Editor’s Note: This post was originally published on April 8, 2019, on sosmadison.com, the website for SOS Madison, one of New Jersey’s largest suicide loss support groups. It has been substantially rewritten and expanded for Sunflowers After Suicide. The core story and personal reflections belong to Jack Klingert, co-facilitator of SOS Madison and father of John, who died by suicide in April 2009.
There is a question that arrives in the early days of loss and doesn’t leave for a long time.
Maybe you are still carrying it. Maybe you have carried it for years. It is the question underneath the question, the one that refuses to be answered by any fact you can find, any conversation you can have, any middle-of-the-night search you have conducted with shaking hands.
How could they want to die?
When I lost my son John on April 10, 2009, that question was everywhere for me. John was 17. He was thriving by every outward measure. He was a football player, an honors student, a kid with real joy in him. And yet within four months of a bipolar diagnosis, he was gone. The idea that he wanted to die felt like a sharp knife I kept accidentally reaching for. It made no sense alongside the person I knew. It caused pain each time iI touched it.
What I eventually came to understand, through years of facilitating a suicide loss support group and sitting with hundreds of other survivors, is that the question itself is likely built on a false foundation.
Suicide is not about a desire to die.
That is one of the most important things the science of suicidology has established, and it is one of the most important things a survivor can come to understand. The clinical term for what actually drives it is psychache, the unbearable psychological pain that builds until a person cannot find another way through. Because for most people who die by suicide, the death is not about a desire to die at all.
It is about wanting the pain to stop.
What Shneidman Understood About Psychological Pain
In 1993, Dr. Edwin Shneidman published a paper that many consider the most important distillation of his career. Shneidman is widely considered the father of suicidology, the scientific study of suicide. He founded the American Association of Suicidology, coined the term suicidology itself, and devoted more than forty years of his life to one question: why do people die by suicide. When he wrote this paper, he was near the end of those forty years. He knew it. And he opened with something rare for a scholar of his stature: a plain, personal summary of everything he had learned.
He distilled it into five words: “Suicide is caused by psychache.”
Psychache is his term for the psychological pain that lives in the mind. Not physical pain. Not circumstantial hardship. The inner anguish, the soreness, the aching that can build inside a person until it becomes unbearable. Shneidman described it as intrinsically psychological, the pain of shame felt too intensely, of guilt that won’t release, of humiliation, loneliness, fear, or dread. The specific shape of the pain differs from person to person. What unites them is the intensity. His argument, grounded in decades of research, was that suicide occurs when a person reaches their individual threshold for enduring that pain and cannot find another way past it.
Notice what this definition does not include. It does not include a desire to die. It includes a desire for the pain to end.
That distinction matters enormously for survivors. Because the question of whether the person we lost wanted to die sits very differently than the question of whether they were in pain they could no longer bear.
Research since Shneidman’s work has continued to support and build on this framework. Studies have consistently found that psychache is a stronger predictor of suicidal behavior than depression or hopelessness alone. The most common statement found in suicide notes, Shneidman observed across decades of research, was some version of “I can’t stand the pain any longer.”
That is not the words of someone who wants to die. That is the language of someone who cannot find another path forward.
The Role of Mental Health Struggles
Understanding psychache also helps clarify the relationship between suicide and mental illness, which is something many survivors think about.
The person you lost may or may not have had a formal diagnosis. But what research consistently shows is that the large majority of people who die by suicide were struggling with a mental health condition, most often depression, bipolar disorder, or another condition that fundamentally altered how they perceived themselves and the world around them.
Mental health conditions do not just change moods. They change thinking. They distort perception. They can take someone who is surrounded by love, by people who would do anything for them, and create an internal environment where none of that love is visible or reachable.
This is not a metaphor. It is a physiological reality about how illness affects the brain.
John was surrounded by people who loved him. I know that. His mother, his sister, his friends, his coaches. That love was real and it was abundant. And yet his illness, that bipolar diagnosis he had barely begun to process, had created a lens through which none of it was enough to hold back the pain.
Understanding that is not the same as accepting it. But it can begin to redirect where you place the blame and responsibility.
Helplessness and Hopelessness Are Symptoms, Not Conclusions
Among the many themes that come up consistently in suicide research, two stand out as central to the experience of someone in suicidal crisis. They are helplessness and hopelessness.
Helplessness is the feeling that nothing can be done. That the pain cannot be addressed, that reaching out will not help, that there is no intervention available. For someone in a suicidal state, this feeling operates independently of reality. It exists even when real help is nearby, even when that person is surrounded by capable, loving, willing people.
You may have been right there. And in that person’s mind, you may still not have been visible as a source of relief. That is not a failure of your love. It is a symptom of the illness that had taken hold.
Hopelessness works similarly. It is the inability to see that the future can be different from the present. That the suffering could ease. That tomorrow, or next month, or next year, things could genuinely change. For someone consumed by psychache, the horizon disappears. The brain is telling them a set of lies with all the force of truth. They are not choosing to believe those lies. They are trapped inside them.
This is what makes helplessness and hopelessness so devastating and so important to understand. They are not accurate reflections of the situation. They are symptoms. And like any symptom of serious illness, they were not within the person’s power to simply will them away.
If you have found yourself thinking that the person you lost should have known you were there, should have reached out, should have been able to see the help available, this may be where the heaviest part of that sentence can begin to loosen. They were not able to see it. Not because they didn’t want to. Because their illness had taken their sight in that direction.
But that doesn’t take away the endless series of questions that so many suicide loss survivors ask themselves. The Should of, would of and could of questions can quickly race into your thoughts as the simple answer to a far more complex situation. You can’t will them away. You need to work through them.
Shneidman wrote extensively about what he called cognitive constriction, a kind of tunnel vision that sets in during suicidal crisis. The mind narrows. Options that would be visible to someone outside the crisis simply disappear from view. It is not that the person considered every available path and rejected them. It is that the crisis had reduced their visible options to what felt like one. This is why “why didn’t they just…” questions almost always miss the mark. The person in crisis is not seeing the same landscape you are. Their field of vision has collapsed inward. And because that crisis state is acute rather than permanent, there is research evidence that most people who survive a serious suicide attempt do not go on to die by suicide. The window of crisis, had it passed, might have closed on a different outcome. That is not a comfort exactly. But it is the truth about what suicidal crisis actually is: a state, not a verdict.
The Brain That Betrayed Them
One of the most painful realities of suicide loss is the invisibility of what was happening inside the person we lost.
They looked okay. Maybe they had a good week before they died. Maybe they seemed to be doing better. Maybe the last conversation you had was even a positive one. And now you replay that conversation searching for what you missed, what you should have seen, what you should have done differently.
What makes this even harder to sit with is that the concealment is often not passive. Research on people in suicidal crisis shows that many actively hide their suffering, sometimes over months or even years. They learn to perform normalcy. They answer “I’m fine” with enough conviction to be believed, because some part of them needs to protect the people around them, or because the pain feels too private and too strange to speak aloud, or because the illness has convinced them that telling the truth would not change anything anyway. This is not deception in the ordinary sense. It is a feature of how this particular kind of pain operates. If you missed signs that now feel obvious in hindsight, it is worth asking whether there were signs to miss, or whether the person you lost was working very hard to make sure you didn’t see them.
The post on hindsight bias explores this in depth, and it matters here too. Our minds, after a loss like this, rearrange memory. They create the illusion that the signs were obvious, that the outcome was foreseeable, that a more attentive or more capable person would have stopped what happened. But that rearrangement is a distortion, not a clear picture.
The person who died was struggling internally while the world around them looked largely the same as always. They were going through what appeared to be a normal life. And inside, they were fighting something no one around them could fully see or reach.
Their brain betrayed them. It generated pain they could not escape and then told them the pain would never stop. It closed off the exits that were actually open. It could not distinguish between “I am in unbearable pain right now” and “I will always be in unbearable pain.”
One of the most specific and devastating lies the suicidal brain tells is this: the people around you would be better off without you. Thomas Joiner, a psychologist who has spent decades studying suicide, identified what he calls perceived burdensomeness as one of the core psychological states that drives suicidal crisis. The person in crisis genuinely believes, with the full force of conviction, that their absence would be a relief to the people they love. That belief is a distortion. It is a symptom of illness. But it feels like clarity. Survivors who later find notes, or who remember things the person said in the weeks before they died, often encounter this belief directly, and it can be profoundly disorienting. Because it looks like a decision. It looks like a conclusion someone reached. What it actually is, is a lie the illness told them. And they believed it because the illness had taken away their ability to see otherwise.
That is the illness. That is the crisis state. And it is not something most people around them were equipped to see, intervene in, or stop, even when they were paying close attention, even when they cared deeply, even when they were doing everything they knew to do.
They Wanted to Live
There is one more thing that research tells us about people in suicidal crisis, and it may be the most important thing of all for survivors to hear.
Most people who die by suicide are deeply ambivalent. Not certain. Not resolved. They want to live and they want the pain to stop, and those two things exist at the same time, pulling in opposite directions. The part of them that wants to live is real. It does not disappear because the crisis overwhelms it. It is simply outweighed, in that window, by a pain that has become unbearable.
This matters because the clean-decision framing, the idea that the person you lost made a clear, deliberate choice to leave, is not what the research describes. What it describes is a person in agony, holding two things at once, with the illness tipping the scales. The part of them that wanted to stay was there. The part of them that loved you was there. The crisis took hold of someone who was still, somewhere inside it, fighting to find another way.
Ambivalence is not weakness. It is not indecision. It is evidence that death was not what they wanted. It was the only path their narrowed vision could find from pain they could no longer hold. If the word “choice” is one you are still wrestling with, Is Suicide a Choice? goes deeper on exactly that question and what seventeen years of sitting with survivors has taught me about it.
What This Means for Your Guilt
For many survivors, understanding the mechanics of psychache does not immediately remove the guilt. The guilt tends to be older and more stubborn than any explanation. If you have read everything above and still feel that you should have done more, that is a normal and documented part of this grief, not a character flaw.
The post on guilt after suicide loss looks at why this feeling is so persistent and what it actually represents. For many survivors, guilt is a way of maintaining some illusion of control, of keeping alive the idea that there was something that could have been done, because the alternative, that there was not, is almost unbearable to sit with.
Here is what seventeen years of sitting in suicide loss support groups has taught me, and what I have heard from researcher after researcher who has spent careers studying suicide loss survivors.
The truth is generally this: you did everything you could do. You could not do everything. Those two sentences live side by side. They are both true at the same time.
The person you lost died from the inside. They died from pain that their mind could not tolerate and could not see its way past. That pain existed independent of how much you loved them, independent of what you said or did not say, independent of your presence or your absence on any particular day or in any particular moment.
You did not give them that pain. You could not have taken it away. Just like you can’t cure cancer or stop a heart attack. There are limits to what we can do.
When Understanding Doesn’t Answer the Question
There is something important to say here, and it is this: understanding the science of psychache and the role of mental illness does not answer the question of why. Not the real one.
The real why question in suicide loss is not actually about neuroscience or psychological theory. It is deeply personal. It is the question of why this specific person, who you loved, who had things to live for, who had you. No research paper fully answers that question. And the only person who could answer it completely is no longer here.
The quest for understanding is one of the most persistent and painful aspects of this grief. Many survivors spend years, some spend the rest of their lives, holding the why without a complete answer. Learning to carry the question without being destroyed by it is its own kind of hard-won wisdom.
What the science can offer is context, not closure. It can tell you that the person you lost was not running toward death. They were running from pain. It can tell you that their brain, in crisis, was not operating with full access to what was true and possible and available. It can tell you that you are not the reason they died.
That is not nothing. For many survivors, it is the beginning of the work of letting go of a guilt that was never theirs to carry.
A Place to Bring What You’re Carrying
If you are sitting with these questions and carrying them mostly alone, please know that you do not have to. Suicide loss support groups, whether in person or online, offer a space where other survivors understand exactly the weight of what you are holding. They do not expect you to explain why the science isn’t enough, or why you still feel guilty even though you know better. They understand because they are in it too.
AFSP’s Healing Conversations program connects newly bereaved survivors with trained volunteer survivors for one-on-one peer support. Alliance of Hope for Suicide Loss Survivors maintains an online community and forum where survivors can connect around the clock, regardless of where you live. And if you are looking for local in-person support, AFSP’s support group finder can help you locate a group near you.
If guilt is sitting especially heavy, Moving Beyond Guilt offers some additional grounding for that specific part of the grief. And if the anger is louder right now than the guilt, Understanding Anger and Conflicted Emotions in Suicide Loss holds space for that too.
Whatever you are feeling, it belongs here. There is no wrong way to be a survivor.
The Pain Was Real. So Was the Love.
John did not want to die. I have come to believe that with my whole heart, and the science supports it. He wanted the pain to stop. He could not find another way, in the state he was in, with the illness that had seized his mind. That is not the same as choosing to leave us. That is not the same as not loving us.
The pain that drove him was real. The love he had for us, and we had for him, was also real. Both of those things are true.
For those of us left behind, finding a way to hold the grief without also holding the responsibility for what we could not prevent is a long and nonlinear process. It does not happen all at once. Some days it is more approachable than other days. But the understanding that someone we loved died from pain, not from a desire to leave us, is a thread worth holding.
We keep turning toward the light. Even when the turning is slow.
Posts You May Also Like
Hindsight Bias: Healing the Pain of “Could Have Known” After Suicide Loss — Why our memories rearrange themselves after a suicide death, and how to begin releasing the false certainty that you could have prevented it.
Guilt After Suicide Loss — An honest look at why survivor guilt is so persistent, what it actually represents in grief, and how survivors begin to set it down.
The Quest for Understanding: When Facts Don’t Answer the Question “Why” — For survivors who have the facts but still don’t have the answer they’re really looking for.
Moving Beyond Guilt: A Path Toward Healing After Suicide Loss — Practical and compassionate guidance for survivors working to release guilt that was never theirs to carry.
Is Suicide a Choice? What Every Suicide Loss Survivor Needs to Know — A deeper look at the word “choice” and why it cuts so deeply for survivors, with seventeen years of reflection on what the science and peer experience actually tell us.
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