![]() ![]() ![]() In nonsuicidal persons, intense mental pain is associated with high sensitivity to bodily pain. Pain threshold and pain tolerance are highly and negatively correlated with personal distress in suicidal persons. It is an escape from intolerable suffering. Suicide occurs when the psychache is deemed by that individual to be unbearable. Shneidman further postulated that psychache is intolerable because it results from basic needs that have been thwarted. Shneidman considered psychache to be the main ingredient of suicide and reported that psychological pain may be correlated to the fact that, if suffering individuals could somehow stop consciousness and still live, they would opt for that solution. Suicide risk is much higher when the general psychological and emotional pain reaches intolerable intensity, particularly in the context of major mood disorders. Psychological pain is a common construct for understanding suicide. Clinical symptoms include inflated self-esteem, elation, a disregard for the painful consequences of one’s behavior, and overoptimism about the future. Inhibited central pain, proposed to occur in mania, results in an inability to perceive the negative qualities of oneself and one’s environment. In manic patients, a disinhibition of central pleasure represents an overresponse to positive images and stimuli, resulting in inflated self-esteem, grandiosity, increased enjoyment of the environment, excessive activity, intrusiveness, and unrealistic optimism about the future. The depressed patient perceives himself/herself as bad, unworthy, and guilty. Changes in self-image due to central pain dysregulation go beyond feelings of incompetence and devaluation. On this basis, the depressed patient perceives neutral events as catastrophic. In the depressed phase, this system is seen as disinhibited stimuli that were previously nonaversive are experienced as distressing. Central pain is increased in depression, as reflected by agitation, pathologic guilt and hopelessness. His model included four neurobiologic components (consummatory reward, incentive reward, central pain, and psychomotor function). ![]() ![]() Expressions such as ‘suffering from intense pain’, ‘suffering from a terminal illness’ or even ‘suffering a hangover’ are indicative of these ambiguities.Ĭarroll extended Klein’s model to characterize mood states in bipolar disorder. As Sensky noted, the term ‘suffering’, however, may mean different things to different people. The term ‘suffering’ contains nonphysical dimensions – social, psychological, cultural, spiritual – associated with being a person that are relatively unaddressed in medical training. Suffering alienates the sufferer from self and society, and may engender a ‘crisis of meaning’ and a disintegration of hope. ‘Suffering is experienced by persons, not merely by bodies, and has its source in challenges that threaten the intactness of the person as a complex social and psychological entity’. According to Cassell, suffering can be defined as a state of severe distress associated with events that threaten the intactness of the person, that occurs when an impending destruction of the person is perceived. This view has many similarities with Cassell’s definition of suffering. ![]()
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