By Sally Spencer-Thomas & Eduardo Vega
“Suicide ideation” — that’s what mental health providers usually call it.
To the general public, this often sounds “jargony”. They say, “ideation — like what do you mean…like thoughts?” And we say, “Yeah…like thoughts…”
And they say, “Well then just say thoughts…”
The experience of suicide for most people, however, cannot be reduced to “thoughts”. For some, there are thoughts of hopelessness and self-loathing. For others, it’s more of a feeling in the body. Overwhelming sensations of dread, fear, despair, or misery that may or may not have conscious thought connected. Some people experience no feeling or thoughts at all — just a numb experience of feeling like the walking dead. For others a wide range of thoughts and feelings can arise, even physical sensations that are difficult to endure or even describe are important elements of the personal experience of suicide.
In order to support people encountering thoughts and feelings related to suicide, or going through them, we need a new vocabulary. One that is driven by respect for the person at the center of a deeply personal struggle. One that is free of judgment or pathologizing aspects. To get to this humanizing value, Eduardo Vega created the term “suicidal intensity”. In addition to being more jargon free, there are many reasons why “suicidal intensity” is a better descriptor and conversation aid than “suicidal ideation.”
Reason #1: Less Pathologizing
So much of our traditional language about suicide that has been used is pathologizing as many clinical terms have made their way even into common parlance. Even as we work decriminalize the experience of suicide by advocating alternatives to language laden with negative nuance – e.g., replacing “committed suicide”, with “died by suicide”– we need to foster humanizing terms that invite dialogue as opposed to dismissing it with a label based in psychopathology.
“Suicidality” is a great example of a term that emerges from psychiatry, which has also acquired significant association with the legal and law enforcement systems as well as the restriction of rights. Just as the phrase “commit suicide” has an inescapable connection to crime and judgment (we commit crimes and commit sins), the relationship between “suicidality” and criminality is much more than a coincidence of rhyme. Suicidality also lacks specificity and lends itself to one of the more common linguistic problems we encounter in English: underdetermination. Words or phrases that are “underdetermined” have vague or unclear meanings but are used as if their meaning is clear and understood by all.
Reason #2: More Personal
The phrase “suicidal intensity” brings focus to the fact that wanting to die, having thoughts about killing oneself, and the desire to find relief in death are potent and deeply personal matters. They are connected to inner anguish, entrapment, self-loathing, and despair that seeks relief. They are connected to perhaps the most important questions any person can ask — “Why should I live? How can I bear this suffering? What is the meaning of my life?”
Reason #3: Dynamic Term Assists Clinical Conversations
One of the main reasons people — both clinicians and people with lived experience with suicide — are resonating with this emerging phrase of “suicidal intensity” is because it is a dynamic term. The word “intensity” indicates movement and varying degrees of strength which can fluctuate over time and are experienced differently by different people.
What is particularly useful when talking about experiences this way is when people can identify what drives surges in their suicidal intensity and what can be done to regulate these surges (listen to Dr. Ursula Whiteside’s Stop, Drop and Roll podcast). Often these surges are linked to more impulsive and sometimes deadly suicidal behavior (See Harvard’s Means Matter article on “Duration of Suicide Crises”: https://www.hsph.harvard.edu/means-matter/means-matter/duration/).
Dr. David Jobes, in his collaborative approach to managing suicidal thoughts and feelings, has clients self-rate various components of their suicide intensity from low to high, like psychological pain, stress, agitation, hopelessness and self-hate, and then monitor how changes in intensity move from day to day.
Dr. Matt Nock and his lab at Harvard have discovered that there are a number of pattens in experiences with suicide intensity. It’s research like this and other lived experience descriptions that show us that there are variations on chronicity, fluctuation and acuteness. Some people have “one and done” — when a surge in intensity happens after a difficult life event (e.g., separation from or death of a partner) and passes as the person gains distance from that event. Some people have undulating moderate levels of suicide intensity that may or may not be connected to external triggers. Some people have low suicide intensity all the time, for as long as they can remember. Some people have chronic high suicidal intensity, and sometimes engage in very aggressive forms of mental health care to find any opportunity of reprieve from this pain.
Reason #4: Dynamic Term Helps with Introspection
The possibilities involved in exploring suicidal intensity on the personal level, then, can generate a richer interpersonal understanding, and engage public interest in a new way that is also dynamic.
Whether it is an introspective interest that includes thoughts and feelings (why am I feeling such suicidal intensity now?) or an external interest from someone you are sharing with (how much intensity are you experiencing? What does it feel like? What kind of thoughts are associated with it?) — this phrase can generate thinking and questions that are grounded in compassion. It also supports the important notion that this intensity is something we can dialogue with – it is a real experience that has meaning and importance. “Ideation,” by contrast, conveys the notion of a symptom or a phenomenon perhaps, something foreign and nonpersonal.
Suicidal intensity can be understood as a part of the self that is succumbing to unrelenting pain. People who are often fighting for their life through this intensity can then engage with it by asking, “How is your suicidal intensity faring in its engagement with your will to live?” and “Can these two parts of yourself have a conversation with one another?”
Conclusion
If we want to see different results in terms of suicide death we need to be talking about the human experience in new ways. Ways that promote dignity and respect and which move away from language which is overly clinical or criminalizing.
By contrast, “suicidal intensity” helps us recognize immediately that there is a human being at the center of all this. That although the specifics of an individual’s encounter with suicide vary greatly, it is always a deeply felt subjective experience. An experience that should not be reduced to a symptom or syndrome, one that – for the individual at the heart of it at least– demands attention.
About Eduardo Vega
An internationally recognized leader in mental health systems, programs and policy, consumer/patient engagement, stigma reduction, men’s health and suicide prevention, Eduardo Vega’s work continues to drive the forefront of change for mental health worldwide. A former Fulbright Specialist and California State Mental Health Commissioner, he has spearheaded progressive social and public health change at local, national and international levels.
For over twenty-five years, Vega has worked for the improvement of lives and systems of care in behavioral health. A suicide attempt survivor who experienced serious mental health conditions himself since childhood, Vega has served as counselor and/or manager in virtually every psychosocial and clinical mental health service setting, as well a performing executive roles in government, business and non-profit administration. As President and CEO of Mental Health Association of San Francisco from 2010 to 2016, he drove organizational expansion near one-thousand percent in three years, focusing on innovation in consumer-run services and community empowerment. Simultaneously, as Director and Principal Investigator at the International Center for Dignity, Recovery and Empowerment Vega spearheaded leading-edge research, TA and training projects in suicide and stigma and discrimination reduction, community integration, self-help and peer support. Previously he served at the executive management level of the Los Angeles County Department of Mental Health, one of the world’s largest public mental health authorities.
Learn more about his current work: https://www.humannovations.net/
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