SUICIDE AND LANGUAGE – Why we shouldn’t use the ‘C’ word

Implications associated with ‘commit’

Attention to this issue is important because there are three historically powerful and potentially stigmatising uses for the word ‘commit’ which have implications when associated with the word ‘suicide’.

1. The word ‘commit’ is commonly used in connection with religious offences. Indeed suicide is considered wrong in many religions (Cholbi, 2009). Over time suicide has been regarded as a cardinal sin in some religions and is still often considered a moral sin.
2. In the past, suicide was a criminal act in many countries. For example, there was a legal prohibition against suicide in England and Wales until the Suicide Act 1961 was introduced. As well as decriminalising suicide, this Act made it an offence to assist in a suicide, which had the unique effect of criminalising an accessory when the principal has not committed a crime. The law relating to suicide in Australia varies between States and Territories, but it is no longer a crime in any jurisdiction. In the State of Victoria for example, the Crimes Act 1958, Section 6A, states “The rule of law whereby it is a crime for a person to commit or to attempt to commit suicide is hereby abrogated” (Crimes Act, 1958).
3. The word ‘commit’ has been applied to the incarceration of people against their will in a mental institution. In many countries care for those with mental illness can be sought involuntarily (usually when the person is so unwell that they are unable to admit themselves to care). This is often the only occurrence, outside of committing a crime and being held, where an individual can be detained without his or her consent.

As suicide is viewed differently by different people (both those with and without religious affiliations), is not considered a crime in many parts of the world, and its association with mental illness is not always applicable, using the word ‘commit’ within the context of suicide is not only unnecessary, it is also harmful.

Stigmatising language

Suicide is a considerable public health issue with ripple effects throughout the community. Those affected by suicide (whether personally or due to the death of a person to whom they are connected) are vulnerable and often stigmatised. We need to talk more about suicide, and provide safe places for this to occur in a manner that is helpful and healthy. However, such talk is often steeped in concepts and language from the past (including the use of the word ‘commit’) that perpetuate stigma, constrain thinking and reduce help-seeking behaviour. Those bereaved by suicide and those who have been suicidal themselves have commented on the negative and unhelpful effects of stigmatising language (Alberta Mental Health Board; Sommer-Rotenberg, 1998; Maple et al., 2010).

For example, this comment was posted in response to a resource on suicide and language provided by the Canadian Centre for Suicide Prevention (http://suicideinfo.ca/).

I have always believed language is very powerful, no matter the subject. As a person who has had a number of suicide attempts, I believe the continuing stigma surrounding suicide will make it very difficult to change the language. Consider successful suicide and failed suicide attempts, terms used regularly in ER’s and Mental Health Units. The successful suicide means you’re dead. Would anyone consider referring to any other way in which a person died as ‘successful’?

My ‘failed attempts’ have, when receiving medical attention, made me feel like just that, a failure. I could not even do that right, and the distaste of ER staff is often completely obvious. Once when I drove my car off the road, in ER the nurse asked me if I had taken my seat belt off, when I replied no, she rolled her eyes and shook her head. My ‘failed suicide’ attempt made me a person not to be taken seriously. The unspoken message seemed to be come back when you get it right. Yes, language is very powerful, and I believe those who would try to address the stigma of suicide through language changes have a very difficult job ahead.

As health professionals, our goal must be to reduce the taboo and stigma surrounding suicide. To do so, we must update our language. We must stop using words or phrases such as, ‘committed suicide’, ‘completed suicide’, ‘successful suicide’ or ‘failed attempt at suicide’ and be thoughtful in the ways in which we engage with those who experience suicidal behaviour or attempts, or are bereaved through a suicide death. This is not the first time such consideration has been proposed. In a review of terminology, Silverman (2006) suggested that the term ‘completed suicide’ should be avoided because it implies the success of an undesired outcome, and ‘committed suicide’ should also be avoided because of the connotations of illegality, crime and dishonour, thus stigmatising the deceased as well as those bereaved by the death.

By limiting the use of this negatively associated language, and instead using language that accurately and sensitively describes experience, such as, ‘died by suicide’, or ‘ended his/her life’, we promote a healthier way in which to open conversation about risk and resilience, as well as assisting those bereaved by suicide. ‘Suicide’ is both a noun and a verb so it is also acceptable to say, for example, “she suicided last year”. Language takes time to change. As health professionals we should be at the forefront of championing this change. This both shows respect in caring for people affected by suicide, as well as being accurate in relation to their experience.

Terminology within the suicide field

It could be assumed that authors writing in the suicide field would be most likely to be using up-to-date language when referring to suicide, so to investigate this we reviewed the terminology of authors in peer-reviewed journals in the field of suicidology. We chose the most recent issue (at the time of writing) of two journals, Crisis and Suicide and Life-Threatening Behavior (SLTB), and counted the number of times the words ‘commit’, ‘committed’ or ‘committing’ appeared in association with the word ‘suicide’. These words appeared five times in the most recent issue of Crisis and four times in the SLTB journal. Four of these incidences (two from each issue) were quotations from other sources, while the remaining five were the words of the authors themselves.

While accepting that the field of suicidology has had problems with terminology that has sometimes led to confusion or conflicting use of terms (see, for example, Silverman, Berman, Sanddal, O’Carroll, & Joiner, 2007a & 2007b), this is an area in which stigma has potentially tragic consequences. Therefore, the extra effort involved in becoming familiar with language that is both precise and non-stigmatising is essential. There are other problematic terms used in the field of suicidology which also need to be addressed to improve clarity and consistency of meaning (e.g., suicide attempt, non-suicidal self-harm, suicide survivor and others), but ‘commit’ stands out because of its potential for inducing stigma and so it deserves particular attention with the aim of eradicating its use.

Suicide is a cause of death. Do we ever say that someone ‘committed cancer’ or ‘committed heart failure’, even when they may have lived lifestyles that contributed to such diseases (for example, smoking or having a high fat diet)? Even suggesting this sounds ludicrous, and yet every day we see such examples in relation to suicide. So, let us commit to being vigilant and challenge the use of stigmatising language whenever we hear it used in connection with suicide.

Acknowledgement
Thanks to Emma Ticehurst for her help in preparing this article.

The principal author can be contacted at: susan.beaton4@gmail.com

References

Alberta Mental Health Board. (n.d). What’s in a word? The language of suicide. Retrieved from http://www.albertahealthservices.ca/MentalHealthWellness/hi-mhw-sps-language-of-suicide-1p.pdf

Cholbi, M. (2009). Suicide. In E. N. Zalta (Ed.), The Stanford Encyclopedia of Philosophy. Retrieved from http://plato.stanford.edu/archives/fall2009/entries/suicide/

Crimes Act 1958. Retrieved from http://www.austlii.edu.au/au/legis/vic/consol_act/ca195882/s6a.html

Maple, M., Edwards, H., Plummer, D. & Minichiello, V. (2010). Silenced Voices: Hearing the stories of parents bereaved through the suicide death of a young adult child. Health and Social Care in the Community, 18(3), 241-248.

Olsen, R. (2011). Suicide and Language. Centre for Suicide Prevention, Calgary, Canada. Retrieved from http://suicideinfo.ca/Library/Resources/IEInfoExchange/IE3InfoExchangeSuicideLanguage.asp 

Silverman, M. M. (2006). The language of suicidality. Suicide and Life-Threatening Behavior, 36(5), 519-532.

Silverman, M. M., Berman, A. L., Sanddal, N. D., O’Carroll, P. W., & Joiner, T. E. (2007a). Rebuilding the Tower of Babel: A revised nomenclature for the study of suicide and suicidal behaviors. Part 1: Background, rationale and methodology. Suicide and Life-Threatening Behavior, 37(3), 248-263.

Silverman, M. M., Berman, A. L., Sanddal, N. D., O’Carroll, P. W., & Joiner, T. E. (2007b). 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 and Life-Threatening Behavior, 37(3), 264-277.

Sommer-Rotenberg, D. (1998). Suicide and Language. Canadian Medical Association Journal, 159(3), 239-40.

Suicide Act 1961. Retrieved from http://www.legislation.gov.uk/ukpga/Eliz2/9-10/60