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I think that, lacking fundamental emotional engagement with my
mother, I had been suicidal at some level since my childhood. The
children of the family were not encouraged to express or share emotion,
and any negative feelings were greeted with impatience or outright
anger, with only intermittent and unpredictable parental affection
shown

There is frequently a kind of inner peace and a sense of
control that accompanies the formation of a suicide plan. Any sudden
change in the patient’s affective state towards a relaxation or calm,
rather than necessarily being an indication of improvement, should alert
the practitioner that the patient may have formulated a suicide plan.

Many suicidal
patients suffer from poor self-esteem, are severely self-critical and feel
themselves to be failures. An actual failure, for example getting sacked
or failing an examination, is a danger signal because it is experienced as
confirmation by the outside world of what the patient feels about himself.

Two months before Mr Adams’ suicide attempt, his mother had tried to
kill herself by taking a massive overdose. Actual or attempted suicide by
a parent or close relative may well precipitate a suicide attempt by a
spouse, son or daughter.

The patient who habitually deals with internal conflicts via
external action will be more vulnerable to acting on a suicidal impulse
when he is unable to make use of the activity that provides relief

A split-off part
of the child identifies with the aggressor, the mother, who they feel has
abandoned them to die or intrusively dominated them with inappropriate
feeds. In this unconscious state of mind the body, representing a bad,
greedy child-self, is attacked. The most severe cases of eating disorders,
like anorexia nervosa and bulimia, are covertly suicidal

persistent anxiety about abandonment or engulfment by
mother may arouse irreconcilable hostility towards the mother and lead
the adolescent girl to attack the mother’s sadistic feeding behaviour by
taking over the feeding function, controlling intake, or actively rejecting
food by refusing to eat or vomiting what has been taken in.

Adolescence is also a time of action as the
adolescent experiments with new behaviour and exercises omnipotent
fantasies. When the adolescent’s body is experienced as the source of
maddening thoughts and feelings, it may become the target of an active
attack in the form of cutting and suicide, or more covert suicide in
anorexia nervosa.

The child wants to rob his parents of their greatest and most precious
possession, his own life. The child knows that thereby he will inflict the
greatest pain. Thus, the punishment the child imposes upon himself is
simultaneously punishment he imposes on the instigators of his
sufferings’ (

The Oedipal girl is faced with a different task, namely, to change the
object of desire from mother to father. In so doing, her link to the primary
object is severed with the resultant anxieties of separation and retaliation

As we will emphasise in Chapter 8, ‘Pre-suicide states in adolescence’,
when the boy is unable to identify with his father in a way that supports
his masculine identity, the boy may encounter difficulties in separating
from his mother and establishing a separate and independent existence

In a narcissistic regression, which dominated our patients during the
pre-suicide state, there is the prospect of imminently fulfilling a merging
suicide fantasy. As far as these patients were concerned, they were
already at peace because they had crossed a rational barrier of selfpreservation, identified the assassin/mother with their body, and had no
doubts about killing it.

(It is also relevant that the most common drugs taken in overdose are
either analgesics – pain killers – or psychotropic medication – psychic
painkillers. Moreover, it has recently been established that both physical
pain and psychological pain stimulate the same part of the brain.)

He told me that when he
went to a casino he often started with a little money but soon won
thousands, only to lose it all at the end of the night. (It is interesting that
compulsive gamblers often say that they only feel safe when they have
lost all their money – perhaps in fear of an Oedipal triumph.)

Although there are different types of suicide fantasies (see Maltsberger
& Buie, 1980; Campbell & Hale, 1991) each fantasy is underpinned by
a wish for the ‘surviving self’ to merge with an idealised maternal
imago.

The frequent conscious thought in the revenge
fantasy is, ‘They will be sorry’. The implicit message is that the parents
have raised a child who hates himself because they did not love him
enough. The threat of suicide to blackmail others may accompany the
revenge fantasy.

Do you intend to
commit suicide?’ is unreliable and should not, on its own, be used to
downgrade the risk of suicide. Needless to say, feelings of guilt and
shame, the need to protect suicide as an escape or solution, or the power
of repression make it difficult to discover suicide fantasies

The soul that should not have
been born”

From the earliest
period of development, the child develops complex and often subtle
means of signalling its wishes to the mother, who usually responds
appropriately to satisfy the child’s needs. However, too much or too
little gratification increases the child’s pain, anxiety and aggression, the
blame for which is defensively projected onto the mother

Conrad did not have a sufficiently satisfying affective
relationship with his mother, which left him in a state of narcissistic
depletion that was often felt in his body. ‘The absence of pleasurable
bodily experiences which can be registered at a psychic level creates an
unbridgeable gap or hole in the nascent sense of self that can only be
“covered over” by the use of [the] primitive defences of splitting

One consequence of this process is the breakdown of the object as a
perceptually complete and emotionally balanced whole into a fragmented
and unintegrated part object. The failure to distinguish between self and
non-self (Stern, 1985) may lead to a breakdown in a person’s orientation
to reality, as in psychosis or psychotic-like states,

For our purposes we are mainly concerned with the way the
subject’s body can: 1) come to be perceived as an object that is separate
from the self (a non-self), and 2) that the subject can split off and project
unacceptable aspects of itself into this non-self body (see Klein, 1935).

When these patients reached the point at
which they intended to kill themselves, they experienced their body as a
separate object.

For many despairing
individuals, suicide is the secretly held trump card, which they are
reluctant to give up because they believe, on the one hand, that it will
allow them to triumph over internal adversity, and, on the other hand, to
triumph over others

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.

Because
he knows no other solution by which he can escape his inner conflicts,
the patient is forced to create anew the same scenario in a different
setting. This is the essence of what Freud referred to as ‘repetition
compulsion’ (Freud, 1914)

We understand the suicidal act as fundamentally a solution to internalised
conflicts associated with the primary caretakers of childhood, which are
largely unconscious.