Contemplating Suicide

The Language and Ethics of Self-Harm

Gavin J Fairbairn, Gavin Fairbairn

• Publisher: Routledge
• Year: 2003
• Print ISBN:
  9780415106061
• eBook ISBN:
  9781134845071
• Topic: Philosophy
• Subtopic: Philosophy History & Theory

Suicide is devastating. It is an assault on our ideas of what living is about. In Contemplating Suicide Gavin Fairbairn takes fresh look at suicidal self harm. His view is distinctive in not emphasising external facts: the presence or absence of a corpse, along with evidence that the person who has become a corpse, intended to do so. It emphasises the intentions that the person had in acting, rather than the consequences that follow from those actions. Much of the book is devoted to an attempt to construct a natural history of suicidal self harm and to examine some of the ethical issues that it raises. Fairbairn sets his philosophical reflections against a background of practical experience in the caring professions and uses a storytelling approach in offering a critique of the current language of self harm along with some new ways of thinking. Among other things he offers cogent reasons for abandoning the mindless use of terms such as attempted suicide and parasuicide , and introduces a number of new terms including cosmic roulette , which he uses to describe a family of human acts in which people gamble with their lives. By elaborating a richer model of suicidal self harm than most philosophers and most practitioners of caring professions currently inhabit, Fairbairn has contributed to the development of understanding in this area. Among other things a richer model and vocabulary may reduce the likelihood that those who come into contact with suicidal self harm, will believe that familiarity with the physical facts of the matter - the actions of the suicider and the presence or absence of a corpse - is always sufficient to justify a definite conclusion about the nature of the self harming act.

1
SUICIDE, LANGUAGE AND ETHICS An introduction

The man who kills a man, kills a man. The man who kills himself, kills all men; as far as he is concerned he wipes out the world.

(G.K.Chesterton, cited in Holland, 1969, p. 82)

Every two hours someone in Britain commits suicide. Translated on to a global scale, an estimated one thousand people a day take their own lives or nearly one a minute.

(Wertheimer, 1991, p. 1)

People harm themselves for a variety of reasons and in a variety of ways and sometimes their self harm results in death. Of course not all of the harm that people cause themselves is deliberate. For example, the harm a person causes himself by overeating or by smoking tobacco, is unlikely to be wished for and aimed at. Nevertheless intentional self harm is very common. Some is aimed at achieving the death of the self harmer and some that is not, may look as if it was.

So some intentional self harm that could end in death, does not have death as its aim. In spite of this, when the protagonist ends up dead, it is most often referred to as suicide, the act of intentional and intended, wished-for self destruction. Or at least this is the tendency if the circumstances suggest that the person may have been attempting to kill himself. When a person ends up alive, after acting in a similar way, it is common to talk in terms of attempted suicide, even when there is little evidence that death was his intention.

This book is a study of suicide and other varieties of suicidal self harm. However, it is neither a medical study nor a psychological study; nor is it a sociological study. Although it makes reference to the work of those who come into contact with suicidal self harm through their professional and voluntary work, it is neither a critique of practice nor a guidebook for action. Rather it is a philosophical study. It is concerned both with the development of a new way of thinking about suicidal self harm that recognises its complexity as a phenomenon, and with some of the ethical issues that suicidal self harm throws up. My view of suicide is distinctive in not emphasising external facts: the presence or absence of a corpse, along with evidence that the person who has become a corpse intended by some act of his own to do so; it focuses on inward rather than outward events and facts. Unlike murder, or the scoring of goals in football, the definitions of both of which have external facts as their main criteria, suicide is defined by reference to internal facts about intentions.

Much of the book is devoted to an attempt to construct a natural history of suicidal self harm. It is my hope that elaborating a richer model of suicidal self harm than most philosophers and most practitioners of caring professions that come in contact with suicidal behaviour currently inhabit, might contribute to the development of understanding in this area. Among other things, developing a richer model of suicidal self harm may help to reduce the possibility that those who come across what look like self harming acts should think in a simplistic way about them, and thus misidentify them. For example, it may make it less likely that they will believe, or act as if they believe, that familiarity with the physical facts of the matter—the actions of the suicider—is always, or nearly always, sufficient to justify a definite conclusion about the nature of his self harming act.

Acts, actions and suicidal self harm

When I take a pen and write my name on a piece of paper, the sequence of actions that I perform can constitute a variety of different acts depending on the context in which I do so and the piece of paper on which I write. For example, I may be validating an execution, pledging money to a cause in which I have been persuaded to believe, or agreeing to make regular payments to a bank in relation to a loan that the manager has agreed to advance to me. In a similar way the action or sequence of actions that a person performs in causing himself serious harm can constitute a variety of acts. Consider, for example, Debbie and Paula, each of whom set fire to herself.

Debbie had a long history of ‘suicide attempts’ and of self abuse including the ingestion of non-therapeutic dosages of prescribed medication and the infliction of minor wounds on her arms and legs. She had spent several periods in a psychiatric hospital as an informal patient. During one of these she had an argument with the ward sister, towards the end of which she lit a match and held it close to her nightdress saying that she was going to kill herself.

Paula’s family was in turmoil because of problems that her son was experiencing. As a result they were receiving regular help from community psychiatric services. Though she herself had received treatment for depression many years before, Paula was receiving none at present. One day she went to the newsagent’s and bought a cigarette lighter though she didn’t smoke. The following day she went to a garage and bought a petrol can and a gallon of petrol though she didn’t drive. The next day, after lunch with her family, she went out into the garden shed, poured the petrol over her clothes and set fire to herself.
She died some hours later. After her death a note was found in her desk apologising for having been a bad mother.

Paula planned what she was going to do with great care and took several days to gather together the materials necessary to burn herself to death. Her act was probably suicide; she seems to have wanted to be dead, planned her death carefully and succeeded in bringing it about. By contrast, Debbie acted on impulse, without thinking about the likely outcome. Though she intentionally lit the match that set her nightdress alight causing her injuries, and indeed intended to set her nightdress alight, she was surprised when it caught fire so violently that despite the proximity of help, she suffered 30 per cent burns. Debbie probably did not intend to die. Her act was stupid but not suicidal; it is probably best thought of as an aggressive gesture, aimed at the ward sister rather than at herself. Even if she had died, Debbie would not have been a suicide.¹

In distinguishing between the ‘actions’ Debbie and Paula performed and the ‘acts’ they represented, I am drawing on a distinction made by Harré and Secord (1972) though there is an important difference between the way in which they think of this distinction and the way in which I construe it. Whereas by their account, the act enacted by way of a given action or action sequence depends upon the context in which it is performed, I think the nature of acts depends also on the intention with which the actions, or action sequences that comprise them, are performed. Following a description of the action sequence that comprises the act of marriage for gypsies, Harré and Secord write:

Reference to inner states is of no help…for one can leap over the fire joyfully, resentfully, fearfully, nervously, unintentionally, unwillingly, unwittingly, drunk or sober etc., etc., and still find oneself married. Compare the variety of inner states to the accompaniment of which one may buy something at an auction, where a careless movement, if it has a certain meaning to the auctioneer may land you with a Vermeer that you can ill afford.

(p. 163)

Most acts depend for their meaning on the context in which they are performed; it is this that allows Harré and Secord to make their amusing observation about the dangers of auction sale rooms. But while buying at an auction, becoming married, scoring goals, etc., are acts that gain their meaning in performance, this is not true of all acts. For example, the act of promising, acts of religious devotion and the act of suicide depend upon something happening with a certain intention in mind. In each case the agent’s intention in acting makes his act different from what it would have been had he behaved in the same way but with a different intention.

A priest who recites the words of the eucharistic prayer and distributes the bread and wine while thinking about his Sunday dinner, does not celebrate the eucharist any more than a tape recorder that ‘recited’ the words would, though interestingly enough his flock, using his citation as a focus, may do so. The person who swears faithfully that he will never divulge a secret shared by a friend, does not promise (even though he may say that he does) unless his intention is always to keep the secret. And a suicide is not a suicide because of what a person does, or where he does it, or how he ends up; it is a suicide because of the intention with which he does it.

What act is represented by these actions on the part of this individual?

The same action or action sequence can represent more than one act at the same time. Consider, for example, the meeting of two heads of state on an official occasion. They shake hands warmly because as well as acting in their official capacities, they happen to like one another rather a lot and are hence pleased to meet again. If they make their warm handshaking look vigorous for the sake of the film crews transmitting the event to the world, their handshake constitutes several acts—the official greeting, the genuine meeting of friends and a theatrical performance designed to convince others of their good intentions towards one another.

So the same action can at the same time constitute several acts. Sometimes also it may be construed as representing different acts by different people. Consider, for example, a woman who greets her husband’s best friend warmly as he enters their home before a dinner party. Her husband might construe her actions as representing a warm and kindly greeting to someone she hasn’t seen in ages, while both she and her husband’s friend see them for what they really are—a deliciously warm, because illicit, greeting to her lover, whom she hasn’t seen for twenty-four hours.

Sometimes people set out to deceive others by their actions, intending that they should be viewed as one act when in fact they are another. The dinner party wife suppressed her feelings so that her act in greeting her guest looked kindly rather than passionate; and the husband who tries to persuade his wife that his holding hands with the pretty young woman she saw him with in the café was really the sealing of a business contract, tries to persuade her that his act was honourable rather than a sign of infidelity. Or consider two people holidaying in the same Florida hotel who have met, apparently by chance, but actually because one of them, in the best tradition of Hollywood movies, has set things up so that their meeting is inevitable. The one who has staged their ‘chance’ meeting has designs on the other and spends the evening flattering and wooing and generally setting the scene for a ‘romantic’ and intimate encounter. The other, romantically wooed and flattered, and melting with the passion that such wooing and flattery can produce, is persuaded after more flattery to ‘have a nightcap’ in his new acquaintance’s suite. In this situation a seducer has used all available means to get another into bed. The seduced individual for his part construed his new lover’s flattery as genuine and honourable interest; he has construed his companion’s act—which is in truth not what it seems to be for s/he is acting the romantic while being a scoundrel—as a genuine expression of interest in him as a person. His companion’s act is one of seduction; the flattery was designed to ensnare him. When he wakes up alone the next morning to discover that his lover of the night before has checked out of the hotel, he realises that rather than having been swept off his feet in the spirit of all true romance, he has been used, abused and discarded. As a result he will probably reconstrue his lover’s actions as an act of despicable deceit.

The examples of deception that I have given are examples of what we might call dishonourable deception. But some deception is honourable. Consider an actor on the stage who gives the impression that he is overcome with despair at the news that someone has died—what is his act? From the point of view of a member of the audience, it looks like an act of despair; however, the fact that the ‘tender act’ in question is happening on stage allows the audience to recognise it for what it is, a piece of play-acting. Harré and Secord discuss the range of acts that it is possible to simulate:

some episodes are made up of the genuine performance of the actions constituting the act-action structure of the episode, while in other episodes the very same actions may be only a mock or simulated performance. In this way there can be real marriages, and simulated marriages on the stage, real murders and simulated murders in a TV serial.

(p. 13)

And there can be simulated suicides—which I call gestured suicides— that are enacted in the everyday world.² In the case of simulated murders or marriages or even suicides, which take place in the theatre, in the movies, or on TV, the context in which it takes place tells us when a given act is a simulation and when it is the real thing. In real life on the other hand, it may be difficult to tell when a suicide is simulated because the cues that would tell us that what we were witness to was a simulation in each of the other cases is, in life, missing. The job of deciding what kind of act an apparent ‘suicide’ represents, such as is carried out in a legal setting by coroners, and in situations of practical care by professionals such as doctors, nurses and social workers, involves detective work of a complex kind, drawing together information from the individual’s past, from his friends, relatives and associates, witnesses to his last actions if there are any, and any empirical evidence from the scene that might be available.

Deciding whether an act was aimed at death

Suicide, the act of deliberate, intentional and wished-for self destruction, may be performed via a wide range of self harming actions including overdosing on drugs, cutting one’s throat or wrists, putting one’s head in a gas oven, leaping from a building or running in front of a fast moving train or car. Perhaps more importantly, the same self harming action may represent a number of different acts depending on the intentions of the actor. Does a person who takes an overdose of pills intend to kill himself, to end up alive, or to take a gamble on life? Each of these, by my account, would constitute a different act. But as I have already shown, it is not just the physical intentions that a self harmer has that can change the nature of his act; his social and personal intentions are also important in determining the nature of the act he performs.

In coming to a decision about what act is performed (or what acts are performed) by a person who self harms, it will thus be necessary to consider not only whether he intended to end up alive or dead, but what personal and social intentions motivated him when he acted. An act of suicide performed via the action of taking a fatal overdose could at the same time represent the act of communicating to the world that one’s life is so bad that one would prefer to be dead, and the act of blaming or punishing a loved one for some real or imagined hurt. And an act of gestured suicide performed via the action of taking a non-fatal overdose could constitute a similar range of acts. However, the question of whether a person who self harms suicidally intended by his actions to achieve his death, remains of primary importance.

The ways that we think about (and act in relation to) the self harm that an individual causes himself will depend both upon the act that we take it to represent, and our view of such acts. It is thus important to come to some decision about the nature of a self harmer’s act whether he ended up dead or alive. If alive it is important in order that sensible and helpful action can be taken to do what is best for the individual and those who care about him; if dead it is important in order that those who cared for the person might be able to have the peace that comes from knowing, as far as is possible, the way in which someone they loved or cared for died.

No one can tell with certainty whether a person who has survived serious self inflicted harm intended to live or to die. Nor is it possible to tell in relation to one who dies as the result of such harm whether he intended to die or to live; certainly his ending up dead or alive will not be a sure indication of his intention. However, there is no doubt that some people who take apparently suicidal action have no intention of dying. Perhaps especially in the case of drug overdose, it is possible to miscalculate and to end up dead rather than the object of caring attention, though sometimes, like Frances who I discuss in Chapter 7, a person might both be the object of caring attention for a while and end up dead. More importantly from a practical point of view, an individual who has carried out an intentional self harming which has not led to his death, may actually have intended to kill himself. So it is important to decide what a suicidal self harmer’s physical intentions were in order that decisions can be made about how he should be treated, what would be helpful to him and what, for example, might decrease the chances that he will act in similar ways in the future.

What should count as convincing evidence that someone who has died or who is likely to die, as the result of an intentional act, intended to die? The apparently objective evidence provided by a suicide note may not give a foolproof means of deciding the intentions of a suicidal s...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Preface and Acknowledgements
• A Note About Language and Style
• 1: Suicide, Language and Ethics An Introduction
• 2: Morals and Means
• 3: Where Do Our Views of Suicide Come From?
• 4: Our Impoverished Language of Suicide and Self Harm
• 5: Suicide and Intention
• 6: Defining Suicide
• 7: Extending the Taxonomy of Suicidal Self Harm
• 8: Living Dangerously, Heroism and Euthanasia
• 9: Varieties of Suicide
• 10: Digging up the Past Explorations in the Philosophical Archaeology of Suicide
• 11: The Liberal and Conservative Positions on Suicide
• 12: Autonomy, Paternalism and Intervention in Suicidal Acts
• 13: Justifying Intervention 1 Arguments from Autonomy
• 14: Justifying Intervention 2 Self Defence and the Defence of Others
• References