Suicide terminology

Historically, suicide terminology has been rife with issues of nomenclature,[1][2] and terminology has often been defined differently depending on the purpose of the definition (e.g., medical, legal, administrative). A lack of agreed-upon nomenclature and operational definitions has complicated understanding. In 2007, attempts were made to reach some consensus.[2][3][4][5]

This article lists proposed terminology. The degree to which this becomes adopted widely remains to be seen. The longer-running controversy over the use of "commit" and "committed" in reference to suicide is also discussed.

Suicide-related ideations

Suicidal ideation is any self-reported thoughts of engaging in suicide-related behavior.[2] Subtypes of suicide-related ideations depend on the presence or absence of suicidal intent.

To have suicidal intent is to have suicide or deliberate self-killing as one's purpose.[6] Intent refers to the aim, purpose, or goal of the behavior rather than the behavior itself.[3] The term connotes a conscious desire or wish to leave or escape from life, and also connotes a resolve to act. This is contrasted with suicidal motivation, or the driving force behind ideation or intent, which need not be conscious.

With no suicidal intention

Suicide-related ideation with no suicidal intention is when an individual has thoughts of engaging in suicide-related behavior but has no intention to do so.[4]

With undetermined degree of suicidal intent

When an individual is unable to clarify whether suicidal intent was present or not, the term undetermined degree of suicidal intent is used.[4]

With some suicidal intent

Suicide-related ideation with some suicidal intent is when an individual has thoughts of engaging in suicide-related behavior and possesses suicidal intent.[4]

Suicide-related communications

Suicide-related communications are any interpersonal act of imparting, conveying, or transmitting thoughts, wishes, desires, or intent for which there is evidence (either explicit or implicit) that the act of communication is not itself a self-inflicted behavior or self-injurious.[4] This broad definition includes two subsets.

A suicide threat is any interpersonal action, verbal or nonverbal, without a direct self-injurious component, that a reasonable person would interpret as communicating or suggesting that suicidal behavior might occur in the near future.[4]

A suicide plan is a proposed method of carrying out a design that will lead to a potentially self-injurious outcome; a systematic formulation of a program of action that has the potential for resulting in self-injury.[4]

With No Suicidal Intent

Suicide Threat, Type I

Suicide Threat, Type I is a suicide threat with no associated suicidal intent. The threat may be verbal or nonverbal, passive or active.[4]

Suicide Plan, Type I

Suicide Plan, Type I is the expression of a definite plan to end one's life but with no suicidal intent.[4]

With Undetermined Degree of Suicide Intent

Suicide Threat, Type II

Suicide Threat, Type II is a suicide threat with an undetermined level of suicidal intent. The threat may be verbal or nonverbal, passive or covert.[4]

Suicide Plan, Type II

Suicide Plan, Type II is a proposed method of achieving a potentially self-injurious outcome with an undetermined level of intent.[4]

With Some Degree of Suicidal Intent

Suicide Threat, Type III

Suicide Threat, Type III is a suicide threat with some degree of suicidal intent. The threat may be verbal or nonverbal, passive or covert.[4]

Suicide Plan, Type III

Suicide Plan, Type III is a proposed method of achieving a potentially self-injurious outcome with some suicidal intent.[4]

Suicide-related behaviors

Suicide related behavior is a self-inflicted, potentially injurious behavior for which there is evidence (either explicit or implicit) either that: (a) the person wished to use the appearance of intending to kill himself/herself in order to attain some other end; or (b) the person intended at some undetermined or some known degree to kill himself/herself.[4] Suicide-related behaviors can result in no injuries, injuries, or death. Suicide-related behaviors comprise self-harm, self-inflicted unintentional death, undetermined suicide-related behaviors, self-inflicted death with undetermined intent, suicide attempt, and suicide.

Self-harm is self-inflicted, potentially injurious behavior for which there is evidence (either implicit or explicit) that the person did not intend to kill himself/herself (i.e., had no intent to die).[4] Persons engage in self-harm behaviors when they wish to use the appearance of intending to kill themselves in order to attain some other end (e.g., to seek help, to punish others, to receive attention, or to regulate negative mood). Self-harm may result in no injuries, injuries, or death.

Suicide gesture is an outdated term. Behavior that previously might have been labeled a suicide gesture, if there is no suicidal intent, is labeled as Self Harm, Type I (no injury) or Self-Harm, Type II (with injury), because the purpose of the behaviors is to alter one's life circumstances (interpersonal or intrapersonal) in a manner without suicidal intent but involving self-inflicted behaviors (whether or not it resulted in injuries). If there is an undetermined degree of suicidal intent, it is labeled as Undetermined Suicide-Related Behavior, Type I (no injury), or Undetermined Suicide-Related Behavior, Type II (with injury).[4]

With No Suicidal Intent

Self-Harm, Type I

Self-Harm, Type I is self-harm that has not resulted in injury.[4]

Self-Harm, Type II

Self-Harm, Type II is self-harm that has resulted in nonfatal injury.[4]

Self-Inflicted Unintentional Death

Self-Inflicted Unintentional Death is self-harm that has resulted in death.[4] It is defined as from self-inflicted injury, poisoning, or suffocation where there is evidence (either explicit or implicit) that there was no intent to die. This category includes those injuries or poisonings described as unintended or accidental.

With Undetermined Degree of Suicide Intent

Suicide-related Behavior With Undetermined Degree of Suicide Intent is self-inflicted, potentially injurious behavior where intent is unknown.[4]

Undetermined Suicide-Related Behavior, Type I

Undetermined Suicide-Related Behavior, Type I is self-injurious behavior that has not resulted in injuries and for which the person is unable to admit positively to the intent to die or is reluctant to admit positively to the intent to die due to other psychological states.[4]

Undetermined Suicide-Related Behavior, Type II

Undetermined Suicide-Related Behavior, Type II is self-injurious behavior that has resulted in injuries and for which the person is unable to admit positively to the intent to die or is reluctant to admit positively to the intent to die due to other psychological states.[4]

Self-Inflicted Death with Undetermined Intent

Self-Inflicted Death with Undetermined Intent is self-injurious behavior that has resulted in fatal injury and for which intent is either equivocal or unknown.[4]

With Some Degree of Suicidal Intent

A suicide attempt is defined as a self-inflicted, potentially injurious behavior with a nonfatal outcome for which there is evidence (either explicit or implicit) of intent to die. A suicide attempt may result in no injuries, injuries, or death.[4]

Suicide Attempt, Type I

Suicide Attempt, Type I is a suicide attempt with some degree of suicidal intent and no resultant injuries, regardless of the degree of injury or lethality of method.[4]

Suicide Attempt, Type II

Suicide Attempt, Type II is a suicide attempt with some degree of suicidal intent and resultant injuries.[4]

Suicide

A suicide is a self-inflicted death with evidence (either explicit or implicit) of intent to die.[4] The term completed suicide has also been used synonymously, but is generally believed to be redundant and potentially pejorative, and, as such, is not recommended.

Controversy over use of "commit" and "committed"

According to Fairbairn, “The most common way of speaking about suicide is to talk of its being ‘committed’.”[7] In fact, “committed suicide” or similar descriptions continue to be the norm in both scholarly research and journalism.[8][9] Advocacy groups have suggested that this phrasing has become so entrenched in English vocabulary that it has gained “a naturalness which implies a deceptive harmlessness.”[8] Fairburn further acknowledged the difficulty in finding alternative means of referring to suicide which “are neither clumsy nor misleading,”[7]

However, while common, Lebacqz & Englehardt argue that referring to suicide as an act "committed" may be hazardous to ethical clarity.[10] Others have also argued in favour of alternative language regarding suicide, both in the interest of moral and ethical precision,[9][11] as well as scientific and clinical clarity.[2][4] A United States Navy report urges against the use of the term “committed suicide” on similar grounds, asserting that "suicide is better understood when framed objectively within the context of behavioral health."[12]

The alleged lack of clarity in English suicide terminology has been attributed to the connotations of crime, dishonour, and sin that suicide may carry.[13][14] The German term Selbstmord begehen is similar, denoting an act of commission.[11] Common language has been described as “[portraying] suicide as a ‘crime’ to be ‘committed’ as is, for example, murder.”[10] This is despite the fact that suicide is largely no longer a crime,[9][15] and that, as noted suicidologist Samuel Wallace wrote, “all suicide is neither abhorrent nor not; insane or not; selfish or not; rational or not; justifiable or not.”[16]

Canadian suicide prevention activist, P. Bonny Ball, commented that the alleged criminal implications of suicide are a carryover from the Middle Ages when suicide was considered “both illegal and sinful by the laws and religions of the time.”[17] Sommer-Rotenberg had similarly argued that “the act of self-killing was considered criminal because it was perceived as transgressing the moral authority of God and the righteous feelings of humankind.”[11]

Since “committing suicide” was akin to committing murder or rape, it has been argued that they continue to be linked in some languages.[8] However, this common English expression is not universal: “By contrast the French se suicider and the Italian uccidersi are reflexive. Likewise in Hebrew: l’hit’abbed, ‘to self-destroy,’ is something one does to oneself, with no implication of criminality.”[11]

Various alternatives have been proposed to alter the language regarding the act of suicide from a variety of sectors – including government, journalism, community mental health advocates, and the scientific community. Terms such as “death by suicide,” and “non-fatal suicide attempt” have been suggested to be more objective.[12] The World Health Organization has agreed that these terms “are more accurate and less open to misinterpretation.”[18] The National Institute of Mental Health, the largest research organization in the world specializing in mental illness, also recommends such phrasing is “completed suicide,” or “kill him/herself.”[19]

As it applies to a direct clinical context, the widely cited Beck Classification of Suicidal Behaviour exclusively uses the terminology of “complete suicide.”[20] This classification was revisited in a number of notable documents (such as the Operational Classification for Determination of Suicide, the ‘Tower of Babel’ nomenclature, the WHO/EURO definitions, the Columbia University suicidality classification, the CDC self-directed violence surveillance system, and the Denver VA VISN 19 MIRECC self-directed violence classification system).[21]

A consensus is gaining momentum that suicide is a public health concern to be prevented, rather than a criminal one to be punished, either by law or by language.[8][22][23][24] To that end, many other options and guidelines have been suggested.[25][26][27][28][29][30] As it concerns media reporting of suicide, a key indicator of guideline influence on language as it is practiced in that context reports including one by the Annenberg School for Communication's Public Policy Center at the University of Pennsylvania suggests that there is "evidence of a change in reporting practices following the release of the new media guidelines”[31]

References

  1. ↑ Archives of Suicide Research, 1997, vol. 3, pp. 139–151
  2. 1 2 3 4 O'Carroll et al. (1996). Beyond the Tower of Babel: A nomenclature for suicidology. Suicide & Life Threatening Behavior, 26(3), 237-252.
  3. 1 2 Silverman MM, Berman AL, Sanddal ND, et al. Rebuilding the Tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. Part 1: background, rationale, and methodology. Suicide Life Threat Behav 2007; 37:248–63.
  4. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Silverman MM, Berman AL, Sanddal ND, et al. 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 Life Threat Behav 2007; 37:264–77.
  5. ↑ Posner K, Oquendo MA, Gould M, et al. Columbia Classification Algorithm of Suicide Assessment (C-CASA): classification of suicidal events in the FDA’s pediatric suicidal risk analysis of antidepressants" Am J Psychiatry 2007; 164:1035–43.
  6. ↑ Leenars, A. A. (2004). Psychotherapy with suicidal people. West Sussex, UK: John Wiley & Sons.
  7. 1 2 Fairbairn, Gavin J (1995). Contemplating Suicide: The Language and Ethics of Self-Harm. London: Routledge. p. 34. ISBN 978-0415106061.
  8. 1 2 3 4 Olson, Robert (2011). "Suicide and Language". Centre for Suicide Prevention. InfoExchange (3): 4. Retrieved 15 May 2013.
  9. 1 2 3 Beaton, Susan; Forster, Peter; Maple, Myfanwy (February 2013). "Suicide and Language: Why we Shouldn't Use the 'C' Word". In Psych. Melbourne: Australian Psychological Society. 35 (1): 30–31.
  10. 1 2 Lebacqz, K. & Englehardt, H.T. (1980). "Suicide and covenant". In Battin, M.P. & Mayo, D.J. Suicide: the philosophical issues. New York: St. Martin's. p. 672. ISBN 978-0312775315.
  11. 1 2 3 4 Sommer-Rotenberg, D. (11 August 1998). "Suicide and language" (PDF). Canadian Medical Association Journal. 159 (3). Retrieved 15 May 2013.
  12. 1 2 "What's in a word? How we talk about Suicide" (PDF). Navy Suicide Prevention. United States Navy: Navy Personnel Command. Retrieved 16 May 2013.
  13. ↑ Silverman, M.M. (October 2006). "The Language of Suicidology". Suicide and Life-Threatening Behaviour. 36 (5). doi:10.1521/suli.2006.36.5.519. Retrieved 16 May 2013.
  14. ↑ Centers for Disease Control and Prevention; National Institute of Mental Health, Office of the Surgeon General, Substance Abuse and Mental Health Services Administration, American Foundation for Suicide Prevention, American Association of Suicidology, Annenberg Public Policy Center, in collaboration with the World Health Organization, National Swedish Centre for Suicide Research, and New Zealand Youth Suicide Prevention Strategy (2001). Reporting on Suicide: Recommendations for the Media (PDF). Retrieved 16 May 2013. Cite uses deprecated parameter |coauthors= (help)
  15. ↑ "What's in a word? The Language of Suicide" (PDF). Alberta Health Services. 2009. Retrieved 15 May 2013.
  16. ↑ Wallace, S.E. (1999). "The Moral Imperative to Suicide". In Werth, J.L. Jr. Contemporary Perspectives on Rational Suicide. Philadelphia: Taylor & Francis. pp. 48–53. ISBN 978-0876309377.
  17. ↑ Ball, P. Bonny (2005). "The Power of words". Canadian Association of Suicide Prevention. Retrieved 16 May 2013.
  18. ↑ Preventing suicide : a resource for media professionals (PDF). Geneva: World Health Organization. 2008. p. 8. ISBN 978-92-4-159707-4.
  19. ↑ "Recommendations for Reporting on Suicide" (PDF). National Institute of Mental Health. 2001. Retrieved 15 May 2013.
  20. ↑ Beck, A.T.; Resnik, H.L.P. & Lettieri, D.J, eds. (1974). "Development of suicidal intent scales". The prediction of suicide. Bowie, MD: Charles Press. p. 41. ISBN 978-0913486139.
  21. ↑ O’Connor, R.C.; Platt, S. & Gordon, J., eds. (2011). "Challenges to Classifying Suicidal Ideations, Communications, and Behaviours". International Handbook of Suicide Prevention: Research, Policy & Practice. Oxford: John Wiley & Sons. pp. 18–21. ISBN 978-0470683842.
  22. ↑ The Surgeon General’s call to action to prevent suicide. Washington, D.C.: United States Public Health Service. 1999.
  23. ↑ U.S. Department of Health and Human Services (HHS) Of?ce of the Surgeon General; National Action Alliance for Suicide Prevention (September 2012). 2012 National Strategy for Suicide Prevention: Goals and Objectives for Action (PDF). Washington, D.C.: HHS. Retrieved 16 May 2013. Cite uses deprecated parameter |coauthors= (help)
  24. ↑ O'Carroll, P.W.; Mercy, J.A.; Steward, J.A. (August 1988). "CDC Recommendations for a Community Plan for the Prevention and Containment of Suicide Clusters". Morbidity and Mortality Weekly Report. 37 (S-6). Retrieved 16 May 2013.
  25. ↑ Brenner, L.A.; Silverman, M.M.; Betthauser, L.M.; Breshears, R.E.; Bellon, K.K.; Nagamoto, H.T. (2010). "Suicide Nomenclature – 2010 Suicide Prevention Conference" (PDF). Denver: Department of Defense; Defense Centres of Excellence for Psychological Health and Traumatic Brain Injury. Retrieved 17 May 2013.
  26. ↑ Brenner, L.A.; Breshears, R.E.; Betthauser, L.M.; Bellon, K.K.; Holman, E.; Harwood, J.E.; Silverman, M.M.; Huggins, J.; Nagamoto, H.T. (June 2011). "Implementation of a suicide nomenclature within two VA healthcare settings.". Journal of clinical psychology in medical settings. 18 (2): 116–28. doi:10.1007/s10880-011-9240-9. PMID 21626353.
  27. ↑ Centre for Suicide Research (September 2012). "Media and Suicidal Behaviour: Guidelines and other information". University of Oxford. Retrieved 18 May 2013.
  28. ↑ Media Guidelines for the Reporting of Suicide: 2009 Media Guidelines for Ireland (PDF). Samaritans Ireland. 2009.
  29. ↑ IASP Task Force - Suicide and the Media. "Media Guidelines & Other Resources". International Association for Suicide Prevention. Retrieved 15 May 2013.
  30. ↑ Suicide Prevention: Guidelines for Public Awareness and Education Activities (PDF). Government of Manitoba. 2011.
  31. ↑ "New Guidelines Developed to Promote Responsible Media Coverage of Suicides". Robert Wood Johnson Foundation. March 2007. Retrieved 15 May 2013.
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