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#PsychAche – the Inner Emotions of Suicide

Originally posted September 12, 2013.

Today I’m participating in Cristi Motto Comes of Motherhood Unadorned in her World Suicide Prevention Day Blog Event for the week of September 10th. I’m also participating in Kathy Benson’s Bereaved and Blessed’s Time Warp Tuesday theme, Learning. I wanted to honor Kathy and also to honor my friend, Cristi for their work in helping and bringing people together.

Learning about Suicide Prevention

For the dual themes of Learning and Suicide Prevention, I looked for research articles in my university library exploring the deeper emotional content for persons contemplating suicide and what can be done to recognize and prevent this.

I was pleased to find Richard Lakeland and Mary Fitzgerald’s research article, How People Live with or Get Over Being Suicidal. It’s an analysis of existing qualitative research studies about living & coping with and recovering from suicidal feelings and thoughts. Qualitative research is all about interviewing real people, analyzing their lived experiences, finding common themes and inspirations in their stories so as to identify subjects that need more study or that can illuminate clinical treatment.


I also read The Suicidal Mind by Edwin S. Shneidman, a leading suicide researcher, who identified and the painful, internal landscape of persons who have contemplated suicide “psychache.” He says:

Psychache is the hurt, anguish, or ache that takes hold in the mind. It is intrinsically psychological – the pain of excessively felt shame, guilt, fear, anxiety, loneliness, angst, dread of growing old or of dying badly. When psychache occurs, its introspective reality is undeniable. Suicide happens when the psychache is deemed unbearable and death is actively sought to stop the unceasing flow of painful consciousness. Suicide is a tragic drama in the mind….. ..only a small minority of cases of excessive psychological pain results in suicide, but every case of suicide stems from excessive psychache. (Kindle Loc 161 of 1789)

This article helped me gain a deeper understanding of the internal landscape of those who experience suicidal thoughts and feelings and helped me re-focus and deepen my therapeutic work. The term psychache helps me label and understand the deep despair of persons who are in that dark place.

Lakeland and Fitzgerald’s incorporated Shneidman’s concept of psychache as they conducted their interviews. They found the personal accounts of the persons struggling with deep psychache had common internal emotional themes, described below.

Internal Struggles:


There was a dominant heroic internal struggle between what Freud described as Thanatos (drive towards self-destruction) and Eros (drive towards life)

People described waging an internal emotional battle managing varying intensities of suicidal desire

People forced themselves to be stoic so as not to give in to suicidal desires

They described struggling with the internal constant dilemma as to whether or not to act.

In light of their constant internal struggles, the participants described suicide mostly as a choice


The participants universally describe their personal internal struggle with the dialectic of meaning and meaninglessness. This struggle to find meaning is magnified by loss, illness, and growing old.

This deep dialectic/conflict between meaning and meaninglessness creates an internal emotional landscape of overwhelming terror and distress.

The participants describe experiencing an existential crisis in the form of feeling disconnected and finding life meaningless


The participants describe feelings of deep despair with life and relationships yet yearn for connection with others

The participants say those strong feelings of disconnection from others cause hopelessness

Healing Reconnections and a Sense of “Mattering”

The participants described reconnection with specific people and with humanity as a whole as important to their recovery and healing. As they reconnected to others, they found they could regain control over their thoughts and feelings.

Social connections helped overcome their negative feelings about the self, inspired hope, provided meaning and helped them move beyond suicidality

Reconnecting to one caring person seemed to be the catalyst and the healing balm, whereas connecting to many others was deemed overwhelming.

Connecting to one, intimate, accepting person to whom s/he could reveal his or her inner turmoil was the most healing

The social connections needed to be perceived as “accepting, permanent, encouraging, supportive and intimate”

Reconnecting to God and spirituality was also associated with recovery and healing

In this study, teenagers described having at least one person they felt connected to was significant in healing and coping

In this study, HIV infected men found support groups and professional help available to be healing connections

In older adults, the struggle to cope with growing older was constant theme in older adults. Prior to suicide attempts, older adults expressed they felt “invisible” and had no connection to a social circle. With older adults, as well, as they developed a sense of being connected, their suicidal feelings diminished

Mattering to someone

The participants said that their self-esteem was bolstered and their depression was lifted by feeling like that “mattered” to someone. They wanted to make a difference in someone’s life.

The need to matter is consistent across the lifespan

In general, people who feel they make a difference to someone are statistically less likely to have suicidal thoughts and feelings

Notes About Coping

During the normal course of developmental stages across the lifespan, such as adolescence and older adults, coping skills are strained and need to adapt to new circumstances,. With some people, their coping skills become overwhelmed and psychache may occur.

Some people said a suicide attempt was a way of taking control

Some professionals view suicidality as a coping mechanism in reaction to relating to the world.

Positive change occurs as more healthy coping skills are learned

For some of those with a terminal illness or infected with HIV, fantasizing about the method, time and place to die helped them gain a feeling of control over what is happening to them

The Role of Professional Help

Many participants expressed relief at being admitted to inpatient units in order to get help

Participants said compassionate, engaged, professionals willing to get to know them as individuals and understand their unique situation helped them get better.

The healing role of therapy

Your internal emotional struggles, your personal search for meaning, your internal dialectics, developing ways to feel like you matter, healing on levels that are not easily named….These are the topics of therapy. A therapist’s office is a special healing arena, with many benefits that are not easily identified. Your relationship with your therapist provides a place of personal safety, a place for you to grow, and a place of connection.

The therapy room is where you examines existential and emotional content. It is the place to talk about psychache and recovery.

Don’t be afraid. Reach out and use the health insurance you pay for. Call a local therapist. Get some help.

For those who need immediate help:

Persons who are suicidal and need immediate help please call 911 and obtain immediate services in your local area.

Hotline Websites:

1-800-SUICIDE 1-800-273-TALK


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