Suicide and Life-Threatening Behavior 33(3) Fall 2003 231

 2003 The American Association of Suicidology

Mental Pain and Its Relationship to Suicidality

and Life Meaning
ISRAEL ORBACH, PHD, MARIO MIKULINCER, PHD,
EVA GILBOA-SCHECHTMAN, PHD, AND PINHAS SIROTA, MD

Shneidman (1996) proposed that intense mental pain is related to suicide.

Relatedly, Frankl (1963) argued that the loss of life’s meaning is related to intense
mental pain. The first goal of this research was to test Shneidman’s proposition
by comparing the mental pain of suicidal and nonsuicidal individuals. Meaning in
life and optimism are the polar opposites of suicidality and hopelessness, and the
examination of these variables in relation to mental pain was undertaken to pro-
vide a test of Frankl’s proposition. In two studies, a relationship between a newly
developed measure of mental pain—the Orbach & Mikulincer Mental Pain Scale,
2002 (OMMP; see also Orbach, Mikulincer, Sirota & Gilboa-Schechtman, 2002)—
and suicidal behavior and life meaning were examined. Results confirmed both prop-
ositions. Implications for the study of mental pain and suicide are discussed.

Mental pain is an old and frequently used
concept in clinical psychology and in psychi-
atry and is believed to be at the heart of psy-
chopathology (Frankl, 1963; Jobes, 2000). One
of the first and most extensive contributions
to the clarification of this concept was pro-
vided by Shneidman (1985), who coined the
term “psychache” for this experience. Shneid-
man states that mental pain is energized by
frustrated or thwarted essential needs. He
proposes that negative emotions such as guilt,
shame, humiliation, disgrace, grief, hopeless-
ness, and rage turn into a generalized experi-
ence of unbearable mental pain—a state of
ISRAEL ORBACH, MARIO MIKULINCER, and
EVA GILBOA-SCHECHTMAN are with the De-
partment of Psychology at Bar-Ilan University,
Ramat-Gan, Israel. PINHAS SIROTA is with the
Abarbanel Mental Health Center in Bat-Yam,
Israel, and Sackler Faculty of Medicine, Tel-Aviv
University.
Address correspondence to Israel Orbach,
Department of Psychology, Bar-Ilan University,
Ramat-Gan, 52900, Israel; E-mail: orbachi@mail
.biu.ac.il
emotional perturbation (Shneidman, 1980,
1993, 1996). When pain reaches a high in-
tensity and when there is no foreseeable
change in the future, the suicidal person
seeks to escape pain by committing suicide.
Shneidman (1999) also provided a prelim-
inary operationalization of mental pain by
measuring the degree of need frustration and
perturbation; however, as of yet, this assess-
ment procedure has not been validated em-
pirically. Bolger (1999) produced a self-nar-
rative approach to mental pain by analyzing
the scripts of the emotional pain in peo-
ple who suffered traumatic experiences. Her
analysis yielded a definition of mental pain as
“brokenness of the self ” consisting of a sense
of woundedness, disconnection (from a loved
one), loss of self, loss of control, and a sense
of alarm. Although Bolger described and de-
fined the experience of mental pain, she did
not provide an operationalized assessment of
this concept.
Highlighting the centrality of the con-
cept for the study of psychopathology, Or-
bach, Mikulincer, Sirota, and Gilboa-Schecht-
232 MENTAL PAIN, SUICIDALITY AND LIFE MEANING
man (2003) have conceptualized mental pain
as a wide range of subjective experiences char-
acterized as an awareness of negative changes
in the self and in its functions accompanied
by negative feelings. They have created the
Orbach and Mikulincer Mental Pain (OMMP)
Scale assessing the dimensions and the in-
tensity of this experience, which consists of
nine factors: lack of control, irreversibility of
pain, emotional flooding, narcissist wounds,
estrangement, emotional flooding, confusion,
need for social support, and emptiness. These
experiential entities share some similarities
with some aspects of definitions of mental
pain discussed by Shneidman and Bolger. For
example, aspects related to a sense of loss of
self, perturbation, woundedness, and lack
of meaning resonate with the factors of lack of
control, emotional turmoil, narcissist wounds,
and emptiness in this scale. But there are
some aspects in the present scale that are not
reflected in previous definitions and these in-
clude irreversibility of pain, emotional freez-
ing, estrangement, confusion, and need for
others. All in all, the OMMP Scale provides
a rich web of experiential qualities that define
mental pain.
In a series of studies designed to assess
the discriminative and convergent validity
of the OMMP Scale, it was found to be re-
lated to depression, anxiety, and emotion-
al coping strategies. This suggests that the
OMMP possesses convergent validity with
other related constructs. The pain factors
that repeatedly emerge in association with
the studied variables include irreversibility,
lack of control, emptiness, emotional flood-
ing, emotional freezing, and estrangement.
However, these associations are quite moder-
ate, suggesting that the mental pain scale as-
sesses a subjective experience that is signifi-
cantly differentiated from other measures of
distress, and that the concept of mental pain
is significantly differentiated from the con-
cepts of anxiety and of depression.
One of the most significant associations
yet to be examined using the construct of
mental pain is suicidality. Shneidman (1993,
1996) argued that intolerable psychological
pain, when deemed unbearable by the indi-
vidual, will lead to suicide. In other words,
understanding suicide is understanding the
individual differences in thresholds for en-
during mental pain (Shneidman, 1993). Ac-
cording to Shneidman, individuals with a his-
tory of suicidal behavior would report higher
levels of mental pain than clinically distressed
individuals who have not attempted suicide.
The first goal of the present work was
to test this proposition by comparing mental
pain of suicidal and nonsuicidal participants;
however, it is suggested that the relationship
between mental pain and suicidal behavior
should be studied in a wider context of psy-
chological variables that have been evidenced
to strongly contribute to suicidal behavior,
including depression (e.g., Maris, 1981), anx-
iety (e.g., Fawcett, 1988), and hopelessness
(e.g., Beck, Steer, Beck, & Newman, 1993).
In Study 1 we have investigated these rela-
tionships in three groups: suicidal inpatients,
nonsuicidal inpatients, and nonclinical con-
trols.
An additional purpose of Study 1 was
to explore the relationship between mental
pain and emotional expressivity (Gross &
Oliver, 1998). Emotional expressivity refers
to individual differences in the extent to
which people outwardly display their emo-
tions (Kring, Smith, & Neale, 1994). We
hold that it is critical to examine the degree
of overlap between mental pain and expres-
siveness. A strong association between the
two measures might suggest that mental pain
is merely a compound of the degree to which
people are willing to disclose or display their
feelings and not a natural outgrowth of the
pain they experience. A weak association be-
tween the two measures may indicate that the
two measures are relatively independent, thus
conceptually enhancing the concept of men-
tal pain.
A further goal of the present paper was
to examine the relationships between men-
tal pain on the one hand, and negative life
events, optimism, and meaning in life on the
other. Meaning in life and optimism are the
polar opposites of suicidality and hopeless-
ORBACH ET AL.
ness, and the examination of these variables
is likely to provide a further test of the prop-
osition that mental pain is related to the loss
of life’s value. Testing this proposition was
the main goal of Study 2. One important
source of coping is the personal resource of
being able to remain optimistic (Scheier &
Carver, 1985). Carver and Scheier argue that
in times of adversity people react with a range
of negative emotions. The balance among
such feelings appears to be related to the in-
dividual’s degree of optimism and pessimism,
that is, the degree to which one expects posi-
tive outcomes in the face of difficulties. It is
believed that an optimistic attitude energizes
the person to employ active strategies and to
seek positive results rather than giving in,
thereby regulating possible negative feelings
(Carver & Scheier, 2000). Many studies show
that optimists experience less distress than
pessimists when dealing with life’s adversities
and that optimism is considered to be a mod-
erator of distress (e.g., Aspinwall & Taylor,
1992; Carver & Gaines, 1987; Long, 1993;
Shifren & Hooker, 1995; Zeidner & Ham-
mer, 1992). It is hypothesized that optimism
can be considered a moderator of mental
pain just as it is a moderator of general stress.
Therefore, we expect to find that optimism
will be inversely related to mental pain.
Meaning in life is also related to men-
tal pain. Frankl (1963) has posited that men-
tal pain is actually a reflection of emptiness
and meaninglessness. The individual’s ability
to structure life on the basis of a comprehen-
sive view that dictates his or her duties, val-
ues, goals, beliefs, and actions can be consid-
ered as a personality resource that also has a
regulatory function (Orbach, Iluz, & Rosen-
heim, 1987). Empirical studies show lack of
meaning and lack of commitment to be re-
lated to depression (e.g., Iluz, 1990), to fear
of death (e.g., Orbach et al., 1987), to drug
abuse (e.g., Newcomb & Harlow, 1986), and
to difficulties in bereavement (e.g., Florian,
1989). Assessing the ability to overcome loss,
Davis, Nolen-Hoeksema, and Larson (1998)
have suggested that finding ways to assign
meaning to the loss experience enhances cop-
233
ing. We assume, therefore, that a high level
of meaning as defined by commitment to
goals will also be inversely related to mental
pain. This hypothesis will be examined in
Study 2.
STUDY 1
Method
Participants. Suicidal inpatients con-
sisting of 32 adults, ages 25–60 (M = 32.43,
SD = 5.43) (14 males, 18 females), were cho-
sen from the adult ward of the Abarbanel
Mental Health Center. All attempted suicide
just prior to their hospitalization. Suicide at-
tempts included drugs (n = 15), cutting (n =
7), hanging (n = 5), jumping (n = 3), and
shooting (n = 2). They were characterized
by the following diagnosis: major depression
(n = 15); bipolar depression (n = 12); Psy-
chotic depression (n = 5). Diagnosis was based
on the Schedule of Affective Disorders and
Schizophrenia (SADS; Spitzer, Endicotte, &
Robins, 1975), a regular procedure at the Ab-
arbanel Mental Health Center.
The nonsuicidal inpatients, also from
the Abarbanel Hospital, consisted of 29 adults,
ages 25–60 (M = 34.28, SD = 6.71) (11 males,
18 females). According to medical reports,
staff reports, and patients’ self-reports, none
had made a suicide attempt. They were char-
acterized by the following diagnosis: major
depression (n = 11); bipolar depression (n =
12); psychotic depression (n = 6). There was
no significant difference in length of hospi-
talization between the two inpatient groups.
Control participants were approached
in neighborhood community centers. They
consisted of 30 adults, ages 25–60 (M = 31.62,
SD = 5.84) (14 males, 16 females). Exclusion
criteria were active psychotic state and below
sixth grade reading ability.
Instruments and Procedure. All inpa-
tients and control participants were first ap-
proached by the experimenter (a graduate
student) to request participation in the study.
Approximately one third of the patients were
234 MENTAL PAIN, SUICIDALITY AND LIFE MEANING
tested a few days after admission; the rest
were recruited from patients who were al-
ready hospitalized for varying periods. Time
of hospitalization was recorded in all cases.
The study was presented as research on suf-
fering and mental pain. The Helsinki Com-
mittee’s informed consent was read to the
participants and an appointment was ar-
ranged for testing. Sessions were held indi-
vidually in a secluded room. All participants
received the scales in random order. The re-
search assistants had no information as to
who made a suicide attempt or the type of
the attempt. Attempters were identified by
the hospital staff only after the completion of
data collection.
The experience of mental pain was as-
sessed by the OMMP Scale (see Orbach et
al., 2003). This self-rating 5-point Likert
scale with 44 items consists of nine factors:
(1) irreversibility, (2) loss of control, (3) nar-
cissist wounds, (4) emotional flooding, (5)
freezing, (6) self-estrangement, (7) confusion,
(8) social distancing, and (9) emptiness (4
items). Higher values on each scale reflect
higher mental pain. In the current sample,
Cronbach alpha coefficients for the nine
OMMP factors ranged between .82 and .94.
Suicidal tendencies were assessed by
the Multi-Attitude Suicidal Tendencies Scale
(MAST; Orbach et al., 1991). This self-
rating, 5-point scale with 30 items provides
four independent scores of suicidal tenden-
cies: (1) attraction to life (AL), (2) repulsion
by life (RL), (3) attraction to death (AD), and
(4) repulsion by death (RD). High attraction
to life and repulsion by death reflect low sui-
cidal tendencies, while high repulsion by life
and attraction to death reflect high suicidal
tendencies. Internal consistency of the scales
range from .76 to .83, and the internal con-
sistency of the entire scale is .92.
Hopelessness was assessed by Beck’s
Hopelessness Scale (Beck, Weissman, Lester,
& Trexler, 1974). This is the best known and
most widely used scale for evaluation of hope-
lessness. Each of the 20 statements is rated
on a 4-point scale: the higher the score, the
greater the hopelessness.
Anxiety and depression tendencies were
assessed by the Cognitions Checklist (CCL;
Beck, Brown, Steer, & Eidelson, 1987; Steer,
Beck, Clark, & Beck, 1994). This scale mea-
sures the frequency of automatic thoughts that
are relevant to anxiety (12 items) and to de-
pression (14 items) separately and that typify
depressed and anxious patients. It was used
as an indication for the degree of anxiety and
depression. The authors reported a high de-
gree of reliability and discriminant and con-
current validity. Two general scores were
computed by averaging the items in each
subscale. Higher scores reflect higher levels
of automatic thoughts, typical of people who
are high in anxiety and depression, respec-
tively.
Emotional expressiveness was assessed
by the Emotional Expressiveness Scale (Gross
& Oliver, 1998). This instrument is a 71-
item, 7-point rating scale (ranging from 1 =
strongly agree to 7 = strongly disagree) that con-
sists of five factors, which include: expressive
confidence (e.g., “At small parties I am the
center of attention”); positive expressiveness
(e.g., “when I am happy, my feelings show”);
negative expressiveness (e.g., “When I am
angry, people around me usually know”); in-
puts intensity (e.g., “I experience my emo-
tions very strongly”); and masking (e.g., “I
am not always the person I appear to be”).
The inner consistency ranges from α = .72 to
α = .88.
Results and Discussion
Mental Pain Experience and Suicidality.
Table 1 presents the means, standard devia-
tions, and values of F-tests between the three
experimental groups on the nine OMMP
factors. A multivariate analysis of variance
(MANOVA) yielded a significant difference
between study groups in the set of the nine
OMMP factors, F(18, 160) = 2.44, p < .01.
Univariate analyses of variance (ANOVAs)
indicated that this difference was significant
in most of the OMMP factors, with the ex-
ceptions of narcissist wounds and social dis-
tancing (see Fs in Table 1). Scheff post hoc
tests (α = .05) revealed that suicidal patients
scored higher in the OMMP factors than
ORBACH ET AL. 235

TABLE 1
Means, Standard Deviations, and F Ratios of OMMP Factors According to Study Groups
OMMP factors Suicidal Psychiatric Control F(2, 88)

Irreversibility
M 3.66a 2.68b 2.42b 12.67**
SD 1.21 1.10 0.67
Loss of control
M 3.13a 2.33b 1.89b 13.21**
SD 1.17 1.02 0.62
Narcissist wounds
M 3.62a 3.38a 3.52a 0.24
SD 1.40 1.56 0.96
Emotional flooding
M 3.28a 2.27b 2.31b 6.84**
SD 1.41 1.35 0.76
Freezing
M 2.74a 1.87b 1.68b 6.37**
SD 1.47 1.42 0.69
Self-estrangement
M 2.62a 2.10b 1.76b 4.60*
SD 1.26 1.33 0.63
Confusion
M 3.57a 2.60b 2.77b 5.39**
SD 1.25 1.58 0.79
Social distancing
M 2.83a 2.69a 3.05a 1.07
SD 1.13 1.01 0.76
Emptiness
M 2.58a 1.60b 1.37b 9.82**
SD 1.47 1.11 0.68

Note. *p < .05; **p < .01. Means with different letters were significantly different at
alpha = .05

both psychiatric patients and control partici-
pants (see means and standard deviations in
Table 1). No significant difference was found
between psychiatric patients and control par-
ticipants. A discriminant analysis indicated
that the significant difference between the
suicidal group and the two other study groups
was mainly explained by the unique contribu-
tions of the OMMP factors of irreversibility
(standard discriminant coefficient of .37), loss
of control (.37), and emptiness (.38).
Table 2 presents Pearson correlations
between the nine OMMP factors and mea-
sures of suicidality (the four MAST factors),
measures of distress (hopelessness, depression,
and anxiety), and measures of emotional ex-
pressiveness (expressive confidence, positive
expressiveness, negative expressiveness, in-
puts intensity, and masking). The table re-
veals that, with the exception of the narcissist
wounds and social distancing factors, OMMP
factors were inversely associated with the at-
traction to life score and positively associated
with the attraction to death and repulsion by
life scores. No significant association was found
between the OMMP factors and the repul-
sion by death score. A canonical correlation
yielded a single significant canonical func-
tion, F(36, 294) = 2.94, p < .01. This function
was defined by the contributions of attraction
to life and repulsion by life scores (standard-
ized canonical coefficients of −.72 and .41),
236 MENTAL PAIN, SUICIDALITY AND LIFE MEANING

TABLE 2
Pearson Correlations Between OMMP Factors and Other Assessed Variables
Mental Pain Experience Factors

Variables 1 2 3 4 5 6 7 8 9

MAST factors
Attraction to Life −.56** −.58** −.11 −.35** −.27** −.26* −.22* −.04 −.43**
Attraction to Death .56** .41** .17 .26* .25* .24* .23* .02 .29*
Repulsion by Life .49** .51** .19 .51** .31** .38** .22* .13 .39**
Repulsion by Death .04 −.11 −.10 −.14 −.10 −.11 −.11 −.07 −.04
Affective Measures
Hopelessness .56** .55** .27** .42** .28** .40** .32** .08 .42**
Depression .59** .58** .28** .64** .35** .36** .41** .17 .41**
Anxiety .62** .49** .34** .59** .34** .34** .51** .15 .45**
Emotional Expressiveness
Expressive Confidence −.35** −.27** −.15 −.38** −.28** −.30* −.40* −.06 −.41**
Positive Expressivity −.15 −.23* −.19 −.11 −.08 −.19 −.01 −.02 .41**
Negative Expressivity .43** .29** .29** .35** .27** .23* .35** .26* .15
Inputs Intensity .18 .03 .42** .37** .11 .10 .17 −.12 −.12
Masking .09 .19 −.13 .07 .28** −.10 −.11 .03 .12

Note. *p < .05; **p < .01

1 = Irreversibility; 2 = Loss of control; 3 = Narcissist wounds; 4 = Emotional flooding; 5 = Freez-
ing; 6 = Self-estrangement; 7 = Confusion; 8 = Social distancing; 9 = Emptiness.

on the one hand, and the OMMP factors of
irreversibility (.54), loss of control (.35), and
emptiness (.37), on the other. Importantly,
these three OMMP factors were found to
have a unique contribution to the differentia-
tion between suicidal and nonsuicidal groups.
The Intervening Role of Hopelessness, De-
pression, and Anxiety. We have also exam-
ined the associations between mental pain
experience and scores of hopelessness, de-
pression, and anxiety as well as the extent to
which these scores could explain the associ-
ation between the OMMP factors and sui-
cidality. As can be seen in Table 2, Pearson
correlations yielded significant associations
between hopelessness, depression, and anxi-
ety, on the one hand, and most of the
OMMP factors (with the exception of the so-
cial distancing factor), on the other. Impor-
tantly, similar significant associations were
also found when Pearson correlations were
computed separately in each study group. A
canonical correlation yielded a significant ca-
nonical function, F(27, 302) = 2.67, p < .01.
This function was defined by the contribu-
tions of the depression and anxiety scores
(standardized canonical coefficients of .54
and .45) and the OMMP factors of irrevers-
ibility (.58), loss of control (.43), emotional
flooding (.38), and freezing (.36).
The addition of hopelessness, depres-
sion, and anxiety scores to the OMMP fac-
tors within the discriminant analysis of the
three study groups weakened the unique con-
tributions of the OMMP factors of irrevers-
ibility and loss of control (standard discrimi-
nant coefficients of .17 and .01), but did not
affect the unique contribution of the empti-
ness factor (.36). That is, the OMMP factor
of emptiness still made a unique contribution
to the differentiation of suicidal and nonsui-
cidal groups beyond the contribution of hope-
lessness, depression, and anxiety. Parallel
findings were observed when hopelessness,
depression, and anxiety scores were added to
the nine OMMP factors in the canonical cor-
relation with the four MAST factors. Again,
the unique contributions of most of the
OMMP factors were low (standardized ca-
nonical coefficients ranging from .01 to .12),
ORBACH ET AL.
with the only exception of the emptiness
factor (.38). Again, the OMMP factor of
emptiness still made a unique contribution to
MAST suicidal tendencies beyond the con-
tribution of hopelessness, depression, and
anxiety.
The Intervening Role of Emotional Ex-
pressiveness. Finally, we examined the associ-
ations between mental pain experience and
the five emotional expressiveness factors as
well as the extent to which these factors
could explain the association between the
OMMP factors and suicidality. Pearson cor-
relations between the nine OMMP factors
and the five expressiveness factors (expressive
confidence, positive expressiveness, negative
expressiveness, inputs intensity, and masking)
revealed the following significant associations
(see Table 2): (a) expressive confidence was
inversely associated with most of the OMMP
factors, with the exception of the narcissist
wounds and social distancing factors; (b) pos-
itive expressiveness was inversely associated
only with the OMMP factors of loss of con-
trol and emptiness; (c) negative expressive-
ness was positively associated with most of
the OMMP factors, with the exception of the
emptiness factor; (d) inputs intensity was
positively associated with the OMMP factors
of narcissist wounds and emotional flooding;
and (e) masking was positively associated
only with the OMMP factor of freezing. Im-
portantly, these significant associations were
also found when Pearson correlations were
computed separately in each study group. A
canonical correlation yielded two significant
canonical functions, F(45, 283) = 4.01, p <
.01; F(36, 215) = 2.73, p < .01. The first func-
tion was defined by the contributions of the
expressiveness confidence and negative ex-
pressiveness scores (standardized canonical
coefficients of −.43 and .39) and the OMMP
factors of irreversibility (.48) and confusion
(.40). The second function was defined by the
contributions of input intensity (.54) and the
OMMP factor of narcissist wounds (.48) and
emotional flooding (.35).
The addition of the five emotional ex-
pressiveness scores to the nine OMMP fac-
tors within the discriminant analysis of the
237
three study groups did not affect the original
unique contributions of the OMMP factors.
In this analysis, the OMMP factors of irre-
versibility, loss of control, and emptiness still
made a unique contribution to the differen-
tiation of suicidal and nonsuicidal groups
beyond the contribution of emotional expres-
siveness (standardized discriminant coeffi-
cients of .37, .35, and .36, respectively). Par-
allel findings were observed when the five
emotional expressiveness scores were added
to the nine OMMP factors in the canonical
correlation with the four MAST factors.
Again, the OMMP factors of irreversibility,
loss of control, and emptiness still made
unique contributions to the variance of the
MAST factors beyond the contribution of
emotional expressiveness (standardized ca-
nonical coefficients of .43, .36, and .36, re-
spectively).
STUDY 2
Method
Participants. The sample consisted of
98 Israeli students from Bar-Ilan University
(75 women and 23 men, ranging in age from
19 to 39, Mdn = 22), who volunteered to par-
ticipate in the study without any monetary
reward.
Instruments and Procedure. The study
was conducted on an individual basis and
participants were asked to complete a set of
questionnaires tapping mental pain, opti-
mism, and meaning of life. The order of the
questionnaires was randomized across partic-
ipants.
Mental pain was assessed by the OMMP
(see Study 1). In the present study the partic-
ipants were not considered to be in a present
crisis. Therefore, they were asked to respond
not to mental pain at the present time, but at
its worst. Cronbach alpha coefficients for the
OMMP factors ranged between .77 and .92.
On this basis, we computed nine factor scores
by averaging items that belonged to a factor
(see Table 1).
Optimism was assessed by the Life Ori-
238 MENTAL PAIN, SUICIDALITY AND LIFE MEANING

entation Test (LOT-R; Scheier, Carver, & nificantly and inversely associated with most
Bridges, 1994). The scale consists of 10 items of the OMMP factors, with the exceptions of
that are scored on a 5-point scale from 1 narcissist wounds and social distancing. The
(strongly disagree) to 5 (strongly agree). The higher a person’s optimism and life regard,
scale consists of six optimism items (e.g., “In the lower his or her scores on the OMMP
uncertain times, I usually expect the best”) factors. Although these associations were sig-
and four fillers (e.g., “It’s easy for me to re- nificant, the OMMP factors were associated
lax”). Scheier et al. (1994) report satisfactory to a relatively low to moderate degree with
psychometric data. Cronbach alpha coeffi- both optimism (rs between −.23 to −.35,
cient for optimism was also adequate (.77), Mdn = −.28) and life regard (rs between −.21
allowing us to complete a total optimism score to −.32, Mdn = .29). This finding implies that
by averaging the optimism items. the OMMP factors had a unique variance be-
Commitment to values (meaning) was yond their associations with optimism and
measured by means of the Batista and Al- life regard. A canonical correlation between
mond Life Regard Scale. It consists of 28 the nine OMMP factors and the optimism
items with a 5-point rating for each item. and life regard scores yielded a single signifi-
The following are some examples for the cant multivariate function, F(18, 174) = 2.03,
items used: “I am completely clear about the p < .05. This function was defined by the con-
goals of my life,” and “There are some goals tributions of optimism and life regard scores
in my life to which I devote myself com- (standardized canonical coefficient of −.54
pletely.” Batista and Almond (1973) report a and −.56) and the OMMP factors of irrevers-
satisfactory test-retest reliability of r = .94. ibility (.40), freezing (.45), self-estrangement
This scale was highly correlated with several (.39), and emptiness (.37). Thus, optimism as
similar scales that measure meaning of life. a coping strategy and meaning as a represen-
tation of life perspective and lifestyle have a
Results mitigating effect on mental pain coming
from life’s adversities.
Table 3 presents Pearson correlations
between the OMMP factors and measures of
optimism and life regard. As can be seen GENERAL DISCUSSION
from the table, Pearson correlations indi-
cated that optimism and life regard were sig- The findings of the present studies con-
firm the hypothesis regarding the positive re-
lationship between mental pain and suicidal-
ity on the one hand (Study 1), and a negative
TABLE 3 relationship between mental pain and life re-
Pearson Correlations Between OMMP Factors gard and optimism on the other (Study 2).
and Scores of Optimism and Life Regard Consistent with our first hypothesis, in seven
OMMP factors Optimism Life Regard
of its nine factors, OMMP differentiated be-
tween suicidal inpatients and both nonsui-
Irreversibility −.35** −.28** cidal inpatients and normal controls. Consis-
Loss of Control −.26* −.29** tent with our second hypothesis, the negative
Narcissist Wounds −.15 −.01 associations of seven out of nine scales of the
Emotional Flooding −.31** −.21* OMMP and optimism and life regard sup-
Freezing −.35** −.32** port Frankl’s (1963) definition of mental pain
Self-estrangement −.28** −.29** as lack of meaning.
Confusion −.23* −.27*
In Study 1, the pain factors of irrevers-
Social Distancing −.01 −.12
Emptiness −.33** −.29**
ibility, loss of control, and emptiness dis-
criminated between suicidal and nonsuicidal
Note. *p < .05; **p < .01 participants, but only emptiness remained a
ORBACH ET AL.
significant factor when hopelessness, depres-
sion, and anxiety were partialed out. Similar
but not identical findings were found regard-
ing the association between mental pain and
the other variables, including suicidal tend-
encies. This suggests that the OMMP factors
can discriminate between suicidal and non-
suicidal participants along with other impor-
tant variables related to suicide (hopelessness,
depression, anxiety, and suicidal tendencies),
though the unique contribution of OMMP
to this discrimination becomes limited to the
factor of emptiness only, when including the
other variables in the discrimination analysis.
Indeed, it seems likely that the experience of
emptiness, of loss of meaning, and of lack of
future-directedness is a driving force behind
the attempts of some individuals to attempt
to put an end to their suffering. Moreover,
the negative correlations between optimism
and life-meaning provide further support for
this direction.
The findings of this study indicate that
the associations between some of the OMMP
factors and suicidal tendencies, hopelessness,
depression, anxiety, and emotional expressiv-
ity are significant, but range between low to
moderate correlations. Taken together with
our previous findings regarding the relation
between mental pain and measures of depres-
sion and anxiety, these data suggest that,
although mental pain is related to the associ-
ated measures of emotional distress and emo-
tional expressivity, it does not overlap with
these concepts. Moreover, mental pain seems
to allow a window into the suffering of sui-
cidal patients over and above that provided
by the distress measures (anxiety, depression,
and hopelessness). Put differently, the con-
struct of mental pain appears to provide a
broader insight into the experience of sui-
cidal individuals than the standard distress
measures.
A critical test for the mental pain scale
was its ability to differentiate between sui-
cidal and nonsuicidal participants. While these
groups of individuals differed significantly from
each other on most OMMP factors, only
emptiness was found to have a “purely” unique
contribution for suicide attempts over and
239
above hopelessness. Although this finding fa-
vors Frankl’s (1963) definition of mental pain
as lack of meaning, it raises questions about
the discriminative power of the rest of the
pain factors. But this finding may also be due
to some methodological shortcoming of Study
1. For example, in that study we failed to in-
clude a measure of suicidal intention. It is
possible that the inclusion of such a measure
in the analysis would have revealed that sui-
cidal individuals with serious suicidal inten-
tions are differentiated from the others over
and above hopelessness and depression along
other pain factors as well. Such an explana-
tion is consistent with Shneidman’s (1985)
contention that people who make non-seri-
ous suicide attempts suffer from bearable
mental pain, while serious suicide attempters
suffer from intense unbearable pain. Another
possible explanation is that the results of the
present data represent a variation of a par-
ticular sample and additional examinations
may reveal a stronger, unique contribution of
mental pain to suicidal behavior. Indeed, a
preliminary statistical analysis of an ongoing
study with groups of participants similar to
those of the present study showed a unique
contribution of five of the OMMP factors
over and above hopelessness and depression
(Orbach & Mikulincer, 2002).
Inconsistent with our expectations, no
subscale of mental pain differentiated between
nonsuicidal inpatients and controls in Study
1. We entertain several possible explanations
for this finding. First, it is possible that when
normal participants were asked regarding their
experience of mental pain, they may have in-
terpreted the question as referring to the in-
tensity of their mental pain at its worst rather
than at the present just as they were asked to
do. In contrast, when nonsuicidal inpatients
were requested to describe their mental pain,
they referred to their current experiences.
That is, the comparison between the two
groups may entail a comparison between a
maximal intensity experience (for the control
group) and an everyday level (for the nonsui-
cidal patient group). A clearer separation be-
tween worst levels and current levels of men-
tal pain may help clarify this issue. Second, it
240 MENTAL PAIN, SUICIDALITY AND LIFE MEANING
is possible that the lack of difference in the
experience of mental pain among the nonsui-
cidal inpatients and normal groups reflects an
effective operation of defenses of the nonsui-
cidal inpatient. Apter, Plutchik, Sevy, and
Kron (1989), for example, found that suicidal
patients employ less effective defenses than
nonsuicidal psychiatric inpatients. The more
effective defenses of the nonsuicidal inpatient
in addition to the protective characteristics of
the pathology itself (see Cameron, 1963) could
have been responsible for the observed simi-
larity in the subjective experience of pain
(though not in pathology) between the non-
suicidal inpatients and normal controls in this
study. The inclusion of a defense mechanism
test in future investigations of pathology may
help clarify this issue.
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Manuscript Received: December 26, 2001
Revision Accepted: November 22, 2002