.J. (eds.). Suicide: the philosophical issues. New York: St. Martin's. p. 672. ISBN 978-0312775315.
  18. ^ a b Beaton, Susan; Forster, Peter; Maple, Myfanwy (February 2013). "Suicide and Language: Why we Shouldn't Use the 'C' Word". In Psych. 35 (1): 30–31.
  19. ^ a b "What's in a word? How we talk about Suicide" (PDF). Navy Suicide Prevention. United States Navy: Navy Personnel Command. Retrieved 16 May 2013.
  20. ^ Silverman, M.M. (October 2006). "The Language of Suicidology". Suicide and Life-Threatening Behavior. 36 (5): 519–532. doi:10.1521/suli.2006.36.5.519. PMID 17087631.
  21. ^ "Reporting on Suicide: Recommendations for the Media" (PDF). Suicide Prevention Resource Center. 2001. Archived from the original (PDF) on 2013-05-30. Retrieved 16 May 2013.
  22. ^ "What's in a word? The Language of Suicide" (PDF). Alberta Health Services. 2009. Retrieved 15 May 2013.
  23. ^ Wallace, S.E. (1999). "The Moral Imperative to Suicide". In Werth, J.L. Jr. (ed.). Contemporary Perspectives on Rational Suicide. Philadelphia: Taylor & Francis. pp. 48–53. ISBN 978-0876309377.
  24. ^ Ball, P. Bonny (2005). "The Power of words". Canadian Association of Suicide Prevention. Archived from the original on 13 May 2013. Retrieved 16 May 2013.
  25. ^ Preventing suicide : a resource for media professionals (PDF). Geneva: World Health Organization. 2008. p. 8. ISBN 978-92-4-159707-4.
  26. ^ Beck, A.T.; Resnik, H.L.P. & Lettieri, D.J, eds. (1974). "Development of suicidal intent scales". The prediction of suicide. Bowie, MD: Charles Press. p. 41. ISBN 978-0913486139.
  27. ^ O'Connor, R.C.; Platt, S. & Gordon, J., eds. (2011). "Challenges to Classifying Suicidal Ideations, Communications, and Behaviours". International Handbook of Suicide Prevention: Research, Policy & Practice. Oxford: John Wiley & Sons. pp. 18–21. ISBN 978-0470683842.
  28. ^ Brenner, L.A.; Silverman, M.M.; Betthauser, L.M.; Breshears, R.E.; Bellon, K.K.; Nagamoto, H.T. (2010). "Suicide Nomenclature – 2010 Suicide Prevention Conference" (PDF). Denver: Department of Defense; Defense Centres of Excellence for Psychological Health and Traumatic Brain Injury. Retrieved 17 May 2013.
  29. ^ Brenner, L.A.; Breshears, R.E.; Betthauser, L.M.; Bellon, K.K.; Holman, E.; Harwood, J.E.; Silverman, M.M.; Huggins, J.; Nagamoto, H.T. (June 2011). "Implementation of a suicide nomenclature within two VA healthcare settings". Journal of Clinical Psychology in Medical Settings. 18 (2): 116–28. doi:10.1007/s10880-011-9240-9. PMID 21626353. S2CID 22877623.
  30. ^ Centre for Suicide Research (September 2012). "Media and Suicidal Behaviour: Guidelines and other information". University of Oxford. Retrieved 18 May 2013.
  31. ^ Media Guidelines for the Reporting of Suicide: 2009 Media Guidelines for Ireland (PDF). Samaritans Ireland. 2009.
  32. ^ IASP Task Force – Suicide and the Media. "Media Guidelines & Other Resources". International Association for Suicide Prevention. Retrieved 15 May 2013.
  33. ^ Suicide Prevention: Guidelines for Public Awareness and Education Activities (PDF). Government of Manitoba. 2011.
  34. ^ "New Guidelines Developed to Promote Responsible Media Coverage of Suicides". Robert Wood Johnson Foundation. March 2007. Retrieved 15 May 2013.