Suicide is a reality that nobody wants to talk about. It is a subject that makes us feel uncomfortable. However, while we deny its existence by looking the other way, making it a taboo, every day between 8 and 10 thousand people try to kill themselves. Of these, approximately 1,000 succeed.
In fact, the World Health Organization indicates that suicide is the 10th leading cause of death. In reality, talking about suicide with a person at risk of committing it will not encourage him to take his own life but on the contrary, it will make him feel understood and he will be able to know that he is not alone. Therefore, if a person sends signals like “I do not want to live”, talking about suicide will reduce the risk of committing it.
What is Presuicidal Syndrome?
The Austrian psychiatrist Erwin Ringel began to refer to the Presuicidal Syndrome following a study conducted in 1949 with 745 people who made a suicide attempt. He described it as the mental state that the person experiences before committing suicide. Therefore, it is a psychological condition that maximizes suicidal risk since the act is considered imminent.
Learning to detect it is important because many suicide attempts could be prevented. In fact, statistics on suicide reveal that between 1-2% of people who attempt to take their own life succeed before the first year, between 15-30% of people repeat the attempt before the year and around a 10-20% become great repeaters of suicidal behavior until they finally achieve their goal. Undergoing psychological treatment can break that loop.
The main signs of Presuicidal Syndrome are:
1. Constriction of feelings and relationships. The person experiences a decrease in emotional energy and cognitive functions of it. He plunges into a state of anhedonia and affective flattening. He lives a narrowing of his psychic life. He also limits his relationships with others to the minimum possible and isolates himself. In addition, he cannot think clearly and falls into a state of almost complete withdrawal.
2. Inhibition of aggressiveness. The person who considers suicide usually accumulates many reproaches and resentments against the others or against the world, either due to specific negative events that they have experienced or due to lack of opportunities. However, those aggressive impulses that would normally turn towards the others turn into aggressiveness towards oneself, which is what ultimately leads to suicide.
3. Suicidal fantasies. In the Presuicidal Syndrome, thoughts and fantasies about one’s own death are very present. In fact, there is a kind of narrowing of consciousness in which there is only room for suicidal ideas. These self-destructive images become more intense and recurrent, to the point that the person accepts them as the definitive solution to his problems.
The phases that precede the Presuicidal Syndrome
Before a person attempts suicide, he goes through a series of stages that are generally well differentiated to the skilled eye:
1. Appearance of the suicidal idea
In this first phase, the idea of ending his life makes its appearance. Suicide is presented as a possibility to end suffering or that state of deep anhedonia. It begins to be seen as an option to solve real or imagined problems. It is a relatively short phase since once the idea arises, it usually does not take long for the person to accept it as a valid alternative.
2. Ambivalent conflict
The second phase is characterized by deep ambivalence. The person lives an internal struggle between self-destructive tendencies and the urge to survive. He thinks things like “I don’t want to live, but I’m afraid of dying” or “I don’t want to die, but I don’t want to go on living like this either.” In this phase, which is usually quite long, he experiences great anguish and often sends out repeated alarm signals that often go unnoticed. In a way, it is the SOS of the “self” trying to survive.
3. Sinister tranquility
In the last phase, the decision is already made. The person stops struggling between these internal conflicts, which is usually accompanied by an unusual tranquility or even an “improvement” of the mood. The person finally feels that he has shed his burden because he has made the fatal decision. At this point he becomes disinterested in everything and disconnects even from his own suffering because he is exclusively dedicated to preparing his suicide. It is in this last phase when the Presuicidal Syndrome occurs.
It is worth clarifying that in immature or impulsive personalities, as well as in drunken states or psychotic outbreaks, these phases occur practically like a flash since the person can go from occurrence to act almost without ambivalence. In these cases, it is very difficult to prevent the act of suicide.
Instead, suicidal ideas born from neurotic processes usually go through longer periods of internal debate before taking action, which leaves room to listen to calls for helping the person.
It is important to keep in mind that the main desire of the person considering suicide is not to die, but only to end his pain, anguish and suffering. In other cases, it is not even these negative feelings that lead to suicide but apathy and emotional dullness, the feeling of being empty inside and that nothing makes sense. Therefore, suicide is viewed as an act of liberation when all the other options have been ruled out.
Therefore, anti-suicide therapy focuses on eliminating the feeling of alienation from the person, promoting his interpersonal relationships so that he develops a solid support network, allowing him to vent his anger verbally and helping him to set new goals in life that allow him to find a meaning and a reason to live.
Lekarski, P. (2005) The assessment of suicidal risk in the concept of the presuicidal syndrome, and the possibilities it provides for suicide prevention and therapy—review. Przegl Lek; 62(6): 399-402.
Mingote, J. C. et. Al. (2004) Suicido: Asistencia clínica. Guía práctica de Psiquiatría Médica. Madrid: Ediciones Díaz de Santos.
Ringel, E. (1973) The pre-suicidal syndrome. Psychiatria Fennica; 209–211.