Review: Development and Preliminary Validation of a Scale of Psychache
Holden, Mehta, Cunningham, and Mcleod, 2001 Canadian Journal of Behavioural Science
Suicide kills more people in a year than auto accidents and cancer combined. It is currently, the tenth leading cause of death in the United States. What can be done about this? Researchers in Canada have developed and validated a scale to detect the suffering associated with suicide. This suffering is called psychache. It is the unbearable pain, intolerable despair, guilt, angst, and anguish one feels when contemplating suicide. This is based on Shneidman’s work, “Psychache as Suicide”. He is the father of suicidology and believed that if one does not have psychache, one will not die by suicide.
This seminal paper by Holden et. al, is fantastic. It gets to the heart of suffering people and can also be used as a gauge of whether treatment is decreasing psychache or not being helpful. In my experience using this scale, I have found it helpful. It really states what the therapist needs to know to help the client work on the issues surrounding suicidal ideation. The scale is easy to administer and doesn’t take long to tally up the numbers in a session to give a numerical value to psychache. The higher the number, the more likely the client is thinking about dying by suicide. The lower the number, the lower the risk.
In this paper, the authors did two studies. One to measure the validity of the scale and the other to cross validate the study using the same sample. In addition to the Psychache Scale, the following measures in the first study were given, in order, the Beck Hopelessness Scale (Beck et. al 1974), the Unusual Thinking Scale (Mazmanian et. al. 1987), Reasons for Attempting Suicide Scale (Holden et. al 1998), and the Suicidal Manifestations Questionnaire (Johns and Holden, 1997). There were 294 participants, mostly women (76%). Of these, 197 reported suicide ideation at some point in their lives, 46 thought about suicide in the past four weeks, and 30 participants reported at least one suicide attempt in their life with 21 attempting within the previous five years and 8 reporting multiple attempts. The mean age was 19.1 years (SD 1.6). No racial or ethnic data were collected.
The study found that the psychache scale appears to be reliable and valid in measuring deep psychological pain. It also seemed to be effective in weeding out those that are suicide attempters versus non-attempters.
The second study focused on the childhood abuse exclusively on the women. It was found that the scale was reliable and replicated the previous study in determining psychache.
The Psychache Scale is a thirteen item self report written to be responded on 5 point scales ranging from either never to always or from strongly agree to strongly disagree. It was originally longer than thirteen items but after trimming down the essence of psychache, the scale was finally brought to be a thirteen item report.
What I love about the scale is that it is very easy to spot suicidality. From my own self-report, I have found that the first 9 items focused on my psychological well-being. If the number was great or at its max, I was doing poorly. The last four items dealt with suicidality. It, in my opinion, states how imminent suicide is on the client’s mind. Taken together as a whole, you can monitor treatment goals and see if that decreases the numbers. The lowest to score on the item is thirteen. The highest sixty-five. My interpretation of the scale is that if the number is lower than the medium (33), the person is not in danger, unless the last four items equal a twenty, which I doubt will happen. It will depend on the measurements of the items to determine suicidality. The items themselves will provide clues to the client’s mental state. See the article to see the items.