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Censoring Suicide

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Well-meaning anti-suicide groups publish “media guidelines” that promote myths and increase the pain for survivors of suicide.


In London, Paul Day’s compelling, emotionally dense frieze was pulled from a rail station because it depicted a skeleton driving a train and a commuter “wobbling precariously” close to the tracks – alluding to suicide by train.

Pepsi apologized for, and retracted, ads (published in a German magazine) that depicted a “lonely single calorie” committing suicide. The self-appointed censor who received the apology indicated that electronic communication will help him carry out his inquisition into commercial art: “The lesson here is that social media has eyes everywhere and the network to make sure that advertisers can no longer hide stuff in niche markets,” said Chris Abraham.

Art, advertisements, and video games that deal with suicide – entry points for conversations about suicide among ordinary people – are unjustly criticized, censored, and destroyed. There is only one appropriate way to speak of suicide, one appropriate attitude toward it, and all others are quickly suppressed. This is not the case for other controversial topics – murder, race, gender, drug use – nor should it be. Suicide is tabooed in a unique and unfortunate way.

Joan Wickersham, author of The Suicide Index and daughter of a suicide, thinks that more conversation about suicide would be a good thing:

“I think there is a kind of shame and a kind of taboo attached to suicide,” she says. “We would prefer to think it doesn’t happen. I think we have to acknowledge it does happen. We have to acknowledge that it’s a mystery, that we don’t understand it very well. I just wanted to give a sense of what it is really like to go through this.”

Wickersham says there is a reluctance to talk about suicide, adding, “I would love to see more honest conversation about it.”[“World Suicide Prevention Day seeks to raise awareness,” Voice of America.]

Contrary to Wickersham’s goal, “honest conversation” about suicide is suppressed in the media when a suicide occurs, often based on well-intentioned but flawed “media guidelines” published by anti-suicide groups. In addition to the fact that these guidelines promote the ethical position that suicide is wrong, I see two major problems with these guidelines: one, they promote myths about suicide as if they were facts; two, they increase the guilt of survivors by portraying suicide as preventable.

The “Media Guidelines for Suicide” on suicide.org advise reporters as follows:

Emphasize the number one cause for suicide:

The number one cause for suicide is untreated depression.

And then indicate that depression is treatable, and thus anyone suffering from depression needs to receive IMMEDIATE help.

This is in contrast to the scientific studies, which show that depression only slightly increases the risk for suicide – a fact which in itself carries little weight, since suicidality is one of the possible criteria for diagnosing depression. According to Thomas Joiner (Why People Die by Suicide, p. 195-196), borderline personality disorder and anorexia nervosa are far more predictive of suicide than depression; BPD has a 10% lifetime risk of suicide and a 50% lifetime rate of at least one very severe suicide attempt.

Even given a slight correlation between depression and suicide, it’s overstating the case to say that depression causes suicide – even Thomas Joiner would not agree with that, as stated. It would be more accurate, but less satisfying, to say that the desire to die, coupled with the acquired ability to die, is the leading cause of suicide.

The suicide.org guidelines also recommend using the “fact” that “Over 90% of the people who die by suicide have clinical depression or a similar mental illness when they die.” I have extensively attempted to debunk this statistic, but the comfortable idea that suicide is caused by mental illness is hard to dislodge and unlikely to be questioned too closely.

Other “media guidelines” offered by suicide.org range from silly to intrusive to “whoa, thought police”:

Do not begin a television newscast with a suicide story.

Do not place suicide stories on the cover of newspapers or magazines.

Never portray suicides as heroic.

Never say that a suicide “ended pain” or “ended suffering.” Suicide CAUSES excruciating pain for suicide survivors.

Also, people need to be alive to feel relief from pain. Suicide CAUSES pain.

Do not use the terms “successful suicide” or “committed suicide.” Use the term “died by suicide” instead.

The term “committed suicide” is NOT accurate and is VERY hurtful to those who have attempted suicide and to suicide survivors. Say “died by suicide.”

The media guidelines proposed by suicide.org strictly fit the definition of politically correct bullshit I proposed in an earlier piece: they express majority opinion in a manner unconcerned with truth, and have the function of a moral taboo to protect an important cultural narrative from negation.

The guidelines promulgated by the National Institutes of Mental Health are much more harmful, however, in that they function to increase the pain and guilt experienced by people close to a person who committed suicide. The message promoted by the NIMH guidelines is that suicide is always preventable, and there are always warning signs. The guidelines advise reporters that

Studies of suicide based on in-depth interviews with those close to the victim indicate that, in their first, shocked reaction, friends and family members may find a loved one’s death by suicide inexplicable or they may deny that there were warning signs. Accounts based on these initial reactions are often unreliable.

That is, there are always warning signs; push family remembers until they “remember” the politically correct story. Reporters are advised to ask survivors questions such as

  • Had the victim ever received treatment for depression or any other mental disorder?
  • Did the victim have a problem with substance abuse?

The message is that there were warning signs that, had the family cared enough to look, would have revealed the suicide’s intentions so that the suicide could have been prevented. Unfortunately, this serves to increase the guilt of survivors, legitimize increasingly coercive suicide prevention tactics, and increase the survivors’ sense that the suicide was a tragedy because it was “preventable.”

The problems I identify – promoting false information and unnecessarily increasing survivors’ guilt and pain – are in addition to the harm to the marketplace of ideas that is done in the name of curbing the controversial phenomenon of suicide contagion. A single ethical idea is given precedence over all others, and false facts are repeated in the name of protecting it, and of protecting the institutions that depend on it (“Mention that Suicide.org is available 24 hours a day for anyone who is suicidal,” advises suicide.org).

Update: zarathustra at MentalNurse discusses media treatment of suicide in “How should the media report suicide?

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Written by Sister Y

December 5, 2008 at 2:18 am

Warning Signs

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“A broad range of warning signs for suicide has been identified in school-based suicide prevention programs, with little consistency across programs and many simply incorporating signs and symptoms of depression,” say the authors of a 2006 study, Warning Signs for Suicide: Theory, Research, and Clinical Applications (PDF), in the journal Suicide and Life-Threatening Behavior, 36(3) June 2006. Indeed, “building awareness” of the warning signs of suicide is often the focus of anti-suicide efforts.

What are those all-important signs of suicide – those signs that, if you’re careful and vigilant, can help you stop the suicide of a friend or relative? It depends on who you ask. San Francisco Suicide Prevention provides a set of warning signs, including talking about death, a recent loss (such as death, the end of a relationship, or loss of religious faith), a change in behavior (trouble concentrating on school or work), and menstrual abnormalities. Do you know anyone who exhibits any of those signs? Suicide.org has a different set of warning signs, largely made up of the symptoms of depression, including gaining or losing weight. Neglecting personal appearance, irritability, or lacking a sense of humor could also indicate your loved one is on the brink of suicide, according to suicide.org.

The Substance Abuse and Mental Health Services Administration warns about withdrawal from friends and family, a drop in academic performance, or suspicious cheerfulness. The National Suicide Prevention Lifeline (PDF) is a bit more literal – seeking a way to kill oneself is a warning sign of suicide, as is threatening to kill oneself. WebMD lists calling people to say goodbye and putting one’s affairs in order as possible signs of suicide.

All these disparate signs and symptoms could be indicative of a suicide. Whatever the warning signs and however vague and ambiguous they may be, the American Foundation for Suicide Prevention tells us, it’s important to take them seriously and act on them. “Seventy-five percent of all suicides give some warning of their intentions to a friend or family member,” they assure us, without bothering to cite a source for that statistic. “In an acute crisis, take your friend or loved one to an emergency room or walk-in clinic at a psychiatric hospital.” Got that? Also, “[r]emove from the vicinity any firearms, drugs or sharp objects that could be used in a suicide attempt.”

My problems with such lists of “warning signs of suicide” are several. First, these lists of “warning signs” are vague and confusing, and leave friends and relatives of a suicide with the feeling that they somehow should have foreseen and prevented the suicide, adding to the survivors’ guilt.

Second, these lists of “warning signs” are as likely to be read by people seriously contemplating suicide as by those who would prevent suicides. Given the suicide prohibition and the potential consequences for those caught being suicidal, suicides have every incentive to mask any potential “warning signs,” forcing them to live even more inauthentically if they are serious about suicide. Saying goodbye is a warning sign of suicide – so we musn’t say goodbye. Putting our affairs in order is a warning sign – so we mustn’t do that, either. Most importantly, having serious conversations about suicide, which could help a potential suicide figure out his true desires and, at the same time, help friends and relatives understand the suicide’s experiences and motivations, become extremely risky and, therefore, much less likely to occur when placed on the list of warning signs.

Finally, of course, a “list of the signs of suicide,” published so that people may forcibly intervene in the lives and decisions of others, assumes that preventing suicide is, in all cases, a worthwhile policy goal.

To sum up, the messages conveyed by these lists of “warning signs of suicide” are three:

1. If someone you know commits suicide, you could have, and should have, prevented it. It’s your fault.

2. If you are considering suicide, be careful to avoid exhibiting any of the warning signs – specifically, don’t talk to anyone about your potential suicide. Hide your intentions.

3. Suicide is wrong and should be stopped in all cases, by force if necessary. We must all be junior spies in enforcing the suicide prohibition.

Written by Sister Y

September 24, 2008 at 8:37 am

Suicide, Gun Ownership, and the Ethics of Suicide Prevention

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A 2002 study in Injury Prevention positively links regional rates of gun ownership with regional rates of gun suicide, and with regional rates of overall suicide. This study stands for the proposition that people who own guns are more likely to kill themselves at some point, not merely for the trivial proposition that one must possess a gun, at least for a brief period of time, in order to commit suicide with a gun. (People who bought guns specifically to kill themselves, and then immediately killed themselves, would not be reflected in the regional rates of gun ownership in this study.)

There are two other less intuitive conclusions of the study: regional rates of major depression are completely uncorrelated (r=-0.10) with gun ownership; and – much more shockingly – regional rates of major depression are completely uncorrelated with regional suicide rates (r=0.00!). The latter conclusion, of course, casts doubt on the commonly-held belief that suicide is a symptom of a disease – depression – or the end-point of a disease process, rather than a rationally and freely chosen action. Interestingly, and again supportive of the suicide-as-decision hypothesis, regional rates of suicidal thoughts are correlated with suicide – though suicidal thoughts do not correlate with gun ownership.

You can read the study, “Association of rates of household handgun ownership, lifetime major depression, and serious suicidal thoughts with rates of suicide across US census regions,” by D. Hemenway and M. Miller (Inj Prev 2002;8:313-316), if you have library or school access to Injury Prevention, but if you don’t, I think it’s important to give an idea of how careful and well-planned this study is. On why they chose to do a regional study with data averaged over ten years:

Because the stock of guns in the United States is so high (over 200 million guns in civilian hands) and because guns are highly durable goods, year-to-year variations in survey estimates of firearm ownership rates are as likely to reflect measurement error rather than actual fluctuations in firearm ownership levels. Handgun ownership data are, therefore, averaged over the 10 year study period to obtain more reliable estimates of regional handgun ownership rates.

On the limitations of studies comparing regional variables:

This study has various limitations. First, as in any ecological study, a concern is that the association found at the aggregate level does not exist at the individual level. For example, from our data, even if there is a regional level association between alcohol and suicide, we do not know if the individuals who are alcohol consumers are the ones more likely to commit suicide. However, from other studies we know that guns are the prime method of suicide in the United States, most people who use guns to commit suicide use family guns, and a gun in the home is a risk factor for firearm suicide.[footnote omitted] We thus have somewhat less reason to be concerned about the “ecological fallacy” with respect to the gun prevalence-suicide connection.

In short, the study is the wet dream of those who would like to restrict handguns in order to prevent suicide. Gun advocates disfavor this sort of logic when it means restrictions on handgun use for the general population, because they see a value to gun ownership; however, gun advocates such as the NRA are all too willing to sell out and cheer on this sort of logic when applied to people diagnosed with some sort of mental illness. No one seems to be considering the possibility that banning guns to reduce suicides is wrong because the right to commit suicide is valuable. Mark Daigle, writing (ironically) in Accident Analysis & Prevention (Volume 37, Issue 4, July 2005, Pages 625-632), typifies this assumption in the public health field:

The effectiveness of restricting access to certain means of committing suicide has been demonstrated, at least as regards toxic domestic gas, firearms, drugs and bridges. At the individual level, studies tend to indicate that many persons have a preference for a given means, which would limit the possibility of substitution or displacement towards another method. Similarly, the fact that suicidal crisis are very often short-lived (and, what is more, influenced by ambivalence or impulsiveness) suggests that an individual with restricted access to a given means would not put off his plans to later or turn to alternative methods. [“Suicide prevention through means restriction: Assessing the risk of substitution (A critical review and synthesis)”]

Restricting access to gun, toxic gas, drugs, and bridges reduces suicide, says Daigle – and that’s good, right? If a “suicidal crisis” might be “short-lived,” and if it might be characterized by “ambivalence or impulsiveness,” isn’t it good to prevent the suicide – for the suicide’s own good?

I think we need to take seriously a very real alternate possibility – that thousands of people suffer so desperately that they often wish to kill themselves, and that if a suffering person chooses death, death is what is for his own good. Methods for “suicide prevention” that merely remove access to what Daigle calls preferred means is not good, but cruel – it actually increases the amount of suffering in the world, and does so by forcing suffering on a segment of the population. They do nothing to reduce the need for suicide – only to reduce the occurrence of suicide. This sort of “suicide prevention” is a form of masking the suffering of a population.

It is only good to prevent suicide in people who wish to commit suicide – who want to die – if life itself is good despite suffering, and if it is proper to force this value onto others who do not accept it. Only if suicide is inherently wrong – if dying is inherently worse than living – is it proper to use force, such as legal restrictions, to reduce the suicide rate. It is my firm commitment that life is not inherently good, and that dying is not inherently worse than living.

Banning tattoo needles, for instance, would probably reduce the rate of tattoos, just as banning guns might reduce the rate of suicide. But despite the impulsiveness and ambivalence that might characterize the decision to get a tattoo, the short-lived nature of the desire, and the permanence of the tattoo (n.b.: especially colored ink), most people support the right to get a tattoo. The fact that many people who were prevented from getting a tattoo are later glad to have been prevented from making the decision would not remove the repugnance of a tattoo ban. Advocates of suicide prevention through force and restriction must explain why dying, when freely chosen, is necessarily worse than getting a tattoo. A tattoo you may regret for your entire life – but suicide will result in no regrets, and no conscious suffering at all. This view is consistent with the idea that life may be assigned value by an individual living person – i.e., killing a person who wishes to live is still a wrong to that person, even if he feels nothing. But prohibiting suicide forces this view of life-as-necessarily-more-important-than-your-suffering on those who adamantly reject it.

Written by Sister Y

June 4, 2008 at 9:15 pm