More than ever before, people understand that caring for our mental health is as important as caring for our physical health. However, there is still much work that needs to be done to break stigmas that contribute to unnecessary shame and misunderstanding of mental illness.
Despite strides in understanding that emotional difficulties are not personal shortcomings or a sign of weakness, many continue to believe that mental illness is the result of poor decisions. For example, some people still believe that engaging in suicidal behavior is a personal “choice.” This is often followed by the unfair assumption that “suicide is a selfish choice.”
One might reasonably ask, “Given the unbearable loss and pain felt by those left behind, how can suicide not be considered selfish?”
First, we often underestimate how many factors contribute to an outcome as complex and final as suicide. Those who experience the kind of emotional pain associated with suicide do not typically want to die; they wish for an end to unbearable emotional pain and, often, the resources that allow them to hold on aren’t available. Individuals who struggle with thoughts of suicide usually have a hard time thinking flexibly and their ability to see an end to pain and a life worth living is greatly compromised.
Second, viewing suicide as a choice promotes the misunderstanding that people who engage in suicidal behavior are selfish. Selfishness has been defined by Merriam-Webster as “seeking or concentrating on one's own advantage, pleasure, or well-being without regard for others.” Suicide does not generate pleasure, advantage or well-being. People who take their own lives commonly feel like a burden to others or experience intense emotional pain that overwhelms their capacity to continue with life. Making others feel guilty is typically the furthest thing from their mind.
Third, a choice usually involves making a selection based on multiple factors or preferences. Sadly, an inability to make rational, life-affirming decisions is a hallmark of suicidal thinking. Intense emotion pain, hopelessness and a narrowed, negative view of the future interferes with balanced decision-making. A person may believe they are making the best decision among their options, but it certainly isn’t reflective of all possible choices. What makes this more challenging is that those choices may not be accessible until the crisis has resolved.
These are some additional variables that impact whether a suicide occurs - little of which have to do with choice:
Access to highly lethal means during a crisis, such as firearms
Availability and awareness of crisis supports to delay action - personal and community connections influence whether one has the opportunity to find hope and recovery
Why does reframing suicide as something different from a “choice” matter? It matters because those struggling with thoughts of suicide need all of us to understand that they don’t want to be in a place of overwhelming pain. They would typically rather be alive and living without that pain, and viewing their condition and behaviors as a choice only adds to the burden they already carry.
It takes practice to empathize with someone who feels like death is a better option than life in a given moment. One has to be able to refrain from judgment, understand that suicide is not a personal weakness or someone’s “fault,” and recognize that suicide is often a product of mental health and environmental variables that we don’t fully comprehend.
It can be hard for us to approach such extreme pain with a sense of compassion and curiosity. We would rather rely on simple explanations like “if we had just done this,” “if the parents had done a better job,” or “if he or she didn’t get bullied.” Suicide is nearly always more complex than that, but because answers are elusive and the trauma and loss remain for many years, we look for clarity.
Stigma and discrimination make it less likely that those who stand to benefit from mental health treatment receive it. Too many people blame themselves for feeling depressed or like life is no longer worth living – they struggle to live rich and meaningful lives because of it.
We need to reduce, not increase, the burden on those who struggle with thoughts of suicide. Breaking down stigma is a key to opening conversations, getting help and emerging from those struggles. Let’s commit to viewing people in emotional crisis similarly to those with a physical injury – with care, compassion and a plan for recovery.
If you or your child need immediate help due to having suicidal thoughts, call or text the 988 Suicide & Crisis Lifeline at 988. If there is an immediate safety concern, call 911 or go the nearest emergency room.
John Ackerman, PhD, is a clinical psychologist in Behavioral Health and Suicide Prevention Coordinator for the Center for Suicide Prevention and Research (CSPR) at Nationwide Children's Hospital. He directs community, school, and hospital efforts to educate others about the risks and warning signs of pediatric suicide.
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