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John Greden, M.D., U-M Eisenberg Family Depression Center founder, was appointed to the State of Michigan Suicide Prevention Commission on Thursday, April 2, 2020. Initiated by Governor Gretchen Whitmer in March 2020, the commission evaluates the causes and possible factors of suicide in Michigan to make improvements. 

The Commission just published a report: Michigan Suicide Prevention Commission Initial Report, March 2021.

Language Matters

The topic of suicide is deeply steeped in stigma. Considering the physiology, biochemistry and other factors that influence thoughts and behaviors, suicide should be discussed from a medical perspective. Therefore, we should all strive to use appropriate and clinically correct terminology. Changing the language will reduce the stigmas surrounding the subject and will allow all stakeholders to address suicide as the public health crisis it truly is.

Using people-first language avoids stigmatizing words or phrases and puts the emphasis back on people. This limits the focus on their actions, conditions, and diagnoses.

People first language would include:

• People with (…mental illness, depression, addiction, etc.),
• People who have died by suicide,
• People who have experienced a suicide attempt,
• People bereaved by suicide,
• People impacted /affected by suicide, and
• People with lived experience related to suicide.

General knowledge and use of appropriate terminology when dealing with issues related to suicide helps reduce stigma associated with seeking help. In medical settings, using accurate and appropriate language concerning suicide promotes and facilitates proper and concise care for individuals at risk of suicide as well as those affected by suicide.

When referring to an intentionally self-inflicted death, the clinically correct language is “died by suicide.” The word “commit” has been found to be inaccurate and stigmatizing as “commit” is connected to a criminal act, which is often viewed as an extension of a character defect. Professionals in the suicide prevention community acknowledge suicide occurs when there is a confluence of factors including an emotional crisis in which the brain is reacting to perceived, unbearable stress and the trajectory can be further influenced by mental health conditions that impair the capacity to cope. 

Using the term “commit” can deter those who are struggling with such mental health conditions, crises and/or suicidal thoughts from seeking the help they need. An additional shift in the language is the elimination of the word “successful” when discussing suicide as well as “failed” when discussing a suicide attempt that does not result in death. For obvious reasons, success should not be measured as a completed suicide. Clinicians recommend using the word “completed” when referring to someone who dies from suicide.

Those who attempt suicide but do not die are called either “suicide attempt survivors” or “survivors of suicide attempt.” Family, friends, coworkers and others who are affected by an individual’s death by suicide are referred to as “survivors of suicide loss.” This report also references both behavioral health and mental health. The Commission defines behavioral health as the connection between behaviors and health. Behavioral health is the more inclusive term and less stigmatized than mental health. When “mental health” is used in this document, it refers specifically to an individual’s state of being.

The importance of clear and consistent language for characterizing suicide and suicide-related behaviors is not only needed to decrease stigma but also to provide accuracy of the phenomena. When we replace problematic language with natural and respectful language, we shift how society reacts to and understands suicide. This helps to make the conversation about suicide safer. The way we communicate about suicide needs to avoid further stigma and focus on prevention.