‘The Cord of Life’ - Not Waving, but Drowning: On David Malan's Anorexia, Murder and Suicide: What Can Be Learned from the Tories of Three Remarkable People

David Malan is best known for the workshop he set up together with Michael Balint as a consultant at the Tavistock clinic in the 1960s to develop a model of short-term focal psychotherapy which he described in his seminal book A Study of Brief Psychotherapy (Malan, 1963). Another book Individual Psychotherapy and the Science of Psychodynamics became a favourite textbook on psychotherapy trainings in the 1980s. More recently (1997), he has published a study of anorexia, murder and suicide, three conditions which he considers are ‘among the most difficult, dangerous and alarming conditions therapists are likely to be confronted with’ (1997, p. 1). This book is based on three cases from his clinical practice, each of whom he has followed up for more than 20 years, and which for him have a number of themes in common, namely ‘destruction and self-destruction, instinctual needs of enormous intensity, defended against by control and self-punishment’, and the action of what he calls ‘the two cords, pulling in opposite directions, the Cord of Life and the Cord of Death’ (p. 1). Two other themes with patients of this kind he lists as ‘the use of life experience’ and ‘management and not just understanding’. He recommends the use of psychodynamic psychotherapy as a treatment combined with psychiatry and medication, a flexible interdisciplinary approach, offering psychiatric, medical and analytic techniques with the overall aim of a ‘transformation of self-destructiveness into constructive use of experience, developing the capacity for self-analysis, and bringing about a change from compulsion to free choice, from ought to want’ (p. 90).

I want to focus on the book's final section about suicide which starts off by emphasizing that for the patient to be relieved of the need for suicide in