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6 - Psychodynamic approaches to youth suicide

Published online by Cambridge University Press:  04 December 2009

Robert A. King
Affiliation:
Professor of Child Psychiatry and Psychiatry, Yale Child Study Center, 230 South Frontage Road, POB 207900, New Haven, CN 06511 USA e-mail: [email protected] tel: +1-203-785-5880, fax: +1-203-737-5104
Robert A. King
Affiliation:
Yale University, Connecticut
Alan Apter
Affiliation:
Tel-Aviv University
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Summary

Introduction

The psychodynamic perspective seeks to understand the meaning of suicidal behavior in terms of feelings, motives, and their conflicts, in the context of past and present interpersonal relationships. For example, in looking at the immediate experiential antecedents of suicidal action, we may ask, what are the intolerable affects from which suicide is a perceived means of escape? What kinds of internal or external events serve to trigger suicidal feelings and behavior and what is their significance in the broader context of the suicidal youngster's life? The psychodynamic approach is also a developmental one that attempts to understand the origins of the vulnerability to suicide and depression in the related developmental vicissitudes of the capacity for self-care and comfort, the ability to develop, sustain and make use of protective affiliations; and the regulation of self-esteem (King and Apter, 1996). Finally, the psychodynamic perspective seeks clues as to how the challenges of a given developmental epoch, such as adolescence, may confer a particular vulnerability to suicidal behavior. The psychodynamic approach to suicide is thus intended not to supplant but to complement the biological, sociological, and nosological approaches to suicide.

The earliest psychoanalytic attempts to understand suicide came early in the twentieth century against the background of a perceived epidemic of youth suicide in Germany and Austria (Neubauer, 1992). Much as in our own day, lay writers sought to blame the schools and the decline of family and social values, while medical writers looked for hormonal defects or “hereditary taints.”

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Publisher: Cambridge University Press
Print publication year: 2003

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References

Adams, K. S. (1990). Environmental, psychosocial, and psychoanalytic aspects of suicidal behavior. In Blumenthal, S. J., and Kupfer, D. J. (eds.) Suicide over the Life Cycle: Risk Factors, Assessment, and Treatment of Suicidal Patients (pp. 39–96). Washington DC: American Psychiatric Press
Ainsworth, M. D. S., Blehar, M. C., Waters, E., and Wall, S. (1978). Patterns of Attachment: A Psychological Study of the Strange Situation. Hillsdale, NJ: Erlbaum
Apter, A., Bleich, A., King, R. A., Kron, S., Fluch, A., Kotler, M., and Cohen, D. J. (1993). Death without warning? A clinical postmortem study of suicide in 43 Israeli adolescent males. Archives of General Psychiatry, 50, 138–142Google Scholar
Apter, A., Gothelf, D., Orbach, I., Weizman, R., Ratzoni, G., Har-Even, D., and Tyano, S. (1995). Correlation of suicidal and violent behavior in different diagnostic categories in hospitalized adolescent patients. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 912–918Google Scholar
Arieti, S., and Bemporad, J. R. (1980). The psychological organization of depression. American Journal of Psychiatry, 137, 1360–1365Google Scholar
Baumeister, R. F. (1990). Suicide as escape from Self. Psychological Review, 97, 90–113Google Scholar
Beautrais, A. L. (2001). Child and young adolescent suicide in New Zealand. Australian and New Zealand Journal of Psychiatry, 35(5), 647–653Google Scholar
Beautrais, A. L., Joyce, P. R., and Mulder, R. T. (1997). Precipitating factors and life events in serious suicide attempts among youths aged 13 through 24 years. Journal of the American Academy of Child and Adolescent Psychiatry, 36(11), 1543–1551Google Scholar
Beck, A. T. (1983). Cognitive therapy of depression: new perspectives. In Clayton, P. J. and Barrett, J. E. (eds.) Treatment of Depression: Old Controversies and New Approaches. New York, NY: Raven Press
Berkow, I. (1995). An athlete is dead at 17 and no one can say why. The New York Times. October 1, 1995, Sports section, pp. 1 and 7
Bibring, E. (1953). The mechanism of depression. In Greenacre, P. (ed.) Affective Disorders (pp. 13–48). New York, NY: International University Press
Blatt, S. J. (1995). The destructiveness of perfectionism: implications for the treatment of depression. American Psychologist, 50, 1003–1020Google Scholar
Blatt, S. J., and Homann, E. (1992). Parent–child interaction in the etiology of dependent and self-critical depression. Clinical Psychology Review, 12, 47–91Google Scholar
Blatt, S. J., Schaffer, C. E., Bers, S. A., and Quinlan, D. M. (1992). Psychometric properties of the Depressive Experiences Questionnaire for Adolescents. Journal of Personality Assessment, 59, 82–98Google Scholar
Blatt, S. J., Hart, B., Quinlan, D. M., Leadbeater, B., and Auerbach, J. (1993).Interpersonal and self-critical dysphoria and behavioral problems in adolescents. Journal of Youth and Adolescence, 22, 253–269Google Scholar
Blatt, S. J., Zuroff, D. C., Bondi, C. M., Sanislow, C. A. III, and Pilkonis, P. A. (1998). When and how perfectionism impedes the brief treatment of depression: further analyses of the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Journal of Consulting and Clinical Psychology, 66(2), 423–428Google Scholar
Bowlby, J. (1973). Attachment and Loss, vol. II, Separation. New York, NY: Basic Books
Bowlby, J. (1980). Attachment and Loss, vol. III, Loss, Sadness and Depression. New York, NY: Basic Books
Brown, G. P., Hammen, A, Craske, M. G., and Wickens, T. D. (1995).Dimensions of dysfunctional attitudes as vulnerabilities to depressive symptoms. Journal of Abnormal Psychology, 104(3), 431–435Google Scholar
Brown, G. W., Harris, T. O., and Bifulco, A. (1986). Long-term effects of early loss of parent. In Rutter, M., Izard, C. E., and Read, S. B. (eds.) Depression in Young People: Developmental and Clinical Perspectives (pp. 251–296). New York, NY: Guilford
Burge, D., Hammen, C., Davila, J., and Daley, S. E. (1997a). The relationship between attachment cognitions and psychological adjustment in late adolescent women. Development and Psychopathology, 9(1), 151–167Google Scholar
Burge, D., Hammen, C., Davila, J., Daley, S. E., et al. (1997b). Attachment cognitions and college and work functioning two years later in late adolescent women. Journal of Youth and Adolescence, 26, 285–301Google Scholar
Carlson, E. A., and Sroufe, L. A. (1995). Contributions of attachment theory to developmental psychopathology. In Cicchetti, D., and Cohen, D. J., (eds.) Developmental Psychopathology, vol. 1, Theory and Methods (pp. 581–617). New York, NY: John Wiley and Sons
Clark, D. C., Sommerfeldt, L., and Schwarz, M., et al. (1990). Physical recklessness in adolescence: trait or byproduct of depressive/suicidal states?The Journal of Nervous and Mental Disease, 178, 423–433Google Scholar
Cohen-Sandler, R., Berman, A. L., and King, R. A. (1982a). A Follow-up Study of Hospitalized Suicidal Children. Journal of the American Academy of Child Psychiatry, 21, 389–403Google Scholar
Cohen-Sandler, R., Berman, A. L., and King, R. A. (1982b). Life stress and symptomatology: determinants of suicidal behavior in children. Journal of the American Academy of Child Psychiatry, 21, 178–186Google Scholar
Conwell, Y. (2001).Suicide in later life: a review and recommendations for prevention. Suicide and Life-Threatening Behavior, 31(Suppl.), 32–47Google Scholar
Daley, S. E., Hammen, C., Burge, D., Davila, J. et al. (1997). Predictors of the generation of episodic stress: a longitudinal study of late adolescent women. Journal of Abnormal Psychology, 106(2), 251–259Google Scholar
Dean, P. J., and Range, L. M. (1999). Testing the escape theory of suicide in an outpatient clinical population. Cognitive Therapy and Research, 23(6), 561–572Google Scholar
Dean, P. J., Range, L. M., and Goggin, W. C. (1996). The escape theory of suicide in college students: testing a model that includes perfectionism 138. Suicide and Life-Threatening Behavior, 26(2), 181–186Google Scholar
Dycian, A. (1995). Suicide in the Israeli Military – trends and changes [Abstract]. Paper presented at the International Conference on Understanding Youth Suicide, Tel Aviv, August 30, 1995
Faazia, N. (2001). Dependency, self-criticism and suicidal behavior. Unpublished Master's Thesis, University of Windsor, Windsor, Ontario
Freud, A. (1958). Adolescence. Psychoanalytic Study of the Child, 13, 255–278Google Scholar
Freud, A. (1965). Normality and Pathology in Childhood: Assessments of Development. New York, NY: International University Press
Freud, S. (1917). Mourning and Melancholia. The Standard Edition of the Complete Psychological Works of Sigmund Freud, 14, 289–300Google Scholar
Freud, S. (1923). The Ego and the Id. The Standard Edition of the Complete Psychological Works of Sigmund Freud, 19, 12–59Google Scholar
Apter, P. (ed.) (1967). On Suicide: With Particular Reference to Suicide Among Young Students. Discussions of the Vienna Psychoanalytic Society – 1910. New York, NY: International University Press
Gould, M. S., King, R., Greenwald, S., Fisher, P., Schwab-stone, M., Kramer, R., Flisher, A. J., Goodman, S., Canino, G., and Shaffer, D. (1998). Psychopathology associated with suicidal ideation and attempts among children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 915–923Google Scholar
Green, A. H. (1978). Self-destructive behavior in battered children. American Journal of Psychiatry, 135, 579–582Google Scholar
Hamachek, D. E. (1978). Psychodynamics of normal and neurotic perfectionism. Psychology, 15, 27–33Google Scholar
Hammen, C. (2000). Interpersonal factors in an emerging developmental model of depression. In Johnson, S. L., Hayes, A. M., et al. (eds.) Stress, Coping, and Depression (pp. 71–88). Mahwah, NJ: Lawrence Erlbaum Associates
Hammen, C., Ellicott, A., Gitlin, M., and Jamison, K. R. (1989). Sociotrophy/autonomy and vulnerability to specific life events in patients with unipolar and bipolar disorder. Journal of Abnormal Psychology, 98, 154–160Google Scholar
Hawton, K., Cole, D., O'Grady, J., and Osborn, M. (1982). Motivational aspects of deliberate self-poisoning in adolescents. British Journal of Psychiatry, 141, 286–291Google Scholar
Hawton, K., Simkin, S., Fagg, J., and Hawkins, M. (1995). Suicide in Oxford University Students, 1976–1990. British Journal of Psychiatry, 166, 44–50Google Scholar
Hendin, H. (1991). Psychodynamics of suicide, with particular reference to the young. American Journal of Psychiatry, 148, 1150–1158Google Scholar
Herzberg, D. S., Hammen, C., Burge, D., Daley, S. E., Apter, J., and Lindberg, N. (1999). Attachment cognitions predict perceived and enacted social support during late adolescence. Journal of Adolescent Research, 14(4), 142387–404Google Scholar
Hewitt, P. L., and Flett, G. L. (1991). Perfectionism in the self and social contexts: conceptualization, assessment, and association with psychopathology. Journal of Personality and Social Psychology, 60, 456–470Google Scholar
Hewitt, P. L., and Flett, G. L. (1993). Dimensions of perfectionism, daily stress, and depression: a test of the specific vulnerability hypothesis. Journal of Abnormal Psychology, 102, 58–65Google Scholar
Hewitt, P. L., Flett, G. L., and Turnbull-Donovan, W. (1992). Perfectionism and suicide potential. British journal of clinical psychology, 31(2), 181–190Google Scholar
Hewitt, P. L., Flett, G. L., and Weber, C. (1994). Dimensions of perfectionism and suicide ideation. Cognitive Therapy and Research, 18, 439–460Google Scholar
Hewitt, P. L., Newton, J., Flett, G. L., and Callender, L. (1997). Perfectionism and suicide ideation in adolescent psychiatric patients. Journal of Abnormal Child Psychology, 25, 95–101Google Scholar
Jessor, R. (1991). Risk behavior in adolescence: a psychosocial framework for understanding and action. Journal of Adolescent Health, 12, 597–605Google Scholar
Kernberg, O. F. (1975). Borderline Conditions and Pathological Narcissism. New York, NY: Jason Aronson
Khantzian, E. J., and Mack, J. E. (1983). Self-preservation and the care of the Self. Psychoanalytie Study of the Child, 38, 209–232Google Scholar
Kienhorst, I. C. W. M., DeWilde, E. J., Diekstra, R. F. W., and Wolters, W. H. G. (1995). Adolescents' image of their suicide attempt. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 623–628Google Scholar
King, R. A. (1990). Child and adolescent suicide. In Michels, R. (ed.) Psychiatry, vol. 2. Philadelphia, PA: Lippincott Co
King, R. A. (2002). Adolescence. In Lewis, M. (ed.) Comprehensive Textbook of Child and Adolescent Psychiatry, 3rd edn. (pp. 332–342). Baltimore, MD: Lippincott Williams and Wilkins
King, R. A., and Apter, A. (1996). Psychoanalytic perspectives on adolescent suicide. Psychoanalytic Study of the Child, 51, 491–511Google Scholar
Koestner, R., Zuroff, D. C., and Powers, T. A. (1991). Family origins of adolescent self-criticism and its continuity into adulthood. Journal of Abnormal Psychology, 100, 191–197Google Scholar
Kuperminc, G. P., Blatt, S. J., and Leadbeater, B. J. (1997). Relatedness, self-definition, and early adolescent adjustment. Cognitive Therapy and Research, 21(3) 301–320Google Scholar
Leadbeater, B. J., Blatt, S. J., and Quinlan, D. M. (1995). Gender-linked vulnerabilities to depressive symptoms, stress, and problem behaviors in adolescents. Journal of Research on Adolescence, 5(1), 1–29Google Scholar
Lewis, N. A. (1996). Military strives to reduce a relatively low suicide rate. The New York Times, May 19, p. 18
Lieblich, A. (1981). Kibbutz Makom. New York, NY: Pantheon Books
Luthar, S., and Blatt, S. J. (1995). Differential vulnerability of dependency and self-criticism among disadvantaged teenagers. Journal of Research on Adolescence, 5(4), 431–449Google Scholar
Main, M., and Goldwyn, R. (1989). Adult Attachment Rating and Classification System. Unpublished scoring manual, Department of Psychology, University of California, Berkeley, CA
Negron, R., Piacentini, J., Graae, F., Davies, M., and Shaffer, D. (1997). Microanalysis of adolescent suicide attempters and ideators during the acute suicidal episode. Journal of the American Academy of Child and Adolescent Psychiatry, 36(11), 1512–1519Google Scholar
Neubauer, J. (1992). The Fin-de-Siecle Culture of Adolescence. New Haven, CN: Yale University Press
Orbach, I. (1988). Children Who Don't Want to Live. San Francisco, CA: Jossey-Bass
Orbach, I. (1994). Dissociation, physical pain, and suicide: a hypothesis. Suicide and Life-Threatening Behavior, 24(1), 68–79Google Scholar
Orbach, I., Lotem-Peleg, M., and Kedem, P. (1995). Attitudes towards the body in suicidal, depressed, and normal adolescents. Suicide and Life-Threatening Behavior, 25, 211–221Google Scholar
Orbach, I., Palgi, Y., Stein, D., Har-Even, D., Lotem-Peleg, M., Asherov, J., and Elizur, A.(1996a). Tolerance for physical pain in suicidal subjects. Death Studies, 20(4), 327–341Google Scholar
Orbach, I., Stein, D., Palgi, Y., Asherov, J., Har-Even, D., and Elizur, A. (1996b). Perception of physical pain in accident and suicide attempt patients: self-preservation vs self-destruction. Journal of Psychiatric Research, 30(4), 307–320Google Scholar
Orbach, I., Mikulincer, M., King, R., Cohen, D., Stein, D., and Apter, A. (1997). Thresholds and tolerance of physical pain in suicidal and non-suicidal patients. Journal of Consulting and Clinical Psychology, 65, 646–652Google Scholar
Orbach, I., Mikulincer, M., Blumenson, R., Mester, R., and Stein, D. (1999). The subjective experience of problem irresolvability and suicidal behavior: dynamics and measurement. Suicide and Life-Threatening Behavior, 29(2), 150–164Google Scholar
Orbach, I., Stein, D., Shan-Sela, M., and Har-Even, D. (2001). Body attitudes and body experiences in suicidal adolescents. Suicide and Life-Threatening Behavior, 31(3), 237–249Google Scholar
Osgood, N. J., and Thielman, S. (1990). Geriatric suicidal behavior: assessment and treatment. In Blumenthal, S. J., and Kupfer, D. J. (eds.) Suicide Over the Life Cycle: Risk Factors, Assessment, and Treatment of Suicidal Patients (pp. 39–96). Washington DC: American Psychiatric Press
Priel, B., and Shahar, G. (2000). Dependency, self-criticism, social context and distress: comparing moderating and mediating models. Personality and Individual Differences, 28(3), 515–525Google Scholar
Priel, B., Mitrany, D., and Shahar, G. (1998). Closeness, support and reciprocity: a study of attachment styles in adolescence. Personality and Individual Differences, 25(6), 1183–1197Google Scholar
Ritvo, S. (1984). The image and uses of the body in psychic conflict. Psychoanalytic Study of the Child, 39, 449–469Google Scholar
Rourke, B. P., Young, G. C., and Leenaars, A. A. (1989).A childhood learning disability that predisposes those afflicted to adolescent and adult depression and suicide risk. 22, 169–17
Rudolph, K. D., Hammen, C., Burge, D., Lindberg, N., Herzberg, D., and Daley, S. E. (2000). Toward an interpersonal life-stress model of depression: the developmental context of stress generation. Development and Psychopathology, 12(2), 215–234Google Scholar
Shaffer, D. (1974). Suicide in childhood and early adolescence. Journal of Child Psychology and Psychiatry, 15, 275–291Google Scholar
Shaffer, D., Garland, A., Gould, M., Fisher, P., and Trautman, P. (1988). Preventing teen-age suicide: a critical review. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 675–687Google Scholar
Shaffer, D., Gould, M. S., Fischer, P., Trautman, P., Moreau, D., Kleinman, M., and Flory, M. (1996). Psychiatric diagnosis in child and adolescent suicide. Archives of General Psychiatry, 53, 339–348Google Scholar
Shahar, G. (2001). Personality, shame, and the breakdown of social bonds: the voice of quantitative depression research. Psychiatry: Interpersonal and Biological Processes, 64(3), 228–239Google Scholar
Shahar, G., and Priel B. (2002). Active vulnerability, adolescent distress, and the mediating/suppressing role of life events. Personality and Individual Differences (in press)
Shahar, G., Blatt, S. J., Zuroff, D. C., Krupnick, J., and Sotsky, S. M. (2002). Perfectionism impiedes social relations and response to brief treatment of depression. Journal of Social and Clinical Psychology (in press)
Shneidman, E. S. (1971). Perturbation and lethality as precursors of suicide in a gifted group. Suicide and Life-Threatening Behavior, 1Google Scholar
Shneidman, E. S. (1989). Overview: a multidimensional approach to suicide. In Jacobs, D., and Brown, H. N. (eds.) Suicide: Understanding and Responding (pp. 1–30). Madison, CT: International Universities Press
Tabachnik, N. (1981). The interlocking psychologies of suicide and adolescence. Adolescent Psychiatry, 9, 399–410Google Scholar
Tennant, C. (1988). Parental loss in childhood: its effect in adult life. Archives of General Psychiatry, 45, 1045–1050Google Scholar
Thernstrom, M. (1996). Diary of a murder. The New Yorker, June 3, pp. 62–71
Trillin, C. (1993). Remembering Denny. New York, NY: Farrar, Straus and Giroux
Tzur, M. (1974). Not in a Coat of Many Colors (Le lo Kutonet Pasim). Tel Aviv: Am Oved
Tzur, M. (1979). That which is not yet will build that which is. (Ma she'od eynenu yivne et ma she'yesh). Shdemot, 71, 72–76Google Scholar
Wagner, B. M. (1997). Family risk factors for child and adolescent suicidal behavior. Psychological Bulletin. 121, 246–298Google Scholar
Weller, R. A., Weller, E. B., Fristad, M. A., and Bowes, J. M. (1991). Depression in recently bereaved prepubertal children. American Journal of Psychiatry, 148, 1536–1540Google Scholar
White, H. C. (1974). Self-poisoning in adolescents. British Journal of Psychiatry, 124, 24–35Google Scholar
Winnicott, D. W. (1958). The capacity to be alone. In The Maturational Process and the Facilitating Environment, (pp. 29–36). New York, NY: International Universities Press. 1965
Zuroff, D. C., Blatt, S. J., Sotsky, S. M., Krupnick, J. L., Martin, D. J., Sanislow, C. A. III, and Simmens, S. (2000). Relation of therapeutic alliance and perfectionism to outcome in brief outpatient treatment of depression. Journal of Consulting and Clinical Psychology, 68(1), 114ȓ124Google Scholar

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