“Why do people consider suicide?” Not an easy topic to address, but Norman Weissberg, Ph.D., a psychologist from New York did so recently to a group of psychotherapists.
What he called the “flip” answer he gave first: because these people are experiencing intolerable psychological pain. “It hurt too much to live,” noted one survivor of an attempt. And, further, the “flip” answer to what moves some people to action, says Weissberg, is that they can—they have the means and the capability.
However, Weissberg enjoins us to look further than the quick answer. He asks why are the people in such psychological pain. It appears, according to Thomas Joiner, Ph.D., in his research on suicide, that two factors may drive the death wish. One, there is a perceived burdensomeness. That is, the individual believes that he/she is defective and flawed and therefore a burden to family and perhaps even to country—the sense of “everyone will be better off without me.”
Two, there is, in addition to feeling a burden, there is a sense of failed belonging. This belief carries with it a feeling of isolation, of “standing apart from all the people in my life.” This is not about objective reality: the individual indeed may be a part of a club or a group, e.g., yet internally feel isolated.
According to Weissberg’s study of the data, we do not have good predictors of suicide. Suicidal ideation and a plan by itself are not predictors of attempts. SAMHSA, the Substance Abuse Mental Health Administration of our federal government, notes that four percent of the adult population of the U.S. has acknowledged suicidal thoughts in the past year. Of those 8.3 million people, 2.3 million had made a plan, and 1.1 million had made an attempt.
The important question for suicide prevention is what prompts a person to go beyond the ideation and make an attempt. Our built-in resource, Weissberg reminds us, is self-preservation: “The body tries to keep us alive.” Humans generally fear the pain of severe self-injury. The theory is that persons can undergo experiences to desensitize them to fear and override pain. Then exhilaration replaces fear and risky activity can promote fearlessness.
Because a person overcomes fear of suicide by attempting it, Weissberg reports that a prior attempt of suicide is the simple, best predictor of completing the act.
It was thought that cutting (the act of self-injuring, self-mutilation) was not at all related to suicide because the cutter acts to regulate his or her emotions, suicide not being the motivation. However, cutters, in their experience of pain, are de-sensitizing themselves to pain, thereby habituating to self-injury. So it is now found that there is a correlation between cutting and suicide and, in fact, seventy percent of cutters report suicide attempts. Weissberg notes that watching violent films (and I would add video games, etc.), football, hockey—anything that entails pain in which we get habituated and de-sensitized—provides the capability to override the pain of suicide. Weissberg also reminds us that those habituated to pain and who inflict pain on others are physicians and dentists.
Capability includes having the means. Weissberg recommends that if there is any indication of suicidality to remove the methods—such as medicines in a cabinet, guns in the closet.
Fortunately, suicide risk involves more than capability. Present research points to two other factors that need to converge with capability: perceived burdensomeness and failed belongingness.
Antidotes to these three factors of suicidal risk are what are defined as buffers: the relationships, beliefs, value systems—whatever might reinforce the will to live. Immediate supports include friends, family, social groups, pets. Plans for the future are also buffers, yet sometimes a person plans for the future even in the midst of planning suicide. Weissberg remarks that suicide is most often an ambivalent act. (Of course, this is little comfort to the grievers.)
Sometimes a person may manifest preparatory behavior—an adolescent may start to clean up his/her messy room and give things away; adults may do likewise.
Often, however, there are no outward warnings; and in the aftermath of a suicide, loved ones might blame themselves for not seeing any danger signs. Given the ambivalence of the person in such psychological pain as to consider suicide and given the simple, most accurate predictor of suicide is a past attempt, it is an excruciating acknowledgement that a completed suicide is beyond our control.
So what of suicide prevention? Consider promoting a sense of belonging and connectedness, supporting options for relieving psychological pain other than death, developing a caring supportive network.