Suicide and Social Justice

Why a Political Approach to Suicide?

The fact of suicide turns many of the most basic assumptions of modern political theory upside down. Since the work of Thomas Hobbes, political theorists and legal philosophers have accepted the idea that the fear of violent death provides both the motivational source and the principle justification for the concentration of legal authority and coercive power within a sovereign state apparatus. While critical questions have been raised about the overall weight that Hobbes placed on the fear of violent death within human psychology and social behavior (especially in relation to the religious devout), the Hobbesian thesis remains a cornerstone within theories of the state, jurisprudence, and international politics. ³ Yet, the phenomenon of suicide shows that the highest rates of violent death take place within otherwise stable and legitimate political states through self-initiated acts of destruction. And this has been true for decades. In the sixteen states included in the National Violent Death Reporting System, 62.8 percent of all violent deaths were suicides, with homicides accounting for 24.4 percent of the total (or 12.4 per 100,000 suicides compared with 4.8 per 100,000 for homicides; CDC 2010). Foucault (1990, 139) addressed this perplexing circumstance for modern political states as follows:

This determination to die [by suicide], strange and yet so persistent and constant in its manifestations, and consequently so difficult to explain as being due to particular circumstances or individual accidents, was one of the first astonishments of a society in which political power had assigned itself the task of administering life.

If the biopolitical power of the modern state faces its limit—if not its antithesis—with self-targeted death, is suicide even susceptible to political explanation, or at least a politically minded inquiry? The apparent absence of any such investigation would seem to suggest that the answer to this question is no. Nonetheless, if one of the primary tasks of politics is to provide protection against the great evils of human life (Hampshire 2000; Hobbes [1651] 1996), it would seem that on the basis of well-documented evidence about the rates and distribution of suicide in the United States (42,773 in 2014) ⁴ and around the world (over one million/year), suicide (outside of the context of terminal illness and assisted death) properly belongs among the ills that a socially responsive political theory should confront. But how should it do so, and what can political theory really hope to contribute to this emotionally charged area?

As students of political thought, we are familiar with the various argumentative moves that have been made in relation to the question of suicide—“the one truly serious philosophical problem,” [Emphasis added] according to Camus (1955, 3). Generally speaking, these replies come in two basic forms. Suicide is a gift, a freedom, and later an individual right: that is how thinkers like Seneca (1969), Nietzsche (1968, 1978), Hume (1985), Améry (1999), and Szasz (1999) have viewed suicide. Alternatively, suicide is an act of metaphysical theft, a sin, and a crime (against God, the sovereign, or the self): that is how Socrates (1977), Aristotle (1953), Augustine (2001), Dante (1993), and Kant (1997) viewed suicide.

For all of their significant ethical differences, each of these broad orientations to suicide presupposes a naked soul facing the question of self-initiated death in suspended philosophical animation from the sociopolitical conditions within which all souls are ineluctably shaped (Hamlet’s soliloquy without the moral and political rot in Denmark). As a result, each of these orientations to suicide—as gift/right or sin/crime—purchases existential and metaphysical significance at the price of conceptualizing suicide as a serious political problem about the conditions that imperil or negate human dignity. The tendency to isolate the psyche/soul from its social and material context is further illustrated by studies showing that contemporary moral judgments about suicide (even after controlling for religious and ideological variables) are driven by concerns about “impurity” (Rottman, Keleman, and Young 2014).

As if to bracket centuries of philosophical agonism about suicide, the overwhelming majority of today’s medical/psychiatric profession views suicide as a symptom of severe mental illness. The statistic that is usually cited in this context, based on “psychological autopsies,” is 90 to 95 percent of all suicides entail some form of significant mental illness: depression, bipolar disorder, schizophrenia, and drug and/or chemical dependency. ⁵ In a recent work that maps the historical formation of this “contemporary ‘regime of truth’” about suicide, Ian Marsh (2010) highlights the “compulsory ontology of pathology” that took root in the nineteenth century and continued to make the question of suicide primarily an issue of disciplinary concern for the psychological, psychiatric, and medical professions (see also Battin 2005). As Marsh (2010, 222–23) explains, “Suicide is now mostly constituted as the tragic act of a mentally unwell individual and other ways of conceiving self-accomplished death possess relatively limited currency.” This is not to deny the ongoing relevance of neo-Stoic, Christian, Kantian, or post-Nietzschean orientations to the meaning and status of suicide but to highlight the fact that the dominant discursive frame for explaining (and predicting) suicidal behavior is one of individual psychopathology.

On one hand, the slow scientific and cultural shift in accordance with which suicide has come to be seen as determined by genetic, neurological, and mental disorders is conducive to relatively more humane and less punitive and moralizing responses to suicide (although there are loud dissenters to this view). ⁶ For example, Western political societies no longer deny burial to suicides, confiscate their property, or hammer a stake in their heart (MacDonald and Murphy 1990; Minois 1999; Watt 2004). On the other hand, by turning suicide into an issue that is almost exclusively played out within the interior psyche of a person, the external sociopolitical conditions that are a constitutive feature of all subject formation are left out of the picture. Even within studies that signal an appreciation for the interaction between the individual and the social environment, the primary stress within these investigations is on the genetic and biological factors that predispose individuals to respond to “environmental stressors” in certain self-destructive ways (Goldney 2000; Träskman-Benz and Mann 2000; Williams and Pollock 2000). The “environmental stressors” themselves are treated as uncontrollable exogenous factors about which suicidology has little or nothing to say. This emphasis on interior predispositions (neurological, biochemical, and personality traits) in turn has a significant influence on the recommended strategies for responding to suicidal ideation and behavior, which are overwhelmingly psychotherapeutic and pharmacological. The following observation from the field of psychiatry is representative of this orientation:

There is relatively little that a doctor can do to control many of the major stresses in a patient’s life: they occur too randomly, and thus are difficult to predict and even more difficult to govern. But there are things that can be done to influence and treat the underlying biological vulnerabilities to suicide, as well as the mental illnesses closely linked to suicidal behavior. (Jamison 1999, 239)

I will return to the issue of the supposed randomness and ungovernability of the external conditions that facilitate suicidality further below. For now I simply want to indicate that in suicidology today, psyche-analysis has come at the expense of the Platonic appreciation for the constitutive interrelationship between polis and psyche. In this context, it is hardly surprising that the use of antidepressants and other pharmacological treatments would continue to rise, even as general rates of suicide have remained more or less constant (roughly between 10.4 and 13.0 deaths per 100,000 per year). It is perhaps slightly more surprising to discover that public health approaches to suicide—with their focus on surveillance and targeted interventions with specific populations—tend to leave prior structural questions about the constitution and concentration of “at risk” groups within a general population unaddressed (see Potter 2001; World Health Organization 2010). For all of the merits of population-based public health strategies (see May et al. 2005), the long-term benefits of these programs stand to be improved by a more fundamental political orientation regarding the formation and endurance of the conditions that help to breed suicidal subjectivities in the first place.

Given the above discussion, it would seem that there are very few new arguments left to make regarding the ontological and moral status of suicide, beyond working at the edges of these diverse philosophic and scientific orientations and carving out precarious intellectual planks upon which to balance some elements of each of these approaches. Here is one such line of thought: we can accept the important finding that suicide is highly correlated with a variety of mental and personality disorders in the way that psychologists insist today, but perhaps this does not completely close the door on one’s agency to “die at the right time,” as Nietzsche (1978, 71) put it. After all, most people with various mental and personality disorders do not commit suicide, and for those who do, suicide might still be seen as an element of human freedom and an expression of a desire for personal autonomy. Can we think mental illness and human autonomy together? Take, for example, the following statement from a suicidal “patient” who spent most of his life in mental institutions:

If I commit suicide, it will not be to destroy myself but to put myself back together again. Suicide will be for me only one means of violently reconquering myself . . . By suicide I reintroduce my design in nature, I shall for the first time give things the shape of my will. (Alvarez 1971, 131)

Statements like this—if taken seriously—might raise important questions about the Kantian judgment that suicide necessarily entails an action that puts one in contradiction with one self as a free moral agent.

Here is another alternative line of thought: perhaps suicide is one dimension of human freedom, but it might still remain a kind of theft, not from a creator God at whose disposal we are morally bound (as Socrates and later Christian thinkers believed) but from interpersonal relations and social connections that are irrevocably diminished through the act (see Hecht 2013). Indeed, it is hard not to feel that the suicidal steal away or significantly diminish the phenomenal world that we are all a part of by removing themselves from that world. Can we make sense of a “right” to social theft? Alternatively, if a suicidal individual feels that he or she has already been stripped of equal moral standing and significant social connections to others, perhaps a prior social “theft” needs to be investigated to fully understand and respond to the vexing scene of suicide—and in this context the language of “rights” to, and the “rationality” of, suicide will provide very little illumination and even colder comfort for those who live on.

These unlikely synthetic intellectual orientations to suicide and the additional questions they generate are deeply perplexing, to be sure. Yet for all of their intrinsic philosophical and social interest, the preceding lines of thought are all (with the partial exception of the last question) quite unpolitical. Indeed, it is rare to see politics—understood as the structural conditions of collective life and human governance that shape and are shaped in turn by human agency—factor into discussions of suicide in a meaningful way today. ⁷ Even scholars like Battin (2005) and Marsh (2010) who are deeply attuned to the contingent historical dimensions of contemporary understandings of suicide and who are critical of the “medicalization” of suicide assessment and treatment do not attend to these wider political conditions as a factor in the distribution and concentration of suicide among certain populations. The one thinker who came closest to a political–structural analysis of suicide was Durkheim. However, politics entered Durkheim’s analysis only insofar as political and national crises had an effect on general rates of suicide: Durkheim (1951, 208) found that crises reduce rates of suicide owing to temporarily heightened conditions of social integration. For Durkheim (1951, 299), suicidal aptitude was a purely social phenomenon:

There is . . . for each people a collective force of a definite amount of energy, impelling them to self-destruction. The victim’s acts which at first seem to express only his personal temperament are really the supplement and prolongation of a social condition which they express externally.

Perhaps because he was as concerned with championing the burgeoning field of sociology as an empirical science of man as he was with explaining the causes of suicide, Durkheim’s analysis did not go any deeper than the “social forces” (i.e., egoism, altruism, and anomie) that determine general rates of suicide. Hence, after establishing, as he thought he had, the sui generis nature of collective social tendencies acting upon individual existence, Durkheim could rest his case against the defenders of psychological and other extra-social causes of suicide (most notably in the work of Jean-Étienne Dominique Esquirol).

My plea for a more explicitly political approach to suicide is Durkheimian insofar as it understands suicide not simply as an individual act but also as the consequence of wider social and political forces. However, this approach moves beyond or beneath Durkheimian structural sociology by arguing that the “social facts” of suicide (the patterns and trends of suicide rates in certain populations) also tell a political story—a story (or a series of stories) that is frequently punctuated by marginalization, persistent neglect, cultivated indifference, and bad faith. To be sure, the broad social correlates of suicide are extremely complex and cannot by themselves predict or fully explain the causes of individual suicide (see Hawton and van Heeringen 2000; Rudd, Joiner, and Rajab 2000). Yet the properly political question about suicide today is not only why certain identifiable groups are persistently haunted by higher rates of suicide than others, but how it is that these concentrations of suicide can coexist alongside widespread beliefs about the dignity and moral equality of all persons without raising an acute sense of existential and institutional crisis in need of a collective political response. An organized political approach to suicide would not allow a society and its major institutions (legislative bodies, the health care industry, schools and universities, the mass media, etc.) to characterize suicide as a strictly personal or family problem because such an approach would start with the acknowledgment that suicide is also a collective burden of social justice tied to the distribution of primary goods within a political system. ⁸

While Durkheim’s analysis remains quite influential to this day, the contemporary study of suicide has swung in a decidedly nonsociological and nonpolitical direction. Starting with Henry Murray’s (1938) focus on thwarted psychological needs, Edwin Shneidman’s (1985, 1996) influential discussions of psychological pain (or psychache), and Aaron Beck’s (Beck et al. 1985; 1990) emphasis on hopelessness, individual psychological mechanisms are now at the center of contemporary theories of suicide. Perhaps the most compelling and parsimonious “model” for explaining suicide today is offered by the clinical psychologist Thomas Joiner (2005; see also Van Orden et al. 2010). Joiner’s research effectively distills the previous scholarship of Murray and Shneidman (among others) and explains the origins of suicide with reference to two primary categories: perceived burdensomeness and thwarted belongingness.

Like previous research on the causes of suicide, Joiner focuses on the thwarted psychological needs of individuals in combination with the acquired ability to enact lethal self-injury (through habituated practices of deliberate self-harm, for example). The specific psychological mechanisms at work in suicidal ideation and behavior are reduced to two: the feeling that one is “ineffective” and a burden to others, and the feeling that one does not belong or is not cared about by others. “Thwarted belongingness” is essentially a Durkheimian category referring to the lack of stable and satisfying forms of social integration and interpersonal connection. “Thwarted effectiveness” is a category that refers to a negative self-image about one’s perceived lack of effectiveness that is tied to the belief that one is also a burden to others (not entirely unrelated to Durkheim’s notion of altruistic suicide). According to this model, two psychological conditions are necessary to support the will to live: feelings of connectedness and effectiveness. A person can, by and large, survive on just one of these, but take both away, and the evidence from psychological studies points to a significant increase in suicidal ideation and behavior (see Van Orden et al. 2008).

While Joiner’s theory of suicide is clearly intended for the clinical setting and for assisting those who are charged with assessing, intervening, and treating suicidal “patients,” ⁹ I want to use this compelling explanatory model as a starting point for a more explicitly political intervention into the sociocultural conditions of suicide. To do so, I will offer a political interpretation of “perceived burdensomeness” and “thwarted belongingness” as first steps toward a more general sociopolitical inquiry into the formation and distribution of suicidal subjectivities. A political interpretation of the proximal conditions of suicidality requires that we shift our attention from an exclusive focus on the suicidal mind and ask about the constitutive relationships between psyche and polis as this relates to the formation of suicidal subjectivities.

From the Interpersonal to the Intrapolitical

What are the sociocultural sources for a conception like “thwarted effectiveness” or “perceived burdensomeness”? That is, how do these specific forms of self-consciousness take root within an individual psyche and within members of larger social groups? According to one influential study, evolutionary-psychological pressures surrounding the idea of suicide suggest that one’s perceived liability to one’s relatives undermines self-preservation motives and is a precursor to suicide (de Catanzaro 1991). An evolutionary framework elucidates part of the link between burdensomeness and suicide through theories of natural selection and inclusive fitness. Yet, in the context of advanced liberal democracies characterized by culturally specific funds of ontological commitments and moral values, at least as important is the normative model of autonomous self-mastery. Perhaps it is true that no one wants to be a burden to others. But given the significant role that this perception seems to have in suicidal ideation and behavior, and given the fact that in advanced liberal democracies perceived burdensomeness is often tied to things like unemployment and physical illness, it is crucial to attend to the cultural persistence of an impossible ideal of sovereign autonomous agency as to the specific life events that prompt the use of these scripts in the first place. In other words, a punitive (and frequently gendered) notion of sovereign, responsible agency is implicated in a category like “thwarted effectiveness,” even if it is also underwritten by wider evolutionary-psychological mechanisms. Perhaps it would be more apt to say that evolutionary-psychological currents flowing through the late-modern self are given more condensed, rigid, and moralized form within the contemporary neoliberal-capitalist conditions of life. As a result, contingent life span events are turned into conditions for the self-enforcement of a conceptual model of moral subjectivity that is in its own right (ontologically) implausible.

Joiner and others are right to highlight the ways in which perceived burdensomeness is potentially remediable through cognition, perception, and skill-based psychotherapies—assuming that these kinds of interventions are actually available to individuals in crisis. Yet individual cognitive strategies are really no match for a wider system of socialization that burns into the psyche a conception of responsible autonomous agency that contains, as its dark underside, self-loathing and potential self-destruction for failing to live up to its impossible demands. Hence, alongside individualized psychotherapeutic responses to perceived burdensomeness, liberal democratic societies would be well advised to rework the cultural scripts and “master narratives” that sustain these persistent illusions of self-mastery in a world of contingency, rupture, and precariousness. This work needs to take place within numerous institutional sites of human activity: within families, religious assemblies, the workplace, and the armed forces. Yet none of this “work” on collective moral identification is really meaningful, in a material sense, without significant public investment in the kind of practices of care—health care, mental health services, workforce assistance, and family support services, to name a few—that could provide communities with the resources to respond humanely and with dignity to physical illness, unemployment, drug/alcohol dependency, and family conflict: the very events that spur the perception of one’s burdensomeness to others. In short, no amount of individual cognitive or perceptual therapy (as valuable as they are) should release a political society from (1) renegotiating the cultural scripts that sustain a punitive model of human agency and (2) addressing the material–institutional conditions that prevent a dignified form of reciprocal social care from forming. Indeed, it would be preferable if a more realistic conception of moral subjectivity and identity were cultivated in tandem with a serious investment in a social safety net for all persons: the former on its own risks turning away from the material conditions that undergird a life of dignity; the latter on its own courts social stigmatization.

“Thwarted belongingness” or the loss of stable social connections is a dilemma that provides a clear path of connection and collaboration between the fields of psychology, sociology, and political science. Hegel, Marx, Tocqueville, Durkheim, William James, Robert Putnam (2000), and contemporary social and cognitive psychologists have all highlighted the threat that social alienation and disconnection pose to the vibrancy of the human life drive (the same could also be said of the poetry of Sylvia Plath, the novels of Céline and Faulkner, or the plays of Sarah Kane). Yet when it comes to thinking about how to proactively address the contribution that thwarted belongingness makes to suicidality, none of these disciplines have connected the systemic analysis of the sources of social alienation to the protection from suicidality as a feature of social justice and a fundamental element in the protection of human dignity. To begin to move in this direction, we need to take a more explicitly political turn in our approach to suicide prevention. A more explicitly political turn within the study of suicide would (1) bring critical attention to the formation and distribution of suicidal subjectivities as a question of social justice, and (2) generate a social justice agenda directed at securing the conditions of human dignity for all persons. Both of these steps are but preliminaries to the real political work of cultivating a diverse citizen coalition whose aim is to realize a substantive right to a dignified life for the already born and to hold policy makers and political institutions accountable to this goal. Nonetheless, I provide a preliminary outline for each one of these steps in what immediately follows.

The Formation and Distribution of Suicidal Subjectivities

What do I mean by the formation of suicidal subjectivity? I refer, first, to the presence of systemic social conditions that foster and sustain the kinds of anguished feelings that are highly correlated with suicidal ideation and conduct: hopelessness, burdensomeness, and social isolation. Second, because the social conditions that help to facilitate suicidality are differentially distributed among the population, and because these distributions can be tied—at least in part—to wider sociopolitical patterns and historical practices (like widening income inequality, structural racism, heteronormativity, disproportionate exposure to violence and traumatic stress, and the ongoing withdrawal of a social safety net), the formation of suicidal subjectivity also refers to the social–political conditions that generate these differential distributions. Some groups of people (like the long-term unemployed, the elderly, the members of some Native tribes, young sexual minorities, black children, and combat veterans) are more exposed to life-subverting and dignity-stripping conditions—as part of their everyday existence—than others. A suspicious mind might wonder whether this exposure to the known conditions of suicidality is itself a precondition of life for others who rank higher on a normative scheme of social value. ¹⁰ While no single human life is completely immune to conditions of social isolation and hopelessness, the enduring concentration of these conditions within certain segments of the population might suggest that individuals do not simply “fall into” certain risk categories for suicide; instead, the risk categories for suicide have been allowed—through malign neglect, willful blindness, and thoughtlessness—to constitute the conditions of subjectivity for some so that others might be (in relative terms) more free from this anguish. These distributions, while not always attributable to the actions of a specific liable agent, nonetheless point in the direction of persistent structural injustices that both mirror and further aggravate wider injustices in relation to socioeconomic class, race, ethnicity, age, sexuality, and disability. The main purpose behind addressing the formation and distribution of suicidal subjectivity is to insert political thinking into the question of suicide—not only in relation to the background conditions of possibility for patterns of suicide but also in relation to the formation of an integrated and politically responsible engagement with these patterns.

How might a social science research agenda form around suicide as a question of social justice? Some studies already point in this direction, albeit insufficiently. In one study of black male suicides in metropolitan areas, the authors found that rates of black male suicide are higher in areas where occupational and income inequalities between blacks and whites are greater. The authors reason that “blocked opportunities within a climate of higher expectations about increased opportunity lead to a greater probability of violence—including a higher risk of suicide” (Burr, Matteson, and Hartman 1999, 1054). Yet, like other studies that show statistical links between various dimensions of racial and ethnic inequality and suicide—from residential segregation and income inequalities to unequal opportunities and barriers to acculturation—this study does not interrogate the political–institutional conditions and policy choices that contribute to these differentiated exposures to the known conditions of suicidality. This is not to deny the causal complexity between social correlates (like race and class) and suicide rates but to insist on the need to connect the study of social correlates with the distributions of primary goods that are always the product of policy and budgetary decisions.

Despite the widespread absence of a political sensibility within the study and prevention of suicide today, the Institute of Medicine (2001) has repeatedly declared that almost all states of health and disease are the product of interactions between individual and environmental factors. “Suicide is a clear example of the interaction of multiple factors including individual biological and psychological factors, life-stressors, and cultural and social factors” (Institute of Medicine 2002, 26). Nonetheless, among the most frequently employed methods for studying suicide are “psychological autopsies” that strive to understand the mind and feelings of those who have committed suicide (see Shneidman 2004). This procedure (carried out by psychiatrists, psychologists, and social workers) entails interviewing anyone who might possess information about the mind and intentions of someone who has completed suicide: spouse, relatives, friends, employers, doctors, and others. This technique is widely regarded as valid for providing an accurate diagnosis of suicide (see Kelly and Mann 1996), and psychological autopsies over the last thirty years have been fundamental in forming the now dominant “common sense” that suicide is the product of various mental disorders (see Cavanagh et al. 2003).

What would it look like if these researchers also brought a political–institutional eye to the writing of these reports (call it a psychopolitical autopsy)? What might we learn about the formation and distribution of suicidal subjectivities by combining the evaluation of individual suicides with a wider, macroscopic analysis of sociopolitical conditions? How might suicide prevention programs look differently as a result of a more explicit engagement with the reciprocal constitution of psyche and polis? For one thing, the list of “symptoms” and risk factors for suicide would need to be expanded to incorporate things like social fragmentation (Trovato and Jarvis 1986) and social isolation; community depopulation, blight, and crime; unemployment (Platt and Hawton 2000), measures of union concentration, and real median incomes for working-class citizens; degree of community investment and community programming, especially for youth and LGBTQ and Native American youth in particular; access to mental health services, especially in rural areas (where suicide rates are higher); and regulations governing the possession and safe storage of firearms (Brent and Bridge 2003). The point here is not to challenge the finding that mental illness is a central factor in aggregate rates of suicide but to advance the idea—based on what we know about the differential rates of suicide among certain populations—that the formation of suicidal subjectivities (inclusive of mental disorders) is also the complex product of institutional patterns like racial disparities and ethnic segregation, and political actions (or the absence of political actions) in areas like economic inequality, unemployment, firearms regulation, and access to mental health care that deserve to be scrutinized and challenged as matters of social justice. Each one of these policy domains influences the conditions of possibility for a life of moral equality and human dignity, and thus belongs within a properly political approach to the study and prevention of suicide. This does not mean that every case of suicide should be explained with reference to political phenomena (an ecological fallacy), but rather that a more explicit and sustained turn to the political in the study and prevention of suicide will help advance both social science and social justice.

What can we legitimately expect from this kind of research program? There is no way to know for sure, of course, but psychopolitical autopsies might reveal a mutually constitutive relationship between individual psychopathology and the wider, recurrent pathologies of sociopolitical existence for some citizens. Given widespread commitments to moral equality, human diversity, and personal dignity, this improved understanding of social life and its inequitable distortions might spur advocacy for more thoroughgoing political changes—in both public policy and public morality—as the necessary structural means for preventing suicide. I pursue this last line of thought further in the following section.

“To Take Arms against a Sea of Troubles”: A Social Justice Response to Suicide

I have argued that suicide (outside of the context of physician-assisted suicide) properly belongs among the ills that a socially responsive political theory should confront as a matter of social justice. ¹¹ Even if we cannot expect widespread agreement about the ontological and moral status of suicide as such, it seems more reasonable to expect agreement about the acceptance of a collective political responsibility, rooted in the moral equality and dignity of all persons, to ameliorate those social and material conditions that can strip individuals of the will to sustain their connections with the living. This point is all the more urgent given the unequal exposure to the known conditions of suicidality among certain populations.

But what can political theory really hope to contribute in this area? If the history of political thought offers any guidance, the answer is, more than we might suppose. As was true of many other domains of human life—from the structure of family life and child care, reproduction and human sexuality, to poverty, workplace organization, and consumer practices—what initially struck social observers as “private” and nonpolitical can, and frequently does, become the site of self-conscious political reflection and mobilization through the efforts of agitating nonconformists: preachers, journalists, teachers, artists, writers, and others. In the long process of this “politicization”—where new questions and agents are brought into the contested domain of public morality—the members of society are prompted, however gradually and incompletely, to think, feel, and judge differently about a set of human practices that were “naturalized” by the flow of accumulated experience; covered by layers of religious, philosophical, and ideological sedimentation; or willfully ignored altogether. Despite, or rather owing to, persistent and powerful forms of organized counter-resistance to these tremors within the fibers of public morality, political theory—along with other associated intellectual disciplines and cultural institutions—can play a socially and politically relevant role by offering new conceptual formations and discursive frames through which to challenge and help reorganize long-accepted practices, norms, and collective identities.

The dominant approach to suicide prevention in the United States and other countries is focused on understanding how to accurately identify and productively intervene with individuals in crisis. This approach is fully consistent with the overwhelming medical consensus about the psychopathological sources of suicidality. Together both of these orientations to the identification and treatment of suicidal behavior largely assume that the social–political world in relation to which a suicidal person is constituted is already normative. Perhaps this is an understandable assumption for psychologists and psychiatrists to make since they are serving on the front lines of self-destruction. Perhaps to help illuminate the specific symptoms of individual suicidality, the background conditions of life have to be held as the norm against which to judge the severity and degrees of risk for suicide. Yet, a political approach to suicide will require that we open this assumption to critical questioning. For example, what contribution do social pathologies like systemic-institutional racism and social marginalization make to suicidality? To what extent is hopelessness about a sense of social belongingness and personal effectiveness the product of political decisions like repeated deployments to combat zones, community disinvestment, and/or the failure of public policy responses in areas like income inequality, collective bargaining, and access to mental health services? Instead of isolating psychopathology as biologic and genetic challenges within a condition of societal normalcy, a political approach to suicide prevention will look at rates and distributions of completed suicides as a form of sociopolitical critique for the living, one that challenges the acceptance of what counts as normal. At the same time, a political approach to suicide will invert all forms of moralism (religious and secular) about suicide today: suicide is debasing of humanity, but the debasement is not generated by individual annihilation but by prior distributions in the unequal opportunities afforded to a life of dignity. ¹² The harm of suicide therefore includes the social and material disparities that are part of the condition of suicidality as well as the deeper harm of persistently ignoring these unequal conditions. The purpose of a political approach to suicide is to challenge and bring to an end both sets of conditions.

At this point, a likely response from researchers in psychology will be to point out that even a more politically oriented approach to the structural conditions of suicide will still come down to a personal, psychological question: why, within certain specific sociopolitical conditions, do certain individuals die by their own hands while others (the majority) do not? To this we might respond that while each and every suicide will entail a unique psychological profile, the specific distributions of suicidal subjectivities within a population also signify patterns of policy choice and policy neglect that warrant political scrutiny and organized political resistance. Hence, while psychotherapeutic and pharmacological treatments for individuals will remain a significant line of defense against self-destruction, a political approach to suicide calls for a more active public engagement with the material and institutional conditions that breed suicidal subjectivities in the first place. If this account is persuasive, the claim that nothing politically can be done about a malady of a distressed psyche will begin to look like so much collective bad faith; that is, of denying collective agency in a realm of social life where there might indeed be plenty of room for purposeful and caring action. In this way, suicide might become an issue of social justice as much as it is a question of clinical and pharmacological treatment.

Conclusion

Outside of the context of end-of-life decisions and related cases where individuals seek an end to terminal illness and/or irremediable physical pain, suicide, and more specifically, the distribution of suicidal subjectivities, is a proper site of political reflection and mobilization because the despair and hopelessness of the suicidal, and the loss and suffering of their friends and family, should be the kind of things that a decent political society ought to try to prevent. To make suicide a subject of collective responsibility about which the members of a political society can and should be responsive, we should acknowledge that suicide is not simply a “naturally” occurring social bad that is randomly distributed within a population but is something for which human agency (or the lack of human agency) plays a causal role. That has been one of the argumentative burdens of this article. However, even if we should fail to make a fully convincing case that the distribution of suicidal subjectivities is something for which the members of a political society bear some responsibility—because the chains of causality are indeed quite complex—the case for a politically minded response to suicide does not hinge on that question alone. For if the despair, hopelessness, loss, and suffering occasioned by suicide are great social ills—as I take them to be—then even in the absence of a clear chain of culpable human agency, a decent political society should do all that it reasonably can to prevent and mitigate these traumas. Most political societies take numerous precautions against all manner of human misfortune and significant loss of life without necessarily troubling themselves over the specific and culpable role that human agency may have played therein, and a political response to suicide ought to do the same; providing the initial outlines of what a collective political approach to suicide might look like has been one of the other tasks of this article.

A political approach to suicide is concerned with what a collective political response to the formation of suicidal subjectivities might look like. As I have argued, this response will entail a change in both public policy and in political ethics. If this approach were to catch on, it might be the beginning of a newly constituted pro-life coalition for the already born that understood that its members have agency over the conditions that make life bearable or unbearable for their fellow citizens.