In a previous post I introduced the key themes of my current thinking about suicide – i.e. the key themes that underpin the activism side of my work. This post is the first of a series that will explore each of these key themes in more detail.

Key Themes 1 – The Survivor Voice

The psychiatric survivor community represents a political movement calling for radical change in how we think about emotional distress. It is a diverse community with a wide-ranging agenda. What unites us is the demand that we speak for ourselves and that our voices be heard.

Other terms used to identify us are ‘consumer’ and, mainly in the UK, ‘service user’, which is often abbreviated to just ‘user’. For me, user usually means a drug user, which I used to be, but is not what’s meant here. And service user is not OK as many of us no longer use mental health services, plus we don’t want to be defined based on the services we use(d). The term consumer suffers a similar problem – just what precisely am I consuming? But more than this, for me these other terms are the language of those who oppress us, the language of the medical model of madness.

I can respect those who identify themselves using this language, many of whom are working for change from within the system. But this never worked for me. As a consumer I constantly felt patronised, put down, marginalised and/or co-opted by the hierarchy of our mental health systems. For me, adopting the survivor identity is a political statement that I refuse to participate in my own oppression.

Whether we’re talking as survivors, consumers or users (or whatever else), our many diverse voices speak from the perspective of our lived experiences. This is the voice of experiential knowledge. In mental health, this voice has largely been dismissed or marginalised as subjective, anecdotal and unrepresentative (i.e. individual). Or in the language of the oppressor, this voice, this knowledge, is deemed ‘unscientific’.

Subjective vs Objective Knowledge

The terms ‘subjective’ and ‘objective’ have become so tainted with prejudice and dogma – i.e. objective is good, subjective is bad – that I reckon that we should just stop using them. This is quite easy to do if we simply talk about first-person and third-person knowledge.

First-person and third-person knowledge are simply two different ways of knowing about any humanly experienced event or phenomena. Both are valid forms of knowledge. Both can tell us useful things about the phenomena that we’re curious about. Each has something unique to tell us that cannot be seen by the other. Neither is better or worse than the other – on the contrary, they each complement and complete the other. And importantly, either one by itself can only a partial, incomplete form of knowledge.

Although not as tainted as subjectivity, first-person knowledge still gets a pretty poor rap in academia today. The problem here is that research into first-person knowledge has been seriously neglected compared to the vast resources that are ploughed into third-person research. This is partly because third-person research has delivered so much and continues to promise so much more, which is all well and good. I have no problem with good first-person research. It becomes a very serious problem, however, when the political influence of this research agenda strangles other forms of research, whether though deliberate bigotry or simply by claiming most of the available research funding.

The pinnacle of third-person knowledge and research is arguably medical science, with its extraordinary achievements that have been of so much benefit to so many people. It is hardly surprising then that medical research has the biggest pot of research dollars. It is perhaps more surprising, and certainly more disturbing, that medical science has become the arbiter of constitutes valid knowledge these days.

Medicine’s exclusive reliance on third-person knowledge works well enough (well almost) for its research into flesh and bone. It fails hopelessly, however, when it tries to look into the invisible, intangible, non-physical interiors of our lived experiences – what it feels like to be happy, in love, sad, or suicidal. And even more importantly, what these feelings mean to those who live them. Third-person science has nothing to say about this because it is totally blind to them. And don’t be fooled by the bloated claims of neuroscience, which also tells us precisely nothing about the inner, personal meaning of all that neuronal activity.

No, when it comes to human experiences that are mostly about our dark, invisible interiors, so rich and full of meaning, third-person knowledge is woefully inadequate. Historically, these important questions have been the realm of the arts, and indeed the arts, broadly speaking, are one of the primary ways we can tap into our first-person knowledge. From an academic, research perspective, this makes the arts an important first-person research method. Or, to say this more simply and more generally, the principal first-person research method for exploring these dark interiors is story-telling. Story-telling, unreliable though it can be, is how we disclose, reveal and give expression to our inner worlds. Our stories, the survivor voice, is the vital missing piece in our efforts to understand madness and suicide.

As a short aside, I must briefly mention psychology, which sometimes claims to study our internal worlds. Modern psychology seems to be in a state of chaotic confusion about this, sometimes trying to be a strictly third-person ‘hard science’, sometimes foolishly pretending to delve into first-person interiors with hopelessly inadequate third-person methods, and then sometimes, just occasionally, really daring to go into the first-person realities, though sometimes in pretty kooky ways and often in ways that are frowned upon by their more conservative peers. So when it comes to looking for a clinical psychologist for some help with your innermost feelings, it seems like pot luck what you will find, making it a pretty risky thing to do. Which is exactly what many survivors report.

I’ve not mentioned psychiatry yet because the madness of psychiatry is a separate key theme of my activism and will be a separate essay. Very briefly, psychiatry today is dominated by the biomedical model of bio-psychiatry. The first problem here is that they don’t even practice good science according to their own (third-person) criteria. And then, their commitment to third-person dogma reduces us all to little more than biochemical robots, which is absurd and would be comical if it were not for the great harm it is causing. More on this in a later essay.

So please, let’s stop using the heavily loaded language of subjectivity and objectivity and speak instead of first-person and third-person knowledge. And then recognise that both ways of knowing are valid, useful and important. And furthermore, that one without the other is a very lop-sided and incomplete knowledge. It then becomes apparent that the vital first-person knowledge of the lived experience – the survivor voice – has been grossly neglected and needs to be reclaimed and restored in the discourse around mental health. This has slowly begun to occur in recent times but still has a long way to go.

The survivor voice in Suicidology

In contrast to recent progress in mental health more generally, the survivor voice remains largely absent from the discourse around suicide. When I first looked at the literature of Suicidology, the academic discipline that describes itself as the “science of self-destructive behaviour”, I was taken aback by the stark absence of the actual suicidal person in the literature. I described it at the time as though these learned experts were looking at people like me through the wrong end of their telescope so that we were barely visible specks on the distant horizon. That was over ten years ago now, and I regret that I must report that little has changed since then.

Suicidology – and what I sometimes call the ‘suicide prevention industry’ – does some things better and some things worse than other areas of mental health. For instance, it gives more regard to the social contexts of a person’s distress whereas mental health in general tends to pathologise the individual more readily with psychiatric labels. And although Suicidology is very much dominated by psychiatry these days, its roots include the sociology of Durkheim and the psychology of Shnediman so that it is not (yet) as medicalised as mental health more generally. This is helped by the fact that suicidality does not have the status of a DSM disorder, though this appears to be changing in DSM-5, which is not good news. On the other hand, Suicidology is much worse than the wider mental health sector at including the survivor voice.

Once again we encounter some terminology problems, with the term ‘survivor’ being particularly problematic in suicide prevention. Within Suicidology, especially but not only in the US, the term ‘suicide survivor’ is used to refer to someone who has lost a loved one to suicide. I learned this very early when I did a google search looking for fellow survivors of suicide attempts and was taken aback to find this language taken by those bereaved by suicide. My initial reaction was that the language I needed to describe myself had been stolen. As I struggled to find language to search for others like myself I soon learned that there was none, that we were invisible to the point of virtually not existing.

In recent years, at least here in Australia, there has been some attempt to identify us as ‘suicide attempt survivors’, or just ‘attempt survivors’. But I’m not happy with this because it fails to include those survivors who are intimately familiar with suicidal feelings but have not made (or disclosed) any actual attempt. It also reflects the tripartite taxonomy of Suicidology that divides us into contemplators, attempters and completers, which also irritated me in those early days because I didn’t recognise myself in any of these categories as they were described in the literature. Plus I felt they were artificial and very coarse categories that were convenient, perhaps, for academics and their endless epidemiological studies, but not very useful for understanding the lived experience of suicidal feelings.

Some pedantic academics insist that the word ‘suicide’, by definition, requires a dead body so to call myself a suicide survivor would be oxymoronic. But I’ve asked many people over the years what their common, everyday understanding of this term means to them and invariably they say someone who has survived a suicidal crisis. When I explain that Suicidology uses this term for those bereaved by suicide they are quite shocked, just as I was when I first heard it.

Eventually I gave up looking for acceptable language and decided to reclaim‘suicide survivor’ to identify myself. I realise this causes confusion at Suicidology conferences (though rarely elsewhere) and it will probably be a long time before my usage prevails. So once again, claiming this language is a political act that says I refuse to be invisible, and in particular that I refuse to be invisible within Suicidology where this language is part of the silencing – the invisibilising – of the suicidal person by those who claim to be experts in the field.

I must say that one of the reasons it took me so long to reclaim the suicide survivor language is because I have great sympathy for those bereaved by suicide. I once heard that their choice to call themselves suicide survivors came from the death notices that spoke of the dead person as being “survived by…”, which makes sense to me and I’m not critical of them for choosing this language. But I suspect that they may not have chosen this language if the actual suicidal person had a stronger presence – a stronger voice – at suicide prevention gatherings.

These suicide survivors – the bereaved – also highlight some other prejudices you’ll find in Suicidology. Some of the bereaved I’ve met at suicide conferences have been very supportive of my efforts to speak up for the suicidal person. A few have even agreed with me that suicide survivor should be used to identify suicidal people rather than the bereaved. On the other hand, I’ve also encountered animosity from some bereaved survivors, which at times has even been quite hostile. I now caution my fellow survivors to beware of these people who seem to harbour tremendous resentment towards the loved one they have lost to suicide. A not uncommon remark from these people is “How could they do this to me”. Or the slightly less hostile but even more common, “I’m sure they wouldn’t have done this terrible thing if they knew the pain it would cause us”. I feel for their pain but to me exclamations like these reveal a lack of understanding of the suicidal experience.

I also objected to how the bereaved sometimes spoke as though they were speaking on behalf of their dead loved one. This led me to recognise that there are two important first-person voices that Suicidology needs to hear. Those bereaved by suicide know “from the inside” the unique and terrible grief of losing a loved one to suicide. This needs to be spoken of and I totally support the strong presence the bereaved have at most Suicidology conferences – indeed it’s not uncommon for there to be a separate stream for these ‘survivors’. But this only highlighted for me the stark absence of the other critical first-person voice that needed to be heard, that of the suicidal person.

There are many reasons why we are so absent from these gatherings, none of them good. One is the argument above that suicide, by definition requires a dead body – and the dead cannot speak for themselves. A variant of this is that the only genuine suicide attempt is a successful one – woops, a ‘completed’ one, you’re not allowed to call it successful. This is first of all just plain offensive to people like me. But more than this, it is also contradicted by the data that show the strongest indicator – out of all the very weak indicators – for successful/completed suicides is a previous suicide attempt. Another argument that excludes and silences us is that suicide, virtually by definition, is irrational and therefore suicidal people cannot contribute anything sensible to the understanding of suicide. I recall when I first saw that there is a lively debate within Suicidology whether suicide is ever rational. It struck me as a silly debate at the time and still does, but it continues nevertheless. It does reveal, however, the deep-seated prejudice against the suicidal person as crazy, which we also find in mental health more generally. Such prejudices will only ever be defeated by suicidal survivors having a strong voice within Suicidology and the suicide prevention industry.

I feel I should also mention why I object to the censorship of talking about succeeding or failing at suicide. First, the argument against this language is to discourage any suggestion that killing yourself is a success. I don’t object to this sentiment and I certainly agree that we should not glamorise or sensationalise suicide. But when I woke up in hospital, still alive, I felt like I had failed. Big time. And there’s no sense of failure like failing at suicide. So I see the censorship of this language as yet another example of silencing the suicidal person. My sense of failure was real and I need to speak of it in my language. It is not for these experts to dictate how I describe my experience.

My final comment on why I like the survivor language is that my very simple definition of survivor is that if you’re still breathing then you are a survivor.

Hungry for more?

Given the low status of first-person knowledge in academia, I had to articulate in some detail the arguments for its legitimacy, validity and significance. This would not have been such an issue in most fields of the ‘human sciences’ where subjectivity has been a lively topic of study in the postmodern discourse of the last 40-50 years. But medical science, including the pseudo-science of psychiatry that dominates mental health and Suicidology, remains largely locked into the myth of objective, third-person knowledge as the only valid knowledge.

To make these arguments I am particularly indebted to the Integral Model of the American philosopher, Ken Wilber. It was Wilber who first opened my eyes to first-person and third-person knowledge as equal partners in the knowledge quest. And his Integral Model presents in a clear and simple (and visual) way how any one form of knowledge by itself is only partial and incomplete. Or in his words, “third-person knowledge by itself is not so much incorrect as incomplete”.

Wilber also acknowledges what he calls “the great dignity of modernity”, with perhaps no better example of this than the many great achievements of medical science. But he also reveals “the great disaster of modernity” where the realities of experiential, first-person knowledge are denied by a blind faith in the supremacy of third-person knowledge.

Two other authors that were particularly influential in this work were Francisco Varela (et al) and David Chalmers. Varela was a neuroscientist who was particularly interested in the phenomenology of neural activity. His 1991 book, with Evan Thompson and Eleanor Rosch, “The Embodied Mind”, is regarded by many as a classic in the field and was my introduction to phenomenology. Phenomenology asks the question, “What is it like to be… this or that?”. Or for my work, what is it like to be suicidal? Discovering phenomenology gave me an established and rich intellectual tradition where first-person knowledge is taken seriously.

David Chalmers is an Australian philosopher in the field of Consciousness Studies. He is famous for describing experience – first-person, experiential knowledge – as the “hard problem” of Consciousness Studies. He further argues that this hard problem cannot be resolved by the methods of third-person science. He is also quite a brilliant writer who is a joy to read (not always the case in academia).

Within Suicidology, the shining light and champion for the voice of the suicidal person is Edwin S. Shneidman, a US psychologist widely acclaimed as the founding father of Suicidology as an academic discipline. Shneidman died in 2009, aged 91, lamenting how the discipline he helped to establish was being overrun by medical ideology. Shneidman coined the term ‘psychache’ as the cause of suicide, defining it as unbearable psychological pain – not illness – due to thwarted or frustrated psychological needs. Anything written by this great pioneer is highly recommended. Fortunately, a few dissenting voices within mainstream Suicidology now carry his torch, most notably for me is David Jobes and some of his colleagues in the Aeschi Group.

References and links to these and other important authors can be found at my website. You’ll also find there links to some important, more recent, voices that are emerging to challenging the third-person dogmas that still prevail in Sociology and the suicide prevention industry. Most important of all, of course, is the survivor voice that is only now beginning to find some forums where we can be heard.

Meanwhile, in the words of Professor Shneidman signing off one of his letters to a precocious Phd student…

May your psychache be minimal.

[ PS Comments, criticism, suggestions on this essay are welcome. Once these have been digested, this essay will be given a permanent home at the Survivor Voice page under the Activism menu. ]