Psychol Rev. 2025 Apr 28. doi: 10.1037/rev0000559. Online ahead of print.
ABSTRACT
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., the death of agency). 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 psychologically painful, 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 suicidal capacity, the remnant aspect of an otherwise obliterated sense of agency, enabling the delimited agency to kill. The foregoing together produce suicidal intent, 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).
PMID:40310220 | DOI:10.1037/rev0000559
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