The Suicidal Mind

After someone close to you commits suicide, the nearly universal response is to try to understand what they were thinking. How did they come to view suicide as the only (or best) option? That’s the question that The Suicidal Mind seeks to answer. What is it that makes people commit suicide? Shneidman’s description is robust, but it all comes down to psychological pain that he calls “psychache.”

Psychache

We know from our neurology that our minds and bodies make little distinction between physical and psychological pain. While there are distinctions, it’s important to recognize similarities first. Basically, all the same brain regions light up in the same general way. The body, on the direction of the brain, responds to psychic pain in the same way that it responds to physical pain.

Consider, for a moment, that when you watch a scary movie – or just an action-packed one – your heart races. Obviously safe in your home with locked doors, you’re in no real threat. However, because your brain is simulating what is happening on the screen, adrenaline and other chemicals are released, and the body responds.

Similarly, when you’re in psychic pain, your body responds as if it’s in real pain. The stress response is activated, including adrenaline and cortisol. The net result is both risk for long-term, stress-induced complications (see Why Zebras Don’t Get Ulcers) and a cognitive narrowing of options, as described in Drive. We’ll come back to the narrowing of options soon, as it’s called “cognitive destruction” or “cognitive constriction,” and it plays a major role in the risk of suicide.

The biggest difference between psychological pain and physical pain is that we’ve got pharmacological and other pain management solutions that are effective – or at least partially effective – at managing physical pain. There are not a similar set of solutions for psychic pain, and as a result, psychic pain is often seen as something that will continue to plague a person for years. Few people are taught how to manage their psychic pain.

Cutting

Someone cutting themselves doesn’t make sense on the surface. Why would someone intentionally harm themselves? That answer comes in two parts. First, some people cut because they want to feel alive. The physical pain punches through the numbness. Sometimes, that numbness is the response from the intense psychache.

The other reason for cutting (and other forms of self-harm) is because the physical pain can temporarily distract the mind from the psychache. For most people, our conception is that our brain processes all pain equally, but that’s not exactly right. There are factors that cause the brain to process pain more or less intensely. It’s possible, for instance, to “confuse” the brain into decreasing pain in an extremity by distracting it with physical contact closer to the core. (See The Gate Control Theory of Pain for more) Similarly, new inputs for pain are treated with a higher degree of attention than chronic pains. Thus, an acute physical pain can temporarily overwhelm a psychache.

To be clear, this isn’t a good coping strategy for psychache – but it can explain why people start down the road of self-harm.

Lethality

While psychic pain is the fuel that drives suicide, it needs something to ignite the fire. That fuel comes in a capacity to be lethal to oneself. This is like Joiner’s concept of capacity for self-harm. (See Why People Die by Suicide.) Plenty of people are in psychache but don’t have the lethality necessary to complete a suicide attempt.

Self-harm techniques like cutting are problematic, because they move us closer to lethality. They normalize self-harm, and through habituation, it takes more and more physical harm to mask the psychache. This natural escalation makes it harder to see how you’ll continue to cope. The psychache remains, and it takes more and more self-harm to keep it at bay.

The Dialogue

Self-awareness is a gift – and at the same time, it can be a curse. (See The Righteous Mind for why it’s a gift, and The Worm at the Core for more about how it can be a curse.) Suicide is largely a drama of the mind. It’s how we speak to ourselves, our stream of consciousness, that leads us towards or away from suicide. When we look for our options for relieving our pain, we briefly float over suicide and quickly dismiss it. However, in our constrained decision making, we find ourselves coming back to it as a solution. (See The Paradox of Choice, Sources of Power, and Decision Making for more about how we really make decisions – rather than the way we believe we make decisions.)

As I mentioned in my review of The Satir Model, alcohol is often the solution to the psychic pain that exists in a family system. Similarly, suicide is the solution to the psychache that can’t be blunted. I’m not saying it’s the right solution or a good solution, but rather, in the mind of the suicidal person, suicide is seen as the solution not a problem. One could reasonably wonder how suicide could possibly be seen as a solution. The answer comes down to cognitive constriction.

Cognitive Constriction

One of the problems with alcohol use is what Al Lang from FSU calls “alcohol myopia.” That is, your perceived options and situation are severely constrained. This is like the kind of constriction that we encounter in people who are under stress – in a much more powerful form.

Cognitive deconstruction is a different way the process of suicidal constriction of thinking is termed. Perhaps it’s because our ability to make rational decisions is deconstructed and we’re only able to investigate a few options that are immediately upon us. We tend to not look for new alternatives and instead focus on a very narrow list that we already have. Like the professional game of confirmation bias, we see only those options that we’ve already considered. (See Thinking, Fast and Slow for more on confirmation bias.)

This constriction prevents suicidal people from realizing that self-immolation (setting yourself on fire) would hurt. As difficult as it may be to accept, people who are in a suicidal state of mind can’t process the impact of their own pain, much less the devastation that they’ll be leaving behind when loved ones are forced to live with the worry about what has happened to them or discover their lifeless body. It’s not that they don’t care, it’s that the thought literally doesn’t come to them about how their actions will impact others – or themselves.

Reports from suicide attempters include those who’ve jumped from the Golden Gate Bridge who suddenly realized that they wanted to live and that every problem in their life was solvable – except, of course, having just jumped. These are not isolated reports of a single individual but rather a repeatable pattern of remorse that takes place before the impact but after the jump.

Only

The most dangerous word in all suicidology is the word “only.” As in, “suicide is my only option.” Only is the word that signals that someone has become cognitively constricted and they’re unable to identify new opportunities. They’ve become locked onto the idea that suicide is the only option – whether it’s really the right option or not.

In attempting to help suicidal people, one of the most important aspects is to help them realize that suicide is not only not the only option but that it’s not even a good one. Gary Klein in Sources of Power, Irving Janis in Decision Making, and Barry Swartz in The Paradox of Choice all explain that people don’t develop exhaustive lists of all the potential options. Instead, they often satisfice, picking the first option that seems acceptable. The key is helping people see other options, so they see that suicide isn’t an acceptable option.

The Impact of Explanatory Style

Work going back four decades speaks about the value in the way we talk about our situation to ourselves. The work, which was contributed to by Aaron Beck, Christopher Peterson, Martin Seligman, Rick Snyder, and others, explained the benefits – and limitations – of the way that we explain things to ourselves across three dimensions. (For more background on this, see The Psychology of Hope and The Hope Circuit.) The three dimensions have been given different names, but the labels used more recently are:

Personal – Is it about me or things that are not under my control?
Permanent – Is the situation permanent or temporary?
Pervasive – Is this situation global in nature or unique to this situation?

The more that we describe negative things as personal and under our control, temporary, and isolated to the current situation, the better off we are. (See Why We Do What We Do for our perception of control that Deci describes as internal locus of control.) It’s relatively well established that optimists think better of themselves than those suffering from depression, and though the perceptions are slightly distorted, that this has a positive effect for the individual – if they aren’t distorted too much into narcissism. (See How We Know What Isn’t So for more.)

Ambivalence

In the mind of the suicidal person, there seems to be a conflict. On the one side is the desire for death. It’s the desire to end suffering and pain. It’s perhaps the desire to relieve current or perceived future burden to others. On the other side, there’s the powerful force that drives everyone to keep living, the fear of death that The Worm at the Core claims drives us all. These two forces are in opposition, constantly applying pressure and creating a place of confusing behaviors as the conflicted struggle to work through the conflict as one or the other of the desires gains the upper hand.

As the result of this constant pushing and tugging, most suicidal people are termed to be ambivalent. They’re not apathetic – they do care, they’re just stuck in a conflict. It’s a conflict that they can’t escape from until they see that there are options other than death.

Hopelessness

Marty Seligman and his colleagues first described learned helplessness about 50 years ago. The idea that animals (dogs specifically) would sometimes not escape discomfort when they should. While we call it learned helplessness in animals, we call is hopelessness in humans. Seligman’s colleague more recently used fMRI technology not available 50 years ago to discover that it wasn’t learned helplessness but a failure to learn control – or a degree of influence – that caused the dogs to freeze. In The Hope Circuit, Seligman explains this transition and his personal journey to optimism and positive psychology.

It’s the work of another scholar, C.R. (Rick) Snyder, in The Psychology of Hope that begins to expose how we might develop hope instead of hopelessness. He explains that hope isn’t an emotion – it’s a cognitive process with two components. The first component is willpower – or our willingness to do things even when it may be uncomfortable. (See Willpower and The Art of Learning for more on willpower and its impact.)

The other component, waypower, is much less recognized. Waypower is the knowledge about how something will be accomplished. It’s the map, guide, or path that leads someone from their current situation to the situation that they want.

Both aspects of hope can be encouraged. Willpower explains how willpower is an exhaustible resource, but with repeated work, it can be developed like a muscle. (See Antifragile for more on developing and improving under strain.) The problem with building willpower isn’t that it cannot be done, it’s that it takes a long time to accomplish. The other aspect, waypower, is relatively easier and quicker to influence.

Waypower is simply about knowing how to move. However, the kernel of waypower is found in the ability to explore options that may lead someone to where they want to go. There doesn’t need to be a guarantee of success, just a possibility – and even a possibility that you’ll just get closer. One of the real challenges with cognitive constriction is that it prevents options from being seen and thereby harms our ability to hope.

The good news about waypower is that we can influence the options we see both by creating places of greater perceived safety. (See The Fearless Organization for more.) We can also teach approaches and techniques that are intentionally designed to generate more options. (See The Art of Innovation, Creative Confidence, and Unleashing Innovation as examples.)

Hope is the most powerful force in the world. Whether you start with the idea of Pandora’s box and how hope helps keep all the demons of the world at bay, or you consider how hard we must work against the placebo effect because hope is so powerful, it’s a force to be reckoned with. (For more on the placebo effect, see Warning: Psychiatry May Be Hazardous to Your Health.)

To Disagree Slightly

Building therapeutic alliance is essential. (See The Heart and Soul of Change for more.) In non-therapeutic settings, it’s important to establish rapport. You’ve got to help the other person know that you hear them – but you don’t necessarily have to agree with them. Motivational Interviewing is a great approach for helping transition addicts to better modes of thinking. The tools, techniques, and approaches create an environment where, frequently, the addict realizes that their addiction is the central problem in their lives. However, with suicidal people, it may not be possible for them to see that their beliefs about suicide are problematic. That’s why it may be necessary to disagree slightly.

At some point, the conversation has to turn to the fact that the suicidal person believes suicide is an option – or their best option – and the other person thinks it’s a really bad idea. Rushing into this confrontation to early or too strongly can destroy the rapport and make it impossible to change the person’s mind – conversely, doing it too late, well, may be too late.

The key is to find a way to affirm the person and to disagree with their conclusions in a way that opens up their interest in alternative perspectives and additional opportunities to solve their problem.

Burn as Brightly

It was Louis Terman who converted Binet’s work from French and brought to the English speaking world the Stanford-Binet Intelligence Test – commonly known as the IQ test. While the limitations of the test and its applicability to future performance has been called into question, it has had profound effects on our ability to understand intelligence. (See Emotional Intelligence for a discussion of the limits of IQ.)

Despite this, Terman’s work helped us to understand that those who were highly intelligent weren’t maladapted or physically weak. In fact, he found lower incidence of divorce, alcoholism, and mental health issues while finding that the most intelligent were taller, healthier, and better developed social leaders.

The problem comes, however, when suicide rates are considered. Of the 1,528 subjects of his study, 28 of the highest performers committed suicide – well above the 12 per 100,000 rate that occurs normally. It seems that their higher intelligence made them more susceptible to suicide. As a group, they were socially and professionally successful, but something in the drive put them at risk.

In the 1970s, Herbert Freudenberger was running a free clinic in lower Manhattan, and he discovered that his clinicians were struggling. Eventually, he’d call these struggles burn-out. His 1980 book, Burn-out, explains how he saw the syndrome play out. Even in these early writings, it was clear that his clinicians weren’t feeling effective, as people kept coming through the doors asking for help. (We’ve developed a wealth of materials at https://ExtinguishBurnout.com that are designed to help you recover from burnout if you need that help.)

Inefficacy is at the heart of burnout – despite some of the missteps that the discussion has taken since Freudenberger’s work. It’s that same perceived inefficacy that may have doomed Terman’s subjects. While they were by all accounts very successful, it can be that their expectations of success exceeded their actual success, and therefore the gap caused them to feel like they’d never be enough. They were hopeless that they’d ever achieve the level of success that they expected they should.

Loneliness

Loneliness is a powerful predictor in someone’s interest in attempting suicide. Joiner’s model (as explained in Why People Die by Suicide) contains only the ability to commit self-harm, a sense of burdensomeness, and a lack of connectedness. However, as the book Loneliness explains, the experience is different than the objective reality. I can be in a room full of people at a party and experience loneliness. Conversely, I can be alone on a mountaintop and not experience loneliness. It’s not the objective reality that matters, it’s my subjective reality of how I feel.

Emotional Processing

One of the largest challenges, I believe, in suicide today is the inability for people to process emotion – theirs or other people’s. We’ve simply not been taught how to decompose our emotions to understand what’s behind them. Both How Emotions are Made and Emotion and Adaptations explain that our emotions are based on unconscious perceptions, and it is possible to explore these foundations and ultimately to shape how we feel. (See Hardwiring Happiness for practical examples of how to do this.)

Jonathan Haidt’s perspective is a bit different in that he encourages a better relationship between the rider and the elephant. (See The Happiness Hypothesis and Switch for more on the rider-elephant-path model.)

Ten Commonalities

Shneidman explains that he believes there are ten commonalities of suicide, which are:

The common purpose of suicide is to seek a solution
The common goal of suicide is cessation of consciousness
The common stimulus of suicide is unbearable psychological pain
The common stressor in suicide is frustrated psychological needs
The common emotion in suicide is hopelessness-helplessness
The common cognitive state in suicide is ambivalence
The common perceptual state in suicide is constriction
The common action in suicide is escape
The common interpersonal act in suicide is communication of intention
The common pattern in suicide is consistency of lifelong styles

This is just one way that Shneidman believes that we can peer into The Suicidal Mind.