When trying to understand the suicidal mind, the main focus should be on what is behind the wish to die. Odd as it may be, death may not be a central topic, as most suicidal individuals wish to live but end up wanting to die as a solution to solve a state of mental suffering. Focusing on how to ameliorate mental pain may help to produce new patterns of action for wanting to live. Therefore, before considering the likelihood of dying by suicide, it seems relevant to pay attention to how perturbed the individual is in terms of inner turmoil, agitation and upset.

The subjects who experience the state of suffering, including restlessness, bewilderment, sadness and anxiety, which is often a precursor of suicide risk, try to contain this unpleasant state with behaviours that are ill-suited to the correct management of said negative emotions. The use of alcohol and drugs only temporarily allows the person not to think and to feel relief from agitation and anxiety. However, this comes at a very high price as it is a short-lived effect often followed by a worsening of mood, which then requires the further use of these substances without ever really getting rid of the primary problem. For many, it is the abuse of psychotropic drugs, primarily benzodiazepines, which can provide temporary relief but then impose dependence and habituation on the subject with the need to repeatedly increase the dosage, not to mention other effects that can be traced back to dysphoric and irritable states which are also often associated with the risk of suicide.

As mentioned, not thinking often becomes vital; not thinking means not having the thorns of pain made up of conclusions, elucubrations, inner dialogues, and infinite pessimistic, self-defeating and painful reasoning for which the subject cannot find solutions. This is how, for many, the end of the day is configured, as relief in thinking that maybe something will change. Sleep often brings comfort as thinking is stopped. Unfortunately, the night is often sleepless; the next day, the subject is even poorer in resources.

Since the disturbed state of the person experiencing a crisis motivates the person to consider suicide, knowledge of this situation is necessary to comprehend the suicidal mentality. Therefore, even though it seems obvious and straightforward, asking questions about the source of the pain and how it has intensified is a technique of intervention that those overseeing a person in crisis frequently overlook. Entering into the person's suffering in the internal conflict, which fundamentally involves ambivalence, allows one to stop such rumination and return the conversation to a place of life and hope. It seems reasonable to support the notion that perturbation of the mind supplies the motivation for suicide; lethality, as the probability of dying through a specific method, is the fatal trigger. However, Shneidman [26] stated “admittedly, perturbation is difficult to define. In a sense, it encompasses all psychiatric nomenclature and terminology. But in the same way that we have established such concepts as “free-floating anxiety””.

The state of suffering invites suicide as the only option left [22]. This results from an explosive mixture consisting of four constellations of emotional experience: heightened inimicality (acting against the individual’s best interest), the worsening of perturbation (refers to how disturbed the individual is; a state of being emotionally upset, disturbed, and disquieted, a state related to its dependency for action), increased constriction of intellectual focus and the narrowing of the mind’s content (dichotomous thinking). Fourth, the dea of cessation is the insight that it is possible to stop consciousness and put an end to suffering [27]. The realization that suffering may be ended and consciousness can be stopped is ultimately what the concept of cessation is all about. In this context, inimicality describes the mindset that causes a person to behave in an antagonistic way towards oneself, even to the extent of turning him into his own twisted adversary. Suicidal people experience this condition and struggle with a variety of issues, including their physical well-being, rejection, feelings of failure, pain, and other unpleasant emotions. Despite having resources at their disposal, the person cannot handle these problems. Family and friends may provide helpful assistance, yet the person cannot gain from them. The individual prioritizes their interpersonal experiences and positive recollections, which do not yield advantageous outcomes. To decipher the risk of suicide, clinicians must possess an in-depth knowledge of this intricacy. Under those circumstances, the person reaches the ultimate conclusion and, to cite Shneidman, “the spark that ignites this potentially explosive mixture is the idea that one can put a stop to the pain. The idea of cessation provides the solution for the desperate person” [26].

The notion of cessation arises when an individual contemplates the possibility of putting an end to the mental turmoil by means of death. The individual then realizes that death will resolve their experience by eradicating all those aspects that cause unacceptable suffering.

In addition to the main focus on psychological pain, Shneidman [25] also emphasized the concept of "press”. In this context, "psychological pressures" refers to the external factors that might cause stress or demand on an individual, sometimes even originating from within. These often encompass external factors, such as relational disputes, job loss, and large distressing life events. Presses are intricately connected to the sensation of being overwhelmed, which refers to the experience of being inundated by psychological demands.

The concept of "perturbation," defined by Shneidman [25], differs from mental pain, although not always easy to define. He claimed that perturbation encompasses being emotionally agitated, disrupted, and unsettled. According to Shneidman, perturbation refers to a state of cognitive restriction and a tendency to engage in self-harm or unwise actions. Perturbation refers to the patient's spontaneous inclination to take action to modify or amend their current intolerable circumstances. It is a fundamental psychological drive that serves as the primary motivator for all suicidal actions.

A tri-dimensional model encompassing mental pain, as described, is associated with a condition of the so-called “perturbation”; this is the upset of inner turmoil, including every diagnosis in the DSM and the press as conceptualised with pressures and vicissitudes of the outer world has been used to depict suicide as a result of the maximum level of sufferance in each of these three aspects.

The conventional classifications pertaining to suicide are somehow binary divisions, such as attempted, threatened, and completed. A more accurate perspective is to perceive them as potential continuums. Three continuous factors that are always present in the context of suicide are pain, disturbance, and pressure. The intensity of psychological pain can be measured on a scale ranging from hardly perceptible to extremely agonizing, using a numerical rating system from 1 to 5. Perturbation, can be assessed on a scale ranging from calm to highly distressing, using a rating system of 1 to 5.

Similarly, the external pressures and fluctuations of the outside world can also be evaluated on a scale of 1 to 5. A schematic cubic model for suicide can be derived from these thoughts. Suicide is said to happen when a person experiences a combination of intense suffering, disturbance, and pressure, referred to as the 5–5–5 cubelet. The therapeutic implication is to decrease at least one of those pertinent dimensions to a value of 4 or lower. Indeed, the most effective way to decrease the intense psychological pain that leads to suicide is first to decrease the intense disturbance that causes the pain. This can often be achieved by addressing the increased external pressure from strained interpersonal relationships, unemployment, school problems, and other factors.

According to Shneidman [25], “the most direct way to reduce the heightened psychache (pain) that drives suicide is first to reduce the heightened perturbation that drives the pain—and frequently this can be done by addressing the heightened external press (of strained interpersonal relationships, unemployment, school problems, etc.)”.

Of note is the fact that suicidologists have often referred to tunnel vision to describe a peculiar logic of suicidal individuals as a condition that derives from the state of suffering. Such a way of thinking postulates the increased constriction of intellectual focus; this refers to the narrowing of the mind’s content, with fewer options to cope with the suffering. In such a state, as part of tunnel vision, suicidal individuals may develop a dichotomous thinking process, because they reason with only two options when confronting the suffering that has become unbearable: wishing for either some specific (almost magical) total solution for their perturbation or cessation, in other words, suicide. The therapist must be vigilant for the patient's use of perilous suicidal language, such as the word "only" in phrases, such as "the only thing I can do" or "the only way to do it". They cannot see a way out, because the mind reacts to suffering with a logic restricting the possibility of finding a suitable solution to the pain-producing circumstances [22].

Such a restricted way of thinking comes after a long chain of option scans, with the rejection of the idea of suicide but ultimately accepting it as the best solution to the state of suffering. We acknowledge that the very core of tunnel vision is a gradual process guiding the individual into the only way out when other options fail. The individual convinces himself that, regardless of his efforts, suicide appears to be the only solution. This conclusion appears as the result of a peculiar logic of the suicidal mind, affected by overwhelming mental pain [22].

They can wander for hours, go away from home, or harbour a sense of great concentration made up of extremely intimate questions and answers on whether dying by suicide is right or wrong if it will be decisive or cause damage to those who remain.

Shneidman [27] outlined some doable strategies for assisting severely suicidal individuals and, as a result, saw suicide as a means of escaping agonizing mental suffering, with this suffering serving as the trigger for suicide. Shneidman [see [27], although described in various contributions of the author, such as [22]] identified several features that are found in at least 95% of individuals who die by suicide. He refers to these elements as "Commonalities of Suicide", which I will overview. Briefly, what follows is a list conveying such features which are almost always found in the suicidal mind that I aim to comment:

1) The common purpose of suicide is to seek a solution; it is never only an act without a conclusion. It pertains to the desire to escape a crisis or an intolerable condition that causes psychological distress. 2)The common goal of suicide is the cessation of consciousness. Indeed, suicide might be comprehended as an action that eradicates the individual's consciousness, where profound mental anguish resides, making it intolerable. Consequently, it is posited as the optimal resolution for the individual. 3) The common stimulus in suicide is intollerable psychological pain. If the individual desires to achieve cessation, they are attempting to escape psychological agony. Upon meticulous examination, suicides manifest as the convergence of a desire to stop the flow of concusses and the act of creating emotional distance due to excruciating mental anguish. When the degree of pain diminishes, suicide does not transpire. 4) The common stressor in suicide is frustrated psychological needs. Ironically, the individual contemplating suicide employs the act of suicide as a means to fulfil essential psychological needs that have been unmet. This, once again, leads to the inference that there could be numerous avoidable fatalities; 5) The common emotion in suicide is hopelessness–helplessness. Suicidal individuals often experience a sense of emotional despair and powerlessness. These individuals express a sense of hopelessness, believing that they have exhausted all options and that no one is capable of assisting in alleviating their suffering, to the extent that they contemplate suicide as the only viable solution. 6) The common cognitive state in suicide is ambivalence. Suicidal individuals commonly experience ambivalence in their cognitive state. Suicides are marked by a state of ambivalence, where individuals experience conflicting feelings towards life and death until they ultimately carry out the lethal act. Despite their preparations, they yearn for salvation from death. 7) The common perceptual state in suicide is constriction. Suicidal individuals exhibit a sense of temporary mental constriction that affects both emotions and intellect. Indeed, individuals contemplating suicide express sentiments such as "I had no alternative," "The sole path to demise was through exit," and "Taking my own life was the only viable option." This phenomenon is commonly referred to as tunnel vision, characterized by a limited range of choices and a mental focus on only two possibilities: a miraculous and joyful resolution or the act of ending one's life, known as suicide. In these instances, the principle of binary outcomes is enforced. 8) The common action in suicide is escape or egression. Suicides commonly occur as a means of escaping from difficult circumstances, an exodus from something distressing; 9) The common interpersonal act in suicide is communication of intention. Suicidal individuals typically communicate their intentions to others. From the initial psychological autopsies, it was discovered that in cases of uncertain deaths, which were ultimately categorized as suicides, there were indications of suicidal intention expressed in a more or less direct manner. These subjects engaged in psychotherapy intending to reduce mental distress in individuals who were at risk of suicide. Instead of expressing hostility, anger, depression, or withdrawal, they communicated their intention to commit suicide either verbally or through their behavior. In addition, the patterns of suicide observed were similar to the adaptive patterns of life exhibited by the individuals contemplating suicide. 10) The common pattern in suicide is consistent with life-long styles of coping. Suicide patterns are similar to adaptive patterns of life of the suicidal individual. In other words, by observing how a certain person has behaved in other difficult moments in their life, one can predict how the individual will approach the present crisis. Probably during other difficulties, that person has experienced the tendency to have dichotomous thinking and escape from pain. Although suicide, by definition, is an event never experienced. However, we can investigate the subjects' minds compared to lethal gestures by analyzing various kinds of mourning, separations, and losses.

As the flow of consciousness holds the thoughts referred to as negative emotions, and such thoughts are how the individual decides upon suicide, the cessation of such a process is the ultimate goal. In terms of emotional state, individuals in crises experience hopelessness and helplessness and, therefore, are trapped into conditions such as “there is nothing I can do (besides suicide) and there is no one who can help me (with the pain I am suffering)”. Notwithstanding the dreadful emotional situation, the individual in crisis feels the need to communicate their intention to die by suicide. Although not always traceable, such communications are provided directly or indirectly beforehand. It follows that there is a need to pay attention to any reference to suicidal wishes. Many people who die by suicide, even if ambivalent, consciously or unconsciously, leave clues about the intent, signs of unease, cries of impotence, or requests for intervention [22]. When experiencing a crisis, suicidal individuals often use adaptive schemes implemented in previous difficult moments of their lives. Therefore, a proper understanding of the history of each subject can shed light on the possible involvement of maladaptive solutions, such as, for example, the use of alcohol and drugs, as well as acting upon suicidal wishes.

Planning a suicide is often a drawn-out and challenging procedure. The individual starts to consider a good time; they need enough lead time to get ready. The person keeps having several conversations with themselves in the weeks and days leading up to the actual preparation and execution of the act. They may allude to their conviction that they are unworthy of anything, let alone others, that they have failed, and that they are a burden to their loved ones. This sets off an increasingly difficult task, during which there may also be a brief period of emotional elation in which the person begins to glorify suicide, sees it as a way out of a difficult situation, and arranges it as a plan to carry out without outside intervention. Consider doing something that, although it seems the wrong action to the subject, he feels is required to improve. Suicide is an act that is frequently planned out for a longer period than is commonly thought. The gesture does not turn into an impulsive one until beyond this point. The person who is in danger considers his loved ones during this time of planning the deadly act and feels regret for them. The person in question has considered ending their own life on multiple occasions; yet, each time it was considered, even though it was ultimately rejected, the option gained more significance. The person who is in danger of suicide starts to show signs at this point, indicating that they are sick of life, that they are thinking about dying, and that they would like to pass away. It is a human condition that can cause "emotional storms," significant ambivalent swings, and simultaneous adjustments to eating, sleeping, hygiene, and social interactions. The person who is in danger thinks about his loved ones during this time of planning the deadly deed and feels guilty and regret for coming up with such a horrible solution. In certain instances, complicated relationships with friends, family, or partners exist as well, to the point where the suicidal person nearly feels guilty for not getting enough support from them. The person in danger also feels alone in their emotional anguish and hopelessness. They also come to this conclusion after realizing they cannot express their pain to those tasked with assisting. Every person has a desire to die, and because every person has a unique set of motivations and thoughts, no two persons who are at risk of suicide are alike. According to Shneidman, the primary causes of psychological suffering are feelings of shame, guilt, rage, loneliness, and despair that result from unmet psychological needs. When these demands are not met, and the ensuing suffering is felt to be an intolerable state in the suicidal person, suicide is thought to be the best course of action. Psychological needs are what give a person their identity and drive them to live, and when those needs are not met, they can lead a person to decide to end their life.

We could characterize this as an unfulfilled need. Some examples of these psychological demands are achieving objectives like joining a buddy or group of people, attaining autonomy, opposing something, imposing oneself, and feeling accepted, understood, and comforted. Suicide is viewed as the most suitable solution for the suicidal person because of the agony that results from these requirements not being met and from this unacceptably painful state. There are psychological needs that define a person's life and personality, as well as psychological conditions that, when unmet, lead a person to decide to end their own life. From this vantage point, Shneidman believes that the best way to support suicidal people is to have a therapist who in some way attends to their unmet mental health needs by posing as a secular priest, an ombudsman, or an elderly woman who shops for them and depending on the idea of assistance. Continuous monitoring of suicide risk is crucial, taking into account warning indicators, such as alterations in behavior, particularly when accompanied by insomnia, and any expression of a desire to die. Individuals may have a sense of confinement and resort to unhealthy actions, such as consuming alcoholic beverages and utilizing psychotropic substances. Subjects contemplating suicide frequently exhibit behaviors such as organizing their personal matters and bestowing symbolic possessions, indicating a desire for someone else to assume responsibility for a cherished item, irrespective of its monetary worth. Orbach [28] examines the content analysis of pain narratives from suicidal patients and discusses several characteristics of the suicidal mindset. These include alterations in one's identity, instances of feeling disconnected from oneself, dissociative traits, a feeling of being devoid of value, emotional deprivation, and a decline in self-confidence. Moreover, the mind is frequently defined by the encounter of deprivation, such as occurrences that disrupt an individual's sense of ongoing identity and the loss of purpose in life. In addition, oxymoronic experiences involve intense contrasts in emotions, thoughts, and wants. These contradictions can include the simultaneous experience of living and dying and the conflicting feelings of grandiosity and shame. Moreover, the out-of-ordinary experience of pain highlights the inadequacy of conventional language in capturing these unique and individualistic feelings. Maltsberger [29] reported that intense despair is a mental emergency. Those patients who can escape it by turning to others for relief are fortunate. Some patients are able to access psychiatric therapy that alleviates their condition. Others end up falling back on drugs and alcohol to stem the anguish. However, many unfortunate patients may choose suicide as they cannot wait for this relief. Many desperate and anxious patients show how they are feeling with their facial expressions, body movements and behaviours, although many can seem quite calm and strangely calm. Potentially suicidal individuals must, therefore, be questioned about their emotional distress and whether and to what extent it is becoming intolerable. They should be asked to compare the severity of what they feel with other circumstances such as suicide attempts in the past. Those who appear calm may have already resolved their dilemma and have decided definitively to die by suicide. Having made the decision, others experience greater serenity, calmness and self-control before carrying out the lethal act. Still, others, to avoid having their suicide plans jeopardised, hide their desperation.

In this context, it is worth noting the model proposed by Maltsberger [29], which highlights the phenomena of ego failure (breakdown of the Self) in suicidal dynamics by proposing a model of suicidal collapse that involves four interconnected aspects. These aspects must not be understood as elements of a rigid sequence that follow one another according to an overdetermined order but rather as dynamic parts: one can see how patients can move back and forth from one aspect to another, observing a passage of level; some individuals show some parts more than others or even more than one aspect at the same time, but, regardless of the different individual characteristics, as suicide approaches, we observe how patients are more marked by the third and fourth parts of self-devolution (involution of the Self).