A Note on Suicide

I treated a schizoid girl of twenty who had made six serious, and a number of half-hearted attempts at suicide, usually by taking luminal, one tablet at a time, over a period of about twenty-four hours. She was in a state of extreme emotional rigidity and depersonaliza-tion, which she could dispel only with the help of luminal. She had intense guilt about taking it, the first few tablets symbolizing all her guilty instinctual impulses. (Oral greed, masturbation, etc.) She was by then overwhelmed with this guilt and the tablets she took later on represented the punishment. She sentenced herself to death by suicide, but always allowed herself to be saved. At the last moment she told someone what she had done and was usually sent to a nursing home, which she dreaded, since for her it symbolized a prison in mitigation of the death sentence. These events went on for about five years during which time she had been under the care of many doctors and psychiatrists and had been in several institutions. Her medical care had cost her family a great deal of money which they could ill afford. She hurt her parents in their most vulnerable spots. She shook her mother's faith in herself as a mother, and injured her father financially.

Whenever she made a suicidal attempt, she was overwhelmed by guilt, largely because of her parents' recriminations. She told me repeatedly how heart-broken they would be over her death. I had had some contact with her parents and gained the impression that they had great difficulty in controlling their increasing hostility towards the girl. Her excessive guilt towards her parents was a defense against the realization that they might be relieved at her death. She wanted to kill herself before their hostility became obvious.

In every case of suicidal impulses, we should pay particular attention to the latent hostility of the family and the patient's unconscious awareness of it. If this is consciously expressed on either part, it is less dangerous. The gir