Chronic Pain and Suicide: Three Ways to Recognize and Reduce Risk
/By Dr. Thomas Rutledge
Suicide is a cause of death that haunts the living in perpetuity. After a suicide event, those left behind are tormented by questions:
"Could I have done something?" "What did I miss?" "How could this happen?" "Was it my fault?"
Even the best answers fail to return the person lost, and natural grief is often compounded with unnecessary blame.
Discussions about suicide prediction and prevention primarily focus on known risk factors such as mental illness and suicidal ideation.
In comparison, far less attention is paid to another common contributor to suicide present among a staggering 24.3 percent of the adult U.S. population. That makes this risk factor as prevalent as clinical depression, yet far more likely to be overlooked due to suicide stereotypes.
This unheralded suicide risk factor is chronic pain. In this post, we'll dive into three specific ways that chronic pain increases suicide risk, practical signs by which to recognize the patterns, and general strategies to help.
The Perfect Storm for Suicide
More than perhaps any other medical condition, chronic pain poisons the emotional well of what it means to be human. Although people differ in countless ways, our similarities are even more striking. Across time and cultures, for example, people universally share fundamental needs for meaning, interpersonal connection, safety, contribution, personal growth, and adventure, as articulated famously in psychological theories such as Maslow's hierarchy.
Many medical conditions compromise our ability to fulfill these fundamental human needs. Emotional struggles and mental health conditions are often a result of a medical condition impairing a person's ability to function in an important human need domain. Yet what makes chronic pain uniquely psychologically damaging is that it doesn't impact just a single human need. Chronic pain jeopardizes all of them.
As a psychologist who specializes in helping U.S. military veterans living with chronic pain, my aim is to share three of the most common patterns I see where pain becomes an existential threat.
1. Pain Without Purpose
One of the most profound ways that chronic pain increases suicide risk is by taking away a person's North Star for living. Like a sailor at sea without stars or a compass to guide them, chronic pain can remove the sense of purpose that allows people to endure in the face of suffering. Without sufficient purpose, pain becomes unbearable.
Scenarios: A retiree whose pain leaves them mostly housebound, estranged from friends, and increasingly unable to live independently. A veteran living on disability who has lost any sense of mission or way to contribute. A young adult whose pain condition limits opportunities for work, isolates them from others, and undermines their belief in a worthwhile future.
Characteristic thinking: "What's the point?" "Why go on this way?" "I feel like giving up."
Solutions: Based on the person's own values and lived experiences, explore flexible ways to reconnect them with their sources of meaning. Retirees may volunteer or consult in an area of interest. Former athletes may coach. Veterans may engage with military organizations and causes. Parents may become involved with youth activities. And, due to the staggering advances in technology that enable online and virtual participation, developing meaning-oriented lifestyles with chronic pain has never been more practical or lower cost.
2. Suffering in Solitude
No relationship is 100 percent safe from the corrosive effects of chronic pain. Chronic pain can ruin once-strong marriages, corrupt lifelong friendships, and erode the parent-child bond. Even as the person with chronic pain may need more social support in light of their condition, they frequently experience less in both quantity and quality.
Scenarios. There are two classic versions of this scenario. In the first, other people pull away or drift apart over time. In the second, the person living with chronic pain themselves retreats from others, usually because they feel like a burden or that they are holding other people back.
Characteristic thinking: "I'm useless this way." "I'm no good to anybody like this." "They would be better off without me."
Solutions: Consider all options for rebuilding a healthy social network. Although in-person activities may be best, virtual options—phone calls, text messaging, even multiplayer virtual reality or video games—may be good starting points. Aim, where possible, for relationship settings and activities where the person is an active contributor and teammate, where they can give as much or more than they receive.
Because men often struggle more with forming new relationships, explore options where an activity of interest is the centerpiece, while in a setting where social interactions can spontaneously occur.
3. Loss of Self
Chronic pain can not only steal purpose and corrode personal relationships, it can even threaten personhood and self-image. What are the psychological consequences when chronic pain leaves a person adrift from the core values and ways of living that enable their sense of self?
Scenarios: A person whose pain took away a career that previously gave them a sense of worth and identity. A middle-aged parent struggling with chronic pain and whose grown children have left home. A veteran who spent their military career serving the greater good, who now has nothing but memories. A young adult whose pain condition took away the plan and future they envisioned for themselves.
Characteristic thinking: "I don't know who I am anymore." "I feel lost." "I'm just a disability now."
Solutions: Help people grieve the self they've lost while building a new one. Post-traumatic growth examples through stories, movies, and relatable people can be powerful mental seeds to help people see themselves as a human phoenix—capable of rising from the ashes in a new form—instead of as a person permanently broken by pain and loss.
As in every hero's journey, people need not just examples but also guides and mentors to construct a new sense of self. A sense of self where their chronic pain helps them help others, view themselves as a survivor and not a victim, recognize hidden personal strengths, and find healthy ways to live their highest values.
Thomas Rutledge, PhD, is a Professor of Psychiatry at UC San Diego and a staff psychologist at the VA San Diego Healthcare System.
This post originally appeared in Psychology Today and is republished with permission from the author.
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