What is The Anxiety of Suicide?

Suicide is a highly complicated psychiatric phenomenon; I often see it as falling into five major categories. The first would be an impulsive act in a person with a highly self-destructive nature who becomes disinhibited enough through the use of alcohol—or another method leading to a lack of impulse control—which allows him to act on the actual pain he feels in life. In this situation, the anxiety is that of intense psychic pain and a wish to rid oneself of it. Victims of incest, survivors of overwhelming trauma, or end-of-life patients might be examples of those who struggle with fantasies of hopelessness or worthlessness that take the risk of acting on them one day.

The second is that person who realizes at some level that he is becoming psychotic or having a break with reality—he knows he is beginning to lose his mind.

Patients describe this mind-shattering experience as profoundly disturbing, especially to someone who realizes some version of what he is losing. It is not uncommon for such patients to try to kill themselves. The anxiety may be a sense of annihilation or fragmentation which feels beyond repair. To leave this panic, a patient in this state might impulsively jump off the roof, out the window, or off of a bridge.

The third is the chronically suicidal patient. This patient spends years thinking of suicide and keeping suicidal thoughts and feelings a secret. It seems that this kind of patient feels trapped in a life of pain. Therefore, thinking of suicide serves as a way out, an option or escape hatch from the pain and seemingly enslaved nature of life. One day, often for reasons we will never know, the person decides to make fantasy a reality.

A fourth major category is the patient who has become majorly depressed. Symptoms can be an absolute wish not to wake up, a profound sense of hopelessness, or an inability to visualize life’s going on.

These patients can develop an impulsive pressure to kill themselves. The anxiety in these situations is similar to that of psychosis, in that the patient is suffering from a kind of pain that seems insurmountable. How-ever, this anxiety represents distorted thinking. Patients who accidentally survived jumping from the Golden Gate Bridge all reported that they knew they had made a mistake the second they jumped.

The last category is the patient who receives bad news, possibly news of a worsening or progressive medical condition. These patients, it seems, become suicidal as a way to try to manage the overwhelming pain and anxiety that they are feeling in the moment.

One feature that we see clinically is that oftentimes the patient who is able to speak about wanting to kill herself is at least ambivalent about it. She leaves genuine room for intervention, but the person who feels deeply ashamed of his wish and is unable to speak with anyone about it might jump or shoot himself before anyone has had a chance to intervene.

Anxiety is central to all of these types of suicide. Taking anxiety seriously and obtaining the right treatment can prevent suicide. If you are in an urgent situation, call 911 or 1-800-SUICIDE. Help is always available, and options other than killing yourself always exist.