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Instrumental rationality and suicide in schizophrenia: a case for rational suicide?
  1. Markella Grigoriou1,
  2. Rachel Upthegrove1,
  3. Lisa Bortolotti1,2
  1. 1 Psychiatry Department, Institute for Mental Health, University of Birmingham, Birmingham, UK
  2. 2 Philosophy Department, University of Birmingham, Birmingham, UK
  1. Correspondence to Markella Grigoriou, Psychiatry Department, Institute for Mental Health, University of Birmingham, Birmingham B15 2FG, UK; mxg424{at}


It is estimated that up to 7500 people develop schizophrenia each year in the UK. Schizophrenia has significant consequences, with 28% of the excess mortality in schizophrenia being attributed to suicide. Previous research suggests that suicide in schizophrenia may be more related to affective factors such as depression and hopelessness, rather than psychotic symptoms themselves. Considering suicide in schizophrenia within this framework enables us to develop a novel philosophical approach, in which suicide may not be related to loss of self-consciousness, thought processing dysfunctions or perception disturbances. The action of suicide may be due neither to persistent hallucinations nor other psychotic symptoms, such as delusional beliefs, but to other underexamined, perhaps rational reasons, such as extreme social isolation, severe depression or emotional withdrawal. This paper does not examine the moral character of suicide. Instead, it argues that we should conceive the action of suicide in schizophrenia as an act that is not necessarily irrational. People with schizophrenia might end their life based on reasons if suicide is the best means to achieve their ends. However, the paper does not support assisted suicide. It aims to provide a better understanding of the reasons why people take their own lives and suggests that understanding can inform effective interventions to reduce high rates of suicide.

  • psychiatry

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  • Contributors MG wrote the manuscript with support from RU and LB. RU contributed to the clinical data and literature evidence reported in the paper. LB contributed to the interpretation of the ideas and arguments formation.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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