A Five‐Month Longitudinal Study of Psychache and Suicide Ideation: Replication in General and High‐Risk University Students

Shneidman's (1993) model of psychache as the cause of suicide was evaluated in a 5‐month longitudinal study of psychological pain and suicide ideation. Replicating across general (N = 683) and high‐risk undergraduates (N = 262), psychache was significantly associated with suicide ideation, and change in psychache was significantly associated with change in suicide ideation. For general suicide ideation and suicide preparation, these significant results were maintained even when depression and hopelessness were statistically controlled. This research is a unique contribution being the first large‐sample longitudinal study that evaluates and supports Shneidman's psychache causal model of suicidality in general and high‐risk groups.     

Understanding suicidal behaviour in young people referred to specialist CAMHS: a qualitative psychoanalytic clinical research project

A qualitative psychoanalytic clinical research project using a post-Kleinian contemporary approach was undertaken by a team of seven qualified and experienced child psychotherapists working in community Tier 3 Child and Adolescent Mental Health Services (CAMHS). A number of referred young people who deliberately harmed themselves or attempted suicide, who fulfilled the inclusion criteria and consented to participate, were offered an extended individual and family assessment. Grounded Theory analysis of the qualitative data led to the formulation of the Truth Danger Theory. Typical situations in which suicidal behaviour occurred were identified, including intergenerational confusion, neglect, physical and/or sexual abuse within the family, Oedipal conflict, maternal depression and families in which there was a chronically ill sibling. We found that there was a marked disparity between the young person's experience of relationships in the family and the family's own account of their situation, a fractured reality. This can be reflected in an incongruence in the young person's presentation, which may be misleading when assessing risk. The young person feels him/herself to be in a dead end from which there seems to be no escape. Self-harm, for some, contains this impossible dilemma (albeit pathologically) but when it does not, suicide may seem the only option. The Truth Danger Theory provides explanations and predictions for suicidal behaviour and has implications for clinical practice.     

A School-Based Suicide Risk Assessment Protocol

Suicide remains the third leading cause of death among young people in the United States. Considering that youth who contemplate suicide generally exhibit warning signs before engaging in lethal self-harm, school-based mental health professionals can play a vital role in identifying students who are at risk for suicidal behavior. Nevertheless, the assessment of vulnerable children and adolescents is a challenging undertaking, with many variables considered relevant to the determination of a student's suicide risk level. This article introduces school-based mental health professionals to the Student Suicide Risk Assessment Protocol, an evaluation tool developed by the author to aid in the determination of student suicide potential, assist with the selection of appropriate interventions, and allow for documentation of school personnel's actions taken to mitigate a student's suicide risk.     

3 Culture and Ego-Ideal in Suicide: An Adult Case

A case is presented in which the patient's self-expectations, arising from his ego ideal, were violated by a conflict with his wife, who came from a different culture and did not share his marital and family values. When she left him he was devastated, not only by the loss of his family, but by the destruction of his ideal vision of himself as a husband and father. A dangerous suicide attempt followed. The psychodynamic formulation of the case and the treatment that followed from it are discussed.     

Some Psychological Reflections on the Death of Malcolm Melville*

ABSTRACT: Malcolm Melville died on September 12, 1867, at age 18 from—to quote his death certificate—a “pistol shot wound in [his] right temporal region.” Contemporary designations of the mode of his death changed within hours from suicide, to accident, to death while of unsound mind. Historically, the mode of his death has remained equivocal. In order to approach this enigma a “psychological autopsy” of an equivocal death case as identical to Malcolm Melville's as was possible was conducted as though it were a genuine current “open” case at the Los Angeles Suicide Prevention Center in 1973. That procedure resulted in a near-unanimous judgment by the center staff that the most accurate certification of the death as described was “probable suicide,” which would then be certified as “suicide.” In this paper the assertion is made that Herman Melville himself had been a psychologically “battered child” and, in a way typical for battered children, psychologically battered his own children when it came his turn to be a parent. The further assertion is made that, for Malcolm, his father was suicidogenic; and established this penchant in Malcolm (through his neglect, active rejection, fearsomeness, and his fixed attention to his own writing—Redburn, White Jacke, and Moby Dick) within the first 2 years of Malcolm's life. For Malcolm, the psychological basis of his suicidal state was isolated desperation—a ubiquitous characteristic of most suicides. Malcolm had a deep unconscious feeling of not being wanted by his father; that it would be better if he were out of the way, dead. On the morning of his death, the choice for Malcolm was between the memory of his mother's kiss a few hours before and the terror of (and the need to protect himself against) his father's rage to come.     

The trauma of attempted suicide

Suicide is a traumatic event, one which may acutely recreate a previously-experienced traumatic situation. The person's capacity to think after a failed suicide attempt is affected by the use of defence mechanisms against persecutory anxieties and depressive pain, and there is a wish to turn a blind eye to the seriousness of the suicidal act. This includes the damaging effects on the person's relationships with others, and damage to his own psychic integrity.

The need to turn a blind eye to the consequences of a failed suicide attempt may also be mirrored by the therapist who assesses and treats the patient in the early hours after such an event. Suicide is associated not only with the pain of despair but also with a ruthless abandonment of life. It is a complex and difficult task for a therapist in the immediate aftermath of a suicide attempt to be able to keep in mind a concept of suicide that includes both the patient's role as the perpetrator of great violence against himself, in which death is the intended outcome of his actions, and at the same time recognise the patient's identification with an abandoned and cruelly treated object.

In this paper, we describe some of the psychodynamic factors that affect and influence the assessment and treatment of patients in the immediate period following a failed suicide attempt. We emphasise the importance of supervision in helping prevent destructive acting-out by the therapist when treating disturbed patients under such painful circumstances.     

A misinterpreted psychoanalyst: Herbert Silberer and his theory of symbol-formation

The primary aim of this article is to give a more detailed exposition of the cultural, personal, and theoretical contexts in which the Viennese psychoanalyst, Herbert Silberer's theories were born. When assessing the broader picture that this approach offers, it can be concluded that Silberer was an innovative thinker who inspired several of his contemporaries. Recognized in many respects by the society and scholars of this time, he represented quite a different viewpoint that was significantly influenced by several forms of Western esoteric thinking. Yet his main aim was to contribute to the field of psychoanalysis and develop a theory in which rationalistic psychoanalytic interpretations were combined with nonreductive approaches to mystical experiences. Silberer's name is frequently mentioned in a specific context in which his tragic suicide is emphasized rather than his innovations. Upon evaluating the materials recording Silberer's private life, it seems very likely that his suicide was not triggered by the criticism of Freud alone. Silberer's family affairs, his relationship with his father, and his financial and professional struggles could have all contributed to his tragic decision. This paper contends that Silberer's oeuvre deserves greater attention and must be evaluated based upon its own merit.     

Early Stages of a Psychoanalytic Treatment: The Case of Laura

This case analysis describes a young woman's jouney to integrate the experiences of having an unresponsive and nonnurturant mother and an invasive, seductive, and chronically anxious father, who functioned as the loving and responsive parent. From the outset of the analysis, mother's difficulties in attachment and empathy with her daughter's needs or fears, and father's overstimulating and intrusive relationship to his daughter, were present in the patient's dreams and in the transference. The early stage of treatment reported here describes the patient's efforts to find a self-regulatory balance between states of extreme overstimulation and excitement and of withdrawal and a fear of invasion.     

Is Jessie right to end her life?

Presupposing that our consideration of ethical issues can be enriched by examining literary works, this paper focuses on Marsha Norman's play ‘night, Mother. The play describes the last hour and a half in the life of Jessie, a young woman who decides to die by suicide. Before ending her life, Jessie explains to her mother her reasons for her suicide. In the context of the play, these are presented as quite weighty and as, perhaps, justifying her decision. Scholarly research on the play has also treated Jessie's suicide favorably. In this paper I argue that Jessie, and people in similar conditions, are wrong to die by suicide. Among other points, I criticize Jessie's arguments from the impossibility to improve life; the assured termination of suffering; the badness of the world; and the right for suicide. I also criticize arguments in the scholarly literature that view Jessie's suicide favorably, such as the arguments from independence, heroism, authenticity, and emotional closeness.     

Differentiating Suicide Attempters from Suicide Ideators: A Critical Frontier for Suicidology Research

Most individuals who consider suicide do not make suicide attempts. It is therefore critical to identify which suicide ideators are at greatest risk of acting on their thoughts. However, few seminal theories of suicide address which ideators go on to make attempts. In addition, perhaps surprisingly, most oft‐cited risk factors for suicide—such as psychiatric disorders, depression, hopelessness, and even impulsivity—distinguish poorly between those who attempt suicide and those who only consider suicide. This special section of Suicide and Life‐Threatening Behavior serves to highlight this knowledge gap and provide new data on differences (and similarities) between suicide attempters and suicide ideators.     

Clarifying the Role of Psychological Pain in the Risks of Suicidal Ideation and Suicidal Acts among Patients with Major Depressive Episodes

The role of psychological pain in the risk of suicide was explored using a three‐dimensional psychological pain model (pain arousal, painful feelings, pain avoidance). The sample consisted of 111 outpatients with major depressive episodes, including 28 individuals with suicidal histories. They completed the Chinese version of the Beck Scale for Suicide Ideation (BSI), the Beck Depression Inventory (BDI), the Psychache Scale, and the three‐dimensional Psychological Pain Scale (TDPPS). A structured clinical interview was conducted to assess the history of suicidal acts. Significant correlations were found among BDI, BSI, and TDPPS scores (p < .01). Stepwise regression analyses showed that only pain avoidance scores significantly predicted suicide ideation at one's worst point (β = .79, p < .001) and suicidal acts (β = .46, p < .001). Pain avoidance was also a better predictor of current suicidal ideation (β = .37, p = .001) than were BDI scores (β = .31, p < .01). Increased levels of pain avoidance during a major depressive episode may be a dominant component of the motivation for suicide. Future clinical assessments for populations at high risk of suicide should include measures of psychological pain to reduce the incidence of suicide.     

Acquired Capability for Suicide,Pain Tolerance,and Fearlessness of Pain—Validation of the Pain Tolerance Scale of the German Capability for Suicide Questionnaire

The interpersonal theory of suicide (Joiner, 2005) postulates that for a serious suicide attempt, one has to possess the acquired capability to commit suicide. Acquired capability includes higher pain tolerance, which is further assumed to comprise both an elevated physical pain tolerance and fearlessness of pain. Recently, the German Capability for Suicide Questionnaire (GCSQ) was validated. The aim of this study is further validation of the GCSQ's Pain Tolerance scale by investigating the scale's association with objective pain tolerance and fearlessness of pain in two undergraduate samples (N = 81; N = 76). Both associations were found indicating a strong criterion validity of the Pain Tolerance scale.     

Passing‐over: The Death of the Author in Hegel's Philosophy

Criticism of Hegel has been a central preoccupation of “postmodern” philosophy, from critical theory and deconstruction to Lacanian psychoanalytic theory and Foucauldian “archaeology.” One of the most frequent criticisms is that Hegel's invocation of “absolute knowledge” installs him in a position of authorial arrogance, of God‐like authority, leaving the reader in a position of subservience to the Sage's perfect wisdom. The argument of this article is that this sort of criticism is profoundly ironic, since Hegel's construction of the role of the Sage possessing absolute knowledge is in fact an elaborate mask covering over a radical project of disappearance of the author by which it becomes the reader who is left to author the text. The article explores Hegel's commitment to his own death as an author in his invention of a new method of demonstration, his epistemology, his philosophy of language, his theory of desire, and even in the seemingly least likely place of all, his portrait of “absolute knowledge.”     

Psychic family violence and pathological jealousy with tragic consequences: Homicide

The presented case is not a singular one and it belongs to the pathology of the last period in Romania as a consequence of an unprecedented social phenomenon in the last 50 years, namely the massive migration of the young labor force especially in Western-European countries. One of the consequences is that many children are left in the care of only one parent or more often in the care of the grandparents. Another consequence is that the spouses separate for shorter or longer periods of time, they keep in touch only through telephone and after months, or even years, when they meet, they fight, especially regarding the possible infidelity. Authors have published several papers about children left to grow up without parents. This time it's about a young man who killed his wife in a very particular way, the wife having returned from working in Italy for one day. The psychological profile of the perpetrator and even more the lack of psychiatric antecedents wouldn't have suggested such an ending to the relationship between the two, but still the murder took place and the authors are trying to explain it.     

LGB-Affirmative Cognitive Behavioral Treatment for Social Anxiety: A Case Study Applying Evidence-Based Practice Principles

Guided by the American Psychological Association's principles of evidence-based practice, this article reviews a single-case treatment outcome study whereby a client characteristic, sexual identity, was integrated into the assessment and treatment of social anxiety symptoms. The case involved a young adult European-American male who presented to a training clinic with a primary diagnosis of social anxiety disorder as well as secondary symptoms of excessive worry and concerns of sexual identity confusion. Recent evidence suggests that gay men report more symptoms of social anxiety when compared to heterosexual men, and those who make more efforts to conceal their sexual identity experience increased anxiety and have greater difficulty committing to a personal identity. Further, it has been hypothesized that fear of rejection from heterosexual individuals underlies this anxiety. The client attended 50 sessions over the course of 18 months. Treatment progress was assessed via self-report questionnaires assessing social anxiety and worry. Consistent with principles of evidence-based practice, a cognitive behavioral treatment protocol was employed at the outset of therapy and resulted in a decline in the client's social anxiety scores. However, once the case conceptualization and treatment focus shifted to focus on sexual identity, his scores continued to decline at an even steeper rate. He ultimately came to identify himself as having a same-sex sexual orientation, began living his life in a manner consistent with that identification, and reported a number of positive outcomes at termination of therapy. Implications for treatment of social anxiety in sexual minorities are discussed.     

The Sexual Harassment–Suicide Connection in the U.S. Military: Contextual Effects of Hostile Work Environment and Trusted Unit Leaders

Sexual harassment has been associated with suicidal behaviors, and with the rise in suicides in the U.S. military, sexual harassment's role in suicide has been of growing interest. Lacking are studies that examine group‐ or unit‐level variables in the relationship of sexual harassment to suicidal behaviors (thoughts, plans, and attempts). In this study, survey data from soldiers (12,567 soldiers in 180 company‐sized units) who completed the Unit Risk Inventory administered during calendar year 2010 were analyzed using hierarchical linear modeling. At the individual level, sexual harassment was associated with a fivefold increase for risk of suicide. Reporting that leaders could be trusted was associated with a decreased suicide risk by about one‐third. There was no statistically significant interaction between sexual harassment and trusted leaders in predicting the suicidal behaviors. At the group level, units or companies having higher levels of sexual harassment also had soldiers three times more at risk for suicide. A cross‐leveling effect was also observed: Among units having higher levels of sexual harassment, the negative correlation (buffering effect of unit leaders on suicidal behaviors) was diminished. Implications of findings for preventing sexual harassment and suicide risk are discussed.     

Counselling marginalised young people: A qualitative analysis of young homeless people's views of counselling

Aims: This study explored young homeless people's views of counselling, with a view to considering how the counselling profession can better meet their needs. Method: A small scale qualitative research project was undertaken in two residential projects for young homeless people. Data was gathered through focus groups and then analysed using grounded theory. Findings: The study revealed a lack of trust in counsellors and counselling, as well as a dislike of the counselling process. Implications for practice: Some suggestions for how best to work with this particularly marginalised client group are discussed. These include ways of making counselling more engaging, raising the profile of the counsellor in the young person's environment and having an awareness of the needs specific to at‐risk young people.     

Who was Pierre Rivière? Introduction to the special issue

Foucault's (1975) edited book, I, Pierre Rivière, having slaughtered my mother, my sister and my brother… A case of parricide in the 19th century, includes the court documents and newspaper reports from the 1835 trial of Pierre Rivière, Pierre Rivière's memoir written while in prison, and the “analytic notes” written by Foucault and his colleagues. Whereas the court focused on the question of whether Pierre Rivière was of sane mind or not, Foucault and his colleagues sought to avoid the closure that such categorical thinking invites the reader into. This paper introduces the story of Pierre Rivière, and opens up some of the questions to be addressed in this special issue. The papers examine the memoir, the accompanying documents, and Foucault's and his colleagues' take on them, and reopen discussion of the Pierre Rivière case and its contemporary twenty-first century relevance, using a combination of both philosophical ethnography and arts-based enquiry. These contemporary papers are based upon a series of interdisciplinary workshops and seminars that took place at the University of Bristol during 2010. In this introductory paper we ask what was the emotional geography of this young man who engaged in such an unthinkable act? And how did that geography intersect with the emotional geography of his village in France in 1835, and what does it still have to tell us about our own contemporary society?     

Extending the Validity of the Personality Assessment Inventory's (PAI) Level of Care Index (LOCI) in Multiple Psychiatric Settings

The purpose of this study was to extend the validity and clinical application of the Level of Care Index (LOCI) from the Personality Assessment Inventory (PAI) in 2 independent psychiatric samples. In Study 1 (N = 201), the LOCI effectively differentiated level of care (inpatients from outpatients), and was also meaningfully associated with risk factors for psychiatric admission (e.g., suicidal ideation, self-harming behavior, previous psychiatric admission, etc.), even after controlling for other demographic variables (range of Cohen's ds = 0.57–1.00). Likewise, the LOCI also incremented other risk indicators (suicide and violence history) and relevant PAI indexes (i.e., Mean Clinical Elevation, and Suicide and Violence Potential) in predicting level of care, and explained an additional 6% to 12% of variance in the target variable. Diagnostic efficiency analyses indicated LOCI scores in the range of 15 to 18 optimize positive and negative predictive power, and classification rate. In Study 2 (N = 96), the LOCI was found to be significantly higher in those with a recent psychiatric admission within the past 6 months (d = 0.64), as compared to those without an admission. Similarly, those who were admitted for suicide risk had significantly higher mean LOCI scores as compared to those who did not (d = 0.70). The clinical implications of these findings and potential application of the LOCI are discussed.