Suicide and Life-Threatening Behavior 40(2) April 2010 181

 2010 The American Association of Suicidology

The Internal Suicide Debate Hypothesis:

Exploring the Life versus Death Struggle
Keith M. Harris, PhD, John P. McLean, PhD, Jeanie Sheffield, PhD,
and David Jobes, PhD, ABPP

Researchers and theorists (e.g., Shneidman, Stengel, Kovacs, and Beck)

hyothesized that suicidal people engage in an internal debate, or struggle, over
whether to live or die, but few studies have tested its tenability. This study intro-
duces direct assessment of a suicidal debate, revealing new aspects of suicidal ide-
ation. Results, from an online survey (N = 1,016), showed nearly all suicide-risk
respondents engaged in the debate. In addition, debate frequency accounted for
54% of the variance in suicidality scores, and showed significant associations with
other indicators of suicide risk. Likely factors of the debate, reasons for living and
dying, showed significant differences by suicidality, and most suicide-risk partici-
pants reported going online for such purposes, demonstrating a behavioral com-
ponent of the debate.

The internal suicide debate hypothesis en-
capsulates a belief that suicidal individuals,
cognitively constricted though they may be,
are sometimes embroiled in an internal
struggle over whether to live or die. The hy-
pothesis incorporates ambivalence toward life
and death with a unique human attribute—
deliberation. Although Kovacs and Beck
(1977) initiated empirical study of the hy-
pothesis over three decades ago, there have
been few researchers since who have ex-
plored this aspect of the suicidal mind. In this
study, we bring forward new evidence for the
Keith Harris is Lecutrer of Psychology at
James Cook University; John McLean is Associ-
ate Professor of Psychology at The University of
Queensland, Australia; Jeanie Sheffield is a Post-
doctoral Research Fellow at The University of
Queensland, Australia; and David Jobes is Profes-
sor of Psychology and Co-Director of Clinical
Training at The Catholic University of Ameria.
Address correspondence to Keith Harris,
Department of Psychology, James Cook Univer-
sity Australia, Singapore Campus, 600 Upper Thom-
son Rd. Singapore 574421. E-mail: keith.harris@
jcu.edu.sg
hypothesis, and present characteristics of
what are likely to be the opposing sides; that
is, reasons for living (RFL) versus reasons for
dying (RFD) ( Jobes & Mann, 1999).
Shneidman (1964), based on observa-
tions of suicidal patients and suicide notes,
described the ambivalent thoughts and feel-
ings he encountered as an internal debate, a
“continuum of vitality-of-consciousness, rang-
ing between cessation and ardent living” (p.
98). Similarly, in his chapter “For and
Against Self-Destruction,” Stengel (1964, pp.
85–88) discussed how the opposing sides of
self destruction and survival can coexist in
the suicidal person, but to differing degrees.
Neuringer and Lettieri (1971) further pro-
posed that while suicidal individuals were
more death than life oriented, they still re-
tained a paradoxical drive toward life. Indeed,
it can be argued that indecision—ambiva-
lence—on whether to live versus die may be
the most defining feature of the suicidal
mind. In The Encyclopedia of Suicide, Evans
and Farberow (1988) refer to ambivalence as
“perhaps the single most important psycho-
logical concept in our understanding suicide”
182
(p. 12). Shneidman’s (1996) ten commonali-
ties of suicide include “the common purpose
is to seek a solution,” and “the common cog-
nitive state is ambivalence” (pp. 131–133).
These two commonalities help to define the
debate, and suicidality in general, as an am-
bivalent struggle for a solution to seemingly
insurmountable problems. These earlier ob-
servations have been well supported, if indi-
rectly, by research findings on aborted suicide
attempts (e.g., Barber, Marzuk, Leon, & Por-
tera, 1998; Marzuk, Tardiff, Leon, Portera,
& Weiner, 1997). Also, studies on attempters
have demonstrated that many did not fully
expect to live or die due to their most recent
attempt (e.g., Freedenthal, 2007; Hjelme-
land, Stiles, Bille-Brahe, Ostamo, Renberg,
& Wasserman, 1998; Rudd, Joiner, & Rajab,
1996).
Many authors have described suicidal
individuals as limited in cognitive and ratio-
nal abilities. If suicidal people are cognitively
impaired by tunnel vision, that may prevent
them from engaging in a rational decision-
making process, such as an internal life versus
death debate. As part of his ten commonali-
ties of suicide, Shneidman (1996) stated that
“the common perceptual state of suicide is
constriction“ (p. 133). Neuringer and Let-
tieri (1971) found suicidal females were char-
acterized by their dichotomous thinking;
while Weishaar and Beck (1990) found sup-
port for suicidal individuals’ tendencies to-
ward cognitive rigidity and problem-solving
deficits. More recently, in a clinical sample,
those with a history of suicidal behavior
scored significantly lower than controls on
the Iowa Gambling Task, leading the authors
to conclude that impaired decision making
may be a suicide risk factor ( Jollant et al.,
2005).
If most suicidal individuals enter a
state of tunnel vision, or cognitive constric-
tion, is an internal suicide debate possible?
There are at least two conditions in which a
debate might occur. Before becoming acutely
suicidal, a person might, with some degree of
rationality, debate whether their life is worth
living or not. An internal debate could be
part of early suicidal ideation, a stage where
The Internal Suicide Debate Hypothesis
death by suicide first becomes an acceptable
choice. This specific type of suicidal ideation
may be a pivot point, where a person takes
their first suicidal step by thinking seriously
about suicide and allowing for the possibility
of a fatal outcome. Afterwards, whether sec-
onds or years later, he or she may become
(more) cognitively constricted and attempt
suicide. A second scenario for an internal sui-
cide debate is possible if we acknowledge that
cognitive constriction is not itself dichoto-
mous, and that there is a spectrum of cogni-
tive limitations. A range of constriction could
allow for some, albeit limited, rational thought
for those less cognitively impaired.
The hypotheses and findings above
help to encourage thoughtful discussion on
ambivalence and the debate; however, empir-
ical studies are needed to examine the nature
of the debate and its importance to suicidol-
ogy. Kovacs and Beck (1977) determined that
50% of patients hospitalized for suicide at-
tempts experienced an internal suicide de-
bate, based on discrepancies in wish to live
(WTL) and wish to die (WTD) scores. Later
research (Brown, Steer, Henriques, & Beck,
2005) on a large sample of outpatients con-
firmed that the interplay between WTL and
WTD posed a significant risk factor for
eventual suicide, even controlling for history
of attempts, psychiatric illness, hospitaliza-
tion, and demographics. If people do debate
within themselves to live or to die, there
must be factors they consider as weights for
life and for death. Linehan, Goodstein, Niel-
sen, and Chiles (1983) introduced the Rea-
sons for Living Inventory (RFLI) as a means
of assessing reasons for not committing sui-
cide. Total RFLI scores and the subscales
survival and coping beliefs, responsibility to
family, child-related concerns, and moral ob-
jections to suicide have been found to be sig-
nificantly higher for nonsuicidal respondents
compared with suicidal counterparts (e.g.,
Dean & Range, 1999; Hirsch & Ellis, 1996;
Malone, Oquendo, Haas, Ellis, Li, & Mann,
2000; Muehlenkamp & Gutierrez, 2007;
Osman, Gifford, Jones, Lickiss, Osman, &
Wenzel, 1993; Range & Penton, 1994).
While the RFLI has demonstrated sta-
Harris et al.
tistically significant differences between sui-
cide-risk and nonsuicidal groups, the differ-
ences are not always consistent by sex
(Hirsch & Ellis, 1996; Linehan et al., 1983),
age (Miller, Segal, & Coolidge, 2001), cul-
ture (Dobrov & Thorell, 2004; Oquendo et
al., 2005), and sexuality (Hirsch & Ellis,
1998). Despite these limitations, assessment
of RFL remains a potentially valuable area
for prevention and therapy; however, more
research is required to understand how spe-
cific RFL fit into the array of suicide risk and
protective factors.
Gutierrez, Osman, Kopper, Barrios,
and Bagge (2000) used the RFLI and other
established measures to predict suicidality,
as assessed by Linehan’s Suicide Behaviors
Questionnaire (SBQ; Linehan & Nielsen,
1981). Gutierrez et al. (2000) found that two
distinct facets, protective and risk factors,
were related to suicidality. However, research
comparing the utility of these polar opposites
has shown risk factors (e.g., hopelessness, sui-
cidal ideation, and repulsion by life) remain
the better predictors of suicide risk (e.g.,
Dean & Range, 1999; Gutierrez, Osman,
Kopper, & Barrios, 2000). Therefore, while
RFL remain important, it appears more per-
tinent for suicidologists to assess the factors
inherent in the suicidal person’s attraction to
death.
Work by Jobes and Mann ( Jobes,
2006; Jobes & Mann, 1999; Mann, 2002) has
brought forward a much needed assessment
of reasons both for living and for dying. In
her study of these constructs, Mann (2002)
found significant differences between suicidal
and nonsuicidal individuals. Specifically, sui-
cidal university patients who expressed gen-
eral feelings of hopefulness, in contrast to
specific requirements for a hopeful future,
were more likely to resolve their suicidal be-
haviors. Additionally, Jobes and Mann (1999)
found suicidal participants tended to endorse
their self, escape, and other people as RFD.
Jobes’ inclusion of RFD along with RFL rep-
resents an important step forward in the sys-
tematic evaluation of suicide risk and protec-
tive factors. However, further work is required
to normalize these constructs, such as includ-
183
ing nonsuicidal individuals and a broader age
range.
The current study was designed to fur-
ther explore the internal suicide debate hy-
pothesis, as well as other unique facets of sui-
cidal ideation and behaviors. Rather than
infer through circuitous means that a debate
had occurred, we decided to ask in a straight-
forward manner—both suicidal and nonsui-
cidal individuals—if they had ever engaged
in an internal suicide debate. It was hypothe-
sized that a majority of suicidal participants
would indicate experience with the debate.
Demonstrating unique characteristics of the
debate, RFD and RFL were hypothesized to
show significant differences between suicidal
and nonsuicidal respondents. Frequency of
the debate was also examined as it related to
other indicators of suicidality, such as the
wish to live and die, as well as depressive
symptoms.
METHOD
Participants
Ethics clearance was obtained from the
School of Psychology, University of Queens-
land, Australia. Volunteer participants from
40 countries were solicited through an anon-
ymous online survey (N = 1,016). To attract
suicide-risk participants, we promoted the
survey online as a study on the Internet and
suicide. The survey (described in more detail
in: Harris, McLean, & Sheffield, 2007) was
advertised through Google, online forums,
and distributed through university networks.
Participants were aged 18–76, (M = 30.37,
SD = 10.54); 62.3% were female; 75.4% had
a university degree; and 82.2% were Cauca-
sian and 11.7% were Asian. A total of 6.7%
stated a history of psychiatric institutionaliza-
tion, and 25.9% volunteered a history of psy-
chiatric diagnosis.
Materials and Instruments
Internal Suicide Debate and Current Life-
Death Orientation. The debate question, de-
vised for this study to determine the presence
184
and frequency of internal suicidal debates,
asked “Have you ever had an internal debate
(in your head) about whether to live or die?”
(1 = Never, 7 = Frequently). Prior to the on-
line survey, a pilot test (N = 17) included dis-
cussions with a multicultural group of univer-
sity undergraduates on their comprehension of
the debate question. No problems with inter-
pretation of meaning were found. To assess
current life-death orientation, participants
were asked to respond to questions on their
current wishes to live and die (Brown et al.,
2005; Kovacs & Beck, 1977); that is, “Right
now, I wish to live (or die) to the following
extent” (1 = Not at all, 10 = Very much).
Reasons for Living and Dying. These
items are part of the Suicide Status Form
( Jobes, 2006). Respondents are instructed to
type in up to five RFL and RFD and to rank-
order them by importance. To elicit examples
of behavioral aspects of the debate, partici-
pants were asked “Have you ever gone online
to look for, or confirm, your reasons for liv-
ing (also dying)?” (1 = Never, 7 = Frequently).
Suicide Behaviors Questionnaire–Revised
(SBQ-R). The SBQ-R (Osman, Bagge, Gu-
tierrez, Konick, Kopper, & Barrios, 2001)
was chosen to explore relationships among
the debate, RFL, RFD, and suicidality. It is a
4-item measure assessing current and lifetime
suicidality. The four items assess history of
suicidal behavior (History), suicidal ideation
over the past year (Ideation), disclosing sui-
cidal plans (Disclose), and possibility of fu-
ture suicide (Predict). Item scores are summed,
with higher scores reflecting more severe sui-
cidality (Total). Osman et al. found that a
cutoff total score of seven for community
samples and eight for clinical samples pro-
vided good sensitivity and specificity for dif-
ferentiating suicidal and nonsuicidal groups.
As respondents may indicate more severe
symptoms on computer-administered scales
than offline (e.g., Beck, Steer, & Ranieri,
1988; Joinson, 2007), the more stringent cut-
off score of eight was adopted for this study.
Adequate to moderately high internal reli-
ability has been reported for community and
clinical samples (Osman et al., 2001). For the
current study, Cronbach’s α = .83.
The Internal Suicide Debate Hypothesis
Center for Epidemiologic Studies Short
Depression Scale (CES-D 10). The CES-D
10 (Andresen, Malmgren, Carter, & Patrick,
1994) was chosen to examine relationships
between depressive symptoms and suicidality
measures. This 10-item version of the origi-
nal 20-item CES-D assesses depressive symp-
toms in the general population by examining
the endurance and intensity of depressive
symptoms over the past week. Items are
scored on a 4-point Likert scale (0 = rarely or
none of the time [less than 1 day] to 3 = all of the
time [5–7 days]). Higher scale totals indicate
greater depressive symptoms. Andresen et al.
found the CES-D 10 to have adequate con-
vergent validity, internal consistency, and
test-retest reliability. For the current study,
Cronbach’s α = .90.
Procedure
After a screening item on age, anony-
mous respondents were asked to complete
the above scales and respond to questions
concerning suicidality, Internet usage, and
demographics. The final page included infor-
mation on help for suicidal and other per-
sonal problems.
RESULTS
We followed recommendations by Ta-
bachnick and Fidell (2007) to cleanse the data
set and insure the overall integrity of the
data. Various univariate and multivariate out-
lier adjustments were necessary and there was
an overall reduction of the sample from
1,058 to 1,016 complete surveys. To better
explore key variable relationships by suicidal-
ity, two extreme groups were formed by
meeting criteria assessing lifetime prevalence
of suicidality and current life-death orienta-
tion. Groups were formed based on Osman
et al.’s (2001) research, mentioned above, and
Brown et al.’s (2005) study, which found a
combined WTL/WTD score to be a unique
risk factor for suicide. Respondents were cat-
egorized as not suicidal by meeting the follow-
ing criteria: minimum score on SBQ-RTotal,
Harris et al. 185

WTL = 10, and WTD = 1 (n = 192). Re-
spondents were grouped as high suicidal by
meeting the following criteria: SBQ-RTotal ≥
8; and WTD ≥ WTL (n = 101).
Pearson’s chi-squares were conducted to
test for differences between the not suicidal
and high suicidal groups on sex and ethnicity.
Only ethnicity showed a significant difference
(at p < .05), with non-Caucasians overrepre-
sented in the not suicidal group (24.9%) com-
pared to the suicidal group (14.9%), χ2(1, N =
290) = 3.93, p = .047, Cramer’s V = .12. A
one-way ANOVA showed no group differ-
ences on age, p = .44.
Pearson correlation coefficients, con-
trolling for sex, were calculated for the full
sample to examine the relationships among
debate, WTL, WTD, and SBQ-RTotal scores.
The results showed that self-reported debate
is significantly and positively correlated with
all measures of suicidality, and negatively
with WTL, while WTL and WTD are sig-
nificantly negatively correlated with each
other (Table 1). Also of interest are the on-
line RFL and RFD items, both significantly
positively correlated with suicidality, indicat-
ing that going online for RFD and RFL are
both suicidal behaviors.
Of the total sample (N = 1,016), 66.5%
indicated some experience with the RFL ver-
sus RFD debate (M = 2.64, SD = 1.78). Ex-
amining this item by degree of suicidality, we
found that 22.4% of the not suicidal (M =
1.30, SD = 0.66) and 94.1% of high suicidal
(M = 5.51, SD = 1.67) participants indicated
engaging in a debate, while a considerable
37.6% of the high suicidal participants re-
ported frequently engaging in a life-death
debate. To examine further relationships with
the debate item, two hierarchical multiple re-
gressions were run with SBQ-RTotal scores as
the dependent (criterion) variable. Hierarchi-
cal multiple regression is recommended for
testing how much additional variance, in the
criterion, can be explained by the inclusion
of new predictor variables (Petrocelli, 2003).
In this case, due to its specificity to suicidal
ideation, it was hypothesized that an internal
suicide debate would be more relevant to sui-
cide risk than depressive symptoms, WTL,
or WTD. When conducting hierarchical re-
gressions, variables are entered in order of
causality or relevance (Cohen, Cohen, West,
& Aiken, 2003). Depression covers a number
of types of related disorders and is not spe-
cific to suicidality (e.g., Joiner, Walker, Pettit,
Perez, & Cukrowicz, 2005). Wishes to live
and die are more likely than depressive symp-
toms to be relevant to suicide risk but are
vague, and even a strong WTD may not in-
clude suicidal plans or other risky behaviors.
In contrast, if we consider causality, depres-

TABLE 1
Interrelationships Between Suicidality and Key Variables (Controlling for Sex)
Correlation coefficients*

Variable Debate CES-D WTD WTL SBQ-RH SBQ-RI SBQ-RD SBQ-RP SBQ-RT

Debate — .51 .55 −.55 .67 .61 .45 .53 .69

CES-D .51 — .59 −.59 .46 .56 .34 .38 .50
WTD .55 .59 — −.80 .52 .65 .38 .49 .57
WTL −.55 −.59 −.80 — −.51 −.62 −.34 −.49 −.56
e-RFL .38 .35 .38 −.35 .29 .33 .20 .25 .30
e-RFD .46 .45 .53 −.48 .38 .46 .32 .35 .40

Note. N = 1,009 (7 cases were omitted due to missing data on sex). Debate = internal suicide de-
bate; CES-D = Center for Epidemiologic Studies short Depression scale; WTD = Wish to Die; WTL =
Wish to Live; e-RFL = going online for reasons for living; e-RFD = going online for reasons for dying;
SBQ-R = Suicidal Behaviors Questionnaire–Revised (H = history, I = ideation, D = disclose, P = predict,
T = total); *p < .0001 (all correlations).
186 The Internal Suicide Debate Hypothesis

sive symptoms are likely to precede current
wishes to live and die, as well as the begin-
ning of a suicide debate. Therefore, a causal
model would place depressive symptoms first,
followed by WTL (WTL should be more
natural, instinctive, than WTD), WTD, then
debate. In the first model (causal), depressive
symptoms explain 25% of the variation in
suicidality scores, while WTL adds a further
11%, WTD 2%, and debate an additional
16% to the variance explained by the preced-
ing variables (Table 2). Together, these four
variables explain 54% of the variance in
SBQ-RTotal scores. In the second model (rele-
vance), debate alone accounts for 48% of
SBQ-RTotal variance, WTD adds an addi-
tional 5%, while depressive symptoms and
WTL contribute very little. These analyses
highlight the importance, and particularly
the relevance, of the debate item to suicide
risk.
RFL and RFD Responses
Participants entered 3,787 RFL and
2,394 RFD. Responses were categorized ac-
cording to Jobes’ (2006) coding manual, with
the exception of two new RFL categories,
fear and none, and one new RFD category,
none. Fear includes any mention of fear of
suicide, or death, or their consequences. The
none responses were nearly always listed as
the first and only response and clearly indi-
cated no compelling reason to live, or die.
RFL and RFD responses were evaluated by
two trained coders, with high inter-rater reli-
ability (RFL κ = .83; RFD κ = .81). Ques-
tionable responses and disagreements in cod-
ing were finalized by discussion and consensus.
When response quantity was com-
pared by degree of suicidality, not suicidal re-
spondents were found to have produced sig-
nificantly more RFL (M = 3.58, SD = 1.68)
than high suicidal respondents (M = 2.97, SD =
1.68), t(291) = 4.39, p < .001, while high sui-
cidal participants produced significantly more
RFD (M = 3.58, SD = 1.61) than not suicidal
participants (M = 1.24, SD = 1.53), t(291) =
18.03, p < .001. Of importance to life versus
death orientation, the high suicidal group’s
number of RFD responses was significantly
greater than their RFL quantity, while the
not suicidal group’s number of RFL re-
sponses was significantly greater than their
RFD output (all p < .001).
First-ranked RFL and RFD were cho-
sen, due to their obvious importance and
higher completion levels, for inter-group
comparisons. Chi-square analyses were first
conducted to determine if there were any dif-

TABLE 2
Hierarchical Regression Models Predicting Suicidality Scores (SBQ-RTotal)
Model, Step, and Predictor Variable R2 ∆R 2 ∆F df

Model 1 (causal priority)

1. CES-D 10 .25 .25 337.64** (1, 1014)
2. Wish to live (WTL) .36 .11 167.62** (1, 1013)
3. Wish to die (WTD) .38 .02 37.74** (1, 1012)
4. Debate .54 .16 553.78** (1, 1011)
Model 2 (relevance priority)
1. Debate .48 .48 936.49** (1, 1014)
2. Wish to die (WTD) .53 .05 106.93** (1, 1013)
3. CES-D 10 .54 .01 14.62** (1, 1013)
4. Wish to live (WTL) .54 .004 8.45* (1, 1011)

Note. SBQ-R = Suicidal Behaviors Questionnaire–Revised; ∆R 2 =

change in R 2; ∆F = change in F; CES-D 10 = Center for Epidemiologic
Studies short Depression scale; Debate = internal suicide debate; *p < .01,
**p < .001.
Harris et al.
ferences on RFL by sex, age, or ethnicity.
There were no significant differences by sex,
χ2(9, N = 941) = 13.23, p = .15; but there
were significant differences by age, χ2(9, N =
949) = 23.34, p = .005, Cramer’s V = .16, and
between Asians and Caucasians, χ2(9, N =
884) = 33.44, p < .001, Cramer’s V = .19.
Younger participants more often reported
burdening others, friends, and future plans as
RFL, while older respondents more often in-
dicated family as RFL. Caucasians more of-
ten listed burdening others, enjoyment,
friends, hopefulness, and fear as RFL, while
Asian participants were more likely to report
responsibility, plans, and beliefs.
Chi-square tests were conducted to
determine if participants’ choices for RFL
differed by level of suicidality. The not sui-
cidal group was found to significantly differ
from the high suicidal group, χ2(9, N = 273) =
46.99, p < .001, Cramer’s V = .41. The im-
portance of family, beliefs, a strong self, and
enjoyable things rank strongly as possible
protective factors. In contrast, fear (of suicide
or death), fear of burdening others (by com-
pleting suicide), and responsibility appear to
be important RFL for the high suicidal
group. Also of interest is that 5.1% of the
high suicidal group indicated they had no
RFL (see Figure 1).
Chi-square tests revealed even greater
differences (based on Cramer’s V scores) be-
tween the high and not suicidal groups on
first-ranked RFD, χ2(7, N = 212) = 64.07, p <
.001, Cramer’s V = .55. The not suicidal re-
spondents were likely to indicate no RFD, or
a hopeless situation, while the high suicidal
respondents were focused on escape, hope-
lessness, and their self. Of note, the four es-
cape categories combine for 19.3% of RFD
for the not suicidal respondents, but appear
nearly twice as often (35.7%) for the high
suicidal group (see Figure 2).
Lastly, we compared the not suicidal
and high suicidal groups on their tendencies
to go online to look for, or confirm, their rea-
sons for living and dying. Not suicidal re-
spondents reported very little active online
pursuit of RFL or RFD, with only 4.7% go-
ing online for RFL and 3.1% for RFD. In
187
stark contrast, 54.5% of the high suicidal
group reported going online for RFL (24.7%
frequently), while 63.4% went online for
RFD (37.6% frequently).
DISCUSSION
In this study, anonymous Internet us-
ers were asked to report their experiences of
engaging in an internal suicide debate, their
specific reasons for living and dying, and the
intensity of their current wishes to live and
die. Support for the suicide debate hypothe-
sis was strong. We found that two-thirds of
the total sample indicated at least one occur-
rence of debating within themselves to live
or die. Further, in support of our hypothesis
that most suicidal people have engaged in an
internal suicide debate, 94.5% of the high
suicidal group indicated debate experience,
with 37.6% of these reporting often engag-
ing in the debate. In addition, significant pos-
itive correlations between the debate and sui-
cidality and WTD, and a significant negative
correlation with WTL, demonstrate the po-
tential of this one item in extrapolating sui-
cidal characteristics. While previous research
(Brown et al., 2005; Kovacs & Beck, 1977)
found evidence for the internal debate through
ambiguity in WTL and WTD scores, this is
the first study to present direct evidence for
the debate as a debate.
The debate factor correlated most
highly with respondents’ history of suicidal
behaviors and with SBQ-RTotal scores, fol-
lowed by SBQ-RIdeation. Beck and colleagues
(Beck, Brown, & Steer, 1997; Beck, Brown,
Steer, Dahlsgaard, & Grisham, 1999) found
worst point suicidal ideation to be a signifi-
cant predictor of suicide behaviors and even-
tual suicide, well beyond typical Scale for
Suicide Ideation scores. The results of this
study indicate that the debate could be an in-
dicator of serious suicidal ideation, possibly
similar to worst point ideation. Further study
is required to understand where the life ver-
sus death debate and worst points fall in the
spectrum of suicidal ideation.
To help identify some of the specifics
188 The Internal Suicide Debate Hypothesis

Figure 1. First-ranked reasons for living (RFL) by degree of suicidality

of the debate, we asked participants to pro-
vide their reasons for living and dying. Re-
spondents contributed nearly 3,800 RFL and
nearly 2,400 RFD. As hypothesized, and sup-
porting previous findings ( Jobes & Mann,
1999; Mann, 2002), chi-square analyses re-
vealed significant differences in the ways sui-
cidal and nonsuicidal people value their lives.
For RFL, family oriented, positively self-
focused, more enjoyable things (g.e., pets,
nature), and personal beliefs were character-
istics of the not suicidal group. Reports of
Harris et al. 189

Figure 2. First-ranked reasons for living (RFD) by degree of suicidality

190
burdening others, responsibility, fear of sui-
cide/death, or having no RFL emerged as
primary rationale for the high suicidal group.
In direct contrast to their RFL responses, the
high suicidal respondents were more self-
focused when stating RFD, and more likely
than not suicidal respondents to indicate a
desire for escape, while the not suicidal par-
ticipants were more likely to state having no
RFD or could not imagine a hopeless situa-
tion.
Active development of RFL and RFD
could be interpreted as engagement in at
least one side of the debate to live or die.
While less than 5% of not suicidal respon-
dents sought either RFL or RFD online,
54.5% of the high suicidal group went online
for RFL and 63.4% went online in pursuit of
RFD. These results offer additional support
for the suicide debate hypothesis, and dem-
onstrate the dynamic intentional nature of
the internal debate. Respondents also re-
ported frequently going online to look for
and confirm RFL and RFD, providing evi-
dence not only for the relevance of the de-
bate, but for the important role the Internet
is playing in the life of suicidal individuals.
Consistent with Baumeister’s (1990)
suicide as escape from self theory, self-focus
was a significant characteristic of suicidal in-
dividuals when presenting their RFD. Also,
in line with Shneidman’s (1993) theories on
psychache (or anguish) and one of his ten
commonalities of suicide (i.e., “the common
stimulus in suicide is intolerable psychologi-
cal pain”; 1996, p. 131), our research showed
escape from anguish to be more often stated
by suicidal than not suicidal respondents.
Combined, escape from anguish, escape from
responsibility, escape from the past, and a
general desire for escape accounted for
35.7% of the first-ranked RFD of the high
suicidal group. Other categories of note were
statements of hopelessness (24.5%), negative
statements of the self (21.4%), and state-
ments concerning loneliness (8.2%). Based
on these results and the writings of the theo-
rists above, highly suicidal individuals present
escape from the psychological pain of a nega-
tive self-image, a hopeless future, and termi-
The Internal Suicide Debate Hypothesis
nal loneliness as their most substantive RFD,
in a debate tilted toward death.
While this study included anonymous
responses from 1,016 respondents in 40 coun-
tries, the sample was not a random selection
of Internet users and was biased toward
higher educated, female, and (intentionally)
suicide risk netizens. However, these demo-
graphics are not unusual; Internet users gen-
erally show higher education levels than non-
users (Estabrook, Witt, & Rainie, 2007), and
the number of females online is beginning to
surpass that of males (Simpson, 2007). Al-
though the pilot study discussants indicated
no problems in comprehending the debate
item, the nature of the internal debate and
the cognitive processes involved are complex
and not easily articulated. To be of use in de-
constructing the suicidal mind, this item
would benefit from additional work specifi-
cally examining its construct validity.
This study found substantial support
for the internal suicide debate hypothesis.
Not only did nearly all high suicidal partici-
pants report engaging in the debate, a third
indicated they do so often. The debate factor
correlated significantly and positively with
items assessing suicidality, depression, and
WTD, and negatively with WTL. Also note-
worthy is that the debate item correlated
with going online for RFL and RFD, and was
more strongly associated with suicidal behav-
iors than suicidal ideation. Suicidal and non-
suicidal respondents were also found to differ
significantly on RFL, and even more strongly
on RFD.
There are several clinical and research
related implications we can draw from these
results. While maintaining a cognitive and
behavioral focus on RFL, discussing and un-
derstanding a suicidal person’s RFD can be
very useful in their treatment, as has been
pointed out by a number of practitioners
(e.g., Ellis, 2004; Jobes, 2006; Kovacs, Beck,
& Weissman, 1975; Shneidman, 1999). This
research has shown that there are important
realms of the suicidal mind left to explore.
Further ventures into this area will better de-
termine where the debate, RFL, and RFD fit
in this psychological puzzle.
Harris et al.
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Manuscript Received: April 7, 2009
Revision Accepted: July 16, 2009