Why people kill themselves- Part 2: It’s not depression

Mark Goulston
6 min readSep 4, 2018

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With regard to Anthony Bourdain and Kate Spade, we have two more reasons to collectively feel the pain and bewilderment from more high-profile suicides as well as our collective search to answer “why?”

We seek to answer that question, because inside, many of us have felt, “There but for the Grace of God — especially at 3 am — go I.” Getting an answer to that “why” offers us a veneer — temporary though it may be- of control, which is especially useful when many of us can rapidly plummet into feeling out of control.

Was it financial problems? Marital problems? Health problems? Legal problems? Depression? Bipolar depression? Alcoholism?

After having spent a twenty-five plus year career as a “boots on the ground” suicide specializing psychiatrist, mentored by one of the pioneers in the field, Dr. Edwin Shneidman, I have to conclude that none of those factors cause suicide. True, they all contribute to it, but there are many, many people with each or even several of the above conditions that don’t die by suicide.

There is however one thing that nearly all people who die by suicide feel at the moment they pull that trigger, tie the knot around their neck, jump from that building, swallow those pills, step in front of that train. That one thing is des-pair.

Yes, des-pair*, not despair. Des-pair as in feeling unpaired with the reasons to live:

1. Hopeless — unpaired with a future that is worth living because all efforts to lessen pain (medications, therapy, etc.) have not worked

2. Helpless — unpaired with the ability to pull themselves out of it

3. Powerless — more of #2 above

4. Useless — unpaired with any solution or treatment that works or alternatively feeling that you contribute nothing to anyone and are only a burden (even if those people protest the opposite)

5. Worthless — ahh yes, unpaired with one of the key reasons for men to exist

6. Purposeless — unpaired with a mission for you to focus on and that gives you a source of pride, without which one can feel aimless and ashamed as in, “My life has no purpose.”

7. Meaningless — unpaired with what Victor Frankl was able to discover in a concentration camp and what one can feel when they have no purpose

8. Pointless — unpaired with any reason to not pull trigger, put the noose around your neck, jump from that building, take those pills, step onto those train tracks

These eight “-lesses” can collectively result in the pain that can no longer be endured, that when collectively felt cause people to pair with death as a way to make it go away by their going away.

Might many of these suicides be prevented if these anguished individuals felt less alone in their Dark Night of the Soul?

I can’t guarantee it, but I think the reason an approach I used in meeting with highly suicidal individuals — many who were multiple attempters — was effective was that instead of giving them treatments and procedures that might treat a symptom and would often be a way to deal with my own anxiety, I learned to listen into their eyes for their hurt, fear, anger, pain, guilt, shame, aloneness, loneliness and exhaustion. When I did that, one or more were always present and always screaming to be heard, and even more, to be felt so they didn’t have to feel so alone in hell.

When they “felt felt” and less alone, suffering they couldn’t deal with became pain they could. And nearly every time, when that suffering stopped, they began to cry and sob, feel relief and with that could step back from the impulse to annihilate themselves.

Deep psychic wounds in suicidal individuals are similar to physical wounds in that someone, attempting to intervene, needs to go to the core of that wound, clean it out by helping that person feel less alone, and then leaving in an empathic drain by remaining emotionally connected to them. From there, they will granulate in from that wound in their core and from their inside out with hope.

When I did that with vets with severe PTSD who were feeling suicidal, one of them told me that it caused him to feel like the person inside the patient.When I asked him what he meant, he replied, “We’re not treated like people; instead we’re patients carved up into billable procedures that don’t even talk to each other. And when the whole treatment plus waiting months for an appointment with a psychiatrist who keeps checking his text messages during an appointment causes us frustration, that psychiatrist will smile — moron! — and say, ‘Let’s throw in anger management to be safe.’”

We all know how highly effective empathy can be in lessening anger and when used early in preventing violence in other people. We also talk about how it might have prevented some mass or school shooting had it been applied to the bullied, unbalanced, mentally disturbed individual who committed such an atrocity.

As long as treatments and procedures don’t penetrate the shame, feeling burdensome, utter aloneness and des-pair at the core of the suffering inside people at the moment they decide to take their lives, we are just “putting lipstick on a pain.”

You earn the right to a patient trying your expert procedure — why should they trust you when they feel let down by the world?- by emotionally connecting with them and spending time with them in their Dark Night of the Soul.

From People by Barbra Streisand https://www.youtube.com/watch?v=9Vjsv8Ry238

Hasn’t the time come to apply empathy to individuals before they commit the greatest violence to themselves and end up dying from suicide?

* The difference between des-pair and depression is that when one is depressed, it is often difficult to engage them in an expressive conversation.There is an inherent inertia in the word “depressed” that can further add to their sense of futility. On the other hand, when you engage someone in any of the eight “-lesses,” it can lead to a more dynamic, engaging and expressive conversation. When that occurs, and the des-pairing person begins to express and describe what any of those words mean to them, they will begin to experience those feelings vs. experiencing nothing and feel relief as they “pair” with the empathic person who is listening to them.


The most astonishing example of the power of “pairing:”

And when I showed this video to 400+ managers from the Russian Federation in Moscow, the pairing between Gladys and Naomi was so powerful that the audience “paired” with me for six hours.



Animated story telling by http://visualcongruence.com
Animated story telling by http://visualcongruence.com
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Mark Goulston

Dr. Goulston is the world's #1 listening coach and author of "Just Listen" which became the top book on listening in the world