Should we stop saying ‘commit’ suicide?

There is a movement in mental health to avoid the phrase ‘commit suicide’. It is claimed that the word ‘commit’ refers to a crime and this increases the stigma for what’s often an act of desperation that deserves compassion, rather than condemnation.

The Samaritans’ media guidelines discourage using the phrase, advising: “Avoid labelling a death as someone having ‘committed suicide’. The word ‘commit’ in the context of suicide is factually incorrect because it is no longer illegal”. An article in the Australian Psychological Society’s InPsych magazine recommended against it because the word ‘commit’ signifies not only a crime but a religious sin. There are many more such claims.

However, on the surface level, claims that the word ‘commit’ necessarily indicates a crime are clearly wrong. We can ‘commit money’ or ‘commit errors’, for instance, where no crime is implied. The dictionary entry for ‘commit’ (e.g. see the definition at the OED) has entries related to ‘committing a crime’ as only a few of its many meanings.

But we can probably do a little better when considering the potentially stigmatising effects of language than simply comparing examples.

One approach is to see how the word is actually used by examining a corpus of the English language – a database of written and transcribed spoken language – and using a technique called collocation analysis that looks at which words appear together.

I’ve used the Corpus of Contemporary American English collocation analysis for the results below and you can do the analysis yourself if you want to see what it looks like.

So here are the top 30 words that follow the word ‘commit’, in order of frequency in the corpus.

Some of the words are clearly parts of phrases (‘commit ourselves…’) rather than directly referring to actions but you can see that most common two word phrase is ‘commit suicide’ by a very large margin.

If we take this example, the argument for not using ‘commit suicide’ gets a bit circular but if we look at the other named actions as a whole, they’re all crimes or potential crimes. Essentially, they’re all fairly nasty.

If you do the analysis yourself (and you’ll have to go to the website and type in the details, you can’t link directly) you’ll see that non-criminal actions don’t appear until fairly low down the list, way past the 30 listed here.

So ‘commit’ typically refers to antisocial and criminal acts. Saying ‘commit suicide’ probably brings some of that baggage with it and we’re likely to be better off moving away from it.

It’s worth saying, I’m not a fan of prohibitions on words or phrases, as it tends to silence people who have only colloquial language at their disposal to advocate for themselves.

As this probably includes most people with mental health problems, only a minority of which will be plugged into debates around language, perhaps we are better off thinking about moving language forward rather than punishing the non-conforming.

Not the psychology of Joe average terrorist

News reports have been covering a fascinating study on the moral reasoning of ‘terrorists’ published in Nature Human Behaviour but it’s worth being aware of the wider context to understand what it means.

Firstly, it’s important to highlight how impressive this study is. The researchers, led by Sandra Baez, managed to complete the remarkably difficult task of getting access to, and recruiting, 66 jailed paramilitary fighters from the Colombian armed conflict to participate in the study.

They compared this group to 66 matched ‘civilians’ with no criminal background and 13 jailed murderers with no paramilitary connections, on a moral reasoning task.

The task involved 24 scenarios that varied in two important ways: harm and no harm, and intended and unintended actions. Meaning the researchers could compare across four situations – no harm, accidental harm, unsuccessfully attempted harm, and successfully attempted harm.

A consistent finding was that paramilitary participants consistently judged accidental harm as less acceptable than other groups, and intentional harm as more acceptable than others groups, indicating a distortion in moral reasoning.

They also measured cognitive function, emotion recognition and aggressive tendencies and found that when these measures were included in the analysis, they couldn’t account for the results.

One slightly curious thing in the paper though, and something the media has run with, is that the authors describe the background of the paramilitary participants and then discuss the implications for understanding ‘terrorists’ throughout.

But some context on the Colombian armed conflict is needed here.

The participants were right-wing paramilitaries who took part in the demobilisation agreement of 2003. This makes them members of the Autodefensas Unidas de Colombia or AUC – a now defunct organisation who were initially formed by drug traffickers and land owners to combat the extortion and kidnapping of the left-wing Marxist paramilitary organisations – mostly notably the FARC.

The organisation was paramilitary in the traditional sense – with uniforms, a command structure, local and regional divisions, national commanders, and written statutes. It involved itself in drug trafficking, extortion, torture, massacres, targeted killings, and ‘social cleansing’ of civilians assumed to be undesirable (homeless people, people with HIV, drug users etc) and killings of people thought to support left-wing causes. Fighters were paid and most signed up for economic reasons.

It was indeed designated a terrorist organisation by the US and EU, although within Colombia they enjoyed significant support from mainstream politicians (the reverberations of which are still being felt) and there is widespread evidence of collusion with the Colombian security forces of the time.

Also, considering that a great deal of military and paramilitary training is about re-aligning moral judgements, it’s not clear how well you can generalise these results to terrorists in general.

It is probably unlikely that the moral reasoning of people who participated in this study is akin to, for example, the jihadi terrorists who have mounted semi-regular attacks in Europe over the last few years. Or alternatively, it is not clear how ‘acceptable harm’ moral reasoning applies across different contexts in different groups.

Even within Colombia you can see how the terrorist label is not a reliable classification of a particular group’s actions and culture. Los Urabeños are the biggest drug trafficking organisation in Colombia at the moment. They are essentially the Centauros Bloc of the AUC, who didn’t demobilise and just changed their name. They are involved in very similar activities.

Importantly, they are not classified as a terrorist organisation, despite being virtually same organisation from which members were recruited into this study.

I would guess these results are probably more directly relevant in understanding paramilitary criminal organisations, like the Sinaloa Cartel in Mexico, than more ideologically-oriented groups that claim political or religious motivations, although it would be fascinating if they did generalise.

So what this study provides is a massively useful step forward in understanding moral reasoning in this particular paramilitary group, and the extent to which this applies to other terrorist, paramilitary or criminal groups is an open question.
 

Link to open access study in Nature Human Behaviour.

An alternative beauty in parenthood

Vela has an amazing essay by a mother of a child with a rare chromosomal deletion. Put aside all your expectations about what this article will be like: it is about the hopes and reality of having a child, but it’s also about so much more.

It’s an insightful commentary on the social expectations foisted upon pregnant women.

It’s about the clash of folk understanding of wellness and the reality of genetic disorders.

It’s about being with your child as they develop in ways that are surprising and sometimes troubling and finding an alternative beauty in parenthood.
 

Link to Vela article SuperBabies Don’t Cry.

A neuroscientist podcaster explains…

There’s a great ongoing podcast series called A Neuroscientist Explains that looks at some of the most important points of contact between neuroscience and the wider world.

It’s a project of The Guardian Science Weekly podcast and is hosted by brain scientist Daniel Glaser who has an interesting profile – having been a cognitive neuroscientist for many years before moving into the world of art and public engagement.

Glaser takes inspiration from culture and current affairs – which often throws up discussion about the mind or brain – and then looks at these ideas in depth, typically with one of the leading researchers in the field.

Recent episodes on empathy and music have been particularly good (although skip the first episode in the series – unusually, there’s a few clangers in it) and they manage to strike a great balance between outlining the fundamentals while debating the latest ideas and findings.

It seems you can’t link solely to the podcast but you can pick them on the page linked below.
 

Link to ‘A Neuroscientist Explains’

Annette Karmiloff-Smith has left the building

The brilliant developmental neuropsychologist Annette Karmiloff-Smith has passed away and one of the brightest lights into the psychology of children’s development has been dimmed.

She actually started her professional life as a simultaneous interpreter for the UN and then went on to study psychology and trained with Jean Piaget.

Karmiloff-Smith went into neuropsychology and starting rethinking some of the assumptions of how cognition was organised in the brain which, until then, had almost entirely been based on studies of adults with brain injury.

These studies showed that some mental abilities could be independently impaired after brain damage suggesting that there was a degree of ‘modularity’ in the organisation of cognitive functions.

But Karmiloff-Smith investigated children with developmental disorders, like autism or William’s syndrome, and showed that what seemed to be the ‘natural’ organisation of the brain in adults was actually a result of development itself – an approach she called neuroconstructivism.

In other words, developmental disorders were not ‘knocking out’ specific abilities but affecting the dynamics of neurodevelopment as the child interacted with the world.

If you want to hear more of Karmiloff-Smith’s life and work, her interview on BBC Radio 4’s The Life Scientific is well worth a listen.
 

Link to page of remembrance for Annette Karmiloff-Smith.

Is psychosis an ‘immune disorder’?

A fascinating new study has just been published which found evidence for the immune system attacking a neuroreceptor in the brain in a small proportion of people with psychosis. It’s an interesting study that probably reflects what’s going to be a cultural tipping point for the idea of ‘immune system mental health problems’ or ‘madness as inflammation disorder’ but it’s worth being a little wary of the coming hype.

This new study, published in The Lancet Psychiatry, did blood tests on people who presented with their first episode of psychosis and looked for antibodies that attack specific receptors in the brain. Receptors are what receive neurotransmitters – the brain’s chemical signals – and allow information to be transferred around the nervous system, so disruption to these can cause brain disturbances.

The most scientifically interesting finding is that the research team found a type of antibody that attacks NMDA receptors in 7 patients (3%) out of 228, but zero controls.

The study found markers for other neuroreceptors that the immune system was attacking, but the reason the NMDA finding is so crucial is because it shows evidence of a condition called anti-NMDA receptor encephalitis which is known to cause episodes of psychosis that can be indistinguishable from ‘regular’ psychosis but for which the best treatment is dealing with the autoimmune problem.

It was only discovered in 2007 but there has been a long-running suspicion that it may be the best explanation for a small minority of cases of psychosis which can be easily misdiagnosed as schizophrenia.

Importantly, the findings from this research have been supported by another independent study that has just been published online. The two studies used different ranges for the concentration of NMDA antibodies they measured, but they came up with roughly the same figures.

It also chimes with a growing debate about the role of the immune system in mental health. A lot of this evidence is circumstantial but suggestive. For example, many of the genes associated (albeit weakly) with the diagnosis of schizophrenia are involved in the immune system – particularly in coding proteins for the major histocompatibility complex.

However, it’s worth being a little circumspect about this new enthusiasm for thinking of psychosis as an ‘immune disorder’.

Importantly, these new studies did blood tests, rather than checking cerebrospinal fluid – the fluid that your brain floats around in which lies on the other side of the blood-brain barrier, so we can’t be sure that these antibodies were actually affecting the brain in everyone found to have them. It’s likely, but not certain.

Also, we’re not sure to what extent anti-NMDA antibodies contribute to the chance of developing psychosis in everyone. Certainly there are some cases where it seems to be the main cause, but we’re not sure how that holds for all.

It’s also worth bearing in mind that the science over the role of the genes associated with the schizophrenia diagnosis in the immune system is certainly not settled. A recent large study compared the role of these genes in schizophrenia to known autoimmune disorders and concluded that the genes just don’t look like they’re actually impacting on the immune system.

There’s also a constant background of cultural enthusiasm in psychiatry to identify ‘biomarkers’ and anything that looks like a clear common biological pathway even for a small number of cases of ‘psychiatric’ problem gets a lot of airtime.

Curiously, in this case, Hollywood may also play a part.

A film called Brain On Fire has just been shown to film festivals and is being tested for a possible big release. It’s based on the (excellent) book of the same name by journalist Susannah Cahalan and describes her experience of developing psychosis only for it later to be discovered that she had anti-NMDA receptor encephalitis.

Hollywood has historically had a big effect on discussions about mental health and you can be sure that if the movie becomes a hit, popular media will be alive with discussions on ‘whether your mental health problems are really an immune problem’.

But taking a less glitzy view, in terms of these new studies, they probably reflect that a small percentage of people with psychosis, maybe 1-2%, have NMDA receptor-related immune problems that play an important role in the generation of their mental health difficulties.

It’s important not to underestimate the importance of these findings. It could potentially translate into more effective treatment for millions of people a year globally.

But in terms of psychosis as a whole, for which we know social adversity in its many forms plays a massive role, it’s just a small piece of the puzzle.
 

Link to locked Lancet Psychiatry study.

The hidden history of war on terror torture

The Hidden Persuaders project has interviewed neuropsychologist Tim Shallice about his opposition to the British government’s use of ‘enhanced interrogation’ in the Northern Ireland conflict of the 1970s – a practice eventually abandoned as torture.

Shallice is little known to the wider public but is one of the most important and influential neuropsychologists of his generation, having pioneered the systematic study of neurological problems as a window on typical cognitive function.

One of his first papers was not on brain injury, however, it was an article titled ‘Ulster depth interrogation techniques and their relation to sensory deprivation research’ where he set out a cognitive basis for why the ‘five techniques’ – wall-standing, hooding, white noise, sleep deprivation, and deprivation of food and drink – amounted to torture.

Shallice traces a link between the use of these techniques and research on sensory deprivation – which was investigated both by regular scientists for reasons of scientific curiosity, and as we learned later, by intelligence services while trying to understand ‘brain washing’.

The use of these techniques in Northern Ireland was subject to an official investigation and Shallice and other researchers testified to the Parker Committee which led Prime Minister Edward Heath to ban the practice.

If those techniques sound eerily familiar, it is because they formed the basis of interrogation practices at Guantanamo Bay and other notorious sites in the ‘war on terror’.

The Hidden Persuaders is a research project at Birkbeck, University of London, which is investigating the history of ‘brainwashing’. It traces the practice to its use by the British during the colonisation of Yemen, who seemed to have borrowed it off the KGB.

And if you want to read about the modern day effects of the abusive techniques, The New York Times has just published a disturbing feature article about the long-term consequences of being tortured in Guantanamo and other ‘black sites’ by following up many of the people subject to the brutal techniques.
 

Link to Hidden Persuaders interview with Tim Shallice.
Link to NYT on long-term legacy of war on terror torture.