Written by Scott Fitzpatrick – Centre for Mental Health Research, The Australian National University

Last year I had the pleasure of reviewing Alexandre Baril’s groundbreaking Undoing Suicidism: A Trans, Queer, Crip Approach to Rethinking (Assisted) Suicide (2023). Building and expanding upon previous work, most notably his conceptualisation of ‘suicidism’ (Baril, 2020), Baril draws upon queer, trans, crip and Mad theoretical frameworks as well as his own personal experience of suicidality to make a compelling case for rethinking the ways we conceive of and respond to suicide.

Suicidism, according to Baril, describes the oppressive system that discriminates against often already marginalised individuals and communities experiencing suicidality. At the centre of this system is a ‘preventionist logic’ embedded within various institutional settings, cognitive frames, laws, interventions and discourses that purport to save lives and ‘fix’ suicidal people, yet which often result in harms to individuals through practices that silence, pathologise, exclude, label incompetent, detain and forcibly treat.

Closely bound to this preventionist logic is what Baril refers to as an ‘injunction to live’ that both renders an individual’s desire for death as abnormal and unintelligible, and imposes on them a normative obligation to themselves and to others to manage, preserve and optimise their mental health and wellbeing. Or alternatively, as Baril claims, leads those experiencing suicidal thoughts to shut up, remain silent or respond with well–rehearsed platitudes about their personal safety to avoid any negative repercussions.

Through diverse testimonials Baril describes how many people feel unsafe discussing their suicidal thoughts despite public health campaigns actively encouraging this. For Baril, the disclosure of suicidal thoughts promoted through these kinds of campaigns is one thing, yet any reflection on whether suicide is a valid option, he argues, is almost always discouraged. Suicidism, the system, quells any such discussion. Yet, for many, suicidality is a complex and meaningful phenomenon that demands exploration.

Baril’s work struck a chord with me, resonating with my own developing ideas about suicide as an understandable response to suffering (Fitzpatrick, 2020), yet conveying the nuanced, complex and layered terrain in which such understandings sit. There were also certain parallels between the lack of support for those experiencing suicidality as described by Baril, and research I recently carried out on suicide in older adults (Fitzpatrick et al., 2021). In this research, the desire to die was responded to in one of two predominant ways. First, with rules-based risk management strategies that prevented practitioners from engaging relationally with those in distress and the existential despair most of them faced. Second, through practices of involuntary detention and treatment that were readily deployed to contain and prevent threats of self-harm, even when this violated an individual’s body, human rights and dignity. This resulted in many people dying alone and in silence.

Baril’s work also resonates strongly with the Alternatives to Suicide (ALT2SU) Project; an approach that creates spaces for mutual connection and meaning–making around suicidal distress, thoughts and experiences. This approach holds people ‘responsible to – and not for or over others.’ That is to say, while one cannot be responsible for another person’s choices or actions, one has a responsibility to be present with one another and to validate, explore and speak candidly about personal experiences.

For Baril, openly discussing suicidality and the desire to die is not antithetical to forms of accountability and support, although these should be based on processes of accompaniment rather than prevention. To this end he advances a ‘suicide–affirmative approach’ anchored in the values of anti–oppressive social movements, self–determination and harm reduction that stands in opposition to dominant approaches based on risk aversion and moral fears around suicide and its potential ‘contagion’. Pre-empting arguments that normalising suicide has the potential to influence already vulnerable individuals, Baril contends that more open discussion of suicide within a suicide–affirmative approach may actually result in more people experiencing suicidality seeking support by reducing stigmatisation.

The suicide–affirmative approach can be operationalised at different levels (eg, law, public policies, health care and social services). When applied to health care it involves an emphasis on peer support, respect for autonomy and self–determination, a nonjudgmental attitude, the refusal to use nonconsensual and coercive interventions, and a set of compassionate and pragmatic approaches that seek to reduce harms stemming from high–risk behaviours.

Baril is at pains to point out that the arguments presented in Undoing Suicidism are not intended to encourage suicide.  The approach aims to reduce suicidality among specific marginalised groups overrepresented in statistics on attempted suicide and suicide including queer, trans, disabled and Mad people.  Full recognition of suicidal people, however, means that a suicide–affirmative approach extends to a positive right to die for suicidal people. This includes support for assisted suicide.

Such a position is contentious, and Baril rightly anticipates criticism of his dual life–affirming and death–affirming stance, as well as the significant hurdles that need to be overcome if social, political and legal change is to be realised. However, as Baril suggests, all transformation must start somewhere. As such, he sees his work as a form of micro–resistance aimed at making visible the voices of those who are suicidal in the hope that a ‘suicidal epistemic community’ will emerge to fill the gaps in our understanding and better meet the needs of those who repeatedly struggle with thoughts of life and death.

Undoing Suicidism is a deeply considered and courageous work that offers an unapologetically moral stance against discrimination and exclusion as the basis for reimagining suicide, social action and caregiving. It asks no more (and no less) of us than to let go of our attachments to certain ideas, ways of knowing and beliefs. This is certainly something the field of suicide prevention needs to do more.

References

Baril, A (2020). Suicidism: A new theoretical framework to conceptualize suicide from an anti-oppressive perspective. Disability Studies Quarterly 40(3).

Baril, A. (2023). Undoing suicidism: A trans, queer, crip approach to rethinking (assisted) suicide. Philadelphia: Temple University Press.

Fitzpatrick, S.J. (2020). Epistemic justice and the struggle for critical suicide literacy.

Social Epistemology 34(6): 555-565.

Fitzpatrick, S.J., Read, D., Brew, B.K., & Perkins, D. (2021). A sociological autopsy lens on older adult suicide in rural Australia: Addressing health, psychosocial factors and care practices at the intersection of policies and institutions. Social Science & Medicine 284.

About the Writer

Scott Fitzpatrick – Centre for Mental Health Research, The Australian National University

Scott is a Research Fellow in the Lived Experience Research Unit at the Centre for Mental Health Research, The Australian National University. Scott is an interdisciplinary scholar whose work is grounded in the sociology of health and illness, public health, and applied ethics. His research interests are suicide, the social and political determinants of health, and lived experience. Scott is especially interested in broadening contemporary ethical discussion of suicide and its prevention within the fields of research, clinical, and public health practice and policy by examining the intersection between knowledge, practice, ethics, and politics.

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