A Theoretical Framework for Conceptualizing Suicide
Sometimes I worry that’s what people around me would do if I were honest with someone [ . . . ] about this lack of attachment to life and the sometimes-desire to be rid of it. After they know my default state, will I be self-conscious? Will I regret it? Will they ever forget it, or will it shadow my every move and our every conversation? Will they become too aware, watch me too closely? But then I think: Isn’t there middle ground between hypervigilance and complete secrecy? [ . . . ] If people talked about feeling suicidal [ . . . ] as much as they talked about feeling depressed or anxious, would we finally be forced to see how common it is and start creating space for these conversations? Would it be the worst thing in the world if we started talking about not wanting to be alive, and what might help keep us here?
—ANNA BORGES, “I Am Not Always Very Attached to Being Alive”
ANNA BORGES, a mental health advocate and writer for a number of media outlets, came out in 2019 as someone who experiences “passive suicidality,” the experience of having, based on her definition, suicidal ideation without actively attempting to complete a suicide. In addition to the courage required for such a public coming out—knowing that suicidal people suffer stigmatization, exclusion, marginalization, pathologization, incarceration, and forms of criminalization—Borges’s essay is noteworthy for its identification of some of the worries, fears, and consequences, such as surveillance and stigma, that surround suicidality and that often lead to the silencing of suicidal people. Borges is not the only public personality to discuss suicidality. Indeed, interest in mental health issues has led many public figures and artists to come out as suicidal individuals and share their experiences.1 In the same year, Anna Mehler Paperny, a reporter for Reuters in Toronto and the author of a 2019 memoir, Hello I Want to Die Please Fix Me, published excerpts of her book in the Canadian magazine The Walrus. Introducing the text, she states (2019b, 49):
For ages, the dictate has been not to write honestly about suicide—not to mention even the word, never mind methods, lest, in referencing it directly, you prompt suicidal spirals in others. But you can’t tackle the endless abyss of wanting to die on tiptoes; that just leaves you with the half-hearted interventions we’ve pretended are the best society can do. I need to be faithful to the experience. This is how I felt, and this is how I acted; this is what people in despair are driven to do. These are the people we fail in myriad ways, and this is the cost of that failure.
This “failure” is the failure to truly listen to suicidal people and to openly discuss suicidality. Like Borges, Paperny names her concerns about being honest about her suicidal ideation, based on her first-hand experience of being brought by police officers to the hospital against her will, being badly treated during her hospitalization, and being physically restrained after suicide attempts.
North American media is replete with horrific stories of suicidal people facing inhumane treatment after expressing their suicidal ideation, from being hospitalized and drugged against their will to being handcuffed and shot by police officers called to suicidal “crisis scenes.” It is worth noting that police brutality is also deeply informed by racial and (dis)ability power relations, since it targets particularly those who are racialized, disabled, Mad, and neurodivergent (Puar 2017). Such stories confirm what some studies have shown to be the harsh realities faced by suicidal individuals (Stefan 2016; Szasz 1999; Webb 2011). These stories illustrate that, despite the public discourses of support, compassion, and care surrounding suicidality, suicidal individuals who reach out for help often do not always find the compassion promised (Fitzpatrick 2020; Jaworski 2020; Radford, Wishart, and Martin 2019; White 2020b; White and Morris 2019). Through the discourses of risk, surveillance, and the protection of vulnerable people from themselves, incarceration and violations of basic human rights are considered justifiable. While it is not my intention to provide a statistical analysis of how many suicidal people suffer traumatic experiences when revealing their suicidal ideation, I argue that a few instances of inhumane treatment are already too many. Additionally, such traumatic experiences haunt the public imagination and prevent people from discussing their suicidal ideation.
While the topic of suicide is often discussed, a widespread but unspoken phenomenon that isolates and silences suicidal people remains unexamined. It is a “problem that has no name,” to borrow an expression from Betty Friedan (1963), who attempted to theorize women’s oppression at a time when conceptual feminist tools were still underdeveloped. In our era of intersectional analyses, when long lists of oppressions have been theorized and denounced, including sexism, racism, colonialism, classism, ageism, cisgenderism, heterosexism, sizeism, ableism, and sanism, to name but a few (Crenshaw 1989; Hill Collins 2000), one form of oppression remains absent from such lists: the oppression of suicidal people, or what I call structural suicidism. Although anti-oppression activists/scholars address suicide, they do so in efforts to prevent suicides rather than to theorize the oppression endured by suicidal people. The absence of this oppression from discussions of suicidality is so profound that the oppression has yet to be named. After reflecting on the realities faced by suicidal people, I sought a term that could capture this oppression. I faced a conceptual desert or, as I demonstrate later, a form of hermeneutical injustice. The fact that no term existed to discuss this oppression is quite revealing. By borrowing from other terms, such as sexism and ableism, I coined the neologism suicidism in 2016–2017. While Merriam-Webster’s Dictionary has included the term suicidism since 1913, its definition, as “the quality or state of being suicidal,” differs radically from mine and is not widely used these days.2 My use of the term suicidism refers to “an oppressive system (stemming from nonsuicidal perspectives) functioning at the normative, discursive, medical, legal, social, political, economic, [religious], and epistemic levels, a system in which suicidal people experience multiple forms of injustice and violence” (Baril 2018, 193; my translation). Suicidist violence is pernicious among anti-oppression activists/scholars because it is framed as protecting vulnerable people from themselves. Furthermore, suicidism is intertwined with ableism and sanism because it often mobilizes arguments about “mental capacity” to revoke people’s agency. However, suicidism should not be reduced to ableism and sanism, as I illustrate later, because suicidist norms and structures are at work regardless of whether ableist and sanist perspectives are deployed to oppress suicidal subjects. Therefore, suicidism is distinct from, though interlocked with, other systems of oppression. The thesis defended in this chapter is simple but radical: Suicidal people suffer individually and collectively from suicidist oppression, and this oppression remains unproblematized in current interpretations of suicidality, including those grounded in anti-oppressive and social justice approaches.
This chapter, which raises epistemological questions about dominant conceptualizations of suicidality, is divided into four parts. The first part reviews four predominant models of suicidality: medial/psychological, social, public health, and social justice. I demonstrate that, despite important differences between and within each of these models, they arrive at the same conclusion: Suicide is never a good option for suicidal people (it only becomes an option for some people through forms of assisted suicide for disabled/sick/ill/old and sometimes Mad people, as I discuss in Chapter 4). Only a handful of scholars, who generally adhere to the social justice model, have recently started to question this conclusion.3 In the second part, I identify problems—namely, forms of suicidism and sanism—raised by these four models of suicidality. In the third part, I discuss alternative conceptualizations of suicidality, which imply that suicide can (or should) sometimes be regarded as a valid option. In this section, I turn a critical eye on these alternative conceptualizations of suicidality, demonstrating the ways in which they are founded on problematic assumptions. Although some pragmatic perspectives may critique the marginalization of suicidal subjects, I argue that they do not ultimately conceptualize their oppression as systemic, nor do they address it from an anti-oppressive approach—hence the importance of developing a new theoretical framework, suicidism, to conceptualize suicidality as an oppression from an anti-oppressive approach. The fourth part of the chapter mobilizes the notions of epistemic violence and epistemic injustice to theorize the testimonial and hermeneutical injustices experienced by suicidal subjects.
This chapter does not provide clear answers and solutions to the issues I am identifying; rather, it offers critiques and questions as a starting point for theorizing suicidal people’s oppression. Furthermore, although I explore various conceptualizations of suicidality, I do not aim to present an exhaustive portrait of each of these positions and their proponents, arguments, advantages, and limits. Authors before me, cited in this chapter, have already done an excellent job of describing and critiquing these various models. The typology I offer here also does not do justice to the porousness of the boundaries between each model. Indeed, while establishing typologies is heuristic, for example pedagogically or in terms of accessibility, for a lay public, doing so simultaneously homogenizes each model and erases the continuities and similarities between some models. I invite readers to conceptualize the boundaries between the four models of suicidality presented here as less categorical and definitive, but more open-ended and fluid. For example, the social model of suicidality, particularly in its historical emergence, often relied on medical/psychological explanations in combination with social factors to explain suicide. This example is but one that illustrates that these models are not always radically different on the ontological, theoretical, or epistemological level; in fact, they sometimes strongly influence each other, as I briefly show in the following pages.
Despite lacking the space to do justice to the complexities of each model, the exploration and mapping of these various conceptualizations of suicidality constitute the foundation for my larger goal of demonstrating two main arguments. First, despite their crucial differences, these models share fundamental postulates, including the endorsement of the preventionist script that this book aims to deconstruct. Second, presenting a typology of existing models demonstrates the absence of a position like mine in the literature. I am also particularly interested in highlighting limitations of the social justice model of suicidality, which relies on anti-oppressive and intersectional approaches and yet continues to uphold assumptions shared by the other models, such as the preventionist discourse. The social justice model does not problematize the oppression of suicidal people in terms of suicidism, nor does it support their right to (assisted) suicide. My work builds on and critiques the social justice model of suicide and proposes an alternative in Chapter 5—namely, my queercrip model of suicidality.
1.1 The Main Models of Suicidality
Before discussing the different models of suicidality, it is important to provide a brief historical contextualization. As numerous authors have argued, conceptualizations of suicide have changed tremendously across various historical periods and cultures (e.g., Cholbi 2011; Colucci et al. 2013; Fitzpatrick 2014; Marsh 2010b). The wide variety of written and oral primary sources in the edited volume The Ethics of Suicide: Historical Sources (Battin 2015), spanning from the twentieth century b.c. to the contemporary twentieth century, is a powerful testament to how current conceptualizations of suicide are recent phenomena. When we look at the extensive range of self-accomplished death practices—for example, the thirty-six categories of suicide put forth by scholars Colin Tatz and Simon Tatz (2019, 61–69) or the six main categories established by philosopher Margaret Pabst Battin (2015, 1), ranging from hunger strikes to martyrdom and suicide bombings—we quickly realize that what we have come to understand as “suicide” in contemporary capitalist, industrialized countries represents a very narrow subset of a range of diversified practices. From Greek and Roman antiquity to the Americas, Oceania, or Africa, as well as in diverse religious and spiritual traditions, The Ethics of Suicide: Historical Sources demonstrates how self-accomplished deaths have not always been as unthinkable as they are today and how the current “monolithic view” of suicide in “Western” countries, often seen through a pathological lens, is a quite recent phenomenon (2015, 2). To take but one example, as scholar Scott J. Fitzpatrick (2014) points out, the seppuku (sometimes known as hara-kiri) was inscribed in a meaningful ritualistic practice in feudal Japan. This example highlights the importance of understanding each practice of self-accomplished death on its own and within its sociocultural and historical context: “Suicide is historical. Its meaning, methods, rates, and concepts are not static but change over time [ . . . ]. Each and every suicide is located within its own temporal nexus of cultural, social, personal, moral, and/or political factors. In this view, knowledge of the prevailing cultural-historical background becomes a necessary condition for understanding the individual act of suicide [ . . . ]” (Fitzpatrick 2014, 225). The social construction of suicide and its various meanings according to specific contexts (Douglas 1967) allow for a multiplicity of discourses on suicide, as Fitzpatrick (2014, 228) notes: “Conflicting views on the meaning of suicide can, and do, coexist. Suicide has been variously described as rational, irrational, cowardly, honourable, brave, and weak.” In sum, conceptualizations of suicide and reactions and attitudes toward suicide vary greatly across and within epochs and cultures, an undeniable fact that helps cast the current dominant view of suicide as a major problem as only one perspective among many others:
A full understanding of suicide cannot start with the assumption that all suicide is pathological, that it can almost always be attributed to depression or mental illness, that it is a matter of biochemical abnormality, that it is always wrong, or that there are no real ethical issues about suicide. These views are to be explored, not presupposed. To be sure, the history of reflection on the ethics of suicide will be a continuing history, as cultural conceptions of suicide and related issues like self-sacrifice, heroism, social protest, self-deliverance, martyrdom, and so on in each of these contexts evolve, but, in an increasingly global world in which once-independent traditions interact more and more fully and in the process shape and reshape each other, it is important to be able to view the deeper roots of these issues. (Battin 2015, 10)
By examining the important historical and cultural variations in conceptualizations of suicide, I hope to highlight that the four predominant models of suicidality presented in this chapter provide only a small glimpse into the wider perspectives on self-accomplished death. I also hope that the alternative queercrip model of suicidality I introduce later in the book, which aims to transform policies and practices regarding (assisted) suicide, will be understood alongside this multiplicity of alternative views on suicide and contribute epistemic, moral, societal, and cultural changes to this “monolithic view” of suicidality.4
Prior to being conceptualized as a form of mental illness or as a response to social and political problems, suicide was perceived as a sin against God and a crime against the state in the fifteenth and sixteenth centuries (MacDonald 1989). Various condemnations and punishments have been used to deter people from attempting or completing suicide, such as desecration of the dead body, refusal of a traditional burial, and fines or imprisonment for survivors.5 The image of a suicidal person as irrational, impulsive, and “insane,” motivated by powerful forces (such as mental illness) instead of bad morals, is a recent development (Marsh 2010b). Scholar Chloë Taylor (2014, 13) calls this phenomenon “the birth of the suicidal subject.” It was only in the eighteenth century, through the emergence of biopower (Foucault 1976, 1997), that the “suicidal person” made its appearance. The apparatus of biopower and biopolitical tools, such as demography and statistics, created conditions under which acts became identities and suicidality was recast as madness. Throughout history, suicide has followed a trajectory similar to that of same-sex sexual practices; it went from being perceived as a sin and an illegal act potentially committed by anyone to being perceived as a psychiatric and psychological condition expressed through a specific set of traits (Marsh 2010b; Taylor 2014, 15). As sociologist Zohreh BayatRizi (2008, 93) contends, “The result was the discursive transformation of suicide from an individual act belonging to the category of morality and free will to a social and medical problem resulting from external, objective forces that are amenable to control, management, and prevention.” However, as scholars Scott J. Fitzpatrick, Claire Hooker, and Ian Kerridge (2015) explain, despite the moral revolution regarding suicidality that followed the emergence of biopower, most contemporary perceptions of suicide remained negative and haunted by moral imperatives. Indeed, the moralization of suicide simply took on new forms. For example, contemporary authors such as Jennifer Michael Hecht (2013, x), discussed in the Introduction, propose secular philosophical arguments to oppose suicide on moral grounds, such as the duty of the suicidal person to stay alive because suicide is seen as doing “wrenching damage to the community.”
Furthermore, as responses to suicide went from punishment and prohibition to regulation, the medicalization of suicide eliminated suicidal people’s previous agency and autonomy. Thomas Szasz (1999, 31) characterizes this process as “transforming badness into madness.” Suicidal ideation and attempts, which had been construed as bad actions, were thus reframed through a process of pathologization as symptomatic of an uncontrollable subject “hijacked” by a disease of the mind or of the society. For example, Hecht (2013, x) qualifies suicidality as a “monster” taking over a person. As BayatRizi (2008, 97) explains:
The individual may have gained the right to kill himself, but in the process, he lost the status of author of his own acts. If he killed himself, he was simply too incompetent to know what he was doing. The old punishments were abandoned, but they were quickly replaced by new preventative measures that nullify the subjective meanings of suicide.
This transformation from punishment and prohibition to regulation, or from “severity to tolerance” (MacDonald 1989, 74), led to the creation of two main models of suicidality in the eighteenth and nineteenth centuries that still exist today. These two main models conceptualize suicidality either as an individual pathology from a medical/psychological approach or as a collective/political pathology from a social approach. In the medical and the social models, as in the other models presented in the following sections, suicidality remains construed as a problem to be fixed. It is also crucial to keep in mind that this major shift in the ways of conceptualizing, judging, and dealing with suicide, from moralization/criminalization to pathologization, was the result of multiple factors, such as religious, social, cultural, political, and legal transformations (Houston 2009; MacDonald 1989) and cannot be considered a “linear narrative” (Fitzpatrick 2014, 223).
1.1.1. The Medical Model
Authors who look at suicide from a historical perspective, such as Thomas F. Tierney (2006, 2010), Zohreh BayatRizi (2008), or Ian Marsh (2010b, 2018a), generally identify the medical model as emerging during the eighteenth and nineteenth centuries. While it would be easy to assume that the medical model resulted mostly from the growing authority of doctors and physicians on the question of suicide, the work of historians such as Michael MacDonald (1989) or Rab Houston (2009) regarding the secularization, decriminalization, and medicalization of suicide in Scotland and England demonstrates that, in fact, doctors and physicians had only a modest contribution in the emergence of this new conceptualization of suicide. The medicalization of suicide, to use Houston’s (2009) words, occurred in a “wider context” of transformation at the social, cultural, intellectual, political, legal, religious, and scientific levels, leading to new understandings of crime and “deviances.” Based on these historical accounts, at least in Scotland and England, it is as though the medicalization of suicide that emerged in the eighteenth century happened without the active support and omnipresence of doctors and physicians. MacDonald (1989, 88) concludes that it is crucial to not conflate the medicalization of suicide and its association with insanity with physicians’ views on suicide during that period or to overestimate the role that physicians played in this process because at that time “the medical profession lacked the authority and organizational strength that it would gain in the nineteenth and twentieth centuries”; rather, we must situate the medicalization of suicide in its broader sociohistorical context marked by profound religious and legal transformations, scientific discoveries, the Enlightenment, and the development of different perspectives on suicide in literature and philosophy.6
While it would be erroneous to reduce the medicalization of suicide to the roles of a few physicians or psychiatrists, it is nonetheless interesting to briefly examine a few key actors within the medical model of suicidality, keeping in mind the broader context in which they have developed their theories. Jean-Étienne-Dominique Esquirol is identified by many authors as an important suicide theorist and the father of what later would become known as the medical theory or model of suicidality (Houston 2009; Marsh 2010b). Whether they originate in “organic disturbances in the body’s organs or tissues” (Fitzpatrick, Hooker, and Kerridge 2015, 309), as believed by Esquirol; in brain or neurobiological dysfunctions, as believed by contemporary authors (Mann and Arango 2016); or partly through genetic or epigenetic accounts (Turecki 2018), suicidal ideations in the medical model are attributed either entirely or partially to individual pathologies. The medical model created what Marsh (2010b, 31) calls a “compulsory ontology of pathology.”7 It is important to emphasize that the medical model of suicidality focuses not only on physiological pathologies (e.g., genetics, neurobiology) but also on pathologies of the mind/heart (e.g., mental and psychological “disorders” or emotional “disturbances”). In other words, the medical model of suicidality includes psychiatric and psychological perspectives on suicidality that situate the “problem” of suicidality totally or partially in the mind. When authors discuss the medical model of suicidality prevalent in the field of suicidology today, they often group the biomedical model with the psychiatric and psychological models, as Marsh (2020b, 17) does in his analysis of the models of suicidality. Following Marsh, I believe that it is useful to group together medical, psychiatric, and psychological theories in what could be called the medical model of suicidality, despite differences between these models, and despite the fact that, as pointed out by Houston (2009, 98), historically, “medical men involved with suicide were cautious about psychologizing.” In fact, many of them were originally quite reluctant to offer psychological explanations of suicide and were more focused on the physical aspects of suicidality, at least until later in the nineteenth century (110). The “psy” disciplines and expertise, as noted by sociologist Nikolas Rose (1999), became more important in the twentieth century, to the point of being central in our current ways of dealing with suicidality in medicine, law, public policies, intervention, and many other spheres.
Within the “psy” disciplines, Edwin Shneidman, one of the most influential authors of suicidology and the man who named the field of study in the 1960s, believes that the illness or disease of suicidal people is inscribed in their psyche. Shneidman argues that suicidal individuals are suffering psychologically and that this “psychache” is the main component of suicidality. Defining some of his key concepts and neologisms, Shneidman (1993, x) writes, “Suicidology simply defines the field of knowledge of suicide and the practice of suicide prevention; psychache throws emphasis on the central role of psychological pain in suicide (and suicide’s irreducible psychological character)” (emphasis in the original). Shneidman (42–45) argues that suicidality stems from three important interrelated factors: (1) psychological pain, (2) perturbation of the mind, and (3) pressures (called “press”) triggering and affecting the individual. Contemporary suicidologists have followed Shneidman’s path. For example, scholar Thomas Joiner (2005), one of the most cited authors in the field of suicidology today,8 suggests an interpersonal theory of suicide, emphasizing the importance of relationships and arguing that suicidal ideation emerges when some basic human needs are unfulfilled, including having a sense of belonging to a group or feeling useful. Joiner believes that unmet relational needs are at the origin of suicidal ideation and that suicide attempts result from the acquired ability to self-harm through progressive exposure to self-injury. In that sense, while psychache is a fundamental element in suicidality, it cannot explain it entirely.
Although the medical model tends to focus on individual, curable pathologies, some proponents nonetheless recognize to some extent the role that social, environmental, political, and cultural factors may play in suicidality. This perception was the case for some of the early medical conceptualizations of suicidality, such as those developed by Jean-Pierre Falret (1822), which combined internal and hereditary factors with external ones (Houston 2009, 93). More than a century later, Shneidman (1993, 3), for example, has built his theory of suicidality on two main arguments: “The first is that suicide is a multifaceted event and that biological, cultural, sociological, interpersonal, intrapsychic, logical, conscious and unconscious, and philosophical elements are present, in various degrees, in each suicidal event. The second branch of my assertion is that, in the distillation of each suicidal event, its essential element is a psychological one” (emphasis in the original). Shneidman mobilizes the example of a tree to better understand the role played by psychological factors in suicidality, arguing that the trunk represents the psychological aspects, while genetics and biochemical states are the roots of the tree. As demonstrated by sociologist Allan V. Horwitz (2002), an increasing number of proponents of the medical model have, in past decades, included in their conceptualization of mental illness some social factors or stressors to explain suicide and distress.
Therefore, the medical model of suicidality is clearly not as homogeneous or as unidimensional as is sometimes depicted. Moreover, its boundaries with other models of suicidality, such as the social model presented in the next section, have become increasingly blurry. That being said, commonalities are evident among most authors adhering to this model. According to Marsh (2016), the medical model of suicidality is based on three assumptions. First, suicidality is seen as resulting from mental illness or, I would add, any other kind of body or mind pathology. Second, suicidology is believed to be an objective science. Third, suicidality is understood primarily as an individual/personal problem. Since critical suicidology scholars have offered convincing arguments to deconstruct the limitations of these widespread assumptions,9 I turn now to the social model of suicidality.
1.1.2. The Social Model
During the same period marked by the passage from punishment and prohibition of suicidality to its medicalization, biopower and biopolitics10 contributed to the development and deployment of a wide array of tools, such as demography and statistics, used by early sociologists to develop a competing discourse on suicidality, the social model (Wray, Colen, and Pescosolido 2011). The social model played a large role in shaping the policies and practices surrounding suicidality that still influence our current preventionist perspectives. However, in keeping with my previous observations regarding the porousness of the boundaries between models, one might wonder whether, in fact, the medical and the social models are fundamentally different. The epistemologies supporting the two models, anchored in positivist and post-positivist frameworks, as well as the methodologies underlying both models that focus on statistical analysis, raise a number of questions regarding their supposed competing discourses on suicidality. The emergence of this second model of suicidality also needs to be contextualized within its broader social, cultural, political, epistemological, medical, legal, and religious era, in which the work of early sociologists often combined medical/psychological explanations and social theorizations of suicidality. For example, in her 1928 book Suicide, Ruth Shonle Cavan, one of the main figures of the Chicago school of sociology, interrogates the role of social factors in relation to suicide, such as climate, geography, religion, or civil status, while relying strongly on psycho-pathological concepts, such as “personal disorganization” and “psychoses.” Other sociologists, such as Andrew F. Henry and James F. Short in their 1954 book Suicide and Homicide, try to establish correlations between economic depression and suicide rates, while still deploying key medical/psychological theoretical frameworks, such as the “frustration-aggression model.” They believe that psychological characteristics, such as feelings of guilt, or even particular types of physiological responses to stress and frustration can trigger aggression, leading to either homicide or suicide. Some contemporary authors in sociology or psychology propose a similar conceptualization of suicidality as an aggressive behavior (e.g., McCloskey and Ammerman 2018).
Even canonical sociological figures who theorize suicidality from a social perspective, such as French sociologist Émile Durkheim (1951),11 are not exempt from mobilizing individual, pathological, and psychological explanations to understand suicidality, while insisting more on the social pathologies that lead to suicidal ideation and attempts (BayatRizi 2008). Instead of situating the “problem” of suicidality solely or primarily in the individual, the social model identifies society and its dys/function as the culprits. The social model aims to identify patterns, recurrences, and tendencies between suicidality and social factors, such as economic crises, wars, social values, familial relationships, marginalized identities, or cultural representations, to understand and prevent suicidality. As Fitzpatrick, Hooker, and Kerridge (2015) explain, the social model of suicidality historically constituted a serious threat to the medical model, challenging the idea that suicidality results from (mental) illness. However, in their critical epistemological and genealogical analyses of the discipline of suicidology, Taylor (2014), Fitzpatrick, Hooker, and Kerridge (2015), and Marsh (2016) suggest that, despite the social model’s search for scientific authority, most laws, regulations, policies, prevention campaigns, and even the field of suicidology itself have been dominated by the medical model, brushing aside the contributions of the social model. Durkheim’s work continues to influence the study of suicidality, despite the predominance of the medical model and despite critiques of Durkheim’s social theorizing on suicide. One such critique is exemplified in the work of existential sociologist Jack D. Douglas (1967), who explains that understanding of suicidality through structural-functional approaches and statistical analyses is limited (or almost useless) if it is not paired with a deeper understanding of each individual’s contextualized social meaning of suicidality.
Several contemporary authors who critique Durkheim nonetheless have adopted some of his hypotheses and notions to theorize suicidality (Wray, Colen, and Pescosolido 2011). For example, in their 2015 book Suicide: A Modern Obsession, scholars Derek Beattie and Patrick Devitt argue that economic position, marital status, and cultural representations influence suicide rates. Deploying theories often mobilized in sociology, such as social learning theory, they believe in the phenomenon of copycat suicides, wherein completed suicides are thought to encourage other suicides.12 As a result, they promote social solutions, such as forbidding media coverage of suicides. Despite their adherence to the social model, the influence of the medical model and its legacy is evident, as in the idea that the suicidal subject is in some way irrational, “insane,” or “crazy” and lacks the capacity to adequately judge their fatal action. Beattie and Devitt (2015, 101) write, “Had these five victims [of suicide] known that their deaths would wreak such devastation amongst those around them, might they have chosen differently? [ . . . ] But our question is in some ways unfair. Many suicidal people are incapable of the rational thought that is required to ponder the effects that their suicide might have on others.” Similar sociological perspectives, embracing the social determinants of health in relation to suicidality, but simultaneously positing suicide as an irrational act, can be found in sociologist Jason Manning’s 2020 book Suicide: The Social Causes of Self-Destruction. Grounded in “pure sociology,” the title of the book evokes suicide as a form of violence turned toward the self. Manning (3) also blames suicidal people for the harm done to others in the midst of their “self-destruction”: “Suicide destroys relationships, alters reputations, and can lead to grief, guilt, blame, shame, sympathy, therapy, vengeance, and more suicide.” While not all sociological accounts of suicide reproduce these renewed forms of pathologization or moralization, the aforementioned authors, from such early sociologists as Cavan, Henry, and Short to such contemporary ones as Beattie, Devitt, and Manning, demonstrate the residual assumptions inherited from the medical model of suicidality as well as forms of moralization of suicidal actions, which permeate the social model. These assumptions also show that the boundaries between the models presented in this chapter are fluid.
Additionally, the social model of suicidality shares similarities with the public health model (sometimes called the biopsychosocial model) and the social justice model of suicidality. In fact, the social model and the social justice model share so many postulates, assumptions, and affinities that they are often conflated, including by me in the past. In my previous work, following numerous authors, I discuss these two models indistinguishably; only later, while reading Suicide and Social Justice, edited by scholars Mark E. Button and Ian Marsh (2020), did I become aware of the differences between the two. While the social and the social justice models interpret suicidality based on social forces and factors, the former inherits its assumptions from the scientific positivist tradition insisting on the importance of objectivity, quantitative data, and sociological generalizations (with a few exceptions), while the latter offers contextualized explanations of suicidality focusing on the importance of qualitative research and proposing critical analyses of suicidality and its relationship to marginalized communities. As Button and Marsh (2020a, 2) explain, the social model of suicidality derives from a traditional sociological perspective and focuses on “social determinants of health,” often brushing aside the political analysis and actions promoted by the social justice model. Button (2020, 89) shows how the objectivity, neutrality, and positivist stance often adopted by sociologists adhering to the social model lead to a depoliticized response to suicidality:
Sociologists (still following Durkheim after all these years) are certainly right to point to the social forces that undermine human well-being, but until these social forces are traced to the political structures and agents that bear partial responsibility for them, and until citizens and leaders close the door on willful blindness and bad faith about the relationship between policy regimes and the distribution of vulnerability to suicide, suicide will remain a public health crisis without an adequate political level of analysis and response.
However, it would be unfair to depict the social model as homogeneous and to reduce it to a form of “objective” study of suicidality by using a traditional sociological lens. Indeed, some contemporary authors are champions of linking economics and epidemiology with social justice. For example, in their 2020 book, Deaths of Despair and the Future of Capitalism, economist academics Anne Case and Angus Deaton show how capitalist economies lead to distress and death, as is the case with suicidality (see also Wray, Poladko, and Vaughan Allen 2011). They propose various social and public policies to counterbalance the deleterious effects of capitalism on marginalized communities. In their 2013 book, The Body Economic: Why Austerity Kills, based on various historical case studies, public health scholars David Stuckler and Sanjay Basu demonstrate how financial cuts in health and social programs deeply affect population health, to the point of killing some people. In an earlier article that Stuckler and Basu published with other colleagues in The Lancet (Stuckler et al. 2009), they look specifically at mortality rates, including suicide rates, in relation to economic crises and austerity measures. They conclude that their demonstration regarding the key consequences of economy on people’s health could have deep impacts on social policies: “The analysis also suggests that governments might be able to protect their populations, specifically by budgeting for measures that keep people employed, helping those who lose their jobs cope with the negative effects of unemployment [ . . . ].” Additionally, to further blur the lines between the social model presented here and the social justice model I introduce later, many, if not most, authors in the field of critical suicidology who adhere to a social justice approach have called, or still call, their approach “social” as opposed to medical, as I did in the past. In that sense, depicting the social model of suicidality as an apolitical approach would be not only imprecise but unfair. Therefore, it is important to keep in mind that no pure “social” model of suicidality exists and that the description provided here does not presume that the four models are mutually exclusive.
1.1.3. The Public Health Model
Falling between the two (supposedly) oppositional medical and social models, an important third approach has emerged over the past thirty years: the public health model (Wray, Colen, and Pescosolido 2011), also known as the biopsychosocial model of suicidality (Webb 2011). This model, anchored in public health epidemiological approaches and favoring evidence-based research and statistical data, is mobilized in relation to multiple public health “problems,” including alcohol, drug, and tobacco use; domestic and sexual violence; and child abuse. This model bridges more individualistic (some might say proximal) and social (some might say distal) approaches to promote population health. Multi- and interdisciplinary by nature, the public health model aims to identify risk factors underlying some illnesses and social problems and to work on multiple fronts—for example, at the individual or sociocultural level—to prevent those illnesses and social problems from affecting the physical and mental health of the population. Adopted by many health care professionals, this model informs international suicide prevention guidelines and strategies (Beattie and Devitt 2015; Stefan 2016; WHO 2012). For example, the World Health Organization (WHO 2014) states, “Research, for instance, has shown the importance of the interplay between biological, psychological, social, environmental and cultural factors in determining suicidal behaviours” (8), calling for a “multisectoral suicide prevention strategy” (9). WHO identifies four pillars of this public health model: practicing “surveillance,” “identify[ing] risk and protective factors,” “develop[ing] and evaluat[ing] interventions,” and “implement[ing]” the solutions identified to maximize health (13).
This third model is an integrated approach that tries to mobilize the strengths and contributions of the medical and social models.13 The public health model tries to reconcile the various explanatory factors of suicidality provided by the medical model (e.g., the role of genetics, predispositions, neurobiology, and mental illness), as well as by the social model, such as the role of situational and environmental elements and social factors (e.g., economic crises or media coverage of suicides). The public health model calls for an array of suicide prevention strategies, ranging from intervening directly with suicidal people to offering guidelines for media coverage surrounding suicidality. In its 2012 document titled Public Health Action for the Prevention of Suicide: A Framework, WHO declares that suicide is a “significant social and public health problem” (2) and proposes multiple prevention strategies, including a “gatekeeper training” for various professionals, such as health care providers, social workers, teachers, or spiritual leaders, to identify populations targeted as “at risk” (16). Some scholars and practitioners adhering to the social justice model of suicidality presented in the next section, such as Rebecca S. Morse and colleagues (2020), embrace this gatekeeping approach and propose to mobilize what they call “paraprofessionals,” or laypeople, to “recognize the warning signs of suicide, know how to offer hope to a person in crisis, and know how to get help and possibly save someone’s life” (163). The public health model also proposes, as Matt Wray, Cynthia Colen, and Bernice Pescosolido (2011, 511) and Susan Stefan (2016, 419) note, to limit access to lethal means of completing suicide, such as access to bridges, guns, pesticides, and poisons. Because of its “one-size-fits-all” approach and its diverse prevention strategies, the public health model has gained much attention over the past decades and is often praised by authors (e.g., Berardis et al. 2018; Stefan 2016).
Although in theory the public health model seems to represent the best of two worlds by reconciling the medical and social perspectives, in practice, this model is not without flaws. Its existence reveals the tensions between various approaches as well as the power relations between various actors and disciplines interacting under this public health umbrella. Button and Marsh (2020, 3) conclude that despite the broader perspectives put forth in a public health model, “suicide continues to be conceptualized as primarily a question of individual mental health.” Some authors have rightly pointed out this model’s numerous limitations, such as its focus on surveillance, as well as its depoliticizing, individualizing, and biologizing effects (e.g., Button 2016, 2020; Marsh 2020b; White and Stoneman 2012). For example, using a critical suicidology lens, scholar China Mills (2015, 2018) insightfully argues that this model remains based upon a “psychocentric approach” that tends to dismiss the importance of structural factors, such as economic and political austerity, and to overemphasize the pathological self. As Fitzpatrick (2014, 2022) shows, this model is also situated in a broader neoliberal context that shapes the conceptualization of suicidality and the solutions devised to respond to what is considered a public health emergency. In a similar way that people are required to manage, optimize, and preserve their health (Day 2021; Pitts-Taylor 2016), Fitzpatrick (2022, 119) notes, in the current neoliberal context, the risk of suicide becomes the responsibility of individuals who must do everything in their power to get better:
The emphasis on individual thoughts, moods, emotions, and behaviour as the gauge by which suicide risk is measured and known thus becomes the solution toward which therapeutic and public health interventions are directed. This is reflected in an increasing emphasis on social obligations and personal responsibilities in the amelioration of suicide risk through education programs that target mental health literacy, help-seeking, stress management, resilience, problem solving, and coping skills.
In the same spirit, some scholars, such as Lani East, Kate P. Dorozenko, and Robyn Martin (2019, 6), argue that public health discourses on suicide are morally charged and often blame the victims, pointing out their individual problems and their lack of “coping abilities.” In sum, as we can see from these critiques of the public health model, while this approach continues to blur the lines between the various models of suicidality and would have, in theory, much to contribute to a conceptualization of suicidality from a nuanced and complex point of view, critical suicidologists argue that this promise is unmet. A cooptation of the public health model by the medical model seems to be at work—hence the development of other models, such as the social justice model presented in the following section.
1.1.4. The Social Justice Model
Before I present this model, I must provide two caveats. First, like the previous models, this one is far from homogeneous. While many of the authors adhering to the social justice model conceptualize suicidality as a “problem” in need of fixing, a few authors endorsing this model have critiqued this pathological vision of suicidality and have proposed nonstigmatizing and cutting-edge alternative discourses and visions regarding prevention strategies. However, none of these authors has proposed, thus far, a clear acceptance of suicide as a valid and positive right. Their scholarship remains a great source of inspiration for my reflections. Second, I feel hesitant about some of the critiques I direct toward the social justice model because in the past year (at the time of writing this book in 2020–2021), some of these authors have started to question with more sharpness, as I have done in my work in the last few years, some taken-for-granted discourses inside critical suicidology. For example, Jennifer White (2020b, 77) writes, “In order for critical suicide studies to maintain its critical and creative (cutting) edge, we will need to move beyond the (now familiar) critiques of psycho-centrism, positivism, and scientism to mobilize and amplify other voices, worldviews, and interpretive resources to pursue greater epistemic justice in the study of, and response to, suicide.” Katrina Jaworski (2020, 590) calls for a “new foundation for critical suicidology” to critique the silencing of suicidal subjects and promote an “ethics of wonder and generosity” toward suicidal people to honor the agency in their choices.14 As I do in some of my previous work, some authors in the field (Broer 2020; East, Dorozenko, and Martin 2019; Fitzpatrick 2020; Fitzpatrick et al. 2021; Krebs 2022; Tack 2019) have also started to critique the harm done by current prevention strategies and what I call the injunction to live imposed upon suicidal subjects. In sum, the social justice model and the field of critical suicidology more generally are fast-growing entities that seem increasingly interested in turning a critical gaze on their own practices. My critiques toward the social justice model of suicidality therefore target not these authors and their renewed perspectives on suicidality but rather those who continue to cast suicidality as only a “problem” to fix. Indeed, many other authors who embrace this model continue to see suicidality as the result of structural violence and therefore frame it entirely negatively, as a social problem in need of eradication.
I would like to begin this section by sketching a portrait of the field of critical suicidology, as it is intimately linked to the social justice model of suicidality. More recently called critical suicide studies by some scholars,15 and previously called critically reflective suicidology (Fitzpatrick, Hooker, and Kerridge 2015) or post-suicidology (Marsh 2015), the field of critical suicidology is sometimes associated with or perceived as a social movement (Tatz and Tatz 2019, 174). While it is not my intention to engage in sociological debates about what could or should count as a social movement, I agree that critical suicidology, as a field of knowledge constructed by politically engaged scholars who fight for social justice for marginalized groups, may be regarded as a field of study and as a social movement. Although critical perspectives on the medical model of suicidality have emerged over the past few decades, putting forward social explanations and solutions and promoting social justice,16 it is only since 2010 that critical suicidology has constituted a field, in reaction to what is considered and called a more “traditional,” “mainstream” (Marsh 2015; White et al. 2016a), or “conventional” (Fitzpatrick, Hooker, and Kerridge 2015) suicidology. Beginning in 2010, scholars started publishing studies that were precursors to the emergence of the field itself.17 At the time, these activists/scholars called for a social approach to suicide rather than a social justice approach per se, even though the work of those precursors clearly rests upon a social justice model. To my knowledge, Jaworski (2014, 153) is the first author to use the expression “critical suicidology.” Since 2015, critical suicidology has emerged as a distinct and recognized field of knowledge, with key works distinguishing critical suicidology from traditional suicidology.18 In comparison to conventional suicidology, according to Fitzpatrick, Hooker, and Kerridge (2015, 319), a “critically reflective suicidology” provides a more complex conceptualization of suicidality and questions the methodological, theoretical, and epistemological assumptions of suicidology. In addition to “shaking up” traditional suicidology (Marsh 2015, 8; White 2015b, 1) and critically questioning the methodological, theoretical, and epistemological presumptions of conventional suicidology, I outline here six main features of the field of critical suicidology.19
First, critical of the positivist stance of mainstream suicidology, critical suicidology offers creative and diversified perspectives, approaches, methodologies, and conceptual frameworks. Second, this inherent diversity situates critical suicidology as an interdisciplinary field of knowledge focused on qualitative research, in contrast to the disciplinary (medicine, psychiatry, and psychology), quantitative, and evidence-based approaches that have dominated conventional suicidology. Third, contrary to the often ahistorical and acontextual lens used to interpret suicidality by conventional suicidology, critical suicidology offers interpretations of suicidality that insist on historicity, complexity, and contextuality. Fourth, in opposition to a psychocentric and individualist approach to suicidality, critical suicidology focuses on the collective, structural, and systemic social, cultural, and political factors that influence suicidality. Fifth, contrary to mainstream suicidology, which pretends to be an objective science unbiased by power relations, critical suicidology recognizes the power relations that influence knowledge, science, and fields of study and is politically engaged. Sixth, in opposition to traditional suicidology, which promotes the expertise of certain types of researchers and practitioners (such as physicians, psychiatrists, and psychologists), critical suicidology invites more people into the conversation and recognizes a multiplicity of perspectives and types of knowledge.
To these six main features, I would add that several authors in the field, either implicitly or explicitly, associate critical suicidology with “social justice oriented and political perspectives” (White et al. 2016b, 2). For Button (2016, 275), one of the objectives of critical suicidology, or the “political approach to suicide,”20 is a demand for accountability from policy makers, institutions, politicians, and society to promote social justice regarding marginalized groups. Describing the social justice model in Suicide and Social Justice, Button and Marsh (2020a) also insist that suicidality is linked to social pathologies, such as colonialism, racism, poverty, heterosexism, and ableism, creating what Button (2020, 87) calls “suicidal regimes.” Furthermore, the social justice model, which conceptualizes suicidality as the effect of systemic factors that diminish quality of life, calls for engaged structural remedies, such as social, cultural, political, economic, and legal transformations.21 Indeed, from a social justice perspective, which conceptualizes suicidality as the result of systemic oppressive factors, activists/scholars promote sociopolitical change as a means of eradicating the violent practices believed to cause suicidality. In sum, proponents of the social justice model believe in the social and political roots of suicidality and call for a structural remedy.
The social justice model posits a “historicization and politicization” (Taylor 2014, 20) of suicidality by pointing out norms and structures that push members of marginalized groups to want to die. Some proponents of the social justice model argue that “hate kills” suicidal people (Dorais and Lajeunesse 2004; Reynolds 2016) and that oppressive systems are the cause of those deaths (Chrisjohn, McKay, and Smith 2014). For example, in an analysis of suicides in the U.K., Mills (2018, 317) argues that austerity measures provoke slow deaths and ultimately kill: “Put another way, people are killing themselves because austerity is killing them. Austerity suicides may be read as the ultimate outcome of the internalisation of eugenic and market logic underlying welfare reform driven by austerity. Such deaths make visible the slow death endemic to austerity.” Such authors as China Mills and Vikki Reynolds also believe that the term suicide itself is misleading and conceals homicides and murders of targeted marginalized groups by using individualized and psychological explanations. Scholar Bee Scherer (2020, 146) agrees:
I maintain that we should consider abandoning the term ‘suicide’ altogether. [ . . . ] From a Social Justice perspective, most ‘suicides’ i.e., self-completed deaths cannot be called ‘self-murder’ i.e., ‘suicides’ properly: the illusion of the extent of individual agency that this loaded term carries only serves to absolve the system that creates the social injustice. Social injustice-induced and/or -underpinned self-completed deaths are not really suicides; those self-completed deaths are, in fact, delayed, self-completed murders.22
Although I concur that we must politicize suicidality and examine the factors influencing suicidality in marginalized communities (as I identify as a trans, bisexual, and disabled/Mad man, I am sensitive to these political analyses), I believe that many proponents of the social justice model nonetheless perpetuate a pathologization similar to that found in the other models examined thus far, even though, in this case, the pathology is situated within the social and political realms. In addition, one of the consequences of focusing on sociopolitical oppression is that the recommendations are largely based on “resisting hate, practising solidarity, and transforming society to be inclusive” (Reynolds 2016, 184) of marginalized groups, often leaving suicidal individuals unequipped to deal with their suicidal ideation.23 Some authors adhering to the social justice model, such as Button (2020, 98), even admit that social and political solutions “will not be relevant at the individual level in all cases.”
In sum, despite numerous advantages, the social justice model of suicidality is not flawless. Like the medical, public health, and social models, the social justice model produces its own forms of suicidist violence, stigmatization, and exclusion by dismissing the realities of certain individuals. However, contrary to the flaws and limitations of other models, the limits of the social justice model remain undertheorized. I would like to ask: What/who is missing from the social justice model of suicidality? What can we learn from those absences? How might renewed social justice–oriented understandings of suicidality help anti-oppression activists/scholars avoid reproducing forms of oppression, including toward suicidal people? The next section highlights the pitfalls of these different models of suicidality, particularly those of the social justice model, which have remained unexplored from an internal, social justice perspective.
1.2. The Ghosts in Suicidality Models
Despite being developed with good intentions and a desire to help suicidal people, the models of suicidality presented thus far inadvertently reproduce suicidist violence at the individual and collective levels. This section explores the “ghosts”24 that haunt these models—that is, limits that are paradoxically omnipresent yet invisible. Although simultaneously critiquing four distinct models is problematic, I contend that they produce similar effects on suicidal subjects. As I demonstrate in the next section, all four models consider suicidality to be a serious social problem or an individual pathology to be eliminated and endorse prevention strategies that often do more harm than good to suicidal people. The only exception in which suicide is an option for some proponents of these four models is in the case of disabled/sick/ill people (and sometimes old and Mad people). In this circumstance, suicide is reframed as assistance in dying, yet it still excludes suicidal people, as I illustrate in Chapter 4. In addition to these limitations, two more side effects of these conceptualizations of suicidality arise: the silencing of suicidal people, leading others to speak on their behalf, and the implicit promotion of discourses and norms that dictate how one should react to suicidality, creating normative injunctions. I contend that these models perpetuate an injunction to live and to futurity that burdens suicidal people.
1.2.1. Suicide = Problem: Suicidality as a Medical, Social, or Sociopolitical Pathology
Despite radical differences, all aforementioned models of suicidality condemn suicide to some extent and support prevention campaigns stating that suicide is never a good option for suicidal people. As I discuss in my previous work (Baril 2017, 2018, 2020c), the assumption that suicide must be prevented is rarely questioned. Only a few authors have started to question the logic of saving lives at all costs.25 For example, scholars Jennifer White and Jonathan Morris (2019, 10) ask, “Could conversations about suicide in mental health or community settings invite more hope and fresh possibilities for living, rather than reproducing predictable and stale conversations that are driven by the prevention imperative to save a life at any cost?” Such alternative discourses, while emerging inside the social justice model, still remain on the periphery. Furthermore, none of these models interrogates the desire to live. Groups, organizations, foundations, and public health initiatives working to prevent suicide do not question the idea that suicide should never be an option, with a few exceptions, such as the discharged program (Radford, Wishart, and Martin 2019) or Trans Lifeline (2020), that condemn coercive prevention strategies but still do not envision suicide as a valid option, as I demonstrate in Chapter 2. In sum, in all the models, suicidality must have a cause and a solution. The need/desire/urge to die must be circumscribed and solved.
The assumption that suicidality is a problem and nothing but a problem is reflected in the negative vocabulary used to discuss suicidality. In her work on suicidality, using a social justice approach long before it had been named as such, scholar Simone Fullagar (2003) discusses how suicides are seen as forms of loss and waste in capitalist and neoliberal societies that aim to maximize profit and productivity. Fullagar (292) also shows how this context fuels moralization and the usage of negative vocabulary: “Suicide as waste is implicated in a whole moral vocabulary about living and dying—tragically sad, incomprehensible, unforgivable, pathological, abnormal, unstable, irresponsible, selfish, morally reprehensible.” This neoliberal context, in which deaths by suicide are considered a “waste,” also perpetuates what I call an “injunction to live,” discussed later in this chapter.
While an increasing number of scholars are calling for the abandonment of the sinful and criminal vocabulary related to suicidality, including expressions such as “committing suicide,” suicidality is still discussed in stigmatizing and negative terms, even by authors who want to destigmatize it. From a more clinical perspective, Domenico De Berardis, Giovanni Martinotti, and Massimo Di Giannantonio (2018, 2) state:
The suicide is always a plague for the population at risk and one of the most disgraceful events for a human being. Moreover, it implies a lot of pain often shared by the relatives and persons who are close to suicide subjects. Furthermore, it has been widely demonstrated that the loss of a subject due to suicide may be one of the most distressing events that may occur in mental health professionals resulting in several negative consequences [ . . . ].
Suicidality is framed as a problem not only for suicidal people themselves but also for their relatives and the health care professionals working with them. As I mentioned in the Introduction, a logic of victim-blaming is at play: Nonsuicidal people are cast, from a suicidist perspective, as those suffering and affected by suicidality (Hecht 2013). Beattie and Devitt (2015) discuss the impact of suicidality on health care professionals and family, the trauma of suicide for those left behind, and the anger those individuals might experience. Adopting a historical and critical stance on suicidality, Tatz and Tatz (2019, 3) contend that “suicide creates such angst and anger, even hysteria, when compared to homicide and other violent causes of death.”
Without reusing the sexist term hysteria to characterize reactions toward suicidality, I agree with Tatz and Tatz that a strong affective response to suicidality exists, as does a discourse of victim-blaming, even within the social justice model of suicidality. For example, despite the desire to theorize suicidality in a nonpathologizing and nonstigmatizing manner, several authors in the edited volume Critical Suicidology (White et al. 2016a) state that suicides cause collateral damage and harm to others. Some authors use terms such as survivors to refer to the relatives and friends of suicidal people, depicting suicidality as something unthinkable and violent. In anti-oppressive social movements/fields of study, we usually refer to “survivors” of sexual violence, parental mistreatments, war, genocide, forced psychiatric treatments, and so on. Those who “survive” have survived something violent that should not have happened in the first place. I believe that we need to go further in our reflections on the vocabulary we use to describe suicidality and adopt a critical stance toward certain expressions that create the perception that suicidal people are hurting their friends, relatives, health care professionals, and society at large. Blaming the victim has not proven to be a good strategy to help any group navigating difficult experiences. Although suicidality is not currently officially punished or criminalized, forms of moralization are still at work when it comes to the conceptualization of suicidality.
From representations of people who “survived” the suicide of a loved one, to proponents of the medical model referring to the “horror” of suicidal acts (Joiner 2005), to scholars who theorize suicide as “self-murder” and a form of sociopolitical “killing,” suicide is often depicted as a negative and violent act, which silences any other interpretations.26 Alternative strategies that go beyond prevention remain relatively absent from discussions. As a result, not only do the four models generally fail to recognize the suicidist oppression faced by suicidal people; they also perpetuate it through what I call a suicidist preventionist script. For example, Button (2020, 99) endorses coercive prevention measures: “More broadly speaking, states that are politically serious about suicide prevention will take steps to act on the ways that they act upon persons: materially/economically; coercively though laws and regulations; and discursively through norms and the perpetuation of shared social scripts.” One of the most perverse effects of these models and their prevention goals is the silencing of suicidal people. I argue in the following section that the voices of suicidal people are mostly absent from these models and that these absences prevent solidarity with them. Suicidism is like the ghost of suicidality’s theorizations and prevention strategies—ubiquitous and pervasive, but never fully visible, named, or recognized.
1.2.2. Silence = Death: “Speak up. . . . No, don’t. . . .” The Suicidist Preventionist Script
In lesbian, gay, bisexual, queer (LGBQ) circles, a famous logo depicting a pink triangle against a black background with the slogan “Silence = Death” was used in the 1980s by activist groups such as the AIDS Coalition To Unleash Power (ACT UP) to denounce the silence surrounding the HIV/AIDS epidemic and the government inaction that led to more deaths each week (Fung and McCaskell 2012).27 In a similar fashion, we often hear about an epidemic of suicides. With eight hundred thousand completed suicides each year at the international level, and many more suicidal ideations and attempts (WHO 2014), public discourse insists that the phenomenon touches almost everyone. In stark contrast to the indifference of the early years of the HIV/AIDS crisis, we are constantly talking about suicidality—but not in a way that invites suicidal people to “break the silence.” The slogan “Silence = Death” may thus be resignified and redeployed for suicidality from a queercrip perspective. Indeed, despite the billions of dollars invested in prevention campaigns that encourage suicidal people to reach out and speak out, these people remain silent, and prevention strategies do not seem to be effective.28
The inefficiency of suicide prevention campaigns is evident in the fact that most suicidal people in North America do not speak up and ask for help (Bryan 2022; Lytle et al. 2018). Suicidology scholar David Webb (2011, 5) openly discusses his own past suicidal experience, explaining why so many suicidal people linger in silence before attempting suicide:
In the current environment [ . . . ] talking about your suicidal feelings runs the very real risk of finding yourself being judged, locked up and drugged. Suicidal people know this and [ . . . ] will do their best to prevent it happening to them. We hide our feelings from others, go underground. And the deadly cycle of silence, taboo and prejudice is reinforced. [ . . . ] There is a fundamental flaw at the core of contemporary thinking about suicide; which is the failure to understand suicidality as it is lived by those who experience it. (emphasis in the original)
The suicidist environment that fuels taboos, stigmatization, incarceration, and even criminalization—including prison sentences for not dissuading someone from ending their life or for helping them do so29—reduces suicidal people to silence. Suicidal people who wish to die cannot speak because it is unsafe to do so.30 As Szasz (1999, 54–55) observes, suicide prevention campaigns are not only ineffective but also “counterproductive”: Suicidal people are prevented from speaking “because of the threats and terrors of psychiatric incarceration” (emphasis in the original). Diverse testimonials, including those of Borges or Paperny quoted at the beginning of this chapter, illustrate that suicidal people feel unsafe in discussing their suicidal ideation, rendering prevention strategies useless. As Webb (2011, 59) reminds us, safer spaces are the key to eliciting open conversations and testimonials: “In order to tell our stories, with all-of-me [sic] fully present, we need a space that is safe. [ . . . ] All of me cannot be present when the biggest issue on my mind at the time, my suicidal thoughts, are denied, rejected, or avoided” (emphasis in the original). Stefan (2016, 107–108), who has interviewed many suicidal subjects, concludes that suicidal people will not reveal their wishes to anyone when they are determined to achieve their goal:
[The experiences] of most of the people I interviewed, and abundant case law, is that many people who kill themselves often plan their suicides carefully and conceal those plans with great success from the people who know them best, including friends and family. The people I interviewed were unanimous in saying that the more determined they were to kill themselves, the more they concealed their intentions from the people in their lives.
Statistics confirm this reality: Suicidal people hide to end their lives.31 Testimonials from suicidal people also confirm this reality (Krebs 2022). For example, Cortez Wright (2018), a self-identified Black fat nonbinary queer femme, shows how quickly suicidal people learn how to lie and “shut up” about their suicidal ideation to avoid negative consequences, particularly when they belong to marginalized communities: “I called a suicide-prevention hotline, not quite realizing that sometimes ‘suicide prevention’ looks like emergency vehicles and mandatory hospital stays when all you want, all you need, is to talk. Making mostly false promises of personal safety, I ended the phone call and learned to shut up about wanting to die.” This concealment is particularly the case for those who live, like Wright, at the intersection of many oppressions, since the interlocking effects of suicidism with racism, heterosexism, cisgenderism, ableism, and so on have huge consequences on their lives. As LeMaster (2022, 2) states, “I have been suicidal for most of my life [ . . . ]. From this early age, I learned to mask suicidality and to re-route those ‘bad feelings’ toward things ‘normal kids’ enjoyed [ . . . ]. The prescription to be/come ‘normal’ (read: to embody the trappings of White cisheterosexist ableism), as a suicidal mixed-race Asian/White trans femme, simply intensified the desire to disappear [ . . . ].” Research projects on innovative programs to support suicidal people, such as discharged in Australia, which offers peer support for trans people and guarantees a safe space to discuss suicidality without the preoccupation of clinical forced interventions, also support such statements (Radford, Wishart, and Martin 2019).
Suicidal people do not speak because they fear the negative consequences of doing so in a suicidist environment. Indeed, as empirical research shows, suicidal people, like those considered “mad” and “crazy,” are institutionalized/incarcerated and drugged against their will, excluded from insurance programs, are not hired for new jobs or fired from their current ones, are expelled from university campuses, have their parenting rights revoked, are seen as incapable of sound judgment and consenting to health care, and are subject to other unfair treatments.32 To create safer spaces in which suicidal people can express themselves, one of the first and most important steps is to acknowledge the systemic oppression they experience and the microaggressions they face. Without this recognition, a safer space is moot. Just as “safer spaces” for disabled people that would deny the existence of ableism could not be considered safe, safer spaces for suicidal people that ignore suicidism and its various ramifications, such as its injunction to live and to futurity, are not spaces that invite suicidal people to openly discuss their experiences. Although some authors have suggested that an open-minded approach allowing suicidal subjects to speak freely may be an effective method of prevention,33 the fact that such an approach has the ultimate goal of preventing as many suicides as possible paradoxically sends the message that suicide is always a bad choice. In sum, a suicidist preventionist script is at work in the various models of suicidality, including the social justice approach. As scholars Lisa M. Wexler and Joseph P. Gone (2016, 65) state in the volume Critical Suicidology, “The need and desire for effective suicide prevention is uncontested. How to practice this best is the question.” It is exactly this “uncontested” truth about the necessity of prevention that I question in this book, arguing that the suicidist preventionist script relies on unexamined assumptions perceived as truths that force suicidal subjects into silence.
Indeed, suicidal people are encouraged to share their emotions and suicidal ideation but are quickly discouraged from pursuing any reflections that would legitimize suicide as a valid option. In other words, distress, suicidality, and suicidal ideation may be explored, but suicide itself as an act remains taboo. As a result, suicidal people must live and die in secrecy. Furthermore, whatever explanations suicidal people may provide to justify their wish to die are deemed irrational or illegitimate and construed as wishes that must be eradicated through medical, psychological, or sociopolitical remedies. As journalist Graeme Bayliss (2016) argues, suicidal people like him are in a lose-lose situation regarding their self-determination and competence34 to make decisions: “I don’t want to live, but the very fact that I don’t want to live means I can’t possibly consent to die.” This silencing is especially paradoxical in relation to contemporary discourses on suicidality and suicide prevention campaigns, such as “Speak Up, Reach Out,” “Let’s Talk about It,” or “Let’s Talk,” which urge suicidal people to share their thoughts. In other words, suicide prevention campaigns send a paradoxical message to suicidal people in the form of “Speak up . . . no, don’t,” encouraging them to speak up about feeling suicidal but not to express thoughts contrary to the suicidist preventionist script. With this issue in mind, I ask: What happens when we question dominant conceptualizations of suicidality and look at them from another perspective? Which new interventions are made possible? What kinds of safer spaces can be created? Which voices need to be listened to for the creation of those safer spaces?
1.2.3. Ghostly Perspectives: Suicidal People’s (Absent) Voices
Inspired by theorist Gayatri Chakravorty Spivak’s (1988) canonical question “Can the subaltern speak?,” I ask: Can the suicidal subject speak?35 The answer is no, or not really. Just as Spivak demonstrates that the subaltern not only has fewer chances to speak in a colonialist world but is often unheard and regarded as lacking in credibility, I argue that suicidal people, in a suicidist world, experience various forms of silencing. When they dare to speak, they often are not heard, are delegitimized, and suffer suicidist consequences. Suicidal people’s voices are often absent from discussions on suicidality because they are reduced to silence by a plethora of mechanisms inherent to the suicidist preventionist script. Their ghostly/absent perspectives arise from structural suicidist violence as well as from forms of (self-)silencing induced by this oppression. In addition to silencing suicidal subjects, other related forms of oppression are produced by the four models of suicidality, which contribute to the absence of suicidal people’s voices from discourses on suicidality: (1) erasing suicidal people, (2) dismissing the value of suicidal people’s voices, and (3) speaking for or in the name of suicidal people.
First, suicidal people are often simply erased or forgotten in publications that should include them. I am thinking here about some fields of study at the heart of this book, such as critical disability studies and Mad studies. While scholars in those fields have been quite vocal in assisted suicide debates, the topic of suicide has remained undertheorized, as I discuss further in Chapter 3. Second, traditional suicidology, with its positivist stance and its tendency to recognize the legitimacy of only experts and scientists, dismisses suicidal people’s credibility by simply not including them in the hundreds of thousands of publications on suicidality.36 As Webb (2011, 24) illustrates, “As I studied the [ . . . ] discipline known as ‘suicidology,’ what first jumped out at me was the almost complete absence of the actual suicidal person. [ . . . ] You never heard directly from the suicidal person in their own words. The first-person voice of those who had actually lived the experience of suicidal feelings was apparently not on the agenda of suicidology.” Some suicidology scholars believe that suicidal people cannot be seen as experts on their reality because they have a “distorted view” of it.37 Other scholars, who self-identify as part of the critical turn in suicidology, argue that, while interesting and relevant, first-person accounts about suicide cannot be seen as truth or as more important than any other explanations of suicidality. This view is the case for scholars Jason Bantjes and Leslie Swartz (2019, 7) who write:
First, perception and attribution are imperfect processes, memories are dynamic and imperfect, and people are sometimes ignorant of the social and intrapsychic forces that shape their actions. Consequently, any narrative of nonfatal suicidal behavior is at best a partial account and there are limits to what truths can be inferred from these narratives. [ . . . ] We need to be circumspect about what we claim to know from narratives or what they can teach us.
I take sincere issue with the rapid dismissal of suicidal people’s perspectives and voices in theorizations about their realities; such an attitude would be considered offensive if similar discourses were held about women and the irrelevance of their first-person accounts regarding women’s issues. Dariusz Galasiński (2017, 174), who analyzes suicide notes from a critical suicidology perspective, contends that sometimes such notes can be “deceptive, manipulative or at least strategic [ . . . ] [and] be the last opportunity to score one, to take revenge, to get one’s own back.” Galasiński rightly points out that suicide notes, like any other texts, are not necessarily transparent and can have “hidden” (175) agendas. While such notes should not be considered simple truths, it is equally important not to dismiss the value of suicidal people’s voices in their final attempts to communicate their reality. We should not override their messages by filtering them through a suicidist lens of interpretation. In other words, although we cannot take for granted that such messages tell the entire “truth,” we should refrain from imposing our own vision on those notes.
Third, a more subtle form of oppression that contributes to the relative absence of suicidal people’s voices in discussions around suicidality consists in speaking for or in the name of suicidal people. Linda Martín Alcoff discusses the importance of questioning the circumstances and ways in which we speak for others. Without reducing the debates surrounding these issues to identity politics, and without trying to police who should be allowed to speak in the name of others, Alcoff (1991, 24) proposes “four sets of interrogatory practices” to guide ethical and respectful practices when speaking for, or in the name of, marginalized groups. My comment is less about who should be allowed to speak about suicidality and more about how sometimes some scholars discuss suicidality for or in the name of suicidal people. Fascinatingly, even in a field characterized by critical thinking and a commitment to anti-oppressive approaches, specialists of all kinds (e.g., scholars, health care professionals, activists) often feel entitled to speak in the name of suicidal people, having had little or no dialogue with the people concerned. For example, most of the contributions to the two key edited collections highlighting the social justice model, Suicide and Social Justice and Critical Suicidology, are written by people who do not publicly self-identify as suicidal, despite the editors’ stated aim to include “first-person perspectives” (Button and Marsh 2020, 10) and “the contributions of [ . . . ] those with lived experience of suicidality” (White et al. 2016b, 9). In Critical Suicidology, only two contributions in the section “Insider Perspectives” constitute first-person voices of ex-suicidal people, out of a total of thirteen chapters in the volume. Not only are the majority of the contributions in this volume supplied by “outsiders,” but giving priority to ex-suicidal people rather than to those who are currently suicidal is an epistemological choice that influences the reflections presented in the book.38 Despite the fact that some of the editors of this volume sensitively insist in their own work on the importance of hearing directly from the people primarily concerned by suicidality, the volume as it stands does not include the voices of self-identified suicidal people. To use an analogy, if an edited volume on trans health mainly featured authors publicly identifying as cisgender, and the insider perspectives in the book were written by social workers intervening with trans people, parents of trans people, and ex-trans (or detrans) people, I would question the erasure of trans people’s voices. This example is but one of the limits of current critical suicidology; while many scholars sincerely want to invite more people into the conversation, the power relations between suicidal and nonsuicidal people often remain intact.
To increase the number of first-person voices in critical suicidology, a few researchers have begun to examine suicide notes from completed suicides.39 This groundbreaking approach provides key information about suicidality from an insider perspective. While I applaud these initiatives, often emerging from historical perspectives, it would also seem beneficial to pay more attention to these voices while people are still alive.40 In sum, in all four models of suicidality, including the social justice model, the preventionist goal raises the question of “Why suicide?” to answer the question of “How can we prevent it?” The simplest solution would be to change the approach focused on prevention to one focused on accompaniment and to ask suicidal people the following questions: What are the biggest barriers and difficulties you face? How can we help you? Surprisingly, most scholars still do not follow the trend initiated by researchers studying people’s suicide notes in order to place the voices of the people most concerned at the center of that field of knowledge. While a few have started to do so, more work needs to be done.
1.2.4. The Injunction to Live and to Futurity: The Complex Web of Suicidism and Sanism
These three limitations of the models of suicidality—namely, (1) seeing suicidality as a problem that needs to be fixed, (2) silencing suicidal people through a suicidist preventionist script, and (3) rendering their voices and perspectives invisible or irrelevant in discussions on suicidality—are anchored in two distinct but intertwined systems of oppression: suicidism and sanism.41 Sanism, also called “mentalism” (LeFrançois, Menzies, and Reaume 2013; Lewis 2013), is a form of mental ableism directed against people who are cognitively/mentally/psychologically/emotionally disabled or who are perceived as having a mental disability/illness, as is often the case with suicidal subjects. As discussed by authors in Mad studies, Mad people are often perceived as irrational and incompetent (legally or otherwise) to make important decisions; their perceived or actual mental health issues/mental disabilities are used to deny their credibility as speakers and their legitimacy in expressing their wishes (Leblanc and Kinsella 2016; Liegghio 2013). In ableist, sanist, and cogniticist regimes, mental competency, decision-making capacity, and autonomy are skewed based on cognonormative standards and narrow perceptions of what constitutes an autonomous, rational, and capable subject (Baril et al. 2020). Only those who are categorized as mentally, emotionally, and cognitively stable are deemed competent enough to make crucial decisions about their life and death.
In his critical analysis of suicide, Marsh (2010b, 221) contends that madness or insanity and suicide were construed together in the nineteenth century:
It was argued that medical discourses on insanity and suicide emerged in relation to each other, as suicide came to be defined by reference to insanity and, reciprocally, insanity by reference to suicide. [ . . . ] The constituting of suicide through a discourse on insanity also had a reciprocal effect in that notions of insanity came to be, in part, defined by reference to medically formulated truths of suicide.
While Marsh does not theorize suicidism and therefore does not say that an analysis of madness would be incomplete without reference to suicidality, based on his meticulous historical demonstration, I believe that suicidism and sanism are interlocked and cannot be studied in silo. Therefore, analyzing madness, sanism, and the forms of violence experienced by Mad people without simultaneously taking into consideration the ways suicidal people are perceived and treated and the role suicidism plays in the constitution of sanism leaves gaps in our understanding of sanism and madness—hence the importance of not erasing suicidal people, suicidality, and suicidism within disability/Mad studies. Conversely, most scholars in (critical) suicidology, regardless of which model of suicidality they endorse, do not engage at all, or engage only very briefly, with the rich reflections proposed by disability/Mad studies. In other words, forms of ableism and sanism are at the core of suicidal people’s experiences, but the theoretical tools developed in disability/Mad studies are underdeployed by (critical) suicidologists. I therefore invite critical suicidologists to engage more seriously with disability/Mad studies and disability/Mad studies activists/scholars to include suicidality and suicidism in their theoretical and political agendas.
Indeed, suicidal people face deep forms of sanism, condemning them to a life/death of silence for two main reasons. First, their desire to die is often perceived as irrational from a sanist approach, which assumes that suicidal people suffer from a mental illness that clouds their judgment and invalidates their competence to consent to a voluntary death.42 Suicidal people are considered “insane” and “crazy” to choose death over life. In that context, as Joiner (2005, 19) observes, because “suicide is irreversible, [ . . . ] everything possible should be done to prevent it.” For Joiner and many others, “everything” includes laws to protect vulnerable people against themselves, allowing involuntary hospitalizations and forced medical treatments. In the Canadian context (as in many other countries), suicidality is unusual in that an adult considered otherwise legally competent is invariably denied the right to refuse medical treatment, a right usually taken for granted for all legally competent individuals (Bach and Kerzner 2010; Cavaghan 2017). For example, dying cancer patients or religious people who refuse life-saving treatments, such as blood transfusions, have the right to refuse medical treatments, even though such a refusal may lead to death, but suicidal people do not have that privilege, and their right to refuse treatment after a suicide attempt is legally revoked because they are temporarily deemed mentally incompetent due to their suicidality.43 In addition, while anti-oppression activists/scholars are usually averse to pathological, individualistic explanations, they often accept them with regard to suicidal individuals.44 Second, although suicidal people are not always perceived by anti-oppression activists/scholars as “mad” or “crazy,” their agency is nevertheless often invalidated and their judgment considered biased by oppressive systems, and the result of this delegitimization is similar: They are considered too alienated and not in a good position to make decisions about their life and death. Indeed, the desire to die is delegitimized because suicide is seen as an illegitimate response to social and political suffering. As a result, many anti-oppression activists/scholars, who are otherwise critical thinkers, tend to endorse without questioning the laws, regulations, and prevention strategies that aim to protect vulnerable people from themselves. Chapters 2 and 3 demonstrate the ways in which this approach is true of many queer, trans, disabled, and Mad activists/scholars.
Intertwined with their experiences of sanism, suicidal people must also endure suicidism, which is anchored more generally in biopower and its interest in maximizing the life of the population (Foucault 1976, 1994, 1997, 2001, 2004a, 2004b). Like any other system of oppression, suicidism works on many levels simultaneously (e.g., social, cultural, political, legal, medical, religious, economic, epistemic, and normative), through various structures and mechanisms, including norms and moral injunctions, such as the “injunction to live and to futurity,” as theorized in my earlier work (Baril 2017, 2018, 2020b, 2020c, 2022). The injunction to live and to futurity influences the social, political, cultural, medical, and legal spheres and underlies the discourses of suicidology and critical suicidology. This injunction is based on the presumption that life should be preserved, often at almost any cost, except when the subjects are deemed unproductive or irrecuperable from a neoliberal, capitalist, ageist, ableist, or sanist point of view, as I demonstrate in Chapter 4. Emily Krebs (2022, 38), who used suicidism as a theoretical framework while studying the narratives of 140 suicidal people that are publicly available through the online art-activism project called Live Through This (LTT), concludes that “though the narrators do not use the term ‘suicidism,’ almost all of them describe this type of violence, and name countering the resulting isolation and harm as their motivation of telling these stories.” As Krebs meticulously demonstrates, suicidism is encountered by suicidal people in all spheres of their life and in their various interactions—with family, with the health care system, with the legal system, and with social policies in general. Krebs notes that these forms of suicidism are founded on the imperative to stay alive that is imposed upon suicidal subjects.
I contend that it is important to theorize the injunction to live and to futurity imposed upon suicidal subjects as a mechanism that is part of a broader normative system of intelligibility, as is the case with the injunction to able-bodiedness or able-mindedness that makes able-bodyminds45 the only normal, desirable option in our societies. When it comes to suicide, while a wide range of conceptualizations exist, almost all, astoundingly, reach the same conclusion: Don’t do it. It is fruitful to consider this conclusion as being influenced by an injunction to live and to futurity that is at work in what I first called “compulsory liveness” (Baril 2020c) in a suicidist system, similar to compulsory heterosexuality in a heterosexist system (Butler 1990; Rich 1980) or compulsory able-bodiedness or able-mindedness in an ableist and sanist system (Kafer 2013; McRuer 2006). I now reframe the notion of compulsory liveness as compulsory aliveness, which I find more self-explanatory. Compulsory aliveness could be defined as the normative component of suicidist oppression, and this normative dimension is composed of various injunctions (or imperatives), including the injunction to live and to futurity. In other words, suicidism, in its normative aspect, takes the form of compulsory aliveness. Compulsory aliveness, as an apparatus, functions through a wide array of tools and mechanisms, such as laws, regulations, attitudes, discourses, and imperatives. The injunction to live and to futurity, as a social, cultural, medical, religious, and even legal imperative, is simply one way through which compulsory aliveness regulates the life/death of individuals and the population as a whole. I contend that compulsory aliveness aims to impose a will to live and makes some people’s desire/need for death abnormal, inconceivable, and unintelligible, except sometimes for those who are disabled/sick/ill/old, in which case the desire/need for death is considered normal and rebranded as medical assistance in dying or physician-assisted death (see Chapter 4). As a dominant system of intelligibility within a suicidist regime, compulsory aliveness masks its own historicity and mechanisms of operation, which give life an apparently stable and natural character but arise from a performative statement about the desire to live that is constantly iterated in various discourses, including preventionist discourses. In the introduction to his seminal book on crip theory, Robert McRuer denounces the constant interrogation of disabled people by able-bodied people about their supposed desire to be “normal.” McRuer (2006, 9) argues, “The culture asking such questions assumes in advance that we all agree: able-bodied perspectives are preferable and are what we are collectively seeking. A system of compulsory able-bodiedness repeatedly demands that people with disabilities embody for others an affirmative answer to the unspoken question, ‘Yes, but in the end, wouldn’t you rather be more like me?’”46
Compulsory aliveness operates in the same way: Nonsuicidal people are constantly wondering why suicidal people are suicidal and what can be changed (in them or in society) so the latter may conform to nonsuicidal norms. Influenced by an implicit injunction to live and to futurity present within the compulsory aliveness apparatus, we constantly ask suicidal people: “But in the end, wouldn’t you rather be more like me, someone who wants to live a long life and enjoy living it?” I believe that some, if not most, suicidal people might answer this question positively. I contend that the wish for a cure to suicidality is not necessarily suicidist, particularly not when coming from the suicidal person, but it needs to be resituated in the broader context of how suicidality is almost always framed as something to fix. Therefore, even though some suicidal people want to be “fixed,” the assumption that all suicidal people would answer affirmatively or, as McRuer says, to “assume in advance that we all agree” is problematic. For many people, it is simply incomprehensible that someone could answer, “No, thanks, I don’t want to be cured. I don’t want to be fixed. I don’t want to wait for the social revolution that will eradicate the oppression that makes me suffer. . . . I just want to die now. I have lived enough. I don’t care if my life is over. This is what I want.” Like the Deaf, disabled, Mad, and crip people who have told and continue to tell us that they don’t want the “ideal solutions” offered by mainstream societies (e.g., cochlear implants, cures, or treatments) but instead want their voices, perspectives, needs, and claims to be respected and supported (Clare 2009, 2017), suicidal people should not have preconceived solutions devised by those who do not experience their reality imposed upon them. Furthermore, as Alison Kafer (2013, 29) mentions, by “focusing always on the better future, we divert our attention from the here and now.” By insisting on the promising futurity of suicidal people, we paradoxically erase their future as some of them would like it to be (i.e., ended) and dismiss their voices, concerns, perspectives, and wishes of nonfuturity. Following McRuer’s (2006, 10) statement on “ability trouble,” in the spirit of Judith Butler’s (1990) “gender trouble,” I argue that suicidal people’s voices and claims, in this context, pose a “life trouble” by unmasking compulsory aliveness imposed upon all human beings. Additionally, as McRuer (2006, 31) contends about the entwined dimensions of compulsory heterosexuality and compulsory able-bodiedness, I argue that compulsory aliveness and compulsory able-bodiedness and able-mindedness are deeply intertwined.
Extending Sara Ahmed’s (2010) and Ann Cvetkovich’s (2012) arguments on the deleterious effects on marginalized groups of the injunction to happiness, I believe that we should analyze the impacts of the injunction to live and to futurity and of compulsory aliveness on suicidal people, including those who live at the nexus of multiple oppressions.47 Their effects are pervasive and invasive, as evidenced by the treatments forced on suicidal people. Although Mad scholars have not discussed the forced psychiatric treatments imposed specifically on suicidal people (with the exception of Burstow 1992), the long legacy of Mad activism and scholarship denouncing forced treatments for Mad people, including incarceration, restraints, involuntary hospitalization, and chemical (e.g., drugs) and physical (e.g., electroshock) treatments, has taught us that these treatments are, in fact, experienced as forms of violence by many people.48 For example, mechanical restraints are often accompanied by other questionable practices, causing people to feel violated, a term used by participants in a study by scholar Jean Daniel Jacob and colleagues (2018), such as the removal of clothing, which is sometimes even directly cut off the body with scissors; the denial of washroom access; and forced bedpan or catheter use. Many women in psychiatric settings are held and stripped by health care professionals, injected with drugs against their will, and feel raped, humiliated, and (re)traumatized (Burstow 1992; Jacob et al. 2018).
Compulsory aliveness and the injunction to live and to futurity are closely linked to disciplinary power, a form of power exercised at the individual level on the body of the subject, and biopower, an apparatus of power that aims to protect and maximize the life of the population as a group (Foucault 1997, 2001, 2004a, 2004b).49 In the current neoliberal era, compulsory aliveness and the injunction to live and to futurity not only serve to make the bodies of suicidal subjects docile (e.g., refraining from engaging in suicidal actions, self-harm, or risky behaviors) or to preserve and maximize the life of a population but also keep potentially productive subjects alive for the benefit of a nation.50 In that sense, as I argue in Chapters 2, 3, and 4, compulsory aliveness and its various injunctions are part of a wide array of technologies representing what I call “somatechnologies of life,” enmeshed in the living body (Baril 2017). I argue that compulsory aliveness and the injunction to live and to futurity, in combination with suicidism and sanism, force us into an unaccountable and uncompassionate approach to suicidality. We push people to complete their suicide without having had the chance to express/explore their suicidal thoughts with others for fear of negative consequences. We rewrite the lives and deaths of suicidal subjects through our dominant scripts of understanding suicidality and suicidal notes, and we speak on their behalf in our public discussions, policies, and regulations.
1.3. Alternative Conceptualizations of Suicidality
1.3.1. Philosophical Perspectives on Suicide
As discussed earlier, the presumption that suicide is only a problem to prevent must be situated in a broader historical, geographical, social, and cultural context. Alternative conceptualizations of suicidality have existed for centuries (Battin 2015), despite the predominance of the preventionist script. For example, Nelly Arcan (2004, 2008), a Canadian author and columnist who died by suicide in 2009, endorses a position on suicide that differs from those depicted so far. Arcan envisions suicide as a radical liberty, echoing a philosophical view that has been expressed throughout history by philosophers and writers, such as Simon Critchley (2019), who offers a nonmoralizing view on suicide as a freedom and a choice that should not be condemned. History is replete with philosophers (e.g., Seneca, Nietzsche, and Sartre) for whom suicide was a possibility under specific circumstances or philosophical schools of thought, such as libertarian or existentialist, which defend suicide as a liberty or a right (Cholbi 2011; Marsh 2010b, 2016; Tierney 2006, 2010). As philosopher Michael Cholbi (2017, section 3.4) contends, the right to suicide is generally perceived as a right of noninterference instead of a right involving active obligations and duties from others:
Libertarianism typically asserts that the right to suicide is a right of noninterference; to wit, that others are morally barred from interfering with suicidal behavior. Some assert the stronger claim that the right to suicide is a liberty right, such that individuals have no duty to forego suicide (i.e., that suicide violates no moral duties), or a claim right, according to which other individuals may be morally obliged not only not to interfere with a person’s suicidal behavior but to assist in that behavior. (emphasis in the original)
As Cholbi notes, this last definition of the right to suicide, formulated as a “claim right,” is usually (I would say always, based on the literature consulted) formulated in the context of the debates surrounding assisted suicide in cases of disability/sickness/illness or old age. Claiming that kind of right to suicide in those specific circumstances is different than claiming a right to suicide for suicidal people, as I do in Chapter 5, based on a critique of the suicidist violation of suicidal people’s rights and a critique of the ableist/sanist/ageist foundations of current right-to-die discourses.
Michel Foucault is the philosopher who comes closest to advocating for a claim right to suicide in his short texts on the subject: two memoirs about people who completed suicide, a short piece titled “The Simplest of Pleasures” and an interview published in the journal Sécurité sociale.51 According to Taylor (2014, 18), “Foucault occasionally mentions suicide as a form of resistance to power, or at least as a minimum requirement for a relation of power to exist. Power necessarily entails the possibility for resistance, even if the only available act of resistance is suicide.” Foucault also believes, beyond this individual possibility of resisting power relations, that suicide could be collectivized. Taylor (2014, 19) writes:
Foucault also imagines the creation of places that would facilitate suicides, but this time he speaks of commercial establishments [ . . . ]: there would be salespeople who would customize suicides according to the client’s wishes and “style,” and there would be a screening process such that “only those potential suicides which are committed with forethought, quietly and without wavering” would be supported (Foucault 1994b, 778–779).
In one interview, Foucault (2001, 1186–1201) also mentions that if he could, he would create an institute where suicidal people could come for a few days or weeks to spend the last moments of their life in an enjoyable surrounding and to die by suicide in good conditions instead of atrocious ones. When asked whether he is referring to a right to suicide, Foucault answers in the affirmative. However, his lack of elaboration prevents us from knowing his position with certainty, and his claim to the right to suicide remains unclear.
A contemporary philosopher who addresses the question of suicide more thoroughly, and who terminated his own life by suicide in 1978, is Jean Améry. His book, titled On Suicide: A Discourse on Voluntary Death ([1976] 1999), is a philosophical essay on what he calls voluntary death, a term he uses instead of suicide: “I prefer to speak of voluntary death, knowing well that the act itself is sometimes—frequently—brought into being by a condition of urgent compulsion. As a way of death, however, voluntary death is still freely chosen even when one is trapped in a vise of compulsions” (Améry 1999, 1–2; emphasis in the original). Améry calls for a depathologization of suicidality and claims that voluntary death is an individual choice everyone should be able to make. Particularly interesting is Améry’s examination of voluntary death from the perspectives of suicidal people themselves. Améry develops what I call a suicidal epistemological standpoint, in which knowledge of suicidality is developed based on the authority of those who experience it. Améry (1999, 13) argues that voluntary death contradicts what he calls “the logic of life”: “Anyone who wants to commit suicide is breaking out, out of the logic of life [ . . . ]. The logic of life is prescribed for us, or ‘programmed,’ if you wish, in every daily reaction. It has gone into our daily language. ‘In the long run, you’ve got to live,’ people say [ . . . ]. But do you have to live?” (emphasis in the original). It is worth mentioning that none of the philosophers or philosophical stances I have read in my ten years of training in philosophy, even the libertarian defense of the right to die by suicide, has theorized suicidism; the closest is the denunciation of the “logic of life” described here by Améry, but his theorization remains on the individual and personal levels. It is also important to note, as Cholbi does (2011, 2017), that except for the libertarians, all other positions on suicide suggest intervening, at least minimally, with suicidal people to prevent suicide. While some of these positions propose noncoercive intervention methods, such as encouraging suicidal people to change their minds, others are quite coercive.
My goal in the remaining discussion regarding alternative conceptualizations of suicidality is not to present an exhaustive portrait of activists and authors endorsing them, a task beyond the scope of this chapter, but to introduce key authors proposing alternative views on suicide, whose positions I then critique.52 As I demonstrate, despite their radical ideas regarding suicidality and even, in some cases, their denunciation of suicidal people’s mistreatment, none has thus far theorized the oppression faced by suicidal people from an anti-oppressive approach or proposed a positive right to assisted suicide for suicidal people (as opposed to a negative right or a liberty to suicide), as I do. However, I contend that if we recognize that suicidal people are systematically mistreated, we must also recognize that they constitute a marginalized group. If this view is correct, giving them the liberty to act as they wish without supporting them does nothing to combat the oppression they face.
1.3.2. Thomas Szasz and the Radical Liberty of Suicide
Libertarian philosopher and psychiatrist Thomas Szasz (1999, 2008) believes that suicidal people are discriminated against by society, psychiatry, the law, and the state. He contends that suicide constitutes a fundamental act of individual liberty, which is violated by the state’s suicide prevention measures: “The option of killing oneself is intrinsic to human life [ . . . ]. We are born involuntarily. Religion, psychiatry, and the State insist that we die the same way. That is what makes dying voluntarily the ultimate freedom. We have just as much right and responsibility to regulate how we die as we have to regulate how we live” (Szasz 1999, 130; emphasis in the original). Known for his strong critiques of psychiatry, Szasz hopes to extract suicidality from the hands of psychiatrists and physicians, as he does not believe that suicidality is a mental illness.53 While Szasz develops a thesis similar to mine—namely, that suicide may be an option—he does so from a libertarian and neoliberal (capitalist) point of view with which I strongly disagree. Therefore, although we begin from the same thesis, we arrive at different conclusions, as my anti-oppressive approach to suicide engages in critiquing dominant systems, such as neoliberalism, capitalism, classism, ableism, sanism, and ageism. Furthermore, while Szasz is strongly opposed to any support being offered to suicidal people by the medical system or the state, I suggest, from an anti-oppressive approach developed in Chapter 5, that suicidal people, as an oppressed group, should be entitled to have their wishes supported by the medical system and the state.
While suicide is no longer considered a crime, Szasz maintains that everything that surrounds suicidality remains criminalized and punishable, based on moralistic views. Szasz (1999, 19–20) discusses the distinction between de jure equality and de facto equality: While the former refers to the legal aspect of equality, the latter refers to its materialization. As demonstrated by Szasz, and in this chapter thus far, in many countries, suicidal people have de jure but not de facto equality. Szasz argues that the best proof of this inequality is that if suicide were really legal, de facto, prevention strategies that violate basic human rights would not be considered treatments but be illegal. Szasz (1999, 34) argues that we live “in a Therapeutic State,” in which psychiatry and its agents have too much power.
Not only does Szasz believe that suicide prevention is inefficient; he believes that it is counterproductive and a form of violence exercised against suicidal people. Szasz maintains that individuals should have the liberty to end their lives without interference. He is, however, strongly opposed to any state or medical interventions that would provide assisted suicide, as these measures would be an interference and would give too much power to physicians, psychiatrists, and the state. In sum, Szasz denounces coercive treatments forced upon suicidal people but does not approve of any forms of support to help suicidal people accomplish their goal. In philosophical terms, this stance is the difference between a positive and a negative right. As Szasz (1999, 108) explains:
By this [a negative right to suicide] I mean that the government ought to be bound by law [ . . . ] to leave the citizen, as suicidal person, alone. The difference between a positive right and a negative right is briefly this: A positive right is a claim on someone else’s goods or services; in other words, it is a euphemism for an entitlement. Because the notion of a right to suicide (or physician-assisted suicide) entails an obligation by others to fulfill the reciprocal duties it entails, I reject the notion of a “right to suicide.” However, I believe we have—and ought to be accorded—a “natural right” to be left alone to commit suicide. A truly humane society would recognize that option as a respected civil right.54 (emphasis in the original)
Based on liberal conceptions of choice, liberty, and autonomy, Szasz supports a division between the private and public spheres and approves of suicide only when it is a “private” affair. Thus, he strongly disagrees with assisted suicide, which would bring a private matter that should be dealt with individually or with the assistance of friends and family into the public sphere. His perspective on suicide also situates him within a neoliberal capitalist calculation logic, where suicides that do not affect society’s productivity are permitted and perceived as ultimate acts of freedom, while suicides that are potentially damaging to and costly for society should be condemned and prevented. Szasz (1999, 113) writes:
The voluntary death of a particular person may be cost-saving, costless, or costly (to family and society). When suicide is cost-saving or costless, there is no prudential reason for preventing or condemning it. When it is costly, it may be justifiable to condemn suicide and use persuasion to prevent it, but it is unjustifiable to resort to coercion to interfere with it.
Promoting a free market based on neoliberal and capitalist conceptualizations, Szasz (1999, 2008) does not believe in a universal health care system. He maintains that free and universally accessible health care is detrimental to patients and to suicidal people. A strong medical system, according to Szasz (1999), is one in which individuals pay for their services. Mobilizing a comparison to abortion, he believes that the best way to serve patients’ interests is to dissociate medicine from what he considers to be individual choices. Therefore, while Szasz proposes one of the first critical reflections on the violence suicidal people experience at the hands of the state and the psychiatric system, his libertarian, neoliberal, and capitalist perspective on suicide offers scant support for theorizing suicidal people’s oppression from an anti-oppressive approach. Further to his problematic libertarian and neoliberal perspectives, Szasz reproduces some troubling ableist and ageist discourses in his work. He believes, for example, that dying is better than experiencing disability, reinforcing the long tradition of prejudice against disabled/sick/ill people: “If we do not want to die a lingering death after a protracted period of pathetic disability, we must kill ourselves while we can, perhaps earlier than we might feel ready to do so” (Szasz 1999, 129). Ableism is also apparent in the language he employs in his book, when, for example, he uses offensive terms to describe some disabled people. Through his anti-psychiatry lens that denies the existence of mental illness, Szasz also invalidates the reality of those who experience mental health issues as a form of mental illness or disability (Mollow 2006; Nicki 2001). Therefore, instead of being theorized from a positive point of view from anti-ableist and anti-sanist perspectives, notions of sickness or illness are construed as negative.
1.3.3. Susan Stefan and Discrimination against Suicidal People
Known for her expertise as a legal scholar and practitioner, Susan Stefan published two monographs on law and mental disability before writing her book Rational Suicide, Irrational Laws (2016). Despite her interest in discrimination and disability, and even though Stefan’s book on suicide has been influential in my reflections on suicidality, I find at times that Stefan’s scholarship lacks critical engagement with disability/Mad studies. For example, in a five-hundred-plus-page monograph, she never uses terms such as ableism, disablism, sanism, or mentalism, and she sometimes uses problematic expressions, such as mental retardation (80). Furthermore, despite a compelling demonstration of the discrimination faced by suicidal people, through relevant legal case studies and hundreds of interviews (as well as 240 online surveys) with current and ex-suicidal people, Stefan paradoxically attaches negativity to illness and sickness. While trying to disentangle and dissociate most suicides from mental illness, she casts mental illness as negative (177). Stefan, like Szasz, not only neglects to conceptualize suicidal people’s lived experiences as part of systematic oppression but often remarginalizes disabled/ill/sick people, as many activists/scholars in social movements have done through their claims for the depathologization of some marginalized groups (Baril 2015).
Like Szasz, Stefan does not pursue a positive right to suicide. Instead of supporting suicidal people in their quest, she claims that it is not the duty of society to help them die. She contends that if they want to die, they should be allowed to do so without interference (474–475, 486). Stefan (240) is clear in her position: She does not think that we should allow assisted suicide for suicidal people or for people living with mental disabilities or unbearable emotional suffering, which would give too much power to physicians and would send the wrong message to those populations about the value of their lives (487). She is against any kind of third-party involvement in suicide (245). Discussing the viewpoints of several suicidal people she interviewed, Stefan (xxiv) explains that “the decision to end one’s life, like decisions to refuse treatment or decisions about reproduction, is a civil right, a fundamental liberty interest, a personal, intimate, and private decision that belongs to the person alone, which should not be the subject of state intervention.” Stefan’s book construes suicide as an individual, autonomous, personal, and private choice and decision, terms she uses abundantly in her book.55 Like Szasz, she adopts a (neo)liberal and individualist approach,56 despite her repeated call for structural approaches and community-led initiatives regarding suicide prevention. She, like Szasz, uses the analogy of abortion and errs on the side of private and individual actions and negative rights rather than universal access to abortion (85, 246–247). Stefan believes that, like abortion, suicide should not be medicalized but be a choice for individuals. But contrary to her belief that access to abortion should be facilitated, Stefan believes that we should limit access to the means to end one’s life.
Therefore, while insisting on the importance of destigmatizing suicide and reducing fears around discussing suicidality, Stefan (240) paradoxically states that one of the most effective factors in suicide prevention remains fear. To facilitate suicide would be to encourage suicide, making it too easy to complete. She even sometimes argues in favor of forms of criminalization: “It [author’s position] would not preclude a society from banning or criminalizing suicide, attempted suicide, or assisted suicide. [ . . . ] Nor does it preclude involuntary commitment for suicidality” (51). To prevent as many suicides as possible, Stefan critiques current ineffective, coercive prevention strategies and calls for the development of a “public health approach” (468) comprising diverse social policies and multisectoral strategies. She contends that current prevention strategies are probably producing more deaths by suicide than they prevent because they shut suicidal people down instead of inviting them to speak openly. She hopes that by destigmatizing suicide and diminishing the forms of discrimination suicidal people face, we will create safer spaces to allow people to share their feelings. She insists that prevention strategies, which could include a variety of methods, such as spiritual intervention, peer support, and limiting access to the means for suicide, should be based on “human connection and patient, caring perseverance” (451).
In the “unified field theory of suicide” she offers in her conclusion, Stefan argues that assistance in dying or in completing suicide should be illegal (496) and that people should be helped to live and not to die (495):
People should have their own decisions about life and death respected, but they should get help, too—not help to die, but help to change their lives into lives worth living. For the most part, [suicidal people] know what they need: to stay in school, to get support taking care of their children, to be taught a new perspective to frame their problems and solve them, to get a bit of a break and some rest, and to have a community that sticks by them for the long, long haul, to have someone listen. They know what they don’t need: involuntary hospitalization, getting shot by police, moralizing judgments by people who don’t have a clue what they’ve been through, and to never be permitted to actually articulate how terribly they are feeling without having their drug dosage increased.
According to Stefan, while we need to change suicide prevention methods and stop discriminating against suicidal people, the status quo should be upheld when it comes to suicide attempts: We should not actively support suicidal people in completing their suicides, and they should die alone through regular (violent) suicidal means or hunger strikes if they choose to exercise their individual autonomy to do so (497).
Contrary to Szasz’s and Stefan’s positions, I believe that, like other marginalized groups, suicidal people are entitled to receive support and assistance (i.e., positive rights). To return to the example of abortion, in their critique of the medical system, Szasz and Stefan err on the side of state disengagement. While I don’t want to infer that abortion and suicide are comparable practices, the example of abortion illustrates that any rights, such as reproductive rights, are ineffective without the implementation of positive rights through concrete measures and policies. Decriminalizing abortion, giving a “negative right” to abort without developing strong social policies, supports, and institutional services that truly provide universal abortion access, does not support reproductive justice. The state should have an obligation and a duty to do everything possible to facilitate access to those services while simultaneously providing people with positive sexual education and contraceptive measures.
Similarly, I believe that decriminalizing and depathologizing suicide, reducing stigmatization, and requesting that the state and its medical and legal institutions stop imposing dehumanizing treatments are not enough to support suicidal people’s rights or to foster social justice for this marginalized group. As a feminist, trans, disability/Mad, and queer activist/scholar, I adhere to the same logic for all marginalized groups. I believe that working toward strong and effective equity for marginalized groups, including suicidal people, is not limited to preventing state control or direct forms of violence but must include creating conditions in which marginalized groups have access to the same opportunities and resources and receive the same social, cultural, political, and legal recognition as others. Without encouraging suicide or offering suicidal people a quick nonreflexive way to end their life, the state should offer assisted suicide as one among several potential options, carefully guiding and counseling those who are contemplating this possibility, as I propose in Chapter 5. In this respect, my thesis differs radically from the positions of the authors presented in this chapter so far. The notion of suicidism I develop here from an anti-oppressive approach aims not only to critique and denounce the oppression suicidal people face but also to end their oppression through structural remedies and sociopolitical, legal, medical, economic, and epistemic transformations.
1.3.4. Additional Alternative Perspectives
Scholar and clinician James L. Werth Jr. (1996, 1998, 1999) provides important contributions on “rational suicide.” In the 1999 edited volume Contemporary Perspectives on Rational Suicide, Werth distinguishes rational suicide from assisted suicide, arguing that rational suicide refers to a rational decision-making process, while assisted suicide refers to help or assistance in implementing this decision. Werth and numerous contributors in that volume discuss the notion of rational suicide in the context of sickness, illness, disability, and (often but not always) end of life; therefore, they are less interested in debates about suicide per se than in debates surrounding assisted suicide. As I demonstrate in Chapter 4 through critiques of current positions in favor of assisted suicide, the “rationality” of a suicidal individual appears to be evaluated differently if that person is old, dying, disabled, or sick rather than healthy, young, and a potentially productive citizen. In other words, Werth’s position on rational suicide would likely be different if he were considering the rationality of a healthy twenty-year-old man who is depressed and wants to die due to financial difficulties or romantic problems. In addition to establishing criteria for characterizing a rational suicide (1996, 62), in other work, Werth (1998) hopes to distinguish between rational and irrational suicides to prevent the latter. He (1998) believes that characterizing some suicides as rational will help create a stronger relationship between mental health professionals and their clients to prevent irrational suicides. According to Werth (1998, 186), some suicidal clients might be put off by prevention. Therefore, acknowledging that suicide might be a sound option in some circumstances, through a nonjudgmental approach to rational suicide, could help consolidate the trusting relationship between clients and clinicians by empowering suicidal subjects. As Werth (1998, 186) explains, feeling empowered decreases suicidal ideation. However, Werth’s ultimate goal remains suicide prevention, and the logic of a rational suicide remains anchored in what I call in Chapter 4 the ableist/sanist/ageist/suicidist ontology of assisted suicide, characterizing suicides as rational only in the context of a hopeless condition, be it physical or psychological. Werth (1998, 187) makes clear that the only thing he is suggesting is an improved process for screening and distinguishing different types of suicidal people to improve current suicide prevention strategies.
On another note, in a post on the now-closed HuffPost Contributor platform and titled “How Being Black & Queer Made Me Unapologetically Suicidal,” activist/scholar T. Anansi Wilson (2016) situates their depression and desire for death as resulting from systemic forms of violence and structural oppressions, including racism, classism, and heterosexism. Wilson affirms that living, or living in sufficiently decent conditions, is a privilege that marginalized groups lack. Like authors who approach suicide from a social justice perspective, Wilson frames suicide as a form of self-murder resulting from the slow death imposed on marginalized groups. Yet contrary to many proponents of the social justice model who inscribe their work in a preventionist script, Wilson (2016, para. 7) contends that suicide could become the queer action par excellence, a revolutionary act of rebellion against oppressive systems:
Suicide[,] then, can be revolutionary. Life can only be privileged when it is more than mere survival. This is not a call for folks who are struggling with depression to kill themselves. This is a call to critically examine what suicide does and does not mean across experiences. It is a call to think about how life is weaponized as a sure-fire way to access, surveil and monetize oppressed bodies.
Wilson invites us to think about how, in this colonialist, racist, and capitalist culture in which some bodies are disposable, suicide could be conceptualized as an individual and collective form of resistance to the commodification and exploitation of the bodies and lives of marginalized groups. As we can see from the excerpt, the author of this post does not romanticize suicide but offers an alternative view on suicide, one that goes beyond its dominant conceptualization as a bad choice for marginalized subjects. Although Wilson adopts an anti-oppressive approach, the conceptualization of suicide as a revolutionary act still relies partially on an individualist notion of choice. Wilson’s work is not apolitical—quite the contrary—but, in their text, death by suicide remains a private action, not one that entails positive rights for suicidal people. In the spirit of the feminist tradition, I believe that the personal is political and that the act of suicide should never be seen as an individual decision to be enacted alone; rather, it needs to be collectivized and politicized—not only to reveal the connections between suicidality and sociopolitical structures but also to develop accountable and collective responses to suicidal people, as I hope to do here.
Activist and community organizer Wright offers a similar perspective to that of Wilson in a 2018 blog post titled “Learning to Live with Wanting to Die.” Wright also discusses their struggle with depression as stemming from forms of oppression they experienced while growing up: fatphobia, sexism, racism, heterosexism, and cisgenderism. Wright denounces the inefficiency of current management strategies for depression and suicidality, which are based mostly on medical and individual solutions. Committed to an anti-oppressive approach, Wright questions the double standard regarding the celebration of diversity for a wide variety of marginalized groups and the silence that seems to prevail regarding mentally ill people. Wright contends that it is important to fight the stigma surrounding suicidality because the silence is more dangerous than is suicidal ideation itself. Wright also promotes alternative discourses on suicidality that go beyond curative ideology and recovery and calls for an acceptance of suicidal ideation, even though they do not push the reflection as far as suggesting that we should support suicidal people through positive rights.57
The authors presented in this section who adopt alternative conceptualizations of suicide offer a number of invaluable contributions, yet their theorizations do not propose a comprehensive framework to theorize and denounce suicidism. While some insist on the advantages of allowing suicidal people to speak more freely to save more lives, they do not question the injunction to live and to futurity underlying the suicide prevention strategies they seek to reform or transform. Furthermore, none argues for the necessity of a positive right to suicide involving a duty to support people in their quest to die. Despite their denunciation of cruel treatments reserved for suicidal people, their call to end the marginalization experienced by suicidal people, and their theorizations of suicide as a choice, none argues for positive rights for suicidal people or for greater accountability in responding to their wishes to die. In sum, while the destigmatization of suicidality is necessary, it does not go far enough to end suicidism and to actively support suicidal people.
1.4. Suicidism as Epistemic Violence
A long tradition of feminist, queer, postcolonial, and Black epistemologies, which are sometimes called “insurrectionist epistemologies” (Medina 2012, 2017) or “liberatory epistemologies” (Tuana 2017), has demonstrated how the knowledge of some marginalized groups is devalued and discredited in comparison to the knowledge of dominant groups and how revalorizing and relegitimizing this knowledge would enrich and rectify current knowledge.58 Spivak (1988) develops the notion of “epistemic violence,” which refers to forms of violence perpetrated on colonized subjects by preventing them from speaking or being heard or by delegitimizing their voices and knowledge when they are heard. Building on Spivak, philosopher Kristie Dotson (2011, 236) offers the following definition of epistemic violence: “One method of executing epistemic violence is to damage a given group’s ability to speak and be heard.” Since then, a rich apparatus of concepts, theories, and notions has been put forward to analyze, describe, and critique various forms of violence exercised at the epistemic level or relating to knowledge. Authors refer to “epistemic oppression,” “epistemic injuries,” “epistemic death,” “epistemic communities” (Medina 2012, 2017), “epistemic resistance,” “epistemic abilities,” “epistemic insurrection,” and “epistemic disobedience” (Medina 2012, 2017; Tuana 2017), to name only a few of these rapidly evolving notions. In his discussion of racism, philosopher and critical race studies scholar José Medina demonstrates how epistemic violence is transversal and connected to various forms of violence, be they political, legal, social, or physical, and that not recognizing those different kinds of violence is itself a form of epistemic violence.
I argue that suicidism represents an oppressive system comprising various forms of violence (e.g., social, cultural, political, medical, legal, religious, economic, and normative), including epistemic violence that influences the life of suicidal subjects by interacting with other forms of violence. Only a few authors in the field of critical suicidology have mobilized notions and concepts related to epistemic violence to theorize suicidality, and these rare contributions began to appear in 2020 (Baril 2020c, Chandler 2020a).59 For example, despite the current trend of mobilizing experiential knowledge in research projects in suicidology, Fitzpatrick (2020) shows how the discourses and narratives of (ex-)suicidal people are often tokenized and their expertise often limited to the role of consultant instead of decision-maker. Fitzpatrick sees this tokenist approach as a form of epistemic violence and critiques the active ignorance underlying forms of epistemic marginalization. The following discussion will help us understand these forms of epistemic violence as well as the mechanisms of active ignorance.
1.4.1. Suicidism as an Epistemology of Ignorance
As Medina (2017, 247) reminds us, the epistemology of ignorance has been theorized, without being named as such, by several people in the field of critical race theory: “Although epistemologies of ignorance have been discussed by that name only recently [ . . . ], they have always been a key theme of race theory, and they have figured prominently in the philosophies of race of classic authors such as Sojourner Truth, Anna J. Cooper, W. E. B. Du Bois, Alain Locke, and Frantz Fanon, to name a few.” Philosopher Charles W. Mills coins the notion of “epistemology of ignorance” in his 1997 book The Racial Contract. He uses the expression to describe the process whereby dominant groups—in this case, White people—actively ignore racism and White privilege and the role they play in the reproduction of that material system and ideology. In his 2012 book The Epistemology of Resistance: Gender and Racial Oppression, Epistemic Injustice, and Resistant Imaginations, Medina further explores this idea by proposing to react to this epistemology of ignorance with an “epistemology of resistance.” As he explains, the epistemology of ignorance goes hand-in-hand with the practices of silencing; through an erasure of the marginalized voices of racialized people, White people remain actively ignorant about racism, its ramifications, manifestations, mechanisms, and impacts—hence the importance of resisting this erasure through various means.
As an ideological and a material system, suicidism is based on an epistemology of ignorance. Nonsuicidal people, researchers in traditional suicidology (and sometimes in critical suicidology), health care professionals, and many others concerned with suicidality (including relatives and friends of suicidal people) reproduce an active ignorance regarding the perspectives, claims, and realities of suicidal people and have the privilege to remain ignorant about suicidism, its ramifications, manifestations, mechanisms, and impacts on suicidal people. Most nonsuicidal people do not understand that their comprehension of suicidality is incomplete and problematic; they can ignore the voices of suicidal people who do not adhere to the suicidist preventionist script and dismiss them as irrational or politically alienated, since the entire society and its norms, institutions, laws, and regulations support their view that suicide should never be an option for suicidal people. To apply Medina’s (2017, 250) words to suicidal people, nonsuicidal people are “cognitively and affectively numbed to the lives of racial [and suicidal] others: being inattentive to and unconcerned by their experiences, problems, and aspirations; and being unable to connect with them and to understand their speech and action.” Medina (2017, 249) demonstrates how difficult it is to dismantle the epistemology of ignorance because of what is considered common sense, widespread preconceived ideas and judgments, and ingrained norms and ideologies, which infuse scientific discourses:
Confronting interpretations that make you radically rethink your most familiar experiences is not easy. It can be quite shocking to hear that something you thought you knew well what it was—well-meant acts of charity toward worse-off others, for example—can be experienced by the other subjectivities involved quite differently—as a subtle form of racism, or as passive-aggressive acts that keep people in subordinate positions and demand their gratitude and conformity.
Going even further, I would suggest that current “well-meant acts” toward suicidal people, be they theorizing suicidality, preventing suicidality, or helping suicidal people—regardless of which model of suicidality is used—often represent subtle (and sometimes not too subtle) forms of suicidism, a type of violence with deep roots and negative consequences in the lives of suicidal people. In other words, to paraphrase Medina, it could be shocking to hear that suicide prevention is often ineffective and counterproductive, as it is the source of the problem it tries to eradicate. It is difficult to understand from a suicidist gaze that the well-intended acts meant to prevent suicidal people from taking their lives are experienced by suicidal people as traumatic and violent. When discussing my thesis and arguments about suicidality with various audiences, I am often confronted with the following reality: While people adhere quickly and almost unanimously to my opening argument critiquing current models of suicidality and prevention strategies that fail suicidal people, many resist my argument that we need to support suicidal people in their quest for death. Indeed, most of my interlocutors are astounded by the cruel treatment and forms of discrimination suicidal people face and are outraged to learn about the difficult reality of being a suicidal person in a suicidist society. In that sense, the majority of my interlocutors easily accept my argument about the existence of suicidism. My theoretical framework on suicidism has even recently attracted the attention of many scholars,60 leading organizations, associations, and groups working in the field of suicide prevention, demonstrating that part of my thesis is increasingly recognized, even by those endorsing a preventionist stance. However, people are quite reluctant when it comes to my subsequent argument about developing an accountable response to ending suicidism that would involve positive rights as well as social policies, accompaniment measures, and support for suicidal people. Many come to see me after conference presentations to tell me that, while they adhere to my theory and they believe that it would be coherent and logical for them to support suicidal people in a way similar to how they support other marginalized groups, they are “blocked” at the affective level. The experience of having suicidal thoughts themselves, having a loved one who died by suicide, or thinking about accompanying a loved one in their suicide makes people uncomfortable. A recognition of the oppression suicidal people experience has started to emerge in the public sphere, but, simultaneously, there is a deep, emotional, affective reluctance to change the status quo regarding the kind of support and accompaniment we offer to suicidal people and the self-determination we allow them to have. In the spirit of Medina (2017, 249), who calls on us to “radically rethink [our] most familiar experiences,” I call herein for thinking outside the box about our relationship to suicidality and suicidal people and for an epistemology of resistance for suicidal people, which I delineate in the following chapters. To better understand this epistemology of resistance, the last pages of this chapter are dedicated to explaining how the epistemology of ignorance functions through various forms of epistemic injustice.
1.4.2. Suicidality and Epistemic Injustice: Testimonial and Hermeneutical Injustice
One important concept that has emerged following Spivak’s notion of epistemic violence is the notion of “epistemic injustice,” coined by philosopher Miranda Fricker.61 This first subsection explains the two types of epistemic injustices Fricker (2007, 1) identifies in her work—testimonial injustice and hermeneutical injustice—which have become foundational to subsequent related notions. While the former type refers to lack of credibility of some people’s voices in the eyes of dominant groups simply because they belong to marginalized communities, the latter refers to the idea that marginalized individuals do not have easy access to the theoretical tools needed to understand and explain their oppression:
Testimonial injustice occurs when prejudice causes a hearer to give a deflated level of credibility to a speaker’s word; hermeneutical injustice occurs at a prior stage, when a gap in collective interpretive resources puts someone at an unfair disadvantage when it comes to making sense of their social experiences. An example of the first might be that the police do not believe you because you are black; an example of the second might be that you suffer sexual harassment in a culture that still lacks that critical concept.
In a subsequent piece coauthored with philosopher Katharine Jenkins, Fricker discusses hermeneutical marginalization, theorized in her earlier work and conceptualized as a precondition to hermeneutical injustice (Fricker and Jenkins 2017, 268). Fricker and Jenkins (268) explain that “someone counts as hermeneutically marginalized insofar as they belong to a social group that under-contributes to the common pool of concepts and social meanings.” In other words, hermeneutical marginalization happens when someone—for example, a disabled person—does not have the same opportunity to build knowledge regarding disability because they are excluded from (or their opinions and ideas are less valued in) certain forms of employment and knowledge-building communities, such as academic milieus, decision-making processes, or public policy development.
Suicidal people experience both types of epistemic injustices as well as hermeneutical marginalization. First, testimonial injustice is produced by interlocking sanist, suicidist, and paternalist views, which perceive the judgment of suicidal people to be irrational, incompetent, illegitimate, or alienated and destroy the suicidal subject’s credibility and agency. In that sense, suicidal people’s voices are invalidated. In other words, suicidal subjects are often not seen to be as knowledgeable as others (be they suicidologists, critical suicidologists, health care professionals, or activists/scholars in anti-oppressive social movements/fields of study) on the topic of suicidality, since their perspectives and viewpoints on life and death are invalidated, discredited, and seen as biased by mental illness, social oppression, or political alienation. Second, as a group, suicidal people lack the conceptual tools necessary to understand their experiences outside the mainstream curative and suicidist preventionist frameworks and to make them intelligible to others. This experience represents a form of hermeneutical injustice. As we saw earlier, no matter what model one uses to theorize suicidality, suicide is not considered a valid option for suicidal people and hence is not rendered intelligible or rational. This limitation does not mean that suicidal people are unable to develop analytical tools to interpret suicidality from a different perspective or that they lack the capacity or agency to do so; it simply illustrates that a scarcity of theories, notions, and concepts exist to help them conceptualize their experience as part of a larger system of oppression rather than as an individual problem. For example, the fact that suicidal people find it difficult or impossible to reach out to prevention services or to their relatives to discuss their suicidality—and that they think that it is their own responsibility to do so—demonstrates the difficulty in conceptualizing their personal experiences as part of a larger oppressive, suicidist system that produces violence and discrimination toward suicidal subjects when they speak openly. Similar to the sexual harassment victims in Fricker’s example, who are aware of and understand the violence they suffer without having access to official concepts to name this lived experience, suicidal people have (or could develop) language and knowledge about their reality, but their experiential knowledge is simply dismissed, labeled as unscientific and unintelligible, as their testimonials demonstrate (Krebs 2022). Until recently, concepts such as suicidism and compulsory aliveness were not available to help make sense of the suicidal experience outside the preventionist script. Even when suicidal people succeed in theorizing their realities outside the dominant suicidist framework, nonsuicidal people, health care professionals, and various activists/scholars practice “willful hermeneutical ignorance” (Pohlhaus 2012, 715), which consists of rejecting the new ideas, perspectives, and conceptual tools elaborated by suicidal people. In this case, willful hermeneutical ignorance would involve denying or dismissing the importance of structural suicidism and its negative impacts on suicidal people. It could also consist of delegitimizing the requests made by some suicidal people—for example, for suicide-affirmative health care—on the pretext that they are too mentally incompetent or too alienated by oppressive systems to decide for themselves. Third, hermeneutical injustice is partly founded on suicidal subjects’ experience of hermeneutical marginalization. As demonstrated earlier, suicidal people are not (or rarely) invited to contribute to knowledge construction on suicidality, both in suicidology and in critical suicidology. This marginalization makes the theorizing of suicidist oppression even more challenging for suicidal people, who are often excluded from spaces and venues where we critically reflect on suicidality. Hermeneutical marginalization feeds hermeneutical injustice, and hermeneutical injustice accentuates hermeneutical marginalization.
1.4.3. Suicidal Subjects, Preemptive Testimonial Injustice, and Testimonial Smothering
Fricker and Jenkins (2017) also expand on a notion developed by Fricker ten years earlier: a “pre-emptive form of testimonial injustice” (272), defined as “an advance credibility deficit sufficient to ensure that your word is not even solicited” (273). In the case of disabled people, for example, the media often does not solicit them or does so only to confirm ableist scripts and narratives that depict disabled people as tragic figures or as supercrips who overcome their disability (Clare 2009; Kafer 2013; McRuer 2006, 2018). In a similar fashion, suicidal people experience preemptive testimonial injustice when, in addition to their voices being dismissed entirely, their testimonials are often solicited only to present a tragic or overcoming narrative. As a result, we are exposed to only a “narrow subset” (Fricker and Jenkins 2017, 273) of experiences, comprising mainly those of ex-suicidal people, who adopt a suicidist preventionist script that aims to show that once they obtained the help they needed—be it chemical, psychological, social, or political—they reevaluated their wish to die. In sum, based in part on hermeneutical marginalization, a scarcity of suicidal people’s discourses exists in the public sphere; furthermore, when we collectively allow their testimonials to emerge, based on preemptive testimonial injustice, the voices solicited are those of ex-suicidal people who reproduce dominant discourses on suicidality to give hope of overcoming suicidality to those who might be contemplating suicide.
In addition, a wide variety of suicidal narratives is further shut down by what Dotson (2011, 237) calls “testimonial smothering.” When marginalized groups testify publicly about their experiences, testimonial smothering pushes them to voluntarily conceal parts of their testimonials or transform their messages to make them more palatable to certain audiences. Testimonial smothering is a form of “self-silencing” (Medina 2017, 257) or self-censorship that occurs when people face an unwelcoming environment. For example, some disabled people might be tempted to soften their critiques of ableism in the media to convince an audience of the importance of accessibility. In the case of suicidal discourses, most testimonials are, unsurprisingly, narrated in the past tense and express what Borges (2019) calls passive suicidal ideation, as if revealing current and active suicidal ideation is so threatening to dominant conceptualizations of suicide, with so many damaging consequences for suicidal people, that current and active suicidal subjects are denied the chance to speak their truth. Critchley (2019), who comes out as suicidal in his essay on suicide, reassures readers that they do not have to worry about him and that his writing does not constitute a suicide note. This example is but one showing suicidal people’s burden to reassure their readership, audiences, and relatives when talking about their suicidality and one form of testimonial smothering. Furthermore, the literature in traditional and critical suicidology is replete with statements about the normality of suicidal ideation (or “passive” suicidality) and the problematic nature of suicidal actions or attempts (“active” suicidality). Indeed, in the abundant literature consulted, several authors agree that expressing suicidal feelings should be encouraged but that expressing a desire to act upon those feelings is not and should be prevented. In that sense, I wonder whether some testimonials on suicide that we read or hear in the public sphere are smothered to present a past or passive narrative of suicidality instead of a current and active one to make a difficult topic palatable to a nonsuicidal audience.
I can testify that testimonial smothering is at work in my case. While I generally use an autoethnographic methodology in most of my work on disability and trans issues, mobilizing my personal experiences as a trans and disabled/Mad man to theorize social and political issues, I did not automatically turn to subjective suicidal experiences in my previous work on suicidality. Despite having published multiple articles and chapters on the topic, it was only after working in this field for a few years and obtaining tenure at my university that I decided in one of my articles (Baril 2020c) to “come out” as suicidal, yet only in a footnote and only after being questioned about my position/situatedness by one of the reviewers of the article. In other words, in previous publications, I voluntarily concealed information about myself and my experience of suicidality to make my thesis and arguments more credible to my audience as well as to avoid generating a “panic” reaction from editors, reviewers, colleagues, and readers were I to reveal being currently suicidal. In sum, preemptive testimonial injustice and testimonial smothering contribute to ignorance and willful hermeneutical ignorance regarding suicidal people’s experiences, since some testimonials are simply not elicited, do not circulate in the public sphere, or are transformed to fit suicidist scripts. Thus, the deadly silencing circle of epistemic violence is perpetuated.
1.4.4. Suicidism, Epistemic Silencing, and Epistemic Death
The epistemic silencing experienced by some marginalized groups, such as racialized people or, as I argue, suicidal people, may be so pervasive that it leads to epistemic death. This notion, coined by Medina (2017), is inspired by the notion of “social death” theorized in 1982 by sociologist Orlando Patterson regarding people who cannot obtain the status of subjects deserving of rights and liberties.62 Several authors following Patterson have theorized the notion of social death. For example, scholar Lisa Marie Cacho (2013) discusses the historical, cultural, and political death of racialized people, particularly those vulnerable to various forms of expulsion, deportation, confinement, or incarceration. Regarding the social death of inmates in solitary confinement, philosopher Lisa Guenther (2013, xxiii) states, “What makes social death different from milder forms of exclusion is its intensity, its pervasiveness, and its permanence.” Similarly, I conceptualize social death as the designation of certain people as less than full citizens, leading to violations of their basic human rights (forced institutionalization and confinement, restraints, and so forth) and to their pervasive delegitimization, marginalization, exclusion, or stigmatization. Social death enables violence against such individuals and can be a condition of extreme vulnerability, as is the case for suicidal people.
Medina (2017, 254) argues that epistemic death “occurs when a subject’s epistemic capacities are not recognized and she is given no standing or a diminished standing in existing epistemic activities and communities.” Extending Fricker’s original distinction between testimonial and hermeneutical injustice, Medina (2017, 255) further develops the idea of epistemic death by distinguishing between testimonial and hermeneutical death. Testimonial death refers to the impossibility of expression because of the total discrediting of a person’s voice. Hermeneutical death refers to the absence of theoretical or conceptual tools for them to make sense of their realities and to make those realities intelligible to others. I contend that the notions of epistemic, testimonial, and hermeneutical death, as theorized by Medina in the context of racism, are useful for thinking about suicidality. As I have shown in this chapter, suicidal subjects experience epistemic silencing to an extent that leads to epistemic death. Indeed, suicidist contexts condemn most suicidal people to silence and push them to complete their suicide without having reached out to anyone. This is particularly true, as I show in Chapters 2 and 3, for racialized people and other marginalized groups, including queer and trans people and disabled/Mad people, for whom contact with a suicide hotline and the deployment of emergency services often involves high levels of violence by police officers and paramedics. For suicidal people, epistemic death is often followed by material death. When suicidal people openly discuss their desire to die by suicide, the suicidist preventionist script, combined with the injunction to live and to futurity, casts their discourses as mad, irrational, alienated, or simply unacceptable. Their view of suicide as an option is not given “minimal amounts of credibility,” to reuse Medina’s words (255), and therefore, unless they adopt the suicidist preventionist script (“I will not do it, I want help to overcome my suicidal ideation”), they are not considered as subjects in the testimonial and communicational exchanges on suicidality. In that sense, suicidal subjects experience a particularly pervasive form of testimonial death. In addition, they also experience hermeneutical death because, as Medina (2017, 255) describes, they are “prevented from participating in meaning-making and meaning-sharing practices.” From my perspective, the absence of theorization of suicidism and its negative consequences on suicidal people is the most powerful proof that suicidal people experience a form of hermeneutical death. Proposing suicidism as a theoretical framework aims to combat this hermeneutical death and to bring hermeneutical justice to suicidal subjects.
This chapter draws on several trends in gray and scientific literature on suicidality, from mainstream to critical suicidology, including sociological/social accounts of suicidality and philosophical considerations. After reviewing four key models of suicidality—medical, public health, social, and social justice—that see suicidality as a problem to eliminate, I have identified limits to those models and the suicide prevention strategies they put forward, including reproducing forms of sanism and suicidism. While the alternative conceptualizations I have presented offer fruitful avenues for questioning the inherent negativity, irrationality, and unintelligibility usually associated with suicide, and even for interrogating, in some cases, the injunction to live and to futurity by conceptualizing suicide as a potentially viable option in certain circumstances, I have demonstrated that these alternative conceptualizations of suicidality also have skeletons in their closets. By theorizing suicide mostly as a private, personal, individual decision and by thinking about suicidal people’s rights as negative rather than positive rights, these innovative theories still passively reproduce forms of suicidism, since the oppression experienced by suicidal people and the support they deserve to end the criminalization, marginalization, incarceration, and pathologization they face remain undertheorized from an anti-oppressive approach. In short, despite the wide range of activists and authors who have dedicated a great deal of thought to suicidality, none has named the suicidist systemic violence suicidal people face on a daily basis or the kind of help and support we would need to offer them to end the structural, ideological, and material suicidist violence they experience. I contend that developing a greater accountability toward suicidal people and taking into consideration the oppression they face would definitely enrich and expand our anti-oppression and intersectional analyses. Suicidality, like racialized status, gender identity, class, age, and dis/ability, is one component of identity that is interlocked with others. Furthermore, suicidism is deeply intertwined with other oppressive systems, as shown in this chapter. Therefore, a better understanding of suicidism in combination with ableism, sanism, ageism, racism, classism, and cisgenderism, to name but a few oppressions, would certainly shed a clearer light on the difficult lived experiences of the most marginalized in our societies, such as LGBTQ people, who are often overrepresented in statistics regarding suicidal ideation, as discussed in the next chapter.