Disillusionment and Suicidality: When a Developmental Necessity Becomes a Clinical Challenge

Research Interview Vignette 1

Consider one research study participant’s answer to the question “Why suicide?” Ms. A informed me that the research interview coincided with the tenth anniversary of her first suicide attempt, made exactly one year to the day after her mother died of a protracted illness. The means of her first suicide attempt included an overdose of pain medication that had been prescribed for her mother. The index event, the near lethal suicide attempt that was the focus of our research inquiry, occurred six months before the research interview, and had resulted in several serious medical complications that necessitated a two-week stay in an intensive care unit. In addition to the multiple life stressors that precipitated the attempt—including the loss of a significant relationship—Ms. A was abusing alcohol and prescribed medications, along with substances she obtained via the internet, including “bath salts” (synthetic cathinones, a psychoactive substance). In the hours just prior to this attempt, while intoxicated, Ms. A experienced mocking auditory hallucinations that goaded her into suicidal action. She already had the motivation to die, which she described as a disillusioned, cynical, nihilistic state, one she had felt periodically for the past twenty years:

futility is the reason for me . . . kinda like a feeling that everything is absurd, I guess that is cynicism . . . when you move from like all of these existential questions all around you to the realm of nihilism, and that’s not to say that you can’t move back out of nihilism, back to you know existential questioning of life. When you get to those nihilistic plans I think that’s a big risk. For me just to feel like there is no fucking point anymore.

After Ms. A spoke a bit more about her nihilism and cynicism, the interviewer acknowledged that this seemed to be the main feeling fueling her attempt. She wondered, however, if there were other, “perhaps somewhat quieter feelings in the background of that.” The participant, becoming reflective, shifted to a sad tone:

Maybe some sadness. Maybe some anger. Maybe some hopefulness that I would see my mom who passed away. I think there was some kind of loneliness and like some hope that maybe in death there would be something better than life.

Later in the interview, she returned to the fantasy of being reunited with her mother. When asked if she could imagine what it would be like to be with her mother in death, she replied,

Ummm, kind of whole. United. I don’t know. Held, supported, nurtured, I don’t know.

Throughout the interview, the participant tacked back and forth between profound disillusionment and a near forbidden but alluring fantasy of reunion with her dead mother. Ms. A sadly reported that she and her mother had endured a very stormy relationship during the height of Ms. A’s adolescent rebellion, when her mother was sick and dying. Ms. A’s mother had died before the fractured mother-daughter relationship could be repaired. The illusion of retroactive reunion and repair, accomplished by suicide, was Ms. A’s solution to the pain of loss and disillusionment. This account is not unlike other research interviews where the pain of disillusionment becomes overwhelming and is met with an illusion suffused with delusional elements.

Illusion and Disillusion

For Freud (1927), illusions are beliefs based on wishes that “come near to psychiatric delusions.” Yet he also felt them to “differ from them too,” in that delusions are in “contradiction with reality” while “illusions need not necessarily be false—that is to say, unrealizable or in contradiction to reality” (p. 31). Illusions may also represent hopes and dreams for the future. Disillusionment is the often painful acknowledgment of the loss of illusions that may affect identity, relationships, our view of the possibilities for the future, or even our wish to be alive at all. Well within the ordinary territory of developmental challenges, the capacity to sustain oneself during the times one feels disillusioned is an achievement that is necessary for psychological growth. It may be that disillusionment provides some of the building blocks for resilience or ego strength, which includes the ability to tolerate the disappointment involved in realizing that things are not as one expected or hoped for (LaFarge 2015; Schafer 2003). Disillusionment also presses us to reconstruct our view of things, which no longer appear quite as we had wished. In this new encounter with reality, we can discover new courage, grieve, and adapt; alternatively, we can defensively refuse this reworking of our expectations, hopes, and fantasies about the self and/or other—in particular, object representations and relations.

A common, if less adaptive solution to feeling disillusioned is the return to a more workable illusion that does not require an extreme sacrifice of the self or others, a defense that can be organized around denial, disavowal, dissociation, repression, reaction formation, or other intrapsychic responses to realities felt to be in need of psychic modification. The restoration of an illusion may also allow us to create a vision of ourselves in the future in some changed state, sometimes allowing for the restitution of hope. Other nonoptimal responses to disillusionment include neighboring phenomena such as (1) delusions as a refusal of disillusionment; (2) despair; and, in some cases, (3) entrenched cynicism about the nature of life or existence. Extreme forms of sustained disillusionment, particularly in the setting of adverse child experiences (including attachment and relational failures), may lead the child to the solution that Steiner (1993) calls a pathological organization or “psychic retreat,” and it is here that development of the individual can come to a near total stall. When the experience of being disillusioned exceeds individual or even community-based resilience, coping and defense mechanisms may fall short, leading to various psychic and social catastrophes—the most extreme being violence, including suicide.

Etymology of Illusion and Disillusion

According to the Shorter Oxford English Dictionary (Trumble and Stevenson 2002), the word illusion (from the French) derives from the Latin illudere, meaning “to mock or jest” (from ludere, “to play”). As a verb or adjective, “mock” can suggest provisional status, as in to “mock up a document,” or something artificial or counterfeit, as in a “mock trial.” Illusions are things or experiences that deceive or delude by giving a false impression of reality. Gutmann et al. (2005) identify three major psychic illusions—omnipotence, immortality, and omniscience—and five transitional illusions: beauty, permanence, individualism, possession, and castration. They examine these illusions in organizations and leadership. Understanding these categories of illusion affords a deeper exploration of illusion’s counterpart, disillusion. The OED defines “disillusion” as “the action of freeing or becoming freed from illusion; disenchantment” (p. 458).

The domains of illusion and disillusion are not limited to psychoanalysis or psychology, but are concerns also of philosophy, art, theater, literature, and theology. One of the examples of disillusionment provided by the OED is from Elizabeth Barrett Browning, who published a long, two-part poem, Casa Guidi Windows, in 1851, when she was living in Florence with her husband Robert. The two parts of the poem were written at different times; in 1848, when the first part was composed, Browning and many others hoped that a new political wave of liberalism instigated by the reforms of Pope Pius IX would lead to unification of the Italian states These progressive hopes would be dashed. Pius was forced to flee in disguise from the Vatican, and lived under the protection of the mayor of Naples. Soon Austrian troops would occupy Florence. It was during this time, in 1851, that Browning wrote the second half of the poem, a meditation on disillusionment with the political situation in Italy.

In her introduction to Casa Guidi Windows, Browning comments on the contrast between the naive hopefulness of the first part and the ultimate disillusion of the second: “If the discrepancy should be painful to the reader, let him understand that to the writer it has been more so. But such discrepancy we are called upon to accept at every hour by the conditions of our nature . . . the discrepancy between aspiration and performance, between faith and dis-illusion, between hope and fact” (pp. vi–vii). Browning juxtaposes aspiration, faith, and hope, with performance, disillusion, and fact. The first group might be thought of as the substrate of a romantic and optimistic vision of the future, while the second group represents the painful encounter with unfolding reality. We often live within this tension, between what was hoped for and what actually occurs. This is a place of limits. The poet captures this human dilemma very well, observing that disillusionment has to do with confronting realities that may seem contrary to—and may even ruin—our aspirations, hope, and faith: everything that gives life meaning.

The Incurable Wound at the Heart of Everything

Theologians and psychoanalysts speak of illusion and disillusion in their attempt to address or acknowledge the notion of a primal, “incurable” wound. Writing about the developmental tasks of what he terms the second half of life, Richard Rohr (2013) observes:

In order to arrive at the second half of life, one has to realize that there is an incurable wound at the heart of everything. Much of the conflict from the age of twenty-five to sixty-five is just trying to figure this out and then to truly accept it. Swiss theologian Hans Urs von Balthasar said toward the end of his life: “All great thought springs from the conflict between two eventual insights: (1) the wound which we find at the heart of everything is finally incurable, (2) Yet we are necessarily and still driven to try!” [p. 306].

Compare Rohr’s comment with the postmodern theorist Jean-Francois Lyotard’s observation about the wounds of history and trauma (1987):

All these wounds can be given names. Their names are strewn across the field of our unconscious like so many secret obstacles to the quiet perpetuation of the “modern project.” . . . Anamnesis constitutes a painful process of working through, a work of mourning for the attachment and conflicting emotions, loves, and terrors associated with those names [p. 14].

I contend that such working through includes recognition of the defensive aspect of illusions, coming to terms with disillusionment, and the facticity of life, which is always bounded by loss and limit, in which the wound is not healed but is always present.

Desire and illusion are intimately bound in many religious narratives and are in tension with suffering and disillusionment. All of the Abrahamic religions regard the acquisition of forbidden knowledge as an attempt to address an essential deficit or lack embedded in the human condition, perhaps one experienced as an incurable wound organized around illusion and disillusion. In this instance, the human lack or wound may be experienced as shame, as evil, and may eventually open the way to other acts of violence and degradation.

Christianity uses the notions of original sin and “the fall” to characterize the consequences of the transgression of eating the fruit of the tree of knowledge. In the Judeo-Christian tradition, the incurable wound forms around illusion and disillusion, beginning with the banishment of Adam and Eve from the garden, in order to allow them to get on with their development as human beings (R. Q. Ford, personal communication, June 6, 2015). Exile from the garden describes the experience of a primal trauma marking humanity with both disillusionment and irretrievable loss. In both Hinduism and Buddhism, illusion is captured through the central concept of māyā, although these religions have different ways of understanding illusion and how it is to be spiritually confronted. In Buddhist thought, māyā is what exists, but it is constantly changing and so by impermanence remains an illusion that captures our desire, leading to the pursuit of what is constantly eluding our grasp.

Illusion, Disillusion, and Psychoanalytic Developmental Theory

Psychoanalysis, at its Freudian beginnings, organizes around a fantasy of an incurable wound known as castration anxiety in boys or penis envy in girls, in an incurable fact of psychic life—the unconscious, and the Sophoclean tragedy of Oedipus—illusion and disillusion turned into developmental theory. The Freudian developmental story begins with a theory of psychosexual stages, the oedipal theme appearing first in The Interpretation of Dreams (Freud 1900), and developed further as the oedipus complex in “A Special Type of Object Choice Made by Men” (Freud 1910).

Freud’s central heterosexual developmental story ushers the child into the experience of disillusionment between three and seven years of age. In his theory, gendered in ways specific to his time, the child (male) has a primary love attachment to his mother; she is his possession and he experiences himself as the center of her world. Eventually another male (his father) comes into the picture and displaces the child; under threat of castration, the child relinquishes his mother as primary love object and identifies with the father and with the father’s object choice, setting the stage for the male child to take a heterosexual interest in other female love objects. The theory can also be understood in a more gender-neutral way, as the move from a world of dyadic to triadic interactions: a world in which the intergenerational imposition of the incest taboo becomes evident, and in which one of the costs of entering civilization is disillusionment. Freud marks this as a moment of sexual differentiation or sexual identity formation, but it is also a moment of generational differentiation: there are things two adults may do together that do not include the child. The oedipal situation confronts the young child with the recognition and disillusionment that he or she is not the center of the universe, nor necessarily the primary love object for the parent.

Research Interview Vignette 2

Consider these words from another research participant:

I sometimes think I am superior because of these types of thoughts that I have, but then remind myself that I am just human and I am one of the billions and I am insignificant. Yeah, it makes me feel sort of insignificant. So I went to this place in my mind where I was special and having these special thoughts that must not sound realistic to other people . . . but there is a side of me that still believes in this stuff.

Being one-among-many can be a tremendous wound for narcissistically inclined persons unable to cope with the demands of the oedipal situation. This young adult woman spoke in a grandiose way throughout the interview about her sense of having been a precocious child, and used this grandiosity to rationalize why she had never had close friends, believing she was simply too special and advanced for people her own age to appreciate her. After many failures to sustain adequate independent functioning in school or in the workplace, the wound of reality around her special status became a site of rage and humiliation; her near lethal suicide attempt was an effort to demonstrate her fantasied special status to her family and to herself.

Melanie Klein (1975a,b; Segal 1973) has a livelier theoretical view of illusion, moving the scene of illusion and disillusion back to the earliest days of infancy. In Kleinian theory, the infant begins in a state of terror about survival and develops a set of projective and introjective defenses to manage death anxiety. An illusion of omnipotence develops and is marked by the hallucinatory wish-fulfillment of the breast as gratifying on demand; alternatively, the infant develops persecutory experiences of betrayal and deprivation when her needs are not gratified. Projected early death anxieties are experienced as external aggression and murderous rage directed toward the self, which seeks to stabilize the danger situation through psychic omnipotence. Illusion and disillusion are implicated in both the paranoid-schizoid position and in the depressive position. It is the integration of illusion and disillusion that is part of what makes the depressive position possible; here love and hate are not confined to part-object experiences of the good and bad breast or other examples of splitting, allowing a more whole and balanced object experience onto the developmental stage.

In his theorizing, Winnicott elaborated the positive developmental role of illusion and the resulting growth and creativity emerging from disillusion. The infant’s wishes for the breast and for omnipotence eventually encounter situations of frustration such that an alternative course must be created. Winnicott understands transitional objects and phenomena, which appear between between four and twelve months of age, as substitute gratifications for the absent breast. The transitional object emerges to forestall disillusion, allowing the infant to experience “going on being” via the creation and possession of a need-gratifying object independent of the breast: “in relation to the transitional object the infant passes from (magical) omnipotent control to control by manipulation” (Winnicott 1953, p. 93). The psychic achievement of a transitional mode of relating modifies the omnipotent illusion of tyrannical dominance over the breast and allows the creativity of a substitute illusion to emerge—one thought to foster psychic growth and development of the infant’s emerging status as an individual.

More recently, Fonagy and Allison (2014) have written about the role of mentalizing in the development of epistemic trust, which they define as the capacity to trust the reliability or authenticity of communications from other persons. Epistemic trust is an important construct to consider in relation to disillusionment and suicidal states of mind, as it allows those in distress to rely on trusted others to present a different point of view, and to be open to contextualizing information that previously has been excluded. This ability is paramount for those who become disillusioned through a process of telescoped vision about their current situation, or who are prone to the collapse of the temporal realm into a “now is forever” type of thinking.

Latency-age children may also encounter illusion and disillusion. Freud’s observation of a “family romance” in latency children (1909) suggests that as some children become less dependent on, and idealizing of, their parents, they come to believe that their parents are actually not their “real” parents and that their “real” family is some other, idealized family. Here disillusion is replaced by a new illusion: “I have a real and a better family somewhere else.” Latency-age children are faced with other disillusioning experiences—the tooth fairy and Santa Claus are not “real” but “imaginary,” and the fantasy world becomes no longer a safe haven for illusions of pure gratification, but a place where they feel duped, deceived, betrayed, or simply disappointed that things are not as they had been led to believe. Accordingly, the adults who have promulgated this form of imaginary play are now suspect.

The discourse of adolescence includes questions of identity formation, sexuality, rebellion. For some adolescents, questions about the meaning or purpose of life become central. While suicide before the age of ten is rare, suicide begins to emerge in adolescence and, according to the CDC’s Web-based Injury Statistics Query and Reporting System (WISQARS), is in fact the second leading cause of death for thirteen- to fourteen-year-olds in the U.S. In adolescence, negotiating the impact of illusion and disillusion on adolescent ideals becomes a central developmental task. Finding a place for oneself in the world outside the family, one that may be quite differentiated from the world and values of one’s parents, is also a challenge for this age group. Erikson (1968) theorized that a negative identity may emerge in response to disillusionment with parental expectations or values; moreover, the adolescent may work to refuse certain aspects of identification with the parents, an expectation that the parents may hope for or demand.

The risk of suicide continues to climb during adult life. According to the American Foundation for Suicide Prevention (AFSP), in 2015 the highest rates of suicide were observed in adults between forty-five and sixty-four (19.6% of completed suicides) and in adults eighty-five or older (19.4%). The capacity to navigate the disillusionment associated with aging is crucial to understand. In Childhood and Society, Erikson (1950) outlined a psychological theory of conflict and growth throughout the lifespan. However, as he aged and his health began to fail, he developed a more complex appreciation of the tasks of “old old” age. In his last book, The Life Cycle Completed (1998), finished by wife Joan after his death at age ninety-one and published posthumously, Erikson surmised a possible ninth stage of development in those who live into old age and must face the decay of body and mind. He defined the developmental tension of this stage as transcendence/faith vs. deepening despair and disillusionment. Before old age is reached, degenerative and terminal conditions may evoke ninth-stage tensions when illness confronts the individual with life’s final task of facing death.

Finally, beyond the story of individual development, there are socioculturally bound illusions and experiences of disillusionment. Freud returns to illusion and disillusion over and over, initially optimistic that psychoanalysis will expose both our private and our shared or group illusions, allowing us to operate with more conscious awareness of the libidinal and aggressive aspects of our inner drives and motivations. But with the onset of World War I, his optimism began to erode. In late 1914 and throughout the war, Freud had more open hours in the day for reflection and writing; many of his patients were off at war—as were three of his sons—Martin, Oliver, and Ernst. In July 1915, Freud dreamt that his sons had died, and the day after the dream he learned that Martin had indeed been wounded in the arm while fighting on the Russian front. Like many, Freud had hoped the war would be over in a matter of months, and grew more despairing as he realized that that was not to be. World War I involved human depravity at the intersection of science in an horrifically destructive way that shocked Europe. As Peter Gay (1988) notes, Freud’s “Thoughts for the Times on War and Death” was “an elegy for a civilization destroying itself” (p. 355). Here Freud had to confront the possibility that his hopes for what psychoanalysis could bring about on a grand social level might not be realized, a failure he attributed to the strength of the aggressive drive, which he would later expand to include the death drive. Here are Freud’s reflections (1915):

We welcome illusions because they spare us unpleasurable feelings, and enable us to enjoy satisfactions instead. We must not complain, then, if now and again they come into collision with some portion of reality, and are shattered against it.

Two things in this war have aroused our sense of disillusionment: the low morality shown externally by states which in their internal relations pose as the guardians of moral standards, and the brutality shown by individuals whom, as participants in the highest human civilization, one would not have thought capable of such behaviour [p. 279].

Finally, in the concepts of Lacan are additional psychoanalytic tools for thinking about the incurable wound, based on the structure of desire and language. For Lacan, “lack” (manqué) represents a type of failure or absence, and it is from the experience of lack that desire arises, giving hope that illusions are attainable. In this way illusions, fueled by narcissistic entitlement, replace what is felt to be missing yet essential for being. There is an impetus to cover lack with something or some idea, producing the illusion that there is no lack. This is what gives rise to a fetish, which is an attempt to undo or repair an incurable wound both in the body and in the mind. Another incurable wound is captured by the Lacanian concept of the “interrogative gap,” seen in psychotic states marked by hallucinations (Lacan 1946). Later, Lacan locates the gap as a gap in being, or a gap between humans and nature. There is also a permanent fissure or rupture that emerges between the sexes, and one that always exists between cause and effect, which Lacan terms a “primordial discord,” not restricted to but potentially implicated in certain psychopathological states (Evans 1996). This is by no means an exhaustive theoretical catalogue of the topic of illusion and disillusion, but should provide a sufficient framework for my discussion of the clinical material.

Suicide as the Failure to Sustain Disillusionment

Each suicidal person has her own developmental story. Collectively, these stories demonstrate that the suicidal state of mind is intricately tied to particular developmental tasks across the lifespan. One hypothesis is that suicide emerges when the normative partnership between disillusion and illusion becomes suffused with the refusal or inability to tolerate tension in this partnership, such that a delusion or pathological illusion of suicide evolves. The third vignette illustrates a concretely destructive illusion, that suicide will serve as a valuable communicative act to others, and will somehow be gratifying to the person who has died by suicide. Such destructive illusions are often based on the longing to have one’s suffering recognized. This vignette involves both a reparative and a destructive illusion working in tandem. The reparative aspect surrounds the illusion that the participant’s painful question of “why?” in relation to his girlfriend’s suicide will be satisfactorily addressed in their imagined postmortem conversation. The destructive illusion is his belief that his death will simultaneously punish both his father and his friends, toward whom he consciously directed a great deal of anger based on feelings that they had abandoned him at a critical time.

Research Interview Vignette 3

The research participant, in his late teens, had suffered several painful losses. His girlfriend had died by suicide seven months before his attempt; he felt that his father had been insufficiently attuned to the seismic nature of that loss because of his own series of personal crises. Here the participant speaks about what was in his mind the day he attempted suicide:

[I thought] if I died I’d be able to see her again. . . . I don’t believe in an afterlife—I’m an atheist—but at the same time I still . . . like I felt differently than I thought. . . . I just thought if I died I’d be like watching over. I felt as if I died I would be watching over and able to see what happened to my body, and I’d see my girlfriend again and I’d just be floating in a spirit world or something. . . . I wanted to see that people actually really cared about me and that they weren’t just laughing at me behind my back. . . . I wanted to see the effect on my father and on my girlfriend. . . . I wanted to see what she would say. . . . I’m sure she would ask me the same. She would probably be as confused.

In this interview the participant also spoke of his considerable anger toward friends and family members he felt had failed him in critical ways, and questioned whether he was loved. His ruminations on the ways he hoped his death would punish those who had left him disillusioned were accompanied by another fantasized illusion—that in death he would be able to find out who really loved him. Persecutory objects would be made to suffer, and idealized good objects would be revealed, confirming to the patient that he was also a good object in the minds of others. Thus, this participant hoped that his death by suicide would provide irrefutable evidence of both guilt and love. Such a trope of envy, revenge, guilt, reparation, and longing for lost love to be restored is perhaps most clearly explained in terms of object relations theory, where good and bad experiences are managed through splitting in order to protect good objects and good experiences from the destructive forces and contamination of bad objects and bad experiences.

While object relations theory addresses alterations in the internal object world and associated defenses, the interpersonal theory of suicide (Van Orden et al. 2010) proposes that external experiences serve as the catalyst for suicidal feelings, which are frequently associated with the oscillation between guilt (feeling oneself to be a burden, disappointment, or damaging to others) and envy and revenge (feelings arising in response to experiencing oneself as rejected and unloved). An integrative perspective recognizes that both external and conscious experiences interact with unconscious dynamics and long-standing object relations aspects of psychic life to create the perfect storm for suicide (Damsky et al. in press).

Through most of life disillusion and illusion are in creative but at times destructive tension with each other. For instance, disillusionment is often successfully repaired through a new illusion, while other illusions do not accomplish a reparative goal but instead are concretely destructive. Reparative illusions may restore hope in the future, or help the suicidal person identify subjectively felt reasons for living, protective factors against suicide. An illusion experienced by some suicidal individuals is that death is not final, but a route to some sort of satisfaction they believe will come to them through and after death. Either delusional or characterological grandiosity, and its correlate of utter shame when the grandiosity is shown to be false, may be implicated in suicidal states of mind. Suicide may be a grandiose, triumphal form of revenge, as seen in vignette 3, or an oscillation between grandiosity and abject shame, as in vignette 2, in which the participant felt grandiosely superior to others in her mind, and intolerably inferior when faced with the reality of her immature and unsatisfying social relationships. This internal conflict produced a type of confusion and pain that was difficult for her to tolerate, as the grandiose illusion could not hold, and the interpersonal and social disillusionment of reality was felt as a wound she could not survive. The participants in vignettes 1 and 3 believed that through suicide something would be attained or resolved through reunion or reparation; again, these fantasies are built around the illusion that death will end psychological pain but not necessarily the entirety of life, magically erasing the boundary between life and death and thereby undoing the final wound.

The incurable wound of separation and irreversible loss is a developmental challenge faced throughout the lifespan. Without early successes in recognizing and developing the capacity to symbolize and bear this wound of the gap or of separation, suicide may represent an attempt to achieve grandiose mastery, or to confirm the belief that psychic pain related to disillusionment and loss is too great to bear. In persons with attachment difficulties, early childhood adversity, or subjectively overwhelming experiences of trauma, internal object relations are fraught with persecutory experiences; grandiose efforts to repair or transcend loss; psychic retreats that foreclose further development; precarious defenses that distort reality in an effort to bear the resulting pain; and frantic efforts to rid the self of all object ties through massive dissociation, denial, or substance-induced alterations of consciousness. An encounter with “reality” sufficient to produce a sudden or particularly painful disillusionment produces a change that LaFarge (2015) has described as “like going off a cliff: the shift is abrupt and feels irreversible, and the newly discovered story feels discontinuous with the old one. This development bears the hallmarks of the paranoid-schizoid position, and splitting plays a key role in the preservation of a sense of the good self and the good object” (pp. 1226–1227). Here either benign or pathological illusions are a way to restore a sense of knowing or control, but the content and strength of the illusions may produce quite different outcomes, with destructive illusions potentially fueling a suicide crisis.

The Analyst’s Disillusionment

Analysts working with patients who are deliberating whether to live or to die are confronted also with their own sense of disillusionment—the limits of our science and our art, and the limits of interpersonal engagement which, at the edge of life, expose a gap or fissure between the living and the dying. Suicidal patients invite the analyst into a world of disillusionment in part to see if an other can bear it—standing in that precarious place without surrendering to delusion or premature restoration of an illusion, remaining present and vigilant for slippage in the capacity to be disillusioned and tolerating an exploration of how loss, disappointment, rage, fear, and hurt are implicated in the disillusioned state. Some therapists who have experienced the death of a patient by suicide speak of their own sense of personal and professional woundedness; others speak of a profound sense of disillusionment about psychodynamic treatment with seriously disturbed patients. (Tillman 2006). There is even a subset of therapists who report feeling that the patient has made a reasonable decision to die by suicide given the ineffectiveness of multiple modalities and trials of treatment. These clinicians have been colonized by the patient’s despair and disillusionment, and accept the corresponding illusion that the psychological pain of the patient will never end and cannot be escaped. Working with disillusioned patients while managing one’s own disillusionment about working with suicidal patients requires careful monitoring of countertransference feelings of despair, grandiosity, numbness, and resentment.

Conclusion

Disillusion and illusion are normative aspects of development and of daily life. They work together to facilitate psychological growth and creativity, and shape the encounter between the inner and outer world of possibility and limitation, optimally with fluidity and flexibility. Under certain conditions of rigidity, illusion and disillusion may become entrenched, mired in a fixed certainty about oneself, others, the world, or the future.

When the delicate balance of disillusion and its accompanying experience of grief and disappointment cannot be used for mourning, working through, and psychological growth, there is a risk of traveling down the alternative path of nihilism, cynicism, perversion, or even delusion, all of which foreclose the future. Suicide enacts this foreclosure, escaping the “incurable wound at the heart of everything,” either by ending what feels like unbearable psychic pain (disillusionment) or fulfilling grandiose fantasies of triumph or exemption (illusion). Disillusion may create the conditions for suicidal thinking, but it is often the refusal or inability to sustain disillusionment in response to loss or failure that stimulates the emergence of pathological illusions that propel a person into suicidal action. The partnership of illusion and disillusionment that works so adaptively and constructively in life becomes destructive in death.