Review: Development and Prelim Validation of a Scale of Psychache

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.

how I manage being suicidal

It’s well past 2 in the morning. This may well be a Mr. Hyde blog as I am very tired but feel the need to write. Mr. Hyde likes to write things, very bad things and depressing things at this hour so this is a warning that this might be a suicidal blog.

I have been up the last few hours battling pain. My foot exploded around 11 pm (2300) and has now settled down some after putting on some gel and taking my pain meds. But then I got sick, I felt like I had to go throw up. So I laid down only it made it worse with reflux.

I wrote my psychiatrist a letter that I am hopelessly depressed and why bother with treatment of any kind as it is not helping me. I tried to get out of therapy with my therapist for today’s session and failed. I just don’t see the point. I am deeply depressed and if I could I would do something to end my life but I have no idea what I would do. Sure I have pills, but that might just make me sick and I hate to clean up vomit, if I survived. My luck, I probably will. I hate being in pain and can’t sleep. It drives me absolutely nuts.

A fellow blogger is battling her demons too. Her psych team wants to hospitalize her because she is suicidal. I suggested an alternative, the SSF to help deal with suicidal thoughts and to come up with a treatment plan. I told her to get the Managing suicidal risk book. It is a good book, if you are trying to manage suicidality. I don’t know what I did with my copy of the book. I know it is somewhere in my room or in my office. I can never find it when I need it. I have the SSF (suicide status forms) all over the place but not the actual book. And, no, because of copyright rules, I cannot post the forms as much as I would absolutely love to. There is one online, used, but helpful just to give you an idea of what they look like. I think I might ask my therapist to use it tomorrow. Or use Holden’s psychache scale. And again, as much as I would love to post it, I cannot because of copyright rules. I just am so hopeless. Everything is dark and gray, and I don’t mean the weather. I feel like I have no future, no purpose in life. Sure I published a book and that is a huge accomplishment. But why am I being “punished” with this depression?? What have I done that is so wrong? I hate my life.

My ex blocked me on Facebook today. I am actually glad because I was getting uncomfortable with the questions she was asking. She wanted to get back together. That is not going to happen. I guess me telling her I just wanted an online relationship pissed her off. Oh well. First time I have been blocked by someone. But this is kind of good because I don’t need her drama in my life. Yes, it bothers me but only because I thought this time we could just be friends and I have no idea what set her off and I will never know. Oh well.

Tonight was the first time all week that I took all my meds that I was supposed to take. I think that is why my stomach is bothering me. I usually have something to eat when I take them but tonight, I didn’t eat anything. I just am not hungry. And feeling sick to your stomach doesn’t make you want to eat anything. And oh joy, I think I may have a UTI. I have been leaking the past few days, more so than usual. Oh the joys of CES. That has me down too, because who likes to piss their pants? I am so tired of dealing with wet underwear. And having to take a shower every time I leak. It sucks because I hate showering. I had a good shower tonight. The water was nice and hot and it relaxed me. It was the first time in a while I felt that way. But I couldn’t stay too long because I knew my foot would act up and it did. Damn foot! Always ruins things. But I did a lot of stairs today and walking so it is my fault it flared up. I wish I could chop it off. Least with the ghost pain, it will be a real reason why it hurts. I don’t have a clear reason why my ankle/foot hurts. They think it is tendonitis. I think it is just nerve damage and over usage from fatigue. My foot gets tired and then it needs to rest but I don’t know it so I keep using it and then it flares up on me late at night. I then write blogs like this because I have nothing better to do and I can’t sleep anyways. I wish I was dead than deal with this pain every night. My heart is so heavy with heartache. I really don’t know why I keep going on. But tomorrow I will call my PCP and hopefully not talk to the stupid nurse about my UTI symptoms because other than leaking, I have no burning or pain. I don’t feel it because of nerve damage down there. I just have had bladder spasms. But those have subsided. But now my urine reeks so I know something is going on. Fucking CES always has to throw a wrench in the works. Can’t always be a simple case. I still will need to give a urine sample and I hope I will be able to. That is always the tricky part. I have to make sure I drink a lot before the appointment. Otherwise, I might not go when they give me the cup to pee. Oh the joys of retention! I no longer get the signal to my brain when I am full. Usually, I have to start leaking and then the signal goes to my brain that I am full. Fucking CES. Wrecks your life forever. And people don’t get it when you tell them. I was telling my cousin tonight the story about how I got CEs and the surgeries I went through. He still didn’t get it. But oh well. Not his life to live.