Death By Suicide: An Interpersonal-Psychological Theory Part One (warning: potentially triggering)

English: Image for mental health stubs, uses two psych images – psychiatry (medicine) and psychology (Photo credit: Wikipedia)

The Way Out, or Suicidal Ideation: George Grie, 2007. (Photo credit: Wikipedia)

For a long time, I have wondered why I and some friends (including my ex fiance’s sister’s completed suicide) of mine have attempted suicide either once or several times. When a good friend of mine attempted suicide about 20 years ago, when she was finally able to talk again (she swallowed a cocktail of pills), she said she had been drinking and it had finally hit her that this guy she was head over heels for was never going to let go of his feelings for his ex-girlfriend. So, she almost lost her life over some guy. I, myself, have a few attempts under my belt, but mine usually seem to be without reason. At least no good reason I have been able to come up with. My ex-fiance’s sister successfully committed suicide at the age of about 36, and about one month after her birthday. She, too, had a history of mental illness and suicide attempts. Please note that this post does NOT mean that I am suicidal. 

I am simply interested in the “whys” of attempted and completed suicides. What are the specific set of circumstances that have to be present for someone to consider taking their own life? Why are we the only creature in the animal kingdom that does commit suicide? I have been interested in this for most of my life. For example, using myself, I have probably attempted suicide about 5 times, maybe 4. I was always a pill popper as I cannot abide the idea of cutting my wrists or using a gun. Too painful and too messy. However, each time I tried and was really set to die, I would call 911. Why would I do that? Maybe it was an effort to garner attention, or maybe I really did mean to die but failed because my desire to live was stronger, or maybe it was my way of saying I need help (I never have had an easy time asking for help even when I clearly need it). 

So, after much research recently and over the years, I have finally found a complex but simple theory that I feel is a valid theoretical explanation as to how a person could overcome the self-preservation instinct and also what conditions need to be present to induce someone to think of killing themselves. It is called the “Interpersonal-Psychological Theory of Suicidal Behavior” by Thomas Joiner, PhD. He specializes in the research of the psychology, neurobiology and treatment of suicidal behaviors and other conditions. He was recently awarded the Shieldman Award by the American Association of Suicidology for excellence in the field of suicide as well as the Guggenheim fellowship. 

This is going to be part one which will introduce the theorist, and the premise of the theory. Part two will discuss the theory itself, it’s parts and conclusions.

The Interpersonal-Psychological Theory of Suicidal Behavior

The basic questions that this theory asks are: 1) What is the desire for suicide, and what types of thinking lead to suicidal ideation? And, 2) What is the ability to die by suicide, and in whom and how does it develop? 

Question one: “The Interpersonal-Psychological Theory” asserts that when people hold two very specific mind states for an extended period of time, they will develop a desire to die. These two states, which I will go into in part two of the post, are “perceived burdensomeness” and “low sense of belongingness/social isolation.” Both of these must be present to come to the desire to die by suicide or suicidal ideation.

Question two: “The Interpersonal-Psychological Theory” states that, in general, the self preservation instinct is so powerful that very few people can overcome it by force of will. The few that have been able to cross that barrier have developed a lack of fear of pain, injury, and death through repeated exposure to painful and/or provocative events. These experiences often include previous self-injury, but can also include repeated accidental injuries, numerous physical fights; and occupations such as a physician or a front-line soldier in which repeated exposure to pain and injury is common either vicariously or directly.

What are the current empirical data for this conceptualization? Some of it is indirect although a growing body of empirical support is accruing. 

So, those are the basic questions this theory seeks to answer, and having been suicidal in the past, it has a strong resonance because this theory explains exactly where my head was at at the time of the attempt. I will go further into the parts and empirical support and conclusions in part Two.