Relating to Self-Harm and Suicide: Psychoanalytic Perspectives on Practice, Theory and Prevention

Relating to Self-Harm and Suicide: Psychoanalytic Perspectives on Practice, Theory and Prevention

Relating to Self-Harm and Suicide: Psychoanalytic Perspectives on Practice, Theory and Prevention

Relating to Self-Harm and Suicide: Psychoanalytic Perspectives on Practice, Theory and Prevention


Alessandra Lemma - Winner of the Levy-Goldfarb Award for Child Psychoanalysis!

Relating to Self-Harm and Suicidepresents original studies and research from contemporary psychoanalysts, therapists and academics focusing on the psychoanalytic understanding of suicide and self-harm, and how this can be applied to clinical work and policy.

This powerful critique of current thinking suggests that suicide and self-harm must be understood as having meaning within interpersonal and intrapsychic relationships, offering a new and more hopeful dimension for prevention and recovery. Divided into three sections, the book includes:

  • a theoretical overview
  • examples of psychoanalytic practice with self-harming and suicidal patients
  • applications of psychoanalytic thinking to suicide and self-harm prevention.

Relating to Self-Harm and Suicidewill be helpful to psychoanalytic therapists, analysts and mental health professionals wanting to integrate psychoanalytic ideas into their work with self-harmers and the suicidal. This text will also be of use to academics and professionals involved in suicidal prevention.


Peter Fonagy

Suicide is responsible for a staggering 1.5 per cent of the total global burden of disease. It represents 20 million years of lost healthy life attributable to either premature death or permanent disability. It is one of those rare disorders where prevalence does not follow the usual lines of socioeconomic determinism. The risk of dying from suicide for whites is more than double that for blacks (Hoyert et al. 2006). The highest rates of suicide are in Eastern Europe where ten countries have suicide rates in excess of 27 per 100,000 population. This compares to a rate of 10–12 in other Western countries, including the United States (Centers for Disease Control and Prevention 2005). Of course these figures shrink almost into insignificance when compared to the rate of suicide attempts, which is around half a per cent a year, and suicidal ideation which is 3.3 per cent (Kessler et al. 2005). The size of the human tragedy associated with suicide is immense. Even in economic terms it has been estimated that in the United States alone suicidality is associated with nearly $12 billion lost income (Goldsmith et al. 2002). In the UK, each day two children or adolescents take their own lives, and each year 16,000 make an attempt at suicide. In UK inner-city areas suicidal ideation is reported in over 40 per cent of the population.

What do we know about the causes of suicide? Most formulations distinguish between factors that predispose and those that trigger (Mann 2002). In most Western countries suicide is strongly associated with psychiatric disorder, particularly mood disorders, which are associated with over half of suicides. Stressful life events are also correlates but clearly this is not the whole picture. Physical illness, age and gender are also strongly related to suicidal risk, as are factors such as substance misuse, the availability of lethal means, media models of suicidal acts, a sense of hopelessness and pessimism, impulsivity and attitudes to suicide (Mann 2002). A particularly striking fact about suicide is how closely related it is to being offered and receiving care. Eighty-three per cent of suicides have had contact with a doctor within a year of their death and 66 per cent within the last month of their life (Andersen et al. 2000; Luoma et al. 2002). This highlights the ambivalence inherent in the suicidal act, the pull from the . . .

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