Depression and the wish to live versus the desire to die

Abstract

The treatment of suicidal clients relies on a thoughtful understanding of suicidal ideation. Suicidal ambivalence is the subjective experience when a person simultaneous holds a wish to live with a wish to die. The present study was designed to understand the subjective feeling of suicidal ambivalence as it relates to suicidal behavior in a sample of depressed psychiatric outpatients. The 76 depressed psychiatric patients who reported a history of suicidal ideation were asked to rate their desire to live and their wish to die as experienced during their most difficult emotional struggle. Across the entire sample, 87% reported experiencing an internal struggle between living and dying. As compared to depressed patients who had never attempted suicide, depressed patients who had previously attempted suicide reported a higher wish to die (t = 3.54, p < .001), a lower wish to live (t = 2.04, p < .05), and higher levels of ambivalence (t = 3.04, p < .01). Furthermore, suicidal patients provided brief narrative descriptions underlying their suicidal distress, revealing issues related to wanting to end the feeling of pain, feeling like giving up, losing a sense of hope for a better future, a fear of a negative afterlife, and concern for surviving family members. Suicidal ambivalence appears important for the assessment of and understanding of a suicidal crisis. Psychotherapy can explore feelings of ambivalence reported by clients during a suicidal crisis and can help to promote a stronger desire to live despite experiencing stress, conflict or loss in their lives.