ABSTRACT
This chapter describes four essential elements of chronically suicidal patients experience: intense psychic pain, emptiness, hopelessness, and the need for control. It discusses the interpersonal context of chronic suicidality. High intensity of psychic pain is a crucial factor driving suicidality. In contrast, emptiness describes a more profound feeling of disconnection. It involves a sense that one barely exists in any meaningful way. Researchers find hopelessness to be an important correlate of suicidality in depressed people and have shown that its presence predicts suicidal actions. The difference in the chronically suicidal patient is that the feeling of hopelessness cuts much deeper. Thus, chronic suicidality can function to communicate distress to other people. Suicide attempts express despair in situations in which patients do not expect to be attended to in any other way. Empathy helps to relieve psychic pain, provides a sense of connection that combats emptiness, and confronts hopelessness by demonstrating that the patient in not completely alone.
