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An Empirical Study of the Psychodynamics of Suicide

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Grady Health System

Susan L. Reviere

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine

Susan E. Chance

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Georgia State University

James H. Rogers

Georgia State University

Carrie A. Hatcher

University of Michigan

Frances Wasserman

Lisa Smith

Forensic Service at Georgia Regional Hospital

Salley Jessee

Emory University Psychoanalytic Institute

Mark E. James

Emory University Psychoanalytic Institute and an adjunct faculty member in the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine

Beth Seelig

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, and a Training and Supervising Analyst, Emory University Psychoanalytic Institute

Nadine J. Kaslow

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Grady Health System, Nkaslow{at}emory.edu

This paper presents results from an empirical study of four key psychodynamic concepts (self-directed aggression, object loss, ego functioning disturbance, pathological object relations) of suicidal behavior. The sample consists of hospitalized psychiatric patients following a suicide attempt (attempters: n = 52) and demographically similar hospitalized psychiatric patients with no history of suicidal behavior (controls: n = 47). The study was designed to ascertain whether attempters differed from matched psychiatric control patients on the four psychodynamic constructs hypothesized to be associated with suicide. It was predicted that attempters would manifest higher levels of depression and self-targeted anger, a more significant history of loss, less adaptive defenses, and more primitive object representations. Results strongly supported an object-relational view of suicidal behavior. In addition, support for the loss hypothesis was found in the identification of one specific constellation of losses. Namely, attempters were significantly more likely to report a history of childhood loss combined with a recent loss in adulthood than were their nonattempter counterparts. Limited support was provided for the other two hypotheses in differentiating suicidal from nonsuicidal severely ill psychiatric patients. This unexpected finding is examined and suggestions are made for the refinement and greater specification of psychodynamic theories regarding the etiology of suicidal behavior, with the aim of differentiating individuals prone to such action from those with similar psychopathology and dynamic issues who do not actually attempt suicide. Limitations of the study are discussed and implications of the findings for the theory and treatment of suicidal behavior are offered.

Journal of the American Psychoanalytic Association, Vol. 46, No. 3, 777-796 (1998)
DOI: 10.1177/00030651980460030701


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