May Your Psychache be Minimal

David Webb
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I’m usually wary of heroes, but I’m happy to include Professor Edwin S. Shneidman in my very short list of personal heroes.

Ed Shneidman was a pioneer of the study of suicide and the inaugural president of the American Association of Suicidology (AAS) – indeed I believe he first coined the word ‘Suicidology’. Another term he coined was ‘psychache’ (pronounced psyche-ache), which he saw as the defining feature of all the many suicides he studied. He defined psychache as psychological pain – not illness – that was due to thwarted or frustrated psychological needs. As a psychologist, Shneidman would then apply his particular taxonomy of psychological needs when working with his suicidal clients.

Shneidman sadly died in 2009, age 91, lamenting what was happening to the discipline of Suicidology that he had helped found. In particular he lamented that Suicidology, which shares three parent disciplines (sociology, psychology and psychiatry), was being excessively medicalised by the juggernaut of modern biopsychiatry. With his typically sharp wit he has given us the most succinct assessment I know of for the shortcomings of the DSM when he describes it as “too much specious accuracy built on a false epistemology”.

I had the great good fortune to meet Ed Shneidman when I visited the U.S. in 2007. Some years earlier I had written to him as a precocious Ph.D. student requesting that he expand his definition of psychache to include spiritual as well as psychological needs. Not too big an ask, I thought, given that psyche means the soul. To my amazement he replied to my cheeky letter, though he graciously declined to accept my suggestion.

I tell this little story by way of introducing myself to readers of Mad in America. Although Ed Shneidman once called me a “fellow suicidologist”, I do not think of myself as a suicidologist. Rather, my interest in suicide is primarily as a survivor. Unfortunately, this is problematic language in Suicidology where ‘suicide survivor’ refers to those who have lost a loved one to suicide.

This language problem was one of my first encounters with Suicidology and I soon learned that people like me are categorised as suicide contemplators, attempters or completers. I started to feel uncomfortable when I could not find my story anywhere in this convenient taxonomy. Was my experience of suicidal feelings so uniquely peculiar to me? I didn’t think so then, and even more so now.

I became increasingly uncomfortable when I realised that what was missing most of all from this expert literature on suicide was the actual suicidal person. It was like these experts were looking at people like me through the wrong end of their telescopes so that we were barely visible specks on the distant horizon.

By rather peculiar circumstances, my curiosity led to me enrolling in a PhD which, by even more extraordinary circumstances, I managed to complete in 2006. The primary motivation for this was to argue that spirituality was relevant to the study of suicide, at least in some cases such as mine. Related to this was the need for Suicidology to consider what suicidal feelings mean to those who actually live them. And for this, Suicidology had to hear the first-person voice of suicidal people.

In future blogs I’ll share with you some of my research, which proved more fascinating than I’d ever imagined. But I’ll also share how alongside my research I became increasingly aware of the politics of suicide prevention. There is considerable overlap here with the politics of mental health in general, but also some distinctive differences that I want to explore with you here at Mad in America.

The main conclusion of my research was to call for a broad, ongoing community conversation about suicide. There are many reasons this is needed, such as to bring suicide out of the closet as a public health issue. But I also see this conversation as a suicide prevention measure. A society that is capable of an open, honest and sensible conversation about suicide is, I believe, a society where suicidal feelings are not only less likely to arise in the first place, but is also a society that is more capable of helping people through these feelings.

I’m obviously talking about a very different kind of conversation to the shallow, frightened, ignorant and prejudiced public discourse that we typically have about suicide. First of all, at the very heart of this conversation will be the first-person voice of survivors, those who know suicidal feelings ‘from the inside’. There are thousand, millions, of us, which is a huge but largely untapped source of expertise that is found nowhere else.

It will also be a conversation that doesn’t shy away from the politics of suicide. To give just one example, a critical question that Suicidology has not yet addressed is, “Do our mental health laws help or hinder suicide prevention?” I’ll spend some time exploring this and other related questions with you in a future blog post.

And just in case it’s not obvious, this community conversation will not be owned and controlled by medical or other ‘experts’ (or politicians or bureaucrats).

I see a great thirst in the community for this very different conversation about suicide. I also see a large mismatch between what people really want to talk about and what the experts are saying. I also see much fear and uncertainty because yes, it’s scary. And yes, we fumble and struggle to talk about this scary and complex issue. So yes, we need to proceed with great care and humility as we learn how to conduct this conversation. But it is overdue, long overdue, that we begin this conversation.

So I’m delighted to have the opportunity to try and help this conversation along here at Mad in America. For me, this blog-space is at the forefront of many different but overlapping conversations on how we might respond better to extreme emotional distress (psychache) and/or altered states of consciousness. And it’s a real milestone to bring these conversations together with so many terrific contributors, including (especially) those who comment on the blog posts.

In my next post I’ll try and give an overview of what I see as the key issues around suicide that we might talk about. I’ll then follow up with separate posts on some of the individual issues. But I’m keen to hear what your views are and what you see as the key issues. And I’m happy for this blog to be guided by your concerns rather than just my own agenda… which I’ll eventually get to in due course…

I’m especially keen for this blog to be a space where fellow survivors can speak freely and openly – and safely – about their experiences of suicidal feelings. A word of caution though. If you’re not already publicly open – out of the closet – as a survivor, you may want to comment using a pseudonym or nickname. I say this because there’s lots of good reasons why you might want to keep your suicidal history private – e.g. one very special friend hasn’t told her kids about her history yet. And because there are some very nasty, almost hateful, prejudices against suicidal people that are worth hiding from if you’re not feeling very strong on any particular day. Keep in mind also that it’s hard to get back into the closet once you’re out.

I must also mention that I am not a counsellor or therapist of any kind. I have neither the expertise nor the desire for that kind of relationship with anyone.

Finally, if you want to contact me directly via email rather than through a comment on one of my posts, I believe you can do this through the contact page here at Mad in America. Alternatively, I also have a contact page at my website, which you can find at thinkingaboutsuicide.org – be careful, there is also a .com with the same name that appears to use the Bible as their primary suicide prevention tool.

I’ll give the last word to Prof. Ed Shneidman, who signed off one of his letters to me with the salutation (and blessing) …

May your psychache be minimal…

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20 COMMENTS

  1. David,

    This is a great post and speaks about what I have been concerned about for quite awhile regarding psychiatry claiming that most suicides are due to mental illness. In my opinion, it is quite possible to be distressed about something to the point where you want to commit suicide and not be mentally ill. Those folks who did that during the depression prove that point as well as folks who committed suicide due to constant bullying.

    Another reason this mental illness pathologizing of suicide greatly bothers me is it is convenient way to blame the victim vs. taking action to deal with the horrific situations that caused the problem.

    I look forward to hearing more about what you have to say on this issue.

    • Above this article is another by Lucy Johnstone, an English Clinical Psychologist, who questions the whole idea of mental health diagnosis. She baldly states that mental distress is about relationships and situations and not chemical imbalances or genetic. Whether her article says that the whole idea of mental illness is a sham or whether the article merely, to my mind, implies it, is something I can’t, at the moment say.

      Perhaps it is possible to be so distressed about something that you hear cruel and tormenting voices and have really strange ideas and yet not be mentally ill?

      I think what Lucy Johnstone is saying is that Mental Illness is a social construction, that is what I understand anyway. It is one that was invented so that Dr’s could make money out of the disturbed and the disturbing. Unfortunately they don’t always seem to be doing a good job of helping people (ironic understatement alert)

  2. Funnily enough, though not funny at all, a friend committed (or as as the above taxonomy suggests, contemplated, attempted and completed) suicide over Christmas. There were probably many reasons but being trapped by psychiatry and forced to have meds by injection, which she hated and saw as destroying her abilities were probably a large part of it.

    I only found out yesterday. So it is a bit odd to come to this website to find this piece.

    • Went to meeting tonight to facilitate support meeting, the group started to review support procedures for people forced to have unwanted psychiatric treatment, the group also started working on a plan for a vigil for our comrade and for those who have not survived psychiatry

  3. John,

    I am so sorry about your friend. I can’t imagine the horror she experienced in feeling trapped by psychiatry.

    What is really disgusting is that psychiatry would look at your friend’s suicide as proof she needed more of the meds.

    Again, my condolences.

    • Indeed, but this was not the whole of her life and I guess there is often more than one cause that contributes to the decision.

      I am helping organise support meetings, informing people who knew her on facebook and encouraging people to talk and support each other. It seems important to do this, especially for activist who may be tempted to rush into activism before digesting the reality of what has happened sufficiently.

      • My sorrow for the loss of your friend. My thought may be striking or harsh. Unintended. What I have to say is this:

        the subsequent gathering of however many others, for support and comfort and whatever other produce and comsumption, is precisely the sort of gathering of care that needs to take place in the life of the isolated and unreachable sufferer. The word might be intervention but I’d say that word is counter-productive and missing the mark.

        I have often wondered – why do people not stop what they are doing, organize to care and suppport and actually get involved, determined to rescue and redeem the sufferer? Why is this so absent in life? In my experience, the structure of family and community are so compromised, in favor of individualism, that those of us who need are silently judged as fundamentally flawed. John Lennon said come together RIGHT NOW over me, not come together over me, after I’m already dead.

  4. Sorry to hear of the loss of your friend, John. A strange, sad way to start the new year. I hope her friends can get together to remember her and help each other through it.

    Really looking forward to your columns, David! A brief discussion about suicide broke out here a few months ago, in response to the article about two men alleged to have killed their children in a temporary psychotic state brought on by antidepressants.

    https://www.madinamerica.com/2012/10/canadian-who-killed-son-while-on-medication-joins-forces-with-u-s-dad-who-killed-twins/

    If they were really remorseful, would they not have committed suicide, some wondered? Or at least tried? It brought home for me that what a society really thinks about your life and your death can have a huge impact on how you react to these impulses. Even suicides brought on by SSRI’s (probably the most biological there are) are probably not only 100.00% chemical. And people who have been there can help figure this out.

  5. Thank you for this. I was at a 12 step meeting and the talk was given by someone who at times was actively suicidal but never acted out. The room was full of nods of recognition as this person spoke elequently about the key factor that triggered the emotional pain. I think this is going on everywhere but doesn’t get talked about and or noticed.
    I have known of several successful suicide attempts and have been greatly affected by them. Always such a sad loss but the words that are needed to be spoken sometimes don’t get said. We carry the words in our heads all of us but never share them so in the world it looks as if things are “normal”.
    Suicde is a rippling wave that afffects the whole community in many different ways and patterns of combinations. I think the 6 degrees of seperation theory fits well. It would be interesting to do a mapping of the effects so that a visual could be used to show the various stress ripples.I think it would show that my several contacts with this tragedy is not uncommon and the conversation needs to be started sooner rather than latter.

  6. I share your interest in learning more about suicide, and look forward to the conversation. My fourteen year old son’s death certificate indicates he died from a self-inflicted gunshot wound to the head (a suicidal death), but I’ve long questioned if this was the actual cause of his death. I have three statements from various experts who believe he may have been shot by someone else, and that the stated cause of death is questionable. It makes me wonder how many deaths have been attributed to suicide, but may not have been.

  7. I was almost a “completer.” I fought tooth and nail with every psychiatrist and professional who dealt with me in the so-called “mental health system” that my wanting to die did not prove that I was mentally ill or sick or “crazy.”

    In the first psych hospital where I was held before I was sent to the state hospital a number of us would gather in the rec room and talk about our suicide issues. One of the residents, who always wanted to control the behavior of everyone else on the unit, ran to the staff and told them about our conversations. Some felt that our discussions were “inappropriate” and that we should be working on our “recovery.”

    I agree, we need to bring suicide out into the open and really discuss it. Maybe then it wouldn’t happen as much as it does.

  8. Great to see you on here David.

    While I have had this discussion with you before, and I agree that feeling suicidal is not a mental illness, I think one has to understand that the whole concept of mental illness has changed over recent years. The slightest feelings of sadness are now see as an incurable brain disease and a mental illness. Sure mental illness used to mean psychosis, or profound unremitting depression, but with the obsession with early intervention, especially in Australi, which means we treat everyone before they even show any of the behaviours that they classify as symptoms, everything is a mental illness, and that includes the slightest feelings of sadness, loneliness, etc, all of which we all experience at some stage or another, well maybe not our pat, but one wonders what if anything he actually feels.

  9. I used to work on a suicide hotline, staffed almost entirely by volunteers, and it was amazing how helpful it was for the suicidal person just to have someone listen to what they were struggling with that made life not seem worth continuing. Validating that life can be awful and that many of us (including me) may contemplate suicide as a potential solution to the dismal appearance of our lives seemed to be the thing that helped the most.

    I do think suicidal feelings are a very normal reaction to the stresses of modern society. That the folks on a psych ward would try to stop patients from discussing their suicidal feelings with each other just shows how very far psychiatry has come from even understanding the problem they think they are working on.

    I totally agree, any discussion of suicidal behavior and feelings needs to start with the person experiencing those feelings. That’s how I always approached it and it worked very well for me and the callers.

    Looking forward to reading your research.

    — Steve

  10. I saw this blog’s title in the side section and smiled. I couldn’t wait to see who the author was. I am excited to read more in the near future.

    I’m bursting with thought ~ so many points and memories. Suicide is something that has been written on my heart, along with a few other of humanity’s greatest sufferings. I have figured out that sui-cide and homi-cide are two cides of the same coin, so to speak. It is the very lowest point a person can be at – so low that I would compare it to the roots of a tree, buried and twisted deep beneath the dark, cold and squirming ground. Now imagine that tree has been stumped – it’s branches and limbs severed, cut off from life. The sky is unreachable, no riding on clouds and no dreams. A severed tree is a dead tree, half-alive.

    Suicide is the murder of self and homicide is the murder of other. I see the condition / state-of-being as a sign that the sufferer is the one who has suffered a fatality, some place within themselves. In one of my 7 psychiatric incarcerations I spoke out loud what occured to me in thought while in a group sitting. Suicidality is the condition where there is something you cannot live with, something you cannot live without or both of those things simultaneously. The response was positive, as if I had used a golden key and unlocked the door to better understanding. The story is rather long but in short, that hospital was significant for me because it was in Warren County and I always wondered about my cousin Warren from NJ – whom I’ve never met but might have, if he had not killed himself.

    I exist in that low, low state of morbid death. From the inside, I know how dead I am (I have not survived fatal traumas). I know that SPIRIT animates me and keeps me alive. I am meant to see that as a blessing though very often, I feel quite tortured – kept alive against my will to pass away. Suicide / homicide are ever-present in my every day’s thoughts and feelings. I only exist. I do not live and cannot ever be found among the land of the living.

    Very much looking forward to reading more from David Webb.

  11. So glad to see you here David. And from the responses it is obvious how much the discussion is needed. It’s a starting point that goes beyond suicide itself, just as the work of the hearing voices network goes beyond hearing voices. I like very much what the comment just above mine here (by mjk) says about suicide being about something you can’t live with, or can’t live without, or both.

    Look forward to seeing how the conversation develops.

  13. It’s been one year and exactly four months today that the woman I loved completed suicide. I still open my eyes everyday feeling the ache and pain of the moment I learned I would never see her again. The American Association of Suicidology (AAS) says that there are on average 6 family members left after each completion. I have found that number to be an underestimate. It also does not account for close friends who had extremely close relationships with the person that left. As a person that has who has struggled with suicidal thoughts since the age of 5 or 6 it is something that takes years to work through and each and every time I planned and tried to complete I traumatized myself beyond imagination. I am thankful to be here but somedays my heart aches from my own internal personal pain as well as the pain of losing someone to suicide. Thank you for sparking this conversation.

  14. When I was 16 and off psycho-tropic drugs for the first time in four years I didn’t necessarily feel the weight of suicidal thoughts lessen but I did find my mind reaching out for more meaning in these experiences.

    I sought out a Tibetan Buddhist temple nearby in a rural NJ town (oddly enough: previously known to me only as a place with an active KKK group). My experiences of the rituals and ideas there by no means turned me into a devout follower–I was pretty staunchly agnostic at that age–but definitely guided me to see my struggles against self-annihilation as something to learn from in the struggle instead of something to be wholly burdened by.

    I’m curious about the ways standard treatment through biological psychiatric (or at least the kind I’ve been exposed to as a younger person in the US) straps so many people of any inborn capacity to seek out meaning in life. To angle people’s eyes and minds to the ground, focus them on maintenance of a dismal or limited present and even chemically drive many towards suicide.

    Thanks David for this thoughtful post–even though I may have read it months after the fact.

    I feel that suicide is less of a public health problem (i.e., a clearly “diagnosable” biological social ill) and more of an individual crisis of meaning and dignity brought on by other public health crises–among those poverty, malnutrition and the over-medication of people who seek support and guidance through painful experiences of emotional distress, which often only prolongs the focus in someone’s life of themselves as a sick, shiftless human being instead of as a resilient one.

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