400th blog post: A post about Edwin Shneidman, PhD

This is my 400th blog. I want it to be meaningful so I thought I would write about Dr. Edwin Shneidman. He was a wonderful man that I really admire. He was the father of suicidology and really pioneered the field.

His famous quotes, one of many, was that you should not kill yourself while you are suicidal. I think he meant it to be as a sort of giving yourself time before acting on such a dangerous act. I know that in my time I have been putting it off. It keeps me here.

My favorite book that he wrote was called “the suicidal mind”. I swear this guy was in my head as I was reading it. It perfectly described everything that I was feeling. The psychache, the despair, the guilty worthless feelings, all of it. He was the one that termed the word psychache, which is feelings of psychological pain that can best be described as feelings of despair, frustration, guilt, worthlessness, hopelessness, and helplessness.

His other connotations are constriction and perturbation. These two words are the most dangerous in a suicidal mind. The constriction means there is a narrowing of the mind, a kind of tunnel vision that is set on one thing: easing the psychache at any and all costs, by killing oneself. Perturbation is the agitation, frustration, the “must do something now” type feeling that provides that person to think about suicide and it is difficult to calm or settle these feelings once constriction is in full gear.

Another word Dr. Shneidman often uses to describe suicidality is press. This word is sort of a disambiguation. He uses it to describe a lot of things but mostly the pressure one feels to act on suicidal feelings and thoughts. It can also be used as a sort of perturbation. In Dr. Shneidman’s eyes, the level of the perturbation, press, and psychache will ultimately lead to suicide. If you were to rate each on a 1-5 scale model and have a 5-5-5, the likelihood of completing a suicidal act is greatly increased. In fact, he has stated that prolonged feelings of these three things are a major cause of suicide. No one can endure psychache, press, and perturbation for any length of time. You can have fluctuation of the these three things but once they have been at a sustainable level for any length of time, suicide is likely to follow.

Dr. Shneidman was a man that I greatly admire and respect. And what is very special to me and what I will always remember is him calling me out of the blue one day to discuss my paper that I sent him on “ten faces”. It was a paper that I wrote up for the AAS 41st annual conference and was my first poster session for this organization. I will always be grateful for that phone call.

Needs and wants

Every body needs somebody some times… These lyrics from Keith Urban describe how I feel today. Everyone has needs that have not been met and because of that they feel out of sorts. It could be disconnected from the world, feeling left out from a group, or even feeling unloved by those that love them the most. There is summary of the needs that Edwin Shneidman says are the core of suicidal thinking. I know I wrote about this in a previous blog called a little of this and that. But today I think I will write the needs in detail and what they mean.

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

You be the judge of your own needs and how they play out in your suicidality. Then work on ways to improving them, if possible.

Need for Affiliation

Need for Affiliation

We all feel the need to affiliate, to have this connectedness to one another and to have our work validated and to be validated for who we are. When this doesn’t happen, we tend to feel alone and worthless. Over time this builds up and may lead to depression which then leads potentially to suicide.

In his lifetime work, Edwin Shniedman thinks that there are 20 needs that leads to suicide and affiliation is one of those, along with validation. I guess I have been feeling like lately my work has not had too much affiliation. I have not had too many comments like I have in the past and my readership has dwindled. I have tried to figure out why things have been bothering me so much and I think this is why. I no longer feel like I have affiliation with anyone in regards to my work. I haven’t gotten a good job or I have been through what you have been through in weeks. I know it sounds silly, but to me it means a lot. I am not saying that I am going to die because I don’t have this. It just is another reason for my unhappiness. Now that I know this I can bring it up with my therapist and come up with ways of dealing with it. Because we all have these needs, some more than others.

psychological pain: real or not?

I did some Google research on psychological pain. I got over 34 million hits on those terms alone and had to narrow it. I really miss having access to PsychLit, a search engine tool for psych papers and other related mental health professions. So I put the psych pain in quotations to narrow the search. I narrowed it down to 444,000. Yikes. How was I going to get through that many? I decided to go through the first three pages of results. I found what I was looking for and did another search for that. Sometimes you can get lucky and get a free PDF of the research article. I wasn’t lucky this time. I did pay $20 USD for to “look” at the research article. What I found was another psychological pain scale that has been in use for the past six years. I don’t know how I missed this article in my previous searches, but then I have been following ONLY the works and “followers” of Dr. Shniedman.

From what I have read about this article, this is a quantitative research measure for psychological pain. Unlike Jobes’s SSF (Suicide Status Form), which measures multiple psychological pain issues and is a qualitative form, it does not measure anything related to suicidal thinking. This is disappointing. Most of the measures have been for major depression, whereas the research for the SSF has been across all psychiatric disorders.

OMG I just read one of the results that Tylenol would help psychological pain. WTF, ARE YOU SERIOUS??? No wonder there is so much liver failure in this country. But then most people don’t think that this pain is real and only physical pain can be felt. I think this is bogus because I have suffered from psychic pain for a great many years and I can say that it is just as real as any physical pain that I have ever felt. It might not be the same as say the pain from a broken limb but a broken heart hurts just as bad.

In this article that asks is there such a thing as psychological pain? And why it matters. I found this article interesting as he was comparing the pain and grief of losing a child to cancer can be just as painful as a kidney stone.

 

 

References

Biro, David. Is There such a thing as psychological pain? And Why it matters. Culture, Medicine, and Psychiatry 2010.(34).4.658-667

Mee S, Bunney BG, Bunney WE, Hetrick W, Potkin SG, Reist C. Assessment of psychological pain in major depressive episodes. J Psychiatr Res. 2011 Nov;45(11):1504-10. Epub 2011 Aug 9.