Why people kill themselves: Part 9 -Fight, Flight or Freeze — The Ten Emotional Stages to Suicidal Thinking

Naomi Feil and Gladys Wilson

The Ten Steps to Suicide

2. Secondary Vulnerability — As we venture as an infant or child out into the world, it pressures us to adapt to it and if we are not able to do that we can feel overwhelmed.

3. Cumulative Vulnerability — As we go through life and more and more stress is added to our lives that we merely get past but not fully over, it builds up and we cross over into distress where our focus is relieving that distress in any way possible.

4. Fragile — The point at which the distress so overwhelms us that we are no longer able to attack it by fight (getting angry at others or ourselves) or run away from it by flight (into frenetic activity, busyness or mania) and instead freeze and begin to feel internal cracks in our mind.

BTW this is also the point where when we can’t escape the mounting vulnerability that our anxiety increases (as in feel increasingly awful and there is no escape) and depression increases (with no escape and no longer able to cope by being angry outward, we follow Freud’s explanation that “Depression is anger turned inward”).

5. Brittle — The point at which the internal cracks continue to intensify and we feel brittle and as if we could shatter at any moment and we make a last ditch effort into escaping into alcohol and/or drugs — especially opiates.

6. Shattered — The point at which our mind feels as if it has shattered but is still in place (like a shattered windshield which has not yet fallen apart).

7. Terror — The feeling that the next step will be that our mind will fragment.

8. Fragmented — The point at which our mind feels as if it has exploded and will never come back.

9. Panic — The point at which we do anything to get away from the continued fragmentation.

10. Suicide — The point at which we end our life because we cannot exist in a state of terror and panic.

What can be done to prevent the runaway train of our mind going off the track?

In chemical reactions the Rate Limiting Step is that point in the reaction that is the slowest and the point after which the reaction just takes off on its own.

In the above ten steps the Rate Limiting Step or more accurately Steps are: Primary Vulnerability and Secondary Vulnerability.

With Primary Vulnerability, we are completely helpless, powerless, exposed and vulnerable and, as mentioned above, without care by others and protection from the world we will not survive. This is mainly in the form of the maternal bond coming from our mothers who adapt to us to feed us when we are hungry, change our diapers when we are in GI distress, hold us when we are cold and hold us when we are scared.

When instead of being cared for and protected we are neglected or abused we will die or at the very least Fail to Thrive.

That said our mothers do not have to be perfect in their connecting to us. In fact, being a “Good Enough Parent” as described by D.W. Winnicott, nurtures in us an early adaptability to the world. The key is whether our adaptability will be sufficient to keep us moving onward and outward developing increasing self-sufficiency and self-reliance as we grow.

If however the gap is too wide as with a mother or parent who too often yells, screams, becomes angry or completely abandons us when we are experiencing normal infantile or child appropriate neediness, we can develop learned helplessness. Learned helplessness first describe by psychologist, Martin Seligman, is the state where when we believe anything we do will not help us out of distress, we just give up.

In spite of such primary abuse or neglect, some fortunate individuals can throw themselves into super achievement telling themselves and the world, “I don’t need anyone.”

When Primary Vulnerability is met with warmth, compassion and empathic attunement to our pain and fear usually by a mother, we develop an internal sense of feeling solid. When however Primary Vulnerability is met with abuse, neglect and overindulgence (which spoils us from being able to handle the upcoming demands of the world), we grow up easily devastated by disappointment. In essence, when we lack an internal core built upon healthy and accurate empathic attunement by our mothers, we grow into people who have trouble “taking the hits” from life without falling apart.

Secondary Vulnerability occurs when having managed to survive Primary Vulnerability, our vulnerability comes from the challenges and demands of the outside world. What helps us with Secondary Vulnerability is much more the input from our fathers in the form of teaching, coaching and mentoring us. Such fathering does not come with warmth at its center, but rather comes from belief, teaching, coaching, training, practicing the skills of life with us until we master them.

When Secondary Vulnerability is not responded to with belief, teaching, coaching, etc. and we are left to figure it out on our own, some people make it, but many of the people who don’t fall into Learned Helplessness and start to slide down through steps 3 through 10 above.

One of the reasons that many treatments for mental illness are not lasting is that they provide bio, psycho and social ways to cope better with life when it continues to stress and distress us, but they don’t go back and heal the Primary and Secondary Vulnerability inside. Hence, many treatments — evidence based as they might be — are like putting “lipstick on a pain.”

I am not suggesting we abandon those treatments. What I am suggesting is that we see them as supplements to addressing Primary Vulnerability with highly attuned empathy and Secondary Vulnerability with an unrelenting “you can get through this and we will keep practicing it together until you believe you can and will.”

Two Examples of Empathizing with Primary and Secondary Vulnerability

A wonderful example of the power of highly attuned empathy and going to the core of Primary Vulnerability is demonstrated by this video in which Naomi Feil reaches into the essential “deadness” of Glady Wilson and brings her back to life life.

And a wonderful example of the power of belief, positivity, teaching and doing something with someone whose Secondary Vulnerability has progressed to Step 10/Suicide in the sequence above is demonstrated in the movie Gravity.

In that movie, after having lost a child, running away from the pain by becoming an astronaut, then suffering a catastrophe in space that kills off everyone including her mentor, played by George Clooney, Sandra Bullock’s character just wants to die. In this scene, Bullock hallucinates George Clooney coming back into her capsule with the exact kind of empathy she needs to touch her emotions, her mind and then get her to take action.

In summary, treatments that are directed at the symptoms of depression and suicide should be used and further research continued, but they should be built upon approaching the core of mental illness which is about Primary and Secondary Vulnerability that can snowball into Cumulative Vulnerability and drive people to suicide.


Dr. Goulston is the inventor of Surgical Empathy, a speaker, executive coach & the author of "Just Listen" which became the top book on listening in the world.

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