From Risk to Harm and from Harm to Suicide

by Guest Contributor Louise Tam, originally published at Hyphen Magazine

In September, I wrote a piece describing my perspective as a disabled woman of color and psychiatric survivor. I explored how race-specific self-killings are differentially represented by the media to demonstrate how public perceptions of suicide depend on social and political contexts. My intention was to de-sensationalize model minority suicide in order to draw attention to how particular non-white bodies are often presumed to be volatile and violent.

This month, I look more closely at clinical explanations of ethnic minority suicide and respond by citing current non-clinical and community-based anti-racist reflections on the significance of emotional pain and anger.

Before I proceed, I would like to draw attention to how the term suicide is invoked by the viewer rather than the subject of suicide: the neighbor who calls 911 rather than the person exhibiting suspicious behavior. This can have negative repercussions on the “allegedly suicidal” that we don’t often think about. In fact, daily we are surrounded by public campaigns that encourage us to report at-risk behavior with the intention of saving lives: we believe it is our civic duty to do so. This is especially true in communal living environments such as campus residences.

The “peril of help” arises in (1) how we, as the public, determine what is suspicious or at-risk behavior and (2) how our social infrastructure then deals with the people we “call out.” Behavior can be “cut out” of context, of an individual’s life history, when it does not make sense to onlookers, including family, friends, and employers. Behavior might not make sense and alarm us because an individual’s actions are inconsistent with social rules and, furthermore, associated with narratives of harm we are taught to recognize daily by institutions around us. For example cutting is strongly associated with suicide. Seen in the absence of context, most of us would be compelled to stop this action and probably call on professional expertise to intervene and solve what we identify as a threat.

However, a growing number of self-advocacy groups and allies assert that attention-seeking and attempted suicide are professional myths about self-harm. According to Mark Cresswell, these groups critique the underlying pathology and disease assumed with self-harm, despite there being socially acceptable forms of self-harm such as smoking, body modification, and waxing. More importantly, he notes that people with experiences with self-harm identify strongly with the concept of survival. Activists such as Louise Pembroke have spoken about needing to self-injure to stay alive and survive the pain of sexual violence and institutionalization.

Thus, when a mobile crisis intervention team is called because someone appears to be a danger to himself, it is important to reflect on the potentially negative effects this can have on self-harm survivors because of existing mental health laws.

When mobile crisis teams work jointly with the police, the police — regardless of the outcome of an intervention — may keep a record, which can affect civil liberties. According to Ryan Fritsch, legal counsel for the Psychiatric Patient Advocate Office in Ontario, there have been eight recorded cases of non-criminal contact between police and Ontarians with various psychiatric histories appearing in the Department of Homeland Security in 2010. None of this actually benefits the well-being of persons in distress and can create numerous lifelong barriers, all thanks to one phone call. By equating mental health records with violence and criminality, border control has prevented people from traveling and immigrating.

Combined with the criminal justice system’s unsavory history of racial profiling, this link has at times produced deadly results. For instance, in 1997 police shot and killed Edmund Yu after he raised a small (toy?) hammer over his head on a bus in Toronto. Psychiatric survivors in Toronto have remembered Edmund Yu through memorials such as Edmund Place, which provides supportive non-medicalized housing to ex-users of psychiatry, who are typically discriminated against in other forms of housing.

As someone who has a psychiatric history and who identifies as “mad,” my survival hinges upon having a network of loved ones who can approach the subject of distress with an open-mind and willingness to learn about other “rhythms” to our existence — on knowing people who will not assume that X or Y thought or behavior will equate with danger to myself or others. Besides the everyday violence of medical records and police reports, increased suicidality has been associated with the use of various anti-depressant medications, such as the selective serotonin reuptake inhibitor fluoxetine.

This kind of evidence complicates the professional consensus that ethnic minorities are at higher risk of suicide in North America and in need of specialized services. McKenzie and Crawford argue that rates of ethnic minority suicide have been consistently higher than those of the majority group in the USA and Australia, especially in areas where there is a lower concentration of ethnic minorities. They suggest this is because of “a relative lack of support by people with similar social situations or the perception of a more hostile social environment,” and that on an individual level “socio-economic stress, thwarted aspirations, racism, acculturation, culture clash with parents, loss of religious affiliation, difficulty with identity formation, and loss of family and community support may have effects on suicide risk.” While I would like to examine these claims carefully in separate post, what concerns me are the solutions that McKenzie and Crawford propose.

They suggest that untreated mental health problems in ethnic minorities (due to factors such as a reluctance to seek services, conflict with services, and poor compliance) exacerbate rates of ethnic minority suicide. They combine the above with “skewed age distribution” towards “younger age groups,” and recommend further investigation of risk factors to develop youth-focused prevention strategies.

The ever-expanding circle of “risk” factors turns an increasing number of people and whole communities into disabled targets of mental health services, and helps to justify psychiatry’s expertise and expansion at the exclusion of suggesting or fostering other kinds of explanations for distress or other types of support for racialized communities. McKenzie and Crawford assume that the community is incapable of developing its own strategies to prevent death and that they have already failed due to second-generation suicides. What if we reconsider rates of “death” beyond sensationalized self-killing and reflect on how we get to live day to day — what Jasbir Puar refers to as the unevenness of our rights to a certain lifespan? For example, poor housing infrastructure changes the everyday bodily comportment of marginalized communities, displacing long-term goals such as education with the immediate need for shelter.

In the context of the myriad ways in which racialized people slowly die, educating “at-risk” individuals redirects us to be happy in conditions that are reasonably unhappy. What possibilities exist for us to grieve this everyday struggle without the imposition of becoming normal — indeed, “civilized” — and okay with our conditions? I don’t have any fast answers. However, I can say that non-clinical modalities such as community acupuncture can illustrate some of the possibilities growing across North America. In an account I shared with Six Degrees Community Acupuncture, I described how community healers who work in solidarity with queer, Indigenous, and people of color political organizing are sensitive toward the bodily labor of resistance and anger, accepting rather than rejecting the need to put our bodies in potentially compromising situations for social change. Here acupuncture has served as a tool to mediate how strong, yet informative emotions register on the body. I am amazed by how acupuncture can be a thread of connectivity between different communities of color who all want alternatives to Western medicine — a source of dialogue.

There have also been non-pathological ways developed by artists and activists to talk about and speak out about our distress, such as Yolo Akili’s perspective on emotional justice. Rather than drawing conclusions about how oppression leads definitively to illness or suicide, Akili encourages people to explore the emotional texture of social inequity by transforming the way that activist work typically occurs. In activist spaces, Akili suggests we challenge misogyny by revealing our feelings and intuition, as a way to begin our intellectual work while at the same time mediating that expression by avoiding hurtful tactics such as interrupting, yelling, and belittling. His objective is to address, but not remove, pain by thoughtfully expressing it within our support networks, which include activist networks.

On the West Coast, there is also Creative Collective Access (CCA serving the Bay Area), a group of disabled queer and trans people of color working to create interdependent care networks. One of their goals is to resist the culture of individualism through resource sharing. Their most recent project is The Living Room Project, a multi-disciplinary space for healing, wellness, art, and youth events — founded by Micah Hobbes, a somatic doula and healer.

Anthropologists such as Miriam Ticktin have begun to trouble how “biology plays in the politics of immigration,” determining who is worthy of citizenship and asylum. Scholars should likewise trouble “psy” technologies (such as the criteria for “competency”), as they are deployed by institutions like mental health and law to determine who has freedom of movement — to determine who is fully human. This relationship between psychiatry and detention, from forced institutionalization to border control, particularly affects the lives of people of color.

Ironically, as social workers and psychologists (many of whom are African American and Asian American themselves) seek to use mental health as a tool to fund anti-racist community services, their research fortifies an ever-growing body of knowledge about race-specific mental illness, knowledge that can be appropriated by other institutions to increase the surveillance of ethnic minorities. We are left with the question of how service providers who are critical of the power relations between helper and user can be better allies to (take greater ‘risks’ with?) patients who are looking for support, and not be another source of barriers. Though the alternatives I have described are largely grounded in social justice movements (which may or may not appeal to your needs), they demonstrate just some of the possibilities that exist for living.

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Louise Tam is a graduate student in Sociology and Equity Studies in Education at the University of Toronto.

(Image Credit: “Image of a Lonely Lady,” Low Chin Han, via Shutterstock)

  • Anonymous

    This is really interesting. I’m kind of struggling with this issue myself because I would like to feel better, I’m not particularly trusting of The System and have seen plenty of evidence I should be a bit unsure of it. Right now legitimately I have things going on in my life and around me that are bad; my problem isn’t that I’m upset for no reason, so I don’t see how drugging myself into feeling “better” would improve anything. The increased risk of suicide with antidepressants bothers me, and I just can’t shake the feeling that it’s a counterproductive and rather risky undertaking to try to solve a problem in that way. Being depressed is quite hellish, but it isn’t literally being dead, so a choice between the two isn’t tough, especially since I don’t like the way I feel on antidepressants. I don’t feel the way I feel when I’m depressed, I just feel vaguely high. I don’t want to be fuzzy around the edges, and the whole endeavor reminds me too much of the old practice of giving women tranquilizers and lobotomies in order to make them more biddable. It just doesn’t sit right.

    What would make me feel better is if I didn’t have to be stuck in the house taking turns with my grandmother caring for my grandfather because even with insurance we can’t seem to get him a qualified caregiver, not even during the day. We keep being given women that have obviously been drinking, come her and just fall asleep, verbally abuse Papa thinking he’s too senile to tell us or that we won’t believe him, or are flat out negligent to the point that we can’t leave him alone with them. I’d feel less depressed if I didn’t have to deal with that. I’d also feel less depressed if the medical bills weren’t constantly piling up and the bill collectors weren’t calling nonstop, even though we HAVE insurance; Papa has Medicare and Medicaid, Grandma has Blue Cross and Blue Shield. We shouldn’t be buried in medical debt like we are, but we are anyway (copay my ass, those things are definitely bill-sized.)

    I would be less depressed if I hadn’t had to drop out of college when I got pneumonia because I didn’t have health insurance, so wasn’t willing to go to the hospital and had to spend two months mostly just being waterboarded by my stupid lungs, and then having to pay back $4000 worth of tuition because I failed to get tuition insurance and apparently deathly illness isn’t sufficient cause to fully refund my tuition by three months into the semester. I’d be less depressed if I didn’t have my own bill collectors up my hind parts for that reason. I hardly need happy pills, I need some damn help and it’s hard not to wonder if someone is missing the point if they look at real world problems, like many people of color face and thing “maybe they need more drugs.”