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Daniel

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The Inner Voice that Drives Suicide
Psychology Today blog: Compassion Matters

By Lisa Firestone, Ph.D.

One in five therapists has a patient who completes
suicide. Understanding and preventing suicide is therefore one of the most frightening and important responsibilities of anyone who works as a psychologist or counselor. To treat suicidal patients, a therapist must understand what is going on in the mind of these individuals, what is driving their suicidal behavior and how the therapist can help them comprehend and cope with their self-destructive states of mind.

In the past 25 years since I completed my dissertation on suicide, I have learned a great deal about the critical inner voices that drive a person toward suicide. In my years of experience publishing
books and articles, producing films and creating assessment scales on suicide, what has fascinated me the most is the consistent finding of the role of the destructive inner voice in suicide. This voice drives suicidal tendencies, deceptively convincing people that it is better to end their lives than to find an alternate solution to their suffering. On April 20, I will host a Webinar on Understanding and Preventing Suicide in which, in addition to outlining warning signs and helper tasks, I will show how people who are suicidal are not acting on their own point of view but rather are driven by these internalized voices instructing them toward their ultimate destruction.

My father, psychologist
Robert Firestone, initially made the link between suicide and the inner voice in 1986 after interviewing a young woman who had recently made a serious suicide attempt. The woman described in detail how cruel, sadistic thoughts instructed her throughout the planning and execution of her suicide attempt. The case study led my father to write his first article on the "inner voice" in suicide.

In the years since, we have come to recognize that in suicide cases throughout the world, one can identify the presence of a critical inner voice. For example, Richard A. Heckler's book
Waking Up Alive, provides detailed accounts of what went on in the minds of real individuals throughout the United States prior to their suicide attempts. In a state Heckler refers to as "a suicidal trance," these individuals described a strong presence of the severe self-attacking thought process referred to as the "voice."

To make the correlation between these
self-destructive thoughts and suicide, my father and I developed an assessment scale to evaluate the risk of self-destructive tendencies. First, we created the Firestone Assessment of Self-Destructive Thoughts (FAST), and eventually, we developed another scale that uses the identification of a self-destructive thought process to assess suicidal intent. This became the Firestone Assessement of Suicidal Intent (FASI).

A 2001 comparative study used the FAST to identify suicidal potential among Pakistani and American
psychiatric patients. The results showed that these self-destructive thoughts held a "significantly high correlation with suicide attempts." A similar correlation was found in hospitalized Swiss patients interviewed immediately after their suicide attempts by Dr. K. Michel. In the same manner as the woman my father had interviewed years before, these individuals clearly recounted the "voices" that led to their suicide attempts. Both studies are indicative of how these voices appear to have a cross-cultural presence among suicidal individuals.

Confirmation of this connection inspired me to create the documentary
Voices of Suicide, in which three survivors of their own suicide attempts tell the stories of what went on in their minds leading to their attempts. Each of these individuals described themselves as being totally disconnected and possessed by something that was compelling them to end their lives.

Susan, one of the film's subjects described the "snide" voice she heard before her suicide attempt as follows:


Who would care if you weren't around? People would miss you a little bit at the beginning, but who would really care. You don't care...You thought you mattered, you don't matter now. You don't matter... If you don't matter what does matter? Nothing matters. What are you waking up for?


Trish, another subject of the film recounted a similar course of thinking:


Your own family doesn't love you. Nobody's ever going to love you. Your own mother gave you away... You're alone, you'll die alone. You'll always be alone. The only thing you can do is go and kill yourself.


The film's third subject, Kevin, revealed how an inner voice convinced him that his pain was hurting others:


I'm a bad person. I'm a burden to my family and friends. I'm hurting them with this bipolar, this, this annoying nuisance of a guy. That's the way I thought. That's the way my demons thought.


In all of these cases, at the moment when they actually made the attempt, these individuals immediately reconnected with themselves and did not want to die. After their lethal suicide attempts, both Susan and Trish took actions that saved their lives. Kevin miraculously survived his leap from the Golden Gate Bridge and has since become a public speaker and advocate for suicide prevention.


The negative thought processes that led these people to an action as desperate and as hopeless as suicide proves that very often one's worst enemy lives inside him or her.


Therapists treating suicidal individuals must therefore help their patients uncover these self-destructive thoughts and recognize how they can separate from this dangerous point of view.


My father developed "
voice therapy" as a way of helping people to combat destructive thought processes and strengthen their sense of self. Voice therapy involves encouraging patients to verbalize their voices in the second person and develop insight into the voices' origins. Next, patients answer back to the voices and recognize the connection between voices and destructive actions, and lastly they collaborate with the therapist to change these behaviors

By treating patients through voice therapy you help them to separate from this internal enemy and fight against it in their thoughts and actions. Therapists should encourage patients to respond to these voices, to fight back with a more realistic and compassionate point of view. The use of voice therapy can benefit anyone who has internalized an inner critic in any area of their lives, but in the case of the suicidal client, getting the person back on his or her own side can actually save a life.


You can learn more about Understanding and Preventing Suicide by joining me for a FREE Webinar on April 20 from 11 a.m. to 12 p.m. PSD.
Click here to learn more and to register.
You can also visit The Glendon Association's online resource on Suicide and Self-Destructive Behavior or you can visit the public resource I created on PsychAlive.org, Suicide Prevention Advice.

IF YOU OR SOMEONE YOU KNOW IS IN CRISIS OR IN NEED OF IMMEDIATE HELP, CALL 1-800-273-TALK (8255). This is a free hotline available 24 hours a day to anyone in emotional distress or suicidal crisis.

Related books:

Conquer Your Critical Inner Voice
http://www.igive.com/html/fmsw.cfm?vendorid=259&uuid=k460854cf702fSuicide and the Inner Voice: Risk Assessment, Treatment, and Case Management
 
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oh this is an excellent post thank you I thought i was just a little of my rocker because i do so much self talking very informative and good ideas on how to take away some the the power of these inner voices
 

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Yes, excellent article. I wrote out an eviction notice one day to my inner voice, that for some reason, sounded like my mother. I actually sat down with pen and paper and evicted it from my head. Since doing that, it has gotten better, for me at least and when I do hear a voice talking to me now, it is my own and if I don't like what the voice is saying, I just tell me to smarten up, shape up and get real. Works for me so far. Really interesting article, explains what I was hearing/doing when I did OD many years ago and other half hearted attempts.
SoSo
 
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very insightful article, thank you daniel. what struck me was that the moment people made their attempt they realized they wanted to live. i wonder if this is happens every time someone starts their attempt.
 

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From an interview with Albert Ellis:

"What are you telling yourself to make yourself suicidal? You largely constructed your depression. It wasn't given to you. Therefore, you can deconstruct it. What do you think you're telling yourself to make yourself this way?" We'd get the client to admit things like, "I don't like my life," and then we'd say, "Yeah, but that wouldn't induce you to commit suicide. What else are you telling yourself?" And that's when clients say things like, "It shouldn't be the way it is. It's terrible that I failed. I'm no good." That's when we hear the shoulds, the oughts and the musts, and then we convince the client to abandon these irrational demands. Our slogan is, "I will not should on myself today."

~ Albert Ellis

The Prince of Reason | Psychology Today
 

Murray

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My therapist is always pointing out my "should statements". They are insidious.
 

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The Critical Inner Voice that Causes Depression | Psychology Today

...As the manifestation of the "anti-self," the critical inner voice can even sound friendly or soothing, as it lures us to take self-harming actions, and then punishes us for failing to live up to our goals: "Go ahead. Have that second piece of cake. You've been doing so well on your diet" or "Just stay home and be by yourself. You're perfectly fine on your own." But when we heed their advice, they turn and become harsh and punishing: "You're such a pig. You never follow through! or "You'll never meet anybody. You'll just wind up alone."

...Once someone experiences depression, they can be sure that they have reached a stage where the point of view represented by the voice has actually become their own viewpoint. They are now aligned more against themselves than for themselves and wholeheartedly believe everything their voice tells them. As a result, they no longer have contact with their real self and may feel hopelessly alienated from the people closest to them as well. So how can they challenge the voice that leads to depression?

...Important steps to conquering your internal enemy or anti-self:

1. Identify the negative thoughts and beliefs you experience as early in the self-destructive cycle as you can.

2. Try writing these thoughts down in the second person as if someone is talking to you (i.e. Instead of writing "I am different from everyone else," write "You are different from everyone else.") This will help you see the voice as an external enemy as oppose to your own point of view.

3. Respond rationally to these statements using the more realistic tone of a compassionate friend. (i.e. You are unique in many positive ways and people appreciate you.")

4. Talk to a close friend who tends to have a more optimistic outlook. Talking to someone who is also down or cynical about life can actually make you feel worse.

5. Force yourself to engage in activities that you have found pleasurable in the past. Even if they don't seem appealing right now, they will help you start to overcome the apathy, indifference, and lack of energy that are major symptoms of depression.

When we take these steps to counter our attacks, we must be aware that like the Wicked Witch in The Wizard of Oz, these voices will put up quite a fight, even as they melt away. Acting against this internal enemy will make it even louder for a while. When we feel good, it will warn us of impending failure or tempt us into falling off the tracks, but the more we ignore it, the more it will shrink. As people combat this inner critic, they shed themselves of its dark rule and take the first steps into the light and out of their depression.
 

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Voice Therapy
by Robert Firestone, PhD

...Although it is relatively easy to elicit the destructive voice process and bring it to the surface, voice therapy is not a short-term procedure or a simple cure-all. It is impossible to conceive of "cure" without the patient being able to change the fundamental aspects of the way he or she is living out his or her defensive structure...

Voice Therapy: A Treatment for Depression and Suicide

by Lisa Firestone, PhD

...All people exist in conflict between an active pursuit of goals in the real world and a defensive reliance on self-gratification. An individual who chooses to cultivate life and lead an honest and undefended lifestyle will experience both the joy and pain of his or her existence. In contrast, the defended person's attempt to block out pain neutralizes the life experience and deprives the individual of life's enrichment. To the extend that individuals succumb to a defensive posture, form addictive attachments and habit patterns, and choose an inward self-protective life, their adjustment will suffer, and it is unlikely that they will approach their potential. Retreat to an increasingly inward posture represents, in effect, a form of controlled destruction of the self. Anything that threatens to disturb an individual's solution to the core conflict arouses fear. Descending into this process more and more and withdrawing investment from real life often creates the necessary conditions for suicide....

 
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isolation the sadness inner conflicts how does one reach out really one tries and tries and each time fails one is reminded again and again their position in this life the only safe place is to turn inwards away from the conflict yet it is so destructive this voice it tells you things that you want to hear Like you will have that peace you deserve It is very clever this voice If it were not for a few people that know me i think the voice would have won by now especially now Reach out where i cannot there is no where god i wish i was stronger don't trust dam voice keeps saying don't trust anyone don't then the fear comes don't go there again i wish this would end this battle once and for all the voice is clever and it is so convincing.
 

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The Critical Inner Voice Explained

...Many people think if they stop listening to their critical inner voice, they will lose touch with their conscience. However, the critical inner voice is not a trustworthy moral guide like a conscience. On the contrary, the critical inner voice is degrading and punishing and often leads us to make unhealthy decisions. These negative voices tend to increase our feelings of self-hatred without motivating us to change undesirable qualities or act in a constructive manner...
 

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"That is why in adult life, people generally tend to relive rather than live, that is, to repeat the patterns of the past and defend the primary fantasy in the defiance, and avoid the real gamble or real adventure of taking a chance on something new. They are afraid that if they really cry out, if they really ask, if they really scream for help, that it won't come, and they'll be in the same panicky frightened state they were in when they were little."

- Robert W. Firestone
 

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“When you are depressed, you may have a tendency to confuse feeling with facts. Your feelings of hopelessness and total despair are just symptoms of depressive illness, not facts. If you think you are hopeless, you will naturally feel this way. Your feelings only trace the illogical pattern of your thinking. Only an expert, who has treated hundreds of depressed individuals, would be in a position to give a meaningful prognosis for recovery. Your suicidal urge merely indicates the need for treatment. Thus, your conviction that you are "hopeless" nearly always proves you are not. Therapy, not suicide, is indicated. Although generalizations can be misleading, I let the following rule of thumb guide me: Patients who feel hopeless never actually are hopeless. The conviction of hopelessness is one of the most curious aspects of depressive illness. In fact, the degree of hopelessness experienced by seriously depressed patients who have an excellent prognosis is usually greater than in terminal malignancy patients with a poor prognosis. It is of great importance to expose the illogic that lurks behind your hopelessness as soon as possible in order to prevent an actual suicide attempt. You may feel convinced that you have an insoluble problem in your life. You may feel that you are caught in a trap from which there is no exit. This may lead to extreme frustration and even to the urge to kill yourself as the only escape.”

― David D. Burns, Feeling Good: The New Mood Therapy
 

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