## Definition - Intense, unbearable [[Psychology|psychological]] pain - Associated with feelings of guilt, shame, hopelessness, or perceived failure - Coined by Edwin S. Shneidman, central to his theory of [[Suicide]] ## Core Concepts - Not equivalent to [[Depression|depression]], though often co-occurs - Exists as its own category of mental suffering - Can arise without mental illness; purely existential or situational pain ## Key Characteristics - Internal, subjective, deeply personal - Often described as "mental torment" or "anguish of the soul" - Linked to unmet [[Psychology|psychological]] needs (e.g., belonging, purpose, self-worth) - Drives desire to escape [[consciousness]] when unbearable ## Role in [[Suicide]] Theory - Shneidman’s assertion: **"[[Suicide]] is caused by psychache."** - When pain exceeds perceived coping resources, [[Suicide]] becomes an option - Focuses intervention on alleviating pain rather than solely treating symptoms ## Measurement - Psychache Scale (PAS) - **[[Suicide]] Assessment** frameworks often include [[Psychache]] as a core metric ## Clinical Considerations - Requires acknowledgment and validation, not dismissal - May not present as visible distress; often masked - Address through therapy aimed at: - Meaning-making - Emotional regulation - Reconnection to purpose/relationships ## Related Concepts - Existential despair - Emotional dysregulation - [[Hopelessness theory of depression]] - Thwarted belongingness (Joiner’s Interpersonal Theory) ## Notable Quotes - % "The central motive in [[Suicide]] is psychache." — Edwin S. Shneidman - "Where there is no hope, there is unbearable pain."