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»Being Suicidal: What it feels like to want to kill yourself
By Jesse Bering Oct 20, 2010 03:45 PM 25

One of the more fascinating psychotic conditions in the medical literature is
known as Cotard’s syndrome, a rare disorder, usually recoverable, in which the
primary symptom is a “delusion of negation.” According to researchers David
Cohen and Angèle Consoli of the Université Pierre et Marie Curie, many
patients with Cotard’s syndrome are absolutely convinced, without even the
slimmest of doubts, that they are already dead.

Some recent evidence suggests that Cotard’s may occur as a neuropsychiatric
side effect in patients taking the drugs aciclovir or valaciclovir for herpes
and who also have kidney failure. But its origins go back much further than
these modern drugs. First described by the French neurologist Jules Cotard in
the 1880s, it is usually accompanied by some other debilitating problem, such
as major depression, schizophrenia, epilepsy or general paralysis—not to
mention disturbing visages in the mirror. Consider the case of one young woman
described by Cohen and Consoli: “The delusion consisted of the patient’s
absolute conviction she was already dead and waiting to be buried, that she
had no teeth or hair, and that her uterus was malformed.” Poor thing—that
image couldn’t have been very good for her self-esteem.

Still, call me strange, but I happen to find a certain appeal in the
conviction that one is, though otherwise lucid, nevertheless already dead.
Provided there were no uncomfortable symptoms of rigor mortis cramping up my
hands, nor delusory devils biting at my feet, how liberating it would be to be
able to write like a dead man and without that hobbling, hesitating fear of
being unblinkingly honest. Knowing that upon publication I would be tucked
safely away in my tomb, I could finally say what’s on my mind. Of course,
living one’s life as though it were a suicide note incarnate (yet remember
this is precisely what life is, really, and I would advise any thinking person
to stroll by a cemetery each day, gaze unto those fields of crumbling
headstones filled with chirping crickets, and ponder, illogically so, what
these people wish they might have said to the world when it was still humanly
possible for them to have done so ) is an altogether different thing from the
crushing, unbearable weight of an actual suicidal mind dangerously tempted by
the promise of permanent quiescence.

In considering people’s motivations for killing themselves, it is essential to
recognize that most suicides are driven by a flash flood of strong emotions,
not rational, philosophical thoughts in which the pros and cons are evaluated
critically. And, as I mentioned in last week’s column on the evolutionary
biology of suicide, from a psychological science perspective, I don’t think
any scholar ever captured the suicidal mind better than Florida State
University psychologist Roy Baumeister in his 1990 Psychological Review
article , “Suicide as Escape from the Self.” To reiterate, I see Baumeister’s
cognitive rubric as the engine of emotions driving deCatanzaro’s biologically
adaptive suicidal decision-making. There are certainly more recent theoretical
models of suicide than Baumeister’s, but none in my opinion are an
improvement. The author gives us a uniquely detailed glimpse into the
intolerable and relentlessly egocentric tunnel vision that is experienced by a
genuinely suicidal person.

According to Baumeister, there are six primary steps in the escape theory,
culminating in a probable suicide when all criteria are met. I do hope that
having knowledge about the what-it-feels-like phenomenology of ‘being’
suicidal helps people to recognize their own possible symptoms of suicidal
ideation and—if indeed this is what’s happening—enables them to somehow derail
themselves before it’s too late. Note that it is not at all apparent that
those at risk of suicide are always aware that they are in fact suicidal, at
least in the earliest cognitive manifestations of suicidal ideation. And if
such thinking proceeds unimpeded, then keeping a suicidal person from
completing the act may be as futile as encouraging someone at the very peak of
sexual excitement to please kindly refrain from having an orgasm, which is
itself sometimes referred to as la petite mort (“the little death”).

So let’s take a journey inside the suicidal mind, at least as it’s seen by Roy
Baumeister. You might even come to discover that you’ve actually stepped foot
in this dark psychological space before, perhaps without knowing it at the
time.

Step 1: Falling Short of Standards

Most people who kill themselves actually lived better-than-average lives.
Suicide rates are higher in nations with higher standards of living than in
less prosperous nations; higher in US states with a better quality of life;
higher in societies that endorse individual freedoms; higher in areas with
better weather; in areas with seasonal change, they are higher during the
warmer seasons; and they’re higher among college students that have better
grades and parents with higher expectations.

Baumeister argues that such idealistic conditions actually heighten suicide
risk because they often create unreasonable standards for personal happiness,
thereby rendering people more emotionally fragile in response to unexpected
setbacks. So, when things get a bit messy, such people, many of whom appear to
have lead mostly privileged lives, have a harder time coping with failures. “A
large body of evidence,” writes the author, “is consistent with the view that
suicide is preceded by events that fall short of high standards and
expectations, whether produced by past achievements, chronically favorable
circumstances, or external demands.” For example, simply being poor isn’t a
risk factor for suicide. But going rather suddenly from relative prosperity to
poverty has been strongly linked to suicide. Likewise, being a lifelong single
person isn’t a risk factor either, but the transition from marriage to the
single state places one at significant risk for suicide. Most suicides that
occur in prison and mental hospital settings occur within the first month of
confinement, during the initial period of adjustment to loss of freedom.
Suicide rates are lowest on Fridays and highest on Mondays; they also drop
just before the major holidays and then spike sharply immediately after the
holidays. Baumeister interprets these patterns as consistent with the idea
that people’s high expectations for holidays and weekends materialize, after
the fact, as bitter disappointments.

To summarize this first step in the escape theory, Baumeister tells us that,
“it is apparently the size of the discrepancy between standards and perceived
reality that is crucial for initiating the suicidal process.” It’s the
proverbial law of social gravity: the higher your majesty is to start off
with, the more painful it’s going to be when you happen to fall flat on your
face.

Step 2: Attributions to Self

It is not just the fall from grace alone that’s going to send you on a
suicidal tailspin. It’s also necessary for you to loathe yourself for facing
the trouble you find yourself in. Across cultures, “self blame” or
“condemnation of the self” has held constant as a common denominator in
suicides. Baumeister’s theory accommodates these data, yet his model
emphasizes that the biggest risk factor isn’t chronically low self-esteem, per
se, but rather a relatively recent demonization of the self in response to the
negative turn of events occurring in the previous step. People who have low
self-esteem are often misanthropes, he points out, in that while they are
indeed self critical, they are usually just as critical of other people. By
contrast, suicidal individuals who engage in negative appraisals of the self
seem to suffer the erroneous impression that other people are mostly good,
while they themselves are bad. Feelings of worthlessness, shame, guilt,
inadequacy, or feeling exposed, humiliated and rejected leads suicidal people
to dislike themselves in a manner that, essentially, cleaves them off from an
idealized humanity. The self is seen as being enduringly undesirable; there is
no hope for change and the core self is perceived as being rotten.

This is why adolescents and adults of minority sexual orientations, who grow
up gesticulating in a social womb filled with messages—both implicit and
explicit—that they are essentially lesser human beings, are especially
vulnerable to suicide. Even though we may consciously reject these personal
attributions made by an intolerant society, they have still seeped in. If we
extrapolate this to, say, Tyler Clementi as he was driving towards the George
Washington Bridge to end his own life in the wake of being cruelly and
voyeuristically outed over the Internet, I’d bet my bottom dollar that he felt
even the songs on the radio weren’t meant for him, but for “normal people”
more relatable to the singer and deserving of the song’s message.

Step 3: High Self-Awareness

“The essence of self-awareness is comparison of self with standards,” writes
Baumeister. And, according to his escape theory, it is this ceaseless and
unforgiving comparison with a preferred self—perhaps an irrecoverable self
from a happier past or a goal self that is now seen as impossible to achieve
in light of recent events—fuelling suicidal ideation.

This piquancy of thought in suicidal individuals is actually measurable, at
least indirectly by analyzing the language used in suicide notes. One
well-known “suicidologist,” Edwin Shneidman, once wrote that, “Our best route
to understanding suicide is not through the study of the structure of the
brain, nor the study of social statistics, nor the study of mental diseases,
but directly through the study of human emotions described in plain English,
in the words of the suicidal person.” Personally, I feel a bit like an
existential Peeping Tom in reading strangers’ suicide notes, but it’s a
longstanding cottage industry in psychological research. Over the past few
decades alone, nearly 300 studies on suicide notes have been published. These
cover a broad range of research questions, but because they tend to yield
inconsistent findings, they have also painted a confusing picture of the
suicidal mind.

This is especially the case when trying to reveal people’s motivations for the
act. Some who commit suicide may not even be aware of their own motivations,
or at least they have not been completely honest in their farewell letters to
the world. A good example comes from University of Manchester sociologist
Susanne Langer and her colleagues’ report in a 2008 issue of The Sociological
Review . The researchers describe how the suicide note written by one young
man was rather nondescript, mentioning feelings of loneliness and emptiness as
causing his suicide, while, in fact, “his file contained a memo inquiring
about the state of an investigation regarding sexual offences the deceased had
been accused of in an adjacent jurisdiction.”

The more compelling studies on suicide notes, in my view, are those that use
text analysis programs enabling the investigators to make exact counts of
particular kinds of words. Compared to fake suicide notes, real suicide notes
are notorious for containing first-person singular pronouns, a reflection of
high self-awareness. And unlike letters written by people facing involuntary
death, such as those about to be executed, suicide note writers rarely use
inclusive language such as plural pronouns, such as “us” and “we.” When they
do mention significant others, suicide note writers usually speak of them as
being cut off, distant, separate, not understanding, or opposed. Friends and
family, even a loving mother at arm’s length, feel endless oceans away.

Step 4: Negative Affect

It may seem to go without saying that suicides tend to be preceded by a period
of negative emotions, but, again, in Baumeister’s escape model, negative
suicidal emotions are experienced as an acute state rather than a prolonged
one. “Concluding simply that depression causes suicide and leaving it at that
may be inadequate for several reasons,” he writes. “It is abundantly clear
that most depressed people do not attempt suicide and that not all suicide
attempters are clinically depressed.”

Anxiety—which can be experienced as guilt, self-blame, threat of social
exclusion, ostracism and worry—seems to be a common strand in the majority of
suicides. As I mentioned in last week’s post, we may very well be the only
species for which negative social-evaluative appraisals can lead to
shame-induced suicide. It’s not without controversy, but the most convincing
data from studies with nonhuman animals suggest very strongly that we are the
only species on the face of the earth able to take another organism’s
perspective in judging the self’s attributes. This is owed to an evolutionary
innovation known as “theory of mind” (literally, theorizing about what someone
else is thinking about, including what they’re thinking about you ; and,
perhaps more importantly in this case, even what you’re thinking about you)
that has been both a blessing and a curse. It’s a blessing because it allows
us to experience pride, and a curse because it also engenders what I consider
to be the uniquely human, uniquely painful emotion of shame.

Psychodynamic theorists often postulate that suicidal guilt seeks punishment,
and thus suicide is a sort of self-execution. But Baumeister’s theory largely
rejects this interpretation; rather, in his model, the appeal of suicide is
loss of consciousness, and thus the end of psychological pain being
experienced. And since cognitive therapy isn’t easily available—or seen as
achievable—by most suicidal people, that leaves only three ways to escape this
painful self-awareness: drugs, sleep and death. And of these, only death,
nature’s great anesthesia, offers a permanent fix.

Step 5: Cognitive Deconstruction

The fifth step in the escape theory is perhaps the most intriguing, from a
psychological perspective, because it illustrates just how distinct and
scarily inaccessible the suicidal mind is from that of our everyday cognition.
With cognitive deconstruction, a concept originally proposed by social
psychologists Robin Vallacher and Daniel Wegner, the outside world becomes a
much simpler affair in our heads—but usually not in a good way.

Cognitive deconstruction is pretty much just what it sounds like. Things are
cognitively broken down into increasingly low-level and basic elements. For
example, the time perspective of suicidal people changes in a way that makes
the present moment seem interminably long; this is because, “suicidal people
have an aversive or anxious awareness of the recent past (and possibly the
future too), from which they seek to escape into a narrow, unemotional focus
on the present moment.” In one interesting study, for example, when compared
to control groups, suicidal participants significantly overestimated the
passage of experimentally controlled intervals of time by a large amount.
Baumeister surmises, “Thus suicidal people resemble acutely bored people: The
present seems endless and vaguely unpleasant, and whenever one checks the
clock, one is surprised at how little time has actually elapsed.”

Evidence also suggests that suicidal individuals have a difficult time
thinking about the future—which for those who’d use the threat of hell as a
deterrent, shows just why this strategy isn’t likely to be very effective.
This temporal narrowing, Baumeister believes, is actually a defensive
mechanism helping the person to cognitively withdraw from thinking about past
failures and the anxiety of an intolerable, hopeless future.

Another central aspect of the suicidal person’s cognitive deconstruction, says
Baumeister, is a dramatic increase in concrete thought. Like the intrusively
high self-awareness discussed earlier, this concreteness is often conveyed in
suicide notes. Several review articles have noted the relative paucity of
“thinking words” in suicide notes, which are abstract, meaningful, high-level
terms. Instead, they more often include banal and specific instructions, such
as, “Don’t forget to feed the cat,” or “Remember to take care of the electric
bill.” Real suicide notes are usually suspiciously void of contemplative or
metaphysical thoughts, whereas fake suicide notes, written by study
participants, tend to include more abstract or high-level terms (“Someday
you’ll understand how much I loved you” or “Always be happy”). One old study
even found that genuine suicide notes contained more references to concrete
objects in the environment—physical things—than did simulated suicide notes.

What this cognitive shift to concrete thinking reflects, suggests Baumeister,
is the brain’s attempt to slip into idle mental labor, thereby avoiding the
suffocating feelings that we’ve been describing. Many suicidal college
students, for example, exhibit a behavioral pattern of burying themselves in
dull, routine academic busywork in the weeks beforehand, presumably to enter a
sort of “emotional deadness” which is “an end in itself.” When I was a
suicidal adolescent, I remember reading voraciously during this time; it
didn’t matter what it was that I read—mostly junk novels, in fact—since it was
only to replace my own thoughts with those of the writer’s. For the suicidal,
other people’s words can be pulled over one’s exhausting ruminations like a
seamless glove being stretched over a distractingly scarred hand.

Even the grim, tedious details of organizing one’s own suicide can offer a
welcome reprieve:



When preparing for suicide, one can finally cease to worry about the future,
for one has effectively decided that there will be no future. The past, too,
has ceased to matter, for it is nearly ended and will no longer cause grief,
worry, or anxiety. And the imminence of death may help focus the mind on the
immediate present

Step 6: Disinhibition

We’ve now set the mental stage, but it is of course the final act that
separates suicidal ideation from an actual suicide. Baumeister speculates that
behavioral disinhibition, which is required to overcome the intrinsic fear of
causing oneself pain through death, not to mention the anticipated suffering
of loved ones left behind to grieve, is another consequence of cognitive
deconstruction. This is because it disallows the high-level abstractions
(reflecting on the inherent “wrongness” of suicide, how others will feel, even
concerns about self-preservation) that, under normal conditions, keep us
alive.

A recent theoretical analysis by University of Rochester psychiatrist Kimberly
Van Orden and her colleagues sheds some additional light on this component of
behavioral disinhibition. These authors point out that while there is a
considerable number of people who want to kill themselves, suicide itself
remains relatively rare. This is largely because, in addition to suicidal
desire, the individual needs the “acquired capability for suicide,” which
involves both a lowered fear of death and increased physical pain tolerance.
Suicide hurts, literally. One acquires this capability, according to these
authors’ model, by being exposed to related conditions that systematically
habituate the individual to physical pain. For example, one of the best
predictors of suicide is a nonlethal prior suicide attempt.

But a history of other fear-inducing, physically painful experiences also
places one at risk. Physical or sexual abuse as a child, combat exposure, and
domestic abuse can also “prep” the individual for the physical pain associated
with suicidal behavior. In addition, heritable variants of impulsivity,
fearlessness and greater physical pain tolerance may help to explain why
suicidality often runs in families. Van Orden and her coauthors also cite some
intriguing evidence that habituation to pain is not so much generalized to
just any old suicide method, but often specific to the particular method used
to end one’s own life. For example, a study on suicides in the U.S. military
branches found that guns were most frequently associated with Army personnel
suicides, hanging and knots for those in the Navy, and falling and heights
were more common for those in the Air Force.

So there you have it. It’s really not a pretty picture. But, again, I do hope
that if you ever are unfortunate enough to experience these cognitive dynamics
in your own mind—and I, for one, very much have—or if you suspect you’re
seeing behaviors in others that indicate these thought patterns may be
occurring, that this information helps you to meta-cognitively puncture
suicidal ideation. If there is one thing that I’ve learned since those very
dark days of my suicidal years, it’s that scientific knowledge changes
perspective. And perspective changes everything. Everything.

And, as I mentioned at the start, always remember: You’re going to die soon
enough anyway; even if it’s a hundred years from now, that’s still the blink
of a cosmic eye. In the meantime, live like a scientist—even a controversial
one with only an ally or two in all the world—and treat life as a grand
experiment, blood, sweat, tears and all. Bear in mind that there's no such
thing as a failed experiment—only data.


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