Orbach I
Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel.
Suicide Life Threat Behav. 1994 Spring;24(1):68-79.
The hypothesis of this paper states that at least some suicidal individuals are characterized by a disposition toward dissociation manifested in relative insensitivity to physical pain and indifference to their bodies. Three main topics are discussed: dissociation and suicide, psychological aspects of pain, and pain and suicide. Various theoretical and experimental studies suggest that certain stress conditions lead to the development of dissociative tendencies, and that once these tendencies are established, they become an integral part of suicidal behavior. Psychological variables that affect pain tolerance are presented and they include perception, motivation, emotions, and behavioral and cognitive strategies of pain control. These can increase tolerance of pain in suicidal individuals, making the suicidal act possible. The specific relationships of pain and suicide are then introduced through an examination of pain analgesia in the phenomenon of self-harm. The integration of the material suggests that early and continuous stress lead to the simultaneous development of dissociative tendencies (including indifference to the body and pain) and heightened vulnerability to stress. These dispositions may facilitate suicidal behavior in the face of mounting intolerable stress, helplessness, and hopelessness. Preliminary empirical support for the present hypothesis is cited. This hypothesis shifts the focus of attention from the question of what causes suicide to what facilitates suicide, and in so doing suggests new directions for research and therapy.
本文的假设指出，至少一些自杀个体的特征是具有解离倾向，表现为对身体疼痛相对不敏感以及对自身身体漠不关心。讨论了三个主要主题：解离与自杀、疼痛的心理方面以及疼痛与自杀。各种理论和实验研究表明，某些压力状况会导致解离倾向的发展，并且一旦这些倾向形成，它们就会成为自杀行为的一个组成部分。介绍了影响疼痛耐受性的心理变量，包括疼痛控制的感知、动机、情绪以及行为和认知策略。这些因素可以提高自杀个体对疼痛的耐受性，从而使自杀行为成为可能。然后通过对自我伤害现象中的疼痛镇痛进行研究，引入了疼痛与自杀的具体关系。对这些材料的整合表明，早期和持续的压力会导致解离倾向（包括对身体和疼痛的漠不关心）与对压力的易感性增加同时出现。面对不断增加的无法忍受的压力、无助感和绝望感，这些倾向可能会促使自杀行为的发生。文中引用了对当前假设的初步实证支持。这一假设将关注焦点从自杀的原因问题转移到促成自杀的因素上，从而为研究和治疗提出了新的方向。
