About a decade ago, I entered suicide prevention naively. I believed wholeheartedly that suicide “prevention” was about creating a world worth living in, and thought that the field shared that belief. I read voraciously, trying to understand as much as possible about experiences other than my own. Throughout so much of the literature, safe messaging (ways of talking about suicide that are “strategic, safe, positive”) and concerns about clusters (suicides that occur in close proximity to each other) were prominent.
The more research I read, the more guidelines I followed, the more I internalized messages about suicide that were in direct conflict with my beliefs and experiences. Suicide was ultimately constructed as pathology. My history with suicide was a problem deep within me to be ferreted out and removed. I was ill, or perhaps corrupted by suicide. It made me vulnerable, fragile, needing protection and oversight.
It did not matter what drove me to suicide. It did not matter that the world was never built with me in mind. The problem of suicide was inside me. Because the problem was inside me, the world didn’t need to change, I did.
Suicide prevention constructs a reality in which the problems of suicide lie within suicidal people. Within this reality, suicidal people are suicidal due only to pathology, whether that pathology is a diagnosable condition, or just a flaw in thinking or judgment. 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. And because of this fatal flaw in judgment or reason, suicidal people need to be kept safe at all costs, at all times. They are fragile, vulnerable, demanding protection, surveillance, and management.
The gaslighting of suicidal people hinges upon this framework that constructs them as insane. Gaslighting is a cultural process that allows non-suicidal people to define reality by pathologizing those who resist. It is a tactic that makes us question our own realities, making us constantly doubt our own experiences.
Safe Messaging as Gaslighting
Two ideas that are central to safe messaging are that:
- Suicide is not normal, and is the result of pathology;
- People who think about suicide are so vulnerable that seeing content about suicide makes them “unsafe.”
Working in the field, the safe messaging guidelines were bored into me. I was taught to believe unequivocally that these guidelines were about helping people who struggle. As I heard them, over and over, it was difficult not to internalize these beliefs. I felt deeply conflicted, struggling to make sense of my experience in these terms. When I was suicidal, content about suicide was soothing for me. It allowed me to work out some of the suicidal energy that vibrated through my bones. And when I found other people who had thought about suicide, or even heard about people who died from suicide, I felt less alone. Safe messaging tells us that our experiences are abnormal or abhorrent, while simultaneously selling the idea that suicide is a huge public health problem that can affect anyone.
Gaslighting isn’t a singular event, but a confluence of experiences. I could spend thousands of pages outlining the insidious ways that this construction of reality permeates suicide prevention. One of those ways is detailed in my previous article about the “good survivor.” The good suicide attempt survivor recognizes their own pathology and affirms the system. They prove themselves sane by admitting that something in them was insane, which is why they attempted suicide in the first place. One of the primary tools that has helped enforce standards of good survivorship and perpetuate reality as defined by non-suicidal people is called “safe messaging.”
The National Action Alliance suggests that the following constitute unsafe messaging:
- Repeated, prominent, or sensational coverage;
- Details about suicide method or location;
- Portraying suicide as a common or acceptable response to adversity;
- Glamorizing or romanticizing suicide;
- Presenting simplistic explanations for suicide;
- Including personal details that encourage identification with the person who died
These “unsafe” messages not only conflict with people’s lived experiences, but also with the data and each other. Suicide is the 10th leading cause of death in the United States, and exponentially more people think about suicide than attempt or die from it. Suicide is extraordinarily common, and despite the pervasive suicide prevention motto “suicide is preventable,” it is becoming more common every year.
The guidelines recommend against including simplistic explanations for suicide, but go on to focus on diagnosable “psychiatric illnesses” in the linked Reporting Guidelines, stating that we ought to “refer to research findings that mental disorders and/or substance abuse have been found in 90% of people who have died by suicide,” a claim that the CDC no longer makes. They go on to say that messages can also cause harm by undermining prevention, which is connected to the concept of only sharing “positive narratives.” This means the only narrative that is allowed is a narrative of hope and system reliance. Hope, in this case, is defined not by the experience of the survivor, but by suicide prevention for the benefit of their perceived audience. Yet again, people who are not suicidal get to define reality for suicidal people, constructing hope around their comfort and assurances that suicidal people can be “cured” or “recovered.” Tying hope to recovery, or not being suicidal anymore, reifies the idea that suicide is rooted in a pathology that can or should be fixed. When the absence of suicidal thoughts is not the ultimate goal, there is space for understandings of suicide that move beyond pathology, and more expansive definitions of hope.
The stated purpose of these guidelines is protecting vulnerable people. As it turns out, there may not even be a relationship between this exposure and suicides. In Caitlin WiIlliams’ recent dissertation, she found that:
“Overall, observational research seems to point to an increase in suicides following well-publicized suicide news articles; however, none of the existing experimental designs (i.e., Anestis et al., 2015; Williams & Witte, 2017; and the current study) have demonstrated any important effects of exposure to suicide news articles… we still do not have direct evidence of a causal relationship between exposure to suicide news articles and subsequent suicidal behavior… Although future research is needed to completely illuminate the relationship between suicide news articles and suicidal behavior, it is ultimately plausible that suicide news articles are not actually causing suicidal behavior. Given this possibility, it will be imperative to approach the dialogue with the journalists and the media in a different manner. Specifically, there are other reasons to be mindful when reporting on suicides, aside from the potential for an imitative effect.”
Additionally, in the rare event that suicide clusters do occur, it is not empirically clear if they have a connection with exposure. So if these guidelines don’t protect people from suicide… what purpose do they serve? I believe that these guidelines, like many of the “Truths” of suicide prevention, serve to help maintain the status quo. They enforce the cultural ideologies that suicide is pathological and suicidal people must be protected from themselves at all costs. They do this, whether intentionally or unintentionally, by gaslighting.
They Make Us Doubt Our Own Experience and Be Complicit in Constructing Their Reality
Safe messaging overrides the reality of people with lived experience with suicide by forcing them to tell their stories through a framework of “hope and recovery.” Our stories must be sanitized, gutted of any details deemed undesirable, like method or the harsh reality that treatment often fails us. The only stories that are allowed are the stories that confirm the work of suicide prevention.
They Pathologize Resistance
Because suicide is constructed as a result of pathology, any resistance to this constructed reality is evidence of pathology. Suicidal people are caught in a trap in which their suicidal thoughts are evidence of their pathology, making them unreliable reporters of their own experiences.
The cultural investment of suicidology in safe messaging is notable. Prevention organizations send safe messaging guidelines to reporters and artists, lambasting those who do not comply with the standards. The field rallied to push Netflix to remove the on-screen suicide in 13 Reasons Why. All of this investment is driven by power and control.
The illusory idea that we can control suicide by controlling the content a suicidal person is exposed to dominates these guidelines. It begs the question — who is really being protected? The stories of suicidal people are being silenced. In the case of 13 Reasons Why, the suicide is edited out, but not all of the rape, violence, and bullying leading up to it. Suicide being the result of a series of traumas is what gets edited out, not the trauma itself. Does this really protect suicidal people who might have shared experiences with the main character, or does it protect others from having to see the potential consequences of traumatic events?
Suicidology owes us some reflection on why a narrative about exposure, risk, and contagion feels so important. Reparations are in order for everyone who has been told that their stories are unsafe or unfit for the public because they challenge us to think about suicide in nonmedicalized terms, or make visible the ways the systems that are supposed to help end up failing so many people (especially those who are already marginalized). All of us deserve the dignity of owning and sharing our stories without mediation or infiltration by systemic silence and shame.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.