# The Inner Voice that Drives Suicide



## Daniel

The Inner Voice that Drives Suicide
_Psychology Today blog: Compassion Matters_
By Lisa Firestone, Ph.D.

One in five  therapists has a patient who completes           suicide.  Understanding and preventing suicide is therefore one of the most  frightening and important responsibilities of anyone who works as a  psychologist or counselor. To treat suicidal patients, a therapist must  understand what is going on in the mind of these individuals, what is  driving their suicidal behavior and how the therapist can help them  comprehend and cope with their self-destructive states of mind.

In  the past 25 years since I completed my dissertation on suicide, I have  learned a great deal about the critical inner voices that drive a person  toward suicide. In my years of experience publishing  books and articles, producing films and creating assessment  scales on suicide, what has fascinated me  the most is the consistent finding of the role of the destructive inner voice in suicide.  This voice drives suicidal tendencies, deceptively convincing people  that it is better to end their lives than to find an alternate solution  to their suffering. On April 20, I will host a Webinar on Understanding and  Preventing Suicide in which, in addition  to outlining warning signs and helper tasks, I will show  how people who are suicidal are not acting on their own point of view  but rather are driven by these internalized voices instructing them  toward their ultimate destruction.

My father, psychologist  Robert Firestone, initially made the link between  suicide and the inner voice in 1986 after interviewing a young woman who  had recently made a serious suicide attempt. The woman described in  detail how cruel, sadistic thoughts instructed her throughout the  planning and execution of her suicide attempt. The case study led my  father to write his first article on the "inner voice" in suicide.

In  the years since, we have come to recognize that in suicide cases  throughout the world, one can identify the presence of a critical inner  voice. For example, Richard A. Heckler's book  Waking Up Alive, provides  detailed accounts of what went on in the minds of real individuals  throughout the United States prior to their suicide attempts. In a state  Heckler refers to as "a suicidal trance," these individuals described a  strong presence of the severe self-attacking thought process referred  to as the "voice."

To make the correlation between these  self-destructive  thoughts and suicide, my father and I  developed an assessment scale to evaluate the risk of self-destructive  tendencies. First, we created the Firestone  Assessment of Self-Destructive Thoughts  (FAST), and eventually, we developed another scale that uses the  identification of a self-destructive thought process to assess suicidal  intent. This became the Firestone  Assessement of Suicidal Intent (FASI).

A  2001 comparative study used the FAST to identify suicidal potential  among Pakistani and American  psychiatric  patients. The results showed that these self-destructive thoughts held a  "significantly high correlation with suicide attempts." A similar  correlation was found in hospitalized Swiss patients interviewed  immediately after their suicide attempts by Dr. K. Michel. In the same  manner as the woman my father had interviewed years before, these  individuals clearly recounted the "voices" that led to their suicide  attempts. Both studies are indicative of how these voices appear to have  a cross-cultural presence among suicidal individuals.

Confirmation  of this connection inspired me to create the documentary  Voices of Suicide, in  which three survivors of their own suicide attempts tell the stories of  what went on in their minds leading to their attempts.  Each of these  individuals described themselves as being totally disconnected and  possessed by something that was compelling them to end their lives.

Susan,  one of the film's subjects described the "snide" voice she heard before  her suicide attempt as follows:

_Who would care if  you weren't around? People would miss you a little bit at the beginning,  but who would really care. You don't care...You thought you mattered,  you don't matter now. You don't matter... If you don't matter what does  matter? Nothing matters. What are you waking up for?_

Trish,  another subject of the film recounted a similar course of thinking:

_Your  own family doesn't love you. Nobody's ever going to love you. Your own  mother gave you away... You're alone, you'll die alone. You'll always be  alone. The only thing you can do is go and kill yourself._

The  film's third subject, Kevin, revealed how an inner voice convinced him  that his pain was hurting others:

_I'm a bad person. I'm a  burden to my family and friends. I'm hurting them with this bipolar, this, this annoying nuisance of a  guy. That's the way I thought. That's the way my demons thought._

In  all of these cases, at the moment when they actually made the attempt,  these individuals immediately reconnected with themselves and did not  want to die. After their lethal suicide attempts, both Susan and Trish  took actions that saved their lives. Kevin miraculously survived his  leap from the Golden Gate Bridge and has since become a public speaker  and advocate for suicide prevention.

The negative thought  processes that led these people to an action as desperate and as  hopeless as suicide proves that very often one's worst enemy lives  inside him or her. 

Therapists treating suicidal individuals must  therefore help their patients uncover these self-destructive thoughts  and recognize how they can separate from this dangerous point of view.

My  father developed "voice  therapy" as a way of helping people to  combat destructive thought processes and strengthen their sense of self.  Voice therapy  involves encouraging patients to verbalize their voices in the second  person and develop insight into the voices' origins. Next, patients  answer back to the voices and recognize the connection between voices  and destructive actions, and lastly they collaborate with the  therapist to change these behaviors

By treating patients through  voice therapy you help them to separate from this internal enemy and  fight against it in their thoughts and actions. Therapists should  encourage patients to respond to these voices, to fight back with a more  realistic and compassionate point of view. The use of voice therapy can  benefit anyone who has internalized an inner critic in any area of  their lives, but in the case of the suicidal client, getting the person  back on his or her own side can actually save a life.

_You can  learn more about Understanding and Preventing Suicide by joining me for a  FREE Webinar on April 20 from 11 a.m. to 12 p.m. PSD. _ _Click  here to learn more and to register.
You  can also visit The Glendon Association's  online resource on Suicide and  Self-Destructive Behavior or you can visit  the public resource I created on PsychAlive.org, Suicide Prevention Advice._

IF  YOU OR SOMEONE YOU KNOW IS IN CRISIS OR IN NEED OF IMMEDIATE HELP, CALL   1-800-273-TALK (8255). This is a free hotline available 24 hours a day to anyone in  emotional distress or suicidal crisis.

_Related books:_ 
_Conquer Your Critical Inner Voice_
iGive - You Shop. Your Charity Gets Money. For Free.<sup>™</sup>_Suicide and the Inner Voice: Risk Assessment,  Treatment, and Case Management_


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## Daniel

> Voice therapy  involves encouraging patients to verbalize  their voices in the second  person and develop insight into the voices'  origins.


A related video blog:
http://forum.psychlinks.ca/positive...ugh-of-your-crap-naming-the-inner-critic.html


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## forgetmenot

oh this is an excellent post thank you   I thought i was just a little of my rocker because i do so much self talking   very informative and good ideas on how to take away some the the power of these inner voices


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## SoSo

Yes, excellent article.  I wrote out an eviction notice one day to my inner voice, that for some reason, sounded like my mother.  I actually sat down with pen and paper and evicted it from my head.  Since doing that, it has gotten better, for me at least and when I do hear a voice talking to me now, it is my own and if I don't like what the voice is saying, I just tell me to smarten up, shape up and get real.  Works for me so far.  Really interesting article, explains what I was hearing/doing when I did OD many years ago and other half hearted attempts.
SoSo


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## Into The Light

very insightful article, thank you daniel. what struck me was that the moment people made their attempt they realized they wanted to live. i wonder if this is happens every time someone starts their attempt.


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## Daniel

On that note:

http://forum.psychlinks.ca/suicide/...idal-individuals-are-full-of-ambivalence.html


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## Daniel

From an interview with Albert Ellis:



> "What are you telling yourself to make yourself suicidal? You largely  constructed your depression.  It wasn't given to you. Therefore, you can deconstruct it. What do you  think you're telling yourself to make yourself this way?" We'd get the  client to admit things like, "I don't like my life," and then we'd say,  "Yeah, but that wouldn't induce you to commit suicide. What else are you  telling yourself?" And that's when clients say things like, "It  shouldn't be the way it is. It's terrible that I failed. I'm no good."  That's when we hear the shoulds, the oughts and the musts, and then we  convince the client to abandon these irrational demands. *Our slogan is,  "I will not should on myself today."
> *
> ~ Albert Ellis
> 
> The Prince of Reason | Psychology Today


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## Murray

My therapist is always pointing out my "should statements". They are insidious.


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## Daniel

The Critical Inner Voice that Causes Depression | Psychology Today

...As the manifestation of the "anti-self," the critical inner voice can  even sound friendly or soothing, as it lures us to take self-harming  actions, and then punishes us for failing to live up to our goals: "Go ahead. Have that second piece of cake. You've been doing so well on your diet"  or "Just stay home and be by yourself. You're perfectly fine on your  own." But when we heed their advice, they turn and become harsh and  punishing: "You're such a pig. You never follow through!  or "You'll  never meet anybody. You'll just wind up alone."

...Once someone experiences depression, they can be sure that they have  reached a stage where the point of view represented by the voice has  actually become their own viewpoint. They are now aligned more against  themselves than for themselves and wholeheartedly believe everything  their voice tells them. As a result, they no longer have contact with  their real self and may feel hopelessly alienated from the people  closest to them as well. So how can they challenge the voice that leads  to depression?

...Important steps to conquering your internal enemy or anti-self:

1.    Identify the negative thoughts and beliefs you experience as early in the self-destructive cycle as you can.

2.     Try writing these thoughts down in the second person as if someone is  talking to you (i.e. Instead of writing "I am different from everyone  else," write "You are different from everyone else.") This will help you  see the voice as an external enemy as oppose to your own point of view.

3.     Respond rationally to these statements using the more realistic tone of  a compassionate friend. (i.e. You are unique in many positive ways and  people appreciate you.")

4.    Talk to a close friend who tends to  have a more optimistic outlook. Talking to someone who is also down or  cynical about life can actually make you feel worse.

5.    Force  yourself to engage in activities that you have found pleasurable in the  past. Even if they don't seem appealing right now, they will help you  start to overcome the apathy, indifference, and lack of energy that are  major symptoms of depression.

When we take these steps to counter our attacks, we must be aware that  like the Wicked Witch in The Wizard of Oz, these voices will put up  quite a fight, even as they melt away. Acting against this internal  enemy will make it even louder for a while. When we feel good, it will  warn us of impending failure or tempt us into falling off the tracks,  but the more we ignore it, the more it will shrink. As people combat  this inner critic, they shed themselves of its dark rule and take the  first steps into the light and out of their depression.


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## Daniel

Voice Therapy
by Robert Firestone, PhD

...Although it is relatively easy to elicit the destructive voice process and bring it to the surface, voice therapy is not a short-term procedure or a simple cure-all. It is impossible to conceive of "cure" without the patient being able to change the fundamental aspects of the way he or she is living out his or her defensive structure...

Voice Therapy: A Treatment for Depression and Suicide
by Lisa Firestone, PhD

...All people exist in conflict between an active pursuit of goals in the real world and a defensive reliance on self-gratification. An individual who chooses to cultivate life and lead an honest and undefended lifestyle will experience both the joy and pain of his or her existence. In contrast, the defended person's attempt to block out pain neutralizes the life experience and deprives the individual of life's enrichment. To the extend that individuals succumb to a defensive posture, form addictive attachments and habit patterns, and choose an inward self-protective life, their adjustment will suffer, and it is unlikely that they will approach their potential. Retreat to an increasingly inward posture represents, in effect, a form of controlled destruction of the self. Anything that threatens to disturb an individual's solution to the core conflict arouses fear. Descending into this process more and more and withdrawing investment from real life often creates the necessary conditions for suicide....


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## forgetmenot

isolation the sadness  inner conflicts  how does one reach out really   one tries and tries and each time fails  one is reminded again and again their position in this life    the only safe place is to turn inwards away from the conflict     yet  it is so destructive this voice   it tells you things that you want to hear   Like you will have that peace you deserve   It is very clever this voice   If it were not for a few  people that know me  i think the voice would have won by now  especially now   Reach out where   i cannot   there is no where god i wish  i was stronger  don't trust dam voice keeps saying don't trust anyone   don't then the fear comes  don't go there again   i wish this would end this battle once and for all   the voice is clever  and it is so convincing.


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## Daniel

The Critical Inner Voice Explained

...Many people think if they stop listening to their critical inner voice, they will lose touch with their conscience. However, the critical inner voice is not a trustworthy moral guide like a conscience. On the contrary, the critical inner voice is degrading and punishing and often leads us to make unhealthy decisions. These negative voices tend to increase our feelings of self-hatred without motivating us to change undesirable qualities or act in a constructive manner...


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## Daniel

"That is why in adult life, people generally tend to relive rather than live, that is, to repeat the patterns of the past and defend the primary fantasy in the defiance, and avoid the real gamble or real adventure of taking a chance on something new. They are afraid that if they really cry out, if they really ask, if they really scream for help, that it won't come, and they'll be in the same panicky frightened state they were in when they were little."

- Robert W. Firestone


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## Daniel

“When you are depressed, you may have a tendency to confuse feeling with facts. Your feelings of hopelessness and total despair are just symptoms of depressive illness, not facts. If you think you are hopeless, you will naturally feel this way. Your feelings only trace the illogical pattern of your thinking. Only an expert, who has treated hundreds of depressed individuals, would be in a position to give a meaningful prognosis for recovery. Your suicidal urge merely indicates the need for treatment. Thus, your conviction that you are "hopeless" nearly always proves you are not. Therapy, not suicide, is indicated. Although generalizations can be misleading, I let the following rule of thumb guide me: Patients who feel hopeless never actually are hopeless. The conviction of hopelessness is one of the most curious aspects of depressive illness. In fact, the degree of hopelessness experienced by seriously depressed patients who have an excellent prognosis is usually greater than in terminal malignancy patients with a poor prognosis. It is of great importance to expose the illogic that lurks behind your hopelessness as soon as possible in order to prevent an actual suicide attempt. You may feel convinced that you have an insoluble problem in your life. You may feel that you are caught in a trap from which there is no exit. This may lead to extreme frustration and even to the urge to kill yourself as the only escape.”

― David D. Burns, _Feeling Good: The New Mood Therapy _


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## Daniel

How to Make Your Mind Chatter More Positive | Psychology Today


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## Hickwillas34

Thanks for the article you've shared. Very informative.


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## Daniel

The Downside of Suicide

 If you are convinced that people will be better off without you, you are dead wrong.


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## Daniel

How to Silence Your Inner Critic Once and for All, According to Martha Beck
					


Here’s how to replace those negative voices with your own personal pep squad.





					www.oprahdaily.com
				




"I want you to oust your internal critics, the ones who say you’re not good enough, who think you’re on the wrong track. I want you to be supervised, all day every day, by people who forgive your errors and believe in your destiny."

~ Martha Beck


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## Daniel

Author Tamsen Firestone explains how you can "get smarter" about your inner critic and stop it from driving your behavior.


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## Daniel

_Source:_ Robert Firestone, _Challenging the Fantasy Bond_ (2022)


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## Daniel

Video by Dawn-Elise Snipes, PhD.


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## Daniel

How to motivate yourself with kindness instead of self-criticism
					


How to motivate yourself with kindness instead of self-criticism by Sandy Woznicki, StressAndAnxietyCoach.com May 19, 2021  It’s crazy to me now, to look back and realize how freaking hard I was on myself for decades.  Had I ever talked to anyone else the way I talked to myself, it would surely...




					forum.psychlinks.ca
				




You have a natural negativity bias that is working hard right now.​
When you feel like you can’t be self-compassionate, understand our natural negativity bias.

We all have a negativity bias. It’s there with the intention to keep us safe. Your ancestors who were on the lookout for mountain lions lived longer than those who sniffed flowers all day.

But we are centuries beyond the point in our evolution where we need to be on guard in order to keep safe at all times. When you’re living with chronic stress and anxiety, your negativity bias is sticking in the on position. Meaning, all you can see are threats.

What could go wrong.
What is wrong.
What might be wrong.
If you get a ninety on a test, you look at that ten that you missed and not the ninety that you achieved.
Know that you have blinders on to positivity, that your negativity bias is making you focus solely on challenges instead of achievements.


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## Daniel

Do You Struggle With a Critical Inner Voice?
					


Why some people develop a "critical introject."





					www.psychologytoday.com
				




The attempt to project the image that other people will like, approve of, and judge favorably is very strong. It is this motive that is the primary driver of the introject. That is, the need to look good and to be approved of or to carry a strong reputation gets internalized. As this happens, an inner critic develops that can be thought of as occupying the space between the ego and the persona. That is, it is a voice that is serving to judge the self before others do. Given how important our reputations are in the social world, this basic function to try and “be good” and manage the impression one makes on others is perfectly natural.

Unfortunately, what happens to many people is that the voice takes on a life of its own. Eric Berne made an interesting adjustment to Freud’s tripartite theory of the id, the ego, and the superego. In his transactional analysis, he transformed these three domains into the child, the adult, and the parent. In this formulation, we can see the introject as a kind of critical parent that is judging the inner child harshly in an attempt to ensure that the child behaves in a way that is socially responsible and acceptable.


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