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Theories of Punishment

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Suicide is the only action that is not a crime that may be prevented by force.


Criminal justice is the formal practice of preventing and punishing proscribed behaviors.

There are five generally recognized theories of punishment, in criminal justice terms:

  • General deterrence means making an example of a criminal so that the population at large will be deterred from committing a crime.
  • Specific deterrence refers to punishing an individual criminal so that he or she will “think twice” and be deterred from committing a crime in the future.
  • Incapacitation means isolating and/or restraining a criminal so that he or she will not be able to commit a crime for the duration of the incapacitation.
  • Rehabilitation refers to providing assistance to a criminal so that he or she will not want or need to commit a crime in the future.
  • Retribution involves taking revenge on a criminal for the crime that he or she committed.

Deterrence, incapacitation, and rehabilitation models aim to prevent crime. Deterrence and rehabilitation models operate on the criminal’s mind, whereas the incapacitation model operates only on his body.

Suicidality is often considered to be a mental illness, properly considered to be within the purview of medicine; however, the interventions that are commonly undertaken in cases of suicidality demonstrate that the act is properly viewed as part of the criminal justice model.

The key feature of suicide: it is the only action that is not a crime that may be prevented by force.[1]

The prevention of suicide generally takes punitive, rather than medical, form. Generally, the methods used are incapacitative:

Because [preventing a determined person from committing suicide] is impossible, psychiatrists enjoy (if that is the right word) virtually unlimited professional discretion to employ the most destructive suicide-prevention measures imaginable, provided the measures are called “treatments.” The authoritative American Handbook of Psychiatry (1959 edition) endorsed lobotomy “for patients who are threatened with disability or suicide and for whom no other method seems likely to relieve or restore them.” In the 1974 edition, lobotomy was replaced by electroshock treatment administered in sufficient doses to destroy the subject’s will to kill himself: “[W]e do advocate its initial use for one type of patient, the agitated patient, often middle-aged and usually a man, who presents frank suicidal intention. We give ECT [electroconvulsive therapy] to such a patient . . . daily until mental confusion supervenes and reduces the ability of the patient to carry out his suicidal drive.” Thomas Szasz, Fatal Freedom: The Ethics and Politics of Suicide, pp. 56-57 (citations omitted). [Emphasis mine.]

However, often the methods used are so obviously unpleasant that they fall under the deterrent models as well – if not the retributional models!

In they Army, anyone reporting suicidal ideation is made to wear a bright orange vest and rubber bands in place of his shoelaces – not to mention watched 24/7 by a “buddy.” As reported by Elspeth Reeve:

Suicide watch (also called unit watch, buddy watch, or command interest profile) is how the Army deals with soldiers in garrison who express suicidal thoughts but don’t appear to be in immediate danger of harming themselves. It’s been around in some form since the 1980s, and generally involves a suicidal soldier being watched by one or two fellow soldiers around the clock, and having his gun, shoelaces, and belt taken away, so he can’t kill himself.

. . . . “You’re in an isolated state,” [a recruit who was under suicide watch] says. The orange vest makes you a pariah. “You’ve got the reason you’re on suicide watch to begin with on top of the fact that you stick out like a sore thumb,” he says. “It’s like you’re walking around in a zoo, and you’re the animal.”

. . . . The purpose of the vest is, ostensibly, to make it easy for others to keep an eye on a suicidal soldier, but forcing a soldier to advertise his own depression creates a powerful stigma. “When you see what happens to someone on suicide watch—the orange vest, the trips to the chaplain, the drill sergeant talking about them when they’re not there, saying they can’t handle the military. … When you see that, you’re going to think twice about speaking up and saying you need some help. It makes you not want to talk to someone. You don’t want to be like that guy,” the recruit from Benning says. [Emphasis mine.]

The Army’s treatment of suicidality is clearly punitive. Indeed, there is a strong incentive for soldiers to express insincere suicidality – that is, removal from combat duty. This would make it seem rational for the Army to institute counterincentives (conceding, implicitly, that suicidal behavior is rational in that it responds to incentives). But, as Reeve indicates, the punishment also dissuades genuine suicides from disclosing suicidal ideation.

At any rate, the “treatment” is clearly not rehabilitative, but punitive. General and specific deterrence are at work here, as well as incapacitation.

Similarly, from prisons to mental hospitals, disgusting and punitive “interventions” are used to prevent suicide. This is “mental health treatment” only in the most crudely and obsoletely behavioralist sense. Humiliating heavy dresses/smocks, presumably worn without underwear, are placed on male and female prisoners (of hospitals and prisons) to prevent them from committing suicide.[2] Again, general and specific deterrence are operative, as well as incapacitation. The smock is awful and undesirable, in addition to preventing one from enacting one’s suicidal wishes.

If suicide is a symptom of a mental illness, though, wouldn’t the distress be treated – not the action? People with trichotillomania do not have their hands forcibly restrained from touching their heads. Rather, the distressing compulsion to pull one’s hair is treated – and that only if it distresses the patient in the first place. In the case of suicide, however, the distress of everyone except that of the suicidal person is considered. If suicidal ideation does not cause one marked distress, why is it a mental illness?

The truth is that, despite the ostensible decriminalization of suicide, modern society still encounters suicide under a criminal model. The extreme position of Justice Scalia is, unfortunately, the one tacitly held by our government in general:

“At common law in England, a suicide – defined as one who “deliberately puts an end to his own existence, or commits any unlawful malicious act, the consequence of which is his own death,” 4 W. Blackstone, Commentaries *189 – was criminally liable. Ibid. Although the States abolished the penalties imposed by the common law (i.e., forfeiture and ignominious burial), they did so to spare the innocent family, and not to legitimize the act.” Cruzan v. Director, MDH, 497 U.S. 261 (1990).

Thanks Rob Sica.


1. I realize it may be necessary to distinguish civil injunctions, and civil contempt actions, here. Civil injunctions are ordered only in the case of irreparable harm to others. And, to be punished – by fine or jail – a contempt action must be proved beyond a reasonable doubt. Neither of these criteria are in place in the case of suicide. And, just to be clear, civil injunctions are by far an exceptional case. Money damages are by far the preferred remedy, when they are at all applicable.

2. Gawker says, “It’s weird these models don’t get more work! They are really selling the look. ‘Show me ‘I sure wish I could kill myself but this smock is impossible to rip into strangle-friendly strips’! Perfect.'”

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Written by Sister Y

May 16, 2009 at 3:57 am

With a .22

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I. Fourteen Shots

He shot himself fourteen times with a squirrel rifle. “It is probably the most incredible kind of suicide I have ever seen,” says P. Boxho, reporting the case in the Journal of Forensic Science (“Fourteen shots for a suicide,” 101:1:71-77, 1999).

The man, a 56-year-old Belgian, used such a low-energy weapon (.22 LR cartridges in a 22 mm rifle) that he had to shoot himself fourteen times in the chest in order to effect his end – and, even after fourteen shots, his death was slow. He had to operate the bolt of his rifle between shots, and, most incredibly, he had to reload after the first seven shots. According to Boxho,

The last bullet was certainly the one that went through his left arm for, with a humerus fracture and the fatigue generated by developing hypovolemia, it was getting impossible for him to reload the gun and to keep shooting.

So he had to lie down in the position in which he was found and to wait for death to come.

That death was certainly very slow for, considering their trajectories, the projectiles could only go through his lung, maybe skim past his heart, causing a slow haemorrhage, responsible for death by a hypovolemical shock.

II. Christmas Money

Mychal Bell, best known as one of the Jena Six, shot himself with a .22 pistol. Bell became despondent after being charged with shoplifting, he says.

Police say surveillance video appears to show Bell stuffing merchandise into a bag in a Dillard’s store while another male seems to serve as a lookout.

Bell walked out with the bag without paying, officials said, and a security guard approached and took it from him. Police said Bell and the other male fled, and guards chased Bell because he’d had the bag. Authorities say it contained $370 worth of clothes.

Bell hid under a car in the parking lot, and as a store security officer tried to pull Bell out, he hit the guard in the face with his elbow, police said. Bell, who was charged with shoplifting, simple battery and resisting arrest, was released on bail, according to authorities.

Investigators don’t know who the other male was, and Bell “admitted to everything” to a detective, Lt. Jeff Harris said.

He decided to use his Christmas money to buy a gun, and eventually obtained the .22-caliber handgun. And then he “went awry” at his grandmother’s house, he said.

He aimed it at his head and pulled the trigger, he said, but the gun misfired. Then he pointed the gun at his chest and fired. The bullet clipped his lung, and he was taken to the hospital and treated. It is not clear who found him, or whether he was alone in the house at the time of the shooting.

Does someone who shoots himself in the chest with a .22 really mean to die? It seems that our Belgian man did. However, given the limited availability of reliable means of suicide, I think it is best not to make a hasty judgment that someone did not want to die, and was merely seeking attention and sympathy, based only on the choice of an ineffective method. Perhaps an ineffective method is all the potential suicide could access.

III. Low-Energy Weapons

The term “multiple gunshot wound suicide” is often used sarcastically – a joke, meaning that the alleged suicide was really a homicide, but was (poorly) made to look like a suicide. However, about 1% of gunshot suicides involve multiple wounds. The majority of these multiple gunshot wound suicides involve those aforementioned squirrel guns (or plinkers) – .22 caliber handguns. A .22 is such a low-energy weapon that a single shot may not be enough to bring about death.

IV. Suicide Black Widow

Terry Cottle shot himself behind his right ear with a .22-caliber handgun in 1995. His wife, Cheryl, was present at the time of his death.

Initially, Cheryl told sheriff’s investigators she heard 10-year-old Christopher shouting that Cottle had shot himself. She said she ran into the bathroom and found him on the floor with the revolver still in his hand.

In a second version attached to a coroner’s report, Cheryl said she was eating oatmeal when one of her boys yelled, “Mom, Dad has a gun!” She said she ran toward the bathroom “and saw Terry standing up and looking at her” with the gun in his hand.

“She said that she yelled something like, `Terry, wait!’, and this was at about the same time as she pushed on the door to try to get into the bathroom and at the same time she heard a shot,” the report says.

Cottle was taken to the hospital, but was removed from life support and his organs donated. 57-year-old Sonny Graham received Cottle’s heart.

What makes the story, though, is that a few husbands later, Cottle’s widow Cheryl married Sonny Graham.

Then Graham shot himself.

If your mind weren’t poisoned with Cheryl’s sordid history and strange behavior, you might be tempted to romantically contemplate “cellular memory” or something. But the story seems darker. There were other gun incidents involving her other three husbands. And there’s this shocking failure of proper feminine decorum and chastity:

On her MySpace account – now deactivated – her photo changed from a sweetly smiling portrait to pictures of her on a lake or drinking beer with friends. Her screen name changed, too, from simply “Cheryl” to “PrEttY LAdy,” then “BeaUtiFuL MeSs.”

Family members monitoring the account noticed that shortly after Graham’s death, she posted a man’s photo identifying him as her “new boyfriend.” A flirtatious message on the man’s Web page, from her account, was dated March 26 – six days before Graham’s death.

I find this story remarkable because it is the first time I’ve ever seen a mainstream news outlet imply that a suicide was caused by another person – rather than by, say, mental illness. “Implied” may be too soft a word:

As far as [Cottle’s sister] was concerned, Graham’s death was less about her brother’s heart than about Cheryl – the woman with whom both men had chosen to share it.

Written by Sister Y

May 13, 2009 at 1:09 am

Disincentives, Time Horizons, and the Irrational Continuation of Life

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Social science researcher David Phillips was a pioneer in the theory of suicide contagion. His research has also focused on other fascinating correlates of suicide (and other fatalities), such as day of the month, public holidays, and birthdays.

As these last few professional interests suggest, identification of dates has been important to Dr. Phillips. A 1988 paper * focused on potential difference between deaths from suicide and the suicidal acts or injuries that preceded them. A significant difference in date of suicide attempt and date of death would, of course, be relevant to Dr. Phillips’ studies on how date affects suicide rates.

The motivation for the paper is a 1985 study on a San Diego population that found a whopping 22% difference between date of injury (suicide attempt) and date of death in cases of suicide. The San Diego study analyzed 204 cases of suicide; its findings cast doubt on whether date of death was a good proxy for date of suicidal act.

Phillips and Sanzone, however, studied a much larger sample – 42,698 suicides throughout California – and found that 92.6% of suicide deaths occur within one day of the precipitating suicidal act. In terms relevant to my project, that means that only 7.4% of people who commit suicide have to suffer more than a day before dying.

7.4%. About one in fourteen.

To a potential suicide, this is terrifying – not least because these are the people who succeed. This doesn’t even include the suffering of those who attempt suicide but fail – and are left miserable, with grievous injuries, trapped in a life worse than the one they attempted to leave.

If life is so bad, though, wouldn’t it be worth the risk?

The problem is a possibly irrational time horizon perceived by the potential suicide.

When we decide whether to commit suicide (to shoot ourselves in the head, say, or mix up some community-endangering hydrogen sulfide gas), the risks and benefits of suicide should, rationally, be weighed against the risks and benefits of continuing to live. But “continuing to live” for how long? One rational-sounding candidate would be “continuing to live out one’s natural life span.” Indeed, for most of us, continuing to live our natural life span is unthinkably horrible – much, much worse than the considerable risks of a careful suicide attempt.

But one’s natural life span is difficult to consider. The more tempting, and probably irrational, option – one I find myself preoccupied with – is to weigh the risks and benefits of a suicide attempt with the risks and benefits of living another day or week. Perhaps next week drugs will be legalized. Perhaps next week one will die in an automobile collision or be diagnosed with a fatal illness. Living another day, another week, another month, even six months, is certainly no worse than the alternative – risking extremely serious harm from a suicide attempt. As Dr. Phillips and others demonstrate, even the ones who succeed risk extreme and prolonged suffering.

This is yet another way in which the suicide prohibition encourages irrationality. This is neither just nor compassionate.


*Phillips, David, and Anthony Sanzone. “A Comparison of Injury Date and Death Date in 42,698 Suicides.American Journal of Public Health 78:5:541 (1988).

Rich, Charles, Deborah Young, Richard Fowler, and S.K.S. Rosenfeld. “The Difference between Date of Suicidal Act and Recorded Death Certificate Date in 204 Consecutive Suicides.American Journal of Public Health 75:7:778 (1985).

Written by Sister Y

April 7, 2009 at 3:42 am

Attempted Suicide as a Signal

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How many completed suicides are actually thwarted rescue fantasies?

The answer to this question is necessarily unknowable, locked as it is inside the minds of people about to die. But the number must be substantial, and those who favor coercive suicide prevention methods often refer to the idea of insincere suicides – people who attempt suicide only to send a signal for help – to justify their preferred policies of intervention in all cases. It is only in keeping with the principal of autonomy to do what the suicide attempter wishes, they argue, and what most of them wish is to be rescued. The National Right to Life Committee puts it this way:

It is not actually a desire to die, but rather the desire to accomplish something by the attempt that drives the attempter to consider such a drastic option. Suicide is the means, not the end.

Often, suicide attempters are apparently seeking to establish some means of communication with significant persons in their lives or to test those persons’ care and affection. Psychologists have concluded that other motives for attempting suicide include retaliatory abandonment (responding to a perceived abandonment by others with a revengeful “abandonment” of them through death), aggression turned inward, a search for control, manipulative guilt, punishment, escapism, frustration, or an attempt to influence someone else. Communication of these feelings — rather than death — is the true aim of the suicide attempter. This explains why, paradoxically but truthfully, many say after an obvious suicide attempt that they really didn’t want to kill themselves. [Citations omitted.]

Certainly, there are insincere suicides – those who use a suicide attempt as a signal that they need help – in addition to sincere suicides, those whose only wish is to die. I will argue that, paradoxically, a policy of intervention and “rescue” for suicide attempters, and a general prohibition on medically assisted suicide, are actually the worst, most harmful possible policies in their effects toward insincere suicide attempters who merely wish to send a signal. These policies ensure that the signal is reliable and effective, thereby encouraging people to “communicate their feelings” through a suicide attempt rather than through more healthy methods. Coupled with widespread ignorance about the lethality of various methods, this means that many people harm themselves and even die when they do not really wish to. A general, well-publicized policy of non-intervention, or at least the possibility to opt out of intervention, coupled with a legal assisted suicide option, would actually discourage insincere suicides from attempting suicide by destroying the effectiveness of the signal of attempted suicide, and removing the perceived benefits (the rescue fantasy) that attempted suicide is currently seen to provide.

In order for a person to send a reliable signal, the suicide attempt must appear lethal while not actually being lethal. If medically assisted suicide were legally and practically available, there would be very little value in choosing any other method, and any other method would be less lethal than the medical option. (If organ donation were available as part of the medical procedure, any other method must also, incidentally, be seen as selfish.) This would interfere with the apparent lethality communicated by a suicide attempt, thereby decreasing the motivation to make a “signal” attempt in the first place.

What an insincere suicide attempter – a “signaler” – really wants is to be rescued. That is, he wants to be forcibly prevented from committing suicide, because he does not really want to commit suicide. Remove the possibility for rescue, and you remove this insincere suicide’s motivation to make the potentially harmful attempt in the first place.

An analogy can be made to fights that break out on the popular television show Jerry Springer. Security personnel constantly break up fights and prevent participants from injuring each other – which causes more attacks, because participants feel they can reliably signal their “toughness,” without putting themselves in danger, because of the policy of intervention (rescue) by the show’s security staff. Remove the possibility for intervention, and participants would likely conduct themselves in a much less aggressive manner, as they do on other talk shows.

Of course, it might be argued that suicide intervention is justified in the case of people who are not rationally capable of making the decision to die – for instance, someone experiencing hallucinations, someone in an acute confusional state due to diabetes, or a small child (though we must be aware that people under the age of 18 and people with thought disorders and developmental disabilities still often respond to rational incentive structures, and setting up a structure that rewards them for harming themselves could itself be a cause of harm). There are two options that would at once remove the incentive for “signal” attempted suicides and protect incompetent people. One is to only allow intervention in a suicide attempt if there is reliable evidence – a judicial finding of incompetence, or underage status – that the attempter is incompetent. (Currently, the policy is to intervene in all cases, no matter what, even if reliable evidence of intent to die and competence is available.) A second option is to allow a legally effective “opt-out” procedure, so that a competent adult could legally execute a document refusing intervention in case of a suicide attempt. This option forces a choice to the would-be signaler: either execute the document, in which case one would give up the hope of rescue, hardly an option an insincere suicide would choose, or fail to execute the document, destroying the effectiveness of the signal he’s trying to express.

In addition to the policies I’ve outlined above, accurate information about the lethality of various methods is necessary to prevent accidental death by people making insincere suicide attempts. For instance, it is difficult to say whether Megan Meier, when she hanged herself, knew that hanging has a lethality rate of 70%, and can be lethal within minutes – or that, when not lethal, it often results in permanent brain damage. Had she known this – and if she intended her behavior as a suicidal gesture, rather than intending to die, which is not known – she might have chosen a less lethal method of expressing her feelings. There is a great deal of evidence that many people do not understand the lethality of hanging asphyxiation, as evidence by the apparently accidental deaths from the “Choking Game,” which kills several children every year. Paradoxically, better access to suicide information might actually save the lives of people wishing to send a signal with a suicide attempt but not to die.

As I’ve outlined above, a general policy of disallowing medically-assisted suicide, coupled with a policy of “rescuing” suicide attempters, is harmful and cruel not only to those who wish to die, but to those who do not. It encourages people to attempt suicide when they do not wish to die, but merely wish to send a signal, and contributes to the dangerous fantasy of rescue.

Posts by the intelligent, compassionate Dr. Maurice Bernstein at the Bioethics Discussion Blog, here and here, helped me clarify my thinking on this. Dr. Bernstein explains some of the difficulties facing emergency room doctors when faced with a patient who has attempted suicide and refuses medical intervention.

Written by Sister Y

June 17, 2008 at 8:37 pm