Posted Apr 8, 2019

Suicide Is Not About a Desire to Die

In 1993, after studying suicide for 40+ years, Dr Edwin Shneidman published one of his most famous articles in a medical journal. Dr. Shneidman is thought by many to be the father of the science of understanding suicidal minds. The paper begins with the following paragraph:

"As I near the end of my career in suicidology, I think I can now say what has been on my mind in as few as five words: Suicide is caused by psychache. Psychache refers to the hurt, anguish, soreness, aching, psychological pain in the psyche, the mind. It is intrinsically psychological - the pain of excessively felt shame, or guilt, or humiliation, or loneliness, or fear, or angst, or dread of growing old, or of dying badly, or whatever. When it occurs, its reality is introspectively undeniable. Suicide occurs when the psychache is deemed by that person to be unbearable."

Many suicide loss survivors struggle with the concept of suicide and how someone could "choose" to end their life. My belief is that people don't choose suicide, just like people don't choose cancer or heart attacks. Twenty six years after Dr. Shneiderman said it in just five words, the general consensus has evolved to a belief that the majority of people who die from suicide were struggling with a mental illness such as depression, bipolar disorder, etc. While the circumstances associated with each suicide are unique, there are some common themes. The most commonly cited themes among those who have survived a suicide attempt are feelings of helplessness and hopelessness.

Often suicidal individuals isolate themselves and do not share their struggles with others. It is a symptom of the mental health challenge that they are facing. Even though that are surrounded by loving people who could help them, they can't see the help available, they feel helpless. Their illness prevents them from seeing the help around them, just like a color blind person can't see red and green around them. Similarly, suicidal individuals often feel hopeless. They can't see that there is a future and that their internal suffering could potentially stop. They are consumed by the lies that their brain is telling them and they are feeling an intense self pain. They are struggling internally while going through what looks like a normal life to those around them. Helplessness and hopelessness exist independent of the love and support around the person, it is a symptom of a suicidal mind.

Death by suicide is not about a desire to die, it is about ending the pain. It is about an attempt to stop the struggle inside of their head that we often could not see. Even if we saw them struggling, they rarely give us the opportunity to intervene. Death by suicide is a situation where our loved ones brain betrayed them. They died from the pain and the helplessness and hopelessness that they felt. Most suicide loss survivors struggle to accept and acknowledge this. Sadly, it is so much easier to blame yourselves for a process that is going on inside of someone else's head. Understanding how our loved ones died by suicide requires us to try and reach into the minds of our deceased loved ones. The truth is generally that you did everything that you could do, but you could not do everything. Hindsight bias alters our memories and causes many guilt and pain. The answers are rarely simple and the only person who truly knows those answers is no longer able to share them with us.