Joiner Thomas E, Robison Morgan, Udupa Nikhila S, Robertson Lee, Duffy Mary E, Lieberman Amy, Jeon Min Eun
Department of Psychology, Florida State University.
Veterans Administration Southern Oregon Healthcare System.
Psychol Rev. 2025 Apr 28. doi: 10.1037/rev0000559.
We propose that a state of psychological predeath precedes death by suicide, and that this phenomenon results from the undermining of subjectively experienced contingency and thus of agency (i.e., A consequence of the death of agency is not the dulling of awareness overall, but rather, specifically of one's subjective sense of existence (i.e., the feeling of subjective existence), highly consistent with the phenomenology of Côtard delusion (the fixed belief that one is already dead), and of neighboring clinical entities. The suspension of one's specific sense of existence but not of experience more generally is a haunting juxtaposition, one reason that the death of agency is , uncannily and indescribably so. A sense of deadness inheres in the death of agency; because aggression is in general psychologically more feasible against lifeless than against living things, feeling dead facilitates the remnant aspect of an otherwise obliterated sense of agency, enabling the delimited agency to kill. The foregoing together produce , because they stimulate all of the inputs to planned action, namely, opportunity, urgency, ability, planning, and probability. The death of agency, howling and incomprehensible psychological pain, suicidal capability, and suicidal intent combine, with death by suicide as a possible result. Implications, limitations, and future directions for research are presented. We also note several clinical implications of our work, including with regard to a collection of clinically serious suicidal presentations (e.g., Côtard delusion) that cluster at the severe end of an underlying spectrum of suicide-related psychopathology. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
我们提出，自杀前存在一种心理上的濒死状态，这种现象是由于主观体验到的偶然性以及能动性遭到破坏所致（即，能动性丧失的一个后果并非是整体意识的迟钝，而是具体而言，是个体的主观存在感（即主观存在的感觉）的迟钝，这与科塔尔妄想（坚信自己已经死亡的固定信念）及相关临床症状的现象学高度一致。个体特定存在感的暂停而非更普遍意义上的体验的暂停，是一种令人难以忘怀的并置，这也是能动性丧失令人毛骨悚然且难以言表的原因之一。死亡感内在于能动性的丧失之中；因为一般来说，在心理上，攻击无生命的物体比攻击有生命的物体更可行，感觉自己已死有助于恢复原本已被消除的能动性的残余部分，使有限的能动性得以实施自杀行为。上述因素共同作用，因为它们刺激了有计划行动的所有输入因素，即机会、紧迫性、能力、计划和可能性。能动性丧失、令人痛苦且难以理解的心理疼痛、自杀能力和自杀意图相互交织，可能导致自杀死亡。文中还阐述了研究的意义、局限性和未来方向。我们还指出了我们工作的一些临床意义，包括与一系列临床上严重的自杀表现（如科塔尔妄想）相关的意义，这些表现聚集在自杀相关精神病理学潜在谱系的严重一端。（PsycInfo数据库记录（c）2025美国心理学会，保留所有权利）
