Philosophy, Psychiatry, & Psychology

The stories we tell about acts that come to be labeled as suicidal are influenced by the impoverished language and conceptual apparatus that is available to us. In most “suicide talk” whether among professional or lay people, the whole range of acts engaged in by those whose behavior is actually or potentially self-destructive are subsumed under the umbrella concept suicide and a few variants: parasuicide, attempted suicide, failed suicide, and threatened suicide, along with expressions like “cry for help.” This poverty of language and concepts reflects rather a limited model of suicidal self-harm in which fine distinctions are not made, even in theory, perhaps because they are difficult to make in practice. It is misleading and unhelpful in deciding upon courses of action in relation to those who act in actually or potentially self-destructive ways or are thought to be at risk of doing so.

Recently I have been working on a new and better understanding of the natural history of suicide and related acts—on a more elaborated vocabulary and ways of thinking about suicidal phenomena (Fairbairn 1995). My project has involved the attempt to identify some of the similarities and differences that exist between different acts of self-harm, and in this paper I want, among other things, to share a few fragments of that attempt. In doing so I will briefly visit a number of alternative ways of thinking about acts that might usually be thought of as attempted suicide, using terms like cosmic roulette, nonfatal suicide, and gestured suicide. En route I will hint at a new way of thinking about suicidal acts in which what is of primary importance is not the physical facts of the matter—the behavior in which the protagonist has engaged and the presence or absence of a corpse, but the intentions of the individual in acting as he does.

It is my hope that, among other things, elaborating a richer model of suicidal self-harm than most people currently inhabit might help to persuade those who come in contact with self-harming [End Page 157] acts with some frequency, or whose work means that they may do so in the future, of the need to think carefully about the nature of such acts and the intentions that underpin them. For example, I hope the availability of an elaborated conceptual map of suicide and related acts may make it less likely that professionals will believe or act as if they believe that familiarity with the actions a person has performed and the results of those actions—is always, or nearly always, sufficient to justify a definite conclusion about the nature of his self-harming act. This I hope might help to reduce the possibility that self-harming acts should be misidentified, both in cases where the protagonist ends up dead and in cases where he ends up alive.

Towards the end of the paper I shall draw attention to some of the practical and ethical consequences that our impoverished model of suicide and related acts has both for lay people who have little personal contact with suicidal acts, and for professional people—including doctors, nurses...