1 Suicidism and Suicide Prevention By Alexandre Baril, Ph.D. Photo by Aida L on Unsplash Editor’s Note: This guest post is a departure from Speaking of Suicide’s usual fare, both in style and content. It's a lightly edited excerpt from Dr. Baril’s book Undoing Suicidism: A Trans, Queer, Crip Approach to Rethinking (Assisted) Suicide. I don’t necessarily agree with everything the author states here, but his viewpoint adds to an important conversation about why suicide persists despite many people’s efforts to help. – Stacey Freedenthal I wanted to die so many times while I was writing my new book. Why are some people, such as disabled/ sick/ ill/old people who (at least the vast majority of them) don’t necessarily want to die, offered assistance in dying, while those who do want to die, such as me and other suicidal people, are denied assistance? Suicidal people often have to lie about their suicidality (a broad term encompassing suicidal ideation, suicide Baril, A. (2024). Suicidism & suicide prevention. Speaking of Suicide. speakingofsuicide.com/2024/1/8/suicidism 2 attempts, and completed suicides) because being honest has huge costs. Not only are their suicidal plans thwarted, destroying the escape hatch that was giving them hope of annihilating their despair; they are also subjugated to a vast array of discriminations and forms of violence. Suicidal people are routinely refused job opportunities based on their suicidal history; are denied life and health insurance; are labeled as incompetent parents and lose custody of their children; are deceived by suicide prevention hotlines that trace their calls and force nonconsensual interventions upon them; are handcuffed, arrested, and mistreated by the police (a violence deeply exacerbated when suicidal people are racialized, Indigenous, poor, neurodivergent, or Mad); and are forcibly hospitalized, physically restrained, and drugged against their will. Aware of these consequences of being honest about my suicidality, I, like many other suicidal people, have concealed my suicidal ideation from therapists, psychologists, and health care professionals to avoid these sanctioned forms of criminalization, stigmatization, pathologization, incarceration, and discrimination. As I argue in my book Undoing Suicidism: A Trans, Queer, Crip Approach to Rethinking (Assisted) Suicide, these forms of violence stem from structural oppression affecting people on the basis of their suicidality, an oppression I call suicidism. Before investigating and theorizing the oppression suicidal people face in their daily lives and before coining the term suicidism in 2016–2017 (Baril 2018), I always thought that I was the problem: a broken person, in need of having my suicidality “fixed.” My suicidality should be eradicated by cures. Cures are not only medical; social cures exist as well. I felt my desire to die, stemming mostly from sociopolitical oppression as someone who has lived (and in some cases is still living) through classism, sexism, heterosexism, cisgenderism, ableism, and sanism, Baril, A. (2024). Suicidism & suicide prevention. Speaking of Suicide. speakingofsuicide.com/2024/1/8/suicidism 3 needed to be purged through sociopolitical revolution. My desire to die felt like I was giving up on my communities, giving up on these political battles. I had no conceptual tools; no theoretical paradigms; no clinical models; no sociopolitical, legal, or medical support; and, most importantly, no social movement to help me make sense of my experiences, thoughts, and needs as a suicidal person, outside what I call the dominant suicidist preventionist script. As a trans, bisexual, disabled, and Mad man, who lived as a woman and a lesbian for almost thirty years, I was used to turning to social movements to theorize and politicize my experiences and oppressions. The feminist, queer, trans, disabled, and Mad movements, as well as their fields of study, have been my companions in understanding the oppressions I have experienced and in resisting the violence imposed on me. However, no social movement exists to which I can turn to collectivize and politicize the structural oppression I experience as a suicidal person. Who/what do you turn to when you are suicidal? Who/where are my peers, my political companions? Where is our movement? Why has no one told us that nothing is wrong with us, but that something is wrong with the suicidist system? How can I make sense of my experiences when concepts and notions to theorize this oppression have not been invented? Our oppression starts with the epistemic scarcity surrounding suicidism, to the point of not even having a term with which to denounce it, to politicize it. Suicidism is the word I sought for years. It is the concept many of us have been searching for, as evidenced by texts written by selfidentified suicidal scholars in response to my work on suicidism. Baril, A. (2024). Suicidism & suicide prevention. Speaking of Suicide. speakingofsuicide.com/2024/1/8/suicidism 4 The necessity for this concept is also evidenced by the numerous emails I have received over the years from people, self-declared suicidal (or not), telling me that they had been thinking about the oppression suicidal people face but did not have a term to name it. They thanked me. They shared their stories. So many of them. They cried. I cried. How did we end up not having a term for that oppression in the cacophony of such terms as sexism, heterosexism, cisgenderism, racism, colonialism, classism, ableism, sanism, ageism, healthism, and sizeism, to name only a few? I was flabbergasted. I was disappointed. If anti-oppressive social movements/fields of study did not have a word to name the oppression faced by suicidal people, not only had they not thought about it; they were most likely reproducing suicidist oppression without knowing and despite their best intentions. That disappointment was the spark for my book, and Undoing Suicidism could be the spark for an anti-suicidist movement. My thesis is simple but radical: Suicidal people are oppressed by what I call structural suicidism, and that oppression remains hidden and undertheorized, including in our anti-oppressive social movements/fields of study. My hypothesis is that the suicidist preventionist script actually produces more harm and more deaths by suicide rather than prevent suicides. Photo by Getty Images on Unsplash Baril, A. (2024). Suicidism & suicide prevention. Speaking of Suicide. speakingofsuicide.com/2024/1/8/suicidism 5 Furthermore, suicidist oppression is particularly harmful to marginalized groups, including queer, trans, disabled, and Mad people, on whom my book focuses. My goal in writing Undoing Suicidism was to make not merely a descriptive claim about suicidist violence through the theorization and problematization of this oppression, its characteristics, mechanisms, and consequences, as well as its relationship to other oppressive systems, such as ableism, sanism, heterosexism, and cisgenderism, but also a normative claim that indicates how the world should be in relation to suicidality. In other words, simply studying and describing suicidism is not enough; we must also work to eliminate it. We need to completely rethink the suicidist—and carceral—logic behind our institutions, policies, laws, and other structures regarding suicidality. These structures harm not only suicidal people but all of us, particularly those of us living at the intersections of multiple oppressions, such as racialized, Indigenous, poor, queer, trans, disabled, or Mad people, because they prevent marginalized groups living with distress from reaching out for help and from having transparent conversations about their suicidality for fear of experiencing more violence. In my book, I offer reflections that I hope could nourish the emergence of a new social movement: the anti-suicidist Photo by Randy Laybourne on Unsplash Baril, A. (2024). Suicidism & suicide prevention. Speaking of Suicide. speakingofsuicide.com/2024/1/8/suicidism 6 Photo by Akhil Nath on Unsplash movement. One of the foundational goals of this movement could be to unpack and denounce the suicidism that affects suicidal people at every level: epistemic, economic, political, social, cultural, legal, medical, and religious. This movement could also be a venue to question what I call “compulsory aliveness” (Baril 2020), inspired by the notion of compulsory able-bodiedness or able-mindedness in an ableist and sanist system (Kafer 2013; McRuer 2006). As the normative component of suicidism, compulsory aliveness comprises various injunctions (or imperatives), including what I have previously called “the injunction to live and to futurity” (Baril 2017, 2018, 2020, 2022). Suicidism and compulsory aliveness are also deeply intertwined with multiple oppressions, particularly ableism and sanism. Indeed, compulsory aliveness aims to impose a will to live that makes suicidal people’s desire/need for death abnormal, inconceivable, and unintelligible, except for those cast based on dominant norms as unproductive, undesirable, and unsalvageable subjects, such as disabled/sick/ill/old people. In their cases, the desire/need for death is Baril, A. (2024). Suicidism & suicide prevention. Speaking of Suicide. speakingofsuicide.com/2024/1/8/suicidism 7 considered normal and rebranded as medical assistance in dying or physicianassisted death. However, suicidal people’s desire for death is cast as “irrational,” “crazy,” “mad,” “insane,” or “alienated,” and they are stripped of their fundamental rights. As a dominant system of intelligibility within a suicidist regime, compulsory aliveness masks its own historicity and mechanisms of operation, which give life an apparently stable and natural character. Yet this stability and this naturalness stem from performative statements about the desire to live, iterated in various institutional settings, interventions, laws, and discourses—and particularly in suicide preventionist discourses. Under compulsory alive-ness, suicidal people’s experiences of incarceration are disguised and justified as care. Regardless of a wide variety of models for conceptualizing suicidality, be it the medical/psychological, public health (also sometimes known as the biopsychosocial model), social, or social justice models, all almost invariably arrive at the same conclusion: Suicide is Photo by Basil James on Unsplash never a good option. Even for the proponents of the right to die for disabled/sick/ill people (and sometimes Mad and old people), regardless of whether they adhere to one of the aforementioned models of suicidality, assisted suicide remains out of question for suicidal people themselves. In other words, when it comes to suicidal people, surprisingly, everyone agrees that supporting their assisted suicides is not an option. In consulting more than 1,700 sources while writing Undoing Suicidism, from Greek antiquity to contemporary philosophers, bioethicists, and activists/ scholars in anti-oppressive social movements/fields of study as well as the fields of suicidology and critical suicidology, I have not found anyone Baril, A. (2024). Suicidism & suicide prevention. Speaking of Suicide. speakingofsuicide.com/2024/1/8/suicidism 8 Photo by Getty Images on Unsplash who has ever, to my knowledge, proposed what I suggest here: explicit support of assisted suicide for suicidal people. embrace in my book is one founded on the abolition of the current violent laws and regulations that govern assisted suicide in various countries. I want to briefly mention here that from a disability/ crip/Mad ethos, I firmly denounce the ableist/sanist/ ageist/suicidist foundations of assisted suicide in their current forms in various countries, while also pointing out their complex relationships with other systems of oppression, such as racism, colonialism, classism, heterosexism, or cisgenderism. Inspired by activists/scholars working at the intersection of disability/Mad studies, incarceration, decarceration, and the abolition of prisons (and other institutions that incarcerate disabled and Mad people), such as Liat BenMoshe (2013, 2020), the position I Simultaneously, I endorse a positive right to die for all suicidal people, be they disabled/sick/ ill/Mad/old or not. My position is radically different from what has been proposed so far by other scholars, activists, or policy makers regarding assisted suicide, as it is based on an entirely different sociopoliticallegal project to create new anti-ableist, anti-sanist, anti-ageist, and anti-suicidist forms of support for assisted suicide for suicidal people. My position does not aim to reform current laws and regulations to include mental illness and mental suffering as eligibility criteria for assisted suicide, as Baril, A. (2024). Suicidism & suicide prevention. Speaking of Suicide. speakingofsuicide.com/2024/1/8/suicidism 9 is the case with some proponents of the right to die. Instead of including more people in the current laws based on an ableist/sanist/ageist/suicidist framework, my abolitionist proposal aims to turn upside down these legal frameworks, policies, and interventions to offer forms of assisted suicide to those who are explicitly excluded from all current laws on assisted suicide: suicidal people, regardless of their dis/abilities, health, or age (as long as they’re adults). The preventionist script, nourished by suicidism, compulsory aliveness, and the injunction to live and to futurity, forces us to take an unaccountable and uncompassionate approach toward suicidal people. Suicidal people experience pervasive forms of criminalization, incarceration, moralization, pathologization, stigmatization, marginalization, exclusion, and discrimination, anchored in a logic of preventive care. Despite the public discourses of support and compassion surrounding suicidality, suicidal individuals who reach out for help do not always find the care promised. The media is replete with horrific stories of suicidal people experiencing inhumane treatments after expressing their suicidal ideation. Worse, many experience increased forms of violence through those interventions, particularly racialized and Indigenous people, as well as poor people, trans and nonbinary people, and disabled/Mad people. Despite multiple strategies tried over decades and billions of dollars invested in reaching out to suicidal people and exhorting them to speak up, prevention campaigns fail to convince suicidal individuals to reach out, and suicides continue to happen. Studies show that those most determined to die carry out their suicidal plans without reaching out for help. Additionally, despite a few Photo by Nathan McDine on Unsplash Baril, A. (2024). Suicidism & suicide prevention. Speaking of Suicide. speakingofsuicide.com/2024/1/8/suicidism 10 ebbs and flows, suicide statistics remain relatively stable and have not improved significantly over the past decades. In sum, our prevention strategies do not work because we fail suicidal people who complete their suicides. My hypothesis is that the suicidist preventionist script is harming suicidal individuals rather than caring for them. Simply put, preventionist logic, discourses, and practices propel deaths by suicide rather than prevent them. Through a curative logic focused on the prevention of suicidality, we do not encourage or support the creation of social, emotional, affective, or political solidarities between suicidal people, alliances that may allow them to reflect critically on their common experiences, shared feelings, similar philosophies and values, needs, goals, and claims. Instead, the logic of cure and prevention keeps suicidal people apart from one another by trying to eradicate their suicidality through individual medical/psychological or sociopolitical curative ideologies. I do not want to eradicate suicidality but to offer new ways to imagine it and to live, and sometimes die, with it. In lieu of the curative and carceral logic underlying the suicidist preventionist script as well as the ableist/sanist/ageist logic of disposability and austerity fundamental to various contemporary right-to-die discourses, I propose in Undoing Suicidism a queercrip model of (assisted) suicide that offers positive rights and support for assisted suicide for suicidal people. Photo by Florian Schmetz on Unsplash This assistance would be delivered through a suicideaffirmative approach that is anchored in the values of Baril, A. (2024). Suicidism & suicide prevention. Speaking of Suicide. speakingofsuicide.com/2024/1/8/suicidism 11 multiple antioppressive social movements, such as intersectionality, bodily autonomy, self-determination, informed consent, and harm reduction. Through this suicide-affirmative approach, suicidal people would find safer spaces to explore their suicidality without fears of suicidist consequences. Photo by Gus Moretta on Unsplash I propose a shift from a preventionist and curative logic to a logic of accompaniment for suicidal people, a form of support that could be lifeaffirming and death-affirming. Suicidal people would be accompanied in reflecting critically on their different options, weighing the pros and cons of each, determining the best course of action for themselves, and, if they maintain their preference for assisted suicide, be supported in the difficult passage from life to death. Suicide needs to be avoided, the suicidal person should not be given a choice, and the various interventions (be they medical, psychological, social, and so forth) aim to implement choices made by others that are imposed on the suicidal person, often against their will and their consent. From this point of view, life is the priority, not the suicidal person and what they claim. The epistemic authority of the suicidal person is denied when it comes to matters of life and death. This shift from prevention to accompaniment would empower suicidal people. Indeed, from a suicidist preventionist stance, other people, such as family, researchers, or health care providers, hold the “truth” on suicide: In the anti-suicidist logic of accompaniment I propose, the epistemic authority switches hands. The suicidal person has epistemic authority, following the suicidal epistemological standpoint I offer in my book, and those around them are there to offer support. Baril, A. (2024). Suicidism & suicide prevention. Speaking of Suicide. speakingofsuicide.com/2024/1/8/suicidism 12 In other words, while a suicidist preventionist script has a pre-identified goal and solution (saving lives) usually designed by nonsuicidal people, the anti-suicidist logic of accompaniment centers on the suicidal person to help them identify their own goals and solutions. The priority is the suicidal person, not life itself. transformation and social justice for various marginalized groups is not antithetical to greater accountability for the lived experiences of suicidal people, the stigma they face, the prejudices they must live (and die) with, the structural suicidist violence they experience, and the support they need to make decisions regarding life and death. Another important point is that my queercrip model of (assisted) suicide is meant to complement, not supersede, the fight against systemic oppressions that influence suicidality in marginalized groups. This model puts forth the idea that fighting for social While the primary goal of my queercrip model of (assisted) suicide is to provide more humane, respectful, and compassionate support for suicidal people rather than to save lives at all costs, one of my hypotheses is that a suicide-affirmative approach that Photo by T. Kaiser on Unsplash Baril, A. (2024). Suicidism & suicide prevention. Speaking of Suicide. speakingofsuicide.com/2024/1/8/suicidism 13 supports assisted suicide for suicidal people might actually save more lives than current prevention strategies do. I contend that many unnecessary deaths by suicide could be avoided through my suicide-affirmative approach. Currently, to avoid suicidist violence, many suicidal people who might be ambivalent retreat into silence and act on their suicidal ideations before speaking with professionals, relatives, friends, or prevention services. In other words, instead of talking through their suicidal ideations to make an informed decision about their death by suicide, they make the most crucial decision of their life alone, with no process of accompaniment and no support from their surroundings. Research and statistics on suicidality prove my point: Suicidal people determined to die do not reach out and end up completing their suicide without having discussed all the pros and cons of this decision. In that sense, a suicideaffirmative approach, focused on accompaniment rather than prevention, would open up channels of communication with suicidal people to help them make an informed decision. In sum, while our societies appear to really care about suicidal people and their well-being, a more careful examination reveals that, through a preventionist and “caring” script, we actually exercise violence, discrimination, exclusion, pathologization, and the incarceration of suicidal people. Every year, this negative conceptualization of suicidality and its curative logic of prevention cause more damage and more deaths. Therefore, my book unpacks the idea that the best way to help suicidal people and to prevent suicide is through the logic of suicide prevention. Worse, prevention, informed by suicidism, produces suicidality. Making a provocative argument that supporting assisted suicide for suicidal people, from an anti-suicidist perspective, may better prevent unnecessary deaths, Undoing Suicidism proposes to rethink our conceptualizations of suicide and assisted suicide in radical ways. Excerpted from Undoing Suicidism: A Trans, Queer, Crip Approach to Rethinking (Assisted) Suicide, by Alexandre Baril. Used by permission of Temple University Press. © 2023 by Temple University. All Rights Reserved. The book can be purchased and an open-access edition can be found at: https://tupress.temple.edu/books/undoing-suicidism Baril, A. (2024). Suicidism & suicide prevention. Speaking of Suicide. speakingofsuicide.com/2024/1/8/suicidism 14 About the Author Alexandre Baril is associate professor at the University of Ottawa. His work is situated at the crossroads of gender,queer, trans, disability/crip/Mad studies, critical gerontology, and critical suicidology. His commitment to equity has earned him awards for his involvement in queer, trans and disabled communities, including the Canadian Disability Studies Association Tanis Doe Francophone Award, and the Equity, Diversity and Inclusion President’s Award at the University of Ottawa. A prolific author who won the Young Researcher Award from the Faculty of Social Sciences at the University of Ottawa, Dr. Baril Photo by Marjorie Silverman has given over 225 presentations at the international level and has over 80 publications. He is the author of Undoing Suicidism: A Trans, Queer, Crip Approach to Rethinking (Assisted) Suicide (2023). You can email him at abaril@uottawa.ca and follow him on Academia.edu.. Baril, A. (2024). Suicidism & suicide prevention. Speaking of Suicide. speakingofsuicide.com/2024/1/8/suicidism