Thursday, May 26, 2016

Words Make Worlds: Language and the Culture of Mental Health in the Workplace

Republished with Permission from Insurance Thought Leadership
By Sally Spencer-Thomas and Donna Hardaker

Part II: The Words about Suicide

[Part I of this series focused on why language matters in mental health advocacy and suicide prevention in the workplace. This article explores wording related to suicide that we want to see change and why. Part III will look at wording related to mental health.]

"suicidal" -- "suicide attempter" -- "he chose to die by suicide"

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Language evolves as understanding evolves. We seek to draw attention to word and phrase choice about suicide and mental health as a means of articulating current understanding and intentionally pushing further evolution.

We are often asked: What is the best way to talk about suicide?

"Died by suicide"

Much of the language related to suicide death comes from a stigmatizing history. The term "committed suicide" originated when suicide was thought of as a sin or a crime, instead of as a fatal outcome of a set of thoughts, often a result of a mental health condition. It is still the most common way for people to describe a death by suicide in the general public, the media and even in the mental health sector. We can ask ourselves: does someone die by committing a car accident? By committing cancer?

Terms commonly used to describe whether a person has died or not: "successful" suicide or "unsuccessful" attempt. The use of the word successful is highly insensitive to the tragedy of a death by suicide. Similarly, we hear the term "completed suicide" to refer to a death by suicide. In North American culture we place a positive value on success and on completion, as with goals, projects, education, etc., so there is an inference that there is a good inside of the suicide death when we refer to it as successful or complete.

When talking about suicide in general, the suggested practice is to test language by substituting the word "cancer" for the word "suicide." If it sounds odd, chances are the phrase has come from a stigmatizing origin. For example, we wouldn't say "the cancer was successful," we would say "a person died from cancer." Thus "dies by suicide" is the best option we have to describe suicide death.

This also informs us as we are speaking that suicide is a cause of death, which encourages us to look at it with the same lens we look at cancer, car accidents, and other causes of death. We can seek to apply a public health advocacy approach, rather than a blame the victim approach which is a result of the use of archaic language.

"A person who is thinking of dying suicide"

When we label people, and group them according to an identifier, we are seeking to simplify who they are. It is a short-cut language strategy that also short-cuts understanding and connection. In suicide, it is often seen the label: "a suicidal person", "he is suicidal". Using our swap "suicide" for "cancer" rule: Are you cancerous or are you a person who has cancer? We prefer: "a person who experiences suicidal thoughts". "a person who is thinking of dying by suicide".

The fallacies of choice and manipulation

For most who die by suicide, we believe their choice would have been to live if they could have found a way out of the mindset of dying. Unbearable psychological pain may be accompanied by very strong internal commands to die. This experience is not the usual type of rational choice in the way we commonly think about choice. People often say "a person chose to die by suicide". Inside this thinking, there is a sense of an absolving anyone other than the person who died of any responsibility, which we understand. It is very difficult to grasp that a person has died by suicide, and we often seek solace in using language that infers that the person acted completely freely. We wish to undo this type of phrasing that infers that true "choice" is part of the picture. We prefer that people do not use the word "choice" when talking about a death by suicide.

Also in the language of suicide, we find phrases that infer that a person who has made a suicide attempt is manipulative, and is just "seeking attention." The phrase "suicide gesture" has an inference that intent is not genuine. We prefer: "an action with suicide intent."

"Precipitating Events"

When a person dies by suicide and we wish to talk about what lead up to their death, we often talk about "triggering events." The word "trigger" is problematic because of its strong connection to firearm use. Also, by calling something a triggering event, the phrase denies an opportunity for people to have mastery over the impact of the event. It is preferable to use a more objective term to describe prior events and challenges. We prefer: "precipitating events."

Clarity around "survivor"

The term "suicide survivor" is confusing. Depending on how it is used, this phrase may mean a suicide loss survivor (a loved one left behind when a person dies by suicide). At other times, it means suicide attempt survivor (the person who has made an action with suicide intent, and survived the action). Thus, the preferred terminology for people who are left behind: "a person who is bereaved by suicide," or "a person who is surviving a suicide loss". People who attempt suicide, but do not die can be referred to as: "a person who attempted suicide and survived" to help with clarity. In addition, the field of suicide prevention also seeks the expertise of people who have lived through a suicide crisis and did not have an attempt, and sometimes these folks are included under the umbrella of "people with lived experience of suicide."

In conclusion, "messaging matters" in suicide prevention and suicide grief support. For more best practices, review "The Framework for Successful Messaging by the National Action Alliance for Suicide Prevention:


SALLY SPENCER-THOMAS: As a clinical psychologist, mental health advocate, faculty member, and survivor of her brother's suicide, Dr. Sally Spencer-Thomas sees the issues of suicide prevention from many perspectives. Currently, she holds leadership positions for the Carson J Spencer Foundation, the National Action Alliance for Suicide Prevention, and the American Association for Suicidology.

DONNA HARDAKER: Donna is an internationally recognized industry expert in the emerging field of workplace mental health. She is an award-winning curriculum developer, advocate, public speaker, writer, and advisor, who has leveraged her personal experience of mental health challenges and their impact on her employment history into a significant body of work. She is the Director of Wellness Works, a workplace mental health training program for Mental Health America of California that has been evaluated as highly effective in stigma reduction with lasting behavior and culture change. Donna is from Toronto, Canada, but now lives in Sacramento, where she greatly enjoys the California sunshine.