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Press: Traumatic Brain Injury Makes Suicide Rational

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From a story on a professional athlete who committed suicide, suspecting he had traumatic brain injury:

BOSTON — The suicide of the former Chicago Bears star Dave Duerson became more alarming Monday morning, when Boston University researchers announced that Duerson’s brain had developed the same trauma-induced disease recently found in more than 20 deceased players.

What is amazing about this story is this: there is no recommendation for greater mental health screening, detection, and services among former professional athletes. There are recommendations, however, to actually SOLVE THE PROBLEM that made the guy’s life hell in the first place.

Duerson shot himself Feb. 17 in the chest rather than the head so that his brain could be examined by Boston University’s Center for the Study of Traumatic Encephalopathy, which announced its diagnosis Monday morning in Boston.

In this case, the reporter seems to clearly accept the proposition that the former athlete’s suicide was caused by his traumatic brain injury – but NOT because his traumatic brain injury made him insane. Rather, it seems that his traumatic brain injury made his life bad enough that it’s impossible to completely reject the notion that he committed suicide rationally.

The medical model of suicide – the idea that suicide is a pathological symptom of a curable medical condition – has always been dubious, but it is clear from accounts like this that not even the media (repeatedly warned by well-meaning bullies to self-censor) fully buy the story. Everyone knows that there are good reasons to commit suicide. What few acknowledge is that most genuinely good reasons to commit suicide are not as easy to verify as this former athlete’s brain injury.

As David Foster Wallace describes it in Infinite Jest:

Think of it this way. Two people are screaming in pain. One of them is being tortured with electric current. The other is not. The screamer who’s being tortured with electric current is not psychotic: her screams are circumstantially appropriate. The screaming person who’s not being tortured, however, is psychotic, since the outside parties making the diagnoses can see no electrodes or measurable amperage. One of the least pleasant things about being psychotically depressed on a ward full of psychotically depressed patients is coming to see that none of them is really psychotic, that their screams are entirely appropriate to certain circumstances part of whose special charm is that they are undetectable by any outside party. [Emphasis mine.]

Written by Sister Y

May 2, 2011 at 5:17 pm

"Harnessing the Power of Friendship"

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Facebook is “harnessing the power of friendship” so suicidal people can get “help” – that is, it’s ordering users to call the police when any user mentions suicide, so that such users are (a) denied the opportunity to talk about suicide, and (b) forcibly prevented form committing suicide.

To get an idea of what the euphemism “help” refers to, see, e.g.:

Please don’t help enforce unethical laws or policies like Facebook’s.

Written by Sister Y

March 8, 2011 at 8:28 pm

Reuters Refusing to Use Stupid Euphemisms

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(Reuters) – The body of a man who apparently committed suicide last week was found inside a car buried in snow on Tuesday, police said. [Emphasis mine.]

It’s not a particularly noteworthy suicide story, but I’m pleased that writer Aman Ali uses the natural phrase “committed suicide” instead of the unnatural euphemism “died by suicide,” preferred by self-appointed media censors. Ali also uses the construction “shot himself with a shotgun,” which is about as non-euphemistic as you can get without describing the entry wound.

Written by Sister Y

February 1, 2011 at 7:33 pm

Censoring Murder-Suicide: What If Everything Is Contagious?

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Ecological studies suggest that highly publicized suicides cause more suicides. But what other behaviors are media-contagious – and why are we so slow to censor (or even study) them?

Idea Contagion

For good or ill, behaviors among humans pass not only by genes, but by language. A judgmental way to put this is that behaviors and ideas are “contagious.” Pathological homesickness, apotemnophilia,[4] multiple personality disorder, and even Ursuline convents in seventeenth-century France[6] have been posited to arise from contagion.

In particular, suicide is widely accepted as a contagious behavior. The posited contagion even has a name – the “Werther effect.” Belief in the media contagion of suicide is so strong and pervasive that “media guidelines” – a form of voluntary censorship – are widely observed in reporting on suicide.

There is evidence that many behaviors other than suicide are similarly “contagious,” however. Violence against others, in particular, is well-studied in its relation to media contagion. The harm of violence, especially homicidal violence like murder and murder-suicide, is much greater than that of suicide. And the evidence in favor of “violence contagion” is stronger than that of suicide contagion. Why, then, are reports of suicide voluntarily censored, while reports of violence are not?

Suicide Contagion: The Evidence

The evidence for suicide contagion through the media is almost entirely ecological. The studies that provide the basis for the phenomenon of suicide contagion are somewhat questionable.[7] Many suffer from lack of control for important variables; those that are controlled suffer from problems with the control groups or small sample size. Some ecological studies have indicated that the suicide contagion phenomenon is real;[2] others have contradicted those findings. Even among studies that find a correlation between suicide rate and media reports of suicides, the correlation is often much weaker than the correlation of the suicide rate with other factors, such as the unemployment rate.[9]

Of course, there is a more abstract critique of ecological-level data in general. A criticism[1] of David Phillips’ ecological data on suicide contagion and fatal aircraft incidents goes as follows:

Phillips asserts that the statistically significant increase in aircraft fatalities can be explained due to suicide, as well as a “consciously or unconsciously” induced motive on the part of the pilot to also murder some person or persons. What Phillips does, in effect, is impute suicidal motives to some deceased persons on the basis of the statistically significant increases in accidents. Such a jump is conceptually unwise because it is based on a tautology: the statistical increase is the basis for defining some cases as suicide, but these cases are also used to explain the increase. [Citations removed.]

At any rate, a major problem with suicide contagion research is a lack of empirical evidence at an individual level. The one case-controlled study that I am aware of[7] fails to demonstrate any link between hearing media reports of suicide and making a suicide attempt – and, in fact, demonstrates that hearing a media report of suicide has a significant protective effect against suicide attempts.

The study authors interviewed 153 people, ages 13-34, who were “victims” of nearly lethal suicide attempts and who had been treated at local emergency rooms in the Houston, Texas, area. A control group of 513 subjects was similarly interviewed. The conclusion? Not only did the study fail to demonstrate any sort of “suicide contagion,” but, as mentioned above, the authors note a statistically significant protective effect when a subject heard a news report of suicide within 30 days prior to the suicide attempt or had a friend or acquaintance make a suicide attempt. That is, the ER suicide-attempt group was actually less likely than the control group to be aware of a recent media report of a suicide, or to have experienced the suicidal behavior of an acquaintance! The suicide attempt of a parent or relative had no statistically significant effect on suicidal behavior, whereas the usual “suicide contagion” sources had a statistically significant protective effect – the opposite of what the suicide contagion model predicts.

Violence Contagion?

The evidence for violence contagion is much stronger than that for suicide contagion. But whereas suicide censorship is widely accepted, censorship of other-directed violence in media stories is rare.

Violence contagion is demonstrated by the same type of ecological study as suicide contagion.[8] In addition, unlike the suicide case, there is a body of laboratory evidence suggesting that exposure to violent stimuli increases aggressive behavior. However, despite both sources of evidence, the theory that media reports of violence “cause” real-life violence is not at all universally accepted.[5] And the idea that the media should voluntarily self-censor with regard to reports of violence is much less widely accepted than self-censorship of reports of suicide, despite greater evidence for a causal link in the former case.

Contagion and Moral Responsibility

I believe that the insistence that suicide is media-contagious, but violence is not, is not rational, but is a consequence of the differential attributions of moral responsibility in cases of suicide versus other-directed violence. Suicide is seen as an irrational act; the actor, as the story goes, is not in control of himself, certainly not sane, and is therefore vulnerable to external effects.

On the other hand, the idea that violent acts like homicides are attributable to media suggestion is generally seen as a pathetic excuse. Perpetrators of violence are perceived as much more morally responsible for their acts than suicides; despite evidence to the contrary, idea contagion is psychologically ruled out as a cause of violence, but not of suicides (though there are exceptions to this line of thinking[3]).

Is political corruption contagious? Adultery? Prostitution? Drug abuse? Such questions are rarely even studied. Obesity certainly appears to be contagious. If so, should we censor reports of these topics to avoid a contagion effect? To do so would seem ludicrous and counter-productive, not to mention contrary to our political ideals. But the censorship of suicide goes unchallenged.

Moral Responsibility and Willingness to Censor

The more an actor is seen as the agent of his actions, the less outside influences are seen as affecting his actions. Therefore, in cases where moral responsibility is strongly attributed to an actor, outside influences are unlikely to be taken seriously as a cause of his actions – and, therefore, it is not necessary to censor these “outside influences” (such as media reports).

It is my belief that the widespread voluntary censorship of reports of suicide – from use of politically correct language to pervasive norms of message content – are the result of the modern trend to exculpate suicides from moral responsibility and redefine suicide as an act of insanity. There is, however, little evidence that suicides are any less morally responsible for their actions than murderers. Certainly, many other behaviors are media-contagious – but they are not censored, nor are many of them even studied.

I think that one possible explanation is that, at a deep level, people understand that suicide is just not that bad compared to actual acts of violence – despite hysterical language describing suicide as “self-murder.” We want to exculpate people from acts to which we are sympathetic. While we often refuse to define acts outside of societal norms as “not wrong,” we may nonetheless refuse to attribute full moral responsibility to these acts. However, this sort of sympathy backfires in our society. People who are “not responsible for their actions” must be “protected,” often in painful and dehumanizing ways; and society is responsible for their “protection,” often to the detriment of freedom.

Think of the children.

On a largely unrelated note, could this be the stupidest news story about suicide of all time?

Works Cited

1. Altheide, David. “Airplane Accidents, Murder, and the Mass Media: Comment on Phillips.Social Forces 2:593-596 (Special Issue, 1981).

2. Bollen, Kenneth, and David Phillips. “Imitative Suicides: A National Study of the Effects of Television News Stories.American Sociological Review 47:802-09 (1982).

3. Coalition of Law Abiding Sporting Shooters. “Ideas Kill: Science Shines a Light on Port Arthur Deaths.” Retrieved from on 04/06/2009.

4. Elliot, Carl. “A new way to be mad.The Atlantic, December 2000.

5. Gunter, Barrie. “Media Violence: Is There a Case for Causality?American Behavioral Scientist 51:1061 (2008).

6. Jones, Marshall, and Elizabeth Rapley. “Behavioral Contagion and the Rise of Convent Education in France.Journal of Interdisciplinary History 31.4:489-521 (2001).

7. Mercy, James, Marcie-jo Kresnow, Patrick W. O’Carroll, Roberta K. Lee, Kenneth E. Powell, Lloyd B. Potter, Alan C. Swann, Ralph F. Frankowski, and Timothy L. Bayer. “Is Suicide Contagious? A Study of the Relation between Exposure to the Suicidal Behavior of Others and Nearly Lethal Suicide Attempts.” (American Journal of Epidemiology 154:2 (2001).

8. Phillips, David. “The Impact of Mass Media Violence on U.S. Homicides.American Sociological Review 48:4:560-568 (1983).

9. Stack, Steven. “Divorce, Suicide, and the Mass Media: An Analysis of Differential Identification, 1948-1980.Journal of Marriage and the Family 2:553-560 (1990).

Written by Sister Y

April 9, 2009 at 6:58 pm

On Pulling the Suicide Debate Out of the Shadows

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Jay Bookman’s article, “Time to pull the suicide debate out of the shadows” – in a newspaper in Georgia, the site of an idiotic new development in assisted suicide criminalization – articulates the most typical position toward suicide in our society. He is in favor of a limited right to suicide for people who really have a good reason to die – paralyzed people, or people with physically painful, terminal illnesses – but not in favor of a general right to suicide for those of us who are suffering, but don’t have a good reason to want to die. His questions, and his responses, are:

[D]o my inalienable rights as a human being extend to the right to self-destruction? If my life is truly my own, shouldn’t I be able to end it as I see fit?

Personally, I think the answer is almost always no. Societal consensus, backed by medical research and experience, dictates that a person in decent physical health who wants to commit suicide is by definition mentally ill — no fully sane person would make such a decision. [Emphasis mine.]

The key to this is the “by definition.” Suicide is believed to be a product of mental illness because it is defined as such. Suicidal ideation is one of the criteria for diagnosing DSM-IV Major Depressive Disorder. But defining something as mental illness does not make it so.

I fear that Bookman would not believe how much many of us suffer – to the point of wanting to die – who are not, unfortunately for us, terminally ill – who are not, technically, “suffering intolerably from an irreversible condition which has become more than [we] can bear,” a definition that is too “loose,” in Bookman’s words. Yet this “standard so loose as to be no standard at all” does not nearly cover all of us who deserve to be allowed to die. We have taken all the antidepressants. We have tried all the therapies. We still want to die. Why should we be forced to stay alive? Or forced to choose between a miserable, unwanted existence and a horrible method of suicide, like shooting ourselves in the head or slashing our arteries? A method that carries the risk of ending up paralyzed and suffering even more in a hospital for the rest of our lives?

Bookman is right to argue that sick, dying people should be able to end their lives. But why? Bookman reports of the Georgia case,

Celmer, the man who died in June, was recovering from cancer of the jaw and apparently sought death not because of pain or looming death, but because of shame at the disfigurement the cancer had caused. In those and other cases, if the factual claims against them prove true, Final Exit members appear to have acted irresponsibly and criminally.

Why is it okay to want to die if you’re in physical pain or about to die, but not if you’re horribly disfigured? Or unbearably miserable, and unlikely to get better?

If the right to die is grounded in autonomy, there’s no reason not to extend the right to a comfortable death to those of us who rationally want to die (i.e., who have a serious, longstanding wish to die that is not the product of a delusion) but are not physically ill. There are ways to ensure that only rational people (regardless of DSM-IV diagnosis) are allowed to commit suicide. If anything, those of us who are defined as mentally ill (especially those of us with treatment-resistant DSM-IV “Major Depressive Disorder“) have a better reason to die than people with terminal illnesses: we have much longer to live in pain.

Written by Sister Y

March 5, 2009 at 8:32 am

Suicide as a Religious Act

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In her laudably dangerous article, “Religious Suicide in an Investor’s World,” Rita Polevoy dares to take suicide seriously. Suicide, says Polevoy, is often a religious act – a conscious act, in protest against the evils of the world, and in preservation of a different kind of dignity than J. David Velleman has in mind in his papers on suicide.

Polevoy, identified as “a student at Loyola University Chicago,” writes:

Suicide, as historian of religion David Chidester reminds us in Salvation and Suicide, his seminal study of the People’s Temple, is frequently a religious act, invested with religious motivations and following a religiously understood logic. The Jewish zealots at Masada, for instance, facing death (or, worse, torture, rape, forced conversion, and slavery) at the hands of the Romans in 70 CE took their own lives as a way of escaping with their religious identity and dignity intact. Likewise, when the utopian community at Jonestown drank poison in 1978, a ruling interpretation among those who participating willingly was that this act of suicide was in protest of “the conditions of an inhumane world.” Suicide presented a means of remaining fully human in the face of a society defined by race, class, and gender divisions and, thus, intent on dehumanization. [Emphasis and links mine.]

In response to the suicide of Rene-Thierry Magon de la Villehuchet, we have seen the predictable, safe ruminations on selfishness and mental illness. And yet, with shocking boldness, de la Villehuchet’s brother, Bertrand, told the press that his brother’s suicide was an “act of honor.”

Advocates of suicide censorship abhor any consideration of the idea that suicide might sometimes be honorable or right. Douglas Faneuil, who claims to “work in the field of suicide prevention,” writes that “Praising a suicide as honorable may come with an extremely high price: namely, more suicides.” He encourages censorship (though you’re not supposed to call it censorship, he says, but rather “putting it in context”) of suicide coverage and justifies that by clinging to the idea of suicide contagion. (I have previously argued that there is clinical evidence that suicide contagion might not exist, and that even if it does, it does not justify censorship.)

But rather than failing to put suicide “in context,” Polevoy is merely describing a genuine aspect of many suicides, including de la Villehuchet’s. She writes,

Villehuchet’s suicide was a public act, an utterance aimed, surely, to resonate throughout the media and thus voice the outrage and despair of many anonymous investors, in the process focusing public attention on the very real ramifications of this white collar crime.

Not all suicides are idealistic, but certainly some are. Polevoy acknowledges a truth; to insist that all suicides are the product of mental illness, that there is never honor in suicide, is to sacrifice truth for the sake of political correctnessbullshit in the strict Frankfurt sense.

Update: An anonymous commenter points to a note by Nassim Nicholas Taleb (author of The Black Swan) on the suicide of his acquaintance, de la Villehuchet. Note 106, “On Killing Oneself,” reads in part:

This is an aristocratic act coming from an aristocratic character: you take your own life when you believe that you failed somewhere — and the solution is to inflict the ultimate penalty on yourself. It is not the money; but the embarrassment, the shame, the guilt that are hard to bear. Someone callous, indifferent to the harm done to others would have lived comfortably (“it is all about money”). A life of shame is not worth living. Christianity never allowed suicide; the stoics did –it allows a man to get the last word with fate.

Thierry, veuillez recevoir l’expression de mon respect le plus profond. [Emphasis in original.]

Written by Sister Y

January 16, 2009 at 9:13 pm

More Evidence for Rational Suicide

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A letter in the upcoming January 2009 issue of the journal Psychiatric Services (Psychiatr Serv 60:126, January 2009) reports on the relationship between suicide method and past health care contacts. The authors of the letter report that people who commit suicide by charcoal burning (a method of carbon monoxide poisoning gaining popularity in Hong Kong and Taiwan) are significantly less likely to have had mental health care (or hospital visits for any reason) than people who commit suicide by hanging or solid or liquid poisoning. That is, there is an identifiable population of people who commit suicide using relatively painless means that require preparation, and this population is less likely to be mentally or physically ill than people who commit suicide using other means. These results are in line with past studies, and “corroborate findings from Hong Kong that victims [sic] of charcoal-burning suicide were less likely to have pre-existing mental or physical illness,” say the authors [emphasis mine; citations omitted].

The letter displays problematic logic in the interpretation of its findings. In relevant part, the authors say:

Our results support the point previously raised by researchers from Hong Kong that this new method may have attracted individuals who would otherwise not have considered suicide. Acute stress, particularly economic difficulty, rather than mental disorders may be the major precipitating factor of suicide in this suicide subgroup. Population-based prevention strategies to prevent charcoal-burning suicide that might be considered include efforts to destigmatize mental illness to enhance appropriate help-seeking behaviors, restrictions on access to charcoal (for example, by removing charcoal from open shelves and making it necessary for the customer to request it from a shop assistant), and guidance for the media on how to report on suicide events. [Emphasis mine; citations omitted.]

The authors’ perspective is that the availability of the method is what is causing the suicide. But isn’t it the individual’s choosing to commit suicide that is the proximate cause of the suicide? Is the “cause” of suicide the man or the gun?

The authors assume that suicide should not be allowed and that it is right to prevent it. Why should this be? No reason for or defense of this position is given. People committing suicide using the charcoal burning method are not likely to be mentally ill! Why shouldn’t they be allowed to choose to commit suicide in a relatively painless manner? Even forced life advocate Ezekiel Emanuel purportedly favors a “negative right” to suicide for rational people.

In addition, the authors’ proposed solution to the problem of non-mentally ill people committing suicide is: destigmatize mental illness. Huh? My interpretation of the data is that charcoal burning suicides are likely to be rational suicides – not the product of mental illness. How will destigmatizing mental illness help anything here? The authors also, predictably, recommend coercive suicide prevention methods (using the laughable tactic of restricting the sale of charcoal – no picnic barbecue for you if you look sad!) and media censorship.

There is little evidence that “destigmatizing mental illness” will prevent suicides in these cases. And even if coercive suicide prevention does prevent some suicides, they will be the wrong suicides. Take away the right to charcoal burning (not to mention the right to barbiturates), and you force people to choose between committing suicide by violent or ineffective means, or remaining alive in misery. And that is wrong.

Written by Sister Y

December 30, 2008 at 5:26 am