Language and Mental Health (Part 2)

[Part 1 of this series focused on why language matters in mental health advocacy and on suicide prevention in the workplace. This article explores wording related to suicide that we want to see change. Part 3 will look at wording related to mental health.] We are often asked: What is the best way to talk about suicide? “Died by suicide” Much of the language related to suicide death comes from a stigmatizing history. The term “committed suicide” originated when suicide was thought of as a sin or a crime, instead of as a fatal outcome of a set of thoughts, often a result of a mental health condition. The phrase is still the most common way for people to describe a death by suicide in the general public, the media and even in the mental health sector. We can ask ourselves: Does someone die by committing a car accident? By committing cancer? Certain terms are commonly used to describe whether a person has died or not: People talk of a “successful” suicide or an “unsuccessful” attempt. The use of the word "successful" is highly insensitive to the tragedy of a death by suicide. Similarly, we hear the term “completed suicide” to refer to a death by suicide. In North American culture, we place a positive value on success and on completion, so we suggest a certain amount of good when we refer to a suicide as successful or complete. When talking about suicide in general, test language by substituting the word “cancer” for the word “suicide.” If the result sounds odd, chances are the phrase has come from a stigmatizing origin. For example, we wouldn’t say “the cancer was successful”; we would say “a person died from cancer.” Thus, “died by suicide” is the best option we have to describe suicide death. See Also: The Daily Grind is Good for the Mind We should talk about suicide by viewing it through the same lens we use to look at cancer, car accidents and other causes of death. We can seek to apply a public health advocacy approach, rather than a blame-the-victim approach, which is a result of the use of archaic language. “A person who is thinking of dying by suicide” When we label people, and group them according to an identifier, we are seeking to simplify who they are. It is a short-cut language strategy that also short-cuts understanding and connection. In suicide, there is often a label: “a suicidal person”; “he is suicidal.” Using our rule about swapping “suicide” for “cancer”: Are you cancerous, or are you a person who has cancer? We prefer: “a person who experiences suicidal thoughts,” “a person who is thinking of dying by suicide.” For most who die by suicide, we believe their choice would have been to live if they could have found a way out of the mindset of dying. Unbearable psychological pain may be accompanied by very strong internal commands to die. This experience is not the usual type of rational choice in the way we commonly think about choice. People often say “a person chose to die by suicide.” Inside this thinking, there is a sense of absolving of responsibility anyone other than the person who died, which we understand. It is very difficult to grasp that a person has died by suicide, and we often seek solace in language that implies that the person acted completely freely. We wish to undo this type of phrasing that implies that true “choice” is part of the picture. We prefer that people do not use the word “choice” when talking about a death by suicide. Also in the language of suicide, we find phrases that imply that a person who has made a suicide attempt is manipulative and is just “seeking attention.” The phrase “suicide gesture” has an implication that intent is not genuine. We prefer: “an action with suicide intent.” “Precipitating events” When a person dies by suicide, and we wish to talk about what led up to their death, we often talk about “triggering events.” The word “trigger” is problematic because of its strong connection to firearm use. Also, by calling something a triggering event, the phrase denies an opportunity for people to have mastery over the impact of the event. It is preferable to use a more objective term to describe prior events and challenges. We prefer: “precipitating events.” Clarity around “survivor” The term “suicide survivor” is confusing. Depending on how it is used, this phrase may mean a loved one left behind when a person dies by suicide. At other times, the term means someone who has survived a suicide attempt. Thus, the preferred terminology for people who are left behind is: “a person who is bereaved by suicide,” or “a person who is surviving a suicide loss.” People who attempt suicide but do not die can be referred to as: “a person who attempted suicide and survived.” In addition, the field of suicide prevention also seeks the expertise of people who have lived through a suicide crisis and did not have an attempt. Sometimes these folks are included under the umbrella of “people with lived experience of suicide.” In conclusion, “messaging matters” in suicide prevention and suicide grief support. For more best practices, review “The Framework for Successful Messaging by the National Action Alliance for Suicide Prevention": http://suicidepreventionmessaging.actionallianceforsuicideprevention.org/.