Between Life and Death: Existential Care for People With a Death Wish Related to Unbearable Psychiatric Suffering

Abstract

This paper examines factors that may facilitate existential counseling or psychotherapy for persons with an enduring death wish related to unbearable psychiatric suffering (DWUPS) and explores how personalized care can be provided and conditions for change can be created. The study employed a generic descriptive–interpretative qualitative research method, analyzing 10 in-depth interviews of individuals with DWUPS. Findings indicate that counseling or psychotherapy centered on acknowledgment of the death wish and the gravity of suffering—combined with genuine involvement—can foster conditions for tentative contact with oneself, others, and death-and-life concerns. Despite ongoing, multilayered suffering, participants described moments of tentative hope, emerging meaning, and a fragile sense of the right to exist. Existential counseling or psychotherapy may support individuals with DWUPS in accepting their suffering, developing the ability to engage with their death wish, and fostering meaningful connection with others and with life itself. Through acknowledgment and presence, participants not only became more attuned to their inner and relational world but also demonstrated a cautious yet tangible ability to connect—despite the weight of their suffering. The findings highlight the value of existential presence, dignity, and attunement—moving beyond symptom management toward human encounter.