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Language matters

Caffeine and contemplation

Dominique Thompson

Friday, 20 April 2018

consultation_AdobeStock_58642481_v2.jpgThere has been an interesting shift in recent times around how we, as a society, talk about suicide and self-harm. With increasing national focus on suicide prevention has come an increasing awareness of the potential for unintended harm done through casual use of specific words, and descriptors, which many now find to be judgmental or insensitive.

In particular, there has been a strong campaign from those affected by suicide, but also from health care professionals, to move away from saying ‘commit’ suicide and move towards using phrases such as ‘died by’ suicide. This pull away from using ‘commit’ is driven by the wish to remove the implication of criminality, or sin, in the act of suicide, as dying by suicide was a crime in the UK until 1961 and it had been considered a ‘sin’ by many for centuries before that by some religious faiths. It is therefore felt to be more sensitive and appropriate, 57 years after its decriminalisation, to stop talking about ‘committing’ suicide. The Samaritans do not use ‘commit’ and media guidelines advise against its use also. Perhaps medical professionals could lead the way in consciously using more sensitive and non-judgmental phrases and terms in the future?

Other traps to avoid include talking about ‘successful’ suicide, or ‘unsuccessful’ or ‘failed’ attempts, which can compound the feeling of failure, inadequacy and despair by those already in a desperate situation. Better perhaps to speak simply of attempted suicide, or self-harm, in such cases?

Careless talk, in this case, really could cost lives, as such comments could potentially drive a distressed individual (who overhears this) towards more lethal means at the next attempt and leave them feeling that their health care professional is not sympathetic to their situation.

With self-harm, I personally stopped using the adjective ‘deliberate’ as a descriptor many years ago, when it was pointed out to me, by those with lived experience, that although it might be what we had been trained to name such behaviour, that it was both unnecessary (the harm inflicted was by definition ‘deliberate’) and judgmental to boot.

Similarly, use of the adjective ‘superficial’ to describe cuts or wounds in notes became unacceptable, as patients, reading their notes later, or catching sight of the Problem Definition on screen ‘Superficial Self Harm’ would ask quietly if I thought that they weren’t serious, or trying ‘hard enough’ to harm themselves. I would hastily explain that my comment was purely about anatomical injury depth but have now stopped ever writing or saying it for the reasons above. Patients are distressed enough without it being compounded by their GP being unintentionally insensitive.

The careful and thoughtful use of language around suicide and self-harm can be of great comfort to patients, carers, and survivors, as well as benefiting the relationship and trust we build with our patients.

Language matters, and in this we can really make a difference for the better.

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Dominique Thompson

Dominique has been a student health GP since 2000, developing innovative new services to treat eating disorders and personality disorder in primary care. She was the GP member of the NICE Eating Disorders Committee 2017. She was a Pulse ‘GP hero’, in 2014, and a ‘Rising Star’ in 2016. Dominique writes about young adult wellbeing and mental health, in both the medical and non-medical press. Her latest adventure is as an independent consultant in student health and wellbeing www.buzzconsulting.co.uk. She is fuelled by caffeinated drinks.
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