The psychodynamics of hope in suicidal despair

For suicidal individuals, crushing hopelessness correlates more strongly than depression with suicidal intent. Ambivalence is recognized as a principal aspect of suicidality – wanting to die and wanting to be rescued at the same time. Hope is the mental state in which the desire of a positive outcome in one’s life is directed toward the future, and supports a positive resolution to psychic pain, thereby playing an important role in suicide prevention by delaying self-destructive action. This paper explores the psychodynamics of hope in suicidal distress, as it functions to support the suicidal patient’s sense of connection over abandonment and rescue over the wish to die. Three pathways that instill and support hope in suicidal patients are examined through the use of clinical examples.     

生活应激诱发大学生抑郁症状及轻生意念预警模型

用“大学生人格问卷”(UPI)和“学生生活应激量表”(SLSI)检测大学生3558例,并用回归分析和路经分析探讨其应激过程(应激源—应激反应)诱发抑郁症状及轻生意念的预警模型。结果显示,大学生生活中所承受的挫折、压力、变化和自我强加是预警抑郁症状产生的主要应激源;情绪反应、生理反应、行为反应和认知反应是预警抑郁症状产生的主要应激反应;大学生抑郁症状诱发轻生意念的预测正确率为97.0%,发生比(OR)或危险率1.86倍于非抑郁症状者,其中女生抑郁症状诱发轻生意念的危险率近2倍于无此症状者;应激源直接引起应激反应,应激反应直接诱发抑郁症状,抑郁症状直接引发轻生意念,应激源和应激反应不直接影响轻生意念,而通过诱发抑郁症状间接影响轻生意念。此预警模型为大学生危机心理鉴别干预提供了临床心理学依据和参数。     

Family Factors Predicting Categories of Suicide Risk

We compared family risk and protective factors among potential high school dropouts with and without suicide-risk behaviors (SRB) and examined the extent to which these factors predict categories of SRB. Subjects were randomly selected from among potential dropouts in 14 high schools. Based upon suicide-risk status, 1,083 potential high school dropouts were defined as belonging to one of four groups; 573 non-suicide risk, 242 low suicide risk, 137 moderate suicide risk and 131 high suicide risk. Results showed significant group differences in all youth self-reported family risk and protective factors. Increased levels of suicide risk were associated with perceived conflict with parents, unmet family goals, and family depression; decreased levels of risk were associated with perceived parental involvement and family support for school. Perceived conflict with parents, family depression, family support satisfaction, and availability of family support for school were the strongest predictors of adolescent SRB. Our findings suggest that suicide vulnerable youth differ from their non-suicidal peers along the dimensions of family risk and protective factors.     

Drop-in suicide prevention group decreases suicidal ideation among Veterans

This study examined the effectiveness of a weekly, drop-in therapy support group designed for Veterans identified at increased risk for suicide. Veterans were identified as at risk for suicide and referred to the group following hospitalization on the inpatient psychiatric unit after an increase in suicidal ideation (SI), presentation to a provider with SI with a plan, or having made a suicide attempt. An archival chart review was performed on 359 patients who were referred to the Coping, Understanding, Support, and Prevention Group from 2009 through 2011. Documented risk of suicide was collected from the chart including: frequency of inpatient psychiatric hospitalization, visits to the emergency department or mental health walk in clinic for SI, reported SI in clinical notes, consults resulting from calls to the Veteran’s Crisis Line, and assignment or removal of suicide risk behavior flags in the electronic medical record, for a period of 12 months prior to referral to the group and for a period of 12 months after referral to the group. Negative binomial regression models found that Veterans attending the support group showed a significantly greater reduction in frequency of endorsing SI post-referral compared to those who did not attend the group. Results imply that offering Veterans an ongoing therapeutic group format to give and receive support from peers also struggling with suicide risk factors is an effective way to reduce suicide-related thoughts.     

Stefan Lux (1888–1936): a calculated suicide before the Second World War

In 1936 Stefan Lux, a Jew born in Vienna, and naturalized in Czchoslovakia, shot himself during a session of the League of Nations in Geneva. The situation would become much more dire for German Jews in the coming years, and few sensed that anything akin to the Holocaust was in store. Lux believed he had timed his suicide precisely to bring attention to, and counteract, the problem of “statelessness” that was on the agenda of the League. Lux also feared that the defences Jews had utilized before 1933 to ward off antisemitism were no longer viable, as they were under assault by the entirety of the arts and cultural apparatus in Germany. This case illustrates both the prescience and limits of Lux’s carefully orchestrated suicide.     

PSYCHOANALYTICAL PSYCHOTHERAPY: Death in the afternoon

One afternoon, a patient who had been in three-times-weekly psychoanalytic psychotherapy for over fi ve years with the author left the offi ce after her session, drove down to the train tracks half a mile away, and sat down facing an oncoming train. Her suicide occurred a little over a year after 19 hijackers took over four passenger airplanes and fl ew two of them into the World Trade Center, and during the period of the massive buildup for a pre-emptive war with Iraq. This paper explores the very personal impact of these interlocking events of personal, political, and state-sponsored terrorism on the author. Interweaving the patient's and the author's personal struggle with the patient's overwhelming destructiveness-and how it ultimately failed-with the inability to stop the war despite the unprecedented mobilization of voices for peace across the world, it is a journey through the shattering impact of violence into the tentative discovery of a sustaining vision of hope. It explores the theme of terrorism, both personal and political, as a theater of violence designed to create maximum impact, and how fantasies of redemption, fueled and blinded by righteous certainty, can transmute into acts of breathtaking violence, and fi nd justifi cation in their own mad logic. Through the elaboration of the patient's story and its impact on the author, she offers a very personal attempt to understand and reckon with violence and destructiveness as manifested in these different forms, to grasp how openings of hope and new creative possibility are often followed by a violent regressive backlash, and to fi nd a way to survive them without losing heart for the work.     

Heart and spirit

In qualitative interview research with 25 psychoanalysts and psychoanalytic psychotherapists in London, Sydney and Melbourne, the author explored how these clinicians experienced, conceptualised and worked with spiritual issues. Bringing to bear their experience on both sides of the couch, this 'information-rich' sample of mainly senior practitioners reflected on a psychoanalytically informed view of spirituality, and its understanding in clinical practice. Two methods of analysis were used. The technique of 'narrative finding' was followed by coding of core ideas, themes and concepts expressed. Participants noted that spirit may be the 'blind spot' of psychoanalysis, and reflected that what they had wanted in their own analyses-and consider that what patients want-is to be able to have spiritual issues addressed in a similar manner to other matters, not prejudged as infantile or pathological. In participants' concepts and experience of spirit, a comfort / challenge dimension was identified. Comfort was taken in having a 'wider view', a more inclusive sense of inter-relatedness, with challenge involving a heightened sense of the unknown and a greater degree of uncertainty.     

A Woman's Choice? — On Women, Assisted Reproduction and Social Coercion

This paper critically discusses an argument that is sometimes pressed into service in the ethical debate about the use of assisted reproduction. The argument runs roughly as follows: we should prevent women from using assisted reproduction techniques, because women who want to use the technology have been socially coerced into desiring children--and indeed have thereby been harmed by the patriarchal society in which they live. I call this the argument from coercion. Having clarified this argument, I conclude that although it addresses important issues, it is highly problematic for the following reasons. First, if women are being coerced to desire to use AR, we should eradicate the coercive elements in pro-natalist ideology, not access to AR. Second, the argument seems to have the absurd implication that we should prevent all women, whether fertile or not, to try to have children. Third, it seems probable that women's welfare will be greater if we let well informed and decision-competent women decide for themselves whether they want to use AR.     

“桑美”台风下受创学生的特质应对方式对自杀态度的影响

为了探讨自然灾害事件下受创学生的特质应对方式对自杀态度的影响,采用创伤后症状反应问卷、特质应对方式问卷和自杀态度问卷对“桑美”台风重灾区的650名中小学生进行了测查,结果表明：（1）学生的创伤后症状反应与自杀态度有着显著的相关;（2）特质应对方式对创伤后症状反应与自杀态度关系的调节效应不显著。结果支持了应对的关联模式,应对具有情境化特点。