From Risk to Harm and from Harm to Suicide

December 8, 2011


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
, 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
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
, 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
, 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
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

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.

* * *

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




Hi Louise, how refreshing to get a fantastic article that says it as it is! there is so much marginalisation and stigma in society that is there essentially to justify someone else's existence! , but at other members of society's detriment! re self harm, we work particularly with the Education sector/teachers and educators to raise their awareness about self harm and to eradicate the myth that self harm is attention seeking. we assist them in looking at the underlying issues that are causing young people to self harm and that self harm is a strategy to manage emotional distress.