What it feels to want to kill yourself

Posted on September 10, 2016

Photo: flickr

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". That is, 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: "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."

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 would it 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. 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 futile.

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Category(s):Depression, Suicide Prevention

Source material from Scientific American


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