Suicide: A second look; The role of psychodynamic attitude in understanding suicide and self-harm
Almost all health and disease states are the results of interplay between individual and environmental factors, and suicide is an example of the interaction of several factors including biological, psychological, cultural and social.
The psychodynamic feature of suicide is an important aspect of the assessment and treatment of these patients. Actually, suicidal ideation is the product of conscious and unconscious mental activity. Suicidal attempt is the result of intrapsychic factors that work against the physical existence of one’s being.
The contemporary psychodynamic approach to suicide comes from the early works of Freud (1917) and at present, there are different conceptualizations and understandings of suicidal behavior. Psychodynamic perspectives on suicide agree that it may be associated with a state of depression, and they also assume the narcissistic aspects of suicide. Nevertheless, the most common view held by psychodynamic therapists is that suicide is an act of aggression and the psychodynamic view postulates that if we want to understand suicide we need to consider aggression within the human psyche.
Generally, suicidal attempts or ideas happen while the patients can not contain, tolerate and understand their aggression toward themselves and others. These parts and feelings might be communicated to the therapist through projective identification. The therapist is faced with the dilemma of containing, tolerating and understanding the unconscious meanings to help patients gradually re-own their aggression.
In this symposium, with the help of clinical vignette; we will try to explore the psychodynamic mechanisms of self-harm and suicide, concentrating on how comprehension of unconscious meanings of these destructive acts against the self may help in the patients’ assessment and management.
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Bion, W. R. (1962). Learning from Experience. London: Karnac Books.
Freud, S. (1917). Mourning and melancholia. In Standard Edition, Vol. 14 (pp. 237–260). London: Hogarth Press.
Grunberger, B. (1990). Suicide of melancholics. In B. GRUNBERGER (Ed.), Narcissism: Psychoanalytic Essays. Madison: International Universities Press.
Winnicott, D. W. (1956/1992). Primary maternal preoccupation. In Through Paediatrics to Psychoanalysis. London: Karnac Books.
Mozhgan Amini, MD
Lecture 2) Suicide and self-harm as a communication
Suicidal patients often have relationships that are associated with intense symbiosis and explicit dependency needs. When a conflict occurs, the patients feel unloved and are vulnerable and easily upset. Suicidal communication might be interpreted as a cry for help.
Suicide and self-harm may be perceived as acts with unconscious meanings, communications that convey in action repressed thoughts, feelings and fantasies that cannot be allowed into consciousness or verbalized. Previous traumas including neglect or abuse of one’s body during infancy or childhood cannot be mentalized and remain trapped in the body. However, if these early memories and feelings cannot be symbolized or represented in the mind, they remain unconscious and unprocessed and will continue to be expressed in action and the body becomes the medium of communication in which a form of writing on it records the internal dynamics of relationships with self and others.
In this lecture, I intend to address the communicative aspects of suicide and self-harm, which has received less attention than other aspects.
- Yakeley, J., & Burbridge-James, W. (2018). Psychodynamic approaches to suicide and self-harm. BJPsych Advances, 24(1), 37-45.
- Wolk‐Wasserman, D. (1986). Suicidal communication of persons attempting suicide and responses of significant others. Acta Psychiatrica Scandinavica, 73(5), 481-499.
Atieh Chapari, MD
Lecture 3) The trace of narcissism in suicide
Suicide seems to be the most aggressive behavior of human being against himself that shatter the base of human existence. It is very complicated and mysterious; in one hand it results in very severe pain and on the other hand it is committed to release pain. Many Psychologists and psychiatrists have been searching for the source of unbearable pains that ends into suicidal attempt.
Narcissism is one of the most important sources of pain that many psychoanalysts like: Rosenfeld, Kernberg, Kohut, Horney, Winnicott, and others addressed it directly and indirectly as a cause of suicide. Even one can find a trace of narcissistic attitude in some of the very beautiful explanations and quotations in the literature about suicide.
In this lecture I will try to describe the pathway in which narcissism ends into suicide and also to show the trace of narcissism in suicide with the aid of clinical vignette.
- Olga Mikhailova. (2005). Suicide in psychoanalysis. Psychoanalytic social work, vol12(2):19-45
- Anthony Bateman. Narcissism and its relation to violence and suicide. Psychoanalytic understanding of violence and suicide. Rosine Jozef Perleberg,2005.
- Hand book of narcissm and narcissistic personality disorder.W. Keith Campbell, Joshua D. Miller,2011. psychoanalytic theories on narcissism and narcissistic personality.