Abstract
This book seems initially small in size when one picks it up to read it. As one begins to delve into its pages, the authors’ inquiring minds and extensive clinical experience coupled with in depth psychoanalytic insights is immediately apparent. Through the authors’ multiple encounters with pre-suicidal patients, an in depth exploration of the suicidal mental pathway takes place in an attempt to illuminate clinicians through these very dark processes of the mind. Understanding what constitutes an extremely complex psychological process that can lead a patient to a pre-suicidal state of mind and eventually to one’s suicide provide a beacon of light and hope for the clinicians’ darkest moments when they lose a patient via suicide.
The suicidal patient’s fundamental anxieties are described and explored in depth as well as suicidal phantasies. The mind’s pathway towards plotting one’s own murder is beautifully described together with how, through the transference and countertransference process, the clinician can enter a sadomasochistic relationship with the patient and unconsciously become the patient’s own executioner. The clinical examples offered are clear, poignant and powerful. They reminded me of my own encounters with some of my patients as well as my own responses to patients’ suicides over the years of my psychiatric career.
The authors draw theories and concepts from psychoanalysis and the dyadic situation and mainly make use of the core complex (Glasser, 1979) in making a psychoanalytic formulation of the suicidal process. I had the privilege of meeting one the authors (Hale) when he was director of the Portman Clinic, working with him on a study of follow up of parasuicide to completed suicide (Jenkins et al., 2002). Some years later I was therefore not surprised to find out that this author with such wisdom, passion in his clinical work and in depth psychoanalytic knowledge, produced such a wonderful book about suicide. I felt very proud indeed to have been given as a present this book by Rob Hale when it was first published.
Finally whilst I believe that this book should occupy every clinician’s library and be read again and again in small parts in order to be fully understood and taken in, I also believe that it partially lacks the wider dimension of discourse that group analytic thinking could offer in the psychopathology of the suicidal process. I believe that there is scope for group analysis to make significant contributions in this domain as suicide in my opinion is not a dyadic or triadic process but a group event which arises out of the location of disturbance in a group and then impacts another group, the group of clinicians, family institution and society when it occurs. Social unconscious power dynamics of why some people kill themselves when others do not, as well as location of disturbance might be some of the group analytic ideas that could be explored in the contribution of a suicidal act. Until then, this book is a must have for all group analytic trainees and group analysts who have undoubtedly at some point in their career encountered the death of a patient by suicide or even the death of a colleague.
