T
Terrible_Life
Specialist
- Jul 3, 2025
- 356
1. Psychache: The Central Concept
· Definition: Psychache is intense, unbearable psychological pain. It's not just depression, sadness, or anxiety in a clinical sense; it's a feeling of immense mental agony, hopelessness, and helplessness.
· The Core Proposition: Shneidman famously stated, "Suicide is caused by psychache." He argued that when this pain is perceived as endless and intolerable, and when an individual can see no other way to escape it, suicide emerges as a solution. He wrote, "The enemy to life is pain, self-perceived psychache. The key clinical question is: 'Where do you hurt?' and the key operative question is: 'How can we reduce your pain?'"
2. The Ten Commonalities of Suicide
Shneidman identified ten common characteristics he observed in most suicides. These are not causes in themselves, but rather the typical "symptoms" or "profile" of a suicidal state of mind.
1. The Common Purpose: To seek a solution. Suicide is seen as the only way out of an unbearable problem or emotional state.
2. The Common Goal: To cease consciousness. The goal is to end the unbearable pain, not necessarily life itself. The shutdown of awareness is the desired result.
3. The Common Stimulus: Unbearable Psychological Pain (Psychache).
4. The Common Stressor: Frustrated Psychological Needs. Shneidman drew on Henry Murray's work on personality, identifying needs like achievement, affiliation, autonomy, and shame avoidance. When these core needs are chronically frustrated, psychache results.
5. The Common Emotion: Hopelessness-Helplessness. A profound feeling that things will never get better and that no one can help.
6. The Common Cognitive State: Ambivalence. Most suicidal people have conflicting feelings—part of them wants to live, and part of them wants the pain to stop. This is a critical window for intervention.
7. The Common Perceptual State: Constriction (Tunnel Vision). The person's thinking becomes dichotomous (either/or) and rigid. They can only see two options: a magical solution or death. They lose the ability to see alternative paths, past coping mechanisms, or the impact on others.
8. The Common Action: Egression. The desire to escape, to flee, to "get out."
9. The Common Interpersonal Act: Communication of Intention. Shneidman emphasized that most people who die by suicide communicate their intent, either directly or indirectly, beforehand (e.g., "You'd be better off without me," giving away possessions).
10. The Common Pattern: Consistency of Lifelong Coping Styles. People often deal with crisis in ways that are consistent with their lifelong patterns. Someone who has always responded to stress by "running away" may, in an extreme situation, see suicide as the ultimate form of escape.
3. Cubic Model of Suicide
Shneidman also developed a model to visualize the risk of suicide, based on three dimensions:
1. Pain (Psychache): The intensity of the unbearable psychological pain.
2. Pressure (Inner "Can't Stand It Anymore" Feeling): The internal urgency and demand for relief.
3. Perturbation (Agitation/Discomfort): The level of emotional turmoil and restlessness.
According to this model, the risk of suicide is highest when all three of these factors are high simultaneously.
· Definition: Psychache is intense, unbearable psychological pain. It's not just depression, sadness, or anxiety in a clinical sense; it's a feeling of immense mental agony, hopelessness, and helplessness.
· The Core Proposition: Shneidman famously stated, "Suicide is caused by psychache." He argued that when this pain is perceived as endless and intolerable, and when an individual can see no other way to escape it, suicide emerges as a solution. He wrote, "The enemy to life is pain, self-perceived psychache. The key clinical question is: 'Where do you hurt?' and the key operative question is: 'How can we reduce your pain?'"
2. The Ten Commonalities of Suicide
Shneidman identified ten common characteristics he observed in most suicides. These are not causes in themselves, but rather the typical "symptoms" or "profile" of a suicidal state of mind.
1. The Common Purpose: To seek a solution. Suicide is seen as the only way out of an unbearable problem or emotional state.
2. The Common Goal: To cease consciousness. The goal is to end the unbearable pain, not necessarily life itself. The shutdown of awareness is the desired result.
3. The Common Stimulus: Unbearable Psychological Pain (Psychache).
4. The Common Stressor: Frustrated Psychological Needs. Shneidman drew on Henry Murray's work on personality, identifying needs like achievement, affiliation, autonomy, and shame avoidance. When these core needs are chronically frustrated, psychache results.
5. The Common Emotion: Hopelessness-Helplessness. A profound feeling that things will never get better and that no one can help.
6. The Common Cognitive State: Ambivalence. Most suicidal people have conflicting feelings—part of them wants to live, and part of them wants the pain to stop. This is a critical window for intervention.
7. The Common Perceptual State: Constriction (Tunnel Vision). The person's thinking becomes dichotomous (either/or) and rigid. They can only see two options: a magical solution or death. They lose the ability to see alternative paths, past coping mechanisms, or the impact on others.
8. The Common Action: Egression. The desire to escape, to flee, to "get out."
9. The Common Interpersonal Act: Communication of Intention. Shneidman emphasized that most people who die by suicide communicate their intent, either directly or indirectly, beforehand (e.g., "You'd be better off without me," giving away possessions).
10. The Common Pattern: Consistency of Lifelong Coping Styles. People often deal with crisis in ways that are consistent with their lifelong patterns. Someone who has always responded to stress by "running away" may, in an extreme situation, see suicide as the ultimate form of escape.
3. Cubic Model of Suicide
Shneidman also developed a model to visualize the risk of suicide, based on three dimensions:
1. Pain (Psychache): The intensity of the unbearable psychological pain.
2. Pressure (Inner "Can't Stand It Anymore" Feeling): The internal urgency and demand for relief.
3. Perturbation (Agitation/Discomfort): The level of emotional turmoil and restlessness.
According to this model, the risk of suicide is highest when all three of these factors are high simultaneously.