Although concrete counts remain elusive, an estimated 1.7 million people in the US attempt suicide each year (Centers for Disease Control and Prevention [CDC], 2023). Even though only about 4 percent of attempts end in death, one person in this country dies by suicide every eleven minutes, making suicide the eleventh leading cause of death in the nation (recently bumped from tenth place by COVID-19) (CDC, 2022b; CDC, 2023). Contrary to the mainstream biopsychiatric framing of suicide as a medical issue spurred by mental illness, there remains no scientific proof of suicidality being caused by any sort of biological or physiological pathology (Hjelmeland et al., 2012; Marsh, 2016). In fact, according to the CDC (Stone et al., 2018), over half of all suicide deaths in the US occur in individuals with no known mental illnesses. Despite this, the medical model of suicide remains dominant in the US and in most of the Western world (White et al., 2016).
Philosophical and cultural critiques of suicide as a matter of mental illness are promptly rejected within the biomedical "regime of truth" (see Foucault, 2002, p. 131) and even called "clinically and ethically indefensible" by psychiatry's leading scholars (e.g., Jamison, 2000, p. 255). However, Mad justice advocates and critical suicidologists point out that a medical framework for suicide is incomplete at best (e.g., White et al., 2016). Suicidal thoughts and behaviors are always "deeply embedded in particular social, political, ethical, and historical contexts," and cannot be reduced to genetics or biology (White et al., 2016, p. 1). Suicide can, in some cases, be understood as a form of social murder that is induced by an oppressive, uninhabitable world (Reynolds, 2016; Krebs, 2023). Today, most major medical entities engage a more nuanced model of suicide and acknowledge that "a range of factors" at "the individual, relationship, community, and societal levels" contribute to the risk of suicide (CDC, 2022a).
Although this shift toward engaging social and cultural factors alongside medical framings is promising, each of the extant mainstream models of suicide, including medical and social lenses, ultimately frames suicide as an unacceptable act (Baril, 2020). Even in activist circles that link suicidal feelings to sociopolitical oppression, suicide attempts are considered "an illegitimate response to social and political suffering" (Baril, 2020, n.p.). This logic of unacceptability is the core of suicide prevention programs around the world, which unwittingly marginalize suicidal people while aiming to save their lives.
Canadian scholar Alexandre Baril (2020) coined the term "suicidism" to describe the unique form of sanist-ableist oppression faced by suicidal—or presumed-suicidal—people. This type of oppression is widespread and operates at a range of systemic levels including medical and legal arenas, as well as social, political, cultural, and economic realms. In all of these contexts suicidism results in the silencing and surveillance of suicidal people and the eventual removal of their agency through the process of psychiatrization. Baril (2020) states that the type of injustice at the core of suicidism is epistemic violence (see also Fitzpatrick, 2020). Building on Spivak (1998), Mad studies scholars define epistemic violence as the way people are "disqualified as legitimate knowers at a structural level through various institutional processes and practices" (Liegghio, 2013, p. 123). Psychiatrization transforms agentic people into passive patients, enacting a sort of violence that denies patients control over their healthcare. Self-determination and consent for medical care disappear promptly within psychiatrization, especially when linked to suicidality (see Wipond, 2020).
Perhaps the most overt manifestations of suicidism and epistemic violence are nonconsensual interventions (NCIs), often called "carceral care practices" by their critics (e.g., Preston et al., 2022). Carceral care refers to the process through which healthcare resembles, mirrors, and is intimately tied to prison systems (Ben-Moshe, 2020; Burstow, 2015; Stefan, 2016; Wipond, 2020). Carceral care practices for suicidal patients often begin with nonconsensual active rescue. In this process, people experiencing a suicide crisis are confronted by police and restrained for transport to involuntary psychiatric facilities (see Trans Lifeline, 2020). From there, they can be held via 5150 "suicide holds," in which suicidal people are incarcerated in psychiatric wards for a minimum of seventy-two hours (see Krebs, 2020). These three-day stays can be extended to long-term mental hospitalization in which courts decide when a suicidal person can be released from a psychiatric facility (see Wipond, 2020). While in these types of nonconsensual care, psychiatric facility employees use physical restraints and "chemical incarceration" (sedating medications) to make patients easier to manage (see Ben-Moshe, 2020, p. 62). During these involuntary stays, workers can also force patients to intake food, water, and medication (see Sell v. United States, 2003; Wipond, 2023). In all these examples, mental healthcare practices differ from all other forms of health services because they do not require patient consent. While care associated with physical health conditions is up to the patient or their guardians, psychiatric treatment can be forced upon patients even when they or their guardians actively oppose such treatment. All of this occurs under the epistemically unjust belief that those deemed mentally ill cannot know what is best for themselves.
Supporters of involuntary treatment practices suggest that such actions, though not ideal, are necessary for saving lives in the case of suicidal patients. However, the World Health Organization (WHO) points to "the lack of evidence that [coercive practices] offer any benefits" and instead underscores "significant evidence that they lead to physical and psychological harm and even death" (2021, p. 8). The practice of involuntary psychiatric care, for suicidal people and others, has been explicitly condemned by both WHO and the United Nations (UN). In their 2023 co-published report on mental health and human rights, the organizations explain:
From a human rights perspective, coercive practices in mental health care contradict international human rights law…. They conflict with the right to equal recognition before the law, and protection under the law, through the denial of the individual's legal capacity. Coercive practices violate a person's right to liberty and security, which is a fundamental human right. They also contradict the right to free and informed consent and, more generally, the right to health. (p. 15)
As WHO and the UN underscore, the process of carceral/coercive psychiatric care is violent at epistemic and ontological levels. Once suicidal people in particular are deemed incapable of their own sensemaking and understanding of reality, their humanness is compromised (see Bergmans, et al., 2016; Liegghio, 2013; Szasz, 1998).
This symbolic violence has severe and even lethal consequences. Decades of psychiatric research show that in the week following discharge from a mental hospital, people's suicide risk skyrockets (Chung et al., 2017; Freedenthal, 2013; Madsen et al., 2020). According to Chung et al.'s (2017) metanalysis of one hundred studies on this subject covering 183 patient samples, the suicide rate amongst recently discharged patients (under three months post-release) is as much as one hundred times the global suicide rate. In fact, "being a recently discharged patient confers a higher risk of suicide death than any other risk factor" (Chung et al., 2019, p. 1). As this research demonstrates, extant psychiatric practices are inadequate, largely due to the suicidism and epistemic violence that undergird them, and often further harm suicidal people under the guise of saving their lives.
When Baril introduced the concept of suicidism in English in 2020, 1 he stated three interrelated objectives: to "1) interrogate dominant ideas and perspectives on suicidality; 2) make visible and denounce the power relations between suicidal and non-suicidal people; 3) enrich intersectional analyses by naming and problematizing an oppression that has been neglected" (n.p.). Scholars in bioethics (e.g., Fox & Braswell, 2024), communication studies (e.g., Krebs, 2022; LeMaster, 2022), counseling (e.g., Dernbach, 2022), social work (e.g., Thibault-Canas, 2021), and other social sciences (e.g., Marsh, Winter, & Marzano, 2022) have since built on these goals, as have thinkers publishing outside academia (e.g., Lincroft, 2024; Merritt, 2023). Since that initial article, Baril has also published a book on the concept: Undoing Suicidism: A Trans, Queer, Crip Approach to Rethinking (Assisted) Suicide (2023). In this text Baril expands upon his 2020 concept of a "suicide-affirmative approach" to addressing the desire to die. He proposes a shift from a "preventionist and curative logic," which often involves carceral care, toward "a logic of accompaniment for suicidal people, a form of support that could be life-affirming and death-affirming" (Baril, 2023, p. 16-17). This suicide-affirmative approach requires those caring for suicidal people to avoid dominant impulses toward "compulsory aliveness" such as involuntary intervention (Baril, 2020, n.p.), and instead do the difficult work of accompanying suicidal people as they reflect critically on their options, including death, for moving forward. This process restores the epistemic authority of the suicidal person and subverts suicidist norms.
Several scholars from a variety of fields have used the concept of suicidism to address medical aid in dying (MAID) (Webster & Dhungel, 2023; Fox & Braswell, 2024; Wedlake, 2020). They argue that this anti-oppressive framework opens discussions about MAID in productive ways so that people can have better conversations about the ethical dimensions of the practice. For example, Fox and Braswell (2024) use suicidism as justification to reclaim the term "physician-assisted suicide" from critics who have stigmatized the practice. They argue that the rhetoric of "medical aid in dying" "erases the role of human action in the provocation in death" and reduces our capacity to examine the potential for bias in the practice (Fox & Braswell, 2024, p. 6). They also argue that avoiding the word "suicide" perpetuates suicidist oppression, which they say even applies to the euphemism MAID, even though people who use the term mean well.
Other scholars who use suicidism as a conceptual framework focus on reclaiming suicidal people's stories. Thibault-Canas (2021) and I (Krebs, 2022) both use our dissertations to argue for greater attention to the voices of suicidal people as guides for shifts in suicide related healthcare. We focus on restoring testimonial justice in line with Baril's (2023) calls for a "suicidal epistemological standpoint" in which activists and allies make space for the voices of suicidal people instead of speaking for them (p. 27). Similarly, Marsh, Winter, & Marzano (2024) question whose voices are "experts" when it comes to suicide prevention and suggest that Baril's concept of suicide-affirmative healthcare offers "much to admire" in the face of testimonial injustice against suicidal people (p. 21). Finally, LeMaster (2022) takes Baril's invitation to "create solidarities between suicidal people" (2023, p. 6) to heart. She offers an autoethnography about her suicidality in the face of a dear mentor's recent death by suicide and calls for others to "recognize the suicidal relationalities to which we already belong" with our colleagues, loved ones, and other "suicidal kin" (p. 5).
Baril's 2023 book dedicates a full chapter to "cripping and maddening suicide," or situating suicide and suicidism within the frameworks of disability and Mad studies fields (p. 135). He argues that while disability and Mad studies have widely rejected compulsory pushes toward "cures" for non-normative bodyminds, curative sentiments are rarely questioned when applied to suicidal people. In Baril's direct terms: "the erasure of suicidal people is not highlighted as a form of epistemic violence in Mad activism and scholarship" (p. 149). While I agree that more transdisciplinary work between Mad studies, disability studies, and critical suicidology is needed, I reject Baril's assertion that this work is currently absent. Disability and Mad studies scholars and advocates are indeed doing this labor (e.g., Braswell, 2011; Khúc, 2024; Piepzna-Samarasinha, 2018), as are critical suicidologists (e.g., Button, 2016; Krebs, 2023; Mills, 2020). While not necessarily using the term "suicidism," they are meaningfully engaging with issues of epistemic violence and the oppression of suicidal people and linking these issues to matters of disability and Mad justice. This paper continues the work of bringing these fields into direct conversation with one another, notably with a focus on historical contexts.
One way to disrupt suicidism and the violent contemporary practices it upholds (e.g., carceral care) is to theorize how this form of oppression developed and functioned historically. Accordingly, I pose the following research question: How have suicidist beliefs historically existed—or been evaded—in mainstream Western discourses, and how might these historical frameworks open liberatory ways of thinking about suicide and treatment for suicidal people in contemporary times? To answer this, I look at historical frameworks for understanding suicide and focus on key moments in which suicide was understood differently, that is to say, outside dominant realms of suicidism. My goal is to disrupt suicide's current regime of truth, its "compulsory ontology of pathology" (Marsh, 2010, p. 4), by exploring how key historical moments might offer insights into how dominant views about suicide may have developed, and by extension, how they might be disrupted. I see these historical moments as points of interest for future thinking and research, as ways to open our understandings of the desire to die and how we might respond to that desire.
In pursuing this goal, I employ Foucault's method of genealogy, also used by Marsh (2010) in his exploration of suicide. As exemplified by Discipline and Punish (Foucault, 1979), genealogy involves creating a "history of the present" and questioning how current conditions and beliefs came to be. This method is about exposing assumptions behind what is accepted as truth and exploring how such truths came to be. Ben-Moshe (2020) uses genealogy in her history of decarceration and disability, which is heavily tied to suicide treatment and psychiatric oppression. She explains: "Genealogy allows the researcher to investigate imagined possibilities and carefully construct not just an alternative historiography but also a narrative of what could have been, in knowledges that have been discredited as nonscientific and forgotten" (p. 6). To that end, the histories of suicidism I present focus specifically on Euro-Western traditions because that is where ideologies undergirding mainstream suicide prevention efforts in the US (i.e., biopsychiatry) were born (White, 2020). I also focus on Christian theology, as this remains the primary guiding force for moral judgments in parts of the world that birthed biopsychiatric frameworks (Critchley, 2015).
My goal is not to provide a comprehensive or definitive history of suicidism nor is it to claim that what I offer here is the "truth" of suicide. Rather, this is an interpretation I hope will invite others to think about suicide differently. This interpretation is rooted in historical moments in which suicide was conceptualized outside current dominant frameworks. My aim is to look back in order to look forward, to use history as inspiration for a more inclusive future for suicidal people (see Marsh, 2010). As such, I focus not on the veracity of any one claim about the nature of suicide, but rather think about what these claims and logics and histories might do to suicidal people. By extension, this emphasis on impact allows me to consider how activists and scholars might resist suicidist harms in contemporary times.
I use medicalization as a guiding framework for approaching the task of examining historical ways of understanding suicide. First conceptualized by sociologists in the late 1960s, "medicalization" describes the process by which previously non-medical problems become assigned to the realm of medicine, in which they are defined and managed by medical authorities (Conrad, 1992; Zola, 1972). Through this process, experiential knowledges are subjugated while scientific and medical expertise increase in social value and influence (Barker, 2014; Conrad, 2007; Jensen et al., 2019). Initially, scholars addressing medicalization emphasized the punitive aspects of expanding medical power, often citing psychiatry and the pathologization of deviance asc a primary example (see Illich, 1975; Pitts, 1968; Shorter, 1997; Szasz, 1998). These critics of psychiatry argue that "mental illness" has long served as a wastebasket category into which immoral or otherwise undesirable behaviors defying other explanations are tossed (see Rosenberg, 2006; Szasz, 1997). Later studies of medicalization explain that the phenomenon is not always negative. To the contrary, this framework can help people receive legal accommodations, medical treatments, and social legitimacy for their disabilities and illnesses, particularly when these maladies are contested or stigmatized (Aronowitz, 2008; Conrad & Barker, 2010; Jutel, 2011; Lupton, 2012).
Medicalization as a conceptual framework calls attention to the fact that biomedicine is deeply embedded, like all forms of human knowledge, in the sociocultural contexts of its practitioners, despite claims to objectivity and purity (Jutel, 2011; Lupton, 2012). This does not necessarily mean that diseases are "fake" or without scientific evidence, but rather that for a set of symptoms/signs to become classified as a disease via technical and biological tools, they must first be recognized as socially undesirable and problematic (Jutel, 2011). The values that define undesirability are built upon dominant economic, sociopolitical, and cultural grounds, meaning that medicalization is an inherently relational and political process (Aronowitz, 2008; Lupton, 2012). Further, disease categories are framed in extent models of understanding the human body and its systems—and these models reflect dominant logics as well (Jutel, 2011).
The perspectives I offer are heavily critical of the medicalization of suicide. I align my work with Mad studies and Mad justice which are explicitly "devoted to the critique and transcendence of psy-centered ways of thinking, behaving, relating, and being" in an effort to resist the violences of psychiatrization and reclaim the knowledges and experiences of psychiatrized people (Menzies, LeFrançois, & Reaume, 2013, p. 13). However, my goal is not to argue that medicine has no role in understanding suicide or helping suicidal people, nor is it to suggest that suicidism is unique to biopsychiatric frames. As Taylor (2015) argues, replacing the "compulsory ontology of pathology" with a "compulsory ontology of oppression" (meaning that suicide is caused solely by dominant social forces and has no links to biology) continues to limit our understandings of suicide and how to care for people experiencing it. I am wary, as is Baril (2023), of reproducing one oppressive structure with another compulsory logic. Instead, I offer a critical history that "reveals the fragility of that which seems solid, the contingency of that which seems necessary" in order to expose the wide reach of suicidist beliefs and to open alternative possibilities that evade those frames (Rose, 1998, p. 18).
For the purpose of understanding suicidism as both a theoretical concept and a grounded activist tool, unpacking ontological tides of suicide leading to its medicalization is important for two main reasons. First, because suicide has such a dense and fraught moral history throughout the globe, multiple religious and social meanings inevitably linger within contemporary medical definitions of the term. They also inform contemporary suicidist beliefs. Understanding that history is crucial to understanding its present. Other suicide scholars have mapped extensive histories of self-killing around the world using primary sources (see Barbagli, 2015; Marsh, 2010). Building on their work, I focus on how these documented histories might guide contemporary activist work in the face of suicidism. 2 Second, the circular logics of psychiatry's claims protect its jurisdictional hold on suicide from outside critique, for example, by suicide survivors, so they must be carefully excised in order to disrupt this protective shell (see Szasz, 1997). I outline both of these exigencies below.
While medicalization is often cited as a depoliticizing force (e.g., Jutel, 2011), it does not necessarily erase stigma or oppressive elements of healthcare. Rather, medicalization buries the moralizing religious and cultural forces driving it beneath medical (read: objective) rhetoric and evaluations (see Jensen, 2016). From a rhetorical standpoint, this means that as new terms and explanations come into being, previous ones are never entirely replaced; they inexorably "linger" and impact contemporary meanings (Koerber, 2013, p. 13). Thus, while medicalization does shift who is in charge of managing suicidal people and how they are managed, it does not free these people from sociocultural condemnation.
One example of such lingering is the first documented claim of suicide as a psychiatric phenomenon, written in 1821 by French alienist (the early term for what would become psychiatrist) Jean-Etienne Esquirol (see Hacking, 1990). In this document, Esquirol emphasized visual signs of madness that aligned with centuries-old Christian emphases on the eyes as gateways to the soul (e.g., Matthew 6:22-24). Other alienists followed Esquirol's lead. For example, Burrows (1828) offered visual guides for diagnosing suicidality and stated that in suicidal patients, "the eye becomes injected, hollow, and sunk, but glistening, roving, and wild" (p. 422). Such claims echo extensive religio-scientific histories of Satanic influence and demonic forces being revealed through the eyes (Gordon, 1939). The link between evil and suicidality was thus secured in the first formal theorization of suicide within a Western psychiatric diagnostic guide. Suicidist beliefs predated and were present from the outset of suicide's medicalization.
Similar rhetorical lingering is evident in the contemporary use of the phrase "commit suicide," which remains common vernacular for someone dying by their own hand (Sather & Newman, 2016). Many contemporary activists and organizations such as the International Association for Suicide Prevention (n.d.) reject this term, 3 noting that the term "commit" implies a criminal act punishable by law (which suicide was in many US states and other nations around the world). For example, in fifteenth-century Florence, a failed suicide was met with monetary fines (Barbagli, 2015). In Medieval France, the corpses of people who had died by suicide were regularly hanged as if they were "live murderers," though often head-down as a marker of the ignominious nature of their crime (Barbagli, 2015, p. 32). In Sweden, anyone found guilty of a suicide attempt could be placed into detention facilities where they faced torture and endured forced labor (Mäkinen, 1997). Many attempt survivors were also placed on a "stool of shame" during local church services for public humiliation and as a warning to others (Barbagli, 2015, p. 33). In early US history, Massachusetts punished suicide attempters with "twenty lashes and payment of a fine" (Kushner, 1991, p. 22). And in perhaps the greatest irony, several countries punished suicide attempts with the death penalty, including Sweden and Russia (Barbagli, 2015). Suicide remains an official crime in twenty countries around the world, where imprisonment and fines remain the primary sentences (Johnson, 2021).
Although suicide is no longer illegal in the US, it is not truly legal either. If it were, Szasz (1998) explains, then a psychiatrist who forcibly prevents a person from killing themselves would be considered "guilty of assault, battery, and kidnapping" (p. 20). Instead, state and national courts continuously reaffirm that coercive control is "properly in the province of mental health law" (Szasz, 1998, p. 20). This affirms psychiatry as a medicolegal force and expands its power in both medical and penal structures, forming a solid institutional base for suicidist violence. The lingering of criminal rhetoric to describe suicidality (e.g., "commit suicide") is a central force in how suicide is managed today. Suicidism, then, must be understood as a lengthy rhetorical and narrative process rooted in historical conceptions of suicide (unpacked later in this essay) as anti-society, anti-God, anti-Crown, and anti-country.
The medicalized nature of psychiatry's jurisdictional claiming of suicide protects it from outside critique, most problematically from suicidal people themselves (see Berkenkotter & Hanganu-Bresch, 2011; Goffman, 1961; Wipond, 2020). In the words of psychiatrist-turned-critic Thomas Szasz (2011), "Who can be against 'helping suffering patients' or 'providing patients with life-saving treatment'?" (p. 180). Indeed, critiquing psychiatry and suicide prevention is a tricky pursuit that can easily be misconstrued as pro-suicide or even murderous (e.g., Jamison, 2000). And when these critiques come from psychiatrized people themselves (see Harris, 2023; Wilson, 1940), they are often quickly dismissed as irrational in line with suicidist beliefs about the inability of suicidal people to know their own experiences (Cohen, 2016; Moncrieff, 2010). As these examples demonstrate, psychiatric logics are circular and outwardly impenetrable, particularly because power to engage them is limited to the psychiatric professionals (Berkenkotter & Hanganu-Bresch, 2011). For example, the most recent edition of the American Psychiatric Association's (APA's) Diagnostic and Statistical Manual of Mental Disorders (DSM-V) proposed "suicidal behavior disorder" with a single feature: a recent suicide attempt (2013, p. 801). The attempt is the sole sign of the "disorder" that causes it.
Circular, insular logics rest at the core of the primary research method positioning suicide as a product of mental illness: psychological autopsy (Hjelmeland, 2016). Although the term "autopsy" invokes visceral images of Y-incisions and post-mortem flesh, psychological autopsies are interview-based studies. They involve questioning a deceased person's surviving family and friends, and analyzing documents like medical notes and personal letters to discern the person's state of mind prior to their death (Robins et al., 1959; Cheng, 1995). As outlined in Robins's (1981) key text outlining the research method, almost anything can be considered a symptom of mental illness. The study lists more than a hundred signs of mental illness, including weight loss, back pain, "complete silence at times," wearing dirty clothes, noisiness, "a lot of talking about sex," and difficulty with simple arithmetic (Robins, 1981, p. 19). Thus, finding someone mentally well within a psychological autopsy is quite rare; these studies almost always find that the person who died by suicide was mentally ill (Hjelmeland, 2016). Here, the reach of psychiatry remains impenetrable, particularly for those without medical degrees. Between these circular logics and the rhetorical lingering of moral and penal views on suicide, addressing suicide's medicalization is essential for understanding suicidism in current times and pursuing Mad justice goals.
Based on these exigencies, I turn to explore a series of historical moments that can disrupt suicide's "compulsory ontology of pathology" (Marsh, 2010) by exposing how suicide was understood elsewhere and elsewhen. My goal is to offer alternative stories about suicide that explore how suicidist beliefs have been both encouraged and challenged over time in the Western, anglophone world. This is not meant to be an exhaustive history, but rather an exploration of major shifts in dominant thinking about the nature of suicide. I focus on five historical turning points: the spread of Christianity in the Roman Empire, the introduction of the term "suicide" to English language, the Enlightenment and rejection of theocratic power in England, the birth of the lunatic asylum, and the spread of the community mental health movement. In each of these sections I outline shifts in how suicide was rhetorically framed, who was tasked with managing it, and how these factors can inform efforts to resist contemporary suicidism through disability justice and Mad justice activisms.
Although the Bible and early Christianity did not universally condemn suicide, the Church eventually played a major role in marking self-killing as an immoral act. Many scholars argue that the framing of suicide as sin was largely spurred by the Church's ideological collisions with Ancient Rome (see Marsh, 2010). During the early years of the Roman Empire, notions of "the exclusive sovereignty of Christ" clashed with Roman leaders' claims to god-like superiority, and many Christians were persecuted for their perceived resistance to the throne (Cairns, 1996, p. 18). During this time, Christians who refused to renounce their beliefs or make sacrifices to Roman gods were executed throughout the Empire (Gaddis, 2005).
These Christians were celebrated as martyrs by many of their survivors, who eventually formed two new sects of Christianity (both denounced by the Catholic Church): Meletians and Donatists, both of which referred to themselves as "Church of the Martyrs" (Barkman, 2014). Historical scholars such as Minois (1999) and Adamiak and Dohnalik (2023) argue that during this time the Donatists in particular (at least according to the Catholic Church) promoted martyrdom to the point of encouraging their followers toward suicide. They suggested that suicide offered an escape of worldly woes and faster entry to the paradise of Eternal Life. The promise of Heavenly Peace became cause in itself for suicidal action. Resulting rises in Christian deaths threatened the Church and its evangelist goals and ultimately led to, in Minois's (1999) terms, "a moral climate favourable to the prohibition of suicide" (p. 26). This does not mean that all of suicidism is rooted in this specific religio-political moment surrounding fears of mass martyrdom. However, thinking about this context as motivation for a widespread condemnation of suicide offers insights as to how Judeo-Christian theology was interpreted and shifted in response to sociopolitical happenings.
In the later years of the Roman Empire this rising condemnation of suicide was disseminated through texts written by numerous ecclesiastic scholars and religious figures (Marsh, 2010). Perhaps most famously, Augustine of Hippo's City of God 4 (426 AD) condemned suicide and deliberately attacked Roman conceptions of suicide as a heroic or virtuous pursuit, implying that the Roman Empire had polluted Christianity and led its followers astray (see MacDonald, 1992). Multiple synods that followed implemented sanctions against suicide, which included excommunicating anyone who tried to kill themselves and refusing Church burials for anyone who succeeded in their attempts (MacDonald & Murphy, 1990). During this time, the Church—priests, bishops, and God Himself—became the primary entity tasked with managing of suicidal people. Although the excommunication of people who die by suicide is rare today, the modern Catechism of the Catholic Church still condemns self-killing: "It is God who remains the sovereign Master of life…. It is not ours to dispose of" (Part 3, Section 2, Article 5, #2280). The next line explicitly states that suicide "is contrary to love for the living God."
Prior to this widespread Christianization of suicide, self-killing was an act of honor in numerous cultures around the globe. Killing oneself for the good of one's country, family, or community was not condemned, but valorized. Ancient Greeks and Romans primarily viewed suicide as an act of honor and multiple famed figures in both cultures were hailed for their displays of courage and self-sacrifice (Jamison, 2000). Even in the Christian Bible, a site which many claim is anti-suicide despite the fact that no references to the condemnation of suicide exist, there are accounts of self-induced death in the name of honor (e.g., Judges 9:50-54; Kings 16:15-20). Even in the face of framing suicide as a medical issue and calling for compassion accordingly, many Christian denominations including Catholicism continue to condemn self-killing in all forms (see Adamiak & Dohnalik, 2023). Looking at the Church's shifting histories and teachings surrounding suicide, then, I ask: What might it look like to think about suicide differently within Judeo-Christian theologies? Is it possible to use classical theological texts in this arena to reconceptualize suicide as something other than a crime or illness? What would a Mad liberation theology of suicide entail? Looking at other liberation theology work for inspiration, such as Eiesland's (1994) The Disabled God, could offer a productive framework for future scholars aiming to challenge suicidism.
Following the Church's initial condemnation of self-inflicted death, several hundred years passed before the term "suicide" was introduced into English vernacular. I argue that this linguistic entry point offered a second major ontological shift toward suicidism. Linguistic scholars argue that prior to the introduction of this term, widespread condemnation of suicide was not yet possible because self-inflected deaths were not considered a unified phenomenon (Ruff, 1974). The first use of the word "suicide" was published in 1642 by Sir Thomas Browne in Religio Medici. This popular English text used scientific imagery to illustrate religious truths and virtues, offering a bridge between the Church and the growing Scientific Revolution. Religio Medici was one of the first texts to claim self-inflected death for the realm of scientific inquiry. Prior to this publication and its rhetorical introduction of "suicide," self-accomplished death had numerous titles describing a wide range of fatal practices. Linguistic historians note that neither classical Greek nor Latin had a single word equating to what we now call "suicide" (Daube, 1997; van Hooff, 1990). To the contrary, van Hooff (1990) lists over three hundred ancient words and expressions for self-killing in Greek and Latin, noting that these were not mere euphemisms, but entirely different concepts. Instead of condemning suicide, these terms were more poetic and descriptive.
In Latin, language around suicide often indicated how the suicide was conducted (e.g., by sword, poison, cliff), who was seen as the agent (e.g., the decedent, an enemy, a peer), and the reason for death (e.g., to escape, to bring honor, to avenge) (see Ruff, 1974). Each suicide was described with both a modi moriendi (method) and a causae moriendi (cause/motivation) (van Hoof, 1990). For example, the death of a person who starved themselves out of grief was labeled inedia dolor (pangs of grief), while a person who elected to kill themselves when "old and full of years," whether out of physical/mental pain or fatigue, was labeled taedium vitae (tired of life) (van Hoof, 1990, p. 121). The latter was considered by Ancient Roman law to be sufficient grounds to leave life and was not viewed in a negative light. Self-inflicted deaths that were political or philosophical demonstrations, labeled iactatio (gesturing) or ambitiosa mors (seeking glory), were not linked to despair or madness (Edwards, 2007). Suicides considered cowardly, unethical, or signs of madness were described as such, demonstrating that self-inflicted deaths were not universally perceived as negative or as signs of illness.
Contrary to this multiplicitous understanding of self-accomplished deaths, I argue that the rhetorical singularity of "suicide" is a key pillar in present-day suicidism. The term forecloses diverse understandings of suicide previously available through language, suggesting a more universalist and singular conceptualization of self-killing. In the words of Marsh (2010), "the ubiquitous 'suicide'…tends to flatten out any such nuances, and we are left with a somewhat impoverished set of resources for constructing meaning around acts of self-accomplished death" (p. 79). The singularity of the term as a sign of individual fault and tragedy also reflects a major shift in understandings of self, identity, and agency. As Hill (2004) explains, Ancient Roman writers tended to use inclusive rhetoric such as nos (we/ourselves) and the general homines (people) instead of singular pronouns and referents, reflecting more communal understandings of life and death than are common in contemporary English. The Latin language did not leave space for acontextual descriptions of suicide, thus suicidist beliefs were unlikely to be normalized through language.
In contrast with the depth of language for self-killing used prior to the 1640s, many contemporary suicidologists critique the term "suicide" for its erasure of outside influence, particularly related to sociocultural oppression (see Bergmans et al., 2016; Sather & Newman, 2016; Wexler & Gone, 2016). As Reynolds (2016) argues, "Defining the person's death as suicide, depression, or anxiety totally obscures the context of [their] struggles" (p. 174). Suicide is often the result of oppressions such as colonialism, capitalism, racism, homophobia, and transphobia—all of which are hidden beneath biopsychiatric claims of internal error under the medicalized term "suicide" (see Krebs, 2023; Piepzna-Samarasinha, 2018; Puar, 2011). I argue that the 1642 introduction of the word "suicide" and its uptake in the English language marked a major ontological and rhetorical turning point in suicide's medicalization and, ultimately, the formation of suicidist beliefs.
Scholars and activists aiming to reject suicidism might consider adding to the complexity of terms used to describe suicide and suicidality. In line with Mad studies and Mad justice efforts to reclaim language, I ask: What terms for describing the experiences of suicidality might offer more insight, nuance, and agency for suicidal people and those around them? Are there forms of historical language that we might productively reclaim? Although embracing the umbrella term "suicide" may be crucial to challenging suicidist beliefs in a unified way (see Fox & Braswell, 2024), a more diverse set of terms for thinking about this phenomenon can also help suicidal people give voice to their experiences in more nuanced ways that are likely to elicit more tailored support.
Art therapist and illustrator Alyse Ruriani (2020) offers a model for this with her graphic based on the Columbia Suicide Severity Rating Scale, which has the potential to increase "suicide literacy" amongst public audiences (see Fitzpatrick, 2020). Her graphic, which continues to spread widely online, displays a colorful thermometer gauge that measures levels of suicidal ideation with "suicide attempt" written at the top and "no thoughts [of suicide]" at the bottom. This scale shows eight levels of suicidality, all of which are given names (e.g., "suicidal intent, no plan," "random intrusive thought," and "suicidal with plan and intent") so that people can better express and understand different experiences of suicidality. Although the linear model is limited by design (and many of the levels still include the term "suicide"), this gauge represents a step toward understanding suicidality with more nuance.
Future work challenging suicidism can continue to expand the linguistic models we have for expressing suicidality and feelings that surround it. Based on Ruriani's illustration, I pose the question: What other spatial arrangements for gauging the desire to die might offer more insight? Moving beyond linear measures of risk and intensity and toward more complex understandings of the pain and experiences that might influence a person's desire to die is a crucial step in this endeavor. This linguistic expansion could help people understand suicidality—others' and their own—beyond frameworks rooted in liability- and risk-reduction. Embracing the richness of language prior to the singular term "suicide" thus offers an inroad for contemporary anti-suicidism advocates.
Following the spread of Christianity throughout Western Europe and the introduction of the term "suicide" into the English language, the Enlightenment period in Western Europe offered another significant change in historical conceptions of suicidality. Also known as the Age of Reason, this period was characterized by extensive calls for the separation of church and state, rejection of austerity politics, and a newfound epistemological emphasis on the scientific method over faith-based logics (MacDonald, 1992). It was during this time that the first truly medical understanding of suicide rose to prominence (MacDonald & Murphy, 1990; Marsh, 2010). However, the phenomenon's medicalization was not driven by the scientific method or any sort of observational science. Countering blame (mis)placed on psychiatrists, MacDonald (1992) argues that the medical field lacked the authority it has today, so "physicians were riding in the caboose of change, not driving its engine" (p. 98). As MacDonald and Murphy (1990) offer, the medicalized framework of suicide gained significant momentum due to its utility in non-medical spheres, including as a strategic economic and political tool against theocratic austerity.
The English Revolution (1640-1660) marked the height of resistance to theocratic monarchy and the severity of the nation's rulers, notably their feudal economic system. Although the impact of this uprising has been heavily debated, historians credit it with two primary changes in England: an increase in parliamentary power (reduction of the monarchy) and the introduction of a capitalist economy (see Hill, 1991). In line with these revolutionary shifts, medicalizing suicide was one form of compounding economic resistance against the Crown, which legally seized all property of those who killed themselves. Historians argue that key drivers of medicalization were coroners' juries (general citizens) who mitigated the monarchy's legal power and supported lay publics over the Crown (MacDonald, 1992; MacDonald & Murphy, 1990).
During this time, legal trials followed suicides to determine the nature of the deaths. There were two categories into which suicides could fall: felo de se (self-murder) and non compos mentis (of unsound mind) (Barbagli, 2015; Houston, 2009; Szasz, 1998). Being judged felo de se meant forfeiting all properties to the English monarchs, as this type of self-murder was a felony against the Crown. In feudal systems, killing oneself was seen as an escape from duty (labor and payments) to nobility and was punished as though its goal was to avoid such obligations. On the other hand, being deemed non compos mentis was an early version of an insanity defense. Under this judgment, a person who died by suicide was excused from their crime under the logic that they were mentally ill or otherwise incapable of sound judgment, meaning their property was not confiscated and was left to their families instead (MacDonald, 1992). Despite this comparatively compassionate frame, both felo de se and non compos mentis labels were notably negative; both of these categorizations reflected suicidist beliefs of suicidal people as either vindictive or incapable and irrational.
MacDonald's (1992) analysis of parliamentary records from the 1600s shows a drastic decrease in felo de se judgments after 1660, which they argue reflected widespread frustration with monarchal power and increasing class solidarity amongst the peasantry. Courts rarely took the side of upper-level lords in these cases, as juries held little sympathy for their attempts to seize the property of suicide decedents. During this time, society showed increased compassion for the family of a person who died by suicide. This sort of communal/class solidarity continued over the three centuries that followed. Prior to the English Revolution, less than 10 percent of cases were judged non compos mentis (insane/not guilty), but the number drastically increased following the Revolution and climbed to over 97 percent of cases before the 1961 Suicide Act formally decriminalized self-accomplished death in the nation (MacDonald, 1992).
For contemporary Mad justice activists, this example of legal resistance and class solidarity as modes of resisting suicidist violence can be instructive. There are many ways suicidism inflicts economic punishment on suicidal people. For example, when involuntarily committed to a psychiatric ward in the US, patients must pay the bill themselves—even though they didn't consent to receiving such "care" in the first place (Trans Lifeline, 2024). Ambulance rides and overnight stays in psychiatric wards, both of which are common responses to perceived suicide crises, have notoriously high costs and often leave patients with thousands of dollars in medical debt (Rizo, 2021; Wipond, 2020). This can be compounded by lost wages following time spent in psychiatric facilities (see Rizo, 2021; Wipond, 2020). This debt prevents people from seeking consensual care when they need and want it, and also contributes to suicidality by placing people in states of financial ruin (see Mathieu et al., 2022).
With this in mind, the example of class solidarity and legal resistance during the English Revolution provides a pathway for Mad justice activists aiming to reject harms against suicidal people. This example compels me to consider: In what ways does suicidism function economically, and how can we counter those economic effects within capitalist healthcare systems? Can the economic impact of suicidism be meaningfully tempered via legal reform? How might financial activism in this arena function at the level of the populace (i.e., mutual aid) if systemic change is slow-moving? I argue that pushing for legal reforms related to the cost of involuntary medical care and who is responsible for it (i.e., the state covering these costs or having a low, maximum out-of-pocket cost for involuntary patients regardless of insurance coverage) is one path toward resisting suicidist violence. While this economic advocacy wouldn't change the fact that suicidal people are being unjustly detained in the first place, legal shifts that make this type of care unprofitable could reduce the overall number of involuntary intakes. At the very least, it could alleviate the financial distress that follows involuntary care and increases suicide risk (see Chung et al., 2017; Trans Lifeline, 2024).
As argued earlier in this work, a core difficulty in challenging suicidism is that much of the care for suicidal people happens behind closed doors; it is protected from watchdogs and outside critique. The structure designed to manage suicide remains one of the psychiatric field's most controversial systems: the asylum. Most famously critiqued by Foucault in Madness and Civilization (1965), the "lunatic asylum" was (and still is, under other titles like "psychiatric hospital") a central symbol of suicidism: a space of harsh restraint and isolation where scientific experiments and human rights abuses ran largely unchecked. Szasz (1997) and Marsh (2010) argue that early psychiatrists created their own object of study: an unseen and dangerous force in need of containment. While previously the Devil was this invisible force, widespread secularization and the increasing prestige of science meant that in the nineteenth century "mental illness" became a more credible and socially accepted explanation for suicidal impulses. The rise of psychiatry also shifted the duty of managing suicide away from juries and courts and toward medical professionals; psychiatrists relieved the public from their duty to manage suicidal people and made suicide a hidden matter (Marsh, 2010).
From a rhetorical standpoint, the first formal medicalization of suicide was published in 1821 (Hacking, 1990; Szasz, 1998). The Dictionnaire des Sciences Médicales (1821), an early version of a French medical encyclopedia, included a seventy-five-page chapter titled "SUICIDE" written by Jean-Etienne Esquirol, the creator of the first formal education in mental pathology. Esquirol relied extensively upon medical rhetorics including technical terms like épidémie (epidemic), lésions (lesions), héréditaire (hereditary) and guérir (to cure) to back his articulations of suicidal people as mentally ill. This vocabulary, in combination with its location in a medical encyclopedia, offered a novel sense of credibility and authority to psychiatry and gave doctors (then "alienists") the right to "guard, treat, control, and judge suicides" (Hacking, 1990, p. 65). Hacking (1990) argues that its publication is what first allowed suicidal people to be classified as patients and made them confineable for scientific observation and treatment.
This classification of suicidal people as patients helped encourage the widespread construction and use of asylums as public hygiene facilities for the management of the clinically insane (Foucault, 1965). As Foucault (1965) argues, the central tenet of asylums was to not to treat patients, but to contain insanity. He explains that excluding Undesirables from society and preventing their reproduction was, and remains, key to maintaining civilized nations. Building on Foucault's assertions, I argue that asylums contributed to the framing of the desire to die as an explicitly anti-civilization and anti-capitalist act. While alienists, Foucault (1965) argues, essentially served as non-scientific judges who decided what behavior was to be classified as abnormal, their judgments typically went unchallenged because of their medical prestige and isolation in closed-system asylums. In their psychiatric framing, suicide was no longer a sin but a dangerous public health issue linked to fears of contagion (see Maudsley, 1892). The notion of the asylum as a protector of public safety allowed much of the work done within it to be undertaken without public scrutiny.
Behind the closed doors of asylums, nineteenth-century psychiatrists were free to engage in experiments upon their charges, including practices later recreated in many horror films: icepick lobotomies, electroshock treatments, chemical castration, freezing/burning therapies, and sexual manipulation (see Dean, 2014). These "treatments" demonstrate the unique nature of psychiatry to legitimize abuse beneath the guise of scientific progress and treatment (Foucault, 1965; Szasz, 1998). Marsh (2010) explains this closed knowledge system in communicative terms: "The contention of an 'underlying' but 'undetected' pathology is rhetorically powerful in that such a statement cannot be easily rebutted," especially when a patient is not accessible by anyone aside from those making the claims of pathology in the first place (p. 48). As total institutions (see Goffman, 1961), asylums "acted as laboratories for the productions of medical truths of insanity" (Marsh, 2010, p. 220). Their physical nature—locked doors, limited outside visibility and visitations, fences, guard towers—meant that the knowledge created within their doors was nearly impossible to challenge (Goffman, 1961).
While hundreds of Mad individuals wrote about their experiences in asylums and published these accounts for broader audiences (e.g., Camp, 1882; Hamilcar, 1910; Grant-Smith, 1922; Wilson, 1940; see also Rembis, 2022), their voices were largely disregarded in "a world that medicalizes, pathologizes, and devalues or ignores them" (Rembis, 2024, p. 2). The total institution of the asylum did not retain its power by silencing or blocking dissenters. Instead, it existed in an epistemically violent cultural space in which such dissenters were not valued or believed as knowers of their own experiences (see Liegghio, 2013). This closed system of knowledge production and power remains central to psychiatric regimes and their management of suicidal people today (see Wipond, 2020). In this framework, there is no space for suicidality to be understood as anything other than a symptom of illness. Deinstitutionalization, as many disability rights activists have argued, is crucial to disrupting the abuses of such closed systems (see Center for Independent Living, n.d.). Many Mad justice activists agree with this logic and push for psychiatric abolition and/or widespread deinstitutionalization (see Mensah, 2020; Karanikolas, 2022).
In 1963, after almost two centuries of the dominance of the asylum in controlling those deemed mentally ill, the US Congress passed the Community Mental Health Act (CMHA). Labeled a psychiatric "revolution" by its supporters, the law drastically reduced the number of public mental hospitals, leading to a mass deinstitutionalization and the release of almost 75 percent of former patients (Torrey, 2013). The stated goal of the CMHA's closure of public psychiatric hospitals was not simply to let patients loose into the streets. Rather, it aimed to shift them into outpatient care systems via community health centers that would be more compassionate and less expensive (Rochefort, 1984). However, federal reports suggest that only 4 to 7 percent of patients at community mental health centers (CMHCs) were former asylum patients (Torrey, 2013).
While this may seem like a context in which the oppressive powers of state psychiatry might have been productively challenged or even dwindled on their own, critics question the true extent of deinstitutionalization. As Erickson (2021) explains, CMHCs became centers for individuals with relatively mild mental health concerns that didn't require intensive treatment. Individuals "with diagnoses of serious mental illness were scattered across the mental health treatment system, with no single organization accepting longitudinal responsibility to address their basic needs" (Erickson, 2021, n.p.). Critical scholars such as Rembis (2014) gesture to transinstitutionalization, the movement of patients from asylums to the prison system, as a sign that "deinstitutionalization" was not really a result of the CMHA. As Rembis explains, "the community mental health centers and many of the ideals upon which they had been founded were 'dead' by the early 1970s" (2014, p. 150; citing Torrey, 1988, p. 132). They were replaced by law-and-order, tough-on-crime rhetoric that reflected historical discourses of mental illness as intimately linked to criminality. With this political shift, many mentally ill people were incarcerated in jails and prisons, making them the "new asylums" (see Rembis, 2014; Rembis 2024; Treatment Advocacy Center, 2016).
Treatment Advocacy Center (2016) reports that the Los Angeles County Jail, Chicago's Cook County Jail, and New York's Riker's Island Complex each hold more mentally ill inmates than any remaining psychiatric hospital in the US. However, as Rembis (2014) cautions, it's not as simple as saying that people who were or would have been in asylums are now in prisons. In Rembis's words, "Any critical assessment of madness and mass incarceration must begin by thinking critically about madness itself" (p. 143). We must question who gets labeled as mentally ill and why, especially in the face of expanding diagnostic categories that label social deviance as medical problems (see Cohen, 2016). We must also challenge how carceral systems use psychiatric rhetoric to encourage the mass incarceration of marginalized individuals, including people of color and those living in poverty.
As psychiatric oppression has spread from asylums to jails, prisons, and other institutions, suicidism has also branched into many less overt, but still sinister, forms. Since the passage of the CMHA in 1963, psychiatry's power has been disseminated to a broad range of professionals who work outside the walls of asylums (Anderson, 1987). Various forms of care now hold some degree of psychiatric legitimacy: psychoanalytic talk therapy, counseling, social work, occupational therapy, peer support groups, etc. While this seems to suggest a democratization of psychiatric knowledge that might challenge the violences of total institutions, involuntary psychiatric hospitalizations ("5150 holds") remain the quintessential—and often legally mandated—safeguard for suicidal people in the United States. 5
Regardless of the suicidal person's desires, reporting these individuals to authorities, who then transport suicidal people to psychiatric facilities, remains the normative and, in many cases, legally mandated practice (Harris, 2023). Most schools, hospitals, and elder care centers require staff members (and even peers) to report incidents in which people share thoughts of suicide (Lab & Lab, 2010). In many US states, if one of these staff members finds out about their patient's or student's suicidality and does not report it, they can be charged with assisting self-murder and may be found guilty of manslaughter (see Commonwealth v. Carter, 2019). These practices are manifestations of suicidism that reveal a surveillance state in which all of us are responsible for the management of suicidal Others (see Baril, 2020; Foucault, 1965; Foucault, 2002; Szasz, 1998). While psychiatrists are granted so to manage suicidal people, we are all tasked with ensuring that patients find their way to these doctors, as not to be assisting a crime. 6 Unfortunately, this practice forecloses more meaningful conversations about suicidality built on consensual, compassionate care (see Trans Lifeline, 2024).
Anti-suicidist activists hoping to resist the "see something, say something" democratization of policing suicidal people face a tricky task. Do we simply not make reports? Do we challenge our employers' policies directly and seek to educate them on the harms of involuntary intervention and carceral care? What if we don't have skills, knowledge, or capacity to support a suicidal person in other ways? Of course, simply refusing to push people toward involuntary care by deciding not to make reports is a choice one can make. This anti-reporting stance isn't about avoiding the task of helping suicidal people, but rather maintaining their autonomy and human rights by helping them find care or community that they actually desire. Of course, this choice to avoid reporting isn't without risk; failing to follow an employer's explicit policies or directives can come with significant employment ramifications.
Mad justice organizations like Wildflower Alliance (2013a, 2013b) have worked to educate people about widespread misconceptions about "mandated reporting" around suicidality, as they argue that many people's fears about legal ramifications are misguided:
There is a popular misunderstanding that "mandated reporter" means that you are mandated by law to report if someone is talking about hurting themselves or someone else. This is not true. "Mandated reporter" refers to the legal requirement of many professions and organizations to report observed or suspected abuse or neglect of someone who is considered elderly, disabled or a child by a care giver. While organizations may still have clear policies for their employees around reporting perceived risks of self-harm or hurting others, that is an organizational decision and not a black-and-white legal mandate outside of the organization's control as is the "mandated reporter" law. (Wildflower Alliance, 2013a, emphasis in original)
The organization explains that this distinction between law, organizational policy, and organizational norm is a crucial inroad for activist reform. "If you feel that a particular organization's protocol or typical response to these [crisis] situations needs updating," they explain, "there is room to raise that issue and offer your thoughts and wisdom" (Wildflower Alliance, 2013b). Especially for well-informed scholars and activists who are dedicated to Mad justice and resisting suicidism, simply educating colleagues and administrators about the risks of mandated reporting (e.g., carceral care and heightened suicide risk) and the fact that these mandates are not legal in nature is one productive way to open conversations toward reforming how we care for suicidal people by opening pathways toward more compassionate, consensual care.
In offering the neologism "suicidism" to describe the distinct form of sanist-ableist oppression experienced by suicidal people, Baril (2020) provided a key tool for understanding suicide from anti-oppressive perspectives. The historical moments I unpack in this essay allow me to further Baril's goal of "interrogat[ing] dominant ideas and perspectives on suicidality" (2020, n.p.). By hypothesizing and theorizing around historical moments related to the medicalization of suicide, this work offers a platform for future scholars to unpack and challenge suicidism from a wide range of academic fields and activist positions. It also offers four concrete inroads for Mad justice activists seeking to challenge suicidist violence in various forms. First, I highlight the potential of liberation theology work, which can help people understand suicide differently and reclaim Madness within Judeo-Christian texts and teachings on morality. Second, I suggest that expanding language around suicide will allow us to challenge dominant (mis)understandings of suicide as a solely medical issue and add crucial nuance to mainstream beliefs about the desire to die. Third, I posit that economic activism aimed at eliminating patient liability for the cost of involuntary crisis care could benefit suicidal people by removing economic burdens and making these ineffective interventions less economically productive for psy-industries. Finally, I argue that challenging mandated reporting policies in schools and workplaces and educating people about the harmful effects of involuntary psychiatric care are crucial ways to challenge oppressive practices at the institutional level. Each of these four inroads represents a way of using histories of suicidism to inform contemporary Mad justice resistance.
As this project underscores, suicidism cannot be understood as unique to contemporary psychiatry. Suicidist beliefs predate not only the medicalization of suicide, but also the field of psychiatry itself. As such, we must match important critiques of psychiatry with more expansive advocacy outside the medical field in order to productively disrupt suicidist logics. The widespread framing of suicidal people as inherently in need of surveillance and control means that suicidist oppression extends far beyond the walls of psychiatric facilities. Suicidism is deeply enmeshed in religious, linguistic, legal, cultural, political, educational, and economic systems that influence a wide range of non-psychiatric contexts. Mad justice efforts to counter suicidism must therefore address all of these oppressive tendrils if we are to improve the lives of suicidal people.