When pain has no exit: Understanding suicide as a process
Content Note: This post discusses mental health, psychological pain, and suicide. If you are in immediate danger, please call 112 (primary emergency number for all serious, life-threatening situations). This article offers a clinical understanding of suicide, and it is not a substitute for crisis support.
Suicide is one of the most spoken and least carefully thought-through topics in mental health. It is often reduced to slogans (“talk about it”, “reach out”), or avoided altogether, as it refers to elements in life we often would rather not look at. But suicide is a very serious issue: in Denmark alone, suicide accounts for approximately 500-600 deaths per year, corresponding to a rate of around 9-10 per 100,000 inhabitants (WHO, 2023; OECD, 2024). While this places Denmark below the global and OECD average, and significantly below its historical peak in the 1980s, suicide remains a persistent public health issue rather than a rare event.
This entry seeks to offer a comprehensive psycho-educational overview of suicide as a social and clinical phenomenon, what signs surround it, and how we can better understand it as a longitudinal process rather than a single event. Therefore, we need to begin by making distinctions.
Thinking about Death
First and for most: Not every thought about death is suicidal. Death is a constant in our lives. It is reflected across major systems of knowledge, from philosophy and science to religious and spiritual traditions. Our finitude is part of the human condition, and because of it, we think, feel, and fantasize about it.
These reflections are part of being human. And they do not, in themselves, indicate risk.
Thinking About One’s Own Death: Suicidal Ideation
Suicidal thinking is different. It involves a shift from thinking about death in general, to imagining one’s own absence, nonexistence, or to terminate it at least. It can appear in passive forms (“I wish I wouldn’t wake up”; “I would like to rest forever”) or more active and explicit ones (“I want to end my life”; “I want to die”). Even here, however, there is a wide spectrum. Clinically, this spectrum is often described and assessed in terms of intensity, frequency, and proximity to action: from passing thoughts, to recurrent ideation, to intrusive and emotionally charged fantasies that begin to organize experience around the possibility of death. Suicidal ideation is not a single phenomenon but a dynamic field that can fluctuate over time.
Even at more intense levels of ideation, thoughts do not automatically translate into action. The transition from thought to act is not linear, and most suicidal thoughts do not result in suicide. However, certain conditions and states, such as genetics, social vulnerabilities, psychological states (severe and acute mental states, hopelessness, rigid thinking, agitation), or intoxication, can reduce the distance between ideation and the act, and therefore require closer attention and care.
The act of suicide as a process in motion
When suicide does occur, it is rarely an isolated act. Clinically, it tends to follow a progression. It often begins with an affective field marked by intense psychological pain: despair, entrapment, anguish. Like a migraine that simply cannot be shaken off, it is invasive and impairing. That’s why it has been described as “psychache”, not simply sadness, but a felt sense that there is no way around it, no way out of it (Shneidman, 1993). From there, thinking can become constricted, rigid, and forced into a single direction. The future narrows and becomes gloomy. Possibilities collapse into rigid and totalizing binaries: the world turns black and white, and the person inhabits the dark.
Within this affective field, suicidal fantasies may emerge. Not necessarily as a desire for death itself, but as an imagined exit from suffering. For some, imagining the act brings a sense of relief or calm. This does not mean the situation has improved. Nothing really has changed, but the capacity of the mind to organize the pain. That clarity may lead to planning: considering how, when, and under what conditions the act could occur. This phase can be accompanied by a surprising increase in organization, usually taking the form of farewells. And finally, there is the act itself, often occurring in a state of narrowed consciousness.
Ambivalence: Wanting to live and wanting the pain to stop
One of the most important, and often overlooked, features of this process is ambivalence. Many individuals do not want to die. They want an end to a specific form of suffering, and because of this, different parts of the self may pull in different directions at the same time.
This ambivalence is possible in the context of clinical risk. Mood disorders, especially those involving a depressive phase, are frequently present in the background of suicidal states. Bipolar disorder cruising depressive or mixed phases, for instance, is also associated with high risk, as are substance use and access to lethal means. From an epidemiological standpoint, the highest suicide risk occurs when past self-harm, current suicidal intent, cognitive hopelessness, acute psychiatric distress, and access to lethal means converge within a short time window (Turecki et al., 2019). At the same time, most people with depression do not attempt suicide, and suicide cannot and should not be reduced to a diagnosis.
Environment: The Change of Seasons
Context also matters, including something as seemingly external as the time of year. It is commonly assumed that suicide risk is highest in winter, when light dims, cold is everywhere, and mood is lowest. However, epidemiological studies have consistently found that rates of suicidal behavior often peak in spring and early summer (Ajdacic-Gross et al., 2010; Woo et al., 2012). This apparent paradox can be understood clinically. In more severe depressive states, vital energy is often remarkably reduced. Daily tasks such as getting out of bed, brushing teeth, or doing laundry become impaired. As mood begins to shift, energy, agitation, and restlessness may increase, while hopeless or negative thoughts remain. The capacity to act can return before the capacity to reason against acting does.
Sometimes, the most dangerous moment is not when everything feels dark, but when there is just enough light to move.
Prevention is crucial
None of this means that suicide is inevitable, predictable, or reducible to a single pathway. These are patterns, not destinies. The suicidal state often resembles a funneled collapse, a downwards spiral in its cognitive, affective, and relational dynamics. But it remains a reversible process until the final moment, and even then, it is an action chosen (however constrained) by a person in distress.
If you recognize parts of this description in your own mind, or someone else, it does not mean that a particular outcome is fixed. It may mean that a certain degree of attention, care, and support are needed, a painful state and moment that should not be faced in isolation. Reaching out, reducing access to lethal means, and staying near someone who can hold and handle the ambivalence are all ways of widening the funnel again, opening up the field of affect and move back up the spiral.
If you or someone you know is struggling, consider calling the Emergency Number for urgent but non-life-threatening medical situations and Mental health emergencies (Psykiatrisk Rådgivning): 1813.
Also, Livslinien offers free, confidential support in Denmark:
- 🌐 livslinien.dk
- 📞 +45 70 20 12 01
- English counseling is available depending on volunteer availability