Suicide terminology

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

To have suicidal intent is to have suicide or deliberate self-killing as one's purpose.[7] Intent refers to the aim, purpose, or goal of the behavior rather than the behavior itself.[3] The term connotes a conscious desire or wish to leave or escape from life, and also connotes a resolve to act. This is contrasted with suicidal motivation, or the driving force behind ideation or intent, which need not be conscious.

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

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

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

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

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

Suicidal gestures are suicide-related behaviors that are carried out without suicidal intent. It is considered a controversial term.[8] These behaviors may be labeled as Self Harm, Type I (no injury) or Self-Harm, Type II (with injury), because the purpose of the behaviors is to alter one's life circumstances (interpersonal or intrapersonal) in a manner without suicidal intent but involving self-inflicted behaviors (whether or not it resulted in injuries). If there is an undetermined degree of suicidal intent, it is labeled as Undetermined Suicide-Related Behavior, Type I (no injury), or Undetermined Suicide-Related Behavior, Type II (with injury).[4]

According to Fairbairn in his philosophical study of suicide published in 1995, "The most common way of speaking about suicide is to talk of its being 'committed'."[9] An article published in 2011 stated that, although "committed suicide" or similar descriptions continued to be the norm in the English language, the phrase "committed" associates death by suicide, or more accurately, death by mental illness, with criminal or sinful actions.[10] For example, when someone dies by cancer, it is not the norm to say the person "committed" cancer. Research has pointed out that this phrasing has become so entrenched in English vocabulary that it has gained "a naturalness which implies a deceptive harmlessness."[10] Per reportingonsuicide.org, "Certain phrases and words can further stigmatize suicide, spread myths, and undermine suicide prevention objectives such as 'committed suicide' or referring to suicide as 'successful,' 'unsuccessful' or a 'failed attempt.' Instead use, 'died by suicide",[11] 'died from suicide', 'died from/by mental illness,' 'suicided,' or 'died from/by _________ (the mental illness from which the victim suffered i.e. PTSD:Post Traumatic Stress Disorder, Generalized Anxiety Disorder, Major Depressive Disorder, Schizophrenia).'

While common, Lebacqz & Englehardt argue that referring to suicide as an act "committed" is hazardous to ethical clarity.[12] Others have also argued in favour of alternative language regarding suicide, both in the interest of moral and ethical precision,[13][14] as well as scientific and clinical clarity.[2][4] A United States Navy report urges against the use of the term "committed suicide" on similar grounds, asserting that "suicide is better understood when framed objectively within the context of behavioral health."[15]

The lack of clarity in English suicide terminology has been attributed to the connotations of crime, dishonour, and sin that suicide may carry.[16][17] The German term Selbstmord begehen is similar, denoting an act of commission.[14] Common language has been described as "[portraying] suicide as a 'crime' to be 'committed' as is, for example, murder."[12] This is despite the fact that suicide is largely no longer a crime,[13][18] and that, as noted suicidologist Samuel Wallace wrote, "all suicide is neither abhorrent nor not; insane or not; selfish or not; rational or not; justifiable or not."[19]

Canadian suicide prevention activist, P. Bonny Ball, commented that the alleged criminal implications of suicide are a carryover from the Middle Ages when suicide was considered "both illegal and sinful by the laws and religions of the time."[20] Sommer-Rotenberg had similarly argued that "the act of self-killing was considered criminal because it was perceived as transgressing the moral authority of God and the righteous feelings of humankind."[14]

Since "committing suicide" was akin to committing murder or rape, it has been argued that they continue to be linked in some languages.[10] However, this common English expression is not universal: "By contrast the French se suicider and the Italian uccidersi are reflexive. Likewise in Hebrew: l'hit'abbed, 'to self-destroy,' is something one does to oneself, with no implication of criminality"[14] and translates in meaning most closesly to "suicided."

Various alternatives have been proposed to alter the language regarding the act of suicide from a variety of sectors – including government, journalism, community mental health advocates, and the scientific community. Terms such as "death by suicide" have been suggested to be more objective.[15] The World Health Organization has agreed that these terms "are more accurate and less open to misinterpretation."[21]

As it applies to a direct clinical context, the widely cited Beck Classification of Suicidal Behaviour exclusively uses the terminology of "complete suicide."[22] This classification was revisited in a number of notable documents (such as the Operational Classification for Determination of Suicide, the 'Tower of Babel' nomenclature, the WHO/EURO definitions, the Columbia University suicidality classification, the CDC self-directed violence surveillance system, and the Denver VA VISN 19 MIRECC self-directed violence classification system).[23]

Advocacy groups have suggested a variety of guidelines for suicide terminology.[24][25][26][27][28][29] As it concerns media reporting of suicide, a key indicator of guideline influence on language as it is practiced in that context reports including one by the Annenberg School for Communication's Public Policy Center at the University of Pennsylvania suggests that there is "evidence of a change in reporting practices following the release of the new media guidelines".[30]