Suicide and Psychache

I distinctly remember attending a memorial service for the brother of a close friend when I was in college.  My friend's brother hung himself from a tree in his front yard; his stepdaughter discovered him when she went out to catch the school bus the next morning.  Funerals are never happy occasions, but this one struck me as particularly heartwrenching.  It seemed like the deceased's parents felt they needed to defend his character.  "He really was a good boy," I recall his father saying.  I was present on several occasions when members of the decedant's family recalled his last days.  They analyzed every conversation and every interaction, wondering if there'd been some sign of their loved one's intentions.  They second guessed everything they'd said and done in the days leading up to the suicide.  "If only I'd done this instead of that," some lamented.  Others blamed themselves.  "I should've known.  I should've stopped him."

Suicide is a tragedy in so many ways, both for those who commit the act and for those left behind.  Ending one's own life seems to go against the most basic of human drives: the will to live.  There are countless examples throughout the course of human history of men and women fighting to live.  Human societies value life and we believe in the inalienable right of each individual to protect the lives of himself and of those he loves.  With the drive to live so fundamental to our very nature, what could possibly provoke someone to take his own life?

This question comes up quite frequently among mental health professionals, as our patients have a higher risk of suicide than many other populations.  If we can understand why people kill themselves, we can use this information to  identify warning signs and intervene before anything happens.  The goal is suicide prevention.

To this end, there have been a number of studies undertaken and countless theories proposed.  One of the most influential ideas about suicide was presented by Shneidman in 1993.  According to Shneidman, people who contemplate suicide all have at least one thing in common: unbearable mental pain, or "psychache."  The desire of those who contemplate suicide is not necessarily physical death, Shneidman asserts.  Actively suicidal people want only to end their suffering; they believe that nothing short of suicide can accomplish this.  The idea is that people only contemplate suicide when their pain becomes unbearable, when suffering becomes a constant presence, and when there is no relief from their pain; they feel trapped. 

So how do you help someone who has reached this level of despair? 

First, we must listen.  We must try to understand the person's pain from his perspective.  What is it the person needs but is not getting?  What are his goals in life and why does he believe they are no longer attainable?  To the person thinking about killing himself, suicide is logical; it makes sense.  We must seek to understand why it makes sense to him.  We need the whole story and only one person has it.

Fortunately, listening does not require any special training; anyone can do it. This means we are all in a position to help someone who feels helpless.  Of course, a person who is suicidal should get professional help.  Still, that doesn't mean we can't all do our part.