The Relation of Self-Hatred and Suicidality in People With Schizophrenia-Spectrum Symptoms

It is well known that depressive symptoms represent a risk for suicidality in general. It is less clear, however, that general depressive symptoms comprise a definite suicide risk factor for people with schizophrenia. Based on this, as well as on the early writings of E. Bleuler (1911/1987), it was hypothesized that there may be a particular aspect of depressive symptoms that combines with schizophrenia to encourage suicidality. Specifically, schizophrenia may impart to self-concept a quality of self-hatred that encourages suicidality in schizophrenic people. If so, then an index of self-hatred should be more correlated with suicidality among people with schizophrenia-spectrum symptoms than among people with fewer such symptoms. Two studies evaluated this possibility. In Study 1 on 243 suicidal outpatients affiliated with the military, self-hate and suicidality were more correlated among people with schizotypal symptoms than among other patients. In Study 2 on 113 VA psychiatric inpatients, self-hate and suicidality were more correlated among people with a diagnosis of schizophrenia than among patients with a diagnosis of major depression. Study limitations were noted, and it was suggested that self-hatred be a focus of suicide risk assessment in schizophrenic people.     

The Failed Courage of the Fanatic

Fanatic acts are carried out by those who regard their inner being as having to be denied. By means of a projective identification to a leader and a strident religious cause, they experience their unworthy and evil self as having to be sacrificed so that their good self—as projected on the leader and the cause—can survive and reign. True prophets, as contrasted with the leaders of fanatic groups, do not teach their disciples to hate and flee those who oppose them; but, instead, to build a better world by coming caringly together with their adversaries to heal the wounds of loneliness, shame, and self-hatred.     

A perspective on the patterns of loss, lack, disappointment and shame encountered in the treatment of six women with severe and chronic anorexia nervosa

Abstract :  This paper explores how the aggressive fantasies and energies expressed in anorexic self-hatred can be recycled to become the basis of psychological growth and recovery. This shift is made possible by focusing on the telos of the analysand's psychological system as it expresses itself through her illness, and using Clark's idea that sanity is a form of recycled madness. It also draws on Jung's view of the unconscious as an active and purposive agent, and libido as a neutral psychic energy which can serve different purposes.
I discuss a number of clinical vignettes, focusing on the hard, ruthless, defiant and hateful aspects of (what might appear to be) 'monstrous' anorexic behaviour, and the kinds of countertransference reactions these behaviours can provoke. I also explore what these kinds of behaviours might represent in terms of multi-generational family dynamics, as well as mother-daughter dynamics.
At the core of the paper is the idea that the capacity to use aggression in clear ways, but within the limits of conscience, is essential for the protection of one's physical and psychological boundaries. Without the capacity to defend oneself, and the ability to decide quickly and clearly when it is right to risk hurting the other in order to do so, one cannot take any level of risk in life, or draw close to the other. I suggest that for recovery from anorexia to occur, the aggressive, self-hateful, destructive energies which are so central to the illness need to be recycled into these kinds of awarenesses and life-skills.