The words someone chooses can reveal what their face is hiding.
I saw a tragic case of a young man, only 19, who killed himself.
His beaming, handsome face shone from the page.
His bereaved parents, devastated by their loss, had no idea anything was wrong. He was popular, funny, a straight-A student. And yet one morning he left his family home and never came back.
His mother simply said that he could sometimes be hard on himself and was “a bit of a worrier”.
The question is, when there seem to be no obvious signs, might there still be signs if we know what to look for?
From clear to obscure
There are, of course, obvious signs.
- Having attempted suicide before
- A history of self-harm (approximately 50% of all people who die by suicide have a history of self-harm)1
- Talking about wanting to die
- Feeling trapped in life or hopeless that anything can get better
- Withdrawing from family and friends and usual activities
- Expressing being a burden to others
- Feeling great shame and guilt
- Expressing unbearable emotional or physical pain
- Seeing no future
- Setting affairs in order (e.g., unexpectedly writing a will or giving things away)
- Taking more dangerous risks such as driving fast
- Misusing drugs and alcohol more often than usual
- Eating and sleeping more or less than usual.
But interestingly, one of the biggest obvious suicide red flags isn’t extreme low mood on its own.
Chronic, relentless impulsivity: A clinically significant red flag
Agitation is not always the first thing people associate with depression, but it can be one of the most important warning signs when it comes to suicide risk.
While depression is often linked with low energy and withdrawal, some clients experience it as intense restlessness, inner tension, and an inability to settle, sometimes referred to as ‘agitated depression’.
Research suggests that when agitation is present, the risk of suicide attempts may increase by up to 50%.2,3
The reason why agitation presents suicide risk isn’t hard to see.
Catastrophic impulsivity
From a psychological perspective, agitation is closely linked to the feeling of being trapped. Agitation can be seen as the body’s intense response to this state of emotional entrapment.
The suicidal person may not want to die in the sense of permanently ceasing to exist, but rather want to escape the suffering of continuing to live in the present moment. And yes, there is a distinction.
Suicide may occur when five minutes later it might not have. The combination of distress, urgency, and reduced inhibition makes agitation a particularly telling clinical warning sign.
Another key reason why agitation predicts suicide is that it is often associated with impulsivity, which can reduce the gap between thinking about suicide and acting on it.
Part of the therapeutic task, then, is to help gradually widen that gap. This can be done by helping the client slow down their responses through grounding techniques, emotional regulation, and the introduction of small pauses between impulse and action through techniques like urge surfing.
Helping clients to regulate impulsivity in these ways can be a crucial part of prevention.
So impulsive agitation is a short-term risk. But what of the longer-term, more subtle shifts in communication? Is there something in the way people verbally communicate that can alert us to suicide risk?
Me, myself, and I
It’s been found that written and spoken language changes substantially in the months before suicide. Specifically, language becomes much more self-referential.4
The closer a person gets to attempting suicide, the more ‘all-or-nothing’ or ‘absolutist’ their thinking becomes,5 but also the more likely they are to use more pronouns relating to the self (I, me, myself) and fewer pronouns relating to others (you, he, she, they, them).
So why the increase in personal pronouns in the suicidal?
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A classic chicken-and-egg situation – or maybe it’s a vicious circle. Pain leads to self-focus; chronic self-focus leads to painful perspective.
Chronic self-absorption, like rubbing a patch of skin over and over, will lead to pain but is also often a response to pain. Indeed, it’s been shown that rumination fuels depression, but also results from depression.6
It may seem obvious that when in pain people naturally focus more on the self. If I stub my toe it’s all going to be me, myself, and I until the pain goes away. In the throes of agony, I’m really not interested in my neighbour’s lumbago or third-world debt.
To focus off the self, we need the spare capacity to do so. And if we can, that concern for and involvement with others (as long as it’s not catastrophic worry) may protect us from suicide.
Of course, someone can be surrounded by others and still be suicidal.
“They’d be better off without me!”
It may be hard to impossible for a person contemplating suicide to genuinely appreciate the agony they are about to inflict on others by killing themselves.
The feeling that “others would be better off without me” is still about me. Others are seen as corollaries at best to the negative conclusions about the self.
The parents of the young man I mentioned were, of course, beyond devastated. He was described as kind and caring. And yet he may have assumed that his not being here would be better for everyone.
So one important question for the client who has talked of suicide is: “How would it impact others?”
But back to increased personal pronoun usage. It may be that an increase in self-focused language may happen not just before the ending of a life, but before any major change in life.
Intimations of the death of a relationship
Interestingly, it’s been found that in the three months before a relationship breakup, both people in the relationship also use more personal pronouns.7 It may even be that increased personal pronoun usage can predict relationship breakup.
The research showed that language shifted towards an I focus and away from a we and us focus. It was also found that people also used more ‘cognitive processing’ words such as wonder, think, want, realize, need, depend, decide, and reason.
Clearly when a relationship is spontaneous, natural, passionate, fulfilling, and working, then neither partner needs to be overanalyzing it.
This makes me wonder whether overanalyzing a relationship from the very beginning, insisting on continually examining and discussing the relationship, might actually be harmful to its health, as the language used begins to mirror the kind typically associated with relationship breakdown.
Just a thought.
Anyway, the typical language of pre-breakdown is analytical and more personal-pronoun heavy.
None of this is to say that people before a breakup are likely to become suicidal, but we see the greater use of personal pronouns associated with feelings of disconnect and contemplation of a major life change.
Examining personal pronouns, as I’ve done (yes, I have strange hobbies), has also surprised me in other ways. I recommend James W. Pennebaker’s The Secret Life of Pronouns: What Our Words Say About Us if this is something that interests you, too!8
Narcissism and self-absorption
Pain makes us extremely self-focused, but I’d never want to confuse this with the self-obsession of the narcissist.
Someone in pain isn’t suddenly more selfish in a narcissistic sense, even though the self becomes almost all and everything for them. Me with a freshly stubbed toe isn’t a more narcissistic me.
In fact, narcissists don’t seem to use personal pronouns significantly more than others,9 which is interesting and perhaps counterintuitive.
It might be that narcissism reflects self-focus more than explicit self-reference: individuals may avoid I to manage impressions, signal status, and maintain authority, emphasizing achievements and generalizations over introspection.
So their language may reveal ego indirectly rather than through increased personal pronoun use:
- “That project was handled brilliantly.” (implied self-credit)
- “Only a few people really understand this level of work.” (implying they are one of those few elevated people)
The focus is still on them, just less directly.
So suicidal ideation, although of course to do with the self, isn’t a manifestation of the kind of self-absorption of the narcissist (who may, after all, be expert in managing other people’s perceptions of them as more empathetic and other-focused than they genuinely are).
Some clients when they are in pain feel guilty for being so self-focused, so I like to remind them that pain, whether physical or emotional, demands self-focus.
Suicidal ideation recovery
Any recovery from suicide contemplation needs to be comprehensive of course. I’m going to write a blog with more emergency protocols for if you feel your client is actively suicidal, because that, of course, is an emergency.
We always need to prioritize ensuring that our client is as safe as we can possibly help them be, that they have support, and that other services have been informed.
But might it be the case that helping them naturally move from I, me, myself to you, we, they could, at least in part, help shift the mindset? How might we address the particular form of self-focus that a dramatic increase in personal pronouns seems to indicate?
Here are three ideas that may help with that.
One: Help them move from me to we
UK television presenter Chris Packham has described publicly how he would be dead if it weren’t for his dogs.10 How he just couldn’t break the bond he had with them and how they depended on him.
A client told me she felt like killing herself but would never do that because of what it would do to her family.
Bonds and responsibilities strengthen ties not just to others but to life itself. They tether us to existence. So ask about:
- Other people in their lives
- The welfare of those others in their life
- A community they belong to or would like to belong to.
Get them talking about we as much as me.
Of course, if someone’s in pain, we need to talk about their feelings and help them feel calmer and more hopeful as quickly as we can – but we also need to help expand their circle of context, and soon.
I say this because suicidal ideation can be viewed as a huge loss of contextual thinking.
Connection is vital because it provides that fuel of life itself: purpose and meaning.
Two: The purpose of you
Psychiatrist and survivor of Nazi concentration camps Victor Frankl wrote:
“Those who have a ‘why’ to live, can bear with almost any ‘how’.”11
A strong sense of purpose helps us negotiate life’s setbacks. Life isn’t a consumer product. In other words, it’s not just about what we get out of life but what we give to it. This sounds woefully platitudinous and is not the kind of glib sententious moralizing I’d inflict upon a suicidal client… but at the same time, it’s true.
We might gently (more gently than the lines I’ve written here!) explore what meaning the client needs to feel in life to make it worthwhile. Not just what they might get or feel they’re not getting, but what they might bring, share. Nudge them towards thinking about we more than I.
Maybe we only truly get by giving – or when we forget about getting altogether.
Rather than exploring these ideas directly, I might tell a therapeutic story such as the one about the rose in midwinter I tell in this article.
The story expands context, and personal predicament is subsumed by involvement with community and others. Again, this should never appear moralistic but rather should be gently provoked in a client as a way of connecting them back to life. Talking of which…
Three: There are those you’ve yet to meet…
In the famous Frank Capra movie It’s a Wonderful Life, George Bailey, a kind but frustrated man, feels his life has been meaningless. On Christmas Eve, overwhelmed by despair, he considers ending his life.
An angel named Clarence Odbody shows him what the world would have been like if he had never been born. George realizes how deeply he has impacted others, even in ways he could never have foreseen, and how valuable his life truly is.
The film ends with him embracing his life, family, and community with renewed gratitude.
Now as sentimental and trite as you might think that is… the angel was really helping George go from me to we. And you can be that angel for your clients.
I actually asked a depressed client to watch the movie as therapeutic homework. He told me he’d wept then thought and thought and finally started to see how his life truly “fitted in” with life around him.
I’m not saying that’s useful for everyone, but those moving towards suicide contemplation may have fallen into the feeling that they are useless and worthless.
So we might explore what their purpose might have been in the past and what it might become when they stick around.
What good have they done? What difference, however small, have they made to other people? Who would mourn their passing? If they say no one, we might talk about people they’ve yet to meet.
One guy who felt he had nothing to live for told me no one would care or even notice if he died. I relaxed him deeply in hypnosis and had him “get a sense of people from the future” whose lives he would greatly contribute to.
While we still live we still have potential, which was something I told him in trance. If someone’s past doesn’t provide them with enough raison d’être, then we can help them feel that their future does.
To summarize…
So, the more hopeless someone feels, the more personal pronouns they might use, such as me, my, myself, I, and mine. At the same time, language relating to others may decrease. Depressed people use far fewer second- and third-person pronouns, such as he, she, and they.
If you spot a large amount of personal pronoun usage in your client, it might simply be because you are asking them a lot about themselves. It’s not a definitive diagnostic tool. But this pattern might just be something to be aware of.
We’re not diagnosing anything or, heaven forbid, suggesting anything directly to our clients. These are just documented linguistic patterns that we can be aware of.
And I’m not suggesting helping someone go from me to we will cure them of suicidal ideation (although sometimes one intervention does seem to make all the difference).
Rather, I’m suggesting it might be highly useful as a part of a wider approach.
And not just for the suicidal, but for all of us.
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About Mark Tyrrell
Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses.
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Notes:
- Carroll, R., Metcalfe, C., & Gunnell, D. (2014). Hospital presenting self-harm and risk of fatal and non-fatal repetition: Systematic review and meta-analysis. PloS one, 9(2), e89944.
- Swann, A.C., Lijffijt, M., O’Brien, B., Mathew, S.J. (2020). Impulsivity and suicidal behavior. In: de Wit, H., Jentsch, J.D. (eds) Recent advances in research on impulsivity and impulsive behaviors. Springer Cham.
- Ribeiro, J. D., Huang, X., Fox, K. R., Walsh, C. G., & Linthicum, K. P. (2019). Predicting imminent suicidal thoughts and nonfatal attempts: The role of complexity. Clinical Psychological Science, 7(5), 941–957.
- Brancu, M., Jobes, D., Wagner, B. M., Greene, J. A., & Fratto, T. A. (2016). Are there linguistic markers of suicidal writing that can predict the course of treatment? A repeated measures longitudinal analysis. Archives of Suicide Research, 20(3), 438–450.
- Al-Mosaiwi, M., & Johnstone, T. (2018). In an absolute state: Elevated use of absolutist words is a marker specific to anxiety, depression, and suicidal ideation. Clinical Psychological Science, 6(4), 529–542.
- Winterman, D. (2013, October 17). Rumination: The danger of dwelling. BBC News Magazine.
- Seraj, S., Blackburn, K. G.,& Pennebaker, J. W. (2021). Language left behind on social media exposes the emotional and cognitive costs of a romantic breakup. Proceedings of the National Academy of Sciences, 118(7): e2017154118.
- Pennebaker, J. W. (2011). The secret life of pronouns: What our words say about us. Bloomsbury Publishing.
- Carey, A. L., Brucks, M. S., Küfner, A. C. P., Holtzman, N. S., große Deters, F., Back, M. D., Donnellan, M. B., Pennebaker, J. W., & Mehl, M. R. (2015). Narcissism and the use of personal pronouns revisited. Journal of Personality and Social Psychology, 109(3): e1–e15.
- The i paper [@theipaper]. (2025, October 26). “Chris Packham has said he would not be alive today if not for his pet dogs, who were the ‘only …” [Photo]. Instagram.
- See: Frankl, V. E. (2006). Man’s search for meaning. Beacon Press. (Original work published 1946).
