Without question, the largest void when considering the role of mattering in suicide is at the explanatory level. Why and how do feelings of not mattering come to play a role in suicide? These questions are considered in the next segment of this chapter in an attempt to address the current void in the published literature when it comes to conceptualizing the link between feelings of not mattering and suicidal tendencies.
The vulnerability for people who are suicidal can reflect several influences and numerous developmental pathways. For instance, for some people, they may have had the misfortune of being raised in a harsh or chaotic environment and they have been exposed regularly to mistreatment that seems to be sending them the message that they don’t matter to other people. This could be the case for those who have been emotionally abused or emotionally neglected. These forms of maltreatment are linked with feelings of not mattering (see Flett et al., 2016).
Another possibility is that the vulnerable person does not seem to know her or his own worth (Do I matter?) or they suspect they have low worth (I don’t matter) but there is some uncertainty involving the self and identity, so they come to rely on external feedback from other people to determine whether they are valued and if so, how much they are valued. A similar process is involved in social comparison as young people who are uncertain about their merit come to rely on social comparison cues in making judgments of the self (see Festinger, 1954). The person who is uncertain about the self can read social cues in a way that results in forming a highly negative self-view. A negative self-view linked with feelings of not mattering would result if they have daily lives where no one seems to really notice them or listen to them, or worse yet, engaged in negative behavior that sent a message of little social worth.
When someone feels like they don’t matter, what specific elements can transform distress into suicidal tendencies? Three key elements are considered below. But one overarching premise to first consider is that some people are vulnerable, in part, because they have a temperament and life experiences that have resulted in them placing exceptional importance on the mattering to other people. It is suggested here that some people have an acute need to matter and for them, mattering to others has become immensely important. This possibility is being explored in new col-laboration with Silvia Casale and her colleagues. This importance includes a hyper-sensitivity centered around this acute need to matter that can be seen as an extreme form of the interpersonal sensitivity described by Boyce and Parker (1989). Their interpersonal sensitivity construct has elements such as interpersonal awareness, a need for approval, and a fragile inner self. Consider the interpersonally sensitive person who needs to matter too much. This person will be highly attuned and reac-tive to mattering-related events and experiences and their hypersensitivity to matter-ing and cues of not mattering can set the stage for the three elements now considered below that I propose as being central to understanding the link between feelings of not mattering and suicide.
Mattering and Unbearable Psychache It is useful when considering the association between feelings of not mattering and unbearable psychache to continue taking a person-focused perspective. Case exam-ples of suicidal people who feel like they don’t matter are exceptionally helpful in this regard and, sadly, there is no shortage of them. Countless case examples reflect-ing themes of not mattering can be identified after exhaustive searches of the litera-ture (e.g., Benson et al., 2013; Cooper, 1994; Mahammadi, 2018; Rehder et al., 2021; Schechter et al., 2022). As one example, Schechter et al. (2022) described a 48-year-old suicidal father of three children who was in such distress that he reported that he was unable to feel any sense of mattering to his wife and children nor did they seem to matter to him. He described himself as devoid of warmth and feeling exceptionally lonely and disconnected. What becomes clear when reading these accounts is that many people in the depths of despair have feelings of not mattering and ways of expressing it that are simply not being captured by existing descriptions or represented in existing conceptual models and approaches to treatment. These people seem to have an unbearable form of not mattering that is often linked inex-tricably with psychache. There is also an extreme form of thinking that seems to accompany these unbearable feelings. These themes are expressed in the case accounts of people who have been suicidal, including those people who survived a suicide attempt.
Some representative thoughts people have expressed as part of their extreme feelings of not mattering are listed in Box 4.1. The themes found here could form the basis for an automatic thoughts measure of unbearable social insignificance.
The thoughts expressed by people in clinical case accounts represent vital clues and insights into what circumstances can amplify feelings of not mattering so that they are experienced as unbearable. The thoughts shown in Box 4.1 reflecting over-generalization of feelings of not mattering both to other people (i.e., not mattering to anyone) and overgeneralization as a broad and sweeping denigration or negation of the self (i.e., I don’t matter). Thus, there is an amplified sense of worthlessness and not having value to others that seemingly has been internalized into an abject view of the self. In many instances, extreme feelings of not mattering and unbear-able insignificance will be kept hidden due to the sense of shame that arises from having failed to be someone of value to others and to oneself.
Box 4.1 Cognitive Themes of Not Mattering That Reflect Unbearable Social Insignificance
I don’t matter to anyone
I feel small and insignificant
No one cares about me
My life doesn’t matter to anyone
I am never going to matter to others
My feelings don’t matter to anyone
I don’t even matter to myself
I would not be missed by anyone if I was gone I am totally alone
Do I even exist for anyone?
Nobody sees me as necessary
Why don’t I matter to them?
I feel like a number to them/him/her
No one wants to help me
Note. Most of the specific statements above are adapted from actual state-ments of suicidal people.
The notion that feelings of not mattering are closely linked with psychache is very much in keeping with Shneidman’s views of psychache. He is credited with placing importance on psychological pain as the key component in susceptibility to suicide. Shneidman (1996) noted in his seminal book The Suicidal Mind that psy-chological pain is experienced with important psychological needs are frustrated. Shneidman was a proponent of the psychological needs theory of his mentor Henry Murray (see Murray, 1938). Shneidman did not explicitly mention the need to mat-ter, but Shneidman did list several themes similar to mattering such as the need to affiliate and be loved along with other needs such as the need to achieve, the need to avoid harm, and the need to be autonomous.
Mattering becomes relevant once it is recognized that the need to matter is a universal psychological need (for discussions, see Flett, 2018b; Rosenberg & McCullough, 1981). Moreover, for some people, especially those who are psycho-logical insecure, the need to matter should be among their most important psycho-logical needs, if not their most important need.
What does the psychological pain of not mattering to others feel like? When it is combined with unbearable pain, as suggested earlier, life and living can then seem unbearable. Elliott (2009) concluded that, “People cannot bear the realization that they make a difference to no one; the emotional pain and anxiety are literally intol-erable” (p. 41). Elliott went on to suggest when psychological pain is fuelled by feelings of not mattering, people may engage in behaviors they would otherwise not engage in as they try to distract themselves from this psychological pain.
The escalation of feelings of not mattering into unbearable feelings of not mat-tering has clear implications for the distinction between parasuicide and suicide. It may be the case that suicidal gestures are designed to gain the attention that the vulnerable person has been lacking in her or his life, and such acts are deemed to be a form of getting noticed and better understood by someone with a high level of anti-mattering or a low level of mattering to others. However, the person with unbearable feelings of psychological pain and unbearable feelings of not mattering along with unbearable feelings of loneliness is not someone who is seeking atten-tion. This person’s ultimate goal is escape and putting an end to the suffering being experienced. Thus, when there are strong and potentially unbearable feelings of not mattering being experienced, it would be ill-advised to minimize intent by seeing it as just trying to get attention. Not surprisingly, there has been no published research thus far on mattering and unbearable psychache. However, as part of her dissertation on loneliness, my daugh-ter and research colleague Alison Rose provided some key evidence and associated insights. One of her dissertation studies included the Anti-Mattering Scale (Flett et al., 2022) and the brief measure of unbearable psychache derived from the 13-item Psychache Scale created by Ronald Holden and colleagues (see Holden et al., 2001). Programmatic research with this measure has shown that is strongly linked with suicide ideation and often is more predictive than hopelessness (e.g., Montemarano et al., 2018). Research also shows that scores on the Psychache Scale longitudinally predicts changes in suicide attempt status among university students (Lambert et al., 2020). This three-item subscale tapping unbearable psychache proposed by Pachkowski et al. (2019) is comprised of the most extreme psychache items (e.g., I can’t take my pain any more. My pain is making me fall apart). It was found in a sample of 289 York University students that there was a strong positive association (r = .56) between scores on the Anti-Mattering Scale and the three-item measure of unbearable psychache (see Rose, 2024). This fits well with the previous contention that it is very psychologically painful to feel unimportant and insignificant to others. Clearly, the sense of being made to feel invisible and irrelevant can involve a deep sense of hurt and the association between anti-mattering and unbearable psycho-logical pain signifies that much of the pain in life for many people is a form of social pain rooted in unmet needs and perhaps treatment that might involve significant shame and humiliation.