In Japan, suicide has long been depicted as an act of free will, even aestheticized in the cultural notion suicide of resolve. Amid the record-high Japanese suicide rates since the 1990s, however, Japanese psychiatrists have been working to medicalize suicide and, in the process, confronting this deeply ingrained cultural notion. Drawing on two years of fieldwork at psychiatric institutions around Tokyo, I examine how psychiatrists try to persuade patients of the pathological nature of their suicidal intentions and how patients respond to such medicalization. I also explore psychiatrists' ambivalent attitudes toward pathologizing suicide and how they limit their biomedical jurisdiction by treating only what they regard as biological anomaly, while carefully avoiding the psychological realm. One ironic consequence of this medicalization may be that psychiatrists are reinforcing the dichotomy between normal and pathological, “pure” and “trivial,” suicides, despite their clinical knowledge of the tenuousness of such distinctions and the ephemerality of human intentionality. Thus, while the medicalization of suicide is cultivating a conceptual space for Japanese to debate how to bring the suicidal back onto the side of life, it scarcely seems poised to supplant the cultural discourse on suicide that has elevated suicide to a moral act of self-determination.