Why Live? Suicide Revisited (Compilation)

Suicide, let's start with suicide. Let me be clear. As far as mental health goes, suicide is the enemy.

The main obligation of a mental health practitioner, of all kinds, psychiatrists, coaches, therapies, counselors, like me, I'm a counselor, the main obligation, the main duty, the main goal of a mental health practitioner is to prevent suicide and avert suicide and fight off suicide and banish the thought of suicide and present alternatives to suicide. This is the main focus.

This is the raison d'etre. That's the reason for the existence of mental health disciplines.

What is it all about? It's all about prolonging life in a way where the patient or the client flourishes and thrives.

How can suicide enter into this?

Before I proceed, I refer you to the literature in the description.

A good friend of mine, Afshalom Elisur, at the time he was in Bar Ilan University, and another guy called Haim Omer from the Department of Psychology, Tel Aviv University. They published a seminal piece of work titled, What Would You Say to the Person on the Roof, a Suicide Prevention Text? It was published in Suicide and Life-Threatening Behaviors, Sorry, Suicide and Life-Threatening Behavior, Volume 31 in the year 2000.

It's an amazing text, and the authors say, the purpose of this anti-suicide text is to provide potential helpers, professional and lay, with clear guidelines for communicating with a declared suicidal person, particularly in real-time situations, when time is crucial and the act cannot be physically prevented.

The text may also have a preventative effect when diffused to the wide public as an anonymous address to potential suicide.

I recommend that you somehow get a copy of this text. It's amazing.

Now, let us enlarge the scope of the conversation a bit. Let's acquire some kind of philosophical vantage.

There has been an ongoing trend which started in proper medicine, in medicine proper, legalizing clinician assistance in a patient's death. The term is medical assistance in dying, MAID. Physician assisted suicide, not to mince words.

So it started with, okay, if someone is very critically and terminally ill, their life quality is horrible, they're suffering, they are tortured daily and by the minute, there's no hope whatsoever, no known medicine or procedure currently extant or available or about to become available within the lifespan or the longevity, the remaining time of the patient.

Well, in this case, the patient should be given the option to choose suicide.

And one could argue that the clinician has a moral and ethical obligation to assist the suicide, for example, to render it painless.

So it started in countries like Belgium and the Netherlands, and Switzerland, it was physician-assisted suicide there and spread to Canada, and today, physician assisted suicide in terminal stages of physical illnesses, which are irremediable, in other words, there's no cure, is pretty common actually all over the world.

In many places, even where physician assisted suicide is illegal, doctors turn a blind eye and they let the patient expire. Or in cahoots and collaboration with the family, they disconnect the patient from life support systems. This is common practice.

But then a very worrying trend started to occur in several places and again it started in Belgium and in Netherlands. In several cases physician facilitated suicide for psychiatric conditions is now becoming a norm, a reprehensible norm.

In a minute I will explain why I think so.

Patients are provided with medications and lethal injections. And these patients, nothing is wrong with their bodies. They have psychiatric conditions.

This is legalized actually in Belgium and Netherlands. And Canada is now on the verge of legalizing it.

In Canada, physician assisted suicide is legal since 2016, but now they're going to expand it and they're going to add serious mental illness as an eligible category where the physician could assist the patient to commit suicide.

What is a serious mental illness? Only God knows. Homosexuality used to be a mental illness in 1973. It was listed in the diagnostic and statistical manual. Homosexuality. Schizophrenia used to be thought of as a mental illness. Now we know it's a brain disorder. Autism was attributed to refrigerating mothers, bad mothering. Now we know it's bullshit, it's a neurological disorder.

The field is in flux. Our knowledge is transformed all the time.

Our understanding of diseases like tuberculosis or cancer is not philosophically fundamentally different to what we knew a hundred years ago. We know a lot more about the molecular mechanisms and pathways and, you know, we know a lot more obviously.

But the outward symptoms and manifestations of cancer in the year 1923 were the same like in 2023.

You can't, it's not the case with mental illnesses. Our understanding of mental illness and particular mental illnesses is transformed by the year, sometimes by the week, and transformed from the core fundamentally.

So serious mental illness cannot be defined or captured with any accuracy at any given moment, and we are at a huge risk of mislabeling specific mental health conditions as serious mental illness and serious mental illness which is actually we're going to discover merely physiological or bodily.

For example, bipolar disorder. Today we know that bipolar disorder is a physiological condition.

And so, the Canadian government planned to make serious mental illness an eligible category in March 2023.

Luckily, there was an announcement and they deferred their decision to March 2024.

But this decision should never be made. It's wrong.

The government said that the one-year extension would, I quote, provide additional time to prepare for the safe and consistent assessment and provision of MAID in all cases, including where the person's sole underlying medical condition is a mental illness. It will also allow time for the government of Canada to fully consider the final report of this panel.

This is unmitigated nonsense. Unmitigated nonsense.

There is no mental health practitioner or professional alive or dead, which could, who could, with any certainty, even minimal, design or assign a mental health condition to a hopeless category.

In other words, there's no mental health practitioners who can declare that a mental health condition is hopeless.

All mental health conditions are intermittent, exactly like cancer. They have remission periods. All mental health conditions. Many mental health conditions dissipate and disappear altogether. For example, borderline personality disorder with age.

Mental health conditions can be treated in a variety of ways and treatment modalities and vectors. Many of them are reclassified as bodily and physiological conditions.

And I think what I'm trying to say is this.

Classical medicine, conventional medicine, is probably 4,000 years old, psychiatry is less than 100 years old.

What am I talking about? It's 50 years old. It's an infant discipline. Infant discipline populated by infants, professional infants, infants not in the psychological sense, infants in terms of knowledge.

We know nothing about the brain, close to nothing. And we know nothing about the processes biochemical, electrical, in the brain, in the intestines, which are somehow connected to the brain, we are finding out. In the spine, which is connected to the brain, we are finding out, we are finding out things every single day.

We are not in a state of knowledge to make such a decision that a mental health condition is hopeless and therefore suicide is a reasonable option. We don't have sufficient knowledge to say this. It would take another few hundred years before we will be in the position to say anything of the sort.

Think of medicine two thousand years ago and medicine today. Psychiatry is where medicine used to be in the times of Galen. Two thousand years ago.

Treatment refractory conditions, treatments, patients with treatment refractory conditions.

These are conditions which are resistant to treatment.

These people, these patients, they go from one clinical trial to another. This psychotherapy, this medication, this and that, electroconvulsive therapy, transcranial magnetic stimulation, you name it. And they keep trying.

They keep trying because they have hope. Hope sustains them. This becomes the meaning and essence and purpose of their lives to find some relief, if not cure.

And yes, there are treatment refractory conditions, conditions that are not amenable to treatment. And yes, there are patients with such conditions. It's all very true.

But to offer them death as a treatment modality that defies everything that I have come to learn about mental health. This is a betrayal and abrogation of the most basic duty of any mental health practitioner, and that includes coaches and counselors who are not licensed.

When a psychiatrist tells you your only option is suicide, or even when a psychiatrist tells you, it's okay to consider suicide, this creates dissonance.

The psychiatrist, exactly like a mother, should be a secure base. Psychiatrist should provide you with a sense of containment, of holding, of safety. The clinic, the therapy should be a safe space. Not a source of terror, not a death threat.

You know, most mental illness, which is the outcome of the environment, environmental or relational mentalities, such as certain personality disorders, most of it is the outcome of conflicting signals by parental figures.

I love you, I hate you. I love you, but I'm going to torture you. I love you, but I'm going to kill you. I love you but I'm going to kill you. I love you only if you perform.

These conflicting signals create mental illness.

So if a mentally ill person comes to a psychiatrist and the psychiatrist says yeah suicide is one of the options, killing you would be a solution that creates dissonance which then triggers early childhood conflicts, the very root and source of the mental illness. It aggravates the patient's condition, it renders it more treatment refractory.

Where is the line? Where is the line? How does one decide whether this particular patient is hopeless? No treatment is going to work. There's no point in trying anything else. Who could make this decision?

In medicine, the decisionis clear because we have a gigantic body of knowledge we know what works and what doesn't work and what will never work.

That's not the case in mental illness. Not the case. Never is the case.

Because the field is evolving. Medicine as a field is evolving technologically. There are new medical technologies, but there's little new fundamental medical knowledge.

What is going on today in the field of medicine is fine-tuning, refinements, or discovering underlying mechanisms and pathways that lead to outcomes that were known before.

As far as the phenomenology of medicine, we have almost 100% knowledge. As far as the what, what is happening, what is about to happen. We have almost 100% knowledge.

As far as the why things are happening, we're still learning.

When it comes to psychology and psychiatry, as far as the what is happening, we have about 20% knowledge. And as far as why, we have 1% knowledge. It's a young field.

It is grandiose. It is hubristic to claim that anyone, psychiatrists, psychologists, therapists, or committee of these people has sufficient knowledge to render a decision who would react to treatment and who wouldn't.

And what treatment, by the way? Every single day there's a new approach, new theory, new score, new treatment.

Physician assisted suicide for psychiatric conditions is, in my opinion, murder. It's murder.

It's murder because suicide is intimately linked to depression. Depression is.

Depression is a cognitive distortion. The patient believes that he would be better off dead than alive. The patient believes that her nearest than dearest would be better off dead than alive. The world would be a better place if she were dead.

These are catastrophizing cognitive distortions, and we have the tools. We have very powerful tools to deal with cognitive distortions and to reverse them. Automatic negative thoughts and others.

This is part of the illness. The chain is catastrophizing cognitive distortion, depression, suicide. That's a chain and we can break this chain.

Today, mental health practitioners are lazy, indolent, self-indulgent and avaricious. You get a pill. Who wants to talk to the patient? It's too burdensome, too boring, just give him a pill, just give him a pill and that's it.

And the next stage is going to be who wants to talk to a patient? It's too burdensome, it's too boring. And pills cost money. Let's just advise the patient to commit suicide. It'll solve everyone's problem, wouldn't it?

I can envision a future, very near future, where physicians, psychiatrists, psychologists would be remunerated, they will get money for getting rid of patients via suicide. They will charge. Physician assisted suicide? $500 Canadian dollars. I can see the price list in the making as we speak.

This is a very terrifying and serious development.

There are also issues of racial bias, asymmetrical effects on the poor versus the rich.

Competence of people with serious mental illness. I mean, there's a conundrum here, isn't it? There's a paradox. If someone has a serious mental illness, is he in the position to decide whether to commit suicide or not? Isn't there an insanity defense here somewhere? Shouldn't we say, well, this guy or this girl they're not in the condition to make such decisions, life and death decisions? Or is it comfortable and convenient to pretend otherwise? They can't make decisions about their money, they can't make decisions about their family, but they can make decisions whether to live or die.

Mental illness, anyhow, is stigmatized. And patients avoid treatment because they don't want to be labeled. They worry about the consequences of getting care. Today, being labeled mentally ill means you can't get a job. People gawk at you, people mock you and ridicule you, manipulate you, and so on and so forth.

And in this recent piece by Diana Miller, Niner Miller is the co-author of Committed: The Battle Over Involuntary Psychiatric Care. She's assistant professor of psychiatry in behavioral sciences at Johns Hopkins University School of Medicine. And she wrote this piece, as I said, titled, As psychiatrists, do we offer hope or do we offer death?

And in her piece she quotes someone, and I think it would be of interest to us to listen.

Susan Kalish, she's a doctor, a geriatric and palliative care physician in Boston. She does favor the availability of facilitated suicide, facilitated death. She actually in favor of this kind of practice.

She says in the piece that she's in favor of expanding acceptance of an access to medical aid in dying patients who choose to exercise autonomy over their dying process for those who remain with irremediable suffering despite provision of optimal palliative care.

But she says, many countries have lowered the threshold way too far.

She says it is complicated and harmful to the general issue of medical aid in dying.

I think rendering suicide a legitimate option in the case of mental health is not okay, is not okay because mental illness is not like physical illness. Mental illness is intermittent. Mental illness is reversible. Mental illness is a new concept. It's 150 years old. Or if we go very, very far, 300 years old. It's an infant. We are in, the profession is in its infancy.

We keep getting things wrong all the time. We keep classifying and reclassifying and declassifying. We keep labeling things mental illness, which later are considered normal practices. We keep saying that some conditions are very serious and then we medicate them and they go away. Psychotic disorders, for example, bipolar disorder. Depression itself, to some extent, although we got it wrong with many antidepressants, to some extent, anxiety disorders. Many things used to be irremediable, untreatable, only a few years ago, few decades ago, and they're not anymore.

We need, when a patient comes, or a client comes, all hopeless and helpless and fearful and contemplates suicide, this patient or client contemplates suicide as a realistic way out, we need to fight back. We need to refuse to listen. We need to decline. And we need to equip the patient or the client with all the tools at our disposal from the fields of psychology and philosophy and religion and culture and society and history, all the tools, most recent research discoveries, treatment modalities, all the tools. We need to fight tooth and nail to prevent suicide.

Because if we don't do this, what the heck are we good for? What is all this bullshit profession if it cannot prevent suicide? What are we here for? Feel good factor? Pretend knowledge where there's none? Facilitate the pseudoscience known as psychology? What is this show of reality TV pretensions to science?

We have a humane mission to keep people alive so that they can be happy. Which leads me to the next issue.

And that is the issue of happiness and how we place happiness in a straitjacket with a single prescription, universal, good for everyone.

And if this prescription doesn't fit you, nothing is wrong with the prescription. Something is wrong with you and you need to take care of your mental health, of course, at the going rate.

So there's been a study on happiness. The Harvard study of adult development. This is by far the most comprehensive study ever conducted. It has been following its participants for their entire adult lives. The study started in Boston in 1938 and has already covered three generations, grandparents, parents and children. The children are now considered baby boomers.

So more than 2,000 people have been followed for 85 years of longitudinal study. There's nothing remotely close to this. This is by far the biggest study we have.

Marizio Vinegarten, MD, wrote an article titled Lessons from the Longest Study on Happiness, again in the literature in the description.

And he mentions that in January, Robert Waldinger, the current director of the study, published a book titled The Good Life, Lessons from the World's Longest Scientific Study of Happiness, co-authored with the studies associate director, Mark Schultz.

So they were following this huge population, with 2,000 people, for eight decades, their descendants and offspring and grandchildren and so on so forth, and they analyzed the factors most correlated with well-being and with happiness.

And they came up with a series of factors.

They discovered that the happiest participants had two major factors in common throughout the 85 years of the study.

Number one, they took care of their own health, and number two, they built loving relationships with others.

Now, being in good health, eating well, exercising, exposing yourself to the sun, taking supplements if needed, etc.

We all know that if you're not healthy, if you're sick, you're not happy.

So, reverse the sentence. If you're healthy, you're happy.

You know, my grandma could have told them that and saved them a lot of money.

The second factor was that good relationships were the most significant predictor of both health and happiness during aging.

In other words, if you just take care of your body and of your health, but your social life is lacking or you don't have any meaningful connections with friends, family and so on, your health will not survive, you will not stand ground. Your health will deteriorate.

The condition for health and happiness combined is meaningful relationship, good relationship with others. Loving relationships, significant relationship with others.

So there are physiological mechanisms that translate social fitness, social skills, socializing as an activity, social and being embedded in social networks, there are physiological transmission mechanisms, physiological vectors that connect these to your health.

Your health, your happiness, your longevity, your well-being, all depend on being firmly embedded in a social environment.

But not only any social environment, but a social environment where you keep getting positive feedback. You can share with, you can confide in, you can get, obtain support and succor, affection, compassion, empathy, and so on and so forth.

So a highly specific profile of a social environment.

What about professional success? What about career?

No. Professional success, career, money. Do not guarantee happiness. They are gratifying in the short term, but they do not generate long-term happiness.

And this is also something my grandmother could have told you. Alas, she's dead, so I have to refer to the Harvard study.

The study revealed that the happiest people were not isolated. They had valued relationships. They fostered and engendered relationships and then they invested in their relationships.

This was somewhat correlated with level of education, cultural awareness, and income, level of income.

Because these people tended to have healthier habits. They had access to health care.

And strangely, they tended to have more functional social networking, social fitness skills.

Loneliness creates challenges and stress.

And if you don't have anyone to talk to, anyone to confide in, anyone you can vent to, I mean, you're in trouble in this sense according to this study.

Loneliness is the greatest predictor of both unhappiness and shortened longevity and bad health.

It's not quite clear whether loneliness itself is the cause or whether when you're lonely, you develop habits, such as drinking or drugs, doing drugs, which affect your health.

It's not quite clear. What leads to what?

But somehow there's a correlation, a very strong correlation. However, a very strong correlation.

However, a caveat here, this is not for everyone.

People with schizoid personality disorder or people with schizoid personality organization, myself, for example, we are extremely unhappy when we are with other people.

I, when I'm with other people, I'm stressed, I'm anxious, I'm unhappy, I can't wait to get away. My happiness increases exponentially. The longer I'm all alone.

And when I say all alone, I mean all alone. Like when I don't travel, I don't talk to anyone, I don't meet anyone, I don't chat with anyone, I don't correspond with anyone. I'm incommunicado. If I'm in communicado for a day, I'm happy. If I'm in communicado for a week, I'm seven times happier. If I'm in commedico for a day, I'm happy. If I'm in commedico for a week, I'm seven times happier. If I'm in commedico for a year, I'm 365 times happier.

There's no limit to my happiness. It is directly correlated with the amount of time I'm all alone in solitary, imposed solitary confinement.

So I'm in this sense I have a schizoid personality organization and so we cannot generalize this.

I think many many people have grown used to loneliness, developed a habit of loneliness, especially after the pandemic.

But the pandemic was just the tip of an iceberg. People were becoming more and more lonely since the 1980s. And they passed on their loneliness to their offspring and children. Loneliness may be the new normal.

And so these people who have been lonely for 10 years or 5 years or two decades or all their lives, these people would find socializing a very stressful activity. They would become annoyed and irritated. Having to talk to other people, having to spend time with other people, would be perceived as an imposition, as a burden, as an obligation or a duty, the equivalent of going to work in the old days.

So I wouldn't generalize. I wouldn't generalize.

Waldinger recommends to assess how to foster, strengthen, and broaden relationships. He calls this maintaining social connections.

It's like physical fitness. let's call it social fitness which requires constant practice so friendships relationships commitment is investment investment on a daily basis commitment has to be maintained via regular investment.

If you don't maintain the commitment, it fizzles out. A phone call, a single sentence via WhatsApp. This is maintenance.

If you participate in activities, they bring your joy, encourage camaraderie, friendship, I don't know, sports, hobbies, volunteer work, whatever. This broadens the relationships network and enhances its depth.

In short, experiences, common experiences are the glue that holds relationships together, providing these common experiences, are uplifting, joyful, and or meaningful.

Happiness is not a constant. Happiness is not a constant. Life is about difficulties, about losses, about challenges. We need to develop resilience.

Social fitness is about social skills, but also about perseverance, about tenacity.

So it's not true that you can attain a condition of happiness and then it's like a plateau. You know, it's something like that.

You have to work daily at being happy. It's hard work. It's a full-time job.

And life throws at you all kinds of curveballs, and some of them are negative, and some of them are positive.

Things happen, new experiences, surprises, the least expected, and, you know, suddenly you're faced with a distinct possibility of being happy.

And of course, the opposite also happens. Tragedies.

So you need to be on your toes. You need to be on your toes. You need to cultivate your relationships as buffers, defenses, firewalls, against the exigencies, vicissitudes and ups and downs of life.

To become healthier, to achieve happiness, to overcome challenges and difficult moments, you need to be surrounded by people.

This applies to the majority of population, but we need not make it a general principle, universal principle, it's not.

There's a sizable minority who react adversely to the presence of other people. And this minority is growing by the day because loneliness is a muscle. Use it or lose it and people are using it more and more.

People are becoming habituated to loneliness.

I think socializing would be considered abnormal by the end of this century. Totally abnormal because we will have alternatives like the metaverse and so on and so forth. It's out of fashion.

And psychology, individual psychology, shapes itself to positively adapt to the external environment.

And if the external environment imposes on your loneliness, if it incentivizes you to be lonely, if it rewards you for being lonely, then your brain neuroplastically will reshape itself and loneliness will make you happy.

So I think this study reflects the past. The youngest people in this study are actually baby boomers. It reflects the past.

I think the future is happiness through loneliness and self-sufficiency.

Now it sounds ominous to baby boomers like me, but, you know, Generation Z would find it normal.

Generation Z would consider socializing, slimy, smarmy, and pretty disgusting. Revolting! I have to meet someone! Revolting! They're sweating, they're smelly, they talk so much. Why can't I stay with my metaverse and never ever see a human face.

That's the face of the future.

Thank you for having me.

Esteemed colleagues, I'm going to discuss something a lot closer to the topic of the conference.

I'm going to discuss teen suicide, and then I'm going to discuss the philosophical foundations of suicide and attempts to understand suicide within the context of various philosophical schools.

My name is Sam Vaknin. I'm a professor of psychology in Southern Federal University in Wastov-on-Don, and a professor of finance and a professor of psychology in the outreach program of CIAPS, Centre for International Advanced and Professional Studies. I'm sorry, I'm obligated by my contract to state all these things, so apologies.

Let's start with teen suicide.

Teen suicide had been closely linked to social media.

Social media and the devices that they run on are designed to be addictive and to condition users.

Many industry executives of social media and social media companies, many engineers who had designed the platforms, many of them have confessed that the addictive and conditioned elements in social media are intentional, they are by design.

Addiction is always punctuated by periods of withdrawal. It's cold turkey, excruciating symptoms.

The correlation between all manner of addictions and suicide or lesser self-destructive and reckless acts, this correlation is well documented.

Exposure to screen time creates addiction, may lead and often does lead to suicide.

College freshmen are overwhelmed more than ever. 41% of college freshmen in 2016 reported being utterly disregulated and falling apart, disintegrating. This compares to 18% in 1985.

But teens also experience performance anxiety when they're on social media.

This is because these are competitive ecosystems, or shall we say ego systems, where one's social ranking is objectively determined by quantitative yardsticks, such as a number of likes, a number of friends.

And it is publicly available for all to see, for everyone to opine on.

This is enormous stress, enormous pressure.

Diagnosed anxiety among teens shot up 20% since 2007. One sixth of all cases are classified as severe.

Peer pressure is egodystonic and often expressed as bullying or mobbing or in other forms of aggression such as black humor or brutal honesty.

And this is a toxic environment. It's a toxic environment that engenders a lot of destructive envy as well.

Studies show that teens, teenagers nowadays, are more insecure than in any previous generation.

They are especially concerned about their economic future. They are asocial.

Teens prefer surfing to socializing with friends their age. Both dating and sexual activities have declined by more than 50%, 5-0% since 1985.

The teenagers of today are not used to privacy, and therefore they are incapable of intimacy. They are itinerant, peripatetic, and they mature very slowly. They are three years behind on every scale of personal development.

Medically, contemporary teens are obese. They have body image problems. Many more of these teens are on mind-altering medications or drugs.

And these are hallmarks of pathological narcissism.

Jean Twenge discovered that MMPI scores evinced a five-fold increase in psychopathology in 2007 compared to 1938.

Anxiety and depression, according to her studies, Twenge, anxiety and depression have shot up six-fold.

The amount of suicides among young teenage women escalated by 54% in a single decade.

Social media is amenable to mass hysteria, shared psychotic disorders, now no longer a diagnosis in the DSM-5, but still very much alive and well.

On social media, there's the emergence of cults, including personality cults, nihilistic cults, suicide cults, and death cults.

One example is of course ISIS. ISIS was a child of social media.

And this proclivity is aided and abetted by two attendant phenomena.

One, catastrophizing an end of days presentiment which is enhanced by, two, unmooring the profusion of fake news, truthiness, reality TV and the narcissistic tide of anti-expertyise and anti-intellectualism.

Studies are unequivocal beyond a certain level. More screen time leads to reduce levels of happiness, reduce levels of life satisfaction and self-esteem, to increase manifestations of anxiety and depression. All other off-screen activities have the opposite effects.

If you do sports, if you have interpersonal interactions, if you attend religious services, if you consume legacy, print and electronic media, including television, if you do your homework, your spiritual and mental well-being is enhanced.

If you do social media, if you do internet, if you do surfing, if you are exposed to screen time, your depression and anxiety levels will be uncontrolled. You will have become a suicide risk.

These, all the studies agree on, most notably the studies by Twenge, Lisa Wade and others.

Social media reflect our values. We prefer efficiency to quality or quiddity. Ours is a quantitative world, a death count civilization which places value on inanimate objects rather than on human beings.

But some things do not lend themselves to speed or to quantity. Family life, intimacy, romance, friendship, for example.

Modern technology was invented by young white males, schizoids, asocial, asexual, somewhat autistic, recluses. This is the profile of the people who had invented social media across the board.

Businessmen then took over from the engineers, and they stripped the outcome of anything that stood in the way of monetizing the maximum number of eyeballs.

And the result is a psychogenic chimera. The result is a psychogenic nightmare. It's a psychopathology engine. It creates illness.

The ever-diminishing size of screens from the cinema screen to the smart watch, this ever-diminishing size of screens has tracked the atomization of our ever more anomic and narcissistic societies.

In his book Suicide, Emil Durkheim predicted a hundred years ago that suicide rates in anomic societies will tend to increase. He was right and not only about this.

Since 2010, suicide among teens, teenagers, skyrocketed by 31% in a single decade. It became the leading cause of death, the leading cause of death, among people younger than 24.

I refer you to various sources, the Journal of Development and Behavioral Pediatrics, the National Survey of Children's Health, Higher Education Research Institute, UCLA, they have a series of publications on this issue, and an article by Twenge, Martin and Campbell in the January 2018 issue of Emotions.

Suicide is intimately linked to depression. And there's a variety of depressive disorders, and I would like to dwell on one of them.

What is known as the Winter Blues. The Winter Blues are supposed to cause suicidal ideation, SAD, seasonal affective disorder. There is even a mental health syndrome. It supposedly is alleviated by bright light therapy, therapy using artificial sources, emulating daylight.

But suicide rates are highest actually in the spring. They're highest in the summer months. They are the lowest in winter.

The propensity to commit suicide increases with increasing hours of daylight, exactly opposite of what we think, exactly opposite of our intuition.

Suicide is not correlated, and suicidal ideation is not correlated, with any other meteorological variable, such as rainfall or temperature.

Suicide rates appear to increase with increasing hours of daylight, and they show no connection to any other meteorological factors such as changing temperature or rainfall, and surprisingly sunlight is known to indirectly induce heightened brain levels of serotonin, a biochemical inversely linked to depression. The lower the levels, the deeper the depressive episode. Serotonin drops during winter months.

It seems that suicide has nothing to do with depression. I repeat, suicide has nothing to do with depression.

Depressed people do not commit suicide. They are too busy being depressed.

If suicide were caused by depression, suicide rates would have been highest in winter, when serotonin is lowest, and depression rates are highest.

But suicide peaks in spring and summer when depression rates are lowest.

Depression is a biochemical illness. One can feel hopelessness and helplessness to the point of committing suicide without being clinically depressed.

It is this feeling that is very dangerous, that there is not satisfactory solution, no way out, that one is helpless, one is trapped.

Of course it is counterfactual. There's always a way out. There's always a solution. One way or another. Always.

I refer you to the American Journal of Psychiatry, 2003. Volume 160.

But suicide is a much more complex phenomenon and cannot be reduced to mental health, to psychology, to serotonin.

Suicide is a societal, cultural artifact. And this is why various philosophers throughout the ages, religious authorities, they all try to cope and deal with suicide.

Its various dimensions, its morality, its demographics, its proclivities to suicide, who is more prone, who is less prone, why commit suicide? Is it ever justified? etc.

Suicide is a collective endeavor, not an individual one.

Those who believe in the finality of death, those who believe that there is no afterlife, they are the ones who advocate suicide and regard it as a matter of personal choice.

On the other hand, those who firmly believe in some form of existence after bodily death, after corporeal death, these people condemn suicide and they judge it to be a major sin.

And yet, rationally, the situation should have been reversed.

It should have been easier for someone who believes in continuity after death to terminate this phase of existence on the way to the next phase of existence.

Those who face void, finality, non-existence, vanishing after death, they should have been greatly deterred by suicide. They should have refrained from suicide or even entertaining the idea of suicide.

Either the latter do not really believe what they profess to believe, or something is wrong with rationality.

Suicide is very different from self-sacrifice.

It is not the same as avoidable martyrdom. It is not the same as engaging in life-risking activities. It is not a refusal to prolong one's life through medical treatment, euthanasia. It is not the same like overdosing or self-inflicted death that is a result of coercion.

There are many ways and forms to bring about death prematurely, but not many of them qualify as suicide.

What is common to all these is the operational mode, a death caused by one's own actions, by one's own hand.

In all these behaviors, a foreknowledge of the risk of death is present, coupled with its acceptance.

But everything else is so different that they cannot be regarded as belonging to the same class.

Suicide is chiefly intended to terminate a life.

All the other acts that I've mentioned, they are aimed at perpetuating, strengthening and defending values.

Those who commit suicide commit suicide because they firmly believe in the finiteness of life and the finality of death. These people prefer to terminate life rather than continue life.

Suicide may be an obsessive-compulsive ritual aimed at forestalling much-dreaded change.

Indeed, suicide rates are highestamong people whose lives are adrenaline-filled roller coasters.

The more exciting, the more thrilling, the more risky, the more stressful your life is, the more likely you are to commit suicide.

Physicians, policemen, bipolar patients, borderline personality disordered patients, they have the highest rates of suicide.

Yet all the others, the observers of suicide are horrified by people who prefer suicide. They are disgusted by people who choose suicide. They abhorred.

And this is to do with our understanding of the meaning of life.

Ultimately, life has only meanings that we attribute and ascribe to it.

Such a meaning can be external, God's plan for those of us who believe in God, such a meaning can be internal, some kind of meaning generated through arbitrary selection of a frame of reference or a value or a cause.

But in any case, in any case, the meaning must be actively selected, actively adopted, actively espoused.

The difference is that in the case of external meanings, we have no way to judge the validity and quality of external meanings.

Is God's plans for us a good plan or not a good plan? We are not in the position to judge or no. We just take these external meanings on, because they're big, they're all encompassing and come from a good source.

A hyper-goal generated by a superstructural plan tends to lend meaning to our transient goals and structures by endowing them with the gift of eternity.

Something eternal is always judged more meaningful than something temporary or temporal.

If a thing of less or no value acquires value by becoming a part of an eternal thing, then the meaning and value reside with the quality of being eternal, not with a thing that was endowed with meaning.

It is not a question of success. Temporal plans are as successfully implemented as eternal designs.

Actually, there is no meaning to the question, is this eternal plan or process or design successful?

Because success is a temporal thing. It depends on time. It is linked to endeavors that have clear beginnings and clear ends, and eternity does not have an end or a beginning.

And so this is the first requirement.

Our lives can become meaningful only by integrating ourselves into a thing, a process, a being that is eternal.

In other words, continuity, the temporal image of eternity, to paraphrase a great philosopher, continuities of the essence, terminating our life at will renders our life meaningless.

A natural termination of our life is naturally preordained. And natural death is part and parcel of the very eternal process, the very eternal thing, the very eternal being, which had lent meaning to our lives.

To die naturally is to become part of an eternity, part of a cycle and uninterrupted cycle. And this cycle goes on forever. It's a cycle of life and death and renewal.

When we interrupt this cycle with suicide, we betray. We betray ourselves. We betray what we are integrated into. We abrogate any possibility for meaning.

This cyclical view of life and the creation is inevitable within any thought system which incorporates a notion of eternity.

Because everything is possible, given an eternal amount of time, so are resurrection and reincarnation, the afterlife, hell, and other beliefs adhere to by the eternal group of people.

Sidgwick, a philosopher, Sidgwick raised the second requirement and with certain modifications by other philosophers.

He said, to begin to appreciate values and meanings, a consciousness and intelligence must exist.

The value of meaning or meaning must reside in or pertain to something outside the consciousness, outside the intelligence.

But even then, only conscious intelligent beings, only conscious intelligent beings will be able to appreciate it.

We confuse the two requirements, we confuse the two views.

The meaning of life is the consequence of life being a part of some eternal goal, plan, process, thing or eternal being.

Whether this holds true or does not, a consciousness is called for, is needed in order to appreciate love's meaning.

Life is meaningless in the absence of consciousness or intelligence.

Suicide flies in the face of both requirements. It is a clear and present demonstration of the transience of life, the negation of the natural, eternal cycles or processes.

Suicide also eliminates the consciousness and intelligence that could have judged life to have been meaningful had this consciousness or intelligence survived.

Actually, this very consciousness or intelligence makes a decision in the case of suicide that life has no meaning whatsoever.

To a very large extent the meaning of life is perceived to be a collective matter of conformity.

Suicide is a statement written in blood, that the community is wrong, that life is meaningless and final.

Otherwise, the suicide would not have been committed.

This is where life ends and social judgment commences.

Society cannot admit that it is against freedom of expression, and suicide after all is a statement of freedom of expression.

Society could never accept this.

Society always prefers to cast the suicides in the role of criminals or sinful people and therefore bereft of many or any or social or civil rights.

According to still prevailing views, the suicide violates unwritten contracts with himself, with others, with society, and many add with God or with nature with a capital N.

Thomas Aquinas said that suicide was not only unnatural because organisms tried to survive not to self-annihilate, so it's not natural. Aquinas said it also adversely affects the community. It violates God's property rights.

The latter argument is interesting. God is supposed to own us. He owns our soul. Our soul is a gift.

In Jewish writings, the soul is a deposit. The individual gets the soul as a deposit from God.

A suicide, therefore, has to do with the abuse or misuse of the possessions of God, temporarily lodged or lent to a corporeal person, to a corporeal man.

This implies that suicide affects the eternal, immutable soul.

Aquinas refrains from elaborating exactly how a distinctly physical and material act like suicide can have any effect, can alter the structure or the properties of something as ethereal and as eternal as the soul.

Hundreds of years later, Blackstone, the codifier of British law, agreed with Aquinas. He concurred the state, according to Blackstone, this preeminent, juridical mind, the state has a right to prevent and to punish for suicide and for attempted suicide.

Suicide, wrote Blackstone, is the same as murder. It's exactly murder. It is self-murder, and therefore it is a grave felony.

In certain countries, this is still the case. Suicide is a criminal offense.

In Israel, for instance, a soldier is considered to be the property of the army and the state. Any attempted suicide by a soldier is severely punished as being attempted at corrupting army property.

Indeed, this is paternalism, and perhaps paternalism at its worst, the kind that objectifies its subjects. People are treated as possessions, as property, in this malignant mutation of benevolence.

Such paternalism acts against other adults expressing fully informed consent. It is an explicit threat to autonomy, freedom, privacy and free will.

Rational, fully competent adults should be spared this form of state intervention.

It serves as a magnificent tool for the suppression of dissidents in places like Soviet Russia and Nazi Germany.

Mostly, such an intrusive nanny state tends to breed victimless crimes.

Gamblers, homosexuals, communists, people who commit suicide, all these people in some jurisdictions commit crimes.

But who is the victim? It's a victimless crime. All these have been protected from themselves by big brothers in disguise.

If you consume drugs, the state is trying to protect you from yourself. If you commit suicide, the state will intervene and lock you up to prevent you from committing suicide.

But why? Why is that?

Wherever humans possess a right, there is a correlative obligation to not act in a way that will prevent the exercise of such a right.

The state has no right to prevent anyone from exercising their rights, has no right to do so actively by preventing it, by preventing the exercise of the right, and the state has no right to intervene passively by reporting the violation.

In many cases, not only suicide consented to by a competent adult in full possession of his faculties, the suicide also increases utility, both for the individual involved and for society at large.

The only exception is, of course, where minors or incompetent adults, the mentally, the intellectually challenged, the mentally insane, these people, when they are involved in committing suicide, attempting suicide and suicidal ideation, we should protect them.

At that point, a paternalistic obligation does seem to exist.

I use the cautious term seems to exist because life is such a basic and deep-set phenomenon that even the incompetent can fully gauge its significance, even they can make informed choices and decisions in some respects.

In any case, no one is better able, better positioned to evaluate the quality of his or her life and the ensuing justification of a suicide. No one is more competent. No one is more competent than a mentally competent person.

Only the person himself or herself can make this judgment and decide whether to commit suicide or not. And no one has the moral or legal right to intervene.

The paternalistics, the people who espouse state paternalism, they claim that no competent adult, no competent adult will ever decide to commit suicide.

They say, no one in his right mind chooses this option.

This contention is, of course, nonsensical, counterfactual, obliterated by history and by psychology.

But the derivative argument seems to be more forceful.

Some people whose suicides were prevented felt very happy that they are still alive. They felt elated to have the gift of life back.

Isn't this sufficient reason to intervene?

Well, absolutely not. All of us are engaged in making irreversible decisions and sometimes we regret these decisions.

But we should not be prevented from making them. For some of these decisions we are likely to pay very dearly.

Is this a reason to stop us from making decisions? Of course not.

Should the state be allowed to prevent a couple from getting married because of genetic incompatibility? No.

Should an overpopulated country institute forced abortions? No.

Should smoking be banned for the higher risk groups? No.

The answers are clear. The answers are negative.

So there is a double moral standard when it comes to suicide.

People are permitted to destroy their lives, but only in certain permissible prescribed ways.

If you want to commit suicide, you can smoke yourself to death. That's okay. You can drink yourself to death. That's okay. But you cannot hang yourself. That's not okay.

And if the very notion of suicide is immoral, if suicide is even criminal, why do we stop at individuals? Why not apply the same prohibition and the same logic to political organizations, such as countries, to groups of people, to institutions, corporations, funds, not-for-profit organizations, international organizations?

All these have a right to disband. All of them have a right to go bankrupt. All of them have a right to shut up their doors.

Isn't this the equivalent of suicide on the collective level? Why don't we prohibit this as well?

And of course it's a slippery slope. It fast deteriorates to the land of absurdities, long inhabited by the opponents of suicide.

Suicide is a choice, and as we have no right to limit the choice, other choices, we have no right to limit this choice.

We may institute cool-off periods. We may institute counseling. We may try to provide different angles. We may try to aid and abet suicide among vulnerable groups.

But ultimately, if the individual has made up her or his mind, if it's a competent adult, he has, she has the right to terminate her life. It is her life after all.

Thank you for listening.

I would like to ask for the point of the presentation.

Here I would like to have any queries that they ask you if you have to answer us.

I think so.

Sir Mr.

Sirvishma here. Can you hear me?

Yes, I can hear you. Thank you.

Yeah. It is a nice percentage I can find a holistic point.

You would have to speak a bit slower because the line is interrupted constantly.

Yeah, I find that there are many initiatives made by the community and academic level.

But when it comes to that, whether it reaches to the masses, the number of cases in suicide are increasing day by day.

At the same time, like as professionals, we also make an initiative to create an awareness to provide support.

Where is the gap?

Why is the information of need, reaching that target populations. If there is anything which we are made right now are not appropriate to the current system.

What is the problem in it? Can you give inputs on that?

There are many, many myths about suicide.

And the most dominant myth is an ideological myth.

It's the myth that if we only improve the lot of people materialistically, if you provide them with work, if you provide them with material goods.

This is a prescription for happiness and it's an antidote to suicide.

Suicide is a collective communal act. The person who commits suicide is sending us a message.

I no longer feel loved. I no longer feel embedded in anything larger than myself.

I don't have a family, I don't have a community, I don't have friends, I don't have a church, I don't have God.

So people who commit suicide had actually committed social suicide and psychological suicide way long before they had taken their body away.

It is this that we should monitor.

We should intervene not in suicide, because suicide is a libertarian choice, and no one has a right to take your choice away from you not even the state not even your loved ones not even your children no one you are the master of your body we have accepted this for women we say the woman is a master of her body she can commit abortion we should accept it for the whole population.

You want to commit suicide, you have a full right to commit suicide.

But we should try to minimize the phenomenon.

And the only way to do this is to interfere in the much earlier stages where people drift away from support networks, where they drift away from communities, where they drift away from groups, where they no longer belong, where they are atomized, where they're anomized, where they're, in other words, we have to attack loneliness.

We have to attack loneliness. Then the only way to attack loneliness is to force people to re-engage other people, to integrate with other people.

And the first crucial step of this is to substantially restructure online life.

This is the biggest threat. Online life is the biggest threat.

We need to restructure the way social networks work. We need to restructure the way entertainment is delivered and so on so forth.

So as to force people to engage with other flesh and blood, living, breathing human beings.

Absolutely.

It's the only prescription, the only recipe against suicide.

People are poor.

The lowest suicide rates are among the poorest nations. The highest suicide rates are among the richest nations. It's a fact.

The lowest suicide rates are among people whose lives are integrated with other people because they have no choice. They have no leisure, no leisure choice. They have no leisure time.

They must collaborate with other people. They must engage with other people. They must rely on other people. They are embedded in structures and systems and communities and so on because the resources are so scarce that everyone has to share for everyone to stay alive.

As simple.

We have created self-sufficiency, and self-sufficiency is a recipe for suicide.

When you become self-sufficient, you have no more reason to live.

There is only one more question in the chart box, we can give the answer for that answer.

But stay here.

Thank you.

There's a question here by Sherea Pandi.Sherea Pandi.

I have a question for Sam.

Like you said, smoking and drinking to death is okay, but not hanging yourself. Can't we make the things like we shouldn't think about suicide and there should be some device which can measure pressure, like mental pressure, and save them from committing suicide?

The fact is that long before anyone commits suicide, they emit, they broadcast distress to other people.

Every suicide attempt is preceded by multiple times of announcements.

The person who is about to commit suicide usually says, I'm feeling bad, I want to end my life, I'm about to commit suicide.

People send out signals to other people, to institutions, to mental health practitioners, to neighbors, to friends, to colleagues. People send out signals long before they commit suicide.

It is just that we are so desensitized, we are so self-centered, that we don't pick up on these signals.

And we have our own problems.

Depression had become so ubiquitous, so all pervasive, that virtually everyone is depressed. Everyone has anxiety, so we don't see it as anything special. And we all have lately suicidal ideation. Suicidal ideation has become very prevalent.

So the value of the signal, the value of the signal is depreciated.

Because everyone says, oh, I wish I were dead.

Then when someone really means it, we don't pick up on it. We don't pick up on pre-suicide signals.

We need to be very alert. And when anyone mentions death in any way repeatedly and consistently and continuously, we need to step up and help them in any way possible.

Usually, just having a talk, just lending a listening ear, a shoulder to cry on. Usually it's more than sufficient.

It's shocking how little is needed to reverse the decision for suicide. How little is needed? It's absolutely shocking.

That's why, for example, hotlines, suicide hotlines, are very, very successful.

On a suicide hotline, you call, you talk to someone for 20 minutes, you don't want to commit suicide after that.

Suicide is a symptom. It's like fever. Suicide is a symptom of the disease of loneliness, the disease of atomization, the disease of disconnection from fabrics, social fabrics, social safetyness, social institutions.

It's a symptom. It's not a disease.

So we can take care of the symptoms. We can take care of the symptoms, but we need to tackle the disease itself.

And it's a social disease.

Suicide is a social act. Social act, actually anti-social act. It's not an individual act.

It's a message, I give up on you.

The suicide, the person who commits suicide, he is telling society, I'm giving up on all of you. I'm giving up on all of you. I'm giving up on other people. I'm giving out on my family. I'm giving up on my friends. All of you let me down. All of you did not help me when I needed help. I'm giving up on society. I'm giving up on humanity.

It's not an act of self-destruction. It's an act of total separation. It's a goodbye act. Goodbye, I'm out of here. Stop the world. I want out.

Thank you so much, sir.

Thank you. Thank you. Thank you.

Thank you.

Thank you.

Let's have for us and give you a wonderful insights of suicide. Thank you.

We'll move forward to our presentation.

and give you a wonderful insights of suicide. Thank you.

We'll move forward to our presentation.

You are welcome Professor.

Thank you. I have unfortunately to go and I apologize to the future participants, but thank you very much for listening. Have a nice day, everyone.

Thank you.

Like every other mental health practitioner in the world, I am deeply alarmed and unsettled by the rising tide, scrap this by the tsunami of suicidal ideation among people, of all age groups in all cultures and societies throughout the world.

People just want to end their lives. They reject life, they reject reality, they reject the world they live in. They have no hope for the future, not for themselves, not for their offspring, and not for human society and species in general.

Today, I want to tell you why I think you should choose life, even if it's unbearable, intolerable, difficult, you should choose life.

There are a few exceptions, of course. If you've got a few months to live, and your quality of life is horrible, bordering on torture, euthanasia may be the right thing to do.

But otherwise, with this very, very slim, sliver of exception, you should always choose life.

And I would like to provide you with a philosophical foundation as to why you should do that.

Why to not commit suicide? Why suicide is not a solution?

Now you all know me, Shoshanim. You know that I'm abrasive. You know that I'm cynical. You know that I never flinch from the truth. You know that I pay no heed to social conventions and mores, you know that I don't sugarcoat anything, at least I have these credentials with you.

This, you can trust my adherence to the truth as I see it, and yet I'm telling you, suicide is not a solution, life is.

I'm going to try to substantiate this very out of character, Polyanish, optimistic message.

My name is Sam Vaknin. I'm the author of Malignant Self-Love, Narcissism Revisited. I have a PhD in Philosophy, which helps me with this presentation, and I'm also a professor of psychology and a professor of finance in several universities around the world.

Let's delve right in.

Suicidal ideation is a fancy clinical term for someone who is contemplating suicide, doing research as to methods of offing himself or herself, thinking constantly about not being, absenting himself or herself from the world.

Suicidal ideation is a precursor in many cases to actual attempted suicide, and that is why it's so alarming. Its incidence and prevalence now are very, very frightening.

Following the pandemic, on the heels of the pandemic, but not only because of the pandemic. We've seen this trend among the young especially.

Depression and anxiety rates have skyrocketed and suicidal ideation. Suicide rates in general are down in the general population, but among the young they're up.

And so this video is addressed mostly to young people.

Whenever someone tells me about their intention to end their life, I respond, staying alive is the only cogent argument for staying alive.

In other words, the only reason to stay alive is because you have to stay alive. We stay alive simply because the alternative is not being.

Well, isn't this a cyclical argument, what we call in philosophy a tautology? Isn't it a meaningless play with words, the form of scholasticism?

Not really.

Existence is always richer in potential than non-existence. Life is full of pain and frustration.

But pain and frustration are not causes. They don't cause anything. They just are the same way that we are.

Now we have two options. We can exist and experience, or we cannot exist.

When we don't exist, our potential is zero. When we exist, the potential is large.

It's not infinite, as some coaches would have it. It's not unlimited. It's not that if you put your mind to it, there's nothing which is beyond your reach. It's not that there's a giant inside you. I forget all these scams by con artists.

That's not what I'm saying.

What I'm saying is life is full of potentials. And it's full of potentials because it's complex and because there are other people out there.

The interpersonal interactions between people are so multifarious and so complex that they cannot actually be predicted.

And potential is about unpredictability. It's about good and bad things that may happen to you.

When you are dead, your potential is zero. When you're alive, your potential is vast.

We should always choose potential over non-potential. This is the way of the world. This is on a biological, molecular level.

Bacteria choose potential over non-potential.

Everything in the world, the whole universe, the whole creation is geared around the unfolding and actualization of potentials.

My own work in physics builds on this idea.

So potential is the key.

Pain, frustration, suffering, they're phenomena, they're natural forces, human-made forces, but humans are part of nature.

They are there, the same way that rocks and trees are there the same way that viruses are there the same way that other people are there they're just there then they don't imply any action they're not actionable.

So I hope if you're considering suicide, that you reconsider.

And I want you to reconsider in view of this organizing principle of creation, potential, the encounter with potentials and unfolding, exploring, developing your own potential.

Some of you claim to have faith. You contemplate suicide and at the same time you claim to have faith. You contemplate suicide and at the same time you claim to have faith in an afterlife, whatever that may be. You claim to have faith, but you sound as though you have lost all faith.

Suicide is the renouncing of faith. Now, faith in God, faith in yourself, faith in the future, full of potentials, some of them good, some of them bad, definitely. Faith in experiencing, faith in other people.

Suicide is the renouncing of all faith. So it cannot be reconciled with any faith, whether secular or religious.

You are part of creation, not creation in the design sense. I'm not implying that as a creator, but you are part of what there is.

And nothing just is. Everything is about becoming and you are an integral part of that becoming.

You see, people confuse purpose and meaning. However devoid of goals your life may be, your life is meaningful. Even if your life has no purpose, your life always has meaning and it always has meaning because you are an integral part of the becoming, the process of becoming of the whole universe.

The universe would not be the same without you. The universe would not have been the same without you. The universe will not be the same after you are gone.

Your presence in the universe renders the universe what it is.

When you choose to live rather than die, you co-create the world. Your death renders the world instantly different, instantly other.

The extent of your influence on the universe is essentially infinite because you are a defining dimension of the cosmos.

Think about it for a minute. You don't need to be a great philosopher to comprehend what I'm saying. Think of the world without you and the world with you. These are clearly two different worlds.

So it is your presence which determines for the rest of us and for the universe at large how it's going to look, how it's going to behave and what's going to happen.

Had you not been born, reality for every atom and for every person and for every entity, reality would have been radically different.

Your birth made a difference. Your existence makes a difference. Literally, difference. You are altering reality. You're altering the universe by the very fact that you are still here with us.

And so you have a great responsibility.

And don't confuse this responsibility with having goals.

It's not about having goals. It's not about having a purpose in life. It's not making a difference in the colloquial term, in the colloquial sense.

It's making a difference just by being.

Even if your life is meaningless and purposeless, even if you lie in bed throughout your life and do nothing whatsoever, the fact that you and you only are in this bed doing nothing makes a difference. Because without you, the world would not have been the same.

Purpose and action and accomplishments are the icing of the cake of your existence.

But your existence alone suffices. It's not only a gift.

The Jews believe that existence, life is a gift, a deposit, so to speak. It's not only a gift. It's also a responsibility.

You were born. So from the minute you inhaled the first atoms of air into your expanding lungs from that very second or split second. You owe it to the rest of us to maintain the world as it is with your presence in it.

You have a responsibility to keep the universe afloat, to not make it different until your time comes.

Your existence alone suffices to steer everyone and everything in another direction and towards an alternative destiny. You are truly the co-author, the co-author of the universe. What could be more significant than this?

Why are you looking for anything more?

Being yourself, being authentic, being here is all that matters.

When the famous French philosopher Voltaire was on his deathbed, he was asked by a priest to renounce the devil. And he famously responded, it is not the time to make new enemies.

Whatever you may think about Voltaire or the devil or the priest, this answer encapsulates authenticity.

Voltaire remained true to himself to his last breath, because Voltaire understood that just being alive is all it takes to make a difference. And that being true to yourself, being loyal to your quiddity in essence, is the core of existence.

He, Voltaire, explored his potentials actively, but even had he not done so, just by pursuing his life, by not giving up on it, by not committing suicide, Voltaire had fulfilled this role in maintaining this world, this universe, this creation, as it is and as it should have been because of Voltaire's presence.

Your presence has a meaning because your presence determines reality, defines it, changes it, directs it, and no, you don't have to do anything to earn this power.

It is given to you the minute you are born.

Self-actualization is the sole engine of meaning in life.

But self-actualization doesn't mean the pursuit of goals, setting purposes, and kind of accumulating accomplishments.

Self-actualization means first and foremost to live, to maintain life, to not give up on it.

Because you see, every day, every minute you're faced with a choice, should I go on living or should I kill myself?

And every day, most of us take this brave decision to go on with life, to renounce death and its surrogates suicides, suicide and so on.

So the act of survival is active. It requires choice. It requires a mind and consciousness. We have the luxury that most animal species are denied to terminate to be able to terminate our lives.

So we are forced to make this choice day in and day out.

And this creates a lot of anxiety in us.

The need, the compulsive need to confront life, to participate in it, to suffer, and from time to time, however rarely, to experience joy and cheer and elation and satisfaction. This compulsive need is onerous. It's a burden. It's our cross to bear.

And we all do this courageously.

Because to live takes courage.

Regrettably in modern society, we are presented with falsities, with lies, with manipulations, with life substitutes, ersatz life, fake life.

For example, I keep telling you in this video that the potentials in life render your life meaningful, not the accomplishments, not the goals, not the work, the hard work, not the purposes, not the direction, not your career, not other people, just existing in order to experience what life has to offer, what I call potentials.

So why do I rail against consumerism and sex positivity, for example? Aren't these ostensibly intended to help us to realize our potentials.

Consumerism? Isn't it about realizing our potentials?

Sex positivity? Isn't it about exploring other possibilities and dimensions?

So why do I rail against this?

Because they are examples of the fake environment that modern civilization had created.

This fake environment imitates life badly, but it's not life.

Not in the truest authentic sense.

People are forced to become less and less authentic. That's why they want to off themselves. That's why they want to kill themselves, because they feel that they don't exist anymore.

It's very easy to commit suicide when you have been long dead.

It's much more difficult to dispense with life when you experience it truly and directly and maximally.

When you give yourself to the flow and the flux, to the potentials and the surprises, to the suffering and pain and to the joy and cheer, when you are directly involved, when you consummate your relationship with life, when you engage with life, it's much more difficult to let go of it because it has so much to offer.

And because you realize then that your very existence is the difference that you're making and that the world would never be the same without you and would have never been the same without you.

That your presence and existence here changes the entire universe.

But you cannot understand this if you react exclusively with simulations of life, with simulacra, with a spectacle.

So I rail against consumerism and sex positivity because they both actually limit our promise. They constrict our lives.

These are ideologies. These ideologies are death cults. They are death cults. They are not life-enhancing ideologies, but they're death cults.

They objectify people and they humanize objects.

I'm going to repeat this.

Consumerism and sex positivity objectify people and humanize inanimate objects.

And this is a great definition of death.

Modern civilization has chosen death over life.

And so it comes to us naturally, death.

We say, well, why not choose death over life?

Since all the messages we are getting everywhere, through advertising, government, mass media, even social media, mainstream or not, this distinction is nonsensical.

All the messages we are getting are, you are nothing but objects. You are nothing but entities to be manipulated and dispensed with. You are disposable. You are interchangeable.

And when you keep getting this message, time and again, flooded with this signaling from everywhere, it's easy to give up on life.

Modern civilization is trampling on our potential, is suppressing our promise, is constricting our lives, confining us to literal boxes.

Consumeration and sex positivity are only two examples.

But they are great examples because they actually suppress our free will.

They present fake choices between rigidly dictated alternatives and they penalize nonconformity.

And so when I say choose life, it's not like saying choose modernity with all its consumer goods.

That's not what I'm saying.

When I'm saying choose life over death, choose existence, over suicide, what actually I'm saying is choose yourselves, choose yourselves, realize that you are a part of creation and a very crucial one.

Because should you subtract yourself? Should you absent yourself? should you kill yourself should you commit suicide the world will never be the same without you.

Okay, chmadmedmedim end chmadotim and chmadmodedot.

Those of you were fortunate enough to watch my interview with Dalia Zhukowska, the Polish clinical psychologist, realize that suicide is a risk in narcissistic personality disorder, especially during narcissistic mortification.

The rate of suicide among people with antisocial behaviors sometimes can ratchet up to 62% of the cohort of patients with suicidal ideation. That is six times the average among people with borderline personality disorders.

So suicide plays a role in the narcissistic pathology, and yet we don't have any data. I repeat, we don't have any data as to how many narcissists commit suicide, under which circumstances, and why, especially why.

My name is Sam Vaknin. I'm the author of Malignant Self-Love: Narcissism Revisited and a former visiting professor of psychology.

And today we are going to discuss why and when do narcissists commit suicide.

In the narcissistic pathology, suicide or suicidal ideation is not, I repeat, not the outcome of depression, like normal people or healthy people or other mental health disorders.

The narcissist aggrandizes his suicidal ideation. As far as the narcissist is concerned, suicide is an act of self-control. Suicide restores the narcissist's sense of grandiosity. It's the ultimate solution, the glorified exit, a way to signal to the world. I'm showing you the middle finger. I always have a way out. There's no way you can lay your hands on me, etc.

So suicidal ideation in narcissism is suffused with grandiosity and in this sense it reflects an underlying cognitive distortion.

Strangely, the narcissist does not perceive suicide as the end of the road. It perceives it as a signal.

That's very strange because once you are dead, what is the meaning of a signal? Where does it lead you? What good is it to you?

And yet the narcissist perceives suicide exactly this way as a form of, as a way to obtain narcissistic supply, post-mortem, if you wish.

That is the first strange characteristic in suicide among narcissists.

There is a problem with narcissism when it is comorbid with other mental health issues.

The rate of suicidal ideation and suicide among narcissists who also, for example, have major depression, narcissists who are also psychopaths, psychopathic narcissists, and narcissists who also borderline, the rates are very high or much higher than in a population that is purely unadulterated narcissistic personality disorder.

The narcissist who contemplates suicide is not depressed at all. He doesn't communicate his need for help because narcissists never need help. They're omnipotent. They're godlike.

So there are no warning signs in the vast majority of cases.

There is a problem with the regulation of a sense of self-worth and self-esteem following repeated narcissistic injuries, narcissistic wound, or in the throes of narcissistic mortification, as I've said before.

And so the narcissists grapples with his own internal dynamics, with his own psychodynamics. He transitions from internal mortification to external mortification and so on so forth.

I again refer you to my recent interview with Darya Zhukovska, where I dwell upon these dynamics.

What I'm trying to say is that the unfolding of these dynamics in the case of the narcissist is autonomous. It's inexorable. There's nothing the narcissist can do about this, and it is this feeling of helplessness and hopelessness that challenges, undermine, ruins the narcissist's grandiosity.

In some cases, the only way to restore a sense of self-control, the battered grandiosity, the only way is to commit suicide, or at least to contemplate suicide.

In the wake of some life events, for example, narcissists often consider suicide. They have suicidal ideas and suicidal fantasies.

But these serve narcissistic, self-regulatory functions.

As Isa Ronningstam wrote, knowing that suicide is a possible option, can sustain self-regulation and sense of control, and help such people stay connected, work and function, and even enjoy life.

It is very important, she continues to say, to differentiate between the life-threatening and life-sustaining implications of these patients' suicidal thoughts and fantasies.

And again, in comorbidity, in situations of comorbidity, this is doubly, doubly, right.

Okay. What are the characteristics of suicidal behaviors in narcissistic personality disorder when there is no comorbidity in pure cases?

Suicidal ideation comes to the surface, becomes conscious, and then, like everything else in the narcissist life, becomes, transforms itself into a grandiose fantasy.

Narcissism is a fantasy defense gone awry.

The narcissist is expansionist, very much like the psychotic. The narcissist converts external objects into internal objects, this way subsuming the world.

So when the narcissist comes across obstacles, hindrances, challenges, humiliation, public shaming, and so on so forth, suicidal ideation becomes a way of reasserting control over himself, the situation, and his ability to affect other people.

Suicide hurts people. Even people who hate the narcissist. When he commits suicide, are liable to feel guilt and shame. So that's a narcissist's way of getting back at them.

Now the characteristics in pure narcissism, in pure narcissistic personality disorder, and this is lifted from an article by Ilsa Ronningstam and her collaborator, Ego Weinberg. There's a link in the description to relevant literature.

So the characteristics in these cases of contemplated suicide are a loss of ideal self-state and a breakup of a life dream, a fantasy, especially a shared fantasy, not meeting high and perfectionistic standards, a sudden breakdown in defenses, also known as decompensation.

And in this way, suicide is acting out. Suicide is exactly like acting out in borderline personality disorder. And exactly like in borderline personality disorder, it's a form of self-harm and self-mutilation.

The difference between the two is that in borderline personality disorder, acting out invariably involves other people. It is outwardly directed because the borderline is capable of perceiving external objects. She has a problem with introjects. She has interject in constancy, not object in constancy.

But the narcissist is unable to perceive external objects. So everything with the narcissist is internalized, introjected.

Similarly, suicidal ideation is a form of acting out which is self-directed.

Another characteristic is turning revengeful wishes against oneself, punishing oneself for having failed.

The narcissist-bent object resurrects, reasserts itself, resurges and takes over the narcissist, overwhelming him with the equivalent of emotional dysregulation, like in borderline.

And then the narcissist wants to destroy himself because he perceives himself as inadequate, insufficient, a failure, a loser, unworthy of love and unworthy of life.

Some scholars in the 40s, 50s and 60s called it a rejection of life.

The empty schizoid core in the Narcissist, the borderline, other disorders, the empty schizoid core is firewall, is isolated. The narcissist has no access to this core because this core is flooded with shame.

When these defenses break down, the narcissists gets in touch with this reservoir of self-annihilating, self-hating, self-loathing, shame, and then he wants to destroy himself.

Destroying the bad object would restore the all-good object. It's a form of self-splitting.

That's why I keep telling you that narcissists don't perceive suicide as the end. They perceive suicide as the means.

It's extremely irrational, infantile thinking. Children under the age of two don't perceive death as final.

And so another thing is the intolerance of passivity, assuming an active role through suicidal ideation and ultimate suicide.

The narcissist feels that he is objectified by circumstances and by other people, for example, in mortification.

He needs to take over the situation. He needs to reassert control.

The only way to do it sometimes is to commit suicide. There's an intolerance of humiliation, defeat, entrapment, shame, or envy.

Life events precipitate suicidal ideation and attempted suicide in narcissists like with every other person.

Healthy or unhealthy, stress is closely associated with suicidal ideation and suicidal behaviors and suicidal ideas and thoughts and fantasies, even in totally healthy and normal people, let alone people with borderline personality disorder, paranoid personality disorder, narcissistic personality disorder, and believe it or not, antisocial personality disorder.

Watch my video, how does one become a psychopath?

So, when the narcissist is faced with legal problems, disciplinary problems, impending incarceration, unemployment, physical illness, financial problems, problems at school or a job, aging and aging related losses and transitions, a breakdown in a romantic relationship, the narcissist version of a romantic relationship, which is a shared fantasy, being publicly humiliated, berated and shamed, narcissistic mortification, when the narcissist faces with disability, with a chronic illness, with dementia, whenever the narcissist grandiosity is no longer sustainable, no matter the effort put into sustaining it, the narcissist equilibrium is challenged.

Internal and external sources of supply are eliminated. Self-worth, sense of self-worth begins to fluctuate very wildly. The lability of mood and affect.

And the narcissist is overwhelmed.

Clinically, in these conditions, the narcissist becomes a borderline. He regresses from narcissism to the borderline state, and that is Grotschl.

And if we adopt Jung's view, he also becomes introverted.

So all the affect, all the energy, all the emotions, all the cognitions will now be introverted, will become introverted, will be self-directed.

Jung closely associates narcissism with introversion in the early stage of development.

So, when the narcissist is faced with adverse life circumstances, what he does, he retreats, he withdraws, he avoids, and in short he becomes a schizoid. He enters a schizoid phase.

In the schizoid phase he attempts to self-supply and one of the attempts to self-supply is internal mortification, telling yourself that you're godlike.

The narcissist tells himself that he is a puppet master, and everyone around him is playing to his tune and script.

This doesn't work well, of course.

So then the narcissists resorts to external mortification.

And external mortification involves demonizing other people. Paranoid agitation and persecutory delusions, converting internal objects into persecutory objects and so on so forth.

But at the same time, it involves a withdrawal from the world, an avoidance of reality and of life.

It resembles fear, but it's actually not fear. It's self-preservation.

This is the narcissist's way of shielding himself from the slings and arrows of a cruel fate.

This is his way of creating a fortress within a moat within which he is self-sufficient, self-sustaining, self-supplying, and can rebuild his grandiosity incrementally but safely and assuredly.

During this period, one of the ways to reconstruct and reassert grandiosity is when the narcissist tells himself that worse comes to worse, he can kill himself and thereby show the middle finger to everyone.

He tells himself that he is the master of his own fate, body and life, and no one else has any remit or control or power or authority over these. He is the ultimate arbiter and decision maker because he can always take his life.

It is as if the narcissist is saying, you are ungrateful. You did not know how to appreciate me, my contributions to you, my help, my succor, my participation in your life. You rejected me, you abandoned me, you humiliated me, you are not fit to benefit.

And I'm going to withdraw my bounty, and I'm going to absent myself from your lives so that you feel the void, the emptiness, the lacuna that I leave behind and regret your behavior.

It is a narcissistic way of broadcasting. I am so superior to you, I am so supreme, that of course, you lack the capacity to even appreciate who I am and what I've done.

And so now that I've seen your real face, your true face, your bad intentions, I'm going to withdraw, and I'm going to withdraw maximally. I'm going to kill myself so that even in principle I would never be available to you again, and you will spend the rest of your lives mourning and grieving my absence, and what could have been, had you treated me well, had you treated me as I should be treated, a deity, perfection reified, the one and only, a unique entity, a unique creature, a manifestation of some divine grace.

And since you failed to treat me right, I am walking away in every possible way.

This is, of course, suicidal ideation.

However, paradoxically and ironically, this resurgence in godlike, psychopathic, defiant grandiosity is very closely coupled with a volcanic eruption of suicidal ideation.

Because a narcissist perceived suicide as the ultimate solution, the ultimate slap in the face to all his tormentors and persecutors and abusers and haters.

That's his ultimate slap in the face. He's going to show them. He's going to show them. He's going to kill himself.

And then they will feel guilt or in shame or at the very least they will have lost the battle because there's nothing they can do to you as a corpse.

So this paradoxical confluence which was first described, I repeat, by Ronningstam and Weinberg in 2013, this paradoxical confluence separates narcissistic suicidal ideation from borderline suicide ideation, separates narcissistic suicide attempts from typical suicide attempts.

There is no background of depression. There is a background of antisocial psychopathy.

The suicide is a defiant act, a reckless act, acting out in effect, an aggressive act, an externalization of aggression towards others by using the ultimate sacrifice, one's own body and life.

The emotional states associated with narcissistic suicidal ideation and suicide attempts are the best predictors of suicide among narcissists.

Narcissistic vulnerability, I'm going to quote from Ronningstam article.

Narcissistic vulnerability creates susceptibility to feelings of shame, humiliation, defeat, entrapment, and meaninglessness, which force narcissists into a sense of desperation, leading to suicidal behaviors.

Association between these feelings and suicide has been confirmed empirically in several studies, four or five that I'm aware of by you.

So now let me read to you at length the table, a very comprehensive table, which you can find in Ronningstam and Weinberg's article, link in the description, about the personality characteristics of suicidal narcissistic personality disorder patients.

Trait number one, perfectionism, the suicidal dynamic, one, related to high unattainable standards that precipitate a persistent sense of failure of not being good enough and relentless pursuit of elusive perfection.

I'm adding to compensate for the hyperactive bad object triggered by narcissistic injury, narcissistic wound, or more dominantly and prominently by narcissistic mortification.

Narcissistic mortification reactivates the bad object and creates perfectionism as a compensatory mechanism.

Perfectionism is intended to counter the bad object by saying, you're wrong, I'm not worthless, I'm not bad, I'm not inadequate, I'm not insufficient, I am lovable because I'm perfect. I'm perfect, I'm Godlike.

Perfectionism is a defense against bad object dynamics.

And bad object dynamics, left unchecked and uncontrolled, could lead and do lead to suicide, and definitely to suicide ideation, among narcissists.

The second trait is a lack of self-disclosure. Shame avoidance, lead the suicidal dynamic. Shame avoidance leads to self-disclosure deficits, interferes with help seeking, thus contributing to increased suicide risk, say Ronningstam and Weinberg.

Trait number three, dissociation, detachment from one's body. The body provides a sense of being real and represents a valued part of the self. Dissociation eliminates these feelings, making suicide easier to carry out.

Cerebral narcissists especially are divorced from their bodies completely. They consider their bodies mere containers, at best, masturbatory machines, devices. So it's very easy for the cerebral narcissist to contemplate just getting rid of this annex, this appendix of a body. Why do I need it? I have my brain, I have my mind, I have my towering.

And so the cerebral is at a much higher risk of suicidal ideation and suicide attempts.

Dissociation also leads to cognitive deconstruction, a defensive avoidance of thinking in meaningful ways because of threats to the self. It increases the propensity for destructive actions.

Dissociative dissociation leads to inner deadness, the famous Kernberg emptiness ofschizoid core, Stainfels Schizoid Core, inner deadness commonly found in NPD patients, as well as in suicidal people.

The empty schizoid core is a great predictor of ultimate suicide or at least suicidal ideation.

And finally, dissociation makes suicide more likely as an attempt to get rid of a meaningless life and an already dead self, or a life that is about to become meaningless.

Now, another trait is body hatred.

Expectations of Venus or Apollo-like bodies or a preoccupation with body imperfections, for example, body dysmorphic disorder, lead to a desire to get rid of an imperfect body, and this is common among somatic narcissists especially as they age, as they grow older.

So they go into a frenzy of bodybuilding, cultivating muscles, tattoos. I mean, they go nuts. They transform their bodies into a lifelong project in a desperate attempt to render it perfect.

And when they inevitably fail, there's a lot of suicidal ideation and some suicide attempts.

So the cerebral would contemplate suicide and carry it out sometimes because he perceives his body as an encumbrance, as burdensome, as unnecessary, as a liability.

While the somatic would go through the same suicidal ideation, would try to get rid of his body because his body failed him. It's no longer perfect. It's no longer functioning as it used to.

So body hatred in both forms, according to Ronningstam and Weinberg, is a great predictor of suicide among narcissists.

And finally, inconsistent self-representation, a confused self-identity, also known as identity disturbance. This is much more common among narcissistic borderlines.

Inconsistent standards of self, such as ideals and obligations, a propensity for self-integration, self-defeat, self-destructiveness, and a generally increased risk of suicide, owing to changing life circumstances, adversestressors, and life circumstances that threaten the narcissists' self-perception, his grandiosity, his fantastic space, his fantasy defense is disabled, he's shamed and humiliated in public, his freedom is a trace, his livelihood is a tree, etc.

He is romantic or intimate partner has abandoned him, he lost all his sources of supply.

All these pushed the narcissists to say to the world, I'm here and I'm as great as ever, I'm as divine and godlike as I've ever been.

To prove this to you, I'm going to show you that I don't care even about my life and my body. I'm beyond this. I'm superior to this. I transcend this pedestrian low brow concerns. You are mere mortals. I am immortal.

I'm going to show you that I don't care. I'm going to defy you. I'm going to defy your authority. I'm going to be contumacious and I'm going to be reckless with my life and with my body.

And to prove all this to you, I'm just going to kill myself, just to show you how little I care about you and your shenanigans.

This is the narcissist's contorted, convoluted and twisted logic. Everything revolves around the grandiose fantasy defense, and everything is made to fit into this defense, even self-eradication and self-extermination, as acts of grandiosity.

The Germans call it Goetterdämmerung, the twilight of the gods.

When Hitler committed suicide in his bunker, with cyanide and a gunshot, by the way, he did this as a supreme act of historic defiance. He was a god descending into hell. That was the twilight of his divinity.

He didn't consider himself a coward. He wasn't afraid. Hitler was pretty fearless, by the way. He wasn't afraid. He wasn't terrorized. It was none of these things.

He was showing the middle finger to the allies and to history. You shall not get me. You will not put me on trial. I'm going to evade you and frustrate you. I'm just going to take myself out of this game which is for low lives and lowly people. Because I'm above all this. I am God.

And in some respects, Jesus Christ did exactly the same.

He planned and executed his own suicide. He arranged everything and orchestrated it.

But he did this as an apotheosis, as a way to become a god. He did this out of motivations of grandiosity, telling the Roman Empire, the Jewish people and everyone around him, I am the one who controls my own death. I, in cahoots and in collusions with my father in heaven, I am his son. I am going to kill myself. You are just instruments in my own suicide.

The crucifixion was a suicide, of course. Jesus could have easily evaded it, as anyone who has read the New Testament could testify.

Jesus wanted to be crucified. He orchestrated his own demise because it was a historic act of defiance and guaranteed his place in the annals of history as a new god.

Narcissists killed themselves in order to live forever.

Is the act of suicide preceded by a signaling of distress? Do people who contemplate suicide somehow share it with us, directly or indirectly? Are they aware of many of the dynamics that drive them to this fateful decision?

The fact is that nine out of ten failed suicides regret having tried. They regain the joie de vivre, the joy of life, and they commit themselves to never try again.

There is a small minority of serial suiciders, people who try again and again and again until unfortunately they succeed. But that's a really, really tiny minority.

For the vast majority of people who have had a suicide experience or suicide attempt in their history, it's a single one.

So what do we know about the warning signs, the red alerts, the toxins and signals?

This is the topic of today's video.

My name is Sam Vaknin. I'm the author of Malignant Self-Love, Narcissism Revisited, and I'm a professor of clinical psychology.

Many senior scholars, many psychologists and clinicians are calling for the inclusion of a new diagnosis, a new condition in the sixth edition of the Diagnostic and Statistical Manual, and in the next edition of the ICD, the international classification of diseases.

This new condition is dubbed Suicide Crisis Syndrome, SCS. And it relies on a body of studies and theories which are collectively known as the narrative crisis model.

I will deal with both in today's video.

Dr. Igal Glicker is a clinical professor of psychiatry and director of the Mount Sinai Suicide Prevention Research Lab in New York City. He is a harsh critic of the medical community's approach to suicide prevention. He thinks psychologists are doing even worse.

Together with a few colleagues all over the world, Glicker is proposing to validate the use of suicide crisis syndrome as a diagnosis. And he believes that should this be recognized as a clinical entity as a condition, it would reduce imminent suicide risk and allow us to evaluate it and treat it much more efficaciously.

Now these are very big claims. Suicide had been studied at least since the 17th century, and we didn't exactly get better at preventing it.

Suicide above all is a statement, it's a signal. It's exactly like using language. And so it's a kind of free speech act.

The person who is committing suicide is actually informing us that life is not worth living anymore, that he does not see or she does not see any improvement in the future. There's no vision of things getting better.

It's a choice of pessimism over optimism, but it is a choice.

And this is where the philosophy of suicide, the philosophy of the study of suicide, becomes convoluted, because we believe in free choice, and we believe in free speech, and suicide is both.

And yet, as I said at the beginning of this video, the vast majority of people who have ever attempted suicide lived to regret it bitterly.

They think they've done the wrong thing. They think they've been motivated by unconscious and conscious forces which were beyond their control. They are aghast and befuddled by their own choices, especially the choice, to terminate their life.

Suicide Crisis Syndrome is a negative, cognitive and affective state. It is associated with imminent suicidal behavior, and it therefore denotes people with a high risk for suicide.

What Gallegher and his colleagues, again all over the world, it's a loose coalition, loose network, what they want to do is they want the diagnostic and statistical manual committee to recognize that suicide is not a one-time event isolated from anything that came before it or, in majority of cases after it.

They think suicide is integrated in a much larger map of mental wellness or mental illness.

And therefore, they think that there is such a thing as SCS, there is such a thing as a syndrome of behaviors, affects, thoughts, cognitions, and signaling, which put together could tell us with great certainty when someone is about to commit the atrocious and uncommissible act.

And actually, to be honest, the stupid act of terminating one's life.

And so these people, these scholars believe that we should have a suicide-specific diagnosis. We should not consider suicide as a behavior or a choice that is attendant upon other mental illnesses. Kind of a second thought or a byproduct.

They don't believe in this. They believe that suicide is its own mental health condition, unrelated to others.

And so they demand to include it in the diagnostic manuals.

Clinicians depend crucially on self-reporting.

When someone is depressed, when someone is anxious, when someone is psychotic, when someone is paranoid to the extreme, mental health practitioners and clinicians interview them.

They interview them and they ask them, are you contemplating suicide? Are you imagining suicide? Do you consider committing suicide? Did you take any steps towards realizing this goal?

So it all relies crucially. The diagnosis, the treatment, everything, the evaluation, they all rely crucially and exclusively, actually, on self-reporting.

How do you feel?

I am a great opponent of self-reporting in psychological tests, in psychological evaluations, and generally in psychology.

I think relying on self-reporting is a very self-defeating, not to mention inane or dumb strategy.

When we ask narcissists to self-report in the various tests for narcissistic personality disorder, when we are psychopaths to essentially diagnose themselves by telling the truth about their motivations, their emotions, their cognitions, their history, we are shooting ourselves in the collective foot.

Self-reporting should be outlawed, criminalized in psychology. It should be eliminated. It's really, really, really bad idea.

And so people who are on the verge of committing suicide on the precipice, these people are in acute pain. They're in distress.

Their answers are inaccurate or self-deceiving or completely befogged, completely submerged in extreme cognitive distortions and biases.

You cannot approach someone who is thinking about dying and have a reasonable, rational conversation with them. You cannot expect them to introspect and self-observe and provide you with accurate objective data. This is ridiculous.

Gallegher says it is suicide is the most lethal psychiatric, I'm quoting him, suicide is the most lethal psychiatric condition because people die from it.

And yet he says, we rely on people at the worst moment of their lives to tell us accurately when and how they're going to kill themselves.

We don't ask people with serious mental illness to diagnose their own mental illness and then rely on the diagnosis, he says.

The fact is that most people who attempt or die by suicide actually do not have suicidal ideation.

Now, I know this comes as a shock to you, and many of you are going to dispute this sentence. You're going to say, Sam Vaknin, you are wrong again. That's not true. All suicides are preceded by suicidal ideation. All suicidal attempts are preceded by suicidal ideation. All suicidal attempts follow suicidal thoughts.

And yet, this is not true. It's a myth. It's a myth propagated by self-styled experts online, yet again.

That is a myth. Data across multiple studies over multiple decades and meta-analysis demonstrate conclusively that people who attempt suicide and people who commit suicide did not have or do not have suicidal thoughts or suicide ideation in the period preceding the attempted suicide or in the period preceding the actual suicide.

When healthcare providers or clinicians, family members, approach these people, they don't talk about suicide. They actually sometimes are very optimistic. They have plans. They make moves. They don't look like they're about to commit suicide.

When we administer questionnaires and scales to people who are at suicide risk, for example, depressed people or prisoners, we don't see any hint of suicidal ideation.

I could generalize and say that suicidal ideation is more or less a myth, more or less an invention. A fantasy of psychologists maybe. They want to believe in some orderly procession or progression from ideation to action.

But that is not the case. That's not true.

That is not to say that people don't have or entertain suicidal ideation. Of course, they do.

For example, people with borderline personality disorder have a lot of suicide ideation throughout the lifespan.

But these people are actually less likely to commit suicide. It's as if the destructive energy went into thinking about suicide rather than actually attempting suicide.

Okay, these are the facts.

So self-reporting may be very misleading. Outside observation and evaluation is often misleading because we see people who go about their normal lives, perform chores and functions to the very last second, make plans, buy air tickets for a vacation, prepare a party, a birthday party, and so on, and then suddenly commit suicide.

So observing people does not tell you if they're about to commit suicide or not.

We need to change our point of view. We need to become evidence-based rather than fantasy-based.

Patients at acute risk of suicide are assessed and they are treated wrongly.

We try to prevent suicide by gauging them according to our point of view.

We say to ourselves, had I wanted to commit suicide, had I contemplated suicide, this is how I would have behaved.

But that's a wrong way to go about it.

Consequently, we miss many opportunities to intervene.

But Galingker and his allies are pretty optimistic. They say that SCS is the final and most acute stage of what they call the narrative crisis model of suicide. And it reflects the progression of suicidal risk from chronic risk factors to imminent suicidal risk.

In other words, it's a phenomenological approach, not an epistemological one.

The diagnostic approach here is by analyzing risk factors the way we do for example in cardiology.

The narrative crisis model, says Galingker, has four distinct and successive stages, with specific guidance and applicable interventions that enable patients to receive a stage-specific treatment.

This is another myth in suicide. There is a belief that suicide is a binary state, a black and white condition. You either contemplate suicide and immediately commit suicide, or suicide never crosses your mind whatsoever.

That is not true. Suicide is a process, sometimes a multi-annual process, a very long process. And this process has distinct stages. And if we observe these stages, we can predict the next stages, and we can intervene, and we can treat, and we can help.

Galinger says, suicide crisis syndrome is a very treatable syndrome that rapidly resolves with appropriate interventions.

Once it is treated, the patient can engage with psychotherapy and other treatments.

Gallencare and his colleagues tried this approach. They already tested it and they had pretty encouraging results in various studies.

They also engage with clinicians. They try to somehow evaluate or appraise the clinicians' subjective and objective views.

And they use a variety of risk assessment tools to assess suicide ideation and its connection or alleged connection to actual suicide.

And this is a new movement in the study of suicide and the prevention of suicide.

There is a new focus on identifying specific subtypes of individual who are at risk for suicide.

Are you in pain? Are you dissociative? Do you have interoception, the ability to sense and interpret internal signals from your body?

All these are indicators of imminent suicide or looming suicide, or at least a risk of suicide.

Suicide risk factors are well known.

We know that certain physical health conditions predisposed to suicide, certain symptoms. We know that borderline personality disorder does. 11% of all people with borderline personality disorder end their lives.

Positive mental health, the identification and available treatments for depression and other common mental health disorders, and the management of suicidal risk or crisis stigma, all these are adjacent activities.

So there's now a focus on environmental factors, for example, rearranging, redesigning the workplace settings, putting an emphasis on vulnerable groups.

We know that suicides peak, they are at the maximum among young people, the elderly, the unemployed, migrants, and people affected by mental and physical disorders. We need to focus on these populations.

So there is an upheaval in the study and prevention of suicide.

And I would like to read to you sections from two seminal articles, recent articles, regarding this topic.

The first article is titled The Comprehensive Narrative Crisis Model of Suicide. The author is Jessica Briggs. And you can find, of course, the articles in the literature, in the description of this video, the literature section.

So here's the abstract of what she says.

She says, the narrative crisis model of suicide posits that individuals attempt suicide when they experience distinct emotional state termed the suicide crisis syndrome.

This chapter describes the model, which has three components.

Trait vulnerability, suicidal narrative, and the suicidal crisis syndrome.

Trait vulnerability includes all static risk factors which are relatively stable over time and distal to acute suicidal behavior.

Suicidal narrative describes a suicidal person's perception of his or her life story, in which the past has led to an intolerable present and a future that is unimaginable.

The suicidal crisis syndrome is a distinct emotional state, characterized by entrapment, affective dysregulation, and loss of cognitive control.

The result is a suicidal act, brought on by an emotional urge to end the intolerable mental pain of the syndrome.

Imminent suicide risk is primarily decided or determined by SCS intensity, to which both traits vulnerability and the suicidal narrative also contributed independently.

And this is published in a book called the Suicidal Risk: Clinical Guide to the Assessment of Imminent Suicide Risk, edited by the aforementioned Ego Gallinker, highly recommended for practitioners and clinicians who deal with suicide on a regular basis, for example, therapists of borderline personality disorder.

I'm going to read to you something that Ego Gallinker himself has written, together with others, Zara Bloch, El Kubi, Lisa Cohen and others. I'm going to read to you what he has written about the suicide crisis syndrome.

The article is titled Suicide Crisis Syndrome, A Specific Diagnosis to Aid Suicide Prevention, was published in September this year.

So these are recent studies.

He says, suicide is a global public health issue, claiming over 700,000 lives annually worldwide.

Opportunities for intervention are ample, as half of suicide decedents contacted a healthcare professional within a month of their deaths.

So, there has been previous contact.

Okay. In these encounters, says Gvion, suicide risk assessments are based on patients' self-report or suicidal intent and chronic risk factors such as past attempts and prior psychiatric diagnosis.

And yet, he says, up to 75% of those dying by suicide explicitly denied suicidal intent at their last meeting with a health professional.

Almost 20% of suicide attempters do not have a diagnosable mental disorder.

Moreover, traditional risk factors such as previous suicide attempts and a history of mental illness do not reliably predict short-term suicide risk.

You've heard on this? Contra to intuition, contra to myths, contra to misconceptions and the misinformationthat is very prevalent online, unfortunately.

Gvion continues.

Over the last decade, several independent research teams have documented the existence of specific acute mental states associated with emergence of suicidal behavior.

However, neither the DSM nor the ICD ever carried a diagnosis referring to these states.

The Suicide Crisis Syndrome, SCS, aims to fill this gap in psychiatric nosology and is under review for inclusion in the DSM.

This diagnosis provides a systematic tool for recognizing and treating a mental disorder presenting imminent suicide risk without relying on self-reported suicidal intent.

SCS is the last and most acute stage of the narrative crisis model of suicide, which reflects the progression of suicidal risk, from chronic risk factors to imminent suicidal risk, and provides a comprehensive framework for the design and implementation of treatments that specifically target each of the four stages in the suicidal process.

The empirically driven SCS criteria have evolved over a period of 15 years.

They incorporate five empirically validated domains, which together constitute a unidimensional syndrome.

Suicidal ideation is not included due to its demonstrated unreliability as an indicator of imminent suicidal behavior.

The first SCS domain, Criterion A, features a persistent and intense feeling of frantic helplessness and hopelessness, in which the individual feels trapped in a situation experienced both as intolerable and inescapable.

Criterion B includes four distinct symptom dimensions.

B1, affective disturbance, B2, loss of cognitive control, B3, hyper arousal, and B4, social withdrawal.

B1, affective disturbance may manifest through emotional pain, depressive turmoil, extreme anxiety with unusual physical sensations, and acute anhedonia.

B2 involves loss of cognitive control, ruminations, cognitive rigidity, failed thought suppression, and ruminative flooding, loss of control over thoughts accompanied by headaches and head pressure.

B3 hyperarousal involves agitation, restlessness, hypervigilance and intense and exaggerated responsiveness to sensory inputs, irritability and insomnia.

And finally, B4, social withdrawal involves avoidance of social engagements and evasive communication with others.

To be diagnosed with SCS, patients must meet Criterion A and have at least one symptom from each of criteria B1 to B4.

Several SCS assessment instruments have been developed for use among diverse populations.

And then he goes in the article into the various instruments they have developed.

He continues to say, SCS demonstrated excellent internal consistency within and across five symptom dimensions in United States and international samples.

Several U.S. studies, as well as those conducted in India, Korea, Taiwan, Russia and Brazil, further supported the unidimensionality and five-factor structure of SCS.

To date, over 15 studies have demonstrated the predictive validity of SCS for imminent suicidal ideation, preparatory actions, and suicidal attempts.

And then he goes on and on to analyze the utility of the syndrome in the hands of clinicians, especially frontline clinicians, the one who cope with imminent suicide risk and suicide attempts.

And he analyzes the psychometric strength of SCS, various dissemination efforts of SCS tools, and so on and so forth.

He ends by saying, a DSM and possibly ICD diagnosis of SCS with an assigned diagnostic code would provide clinicians with a systematic means for assessing and reducing imminent suicide risk, even in high-risk individuals who deny suicidal ideation and intent, while distinguishing patients with self-reported suicidal ideation at little risk of suicidal behavior.

Furthermore, says Gallenker, the conceptual and operational clarity of the syndrome would likely decrease clinicians' anxiety about working with suicidal patients, in turn, promoting the development of an effective therapeutic alliance.

Lastly, we believe that the increased clarity of suicide risk assessment, using DSM-based SCS diagnosis, would reduce legal challenges, promote education, and stimulate research for new treatments, all necessary to enhance and maximize suicide prevention.

The comprehensive narrative crisis model of suicide. Now that's me.

End quote.

What I have to say is that the comprehensive narrative crisis model of suicide. Now that's me.

End quote.

What I have to say is that the comprehensive narrative crisis model of suicide, coupled with the suicide crisis syndrome as a clinical entity, it's the first time that I see something in the literature that focuses on evidence, on reality, on actual observables, rather than on myths, fiction, self-reporting, and other such nonsense.

This is the first time that I see a real opportunity to increase the efficacy of the treatment and prevention of suicide.

It's a very hopeful theoretical development which can and should be translated into diagnostic tools and into therapy, highly specific type of therapy, suicide prevention therapy.

So I'm very optimistic about the future of this field, and I think this narrative crisis model and the suicide crisis syndrome is the future of the field.

I think this is going to become the orthodoxy and the mainstream within a few years.

At least, I hope so.