CRIPPING AND MADDENING SUICIDE
Rethinking Disabled/Mad Suicidality
Bear, it’s been over a decade since you killed yourself, and still I want to howl. [ . . . ] Once a week, maybe once a month, I learn of another suicide. [ . . . ] They’re queer, trans, disabled, chronically ill, youth, people of color, poor, survivors of abuse and violence, homeless. [ . . . ] Bear, I’d do almost anything to have you alive here and now, anything to stave off your death. But what did you need then? Drugs that worked? A shrink who listened and was willing to negotiate the terms of your confinement with you? A stronger support system? An end to shame and secrecy? As suffering and injustice twisted together through your body-mind, what did you need? I could almost embrace cure without ambivalence if it would have sustained your life. But what do I know? Maybe your demons, the roller coaster of your emotional and spiritual self, were so much part of you that cure would have made no sense.
—ELI CLARE, Brilliant Imperfection: Grappling with Cure
ELI CLARE, a disabled, queer, and trans activist and writer, eloquently captures the complex affects, questions, doubts, and reflections that people struggle with when a relative or friend completes suicide. In his book Brilliant Imperfection, Clare explores the complexity surrounding the notion of cure for bodyminds that differ from ableist/sanist norms. He contends that cures cannot be viewed in a reductive way and must be understood in all their complexity. According to Clare (2017, xvi), cures are real “knots of contradictions.” While he is careful not to label every curative intervention as violent, so as not to condemn the cure-seeking of some disabled/sick/ill/Mad people, he reminds us how the emphasis placed on cure, on the normalization of disabled bodyminds, already somewhat situates cure on a horizon of violence. In his book, Clare mobilizes the same sensitive approach to briefly discuss suicide and assisted suicide. Clare shares with humility his sadness, loss, and incomprehension following his friend’s suicide. The challenges of repeatedly losing friends and acquaintances targeted by cisgenderism, racism, classism, and ableism have caused Clare to admit that he “would do almost anything” (64) to save Bear’s life, including what is nearly unbelievable from Clare’s perspective—that is, to “almost embrace cure without ambivalence” (64). Those quotes illustrate the difficult feelings that arise when a suicide occurs. Such emotions have the power to lead us, like Clare, to positions that we would otherwise avoid. Whereas Clare invites us to sit with him and his nuanced reflections on the topic of cure, heated debates rage among disability/Mad activists/scholars on the question of suicide and assisted suicide.
Actually, it would be more precise to note that disputes relate to assisted suicide, as suicide itself is often not discussed or seen as an option by an overwhelming majority of disability/Mad activists/scholars. As surprising as it sounds, suicidality remains undertheorized in critical disability studies and Mad studies. For example, the canonical Disability Studies Reader, fourth edition (Davis 2013b), includes for the first time one text directly addressing suicide (Puar 2013). This silence about suicidal people is also at work in most key disability/crip studies monographs cited in this book. Even more surprising, most books in Mad studies do not directly address the question of suicide.1 For example, in the recent Routledge International Handbook of Mad Studies (Beresford and Russo 2022), among almost forty contributions to the edited volume, only one chapter, presenting excerpts from David Webb’s Ph.D. thesis (an author in suicidology discussed in Chapter 1) written in the early 2000s, discusses suicidality. In the edited volume Psychiatry Disrupted (Burstow, LeFrançois, and Diamond 2014, 10–13), the editors note seven groups (e.g., trans people, Indigenous people, older adults) who are not extensively discussed in their book, but suicidal people are not mentioned. Despite suicidal people’s high rates of psychiatrization, pathologization, forced institutionalization, and treatment like Mad people, suicidal people are not included among the underanalyzed groups in the book, and suicide remains absent from the index.2 Another example can be found in Liat Ben-Moshe’s brilliant book (2020) on disability, madness, and incarceration. While the author focuses from an abolitionist perspective on the experience of disabled/Mad people who live through various forms of incarceration, suicidality is surprisingly mentioned only twice in the book. When discussed, suicidality represents a foil in the fight against carceral logic; prison and incarceration are causing suicidality. These examples are only a few among many that illustrate how suicidal people’s intersecting realities and oppressions are erased or forgotten when it comes time to discuss topics relevant to them, such as disability/madness.
Contrary to queer and trans activists/scholars who are vocal about LGBTQ suicidality but silent on the question of assisted suicide, disability/Mad activists/scholars remain relatively silent on suicidality but are very engaged with assisted suicide in reaction to neoliberal governments’ ableist/sanist laws on assisted death, euthanasia, medical assistance in dying, or practices that I refer in this book as forms of assisted suicide. In response to many bioethicists’ acritical endorsement of ableist/sanist biases devaluing the lives of disabled/Mad people and their push for a liberalization of regulations regarding various forms of assisted suicide, disability/Mad activists/scholars have reacted vehemently (Reynolds 2017; Wieseler 2016, 2020). Their reaction has been aimed at the eugenic logic encouraging the extermination of disabled/Mad people, before they are born through genetic testing and once they are alive through laws that encourage their death. As I demonstrate in this chapter, most disability/Mad activists/scholars, with whom I completely agree, see the availability of assisted suicide only for disabled/sick/ill/Mad people as the worst possible manifestation of ableism and sanism. I would add that it is also deeply suicidist, as I show in the next two chapters.
Before continuing this discussion, I would like to point out three caveats. First, by combining disability/crip studies and Mad studies, it is not my intention to conflate these social movements/fields of study and to minimize the debates between them as well as the forms of oppression they reproduce toward each other (Thorneycroft 2020). Indeed, the Mad movement and the anti-psychiatry movement (themselves distinct on many levels, as Burstow [2015] reminds us) have often, in their legitimate quest to depathologize Mad people, reused ableist logic and arguments, such as the idea that psychiatric treatments imposed on Mad people physically disable them. Similarly, the disability movement’s focus on physical disability has often excluded Mad people and left sanist biases unexamined. However, as in Chapter 2’s discussion with respect to queer and trans social movements/fields of study, I believe that a heuristic value exists in theorizing them together in relation to suicidality, given the similar analysis presented by activists/scholars in disability and Mad circles.
Second, the terms disability and madness used here are umbrella terms, which aim to be inclusive of a wide range of realities, including physical and sensory disability, chronic conditions or illnesses, and what is sometimes called “mental disability” (Price 2011). My use of the term mental disability, following authors in critical disability and crip studies, refers to a variety of realities: cognitive disabilities, learning disabilities, neurodiversity, and a variety of psychological and emotional issues, sometimes called mental illnesses (e.g., schizophrenia, psychosis, anxiety, or depression; Mollow 2006; Nicki 2001; Price 2011). I therefore consider psychological and emotional suffering a form of mental disability, and I often refer to mental disability as madness in the spirit of Mad studies. I am aware that much debate in disability/Mad communities exists surrounding the classification of depression and other forms of emotional suffering as forms of disability or illness. Despite these debates, studies of suicidal people make one thing clear: Psychological and emotional suffering in the forms of hopelessness, despair, and sadness characterize a majority of suicidal experiences, regardless of the origin (individual, social, or both) of this suffering. While the realities of chronically ill people, healthy disabled people, and Mad people (including suicidal people) cannot be conflated, the goal of grouping these diverse people into the category of disabled/sick/ill/Mad people has heuristic value in terms of analyzing some common forms of violence, exclusion, incarceration, and delegitimization they face.
Third, this chapter is dedicated to suicide and not assisted suicide, which I explore in Chapters 4 and 5. However, in disability/Mad circles, the literature on suicide from a social justice perspective is scarce, and in most cases it is accompanied by commentaries on assisted suicide. Suicidality often remains in the shadows, hidden behind discussions focused on assisted suicide. In this literature, an overwhelming number of authors take a stance against assisted suicide (and, simultaneously, suicide itself),3 evoking its eugenic logic; a minority endorses assisted suicide for disabled/sick/ill people based on arguments about autonomy and self-determination,4 while a few others try to go beyond this binary debate.5 Despite their fierce disagreements over assisted suicide, these authors all leave unquestioned the suicidist preventionist script regarding suicide itself. Indeed, be they for or against forms of assisted suicide for disabled/sick/ill/Mad people, they continue to reaffirm the necessity of preventing suicide, adhering to the injunction to live and to futurity and contributing to somatechnologies of life that affect suicidal individuals.
In this chapter, I propose a cripping and maddening of suicidality. Originally used to insult disabled and Mad people, the terms crip (from crippled) and mad have been reclaimed by those communities and have become vectors of positive resignification. In this movement from derogatory usage to proud affirmation, cripping and maddening also emerged as verbs.6 In a seminal text at the intersection of queer and crip studies, scholar Carrie Sandahl (2003, 137) proposes using queer and crip this way:
To resist the negative interpellations of being queer or crippled [ . . . ], members of both groups have developed a wry critique of hegemonic norms. In queer communities, the application of this critique has been given its own verb: to queer. [ . . . ] Similarly, some disabled people practice “cripping.” Cripping spins mainstream representations or practices to reveal able-bodied assumptions and exclusionary effects. Both queering and cripping expose the arbitrary delineation between normal and defective and the negative social ramifications of attempts to homogenize humanity, and both disarm what is painful with wicked humor, including camp.
As Robert McRuer (2006, 31–32) reminds us, crip theory, like queer theory, occupies a role of opposition or confrontation in relation to dominant norms—in this case, able-bodied-minded norms. It opens up imaginaries and possibilities about disability that would otherwise be shut down by ableist and sanist ideologies and structures. Cripping allows us to integrate a critical disability and crip lens into our reading of certain phenomena, as I do here with suicidality. McRuer (2018, 23–24) mentions that “cripping also exposes the ways in which able-bodiedness and able-mindedness are naturalized and the ways that bodies, minds, and impairments that should be at the absolute center of a space or issue or discussion get purged from that space or issue or discussion” (emphasis in the original). While I think that disability/madness should be “at the absolute center” of discussions and reflections within critical suicidology, since suicidal people are deemed “ill,” “sick,” “mad,” “insane,” “crazy,” and “irrational” for wanting to die, disability/madness “get[s] purged from that [disciplinary] space” due to a movement of quasi-repulsion regarding explanations of suicidality not based on a strictly sociopolitical framework. Mental disability/illness and madness are terms that have been expunged from critical suicidology, and when authors do use them, it is almost always to distance suicidality from mental disability/illness/madness. In that sense, cripping critical suicidology invites us to rethink the space accorded to disability/sickness/illness/madness in that field and the conflicted relationship critical suicidologists have with disability/madness. As I note in previous work regarding the distancing of trans activists/scholars from disability, “the problem resides, I believe, not in the concept of transness as disability, but in individualist, ableist, pathologizing views of disabilities” (Baril 2015, 66). The same is true for suicidality: The problem resides not in conceptualizing suicidality through mental illness, disability, or madness, but in the individualist, ableist/sanist, medical/psychological, pathologizing view of mental disability/illness/madness. Cripping, and particularly maddening, critical suicidology permits an engagement with the intersections of suicidality and mental disability/illness/madness from renewed and critical perspectives instead of embracing the individualist and problematic view of suicidality as deriving from mental illness, as is proposed in the medical model.
While used in the field of Mad studies, the verb to madden has yet to be theorized more systematically. Ryan Thorneycroft (2020, 110) discusses the emerging usage of the verb: “While cripping has entered disability discourse, maddening is a practice that is under-explored and under-theorised. Maddening also involves processes that demand people step back from the ‘known’ and the normative, whereby Mad people engage in practices that expose and critique sanist assumptions, expectations, practices, and effects [ . . . ]. Cripping and maddening involves disrupting and subverting ableism and sanism.” Cripping and maddening suicidality involves highlighting forms of ableism/sanism in critical suicidology scholarship that, despite endorsing a social justice and intersectional approach, have yet to deconstruct some biases in relation to disability/sickness/illness/madness. Cripping and maddening suicidality also means pushing critical disability/crip/Mad studies to engage critically with suicidality instead of casting it as a by-product of ableist/sanist and carceral ideologies and structures. It is in the spirit of cripistemologies, a term coined by Merri Lisa Johnson7 that values the centrality of disabled/Mad people’s knowledge, that I write this chapter.
This chapter is divided into three sections. The first reviews discourses on disabled/Mad suicidality through an examination of debates among disability/Mad activists/scholars surrounding assisted suicide from various perspectives: those who are opposed to assisted suicide and those who are proponents of it. After demonstrating that, regardless of their perspectives, all these discourses constitute forms of somatechnologies of life that perpetuate suicidism and compulsory aliveness, I critique some of their most detrimental effects on suicidal people. This first section also analyzes the reflections of critical suicidologists regarding the suicidality of disabled/Mad subjects. The second section explores two venues where alternative discourses on suicidality are put forward: several contributions to the webzine Mad in America and the disability justice movement. The last section adopts a cripistemology that allows for a cripping and maddening of suicidality. Inspired by disabled/crip/Mad activists/scholars who critique the medical and the social models of disability and put forth a third model that I call the socio-subjective model of disability, I use this model to rethink suicidality.
3.1. Discourses on Disabled/Mad Suicidality as Somatechnologies of Life
Leah Lakshmi Piepzna-Samarasinha (she/they), a queer, nonbinary femme and disabled person of color who is an artist, writer, and educator on disability justice, powerfully demonstrates how suicidality remains taboo, even in anti-oppression circles (2018, 174–175):
If anyone came at me saying, HAVE YOU THOUGHT ABOUT KILLING YOURSELF LATELY?, I’ d automatically lie and say, hell no. The way I have to every single doctor, social worker, and most therapists in my life. Like any smart crazy, I don’t want anything I can prevent on my permanent record, and I definitely don’t want Danger to Self or Others. I’ve been fighting this my whole life, and I’ve seen the oppression and hardness that label can mean to folks. But if you normalized it. Because it is normal. This secret. That so many of us wrestle with suicidality. Then maybe, maybe, just maybe I’d tell you where I was at. (emphasis in the original)
Piepzna-Samarasinha identifies forms of ableism/sanism as barriers in social movements preventing honest conversations about suicidality. The discomfort she expresses about revealing her suicidality shows that somatechnologies of life are at play, not only through formal suicide prevention channels but also within anti-oppression milieus, and take the forms of interlocked suicidist and sanist discourses and practices. This chapter analyzes soma-technologies of life produced by these discourses on disabled/Mad suicidality.
While a large body of literature on mental health and suicide exists, studies are rarely conducted from a disability/Mad perspective. A few empirical studies have been conducted regarding the rates of suicidality among disabled/Mad people. For example, David McConnell and colleagues (2016) report that people who self-identified as disabled among the 19,740 Canadians they surveyed—namely, 25 percent of their sample—were three-and-a-half times more likely to have had suicidal ideation in the past year compared to able-bodied people. Suicidality was explained, among other factors, by pointing to ableist barriers, such as marginalization, poverty, and stigmatization. This risk was much higher when “psychiatric morbidity” (e.g., anxiety or mood “disorders”), as described by the authors, was present (521). McConnell and colleagues conclude that disabled people are more at risk for suicidality and that people who identify as having “psychiatric disorders” are at even greater risk compared to other disabled people. However, they reiterate that suicides remain rare in disabled communities, as is the case in the rest of the population. Another quantitative study by Emily M. Lund and colleagues (2016) surveyed five hundred Americans, presenting hypothetical vignettes of suicidal people, to discover whether disability status elicited a greater acceptance of suicidality. Of their participants, 19 percent self-identified as disabled. While the research team hypothesized that being disabled or having a relative who was disabled would decrease the acceptance of suicide, their study did not validate that hypothesis. In all vignettes presented, when the hypothetical cases involved a disabled person, suicide was seen as a more acceptable choice by able-bodied and disabled people (Lund et al. 2016, 32). Furthermore, the acceptance of suicide was greater when the disability was visible. Lund and colleagues (2016, 33) conclude that their findings have implications for suicide prevention:
This study found that suicide was generally viewed as more acceptable when the hypothetical suicidal individual had a disability than when they did not. [ . . . ] If individuals with disabilities who are experiencing suicidal ideation receive a social message that their disability makes suicide more acceptable or understandable, they may feel that they have implicit social permission to commit suicide; in other words, the message of “suicide is not an option” could instead be conveyed as “suicide is not an option for everyone, but it is an option for you.” Greater acceptability of suicidality in people with disabilities could convey to individuals with disabilities who are suicidal and reaching out for help that their feelings of hopeless are justified and even rational.
The conclusion of this study confirms the fears expressed in disability/Mad communities for years. The aphorism “better dead than disabled” is often evoked in disability/Mad circles to denounce negative judgments and misconceptions stemming from ableist/sanist biases about the quality of life of disabled/Mad people, which lead to the approval of forms of assisted suicide for them but not for the rest of the population (Coleman 2010; Kafer 2013; Reynolds 2017; Wieseler 2016, 2020). The following pages explore the reflections of disability activists/scholars on this double standard regarding the prevention of suicidality.
3.1.1. Disability and Assisted Suicide: Suicide Prevention Exceptionalism or a Right to Autonomy?
According to disability activist Diane Coleman (2020, para. 3), ableism by proponents of assisted suicide is “so extreme that they want to carve a vaguely defined segment of old, ill and disabled people out of suicide prevention, enlist our healthcare system in streamlining our path to death, and immunizing everyone involved from any legal consequences, thereby denying us the equal protection of the law.”8 The right-to-die exception regarding the suicidality of disabled/sick/ill people, in comparison with those regarded as able-bodied and healthy, has shaped the binary opposition between suicide and assisted suicide, regardless of how the latter is framed and named (e.g., physician-assisted death, assisted death, assistance in dying, medical assistance in dying, medically assisted death, or voluntary euthanasia). Catherine Frazee (2020), a disabled activist/scholar engaged in the debates about Canada’s medical assistance in dying (MAID) law, points out the law’s double standard, as it targets only disabled/sick/ill people. She asks, “Why us? Why only us?” (2020, para. 5). Frazee wonders why the same “death on demand” (para. 8) is not offered to everyone and identifies ableism as the culprit of this exceptionalism. She implores Canadians to react to such an extreme form of discrimination toward one group and take action against this institutionalized violence. Frazee is not the only one to denounce the availability of assisted suicide only for certain groups of marginalized people. This exceptionalism has long been critiqued by disability activists/scholars, and I completely agree with them on that matter. The current laws in various national contexts are built on double standards and deep forms of ableism and ageism.9 As expressed at the beginning of this section by Coleman (2018, para. 1), who is involved in the U.S. disability rights group Not Dead Yet, assisted suicide is perceived by most disability activists/scholars as the ultimate form of ableism, treating disabled people “as disposable.” The ableist culture of disposability is compared, in some cases, to Nazi exterminations and is seen by disability activist/scholar Paul K. Longmore as “the ultimate act of oppression” (2003, 168).
Carol J. Gill has dedicated several articles to what she calls “selective” suicide interventions that marginalize disabled people. The importance of her writing on the topic justifies the extent to which I refer to her work in this chapter. In one of her first articles dedicated to disability and suicide, Gill points out double standards about suicidality based on disability status, which exist in society and among health care professionals. When an able-bodied individual expresses a wish to die, they are characterized as suicidal and targeted by suicide prevention interventions, but when this individual is disabled, the desire to die is recast as normal, rational, “natural,” or “reasonable” (Gill 1992, 39), a categorization that represents, according to Gill (1999, 180), “the most dangerous form of discrimination we have ever faced.” Gill (2004, 178–179) further argues that proponents of assisted suicide adhere to three postulates that contribute to this devaluation: (1) Disability causes despair and depression, (2) this despair is irreversible and irremediable, and (3) suicide prevention should not be pursued when the despair is founded in disability/sickness/illness. As Gill (2004, 179) contends:
Those assumptions have triggered the charge from disability activists that assisted suicide is blatantly discriminatory. The practice, they point out, is not universally offered to all adult citizens but is offered only to persons who have incurable biological defects. Moreover, the practice calls for a two-tiered response from health professionals: if the individual has an incurable disabling condition, the wish to die can be judged rational and the individual can be helped to die, whereas “healthy” individuals who wish to die are given suicide intervention to save their lives.
Along the same lines, I have argued that there is an “ontology of assisted suicide” (Baril 2022)—that is, what assisted suicide is, its foundation on pervasive forms of ableism/sanism (among other oppressive systems), and its basis in the systemic dismissal of the quality of life of disabled/sick/ill people (an argument to be further explored in Chapter 4). This ontology creates “two classes of suicidal subjects by considering physically disabled or ill people as legitimate subjects who should receive assistance in dying and suicidal people as illegitimate subjects who must be kept alive” (Baril 2017, 201). Although disability activists/scholars denounce the double standard and exceptionalism about the suicidality of disabled/sick/ill people, they do not question the postulate according to which the second class of suicidal subjects is targeted by the injunction to live and to futurity.
Generally, disability activists/scholars have approached suicide and assisted suicide from an anti-ableist perspective, arguing that impairments are not the primary or the only source of suffering; despair and the wish to die stem from ableist oppression, which pathologizes and discriminates against disabled/sick/ill people. They contend that ableist oppression shapes suicidality and that the remedy for this despair should not be to seek individual solutions through suicide or assisted suicide but to address the social, political, medical, legal, and economic conditions at the root of the problem.10 While no absolute consensus exists within disabled/sick/ill communities, suicide and the request for assisted suicide are generally critiqued. Disability activists/scholars insist on the fact that the notion of autonomy put forward by assisted suicide proponents is individualistic and does not take into account the contexts, structures, and oppressions that influence people’s choices (Braswell 2018; Ho 2014). As many authors argue, disabled/sick/ill people’s decisions to die rely on a false notion of autonomy (Coleman 2010; Gill 1992, 1999, 2004; Longmore 2003). Suicide is seen not as a free choice but as the result of unlivable ableist/sanist and carceral cultures (Ben-Moshe 2020).
Similar to the ways in which many queer and trans activists/scholars depict suicide as a form of internalized heterosexism and cisgenderism, many disability activists/scholars conceptualize suicidality as a form of self-hatred and violence turned against the self. Gill (1999, 174) argues, “Surrounded by invalidation, it is hard not to learn self-hatred. Hatred of the disabled self is an intense internal pressure impelling some individuals toward self-annihilation.” In that sense, suicide is seen as a form of murder of the self. Many authors discuss how ableist stereotypes regarding disabled people, such as being a burden on others and losing dignity, are internalized and fuel a desire to die, be it by suicide or assisted suicide (Amundson and Taira 2005; Coleman 2010, 2020). According to these authors, in addition to this internalized oppression, forms of “disability burn-out” exist, as Gill (2004, 180) explains:
Disability oppression can take a toll on the morale of persons with disabilities. After struggling with employment bias, poverty, blocked access to the community and its resources, unaccommodating and selective health services, lack of accessible and affordable housing, penalizing welfare policies, and lack of accessible transportation, some may experience what is known in the disability community as “disability burn-out.” This term refers to emotional despair engendered by thwarted opportunities and blocked goals. It is aggravated and intensified by years of exposure to disability prejudice and devaluation. In fact, a frequently repeated theme in research interviews with persons with disabilities and illnesses is, “I can live with my physical condition but I’m tired of struggling against the way I’m treated.”
Gill distinguishes clearly between despair that supposedly comes from impairments, and despair that is anchored in the structural hurdles disabled people face—hence her endorsement of a social model of disability (a model to which I return later). Like many other activists/scholars, Gill (2000, 536) suggests working at a structural level to eliminate these barriers and to improve the lived experiences of disabled people: “These are socially mediated problems that demand social intervention rather than aid in dying.”
Moving away from the opponents of assisted suicide for disabled people, other disability activists/scholars, whom we might consider the “dissident” voices in the movement, endorse the opposite perspective.11 For example, Andrew Batavia, who took a position in the 1990s in favor of disabled people having the right to access assisted suicide, insists that there is less homogeneity regarding this debate within disabled communities than may appear at first glance. Batavia (1997, 1672) argues that, according to some surveys, most disabled people support assisted suicide based on arguments of autonomy and freedom of choice: “Many persons with disabilities, including me, fundamentally disagree with the opponents’ arguments. We believe that the disability rights movement in this country stands for our right to self-determination—that is, our fundamental right to control our lives, including decisions about the timing and manner of imminent death from a terminal illness.” Contrary to most disabled people, Batavia does not believe that assisted suicide laws rest on ableist foundations: “We do not believe that the right to assisted suicide is premised on our society’s widespread misperception that people with disabilities have a diminished quality of life. It is based on respect for the autonomy” (1672). Other prominent scholars in disability studies, such as Lennard J. Davis, embrace a similar perspective on assisted suicide laws. Davis (2013b, 107) argues that banning physician-assisted suicide (PAS) is “contrary to the kind of world disability studies envision we should all inhabit. Further, I believe that PAS is part of a progressive agenda supported by those who have developed fair and accountable notions of justice, rights, and citizenship in democracies.” As I demonstrate in Chapter 4, contrary to Batavia and Davis, I believe that assisted suicide laws are entrenched in forms of ableism, sanism, ageism, classism, capitalism, or racism and that it is unrealistic to think that some institutions, laws, regulations, or social policies could be exempt from ableism and other -isms.
Karen Hwang (1999) takes a similar position but provides a more nuanced discussion. Disabled herself, she does not identify as a disability activist but takes a firm stance in the debates on assisted suicide. Hwang insists on the diversity of people included in the broad category of disability; while some are healthy disabled people who are not suffering, others experience chronic illnesses and painful conditions that render their lives difficult. In the case of the latter, Hwang contends that people should be allowed to access assisted suicide; preventing them from making that choice only reinforces the idea that disabled people are weak, vulnerable, and incompetent in deciding for themselves. Without negating structural oppression, Hwang brings into the conversation the question of pain, suffering, and subjectivity, realities often brushed aside by those adhering to a social model of disability. While not denying that structural ableism may in part determine an individual’s decision to turn to assisted suicide, Hwang (1999, 184) argues that opponents of assisted suicide, paradoxically, reproduce forms of ableism: “Far from affirming the dignity and worth of individual self-determination, proponents of this position still would rather we abdicate control of our minds, bodies, and lives to those who want to protect us from ourselves. However, given the choice, most of the disabled people to whom I have spoken would choose self-determination over this kind of protection.”
Another prominent disability activist/scholar who is a dissident in the debate on assisted suicide is Tom Shakespeare (2006).12 Well-known for his critique of the limits of the social model of disability, which I address later in this chapter, Shakespeare thinks that the dominance of the social model in disability studies precludes a focus on pain and suffering. He recognizes the importance of structural ableism and its impacts on disabled people’s decisions but believes that casting disabled people as vulnerable individuals in need of special protection when it comes to their end-of-life choices has pernicious effects. Shakespeare argues that various practices, such as voluntary versus involuntary euthanasia or the withdrawal of life-sustaining treatments, are conflated when assisted suicide is discussed by disability activists/scholars and that careful examination of each case is needed instead of a universal condemnation of such practices. He contends that for all other activities, such as eating, dressing, or bathing, disabled people are entitled to support and argues that denying support to execute a wish to die constitutes a discriminatory exception: “Giving disabled people assistance to die would therefore remove an inequality, putting them in the same position as a non-disabled person” (Shakespeare 2006, 124). Shakespeare anchors his argument for supporting assisted suicide in the notions of free choice, liberty, self-determination, and autonomy. Like Hwang, Shakespeare insists that supporting assisted suicide means adhering to strict rules and safeguards about who, how, and when those acts are permitted. He also argues that assisted suicide should be defended simultaneously with actions that promote structural changes to improve conditions for disabled people. I critique, later in this chapter, how many of the authors presented thus far, including those who promote a right to assisted suicide for disabled/sick/ill people, nevertheless reproduce forms of sanism and suicidism. Indeed, proponents of assisted suicide often re-create two classes of suicidal subjects: one that deserves to be helped to die and another that should be saved from committing the irreparable. For example, Shakespeare (2006) reproduces forms of sanism and suicidism by arguing that careful screening must be performed to make sure that those who want access to assisted suicide are not depressed, mentally ill, or suicidal.
Some bioethicists, such as Harold Braswell (2018), suggest that to overcome unproductive debates, we should refuse to take a position on assisted suicide and switch our focus to more pressing issues affecting disability communities.13 While I agree that we need to put more emphasis on what counts in the daily lives of most disabled/sick/ill people—such as independent living, affordable housing, proper access to health care, employment, and social, legal, and economic support—I contend that questions surrounding death are also pressing issues, and I disagree that scholars should avoid taking a position in the debate about assisted suicide. On the contrary, not taking a side is affirming a position. While this debate is complex and requires nuanced thinking to avoid dogmatism, it is clear to me, and to a vast majority of disability activists/scholars, that the ontology of assisted suicide is rooted in deep forms of ableism, sanism, ageism, capitalism, and other oppressions (Baril 2017, 2022). When it comes to assisted suicide, allyship with disabled/sick/ill/Mad/old communities must entail denouncing the ableist, sanist, and ageist violence that has structured, and continues to shape, assisted suicide discussions, regulations, laws, and social policies. Avoiding taking a position or, worse, denying that this violence lies at the core of the ontology of assisted suicide, reproduces (micro-)aggressions toward disabled/sick/ill/Mad/old people. I want to be clear: I firmly denounce the ontological, social, political, and legal aspects of assisted suicide in their current form. Simultaneously, I firmly adhere to a positive right to die, not specifically for disabled/sick/ill/Mad/old people but for all suicidal people, be they disabled/sick/ill/Mad/old or not. As I wrote regarding MAID law in 2017 (212):
Current laws, public policies, prevention strategies and models/discourses on suicide do not represent accountable, pragmatic or compassionate responses toward suicidal people. From a harm reduction approach, focused on the voices and well-being of suicidal people, my goal is not to reform the medical assistance in dying law to include suicidal people, but to propose an entirely different socio-politico-legal project. I suggest that this law should be repealed because it is doubly ableist and propose instead that, regardless of physical condition or imminent death, all people who wish to die, including suicidal people, should have access to medically assisted suicide. (emphasis added)
My position is often mistaken for the position of those proponents of the right to die who want to extend assisted suicide to people who experience psychological suffering (or other forms of suffering) but who continue to adhere to the ableist/sanist/ageist ontological script regarding assisted suicide. As I demonstrate in Chapters 4 and 5, my position is radically different from what has been proposed so far, as it is based on the creation of new anti-ableist, anti-sanist, and anti-ageist forms of support for assisted suicide for suicidal people.
3.1.2. Redefining Madness . . . Except for Suicidal People
Mad activists/scholars, alongside anti-psychiatry activists/scholars, have denounced the mistreatment, violence, and cruelty exercised toward Mad people and the c/s/x community, “an acronym for consumer, survivor, ex-patient, all of which signify particular identity politics or relations to the psychiatric system” (LeFrançois, Menzies, and Reaume 2013, 335). They want to develop another relationship to a wide range of realities, including depression, anxiety, psychosis, schizophrenia, or mania, one that is not governed by the idea that those different ways of being in the world need to be fixed.14 While an increasing number of authors have discussed the epistemic violence Mad people experience through the delegitimization of their voices and credibility as knowledgeable subjects,15 the erasure of suicidal people is not highlighted as a form of epistemic violence in Mad activism and scholarship. Suicidal people’s voices have been erased from the conversations surrounding medicalization and psychiatrization, forced hospitalization/incarceration, and inhumane treatment (e.g., chemical or physical restraints) of Mad people. Suicidal people are brushed aside in those conversations, and the theme of suicidality barely appears in texts on madness. Additionally, suicidality is often reduced and cast as the result of sanist violence (Lee 2013; The Icarus Project 2015) or as a secondary effect of chemical drugs forced upon Mad subjects (Whitaker 2018).
In my opinion, this omission represents a missed opportunity for Mad activists/scholars because being suicidal and being disabled/sick/ill/Mad are not mutually exclusive, and because ableism, sanism, and suicidism are imbricated. Analyzing one form of oppression without the others (as well as other oppressive systems) can provide only a partial insight into the issues faced by disabled/Mad people. Indeed, to give but one example among many, several medical and psychiatric “treatments,” such as forced hospitalization and physical or chemical restraints, are imposed on those considered “crazy” and “mad” who (might) represent a danger to themselves, a danger often associated with suicidality. In other words, a person is often forcibly institutionalized/incarcerated, physically restrained, or involuntarily drugged because they are considered simultaneously “crazy” and suicidal. The “danger” of suicide is also often used by professionals as the ultimate argument to impose forced treatments on Mad people (Kious and Battin 2019). It becomes almost impossible to distinguish between systems of oppression in those cases: Being suicidal is enough to be labeled as “crazy” or “mad”; being “mentally ill” requires a medical/psychiatric “cure,” and coercive treatments are seen as the norm when it comes to people who represent a “danger to themselves.” While the desire to cure disabled/sick/ill/Mad people is vehemently critiqued in disability/Mad social movements/fields of study, surprisingly, the need to cure suicidal individuals, a desire that emerges from the same ableist/sanist medical and psychiatric systems and mobilizes the same kinds of curative narratives and coercive tools, is rarely questioned. Even among the most radical mental health law abolitionists, no consensus exists on the appropriateness of abolishing such law when it comes to suicidal people (Ben-Moshe 2020; Wilson 2018).16
One concrete example of exceptionalism regarding suicidal people in Mad circles can be found in the work of the Fireweed Collective, formerly known as The Icarus Project, a U.S. organization promoting mental health from an intersectional and healing justice lens. Known for its invaluable work in service of the most marginalized groups living at the intersection of madness, mental disability/illness, and other stigmatized identities, the collective aims to approach mental health crises in ways that avoid reproducing oppression toward people in distress. For example, in its 2020 text, “When It All Comes Crashing Down: Navigating Crisis,” the Fireweed Collective offers more than a dozen suggestions for intervention to prevent further harm in cases of mental health crises, including not automatically calling emergency services, as those services can cause more harm than good. However, the organization affirms the importance of using these services if the crisis reaches a certain level of “dangerosity,” explaining, “Sometimes you need to intervene strongly and swiftly if the situation is truly dangerous and someone’s life is really falling apart” (129). According to the collective, calling emergency services becomes a solution particularly when someone is suicidal, to save their life (130):
Calling the police or hospital shouldn’t be the automatic response. Police and hospitals are not saviors. They can make things worse. When you’re out of other options, though, you shouldn’t rule them out. [ . . . ] Be realistic, however, when your community has exhausted its capacity to help and there is a risk of real danger. [ . . . ] The most important thing is to keep people alive. (emphasis in the original)
What is valid for Mad people in crisis does not seem to be applied to suicidal people in crisis by this collective. They argue that suicidal people’s lives need to be preserved—hence they justify calling emergency services, an action that is seen as detrimental when it comes to other marginalized people. However, as Trans Lifeline (2020) demonstrates (Chapter 2), suicidal people who are subject to nonconsensual rescues often suffer from violence and mistreatment; this is particularly the case when they belong to marginalized groups, including disabled, Mad, or neurodivergent people. I wonder, therefore, what justifies this exceptionalism toward suicidal people. While usually offering creative solutions for people in mental distress, the Fireweed Collective seems to retreat to a traditional approach when it comes to Mad people who are suicidal. The collective tries to find good reasons for suicidal people to keep living and to some extent even shames suicidal people who might be considering suicide as a potential option: “There are ways to make your feelings change and your head start working better. If you kill yourself, nothing in your life will ever change. You will be missed. You will never know what could have happened. Your problems are very real, but there are other ways to deal with them” (The Icarus Project n.d., 3). While I agree with the denunciation by Mad activists/scholars of the awful treatment to which Mad people are subjected, I cannot help but think that suicidism is probably one of the most important forgotten points in their rich activism and scholarship. A theoretical framework that combines sanism with suicidism and compulsory aliveness to understand the harsh realities of Mad people in various institutions and (carceral) contexts has the potential to provide a greater understanding of their complex realities.
3.1.3. Critical Suicidology, Disability, and Madness
Whereas disability and Mad activists/scholars are relatively silent about suicidality, critical suicidologists are generally silent about disability/madness. Disability/Mad perspectives are surprisingly absent in critical suicidology, with a few exceptions, such as the work of China Mills (2017, 2018, 2020), to be discussed later. For example, two key critical suicidology volumes discussed in Chapter 1, Suicide and Social Justice and Critical Suicidology, include only one text on disability (by Mills) and no index entries on disability/madness, respectively. This erasure reveals a problematic relationship between critical suicidology and disability/Mad studies: Either disability/madness is brushed aside as something negative, to dissociate it from suicidality, or it is not discussed. In fact, to my knowledge, only two authors in the field of critical suicidology explicitly discuss disability—namely, Mark E. Button (2016) and China Mills (2015, 2017, 2018, 2020).17
Button, a prominent scholar in critical suicidology who has contributed to putting forward the social justice model that politicizes suicidality, briefly discusses in one of his texts the question of disability. In this piece, he endorses without explanation the exceptionalism of assisted suicide for disabled/sick/ill people (Button 2016, 271):
In my view, there is no categorical duty to sustain one’s life [ . . . ] such that suicide could be treated as an absolute moral wrong, and this is especially significant in the context of terminal illness and physician-assisted death. However, I believe that there is a compelling collective obligation, grounded in the moral equality and dignity of persons, to ameliorate the social, economic, and material conditions that are correlated with higher rates of suicide (outside of the medical context of end-of-life decisions).
This passage could be loosely interpreted if it were not for other passages in Button’s text in which he also distinguishes between rational suicides for disabled/sick/ill people and illegitimate suicides based on social and political suffering. Indeed, he seems to adopt a view that it is natural for those who are disabled/sick/ill or at the end of their lives to opt for suicide. Therefore, while there is an urgent need to politicize “suicidal subjectivities” for all subjects, those who are disabled/sick/ill or who are at the end of their lives are excluded from this political analysis: “Outside of the context of end-of-life decisions and related cases where individuals seek an end to terminal illness and/or irremediable physical pain, suicide, and more specifically, the distribution of suicidal subjectivities, is a proper site of political reflection” (278). Button also mobilizes analogies or metaphors that could be interpreted as ableist/sanist, even though his work claims to take up a social justice perspective that aims to address all inequalities, including those related to disability status (276). He often casts suicide as an illness to combat: “Suicide (outside of the context of terminal illness and assisted death) properly belongs among the ills that a socially responsive political theory should confront” (272).
In his desire to combat all forms of suicide, except for those of disabled/sick/ill people, Button (271) evokes a “right to life” that could form the basis of a new social movement or even coalitions with other (right-wing) pro-life groups. Button (2020) mentions the possibility of making alliances with religious and conservative groups to protect the sanctity of life. Here, the injunction to live and to futurity takes on a concrete form and manifests itself in the endorsement of suicide prevention measures that violate people’s fundamental rights through coercive measures and regulations (Button 2020, 99). Clearly, a position validating potentially forced hospitalization, treatment, and the detention of people who represent a “danger to themselves,” as Mad activists/scholars have demonstrated, is detrimental to Mad people and, as I argue, to suicidal people. In other words, despite the invaluable contribution he has made to critical suicidology, Button’s position on suicide and assisted suicide would certainly not gain favor among disability/Mad activists/scholars. We can, however, credit Button for politicizing suicidality. As such, he paved the way for other analysis, such as that of Mills, which discusses the “psychopolitics of suicide.”
In her work, Mills (2015, 2017, 2018, 2020) provides cutting-edge reflections on suicidality and disability, clearly endorsing a disability/Mad ethos. Mills warns us not to reproduce a pathologizing and stigmatizing view of disabled/Mad people when we discuss the negative consequences of various oppressive systems (2020, 80). Furthermore, Mills (78) proposes a “psychopolitics of suicide” as an analytical or theoretical framework to highlight the links between negative affect and the sociopolitical conditions in which people live: “Here mental distress is used politically to draw attention to the way environments and systems can be designed to induce suicidality. This speaks to my long-standing interest in using the analytic frame of psychopolitics to better understand the anxious entanglements of structural and political phenomena with psychic life (Mills, 2017).” In this text, Mills addresses the psychopolitics behind austerity measures in the U.K. and the transformations in the politics regarding borders and welfare that affect people who are migrants, poor, and disabled.18 Mills establishes links between migrants’ experience of border reinforcement in the U.K. and poor and disabled people’s experience of the rules governing welfare. She contends, as do some queer and trans activists/scholars discussed in Chapter 2, that hate kills migrants and disabled people. Austerity measures constitute banal and nonspectacular slow (and not-so-slow) death, targeting racialized people, migrants, and poor and disabled people through an array of methods, including administrative and financial violence. She contends that austerity measures in the U.K., based on such systems of oppression as ableism and capitalism, are responsible for deaths by suicide: “The underlying logic of these systems create[s] conditions that devalue certain lives, and kill people, partly through inciting them to kill themselves” (Mills 2020, 83). Therefore, according to Mills, the suicidality of disabled/Mad people is the result of interlocking forms of racism, colonialism, classism, capitalism, ableism, and sanism. While I completely agree with Mills’s clever analysis, I disagree with her conclusion that suicide is the ultimate form of oppression because suicidal despair emerges from sociopolitical conditions and that accepting suicide would mean accepting the culture of disposability experienced by marginalized subjects. This conclusion, from a social justice perspective, remains incomplete if it does not integrate suicidism and suicidal people’s perspectives. In the same way that Mills encourages us to think of the co-constitution of ableism, sanism, capitalism, colonialism, and racism, I call for a perspective that understands these forms of oppression as co-constitutive with suicidism.
In sum, while invaluable on many levels, the contributions of disability/Mad activists/scholars on suicide and assisted suicide and of critical suicidologists on disability/madness nevertheless adhere to the preventionist script and unintentionally fuel compulsory aliveness and suicidist regimes. In so doing, they constitute somatechnologies of life that affect suicidal people. Although it is difficult to bring together such disparate and various discourses on disabled/Mad suicidality, many of them produce similar effects on suicidal people, some of which I discuss in the following section.
3.1.4. Sanist and Suicidist Treatment of Suicidal Disabled/Mad People
Discourses on disabled/Mad suicidality have several negative impacts on suicidal people. Not only does the depiction of disabled/Mad suicide or requests for assisted suicide represent oversimplistic explanations in terms of external ableist/sanist pressures and internalized hate; these conceptualizations also reproduce stereotypes of disabled/Mad people (e.g., as vulnerable and passive people reduced to one aspect of their identity—disability/madness) as well as forms of sanism and suicidism.
The literature in disability/Mad studies shows that forms of sanism exist among disability scholars and activists.19 Thus, unsurprisingly, disability activists/scholars often perceive suicidality through a sanist lens, as a mental illness to be “fixed.” To give one example, while justifying assisted suicide for disabled people with terminal illnesses, Shakespeare (2006, 124) insists that people with mental illnesses who want to die should be prevented from doing so: “For example, depression and other mental illness could cloud judgement and may prevent a person with terminal illness making a competent decision to request death.” People with mental illness are cast as irrational and incompetent when it comes to their decision-making capacities. Shakespeare adds that suicide prevention is essential in all circumstances except in rare occasions of terminal illness (40):
Even though suicide has been decriminalised, it is a moral duty for third parties to try to dissuade a person to commit suicide. Therefore it would not be right for society to help any disabled or non-disabled person to commit suicide on autonomy grounds. The only socially sanctioned case where suicide becomes a legitimate choice is in the case of end stage terminal illness.
The suicidist preventionist script and curative model of suicidality itself, endorsed by proponents and by opponents of assisted suicide among disability/Mad activists/scholars, paradoxically fuels the ableist curative trope for some subjects considered “broken” and in need of “fixing.” In addition to forms of ableism/sanism embedded in some analyses of disabled/Mad suicidality, such as in the previous examples, forms of suicidism are also present. For example, the Fireweed Collective (The Icarus Project, n.d., 1) insists that “feeling suicidal is not giving up on life” and, adhering to compulsory aliveness, that a “better life” is always possible. The injunction to stay alive and have a better future is a theme that runs through almost all discourses on disabled/Mad suicidality. I contend that ableism/sanism and suicidism function concurrently to harm suicidal people in three ways: (1) by creating a pathological and negative image of suicidal people, (2) by silencing suicidal people, and (3) by endorsing coercive suicide prevention strategies.
First, a pathological and negative image of suicidal people (disabled/Mad or not) is prevalent in the literature. For example, Gill (1992, 42) endorses a pathologizing view of disabled people who want to die, stating that their requests for assisted suicide “are clearly pathological.” Based on an individualistic and psychological interpretation, Gill depicts suicidal people “as afflicted by tunnel vision” (46). Gill (1999, 174) even questions the legal competence of disabled people, based on their pervasive oppression: “If personal liberties are limited and skewed by the caprices of social policy, it makes little sense to contend that such individuals act freely as mature adults. Furthermore, long-term social isolation and the pain of an imposed meaningless existence [ . . . ] may erode the individual’s capacity to make reasoned decisions.” Later in her career, Gill (2004, 185) continues to adhere to this pathological conceptualization of suicidality, reiterating that “suicide is triggered by a sense of hopelessness related to psychiatric disorders, emotional vulnerability, and/or demoralizing psychosocial stresses.” While it is perhaps understandable that Gill, working from the field of psychology, is tempted to endorse psychiatric explanations of suicidality, a similar conceptualization seems incoherent coming from activists such as Coleman, who otherwise remains critical of individual pathologization. Coleman (2010, 41) refers to studies that emphasize “psychological distress” and “psychological disturbances” to show that disabled people’s requests for assisted suicide are unfounded and unsound and should be prevented, as they are for the rest of the population. These positions in disability/Mad studies are usually anchored in a reconceptualization of autonomy that favors a relational perspective as well as a reconceptualization of competency, which is seen as biased by internalized forms of ableism/sanism. Although I concur with disability/Mad activists/scholars that we must be aware of the deep impacts of structural conditions on our subjectivities, I remain fascinated by the sometimes-acritical adherence to psychopathological explanations when it comes to suicidality. Indeed, statements such as those of Gill or Coleman illustrate that, while disability/Mad activists/scholars are usually averse to pathological and individualistic explanations, they tend to redeploy them quickly when it comes to suicidal individuals. Whereas empowerment and agency are encouraged for other marginalized groups, they are denied when it comes to suicidal people, who may be considered too “mad” or “insane” to make important decisions about their lives and deaths. Sanism and suicidism work together here to delegitimize suicidal people, who may be disqualified as “irrational” and “disturbed.” Furthermore, the negative image of suicidal disabled/Mad people put forth by some activists/scholars fuels the suicidist stereotypes of suicidal people as dangerous, impulsive, lying, and manipulating. To give but one example among many, Gill (1992, 41) writes, “People with severe disabilities characteristically are master survivalists. They learn by necessity how to influence others to assist them. It is an essential, creative skill that, unfortunately, can also be applied consciously or unconsciously for self-destruction.”
Second, sanism and suicidism work together in the silencing of suicidal disabled/Mad people. Many activists/scholars analyzed thus far, particularly those opposed to assisted suicide, discuss famous cases in the media of disabled people who challenged the legal system to have access to assisted suicide (e.g., Elizabeth Bouvia) in the U.S. and in Canada.20 Their main conclusion finds that disabled people are victims of ableist oppression and that if their living conditions were different, they would no longer want access to assisted suicide. I have two critiques of this reductive interpretation, which silences suicidal disabled/Mad people. First, rewriting people’s stories by pretending to know best why they want to die is paternalistic and represents a form of epistemic violence. Second, this reinterpretation does not consider the “creative skill” possessed by “master survivalists,” in Gill’s words. Indeed, suicidal disabled/Mad people can be creative in pursuing their goals, including their desire to die. As discussed in Chapter 1, there seems to be forms of testimonial smothering among suicidal people who know that speaking up and telling their truths will lead to serious consequences and will rob them of their legitimacy as speakers.
As a suicidal person, I have contemplated completing my suicide at many points during my life. I continue to feel ambivalent about my desire to stay alive or to die. While I identify as a disabled/Mad man and think that assisted suicide laws are founded on violent forms of ableism/sanism and suicidism, I would not hesitate to frame my discourse to fit the ableist/sanist/suicidist criteria of the law if I wanted to end my life through assisted suicide at some point. The Canadian context in which I live, based on the current law, would require me to hide the fact that I am depressed and suicidal and that I have certain political views on suicide. I would need to emphasize the fact that I am affected by the “indignity” of my disabilities and that my suffering is unlivable and unbearable. I would engage in this discourse not because I believe it but because it would allow access to a peaceful death, surrounded by those I love, and the time and space to conclude this last chapter of my life. I am quite certain that if I die by suicide at some point, it will be through assisted suicide, as I find the idea of dying alone through violent means—a solution currently forced upon suicidal people in a suicidist context—extremely frightening. Mobilizing an ableist discourse on suffering linked to my impairments would not only constitute a form of testimonial smothering but endorse a discourse contrary to that which I have upheld throughout my life—simply for the sake of accessing what I would consider to be a decent death. My willingness to change my discourse and lie to reach this goal may also be a strategy used by other suicidal disabled/Mad people to obtain what they need. To paraphrase Clare, I would almost endorse a cure and an ableist narrative without ambivalence if it could save me from a horrible death by suicide without assistance. Explanations that reduce disabled/Mad people who request access to assisted suicide to alienated subjects in need of protection could not be more erroneous, at least in my case. I am probably not alone. As disability/crip/Mad scholars such as Ally Day (2021) remind us, no one should impose narratives on others; in addition to potentially being wrong, these narratives cause harm by undermining people as knowledgeable subjects and by reinforcing forms of silencing.
Third, the imposition of some interpretations of disabled/Mad people’s suicidality as stemming from ableist/sanist oppression leads to solutions that are not only incomplete but also problematic and violent. Many disability/Mad activists/scholars do not question the suicidist violence that suicidal disabled/Mad people experience and want to apply the traditional suicide prevention methods to prevent their deaths (Shakespeare 2006). For example, Gill (2004, 178–179) emphasizes the necessity of coercive suicide prevention strategies, including “psychotherapy, dissuasion, hospitalization, or forms of protective vigilance.” Frazee’s discussion of suicide and assisted suicide serves as another example. She (2020, 3) insists that we should apply the same coercive measures to everyone who is suicidal regardless of their disability status, by calling emergency services and using forced hospitalization/incarceration and treatments if needed: “We dial 911, we pull you back from the ledge and, yes, we restrain you in your moment of crisis, autonomy be damned.” The same is true for the organization Not Dead Yet. While recognizing that suicides involve “unpleasant methods,” Not Dead Yet issues a call to “enforce laws requiring health professionals to protect individuals who pose a danger to themselves” (Coleman 2010, 44). Not only does Not Dead Yet activist Coleman not interrogate some of the harmful practices, such as involuntary hospitalization, put forth in the suicidist preventionist script; she adds that suicidal people, be they disabled or not, should be left to fend for themselves in their search for death: “The law should leave them to their own devices. Any competent person, however disabled, can commit suicide by refusing food and water” (49). This solution is insensitive to suicidal people, forcing them to die by solitary and violent means, such as starvation, poisoning, gunshot, or hanging. Furthermore, this laissez-faire attitude toward a marginalized group, such as suicidal people, who are often criminalized, institutionalized, or stigmatized based on their perceived or actual mental disability/illness, seems at odds with the structural analyses put forth from disability/Mad perspectives.21
As I argue in Chapter 5, I believe that my suicide-affirmative approach based on harm reduction would save more lives than current coercive methods do (even though saving lives is not my primary goal) and would offer the option of a less traumatic/lonely death, a better preparation for this phase of life, a better process of mourning/preparation with family and relatives, and fewer negative consequences resulting from nonfatal suicide attempts. Without wanting to reproduce an ableist trope about the fear of disability, it is important to mention that suicide attempts that do not end in a completed suicide (and there are many more attempts than completed suicides) often leave suicidal people with significant physical and emotional trauma.22 A harm-reduction approach would allow those who choose that path to avoid the consequences and traumas of their missed attempts. In sum, disability/Mad activists/scholars offer incomplete solutions based on oversimplified explanations as to why disabled/Mad people are suicidal, and they reproduce forms of suicidism through their endorsement of coercive prevention methods or through their attitude of dismissing the harsh realities of suicidal people. These forms of suicidism are deeply interlocked with forms of ableism/sanism. I believe that taking suicidism into consideration would help disability/Mad activists/scholars provide a richer analysis of how ableism and sanism function.
3.2. Alternative Approaches to Disabled/Mad Suicidality
Since critical suicidologists rarely discuss the reality of disabled/Mad people in relation to suicidality and since disability/Mad activists/scholars primarily address assisted suicide rather than suicide itself, alternative approaches to disabled/Mad suicidality remain scarce. Bonnie Burstow, an important figure in the anti-psychiatry and disability/Mad movement, offered brilliant and cutting-edge scholarship on the topic of suicidality in the early 1990s, denouncing psychiatric treatments imposed on suicidal subjects.23 While her position on suicide constitutes an alternative approach to disabled/Mad suicidality, I focus here on more contemporary material, found on two rare platforms promoting a noncoercive approach to suicidality from a disability/Mad perspective: the webzine Mad in America and some of its contributors as well as the disability justice movement and some of its leaders.
In 2012, Robert Whitaker, an American author well-known for writing about madness, founded the webzine Mad in America. In the spirit of the anti-psychiatry and Mad movements, the website is a venue for authors writing about the failure of the medical/psychiatric system to serve Mad communities. Through a critical lens, some contributors discuss the treatment reserved for suicidal Mad people. Whitaker (2018) himself questions the medical approach to suicide, often focused on drugs and individual solutions, which may cause, rather than prevent, more suicides. He believes that antidepressants may be a potential causal factor in suicidality, a possibility also suggested by other anti-psychiatry authors, such as Burstow (1992, 2015). Other contributors, such as Rob Wipond (2020), insist on the need to switch from individual interventions to strategies that recognize the sociopolitical contexts in which suicidality occurs and demonstrate how current suicide prevention strategies used by many hotlines often cause more harm than good. Using the testimonials of suicidal people, Wipond (2020) reveals how hotlines’ common practice of calling emergency services without the caller’s consent can be violent and distressing for suicidal people: “Yet under-reported and under-investigated is the fact that calls to the National Suicide Prevention Lifeline (NSPL)—which prominently advertises itself as ‘confidential’—are often covertly traced. Callers are subjected to police interventions and forced psychiatric hospitalizations. Many callers describe their experiences as terrifying and traumatizing.” Megan Wildhood (2018), a neurodiverse contributor to Mad in America, has written about the damage caused to Mad people and suicidal people in distress by the current services offered when they experience mental health crises. Like Wipond, she believes that hotlines and their default protocols—namely, calling emergency services when a person intends to attempt suicide—hurt Mad people; interactions with the police often end in violence against the person instead of providing support and human connection.
Another contributor to Mad in America is Jess Stohlmann-Rainey (2018, 2019), a self-identified Mad, disabled, and fat person who adopts an anti-sanist approach to suicide. Stohlmann-Rainey (2018, para. 12) denounces the “hegemonic sanity” that sorts suicidal people into two categories: those who accept medical/psychiatric interventions and want to be fixed and saved by mainstream treatments (the “good” suicidal people) and those who resist various interventions and persist in their suicidal ideation, even after nonfatal suicide attempts (the “bad” suicidal people). For Stohlmann-Rainey, endorsing anti-sanist perspectives would help treat suicidal people more respectfully (para. 17):
When we begin to strip away the ideology of hegemonic sanity, we can more cogently address suicide. An anti-sanist approach to suicide creates space for madness. It never takes suicide off the table, and protects an individual’s right to make decisions about living and dying without forced intervention. Implementing an anti-sanist approach to suicide [ . . . ] requires us to shift from screening and assessing to exploring and understanding. [ . . . ] We can ask what they need. And ultimately, we can trust them to know and make the choice that is best for them.
Stohlmann-Rainey (2019, para. 4) argues, as do I, that sanism and suicidism (even though she does not use the latter term) function together: “Sanity is constructed around wanting to live, insanity around wanting to die. Within this paradigm, the suicidal person can never be trusted. They are always already insane.” In arguments similar to those I have previously put forward (Baril 2017, 2018), she contends that suicidal people’s experiences are defined by nonsuicidal people and that they are forced to express what nonsuicidal people want to hear. If they do not comply with the preventionist script of wanting to be saved and fixed, they are cast as even more “crazy” and “mad.” Like others with alternative approaches to suicidality, Stohlmann-Rainey hopes to create safer spaces for suicidal people to discuss their suicidal ideation without guilt, shame, or negative consequences.
Another venue for promoting alternative approaches to suicidality is the disability justice movement. Disability justice focuses on interlocking systems of oppression, such as racism, heterosexism, or cisgenderism, in analyzing the realities of disabled/Mad people. It is, in some ways, a more radical and intersectional version of the disability rights movement, less focused on formal rights than on justice in general for disabled/Mad, racialized, trans, and queer people. Piepzna-Samarasinha (2018, 15), a leader in the movement, retraces its history:
“Disability justice” is a term coined by the Black, brown, queer, and trans members of the original Disability Justice Collective, founded in 2005 by Patty Berne, Mia Mingus, Leroy Moore, Eli Clare, and Sebastian Margaret. Disabled queer and trans Black, Asian, and white activists and artists, they dreamed up a movement-building framework that would center the lives, needs, and organizing strategies of disabled queer and trans and/or Black and brown people marginalized from mainstream disability rights organizing’s white-dominated, single-issue focus.
It is impossible to claim that all disability justice proponents endorse alternative visions of suicidality. In fact, many simply reproduce suicidism. However, a few who publicly identify as having suicidal thoughts, such as Piepzna-Samarasinha, do not promote intervention that would further harm, criminalize, stigmatize, or isolate suicidal people and therefore put forth alternative approaches that promote better justice for suicidal people. In “Two or Three Things I Know for Sure about Femmes and Suicide,” a chapter in her 2018 book, Piepzna-Samarasinha denounces the double standard regarding the perception of suicidality when it comes to disabled/sick/ill/Mad people, often considered rational, courageous, and sane in their quest for death, while nondisabled people who are suicidal are seen as abnormal and irrational. She points out that this perception is particularly true when those disabled/Mad people are also living at the intersection of other systems of oppression, such as classism, racism, or colonialism. They believe that ableism/sanism plays a key role in the way we react to suicidality, not only in society but also inside anti-oppression communities. Forms of ableism/sanism prevent suicidal people from speaking and reaching out because they are afraid to be perceived as “too much” and “crazy” (Piepzna-Samarasinha 2018, 178). Therefore, preventing suicide not only should consist of inviting people to reach out but must involve a deconstruction of forms of ableism/sanism that bring shame and erect barriers to speaking up about suicidality (199):
So many people say, “I had no idea” when someone dies. I think we have to ask ourselves, “Why didn’t we”? What is okay to talk about in these places we call queer community? What isn’t? It’s not enough to say, “Just call.” I think that we could use suicidal deaths in our communities to interrogate the shit out of how sanism and ableism are diffused throughout queer community. In so many hip queer communities that are not explicitly disabled, it’s not okay to not be okay. (emphasis in the original)
Piepzna-Samarasinha believes, as do I, that “the promise of cure” (230) stemming from the ableist/sanist system is embedded in our conceptualization of suicidality. She points out how suicidal people are cast as good or bad survivors based on their adherence, or lack thereof, to curative ideology. They argue that this ableist/sanist model and its binary categories, such as “broken” versus “fixed,” is one of the only models available when we reflect on pain, distress, and trauma (231). She contends that we need to start accepting human messiness, complexity, and diversity, including suicidal ideation and distress as well as negative affects (239): “I don’t want to be fixed, if being fixed means being bleached of memory, untaught by what I have learned through this miracle of surviving. My survivorhood is not an individual problem. [ . . . ] I do not want to be fixed. I want to change the world. I want to be alive, awake, grieving, and full of joy.”
In many ways, the alternative approaches outlined earlier are compatible with mine. Many of these authors adopt an intersectional approach that parallels my perspective and denounces suicidal peoples’ oppression from an anti-ableist and anti-sanist perspective, even if they do not call this oppression suicidism. Their approaches are humane and respectful, and their critiques of current prevention strategies are cutting-edge. However, while they are critical of forms of silencing experienced by suicidal people due to ableism/sanism, they do not promote any positive rights and actions to support suicidal people in their quest for death, except fighting ableism/sanism and forms of stigmatization, pathologization, and coercive interventions. My work builds on and extends their invaluable reflections and constitutes an invitation to mobilize such critical ideas to theorize suicidism and its deep intersections with other oppressive systems as well as to put forth a political agenda that works toward the liberation and self-determination of suicidal people. Inspired by disability/Mad scholars who propose alternative models of disability that go beyond the medical and social models, in the next section, I propose adopting an alternative model of disability to rethink suicidality.
3.3. Suicidality as Disability: Rethinking Suicidality through Cripistemology
My article titled “Transness as Debility: Rethinking Intersections between Trans and Disabled Embodiments” (2015) mobilizes the conceptual tools of disability studies to rethink trans bodies/identities. According to many people, this publication was risky, since the historical psychiatrization and pathologization of trans bodies/identities has led trans activists/scholars to dissociate themselves not only from medical and psychiatric perspectives but also from disability/sickness/illness. In this article, I argue that the legitimate quest to depathologize trans identities has unfortunately come at the expense of disabled/Mad communities by reproducing forms of ableism/sanism. I simultaneously point to forms of cisgenderism and cisnormativity in disability/Mad circles. Furthermore, I argue that, as is the case for disability, transness has been conceptualized through two main models: medical and social. However, alternative models developed in disability studies to overcome the limits of the medical and social models have been left unexplored in trans studies. My goal in that article, therefore, was to use those alternative models to rethink transness from a disability perspective, or what could be called cripping transness.
Similarly, as discussed in Chapter 1, suicidality has been conceptualized through various models, including the medical and the social (justice) models of suicidality. Medical and social conceptualizations of suicidality are limited, as they leave some people behind and even reproduce oppressions, including ableist, sanist, and suicidist violence. Therefore, I believe that it is necessary to endorse a cripistemology, through a cripping and maddening of suicidality, and to develop a model of suicidality inspired by similar approaches developed in disability/crip/Mad studies that go beyond the medical and social models (Crow 1996; Hall 2017a; Kafer 2013; Nicki 2001; Siebers 2008). Indeed, like a social model of transness put forth by trans activists/scholars reacting to medical conceptualization of trans identities, critical suicidology’s endorsement of a social justice model of suicidality has emerged in reaction to the medical model. This social justice model of suicidality, as demonstrated in Chapter 1, tends to reject physical, psychiatric, and psychological explanations of suicidality. In so doing, critical suicidologists not only unintentionally reproduce ableist/sanist logic but also deprive themselves of tools developed in disability/crip/Mad studies that could be useful for rethinking suicidality. Before elaborating on how these tools could be mobilized in relation to suicidality, I would like to offer a short description of the medical and social models of disability and the alternative models that have been proposed to overcome their limits.24
The medical model understands disability/madness as individual pathologies to be cured. This model aims to “fix” disabled/Mad people due to the assumption that suffering results directly from disability/madness. Criticized for focusing on preventing and eliminating disability/madness and assimilating disabled/Mad people into societies designed for able-bodied and able-minded people, the medical model is considered to be ableist/sanist and reductive by disability/Mad activists/scholars because it does not take into account disabled/Mad people’s experiences of systemic oppression (Clare 2009; Lewis 2010; Wendell 1996). They put forth the social model of disability that distinguishes “impairment,” defined as a physical or mental condition, from disability itself, which results from the interaction between impairment and the ableist environment (Crow 1996; Shakespeare 2010; Siebers 2008). Here, disability stems from a society and environment insufficiently adapted for people with a variety of dis/abilities. In other words, institutions, communication methods, and architecture, to name only a few examples, are based on the needs of able-bodied and able-minded people, thereby relegating disabled/Mad people to the margins. With a few exceptions, many authors cited thus far in this chapter adhere to the social model of disability. For example, scholars Ron Amundson and Gayle Taira (2005, 54), who discuss suicide and assisted suicide, apply the social model to disability and the wish to die: “It was obvious that these people wanted to die because of their social situation, not because of their impairments.”
Despite numerous advantages, the social model is not without flaws.25 Like the medical model, the social model produces its own forms of violence, stigmatization, and exclusion by dismissing certain disabled/Mad people’s realities or by judging their desire for a cure. Based on the belief that universally accessible societies would eradicate disability, the social model often overlooks disabled people’s subjective experiences. Because impairment is generally seen in this model as neutral and not directly causing suffering, eliminating ableist oppression is considered sufficient to liberate disabled people. Artist/activist Liz Crow (1996, 57) writes, “Instead of tackling the contradictions and complexities of our experiences head on, we have chosen in our campaigns to present impairment as irrelevant, neutral and, sometimes, positive, but never, ever as the quandary it really is.” The social model is also criticized for focusing on typical disabilities. For people who experience health issues or whose disabilities are mental, emotional, chronic, invisible, or difficult to measure objectively, the social model’s solutions of solely targeting ableist norms and structures are incomplete. Alison Kafer (2013, 7) notes:
The social model with its impairment/disability distinction erases the lived realities of impairment; in its well-intentioned focus on the disabling effects of society, it overlooks the often-disabling effects of our bodies. People with chronic illness, pain, and fatigue have been among the most critical of this aspect of the social model, rightly noting that social and structural changes will do little to make one’s joints stop aching or to alleviate back pain. [ . . . ] Focusing exclusively on disabling barriers, as a strict social model seems to do, renders pain and fatigue irrelevant to the project of disability politics. As a result, the social model can marginalize those disabled people who are interested in medical interventions or cures.
In sum, the social model tends to favor a disembodied perspective of disability that neglects the hardships caused by physical and mental/emotional impairments rather than considering these difficulties in combination with social oppression.
To circumvent the pitfalls of these two models, some authors in disability/crip/Mad studies have adopted an alternative model, whereby ableist structures and ideologies are theorized in conjunction with the subjective experience of disability and impairments (Hall 2017a). Most of these authors (Mollow 2006; Nicki 2001; Wendell 2001) do not name their model. Others, such as Crow (1996, 70), argue that their model represents an improved or “renewed” social model. Still others refer to their approach as a “theory of complex embodiment” (Siebers 2008, 22), a “hybrid political/relational model” (Kafer 2013, 4), or a “composite model of disability” (Baril 2015, 59). In a previous work (Baril 2018), I changed the name of my model to a socio-subjective model of disability, which seems more intuitive in revealing the intricacy of the social, political, and structural aspects of disability/impairments along with subjective and phenomenological experiences. Critiquing the medical and social models of disability, these alternative models recognize the complex experience of disability while including subjective/personal and social/political dimensions. These models, like the socio-subjective model I propose, seem particularly well-suited to investigating suicidality stemming from possible psychological/emotional pain and depression, aspects of suffering that, despite being connected to sociopolitical factors, are too often overlooked by the social and social justice models of suicidality. Despite their heuristic potential for examining suicidal subjects’ socio-subjective experience, these alternative models of disability, often associated with queercrip perspectives, remain unexplored in critical suicidology, in spite of their growing popularity in disability/crip/Mad circles. Indeed, when it comes to an anti-oppressive approach to suicide, the social and social justice models continue to predominate. Shakespeare (2006, 43) points out how the predominance of the social model of disability prevents disability communities from critically reflecting on assisted suicide for terminally ill people:
It is tempting to interpret some of the disability rights community’s opposition to assisted suicide as arising from the dominance of social model perspectives. For those who claim that disability has nothing to do with impairment, or that disability should not be medicalized, it is simply inappropriate to talk in terms of disease, suffering and death, because the solution to the disability problem is removal of social barriers, independent living, social inclusion and respect, not attention to impairment. The power of social model approaches may have made it harder for the disability rights community to engage with debates about illness, impairment and end of life.
While I agree with Shakespeare about this predominance of the social model, he does not, as I have demonstrated, extend this critique of the social model of disability to suicidality for nonterminally disabled/sick/ill/Mad suicidal people. I argue that the predominance of the social (justice) models of suicidality, endorsed by activists/scholars in anti-oppressive social movements/fields of study, has prevented us from discussing crucial issues in relation to suicidal people, including their struggle with mental disability/illness.
Let me be clear: I do not want to engage in debates about the causes of suicidality (e.g., physical, neurological, psychological, psychosocial, or socio-political). While establishing the causes of suicidality is often seen as crucial to determining suicide intervention practices, I believe that determining the causes of suicidality is less important than putting the emphasis on the lived experience of suicidal people. In other words, regardless of whether the despair and distress experienced by suicidal people come from a neurological chemical imbalance, a psychological childhood trauma, or a miserable life due to sociopolitical oppression, the result is that suicidal people want to end their lives, and they experience a vast array of suicidist violence. Of course, determining the causes may help target specific solutions; if suicidality were determined to derive from “neurological disorders,” the problem would be easily solved with some “cure.” Similarly, if it were exclusively a sociopolitical phenomenon, the solutions put forth by activists/scholars in various anti-oppressive social movements/fields of study would be on point. However, despite decades of research, we still are uncertain about what causes suicidality, and we might never know with certainty what pushes some individuals rather than others to complete suicide (Bryan 2022). Therefore, I am more concerned about suicidal people’s living and dying conditions than about embarking on the race to find the cause of and the solution to suicidality. In their search for causes and solutions, the medical and the social (justice) models take for granted that all suicidal people want to be “saved” and want a greater future or, in other words, want a solution (other than dying). Discussing disability, Kafer (2013, 29) critiques this curative ideology:
Focusing always on the better future, we divert our attention from the here and now [ . . . ]. This deferral, this firm focus on the future, is often expressed in terms of cure and rehabilitation, and is thereby bound up in normalizing approaches to the mind/body. Disability activists have long railed against a politics of endless deferral that pours economic and cultural resources into “curing” future disabled people (by preventing them from ever coming into existence) while ignoring the needs and experiences of disabled people in the present.
While the social model of disability distances itself from this curative perspective and is focused on the “here and now” of disabled people’s lives, the social and social justice models of suicidality unfortunately remain anchored in a curative ideology that defers the preoccupations surrounding the here and now in favor of an attachment to a “better future” for suicidal people materialized through sociopolitical transformations. Economic and cultural resources are invested in finding the causes of suicidality and the solutions to “cure” suicidality, regardless of whether those cures are medical or sociopolitical. This investment in suicidal people’s future obscures their current needs and experiences informed by suicidism.
A socio-subjective model of disability applied to suicide recognizes the implications of systems of oppression in the formation of suicidal subjectivities, but it also places mental health issues and suicidal subjectivities (e.g., suicidal peoples’ visions, experiences, discourses, and claims) at the center of the analysis (Baril 2018). In other words, the here and now of their living/dying conditions is prioritized over their potential “better future,” in which suicidality could be “cured.” This model facilitates the creation of safer spaces where the voices of suicidal people can be heard without being forced into the suicidist preventionist script. The socio-subjective model of disability applied to suicidality allows us to escape the quandary of explanations and solutions founded either completely in individual problems or in sociopolitical structures. Most importantly, this model does not ignore the impairments, sickness, illness, madness, and suffering linked to suicidality that are too often automatically brushed aside in the social and social justice models of suicidality. While I am not claiming to represent the experiences of all suicidal people, as a wide variety exists, one commonality in the testimonials I have read and heard (and I have gathered and read more than 1,700 references on suicide to write this book) is the element of emotional and psychological suffering. Like Tobin Siebers (2008), Alyson Patsavas (2014),26 and China Mills (2017, 2018, 2020), I believe in the psychopolitics of emotions and in the impossibility of isolating emotional suffering from social living conditions—hence the importance of theorizing the imbrication of the social with the subjective aspects of suicidality. Nevertheless, recognizing the interlocking aspects of the emotional and sociopolitical context does not mean negating, dismissing, or forgetting the importance of mental disability/illness (depression, anxiety, and so forth) in the lives of some suicidal people. From a cripistemological perspective, cripping and maddening suicidality means embracing mental disability/sickness/illness/madness, as we do in disability/crip/Mad movements, instead of rejecting them, as is too often the case in the social justice model of suicidality.
As feminist disability scholar Susan Wendell (2001, 18) states in her critique of the social model of disability and its focus on social barriers, “Some unhealthy disabled people, as well as some healthy people with disabilities, experience physical or psychological burdens that no amount of social justice can eliminate. Therefore, some very much want to have their bodies cured, not as a substitute for curing ableism, but in addition to it.” This desire is also true for suicidal people: Some may continue to experience significant suffering and burdens that would not be relieved, or sufficiently or quickly relieved, by social justice solutions. Since social justice is a long-term project, any improvements at an individual level regarding the destructive effects that capitalism, racism, cisgenderism, and ableism/sanism can have on people’s lives may take decades. Meanwhile, suicidal people continue to suffer in silence and may want access to assisted suicide, “not as a substitute for curing [oppressions], but in addition to it.” This situation might have been the case for Leelah Alcorn, discussed in Chapter 2, as she simultaneously asks us to fix society and to respect her decision to die. If I were leaving this world through (assisted) suicide, my deepest wish would be that those who are still alive continue to fight for social justice for marginalized groups but simultaneously respect those who become too tired to continue fighting. In sum, the social justice model of suicidality adopted by so many activists/scholars, while relevant and accurate in its pinpointing of sociopolitical structures that influence suicidality, has unfortunate and unintentional muzzling effects on suicidal people, similar to the effects of the social model of disability on disabled/Mad people. As scholar Anna Mollow (2006, 70) states:
I would therefore suggest that, in examining intersections of forms of oppression, we guard against the dangers of a “disability essentialism,” in which the experiences, needs, desires, and aims of all disabled people are assumed to be the same and those with “different” experiences are accommodated only if they do not make claims that undermine the movement’s foundational arguments. Many of these arguments have been developed primarily with physical disability in mind. Cognitive and psychiatric impairments, although they are gaining more attention, nonetheless remain marginalized [ . . . ].
Adopting a socio-subjective model of disability to start cripping and maddening suicidality may help create welcoming and safer spaces for suicidal people and combat a suicidality essentialism built on the suicidist preventionist script. These spaces need to be as free as possible from judgment, stigma, and oppression, including suicidist oppression. They need to foster a welcoming climate for suicidal people to express their experiences, reflections, and claims, even though these discourses may contradict dominant interpretations of disabled/Mad suicidality.
In a manner similar to the public health model, this socio-subjective model of disability applied to suicidality considers multiple factors (e.g., biological, environmental, social, political) that contribute to suicidal ideation and attempts, yet it arrives at a different conclusion. Suicide remains a possibility, and the preventionist script is questioned. The socio-subjective model recognizes the subjective suffering caused by physical or mental disability/illness while avoiding forms of sanism that would invalidate the ability of suicidal people to choose suicide because of their mental disability/illness. It recognizes that subjective experiences cannot be lived outside social contexts and therefore is firmly rooted in the values of the social justice model of suicidality. This model avoids reductionist explanations and solutions in solely medical or sociopolitical terms. It proposes to work on multiple levels simultaneously; while we must act to transform the oppressive systems (e.g., poverty, racism, heterosexism, cisgenderism, ableism, sanism) that can create or intensify suicidal ideation, we must also be attentive to the individual suffering experienced by suicidal people and respect their desire to die, as I argue in Chapter 5. Otherwise, we take them hostage in our movement toward social revolution. The socio-subjective model accepts the possibility of suicidal people ending their lives, not in isolation according to a (neo)liberal vision of autonomy where each person has the right to complete suicide without interference but rather in an accompanied way (assisted suicide), based on the recognition that, in the current context, suicidal people’s freedom and autonomy are diminished by suicidist oppression and forms of ableism/sanism that affect their agency. In short, fighting for sociopolitical transformations and greater social justice is not antithetical to having greater accountability toward suicidal people or to recognizing the violence they experience, including from disability/Mad activists/scholars or critical suicidology perspectives.
Contrary to queer and trans activists/scholars who are vocal about queer and trans suicidality but silent about assisted suicide, disability/Mad activists/scholars have expressed numerous concerns regarding assisted suicide but have remained quiet on the topic of suicidality itself. However, when they discuss (assisted) suicide, in a similar fashion to queer and trans activists/scholars, regardless of their positions for or against assisted suicide, disability/Mad activists/scholars continue to perceive suicidality itself as an inappropriate solution to be avoided—hence perpetuating suicidist logic and compulsory aliveness. Their discourses, focused on keeping suicidal subjects alive, constitute somatechnologies of life that remain unexamined in the literature. While a few activists/scholars propose alternative approaches to suicidality, underlining the dominance of ableist/sanist ideologies and structures in their critique of coercive suicide prevention measures, they do not endorse positive rights for suicidal people. Their solutions, such as stopping hotlines’ nonconsensual call tracing to send emergency services or preventing forced hospitalization/incarceration and treatment of people experiencing mental health crises, certainly constitute a first step in the right direction to combatting suicidist regimes, yet they are incomplete. A fully accountable response to suicidal people would involve an agenda that not only stops the forms of violence and discrimination they face but also promotes their full citizenship and recognition of their perspectives and needs, including regarding death. This approach implies positive rights for suicidal people. Those rights currently remain unexplored and unthought, and I would say almost unthinkable, in critical suicidology and in disability/Mad communities. My position of support for assisted suicide for suicidal people may be particularly contentious, given the long-standing critical stance of disability/Mad communities toward assisted suicide. However, as the second part of this book illustrates, my vision for assisted suicide represents a radical departure from the current forms of assisted suicide legalized in various countries that are founded in forms of ableism/sanism/ageism/suicidism. My endorsement of assisted suicide derives from my attentiveness to the suicidist violence suicidal people experience as well as my awareness of their suffering (regardless of its causes and sources), made possible by the socio-subjective model of disability presented here in relation to suicidality. The socio-subjective model has enormous heuristic value unused in analyses of disabled/Mad suicidality. Most importantly, this model, which proposes a cripping and maddening of suicidality, avoids relegating people with mental disability/illness to the margins and instead brings them front and center in a queercrip model of suicidality.