Abstract
The article draws from a personal clinical experience of two suicides, not far removed from each other in time. The first patient was a 33-year-old intellectual suffering from depression with narcissistic traits but no psychotic elements, while the second patient was a 21-year-old student with a manifest psychotic episode behind him and with characteristics of post-psychotic depression at the time of suicide. The two suicides had very different impacts on the therapist: the first left open some “space” for reflection, communication, and working-through, while the second closed such a “space,” leaving only a tiny door to the existential roots of human beings and suffering. The therapist was able to find some “shelter” by talking to supervisors, colleagues, and friends in the first case; in the second, the only possible “shelter” was glimpsed in the philosophy of groundlessness (Ungrund) of the Russian existentialist Nicolai Berdyaev. The personal experiences of the therapist, along with some theoretical interpretations of the after-effects of both suicides, are presented using a psychodynamic and existential–phenomenological understanding of the therapeutic relationship with a psychotic and a non-psychotic patient. The main dilemmas exposed by a patient’s suicide, especially if the patient suffers from psychosis, are difficult to deal with in the usual clinical settings and call for resources beyond it. The authors propose that these can be found in philosophical and theological insights.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
Psychotic core is a psychoanalytic concept, defined as a primitive organization of the mind—potentially present in every individual—with feelings of desintegration, dissociative and projective phenomena, and perplexity.
References
Alexander, D. A., Klein, S., Gray, N. M., Dewar, I. G., & Eagles, J. M. (2000). Suicide by patients: Questionnaire study of its effect on consultant psychiatrists. British Medical Journal, 320, 1571–1574.
Anderson, G. O. (2005). Who, what, when, where, how, and mostly why? A therapist’s grief over the suicide of a client. In K. M. Weiner (Ed.), Therapeutic and legal issues for therapists who have survived a client suicide: Breaking the silence (pp. 25–34). New York: The Haworth Press.
Berdyaev, N. A. (1932/1933). Jakob Böhmes Lehre von Ungrund und Freiheit. Blätter für Deutsche Philosophie, 6, 315–336.
Berdyaev, N. A. (1946). Spirit and reality. London: G. Bles.
Binswanger, L. (1956). Drei Formen missglückten Daseins. Verstiegenheit, Verschrobenheit, Maniriertheit. Tübingen: Max Niemeyer Verlag.
Binswanger, L. (1957). Schizophrenie. Pfullingen: Neske.
Bion, W. R. (1959). Attacks on linking. The International Journal of Psychoanalysis, 40, 308–315.
Bion, W. R. (1962). Learning from experience. London: Heinemann.
Bissell, B. P. H. (1981). The experience of the nurse therapist working with suicidal cases: A developmental study. Dissertation Abstracts International, 42(06), 2307B. doi:PublicationNo.AAT 8126678.
Brown, H. N. (1987). The impact of suicide on therapists in training. Comprehensive Psychiatry, 28, 101–112.
Bryce Boyer, L. (1989). Countertransference and technique in working with the regressed patient. The International Journal of Psychoanalysis, 70, 701–714.
Chemtob, C. M., Hamada, R. S., Bauer, G. B., Kinney, B., & Torigoe, R. Y. (1988). Patients’ suicides: Frequency and impact on psychiatrists. The American Journal of Psychiatry, 145, 224–228.
Chemtob, C. M., Bauer, G. B., Hamada, R. S., Pelowski, S. R., & Muraoka, M. Y. (1989). Patient suicide: Occupational hazard for psychologists and psychiatrists. Professional Psychology: Research and Practice, 20(5), 294–300.
Foley, S. R., & Kelly, B. D. (2007). When a patient dies by suicide: Incidence, implications and coping strategies. Advances in Psychiatric Treatment, 13, 134–138.
Gitlin, M. J. (1999). A psychiatrist’s reaction to a patient’s suicide. The American Journal of Psychiatry, 156(10), 1630–1634.
Goldstein, L. S., & Buongiorno, P. A. (1984). Psychotherapists as suicide survivors. American Journal of Psychotherapy, 38, 392–398.
Gorkin, M. (1985). On the suicide of one’s patient. Bulletin of the Menninger Clinic, 49(1), 1–9.
Grad, O. T., & Michel, K. (2005). Therapists as client suicide survivors. In K. M. Weiner (Ed.), Therapeutic and legal issues for therapists who have survived a client suicide: Breaking the silence (pp. 71–81). New York: The Haworth Press.
Grad, O. T., Zavasnik, A., & Groleger, U. (1997). Suicide of a patient: Gender differences in bereavement reactions of therapists. Suicide & Life-Threatening Behavior, 27, 379–386.
Grotstein, J. (1990). The “black hole” as the basic psychotic experience: some newer psychoanalytic and neuroscience perspectives on psychosis. The Journal of the American Academy of Psychoanalysis, 18(1), 29–46.
Hendin, H., Lipschitz, A., Maltsberger, J. T., Haas, A. P., & Wynecoop, S. (2000). Therapists’ reactions to patients’ suicides. The American Journal of Psychiatry, 157, 2022–2027.
Hillman, J. (1997). Suicide and the soul. Connecticut: Spring Publications.
James, D. M. (2005). Surpassing the quota: Multiple suicides in a psychotherapy practice. In K. M. Weiner (Ed.), Therapeutic and legal issues for therapists who have survived a client suicide: Breaking the silence (pp. 9–24). New York: The Haworth Press.
Kierkegaard, S. (1992). Concluding unscientific postscript to philosophical fragments. In H. V. Hong & E. Hong (Eds.), Kierkegaard’s writings, Vol. XII. Princeton: Princeton University Press.
Klein, M. (1975). Notes on some schizoid mechanisms. In M. Klein (Ed.), Envy and gratitude and other works (pp. 1946–1963). New York: Delacorte.
Kolodny, S., Binder, R. L., Bronstein, A. A., & Friend, R. L. (1979). The working-through of patients’ suicides by four therapists. Suicide & Life-Threatening Behavior, 9, 33–46.
Levinas, E. (1981). Otherwise than being or beyond essence. The Hague/Boston/London: Martinus Nijhoff Publishers.
Menninger, W. W. (1991). Patient suicide and its impact on the psychotherapist. Bulletin of the Menninger Clinic, 55(2), 216–227.
Ogden, T. H. (1980). On the nature of schizophrenic conflict. The International Journal of Psychoanalysis, 61, 513–533.
Ogden, T. H. (2004). The primitive edge of experience. London: Karnac Books.
Pao, P. N. (1979). Schizophrenic disorders: Theory and treatment from a psychodynamic point of view. Madison: International Universities Press.
Resnik, S. (2005). Glacial times. A journey through the world of madness. New York: Routledge.
Robbins, M. (1993). Experiences of schizophrenia. New York: The Guilford Press.
Rycroft, P. (2005). Touching the heart and soul of therapy: Surviving client suicide. In K. M. Weiner (Ed.), Therapeutic and legal issues for therapists who have survived a client suicide: Breaking the silence (pp. 83–94). New York: The Haworth Press.
Sass, L. A. (1994). The paradoxes of delusion. Wittgenstein, Schreber, and the schizophrenic mind. Ithaca and London: Cornell University Press.
Schlimme, J. E. (2005). Zur Phänomenologie der Suizidalität. Phänomenologische Forschungen, 2005, 269–284.
Searles, H. (1961). Schizophrenia and the inevitability of death. Psychiatric Quaterly, 35, 631–665.
Šinigoj, B. (2001). A philosopher for the time to come. The question of spirit and being in the philosophy of Nikolai Berdyaev. Logos. International multilingual electronic journal for culture and spirituality. http://www.kud-logos.si/LOGOS-2-2201/Sinigoj-Berdyaev-angl.htm.
Spiegelman, J. S., & Werth, J. L. (2005). Don’t forget about me: The experiences of therapists-in-training after a client has attempted or died by suicide. In K. M. Weiner (Ed.), Therapeutic and legal issues for therapists who have survived a client suicide: Breaking the silence (pp. 35–57). New York: The Haworth Press.
Weiner, K. M. (2005). Introduction: the professional is personal. In K. M. Weiner (Ed.), Therapeutic and legal issues for therapists who have survived a client suicide: Breaking the silence (pp. 1–7). New York: The Haworth Press.
Welz, C. (2008). Love’s transcendence and the problem of theodicy. Tübingen: Mohr Siebeck.
Winnicott, D. W. (1971). Playing and reality. New York: Basic Books.
Yalom, I. D. (1980). Existential psychotherapy. New York: Basic Books.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Skodlar, B., Welz, C. How a therapist survives the suicide of a patient—with a special focus on patients with psychosis. Phenom Cogn Sci 12, 235–246 (2013). https://doi.org/10.1007/s11097-011-9205-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11097-011-9205-3