You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
Working primarily within the National Health Service with patients of high risk of suicide in complex secondary care, I looked forward very much to reading this book. The two authors are extremely experienced psychoanalysts who have gathered together their understanding of the pre-suicide state of mind, and suicidal acts, over long careers working in secondary mental health care within the NHS. Their stated hope is that the book will convince the reader of the usefulness of the psychoanalytic model, both in general mental health settings and in specialist psychotherapy services, and it is written to be accessible to healthcare professionals from any discipline. I certainly found this to be the case, and the book is wonderfully illuminating for the task many of us face, ‘working in the dark’.
The book is divided into chapters that delve into various aspects of the suicidal state of mind, covering both an extensive and comprehensive psychoanalytic formulation of how we might understand a suicidal act (with special mention at the start of the centrality of Freud's ‘Mourning and Melancholia’ paper), to the countertransference experience particular to pre-suicide, the ten danger signals of the pre-suicidal state, and the practical management and containment of the aftermath of a suicide attempt. It is a condensed book, offering both theoretical containment and practical containment, reflecting something perhaps of the mind/body split in the central suicide fantasy. There is also a chapter on self-mutilation/self-harm as distinct from the suicidal state of mind.
At times the language can feel a little convoluted and distancing; I struggled at times to recognize the enormous psychic and emotional pain of some of my own high risk cases, where the creation of a state of physical pain is seen as preferable to emotional pain. In my own experience of suicidal patients, the chosen method of suicide is often hugely informative for a deeper understanding of the unconscious suicide