Psychache

Psychache, a concept created by Edwin S. Shneidman and fully developed in the 1990s, refers to unbearable psychological pain most often found in suicidal individuals. The term comprehends the hurt, anguish, or ache that takes hold in the mind; the pain of excessively felt shame, guilt, fear, anxiety, loneliness, angst, dread of growing old or of dying badly. Although Shneidman admits that each suicide is a multifaceted event, that biological, cultural, sociological, interpersonal, intrapsychic, logical, philosophical, conscious, and unconscious elements are always present, he suggests that the essential nature of suicide is psychological, meaning that each suicidal drama occurs in the mind of a unique individual. Advocates of the concept focus on the mental aspects of suicide [Page 827]and suggest that the study of suicidal acts should concentrate on the phenomenology of suicide.

Psychache can be clearly distinguished from depression or other psychiatric disorders for the uniqueness of suffering perceived by the subject and for the fact that he or she cannot stand it; the individual cannot see a way out and believes that ending life is a solution. Shneidman suggested investigating psychological pain referred to as introspective experience of negative emotions through the Psychological Pain Assessment Scale. This instrument rates present and worst-ever psychache and, from the standpoint of the researcher, should help clinicians and researchers explicate the concept of psychache, explore its theoretical dimensions, and begin the process of developing operational meaning between psychache and suicidal behavior.

Shneidman's great efforts to understand negative emotions in individuals and how to bridge the gap in communication of human suffering was one of the major sources of inspiration of such a concept. The pioneering challenge to introduce the psychological element in the study of suicide began in 1949 when Shneidman serendipitously found himself comparing, in blind conditions, genuine and simulated suicide notes and then trying to distinguish between the two types. In attempting to understand the mind of the suicidal individual, a major contribution was made when the first psychological autopsies were performed. These were retrospective investigations of the deceased person, within several months of death, using psychological information gathered from personal documents; police, medical, and coroner records; and interviews with family members, friends, coworkers, school associates, and health care providers to classify equivocal deaths or establish diagnoses that were likely present at the time of suicide. Taking advantage of this background and after decades of research in the suicidal mind, it was concluded that the main ingredient of suicide is the unbearable psychological pain and that suicide may be, at least in part, an attempt to escape from this suffering. Conceptualization of psychological pain as an ingredient of suicide is traceable in works published in the 1980s by Shneidman, such as in the classic Aphorisms of Suicide Assessment, and has some implications for psychotherapy wherein the role of psychological pain is mentioned as related to the fact that if tormented individuals could somehow stop consciousness and still live, they would opt for that solution. Shneidman believes that in suicide, death is not the key word. The key words are psychological pain, and if the pain were relieved then the individual would be willing to continue living.

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