Am J Psychiatry 1991; 148:1150-1158
Copyright © 1991 by American Psychiatric Association
Psychodynamics of suicide, with particular reference to the young
H Hendin
American Suicide Foundation, New York, NY 10028.
OBJECTIVE AND METHOD: The article reviews the literature on the
psychodynamics of suicide, focusing on factors that will help in evaluating
and treating the young suicidal patient. Articles published in refereed
journals and books and book chapters based on such articles are the source
of most of the material. Articles that first brought a new finding to
notice are given preference. Methodological limitations and contradictions
with the data of other studies are pointed out. FINDINGS: The psychodynamic
meaning of suicide for a patient derives from both affective and cognitive
components. Rage, hopelessness, despair, and guilt are important affective
states in which young patients commit suicide. The meanings of suicide can
be usefully organized around the conscious (cognitive) and unconscious
meanings given to death by the suicidal patient: death as reunion, death as
rebirth, death as retaliatory abandonment, death as revenge, and death as
self-punishment or atonement. CONCLUSIONS: Knowledge of the psychodynamics
helps to distinguish which patients with any given diagnosis are at risk
for suicide. Such knowledge is essential to the psychotherapeutic treatment
of the young suicidal patient. Topics for future research include the role
of anxiety in suicide; the capacity to bear hopelessness, rage, and other
unpleasant affects without regression; the use of particular defense
mechanisms in distinguishing the risk of either suicidal or violent
behavior; and the relation of specific psychodynamic conflicts seen in
suicidal patients to particular psychiatric diagnoses.
