It's one of the two things every therapist will tell you that can force them to break the confidentiality. That it can take away your freedom, get you institutionalized, remove your ability to make your own medical decisions.

It's important to take ideations seriously but as someone who struggled with that at points in my life I never felt completely safe about discuss it.

It makes sense when you consider that the therapist is there to help you but only in a way that does not challenge society. You are right to not feel completely safe to discuss it, unfortunately. I'm not sure why this taboo has evolved to be so strong, though I would guess it runs very deep psychologically in peoples' fear of death and also has something to do with the potential societal implications to any culture which does not treat it as something to be dealt with with extreme prejudice.

>societal implications

I'd expect the quality of a party you're allowed to leave to be higher than one you're not.

I would agree, hence the offensiveness of suicide to society in the large.

american society.

It's not much better in Europe.

Are you American?

The majority of people who attempt suicide do not then go on to commit suicide. Though ironically it does mean that a suicide attempt is the strongest predictor for death by suicide - but the rate is still 1% over the successive 12 month interval.[1]

There is no strong evidence that suicidal people have a genuinely held belief that they wish to stop living, as opposed to a psychiatric episode that once passed does not reflect their actual world view. This, in part reflected in the fact that one of the riskiest periods for clinically treated depression is shortly after anti-depressive medication is started, since depression manifests in large part as a lack of motivation, and the first effect of treatment tends to be to allow people enough action to actually attempt suicide. But again: this is episodic.

Note that this is entirely different to terminally ill people seeking euthansia, who amongst other things will pursue the goal for years if necessary i.e. it is a strongly held belief of a rational mind.

Though finally I'd note I don't know what you propose "challenging" society is meant to mean here. A therapist isn't there to sign off on you killing yourself, nor is that ever required. That option, especially in the US with the absolutely minimal checks on firearms ownership, is constantly available and has exactly one outcome. Dead people don't feel, or have to justify, anything to anyone.

[1] https://en.wikipedia.org/wiki/Suicide_attempt

I wonder, though, if people who attempt and fail suicide are more likely to be the ones doing it impulsively after a psychiatric episode or other major emotional setback. If someone has thought it through and genuinely wants to die I suspect they would have a better chance of succeeding.

It means anything which violates the social norms and laws that undergird a society, one of which is suicide. Another might be illicit drug use, including psychedelics. Any solution or help a state-linked therapist provides must necessarily steer away, if necessary by force, from anything that involves these. This even may be if something like psychedelics could help the individual, although psychedelics are likely to become legal in the future for this purpose. Suicide in most jurisdictions is entirely illegal not excepting euthanasia and in such jurisdictions, a therapist engaging with a rational terminally ill person as you describe would not be allowed in an official capacity to have an honest discussion about euthanasia as an option for their situation.

> There is no strong evidence that suicidal people have a genuinely held belief that they wish to stop living, as opposed to a psychiatric episode that once passed does not reflect their actual world view.

I would argue that there is an overwhelming amount of evidence that suicidal people have a genuine held belief that they wish to stop living, in the form of genuine and sometimes successful suicide attempts. To redescribe it as a "psychiatric episode that once passed does not reflect their actual world view" is to simply negate the validity of the belief by viewing it through a medical rubric which affirms suicidality as something pathological. This is a value judgement. Compound with the complication that, as described through the comments on this post, any discussion of intent towards suicide can have severe consequences and therefore suicidal people will necessarily be coerced into denying their true beliefs of things, and must acknowledge the consensus view that their desire to kill themselves was in fact not "a genuine beliefe". That they may come at some point (possibly much later on) to have genuinely changed their mind not to kill themselves or to have kill themselves may be great but does not invalidate their previous belief at the time they were suicidal.

For comparison, imagine a society in which intent towards abortion was viewed as a pathological state of mind, and any talk towards such was met by extreme force from the state similar to that which it is for suicide, to wit: forced imprisonment, pharmaceutical intervention and koshing of a person until they no longer expressed (openly) a desire to have an abortion. A statement like "There is no strong evidence that these women have a genuinely held belief that they wish to not have their baby, as opposed to a psychiatric episode that once passed does not reflect their actual world view." may sound valid to people living under such a value system but we might recognise something more going on here.

100 percent of those who succeed on their first attempt do not go on to try suicide again.

What's the other thing besides mentioning suicide?

A serious intent to harm/kill others.

Step 1) fabricate an SMS

Step 2) call police

Step 3) enjoy

Wow so easy to take down your political enemies huh

This happened to a friend of mine. "Friend" of theirs who was angry they didn't have a romantic interest in him called the police claiming they were suicidal. Police came, handcuffed them, verbally abused them, and dragged them to a hospital against their will even though they were clearly fine. They were forced to stay there for ~a day and then had no means to get home, thankfully a friend was able to pick them up and drive them home from the hospital.

No consequences for the guy, of course.

Something similar happened to a friend of mine and you can find plenty of stories on the internet - the way suicidal people are treated by the police is actually cruel and I can't imagine it helps anyone who is really feeling suicidal.

My buddy got arrested, restrained to a hospital bed against his will, was given a cocktail of drugs, and had to stay there multiple days while getting a 'wellness check' every fifteen minutes where a nurse shakes you awake.

To top it all off they sent him home with a $60,000 medical bill.

Not a great way to treat someone who's going through a hard time. I definitely learned never to call the police unless someone is literally getting ready to jump off a building.

> I definitely learned never to call the police unless someone is literally getting ready to jump off a building.

This is an important lesson. Do not call the police unless you literally just want them to remove a nuisance and you don't care what happens to the person or how they are dealt with. Even then, police are just a wild card with the potential for life altering outcomes.

My brother called the police once because his then girlfriend was acting really crazy/violent after a night out drinking (not the first time) and they almost arrested HIM.

Calling police is rolling the dice on a range of possible outcomes often times putting you in the crosshairs and rarely resulting in what you would expect.

Wow, that sounds like a good way to make someone suicidal even if they weren't to begin with.

>the way suicidal people are treated by the police is actually cruel

The way people are treated by the police is actually cruel. If you dug into it you would be ill.

> while getting a 'wellness check' every fifteen minutes where a nurse shakes you awake.

Actually, speaking of practices that are implemented for the convenience of administrators rather than the benefit of the patient...

There is a popular belief that, if you have a head injury, you must stay awake because losing consciousness is dangerous. This is completely false. Your urge to sleep reflects the fact that that is what's healthiest for you. If (1) you are caring for someone with a head injury, (2) they want to sleep, and (3) you have no means of addressing a very serious problem such as massive internal bleeding, you should let them sleep, because that is their best chance to recover.

It is, however, absolutely true that, if you have a head injury, 911 will tell whoever is caring for you to make sure that you remain conscious, and if you're already in a hospital, the staff will do their best to ensure you remain conscious. This is not because staying conscious is good for you. It is because they are relying on an index of how severe your injury is ("is he behaving oddly?") which only applies if you're conscious. Everyone who's unconscious is behaving normally.

If the patient is conscious and starts exhibiting symptoms indicative of a medical emergency then there's the possibility of treating it. If they're unconscious you might not know about it until you start seeing cardiac or respiratory symptoms, at which point you've already waited too late and they could die, be left in a comatose state, or suffer from brain damage. How is improving the odds of preventing that not "for the benefit of the patient"?

"convenience" is a hell of a word to use here when the alternative is that medical professionals would have no way to know if your condition is worsening. Which is to say, if you want to sleep you can basically just go home for all the good they'll be able to do.

If it's inconvenient to you then you always have the option of checking out of the hospital whenever you want: you are always (except in psychiatric hold cases) able to sign a form saying you understand it may be Against Medical Advice and want to leave.

> the alternative is that medical professionals would have no way to know if your condition is worsening.

There are other ways; they are more expensive, less accurate, and possibly more dangerous to the patient, but they exist.

But if you go back and read my comment again, you'll see that I'm talking about the popular belief that losing consciousness is detrimental to the patient. It isn't; it is beneficial. The doctor may have good reason to keep the patient awake anyway, because, if the patient suddenly starts to die, he might be able to do something about it.

But if you are not in that situation -- if there's nothing you can do if your injured friend suddenly starts to die -- then you should not be trying to keep your friend awake.

Why on Earth would the police be considered the appropriate service to deal with this situation? There is no overlap between paramilitary law enforcement and social services.

This is where calls for defunding the police come in. Take some of the money spent on using physical force on those whose thoughts do not conform to social norms and use it on a more appropriate agency. We no longer regularly physically restrain and torture the mentally ill in treatment settings. Why do we insist on funding other institutions to do so?

In Soviet Russia, government officials would remove someone, and then claim suicide. In America, they first claim suicide (risk), then remove them.

Soviet Russia also did use phony psychiatry to get rid of opponents.

Political abuse of psychiatry in Soviet Union has its own Wikipedia page.

There is a big difference between murdering someone and detaining someone for a day if a trained professional believes there is a high risk of suicide.

Believing unaccountable decisions placed in the hands of powerful doctors without recourse results in a professional suicide assessment is not what actually happens. You may be detained for no reason and have no recourse. They may pump drugs into you.

Not only that, you may permanently lose some civil rights and privileges, such as the right to own a firearm or pilot a commercial flight.

Scary.

Any ideas of how to fix it?

Come up with a reasonable objective bar to pass before subjecting someone to confinement and medical treatment against their will. Right now police are all too willing to basically arrest someone off of some nebulous accusation. It should be treated no different than the standard of proof for an arrest and should face the same repercussions if done wrongly, both for police and an accuser.

Make it contingent on prompt medical evaluation. The current timeframes for involuntary commitment in certain states can leave people confined on a Friday afternoon and waiting to be evaluated until Monday morning. If it's urgent enough for involuntary confinement it's urgent enough to have a medical professional oncall for prompt evaluation.

The medical necessity of all involuntary medical treatment should have to be substantiated in front of a judge, even if the patient is released before statutory deadlines would have required a judge to approve continued involuntary commitment. The medical facility should have to explain their actions e.g. "On Feb 12th at 5:12AM patient started scratching the skin off of their left arm (Exhibit A) which necessitated the administration of 10 mg of Midazolam intramuscularly". Any medication should also be limited to the shortest duration feasible until a court order is issued, no depot injections of Haldol that will last a month.

No financial liability for the patient. The state doesn't have to foot the bill for all of it, you could mandate that insurance picks up the tab and leave the state to pay for only the uninsured. It's profoundly unjust to not only deprive someone their bodily autonomy but also saddle them with a mountain of debt with no recourse even if the involuntary commitment turned out to be unjustified. If it came out of municipal budgets maybe police departments would be more diligent about making sure that involuntary commitment was necessary instead of using it like a blunt tool to pawn off a tiresome person onto someone else.

trained professional my ass. I have a disability, and I tell you what: Even the people "specialized" in certain disabilities usually have no idea what the fuck they are talking about. But they get good pay and are being treated like specialists by those which have even less of an idea... Outsiders usually have absolutely no idea whats going on.

Swatting only has steps 2 and 3 to worry about.

Step 1) plant evidence of crime

Step 2) call police

Step 3) enjoy

Do you propose that we do away with police, telephones, or crime, to solve this problem?

I think you're joking, but this is actually so true that you might be committing a crime by suggesting it.

> this is actually so true that you might be committing a crime by suggesting it

Perhaps where you live. The legal system I live under has strong protections for freedom of speech that ensure that such a statement cannot be criminalized.

This statement is legal in the USA.