A person may not seemed to be depressed at all and in fact appear to be happy on the outside while drowning internally
Last week, a young medical intern from GMC was found dead. Preliminary investigations suggest suicide. She was undergoing treatment for depression. She was barely few days away from completing her internship and joining her parents back home, in Kerala. She appeared to be okay and not in any danger of self-harm.
According to the National Crime Records Bureau 2020 data, Goa’s suicide rate was 19.9 per lakh, almost twice the national average of 11.3 per lakh. More recent data reveals a worsening trend, in 2023, Goa recorded 333 suicide cases, the highest in a decade. These are not abstract numbers. They are young people, parents, students, doctors, friends and even family.
There is a deep misunderstanding of what it means to contemplate suicide. Some reduce a complex psychological crisis like suicide as a failure to get over depression or to appreciate life. It is rather the outcome of unbearable psychological pain, a state that suicidologist Edwin Shneidman called “psychache”, a word coined by him in the 1990s. It refers to the hurt, anguish, soreness and aching psychological pain in the mind. It encompasses the pain of shame, guilt, humiliation, loneliness, fear, angst and dread. Psychache can also arise when vital psychological needs such as the need for love, belonging, autonomy and self-worth are frustrated.
When psychache becomes unbearable, suicide emerges as a desperate attempt to escape the pain. Research confirms that psychological pain is a more reliable predictor of suicidal risk than depression. A person may not seemed to be depressed at all and in fact appear to be happy on the outside while drowning internally. Many people contemplating suicide mask their pain. They smile, laugh, and perform normally, not because they are faking but because the pain is too terrifying to share.
Thomas Joiner in his Interpersonal Theory of Suicide, proposes that suicidal desire emerges from two interpersonal beliefs. Thwarted belongingness is a belief that one does not belong, is isolated or unloved. Perceived burdensomeness is the belief that one is a burden to others and that their presence hurts loved ones. These beliefs create a sense of hopelessness and result in suicidal ideation. Recent research identifies ‘mental pain’ as a potential risk for suicide. Mental pain is transdiagnostic in nature, meaning it exists across disorders and predicts suicide beyond depression. It could stem from self-disappointment, guilt, anguish, loneliness and helplessness.
Aaron Beck’s cognitive model identifies hopelessness as a belief that things will never get better and this itself could be a core driver of suicide. Hopelessness could grow from negative thinking like one is unworthy, the world is unfair or change will never happen for the better. Psychological theories aside, the emphasis in the current culture on instant success could lead the young to think that they are losers and good for nothing.
Persons contemplating suicide may feel trapped by their own thinking as well as overwhelming negative circumstances around them. They may start to feel that their family would be better off with their absence. They may not even want to die. Often a suicide attempt is a cry for help. This is not weakness nor ingratitude about life. This is psychological pain overwhelming the capacity to cope.
A sudden sense of calm may mean the person has decided to act on suicidal thoughts. There could be signs to watch out for like withdrawal from interactions, giving away possessions, sleep changes, mood swings, substance use, reckless and risky behaviour and fixation on death.
As a community, we must stop stigmatising suicide. Suicide is not a failure to appreciate life. It is a failure of the mind to endure pain. If someone reaches out, listen with presence and without judgement, while prioritising mental health care. Because sometimes, the most healing thing is to know someone sees your pain and does not turn away.
(The writer is Associate Professor and Head of Department of Psychology at St. Xavier’s College, Mapusa.)
