Kayla Williams has never said the word “suicide” on TikTok, even though she uses the platform to discuss mental health issues with her 80,000 followers. Since the beginning of the pandemic, the 26-year-old student from Berkshire, England, has posted multiple videos about suicidal ideation and her stay in a psychiatric ward. Some of these clips are lighthearted, others far more serious. Yet Williams does not utter the word “suicide” to her front-facing camera, or type it in her captions, for fear the TikTok algorithm will censor or remove her content. Instead, she uses the word “unalive.”

The hashtag #unalivemeplease has 9.2 million views on TikTok; #unaliving has 6.6 million; #unaliveawareness has an additional 2.2 million. Though #suicideprevention is a frequently used tag on the app, the hashtags #suicide and #suicideawareness do not exist—if you search for them, TikTok pulls up the number for a local crisis helpline. It’s a well-intentioned policy, initiated in September 2021, a year after a graphic video of a suicide spread across the app. But users have also come to fear elusive content moderation filters that seemingly suppress or remove videos discussing death, suicide, or self-harm.

While the word “unalive” first became popular in 2013 (when it was used in an episode of Ultimate Spider-Man), Google searches for the term have spiked dramatically in 2022. From TikTok, “unalive” has spread to Twitter and Reddit; YouTubers also use it so their content isn’t demonetized. Depending on the context, the word can refer to suicide, murder, or death. Though “unalive” is often used comedically on TikTok, people like Williams also use it to talk candidly, forge a community, and signpost resources on the app. The rapid rise of “unalive” therefore raises a worrying question: What happens when we don’t openly say “suicide”?

“I think it kind of makes a joke out of such a serious subject,” Williams says of the term. Though she likes saying “unalive” when she intentionally wants to make videos “less heavy,” she adds: “It doesn’t sit right with me because we should be able to talk about the heavy stuff without being censored.”

Williams worries that the word “unalive” could entrench stigma around suicide. “I think as great as the word is at avoiding TikTok taking videos down, it means the word “suicide” is still seen as taboo and a harsh subject to approach,” she says. She also swaps out other mental health terminology so her videos aren’t automatically flagged for review—“eating disorder” becomes “ED,” “self-harm” is “SH,” “depression” is “d3pression.” (Other users on the site use tags like #SewerSlidel and #selfh_rm).

Prianka Padmanathan is a clinical academic in psychiatry at the University of Bristol; in 2019, she conducted a study on language use and suicide, surveying slightly less than 3,000 people affected by suicide. Padmanathan asked the participants to rate the acceptability of descriptors on the topic and found that “attempted suicide,” “took their own life,” “died by suicide,” and “ended their life” were considered the most acceptable phrases to discuss nonfatal and fatal suicidal behavior.

A number of those surveyed raised concerns regarding the complete avoidance of the word “suicide.” One participant said it was “dangerous” and “isolating” to avoid the word, while another said, “My brother committed suicide and my sister attempted suicide. I don’t think we should be scared of using the word.”

“Overall, respondents indicated a preference for terms that were perceived to be factual, clear, descriptive, commonly used, non-emotive, non-stigmatizing, respectful, and validating,” Padmanathan says. Further research is needed to determine whether “unalive” could potentially be stigmatizing, but she notes that words can and do affect the way we think about suicide, citing a 2018 study.