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On the topic of psychological pain that underlies most suicides, the late Edwin Shneidman wrote: “In almost every case, suicide is caused by pain, a certain kind of pain–psychological pain, which I call psychache.”

In Shneidman’s view, the root of psychache is thwarted psychological needs, some of which are the need for achievement, affiliation, autonomy, deference, nurturance, order, play, shame-avoidance, succorance, and understanding (The Suicidal Mind, New York: Oxford University Press, 1996, 4, 20).

Within the last decade, another researcher, Thomas Joiner, has begun to refine Shneidman’s concept of psychache. “I believe that Shneidman’s answer [regarding the cause of psychache] is too general, because most of us identify with one or more of these thwarted needs from time to time. What in particular . . . are people feeling psychache about?”

For background: Shneidman was a psychologist and pioneer in the study of suicide. He was a professor at the UCLA School of Medicine and founded the American Association of Suicidology in 1968. Joiner, whose father died by suicide in 1990, is a psychology professor and clinical researcher at Florida State University.

To the question of what exactly causes psychache, Joiner answers, “Perceived burdensomeness and failed belongingness.”

“People who are contemplating suicide perceive themselves as a burden, and perceive that this state is permanent and stable, with death as a solution to the problem.” Helping them requires pointing out how mistaken their perceptions are.

As for failed belongingness, Joiner notes that the human need to belong is fundamental. “The fact that those who die by suicide experience isolation and withdrawal before their deaths is among the clearest in all the literature on suicide.”

To illustrate, Joiner cites the example of a man in his thirties whose suicide note was found in his apartment: ” ‘I’m going to walk to the bridge. If one person smiles at me on the way, I will not jump’ ” (Why People Die By Suicide, Cambridge, Mass: Harvard University Press, 2005, 37-8, 38, 98, 122, 120).

In 1995, my teenage daughter Mary left a suicide note which spoke of her sense of failed belongingness: “I say hello to kids in the hall at school, but that’s about where it ends. I don’t know why they’re laughing or why anyone would want to laugh. I am so alone.” I did not grasp the depth of my daughter’s sense of isolation, and even if I had grasped it, I doubt I would have recognized its danger.

I have also wondered over the years whether Mary perceived herself to be a burden to her family. There was no indication of it in her suicide note, and I’m glad for that, because she was the last person ever to be a burden. Still, Joiner’s reevaluation of psychache provides at least a partial answer to the enduring question of why.

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