Since 2007 there is a vision zero regarding suicide in Sweden, but the suicide numbers do not decrease. Doctors are increasingly imposed to ask questions about suicide, even though the evidence that suicide risk assessment predicts suicide in a clinically meaningful way is weak. Patients often lie to doctors, which is rarely theoretically analyzed within the profession.

This examination of practical knowledge, called The Language Game of Cunning - ascientific essay about lies and gut feeling in suicide risk assessment, starts with a description of a clinical situation in which a patient who is not in need of inpatient care presumably lies to a doctor about having suicide plans, with an assumed intention to remain in the hospital.

The purpose of the essay is, firstly, to make lying visible and to examine the use of language around suicide risk assessments - both from the patient's and the healthcare provider's side. I use texts by Nietzsche and Wittgenstein, and find the concepts of concept and language games particularly useful. I argue that it is a naive and professionally incorrect approach to assume that patients are telling the truth, or that linguistic statements can be equated with objective data. Also, I advise you as a reader not to assume that the words in this language game of an essay is necessarily true. Secondly, the emergency psychiatrist's professional skills are examined using Aristotle's schematic division of knowledge types. Relying too much on scientific knowledge can obviously be problematic when there is a lack of evidence for both assessment and treatment. Suicidal risk assessment requires clinical judgment: It is important to be sensitive to the unique and complex nature of the patient's context and way of understanding the world. Detailed manuals may risk defeating their purpose by making the contact between doctor and patient more mechanical, so refraining from following them often is acceptable. The emotional contact and the role of gut feeling seem to be important in determining the truth fulness of patients' statements, as well as in making a meaningful suicide risk assessment in practice. The concept of cunning is used to highlight the manipulative nature of the patient's actions and to describe how doctors secretly defy routines - and themselves write lies and irrelevant bureaucratic data in the patient record. The complexity and unpredictability of suicide should be recognized more clearly and the vision zero should be rephrased based on the state of knowledge.