A Psychodynamic Perspective on Suicidal Desire in the Elderly

Chapter

Abstract

The number of elderly individuals expressing the wish to end their lives in the absence of overt mental illness is increasing and is expected to grow further as life expectancy increases. Taking an individual’s statements at face value and consideration of only their current circumstances is likely to miss out unconscious meanings governing the wish to die. This chapter discusses psychodynamic factors at play among elderly individuals expressing suicidal thoughts. Prominent psychodynamic theories of suicide are first reviewed. Existing theories are then applied to a clinical case to provide a format for exploring psychodynamic factors that could influence suicidal thoughts among elderly individuals.

Keywords

Psychodynamic Psychoanalytic Unconscious motivations Rational suicide Assisted suicide 

References

  1. 1.
    Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–9. doi: 10.1111/j.1532-5415.2005.53221.x.CrossRefPubMedGoogle Scholar
  2. 2.
    Menninger KA. Psychoanalytic aspects of suicide. Int J Psychoanal. 1933;14:376–90.Google Scholar
  3. 3.
    Freud S. Mourning and Melancholia. Standard Edition 14. London: Hogarth; 1917.Google Scholar
  4. 4.
    Hendrick I. Suicide as wish fulfillment. Psychiatry Q. 1940;14:30–42.CrossRefGoogle Scholar
  5. 5.
    Winnicott D. The maturational process and the facilitating environment. New York: International Universities Press; 1965.Google Scholar
  6. 6.
    Kohut H. The restoration of the self. New York: International Universities Press; 1977.Google Scholar
  7. 7.
    Huprich SK. Psychodynamic conceptualization and treatment of suicidal patients. J Contemp Psychoanal. 2004;34(1):23–39.CrossRefGoogle Scholar
  8. 8.
    Maltsberger JT, Buie DH. The devices of suicide: revenge, riddance, and rebirth. Int Rev Psychoanal. 1980;7:61–72.Google Scholar
  9. 9.
    Muskin PR. The request to die: role for a psychodynamic perspective on physician-assisted suicide. JAMA. 1998;279:323–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Schneidman ES. Suicide as psychache. J Nerv Ment Dis. 1993;181:147–9.Google Scholar
  11. 11.
    Baechler J. A strategic theory. Suicide Life Threat Behav. 1980;10:70–99.CrossRefPubMedGoogle Scholar
  12. 12.
    Baumeister RF. Suicide as escape from self. Psychol Rev. 1990;97(1):90–113.CrossRefPubMedGoogle Scholar
  13. 13.
    Erikson E. Childhood and society. New York: Norton; 1950.Google Scholar
  14. 14.
    Richman J. A rational approach to rational suicide. Suicide Life Threat Behav. 1992;22(1):130–40.PubMedGoogle Scholar
  15. 15.
    Maltsberger JT. Confusion of the body, the self, and others in suicidal states. In: Leenaars A, Berman AL, Cantor P, Litman RE, Maris RW, editors. Suicidology: Essays in honor of Edward Schneidman. Northvale: Aronson; 1993. p. 148–72.Google Scholar
  16. 16.
    Van der Velde CD. Body image of one’s self and of others: developmental and clinical significance. Am J Psychiatry. 1985;142:527–37.CrossRefPubMedGoogle Scholar
  17. 17.
    Orbach I. Suicide and the suicidal body. Suicide Life Threat Behav. 2003;33(1):1–8.CrossRefPubMedGoogle Scholar
  18. 18.
    King A, Apter A. Psychoanalytic perspectives on adolescent suicide. Psychoanal Study Child. 1996;51:491–511.PubMedGoogle Scholar
  19. 19.
    Lindner R. Suicidality in the elderly. Dtsch Med Wochenschr. 2012;137(40):2002–4.CrossRefPubMedGoogle Scholar
  20. 20.
    Hendin H. Psychodynamics of suicide, with particular reference to the young. Am J Psychiatry. 1991;148:1150–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Hendin H, Haas AP. Suicide and guilt as manifestations of PTSD in Vietnam combat veterans. Am J Psychiatry. 1991;148:586–91.CrossRefPubMedGoogle Scholar
  22. 22.
    Hendin H. The psychodynamics of suicide. J Nerv Ment Dis. 1963;136:236–44.CrossRefPubMedGoogle Scholar
  23. 23.
    Maltsberger JT. Suicide risk: the formulation of clinical judgment. New York: New York University Press; 1981.Google Scholar
  24. 24.
    Lifton R. Suicide: the quest for a future. In: Jacobs D, Brown H, editors. Suicide: understanding and responding. Madison: International Universities Press; 1989.Google Scholar
  25. 25.
    Siegel K. Psychosocial aspects of rational suicide. Am J Psychother. 1986;40(3):405–18.PubMedGoogle Scholar
  26. 26.
    Gabbard GO. Miscarriages of psychoanalytic treatment with suicidal patients. Int J Psychoanal. 2003;84:249–61.CrossRefPubMedGoogle Scholar
  27. 27.
    Maltsberger JT, Ronningstam E, Weinberg I, Schecter M, Goldblatt MJ. Suicide fantasy as a life-sustaining recourse. J Am Acad Psychoanal Dyn Psychiatry. 2010;38(4):611–24.CrossRefPubMedGoogle Scholar
  28. 28.
    Koukopolous A, Koukopolous A. Agitated depression as a mixed state and the problem of melancholia. Psychiatr Clin N Am. 1999;22:547–64.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Department of PsychiatryNew York University School of MedicineNew YorkUSA

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