35 Years of Working with Suicidal Patients: Lessons Learned 
by Donald Meichenbaum, Ph.D.
Characteristic Thinking Patterns of Suicidal Individuals
a) dichotomous (black-white) thinking
b) cognitive rigidity and constriction
c) perfectionistic standards toward self and others with high levels of self-criticism
d) lack of specificity in autobiographical memory- Such overgeneral and vague autobiographical memory has been associated with depression, PTSD, and suicidal behavior. Ellis and Rutherford (2008) highlight that such overgeneral memories interfere with interpersonal problem-solving because past experiences cannot be used as references for effective coping strategies in the present.
e) impaired problem-solving and poor problem-solving confidence
f) “looming vulnerability” or the perceived experience of negative occurrences as rapidly escalating, mounting, quickly approaching adversities that generate distress (Riskind et al., 2000)
g) such looming vulnerability can stoke hopelessness and helplessness with negative expectations about the future (Anticipate few positive events or outcomes and accompanying vagueness in future thinking).
h) ruminative process- - feeling “locked-in” to their current perceptions, unable to imagine alternatives, or consider new courses of action
i) more present-oriented and view death in a more favorable light
j) have difficulty generating Reason for Living
k) absence of protective factors such as attraction to life, repulsion by death, surviving and coping beliefs, sense of personal self-efficacy, moral and religious objections to suicide, fear of self-injury, and sense of responsibility to one's family
Examples of the Narratives of Suicidal Individuals
“I can't stand being so depressed anymore.” “I can stop this pain by killing myself.” “I am damaged goods.” (Schneidman, 2001 has characterized this intractable emotional pain as psychache)
“Suicide is the only choice I have.” (The word “only” is considered one of the most dangerous words in suicidology)
“My family would be better off without me.” “I was just a lifeless thing-breathing, but worthless. I knew everyone would be better off if I were dead. It would end my misery and relieve their burden.” “My death will be worth more than my life to my family.” (Joiner, 2005 and Joiner and Van Orden, 2008 have highlighted the perception of being a burden on others as related to suicidal tendencies).
“I am useless and unwanted.” (Joiner, 2005, highlights a sense of “thwarted belongingness,” as contributing to suicidal ideation and actions.) Perceive others as uncaring and unsupportive; feel socially disconnected and lack emotional intimacy
“No one cares whether I live or die.” (Feel rejected, marginalized, worthless, unlovable, isolated, alone, and a failure)
“I am worthless and don’t deserve to live.” (The presence of guilt and shame exacerbates suicidal ideation)
“I have an enemy within that I have to escape.” (Baumeister, 2004, has viewed suicide as a form of escape from self. It also reflects the “drama of the mind” that suicidal individuals are prone to engage in).
“I am in a tailspin, like a freight train or tsunami hit me. There is no hope. I can't get caught up. What is the point?” (Riskind et al. 2000 and Rector et al. 2008 have noted that anxious and suicidal individuals are prone to produce elaborate mental scenarios anticipating rapidly rising risk with multiply increasing threats. They tend to exaggerate the time course of perceived catastrophic outcomes and have an increased sense of urgency for escape and avoidance).
“I hate myself.” (Suicidal individuals have an over-generalized memory and tend to selectively recall negative events that contribute to invalidating themselves).
“I can’t fix this problem and I should just die.” (Tunnel vision, inflexibility in generating alternatives, feel trapped and perceived inescapability)
“I would rather die than feel this way.” (Evidence poor distress tolerance)
“I have lost everything that is important to me.” “My future looks empty.” “Life is no longer worth Living.” “Nothing will change.” “There is no hope for me.” (Ghahramanlou- Holloway et al., 2008, highlight the impact of such loss-related cognitions and the role of feelings of helplessness and hopelessness that exacerbate suicidal tendencies).
“I have screwed up, so I might as well screw up all the way.” (Perception that he or she does not deserve to live which contributes to suicidal ideation)
“Those who hurt me will be sorry.” (Perceived benefits of suicide, revenge)
“Suicide is a way of life for me and I can't stop it.” (Kernberg, 2001)
by Donald Meichenbaum, Ph.D.
Characteristic Thinking Patterns of Suicidal Individuals
a) dichotomous (black-white) thinking
b) cognitive rigidity and constriction
c) perfectionistic standards toward self and others with high levels of self-criticism
d) lack of specificity in autobiographical memory- Such overgeneral and vague autobiographical memory has been associated with depression, PTSD, and suicidal behavior. Ellis and Rutherford (2008) highlight that such overgeneral memories interfere with interpersonal problem-solving because past experiences cannot be used as references for effective coping strategies in the present.
e) impaired problem-solving and poor problem-solving confidence
f) “looming vulnerability” or the perceived experience of negative occurrences as rapidly escalating, mounting, quickly approaching adversities that generate distress (Riskind et al., 2000)
g) such looming vulnerability can stoke hopelessness and helplessness with negative expectations about the future (Anticipate few positive events or outcomes and accompanying vagueness in future thinking).
h) ruminative process- - feeling “locked-in” to their current perceptions, unable to imagine alternatives, or consider new courses of action
i) more present-oriented and view death in a more favorable light
j) have difficulty generating Reason for Living
k) absence of protective factors such as attraction to life, repulsion by death, surviving and coping beliefs, sense of personal self-efficacy, moral and religious objections to suicide, fear of self-injury, and sense of responsibility to one's family
Examples of the Narratives of Suicidal Individuals
“I can't stand being so depressed anymore.” “I can stop this pain by killing myself.” “I am damaged goods.” (Schneidman, 2001 has characterized this intractable emotional pain as psychache)
“Suicide is the only choice I have.” (The word “only” is considered one of the most dangerous words in suicidology)
“My family would be better off without me.” “I was just a lifeless thing-breathing, but worthless. I knew everyone would be better off if I were dead. It would end my misery and relieve their burden.” “My death will be worth more than my life to my family.” (Joiner, 2005 and Joiner and Van Orden, 2008 have highlighted the perception of being a burden on others as related to suicidal tendencies).
“I am useless and unwanted.” (Joiner, 2005, highlights a sense of “thwarted belongingness,” as contributing to suicidal ideation and actions.) Perceive others as uncaring and unsupportive; feel socially disconnected and lack emotional intimacy
“No one cares whether I live or die.” (Feel rejected, marginalized, worthless, unlovable, isolated, alone, and a failure)
“I am worthless and don’t deserve to live.” (The presence of guilt and shame exacerbates suicidal ideation)
“I have an enemy within that I have to escape.” (Baumeister, 2004, has viewed suicide as a form of escape from self. It also reflects the “drama of the mind” that suicidal individuals are prone to engage in).
“I am in a tailspin, like a freight train or tsunami hit me. There is no hope. I can't get caught up. What is the point?” (Riskind et al. 2000 and Rector et al. 2008 have noted that anxious and suicidal individuals are prone to produce elaborate mental scenarios anticipating rapidly rising risk with multiply increasing threats. They tend to exaggerate the time course of perceived catastrophic outcomes and have an increased sense of urgency for escape and avoidance).
“I hate myself.” (Suicidal individuals have an over-generalized memory and tend to selectively recall negative events that contribute to invalidating themselves).
“I can’t fix this problem and I should just die.” (Tunnel vision, inflexibility in generating alternatives, feel trapped and perceived inescapability)
“I would rather die than feel this way.” (Evidence poor distress tolerance)
“I have lost everything that is important to me.” “My future looks empty.” “Life is no longer worth Living.” “Nothing will change.” “There is no hope for me.” (Ghahramanlou- Holloway et al., 2008, highlight the impact of such loss-related cognitions and the role of feelings of helplessness and hopelessness that exacerbate suicidal tendencies).
“I have screwed up, so I might as well screw up all the way.” (Perception that he or she does not deserve to live which contributes to suicidal ideation)
“Those who hurt me will be sorry.” (Perceived benefits of suicide, revenge)
“Suicide is a way of life for me and I can't stop it.” (Kernberg, 2001)
