Working in the Dark: Understanding the pre-suicide state of mind

by Donald Campbell, Rob Hale

Working in the Dark focuses on the authors’ understanding of an individual’s pre-suicide state of mind, based on their work with many suicidal individuals, with special attention to those who attempted suicide while in treatment. The book explores how to listen to a suicidal individual’s history, the nature of their primary relationships and their conscious and unconscious communications.

Campbell and Hale address the searing emotional impact on relatives, friends and those involved with a person who tries to kill themself, by offering advice on the management of a suicide attempt and how to follow up in the aftermath. Establishing key concepts such as suicide fantasy and pre-suicidal states in adolescents, the book illustrates the pre-suicide state of mind through clinical vignettes, case studies, reflections from those in recovery and discussions with professionals.

Working in the Dark will be of interest to social workers, probation officers, nurses, psychologists, counsellors, psychotherapists, psychoanalysts and doctors who work with those who have attempted suicide or are about to do so.

Genres: Psychology, Medicine, Psychoanalysis, Nonfiction

128 pages, Kindle Edition

Published March 16, 2017

Reviews

[Daphne · Rating 4 out of 5]

A psychoanalytic take on suicide and how to manage suicidality in the room with a patient. Interesting vignettes, incorporating psychoanalytic theory in suicide fantasies and talking about the collusion of the therapist with the patient. Found it interesting and enriching to the therapeutic work.

[Dovilė Stonė · Rating 5 out of 5]

In suicide, the unconscious fantasy often revolves around settling old scores from unfinished and unacknowledged battles of childhood. These are memories that reside in that part of the patient’s mind of which he is unaware and of which he has no understanding. Freud (1909) described these memories as ghosts which compulsively haunt the patient. ‘That which cannot be understood inevitably reappears; like an unlaid ghost that cannot rest until the mystery has been solved and the spell broken.'

The painful reality, which every therapist needs to come to terms with, is the fact that it is always within the patient’s power to kill themselves. [...] There may come a time in the therapy that the therapist has to communicate this reality to the suicidal patient. This statement to the patient in no way implies that the therapist does not care or condones suicide. On the contrary, it implies that the patient will only move on from the suicidal state of mind if the therapist can take the risk of letting the patient be responsible for his or her own life. Psychic change can only take place when the patient is free to act and the analyst is free to analyse. If either the patient or the analyst is operating under external pressure, coercion or moral blackmail, the best that can be hoped for is compliance rather than real permanent psychic change.

The word crisis has come to connote a situation with potential for danger; but the original meaning is broader – it is a turning point, a crossroads, a state of affairs in which a decisive change for better or for worse is imminent. The pre-suicide state of mind is a mind in crisis that is balanced between acting out a destructive fantasy or learning from the fantasy. Suicide may always remain an option for some suicidal individuals, but it is our belief that some resolution of the underlying conflicts will play a crucial part in reducing the suicidal potential.

[Travis Pieron · Rating 2 out of 5]

Emphasis on psychoanalysis and Freud. Not sure how helpful it is in practical terms for Crisis Prevention Intervention or addressing Suicidality. Depends on your theoretical orientation I suppose, however, if you are not knowledgeable about Freud's work not sure how helpful this would be for you.

[Adam Felix · Rating 2 out of 5]

I cannot in good conscience rate this book at more than 2, and that is why:

In therapy with patients who were searching for sexual reassignment surgery (SRS), we found that several of them had displaced their impulses to mutilate themselves onto surgeons, so that one component of their fantasy was self-mutilation by proxy. Both the self-mutilator and those mutilating by proxy projected rage against the mother onto the body. Perhaps paradoxically, these patients who were pursing SRS often identified the surgeon with their mother who they felt hated their masculine body.
Alessandra Lemma's (2015) clinical work with patients who requested SRS found that beneath the delusion that gender could, in fact, be assigned' surgically through SRS, these patients had found a way of representing, unconsciously, the incongruity of the subject's gender identity.

That's not the only paragraph that was a cause for my concern, albeit it is definitely the nail in the coffin.

As a psychologist and psychotherapy adept (studying the TFP approach) it's beyond my understanding to still in 2017 (!) write such crap in a book that actually didn't even need mentioning this point of view. It could have been easilly avoided, but
I guess someone felt the itch to share their believes. It could have been a great book.

This being said, I have learnt a lot of good stuff from this book, especially on the basics of why patients commit suicide and what to look out for. I can recommend some chapters.

[Sarinda Wijetunge · Rating 4 out of 5]

Deep, analytical understanding of the pre-suicidal state. Case studies included are helpful. I am glad the authors discuss the heavy emotional impact of this line of work, and am very grateful that experts like these exist to aid our understanding of a tragic phenomenon that has puzzled many a great mind for centuries. This book is not for the faint-hearted, however allows a healthcare professional working with distressed individuals a new perspective from experienced psychoanalysts. I wish I had read this years before.

[Miriam · Rating 5 out of 5]

Excellent and informative psychodynamic analysis of suicide, and to a lesser degree self-harm. Will come back and read this book again.

[Dyl · Rating 2 out of 5]

Interesting at points but very focussed on psychoanalysis and psychodynamic theory that wasn’t very well explained unless that’s your area of expertise