Mark Goulston M.D., F.A.P.A.

Just Listen

Breaking Through to a Suicidal Mind

Pain is pain; suffering is feeling alone in pain.

Posted Apr 05, 2017

When I first started my psychiatric practice many years ago I specialized in intervening with and treating suicidal patients. That’s largely because one of my first mentors, Dr. Edwin Shneidman, who was a pioneer in the study and treatment of suicidal individuals and their families, would do consultations to still-suicidal patients (but not acutely so) who couldn’t be discharged from the inpatient wards of UCLA unless an outside psychiatrist would agree to see them. For many of those patients that outside psychiatrist was me.

Because they were still suicidal, it enabled me to be innovative in dealing with them. After a while what became apparent to me regarding many of them was how their suicidal thinking was more often connected to des-pair than depression.

By that I mean they felt unpaired with hope, i.e. hopeless; with worth, i.e. worthless; help, i.e. helpless; meaningless, useless, pointless, etc. I think you get the point. And when they felt unpaired with all of these at the same time, they paired with death as a way to make the pain go away.

Upon discovering this I realized that if I could pair with them in their des-pair and cause them to feel felt by me and less alone, they might pair with me, instead of dead.  And they might give up their suicidality, which most of them did.

To pair with them I found the following questions very helpful which often generated the subsequent answers:

  1. “At the worst that you can feel, how bad does that get?” Answer: “Horrible.”
  2. “When you’ve felt how bad it could get, how often did you feel alone?” Answer: “Always.”
  3. “And when you were feeling that horrible and alone with it, what did it make you think, feel and want to do?” Answer: “I can’t take it anymore and I have to end the pain.”
  4. “And what did you do?” Answer: “I tried to kill myself” or “I just somehow stopped before I did something self-destructive.”
  5. “If that is the case, I don’t want you to be alone with those thoughts and feelings. So I’m asking you to call me when you are feeling that way and I will do my best to listen to, hear you and keep you company. I promise, I’m not going to give you advice or solutions unless you ask me for them. So would you be willing to call me when you’re feeling like that? And by the way, if you think you’re a burden, you’re not. You’re not a burden because inside you I can see and feel the good person that you are and also that you matter neither of which you can see or feel when you’re feeling so awful.” Answer: They often began to cry with relief and with that their suicidal thoughts and feelings often lessen.

Pain is pain; suffering is feeling alone in pain. When you eliminate the aloneness, suffering that people can't live with becomes pain they can.