Many clinicians and researchers advocate for abandoning the term “suicide gesture,” but its use still persists. Over the last few years, several definitions have been reported:
In another definition of suicide gesture, “a person leads others to believe that he has just made a suicide attempt in order to communicate that he is in distress or to influence the behavior of others in some way.”
Still another definition: “an unusual but not fatal behavior as a cry for help or to get attention, or a suicide gamble, when patients gamble their lives that they will be found in time and that the discoverer will save them.”
What is Wrong with the Term “Suicide Gesture?”
There are several problems with the terms “suicide gesture” and its variant “suicidal gesture.”
Especially in the clinical world, the terms are used interchangeably with the term “suicide attempt.” In some clinicians’ eyes, a suicide attempt in itself is a suicide gesture, because the person survived.
Equating a suicide attempt to a suicide gesture inherently diminishes the gravity of a suicide attempt. It is dismissive. It is even pejorative. It doesn’t take seriously a person who is experiencing serious pain or other problems.
This is especially true when you consider one of the dictionary definitions of “gesture” at www.oxforddictionaries.com:
“An action performed for show in the knowledge that it will have no effect: I hope the amendment will not be just a gesture.”
So, calling a suicide attempt a “suicidal gesture” is just another way of branding someone as manipulative and attention-seeking. After all, their apparent suicide attempt was not an attempt at all, just an action performed for show in the knowledge that it would have no effect.
The dictionary also notes that, in the general sense of the word, “gesture” usually applies to a movement of the head or hands to express an idea or meaning. Even this benign definition suggests that a person who attempts suicide was trying to convey something to others – not to die.
Misrepresenting Suicide Attempts, Misrepresenting Risk
In an article titled “The Problematic Label of Suicide Gesture: Alternatives for Clinical Research and Practice,” Nicole Heilbron and her colleagues note that calling suicidal behavior a “gesture” can understate the person’s suicide risk:
“Labeling of an individual’s behaviors as gestures to family members also may communicate a dismissive stance that may lead to a false sense of security regarding the individual’s safety and needs for monitoring.”
What About “Suicide Attempts” That Are Not Really Suicide Attempts?
Sometimes, a person does something that appears to be a suicide attempt, but without any intent to die by suicide.
Non-suicidal self injury occurs for a great many reasons. Some people hurt themselves without intent to die because it helps them to discharge stress, to penetrate numbness, to punish themselves, or to achieve some other aim such as an adrenalin rush. These are clear cut cases where there is no suicidal intent, and so the act is not a suicide attempt.
Yet there are some people who hurt themselves with the specific goal of actually feigning a suicide attempt. Usually people with these feigned attempts have a specific objective in mind, like to get removed from the general population of prisoners in a jail or to avoid performing an onerous task in the military. In each of these examples, a suicide attempt could end up in the person avoiding a dreaded situation.
For others, an apparent suicide attempt may actually be a “cry for help.” Up to 40% of apparent suicide attempts fall under this category, according to a national study. (I write more about this complex topic here.)
The Reality of Suicidal Behaviors
Sometimes, as I explain in a journal article, we just don’t know whether someone who appears to have attempted suicide really wanted to die. Even people who do intend to die may be ambivalent about dying. They may be afraid of dying. They may even be tormented by the idea of dying. But for whatever reason, to at least some degree death seems preferable to their current situation.
Even when people engage in self harm to cry out for help or manipulate others, they are still engaging in dangerous, potentially deadly self harm that goes beyond “just” a gesture. Most individuals have healthy ways of solving problems or receiving attention. Using the appearance of a suicide attempt to effect change represents a dramatic, life-threatening gap in coping skills. The person may not actually be suicidal, but their behavior could still kill them.
Alternatives to the Terms “Suicidal Gesture” and “Suicide Gesture”
As you have almost certainly discerned by now, I advocate against using the terms “suicide gesture” and “suicidal gesture.” There are other terms you can use in their stead.
If somebody hurts himself or herself with at least some intent to die, then that is a suicide attempt.
If it is clear that the person had no suicidal intent when injuring himself or herself, then that is non-suicidal self injury.
If somebody truly and unequivocally feigns a suicide attempt, then the non-suicidal self injury can simply be described with precision rather than labeled. For example: “The client is homeless and sought admission to the psychiatric hospital during the blizzard. When denied admission, he pulled out a knife and superficially cut himself on the wrist.”
Whatever the case, there is no need to minimize suicidal behavior by calling it a mere gesture. We make gestures with our hands and head – not with suicide.
© Copyright 2014 Stacey Freedenthal, PhD, LCSW, All Rights Reserved. Written for www.speakingofsuicide.com
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