Category: writing

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.

Blog Post 1496

by Midnight Demon, posted in Bipolar Disorder, blogging, chronic physical pain, depression, mood disorders, writing

I didn’t have a good sleep. I was tossing and turning most of the night. I didn’t bother looking at the time as my room was still dark. I finally got up when I got successive text messages around 0830. It was a combination of Twitter and the T messages. Twitter was telling me people were liking and retweeting my tweets and the T was telling me of bus delays. I should have put my phone in “Do not disturb” mode. I didn’t have my phone on the charger so I had to put it on. While my phone was charging I decided to have some breakfast and make coffee. The coffee I made a little stronger than I usually do. I thought I would be ok with rounded scoops but I guess not. I know that for next time.

As I was waiting for the water to boil, I decided to put away some dishes in the strainer by the sink. Now I wish I hadn’t as my thigh is hurting me. I wasn’t planning on doing anything today except to write and read. I guess since I am in pain, I can take my pain meds but I hate taking them when I just wake up only to go back to sleep. Maybe if I “wish” the pain away it will. I am just going to be relaxing on my bed anyway, least till lunch. I really want to try and finish the American Gods, but that book is starting to creep me out. The author kills the characters in cruel ways. One character gets sucked into this story after his wife died because she was having an affair with another man. Then comes back from the dead to save him from some men who were good but very bad. She ends up killing these men. It’s all very strange. I have no idea where the story is going or what is going to come next because the main character just got killed. There are still over a 100 pages to read so the story must go on to something. But it’s very creepy and I am not one for creepy. I’m just glad I don’t fall asleep right away after reading this stuff or I think I would have nightmares.

After midnight last night, I emailed my psychiatrist to tell her I survived another day when I really wanted to end my life so badly. I felt like she had to know my struggle that I deal with these days as she is not around. I am still angry about my therapist making me promise to be around this week for her benefit. There was nothing more that I wanted to do yesterday than to take at least four bottles of pills and see what would happen to me. I know the likelihood of me getting sick would be greater than me actually dying. Now that I am still alive, I am feeling ten times more nervous about my appointment with the neurosurgeon tomorrow. Last week it felt like it was ages away and not it’s a little more than 24 hours away. I know nothing is going to happen, least not at this appointment as I need an MRI to determine the course of action. I am not looking forward to the MRI because I have to lie flat for at least 45 minutes and then be injected with contrast. I have bad veins so I need to be hydrated as possible for them to find the suckers. Otherwise, the MRI is useless. They won’t be able to tell new damage from old. The whole thing is just nerve racking, no pun intended.

Next week, I will have a break from my therapist. I am kind of mixed about this. In a way, I like having a breather from her and in another, I know I am going to miss her. It’s going to make the week longer because I won’t have our time to break up the monotony of the week. It might mean I go to Starbucks earlier. I hope to get some writing done. Last night I was working on my “roots” story. I got it up to about 1,300 words and then had to stop as it was close to 0100. I was tired and couldn’t think where else I wanted the story to go. I keep playing with it and try not to repeat myself as I go along. I had a friend of mine read it and she said that it was a good story. I took out the pieces that I pasted in there, thinking it would mesh but it didn’t. Now I got to write another two hundred or so words to make up for those two paragraphs that were worthless.

 

Quote of the Day 17 Oct 2015

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

The single most dangerous word in all of Suicidology is the four-letter word only. Edwin Shneidman The Suicidal Mind

writing and cooking

by Midnight Demon, posted in Bipolar Disorder, blogging, chronic physical pain, depression, mood disorders, suicide, writing

I didn’t have a good sleep. I kept on having bad dreams and waking up every couple of hours. I woke up feeling hungover from lack of sleep. I needed coffee so I set out to Starbucks soon as I got up as the bus would be coming soon. I had my Carmel Macchiato with four shots. I didn’t drink it all because the espresso settled and it was really bitter. I drank as much as I could while working on the nomenclature paper. I think I have bit off more than I can chew with this one. It is hard to describe the terms without actually quoting from the paper I am getting it from so I had to quote a lot. I tried to use my language as much as possible but the terms were difficult to describe as they were so outlandish. I have four pages to type up. I just hope I can read my handwriting or it’s going to be difficult.

I sent my therapist the rant I made about this part 2 paper. I think she read it because it has a couple of hits on my blog today. I might include some of that rant into this paper because it might stress the aggravation of dealing with terms that are useless. I kind of feel bad that for about ten years, these authors have been mulling around these terms and their concluding terms just didn’t hold water to a lit candle. The terms were so confusing, it really is no surprise they didn’t take hold. All in an effort to “simplify” things.

I got a thing for my former work place about my pension. I don’t know what it means. It was just another policy revision update thingy they send every year. I threw it in the recycle bin. I am keeping the pension as “cash” so that the stock market doesn’t lose my savings. I worked hard for this pension, fourteen years of labor went into it and I will be damned to lose it because of a bad investment on the part of people I don’t know. If I had the money, I would buy stocks in Starbucks and a couple of pharmaceutical companies. Then I would just put the money in a CD or something and call it a day. But I am on disability and don’t think I can do these things. I would love to roll it over to my personal IRA account but I don’t know how to do that. So I am just letting the money accrue interest where it is sitting.

After I finished writing this terminology paper, I decided to leave Starbucks. I just missed the bus so decided to walk down the street to catch the one going away from the Square. I thought I could handle it as I was feeling okay but halfway down, my calves started to flare up and so did my ankle. There was a bench that was about 500 feet from me so I walked slowly towards it and then sat down for a few minutes to walk another 300 feet to the bus stop. I am hurting big time now. I am glad I am not going anywhere tomorrow. I am going to need a day of rest. I think part of the reason I got so tired was because I didn’t eat anything. I had a cheese Danish while I was at Starbucks but I didn’t have breakfast or lunch. I just wasn’t hungry. It’s almost 1600 and I still am not feeling really hungry. I plan on making a grilled cheese sandwich for dinner. I have been craving one for the past few days but haven’t made it. I want my mother to make it because I usually end up burning it. I suck at cooking things that have no specific directions. If it has a recipe, I am usually good with it. I used to make a good chicken dish that was from Campbells. All you needed was the stuff that came in the box, fresh chicken breast and boom, you had dinner in a half hour. I used to make it for my coworkers as my mother didn’t like it and it was way too much for one person. Those were the days when I had time to cook and could do so without pain. Now I am lucky to take a 10 minute shower or make scrambled eggs when I want. I don’t wash the dishes, only because my mother has her own ritual as to how they are to be done and put in the dishwasher. I have my way, she has hers. I will only wash my pans and dishes if she isn’t around.