Tag: Shneidman

a little of this, a little of that

by Midnight Demon, posted in depression, medical, mental illness, suicide, suicide attempt

To write or not to write, that is the question. Been trying the past few days to write something, anything and I came up with nothing. I had jotted down one of my statuses as a starter to write but it too has not gone anywhere. Right now as I am writing this I am becoming exhausted. I was hoping my therapist would call me tonight but it doesn’t look promising.

Been thinking the past few days about needs. Everyone has some need that is not being fulfilled at any given time. Shneidman, the father of suicidology thought there were 20 needs that lead to suicide. I talk about him a lot in my writing so people know this sweet man that called me out of the blue one day. I was actually shaken up by his phone call. To me, he was as famous as Richard Gere. I was so honored that I didn’t know what to say to him when I called. Time was of the essence because his health was frail and if he died before I called him, I would never had the courage to talk with him for a half hour that truly was the highlight of my life. Now if Dr. Jobes ever calls me, I will have a heart attack. He is another person I deeply respect because he writes about suicide and what it is like and not only this but developed an assessment that can be used to help save someone’s life. I will write about his works until my dying day because he has the knowhow of what it is to be suicidal. I am not saying that he is or ever has been suicidal, but he has lead the way in the collaboration of so many professionals for one goal, to end suicide. Granted not all suicidal people can be saved, but he is willing to try, which is more than what I can say for some of the top professionals in Boston. I had my doubts ever since I tried getting a new therapist and failed, ten times!! No one would take me on and then the one, the last one that did was afraid of me. I couldn’t be in that therapy if someone is afraid of me because I am high risk. Sure, statistically I should be dead. But by the grace of some higher power, I am not.

That brings me back to the needs. I have been thinking about what my needs are that are not being met that drive me suicidal. I know that I am not loved, I have a need to feel important because I think I am nothing, I have a drive to succeed but yet I know I will fail. That truly is my biggest thing. I failed at killing myself and feel terrible at that loss. It is a loss that I have yet to get over. I still truly believe that I am meant to die by my own hand though there still is a drive to keep me going. I was asked recently on what it is that keeps me here. To tell the truth I have no idea. Some part of it is faith and hope, others is a pesky therapist that will “die” if I die. The aftermath of a suicide is not pretty. I sometimes wish I could be a part of Jobes world for a little bit and see what he sees in a hopeless case like me. What he would say or do to try and ease my suffering and then I look at my therapist who is doing all she can to keep me sane and alive. There is nothing more that she can do that what she is doing. Suicidal thinking has become a part of me that I can’t let go. I read about it every day to try and ease my pain, I work with my therapist who is a pain in the ass sometimes and she is open to my ideas of what treatment is and does not have the “I know it all you know nothing” attitude. If she did, I doubt that I would have stayed with her for this long.

The twenty needs are abatement, achievement, affiliation, aggression, autonomy, counteraction, defendence, deference, dominance, exhibition, harm avoidance, inviolacy, nurturance, order, play, rejection, sentience, shame avoidance, succorance, and understanding. If I was to fill out the model of the needs, my highest would be affiliation, achievement, succorance, nurturance, and understanding. As I have written in a previous paper (https://midnightdemons7.wordpress.com/2012/09/03/is-suicide-caused-by-psychological-pain/),  the twenty needs are weighted on the sum of 100, though Dr. Shneidman does not say what the scale is for each of the 20, and as much as I have tried to ascertain this information through his research, I have not been able to find it. Everyone has these needs in some way shape or form. And when they become blocked or frustrated, suicidal thinking occurs. I know my need for affiliation is great at times that sometimes I get frustrated. I don’t necessarily become suicidal all the time because I have not been friends with someone but I’ll admit that it is lonely when you don’t have too many friends that call you anymore or that just keep in touch via email. I am a loner by nature but that doesn’t mean that I am friendless.  My online contacts mean more to me than my non-online friends. My family does not know too much about what I write, if they read my blogs at all. But this is my livelihood, writing about suicide because it means so much to me. It is the biggest demon I have had to face in my life and sometimes it gets the better part of me.

This past April I went to the annual conference of the American Association of Suicidology and found out some things I already knew. I met my favorite suicidologist and his trainees again. One of his trainees has become a good friend of mine. I also found out that I am a hopeless case that no one in their right mind would want. I am high risk, psychotic and delusional at times, and have multiple suicide attempts. I asked one of the guys from Mayo about this “case” I was working on and he wouldn’t touch it with a ten foot pole. Thanks dude, you really shown me how much hope I have for my future. It was an exhausting trip. Next one is in Texas and I am not sure if I am going to go. I have never been that far out west. I really don’t know anyone close by. I would have to stay at a hotel for the few days. But it might be fun to meet up with my co-author and discuss my book that she wants me to write. She is the biggest proponent in my writing right now. She had me publish my blog and it has done well so far. Since I started it in July, I have had almost a thousand views. I hope that I am able to meet up with her in Texas but I don’t think I will have the financial resources to pull it off.

I got notification this week that I am found to be disabled. My social security disability has gone through. I now can collect a check every month while I write and not have to worry about how I am going to pay for my Starbucks coffee habit. Starbucks is truly what keeps  me going some days. It is a chance for me to go out of the house, even if it exhausts me. To have that one cup of joy a day is usually all I can get out of my day. Instead of my mocha, lately I have been enjoying the Blue Java of Indonesia. It has a full bodied flavor that I like. I have tried the Panama but wasn’t too thrilled with it. It was a little too earthly flavored. I am going to try the blue mountain as it seems like I will like it. But none of this would be possible if I was not deemed disabled due to my mental illness. Since I found out I have been more depressed. I find it more exhausting to do tasks. Even my writing as dwindled to what it was. I try journaling to keep the ideas going and sometimes I will write something I think worthy of a blog but mostly I keep my personal thoughts personal. There was a time when I used to share my journal with my therapist as a sort of therapeutic processing, but seeing as I don’t see her physically anymore, I might end up sending her an email about my thoughts on certain things. Like my suicide attempt paper I wrote that was extremely difficult for me to write. It stirred up a lot of emotions, some of which I had no idea I was still carrying around.

The reasons I am still around are many but sometimes that is not so obvious in a crisis. It truly is up to the individual to make the choice and no one can take it away. But if they let a professional know they are hurting and thinking of taking their life, they might be able to get the help they need. I just hope that with that help the person finds someone who is understanding and asks, “where do you hurt”?  Because otherwise it is going to be a long road for that person to find the help they need. Not all professionals are alike. They have different disciplines and treatment plans. But if they are able to find a therapist who is willing to take them as they are, that therapist is worth their weight in gold.

is suicide caused by psychological pain

by Midnight Demon, posted in suicide attempt

Since 1949, Edwin Shneidman has done extensive research in the field of suicidology.  He began his research by looking at suicide notes in the coroner’s office in Los Angeles (Shneidman, 1996).  During his intensive research, he came up with the term, “psychache” to refer to the mental pain, which, when intense, makes life so horrible and horrendous, that the sufferer can only think about suicide as the only option out of his/her misery.

Psychache can be defined as “hurt, anguish, soreness, aching, psychological pain in the psyche, the mind (Shneidman, 1996).”  Risk factors associated with suicide are only relevant as far as they can relate to psychache (Shneidman, 1993, 2005).  Dr. Shneidman believes that the true cause of anyone’s thoughts of killing themselves derive from this “psychache.”

During my research for this paper, I concluded that literature concerning the cause for individuals to resort to suicide is sadly lacking.  Most of the assessment scales for determining suicide risk focus on basically, two concepts as proposed by Rosenberg  (1999), action based and affective based interventions. 

Action-based interventions can include items such as a “no suicide” contract, increase sessions or phone check-ins, and, if appropriate, hospitalization. 

Affective based interventions focus on feeling and thoughts that are behind the suicidal ideation. 

Attempts have been made by several researchers for implementing a framework for something close to a “standard” for treatment care that is not determined by litigation (Brown, Jones, Betts, & Wu, 2003; Joiner & Rudd, 2000; Joiner, Walker, Rudd, & Jobes, 1999; Kral & Sakinofsky, 1994; Rosenberg, 1999; Rudd, 1998; Rudd, Joiner, Jobes, & King, 1999; Sommers-Flanagan, Rothman, & Schenkler, 2000; Walker, Joiner, & Rudd, 2001).  Discussion of litigation is not the objective of this paper, so if the reader is interested, Brown et al (2003) would be the work to which one is referred.

The frameworks provided by these researchers have provided many useful scales in determining risk and lethality of suicide, but do not include the assessment of psychological pain.  In Range and Knott’s (1997) analysis of twenty assessment instruments, not one of the twenty examined includes an assessment of psychological pain.  One reason for this is the subjectivity on the individual’s emotions, thoughts, mental state, and experience (Kral & Sakinofsky, 1994).  According to Kral and Sakinofsky (1994), suicidologists are in general agreement that “predicting suicide for a given individual is that, like many human states, the suicidal state has a temporal, fluctuating dimension”.  They propose that the evaluation of psychache experience, the psychological state of the suicidal person, is the key to accurate risk assessment.

Psychache is subjective.  A person is not going to feel the exactly the same way for any length of time.  However, if the level of perturbation (mental anguish) increases in intensity for too long, the individual is going to feel a need to escape from the anguish and despair by any means necessary, including by not existing any more.  If suicide is seen as the only option, the only form of escape, lethality of a suicide attempt is high risk.  Kral and Sakinofsky (1994) have stated that treatment of perturbation will reduce lethality and treatment of lethality ideation will reduce perturbation as these two states can feed off one another (Kral & Sakinofsky, 1994). 

A scale to the assessment of suicide risk would be to have a scale of the person’s needs and current psychological pain.  Dr. Shneidman believes, as do I, that when psychache is intense, perturbation is intolerable, and one or more psychological needs are thwarted or blocked, suicide is seen as the only option of relieving the psychache (Shneidman, 1999).  He has based these needs on described by Henry Murray’s (1938) Explorations in Personality. Shneidman has developed 20 psychological needs.  These needs are weighted and the total sum is 100 (see table 1 for an example).

Table 1

 

Murray Need Form

­­­­­­­­­­­­­­­­­­­­­­­_______________________________________________________________________
Subject: ____________________Sex: _______Age: ______Rater:________Date:_______

­­­­­­­­­­­­­­­­­­­­­­­_______________________________________________________________________

_____   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.

100

(Shneidman, 1999; used with permission)
References:

 

Brown, G. S., Jones, E. R., Betts, E., & Wu, J. (2003). Improving suicide risk assessment in a managed care environment. Crisis, 24(2), 49-55.

Joiner, T. E., & Rudd, M. D. (2000). Intensity and duration of suicidal crises vary as a function of previous suicide attempts and negative life events. Journal of Counseling and Clinical Psychology, 68(5), 909-916.

Joiner, T. E., Walker, R. L., Rudd, M. D., & Jobes, D. A. (1999). Scientizing and routinizing the assessment of suicidality in outpatient practice. Professional Psychology: Research and Practice, 30(5), 447-453.

Kral, M. J., & Sakinofsky, I. (1994). Clinical model for suicide risk assessment. Death Studies, 18, 311-326.

Murray, H. A. (1938). Explorations in personality. New York: Oxford University Press.

Range, L. M., & Knott, E. C. (1997). Twenty suicide assessment instruments: Evaluation and recommendations. Death Studies, 21(1), 25-58.

Rosenberg, J. I. (1999). Suicide prevention: An integrated training model using affective and action-based interventions. Professional Psychology: Research and Practice, 30(1), 83-87.

Rudd, M. D. (1998). An integrative conceptual and organizational framework for treating suicidal behavior. Psychotherapy, 35(3), 346-360.

Rudd, M. D., Joiner, T. E., Jobes, D. A., & King, C. A. (1999). The outpatient treatment of suicidality: An integration of science and recognition of its limitations. Professional Psychology: Research and Practice, 30(5), 437-446.

Shneidman, E. (1996). The suicidal mind: Oxford University Press.

Shneidman, E. S. (1993). Commentary: Suicide as psychache. Journal of Nervous and Mental Disease, 181, 147-149.

Shneidman, E. S. (1996). Suicide as psychache.New York and London: New York University Press.

Shneidman, E. S. (1999). The psychological pain assessment scale. Suicide and Life-Threatening Behavior, 29(4), 287-294.

Shneidman, E. S. (2005). How I read. Suicide and Life-Threatening Behavior, 35(2), 117-120.

Sommers-Flanagan, J., Rothman, M., & Schenkler, R. (2000). Training psychologists to become competent suicide assessment interviewers: Commentary on Rosenberg’s(1999) suicide prevention. Professional Psychology: Research and Practice, 31(1), 99-100.

Walker, R. L., Joiner, T. E., & Rudd, M. D. (2001). The course of post-crisis suicidal symptoms: How and for whom is suicide “cathartic”? Suicide and Life-Threatening Behavior, 31(2), 144-152.

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