Understanding Suicide
The tragedy of suicide as an act of destruction is that, for so many who kill themselves, the aggression remains largely unconscious and unknown.
Suicide, in my view, is a standalone condition which needs its own careful psychological analysis and understanding. It is in no particular way connected with conventional thinking about mental illness but bears better scrutiny in and of itself. There are common aspects to suicide but it always, or nearly always, has a meaning for the individual suicide which is theirs alone.
The suicidal person attests that life is not worth living and that death is preferable. But whilst pessimism, depression and hopelessness are important emotional states which are often present in a suicidal condition they are only half the story. If we are to understand suicide and be more effective we also have to be aware of the aggression and the violence behind suicide. The suicidal act is a violent act of killing and killing is very different from dying. Further to this is the notion of loss and thwart. It is as if the suicidal person has suffered such a loss or thwart, either actual or perceived, from which they are not willing or able to recover. In his book Missing Out, Adam Phillips talks of the difficulty we have with frustration and with change. Quoting Stanley Cavell writing about King Lear: " 'We would rather murder the world than permit it to expose us to change' ... 'We would rather destroy everything than let other people change us, so strong is our memory of how changed we were at the beginning of our lives by certain other people' " (Phillips 2012, p.10). We are always seeking ways to resist change and to refuse frustration. Thus it is as if the suicidal person resists change so much that their very lives depend on not changing. In suicide, our very death depends on refusing to change. To survive and live inevitably involves multiple grievous losses – whereas killing oneself puts an end to suffering the pain of loss and the inevitability of more loss.
In the suicidal mind, the body of the suicidal person is regarded as a separate object. Hence the aggressive feelings that are intolerable, the result of unprocessed felt or real losses, are inflicted on the individual’s body. The mind becomes divided due to this unbearable state. But the intention is to both save the self and to destroy the self! There is a delusional belief that the self will somehow survive to benefit from the death and to have the wished for outcome! Thus suicide is an act both for and against the self. As Jeremy Holmes puts it "At the suicidal moment, in order for life to be endurable, there has to be a death" (Holmes, 1996, p.149). Behind the suicide action is a fantasy that some part of the self will survive in order to achieve the satisfaction of the act. It is as if the person is in a bipartite state. There is the conscious wish to die with all the expressed reasons why death is the "only" option. But at the same time there is a less clearly stated, often quite unconscious, wish to survive. The suicidal person seems convinced that suicide is the right thing to do but at the same time they are also imagining life after the act. In a way, the suicidal person is creating their own afterlife in their mind.
The psychoanalysts Campbell and Hale describe this thus: “The suicidal fantasy always includes a dyadic relationship between a part of the self which will survive and the body which is identified with an intolerable object. Although killing the body was indeed a conscious aim, it was, in fact, a means to an end. The end was the pleasurable survival of an essential part of the self – which we will refer to as the surviving self – a self that survives in another dimension. However, this survival is dependent on the destruction of the body” (Campbell and Hale, 1991, p. 291).
In my book Out of This World: Suicide Examined (Karnac, London, 2017) I explore in detail the various common forms of suicidal fantasy, what they represent and how to identify and work with them. I examine the various forms of suicidal fantasy in order to emphasise what an important concept this is in understanding how to work with a suicidal person and how to help make conscious aspects (notably aggresion) behind their suicidal intentions. The ability to be able to think with the person about their suicidality is crucial. These ideas also help us pick up indirect clues, to confront these, to think, to work hard, to gain ground, and not be too terrified ourselves so we can continue to work with this.
The tragedy of suicide as an act of destruction is that, for so many who kill themselves, the aggression remains largely unconscious and unknown. We may see aspects of depression, psychological damage, pain, messed up lives etc, and we try to treat these and help etc. but we all too often don’t get hold of the aggression until it is too late. Suicide picks away at its victims in such a way as to exclude others and their attention. That’s part of its anatomy. The closed world of suicide. The trick, if at all possible, is to get in there, into the closed world, open it up and work through their intolerable feelings with them. This I believe is more often than not a psychotherapeutic task.
Antonia Murphy is a UKCP registered psychotherapist with over 25 years of clinical experience in the NHS, the third sector and private practice.
Antonia managed the primary care counselling service in Derbyshire, UK, from 1998 - 2006. She was a founding director, responsible for professional and training standards, of Counsellors and Psychotherapists in Primary Care (CPC). Her training portfolio includes the design and delivery of a multimodality supervision training programme; The Therapeutic Frame: Working at the Coal Face; Working with Envy. More recently she has developed her long term clinical interest in working with suicide into a training which has been delivered to over 40 universities and other settings in the UK and Australia.
She is the author of several papers on clinical aspects of psychotherapeutic practice in organisations. She is the former editor of the Journal for the Foundation of Psychotherapy and Counselling and an editorial board member of the Journal of Psychodynamic Practice. She is co-author of Psychological Therapies in Primary Care: Setting up a Managed Service (Karnac, 2004) and author of Out of This World: Suicide Examined ( Karnac 2017).
Antonia works as a psychotherapist and supervisor in private practice in Nottingham, UK.
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