Category: psychache

Shneidman’s Psychache Theory

by Midnight Demon, posted in Bipolar Disorder, blogging, depression, mental disorders, mental illness, mood disorders, psychache, suicidality, suicide, writing

“From the view of psychological factors in suicide, the key element in every case is psychological pain; psychache. All affective states (such as rage, hostility, depression, shame, guilt, affectiveness, hopelessness, etc.) are relevant to suicide only as they relate to unbearable psychological pain. If, for example, feeling guilty or depressed or having a bad conscience or an overwhelming unconscious rage makes one suicidal, it does so because it is painful. No psychache, no suicide”. Edwin Shneidman, Suicide as Psychache p56

 

Psychache is the unbearable guilt, despair, hopelessness, shame, pain, depression, and press one feels when thinking about suicide. It is the corner stone of what this paper is about. The pain of the mind can cause constriction, a narrowing of view of things. It can also lead to perturbation (an unrest that causes one to feel like doing something to alleviate the uneasiness one feels) and also to press, which is also known as stress or the pressure and weight one feels under. The combination of these three things, press, perturbation, and psychache is what is known as the cubic model of suicide.

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The cubic model of suicide is a 1-5 rating of the three things I just mentioned. The higher the rating, the higher the likelihood of suicide. The worst rating is a 5-5-5 scenario and suicide will be imminent. It is important to rate these items when dealing with a suicidal person. It will validate what they are feeling and make them feel at ease in talking about what is causing them to feel so pressured and hurt to make them think of killing themselves.

When dealing with constriction, the dichotomous thinking that a) suicide is the only way out or b) things are always going to stay the same, it is important to always bring in more options to the person so they can see things differently. In his book Suicide as Psychache, Shneidman gives the example of a young pregnant woman who was thinking of killing herself with a handgun. She couldn’t have the baby so therefore in her mind, suicide was the only way out. After discussing several options with her (calling her parents, having the baby and giving it up for adoption, discussing the situation with the baby’s father, etc.), it was agreed that the woman would call the baby’s father. Suicide was no longer the number one item on the list. To prevent a mishap, Shneidman did take the gun away from the woman. An excellent example about means restriction.

In almost every suicidal thinking, there is some measure of lethality and perturbation. You can have high lethality and high perturbation, but you don’t always have high perturbation with high lethality. Perturbation, as described above, is very much like anxiety. It is a perturbed feeling that causes one to feel pressured to do something. Lethality is the doing something.

Also in every case of suicidal thinking is the frustrated needs that bring about the suicidal feelings.

ABATEMENT The need to submit passively; to belittle oneself

ACHIEVEMENT To accomplish something difficult; to overcome

AFFILIATION To adhere to a friend or group; to affiliate

AGGRESSION To overcome opposition forcefully; fight, attack

AUTONOMY To be independent and free; to shake off restraint

COUNTERACTION To make up for loss by retrieving; get even

DEFENDANCE To vindicate the self against criticism or blame

DEFERENCE To admire and support, praise emulate a superior

DOMINANCE To control, influence, and direct others; dominate

EXHIBITION To excite, fascinate, amuse, entertain others

HARMAVOIDANCE To avoid pain, injury, illness, and death

INVIOLACY To protect the self and one’s psychological space

NURTURANCE To feed, help console, protect, nurture another

ORDER To achieve organization and order among things and ideas

PLAY To act for fun; to seek pleasure for its own sake

REJECTION To exclude, banish, jilt, or expel another person

SENTIENCE To seek sensuous, creature-comfort experience

SHAME-AVOIDANCE To avoid humiliation and embarrassment

SUCCORANCE To have one’s needs gratified; to be loved

UNDERSTANDING To know answers; to know the hows and whys

These twenty needs are what Shneidman has called the essential ones when people are suicidal. Most of them are not all twenty but five or six as it pertains to the individual. “The prevention of suicide with a highly lethal person is then primarily a matter of addressing and partially alleviating those frustrated psychological needs that are driving that person to suicide. The rule is simple. Mollify the psychache”. (p53) Shneidman believed that these frustrated needs are what caused psychache.

I believe there should be another need, validation. Everyone needs to be validated in order to feel secure and feel okay. Without this, most people feel shamed and dumb, that what they are feeling or experiencing has no meaning or purpose. They may also feel empty and alone as no one understands what they are going through. This need when frustrated or thwarted can lead to suicide.

Shneidman, Edwin. Suicide as Psychache. 1993. Jason Aronson, Inc.

Reasons for Living vs. Reasons for Dying

by Midnight Demon, posted in Bipolar Disorder, blogging, cauda equina syndrome, chronic physical pain, depression, mood disorders, psychache, suicide, suicide attempt

Reasons for Living vs Reasons for Dying

This title is the name of an article written by David Jobes. It has to do with suicidality. The idea is to list your reasons for living and then your reasons for dying. The hope is that the reasons for living outweigh the reasons for dying.

I have been struggling a lot lately with my suicidality. Last week I wanted to do something very badly. I didn’t care what it was, as long as the end result was death. I texted my therapist and after I met my ungrateful father, she called me. We talked about my plan that was running around my head and the stressors that was leading me to think of suicide. It was a short phone call so we didn’t get into real specifics. I am sure that if we had time for a session, she would have asked what my reasons for living/dying were. It’s her way of gauging just how suicidal I am. Usually if I don’t have any reasons for living, my constriction is pretty high. Constriction is the narrowing of the senses. In this case, I only see suicide as a way out and I am damned to achieve it one way or another. I have been stressed over my birthday, not to mention Christmas and still trying to save money for the new year because I know I will have to pay for my prescriptions again. I also need to save some money so I can see my therapist sometime in the new year. But that is all future planning and it is stressing me out to no end. I don’t want to live to see my birthday in the 9 days. I was planning on ending things this Saturday so I made plans with my sisters for a birthday dinner with just the three of us. I still have Sunday to worry about. And the fact that what I have in mind, I have plenty of is not helping my case. I have three bottles of meds that I could use to try and end my life. But the problem is where I will do this. I can’t do it at home because I don’t want to be found by family members. And I know it will be traumatic to anyone that finds me, but I don’t care. I can’t stand living this hell that is supposedly called life. I am in so much pain lately that I can’t think. The new pain meds have me so sedated it’s not funny. And I think it’s messing up my bowels, too. Instead of being constipated, I am now having loose stools. That might be good for a “normal” person but not good with someone like me who has impaired function of their bowel due to cauda equina syndrome.

I made an appointment with my neurosurgeon the day before my birthday. It is going to be a wasted visit because there are no new images of my back. The latest scan was in 2007. So it’s just talking to him to update him on what is going on and then he will most likely order an MRI. I will then have to have another appointment to discuss the results. I am scared that I will have to have surgery again. I have no idea what that will mean. Or he might decide to pass me off to another neurosurgeon because he is a pedi doc and not an adult doc. I don’t know. I will be pissed off it I am again passed the buck to someone else.

I am also worried that I am not going to get the level of care from the new PCP in my doc’s office when he leaves and my days on opioids might be coming to an end. That is what is really freaking me out. I can’t manage my pain without these meds. It keeps me sane. But some doctors wrote an article in a prominent medical journal about how chronic pain patients get lumped with substance abuse disorders and other mental health issues and therefore “abuse” the meds they receive. Which is utter nonsense. I have never abused nor taken more than prescribed. I take what I need on a given day. Sure there might be some days that I need more medicine than others but that is rare. When I have a pain flare up, it might mean 6 pills instead of 4. Or if I am not in too much pain, it might mean just 2 pills a day. It varies because my pain is not constant all the time. It’s always a three on a scale of 1-10 at any given point but any activity (going up and down stairs, walking for lengths of time, standing for lengths of time, etc.) will increase my pain at night. At night is when my pain is at its worse. That is when my reasons for living go out the fucking window and my reasons for dying increase trifold. This is what it’s like living with chronic pain.

My therapist knows this. She has seen the worst of my suicidality to know when to intervene and when to let me vent. She tries hard to let me work it out on my own as I usually do. She guides me through these rough passages. But I don’t know if this time she has what it takes to see me through these waters. I am so drowning and I just feel like no one is hearing me scream in a crowded room. I am just so sad that my doctor is leaving, my psychiatrist is not available at the moment, and I have to face a neurosurgeon the day before I really don’t want to be alive.

Quote of the Day 29 Nov 2015

by Midnight Demon, posted in Bipolar Disorder, blogging, depression, mental disorders, mental illness, mood disorders, psychache, Quotes, suicidality, suicide, suicide attempt

Suicide in theory should never come as a total surprise if one knew enough about the intimate inner life over the entire course of the individual’s psychological history.–Edwin Shneidman, Definition of Suicide

Quote of the day 27 Nov 2015

by Midnight Demon, posted in Bipolar Disorder, blogging, depression, mental disorders, mental illness, mood disorders, psychache, Quotes, suicide, suicide attempt

The moment that the idea of the possibility of stopping consciousness (popularly called “death”) occurs to the anguished mind as the answer or the way out in the presence of the three essential ingredients of suicide (unusual constriction, elevated perturbation, and high lethality), then the igniting spark has been struck and the active suicidal scenario has begun. Edwin Shneidman, Definition of Suicide