Lifelines pp 83-92 | Cite as

The Moment of Truth: Psychotherapy with the Suicidal Patient

  • Alvin Kahn


There is no typical case and there are no universal motives for suicide, but if science is to be handmaiden to the art of therapy, a model for the dynamic of self-destruction can inform and guide our attempts to intervene as therapists. From antiquity, philosophers have recognized in suicide the need of individuals to assert their autonomy, to retain some mastery of their fate. For Epictetus, suicide is a freedom;1 for Horace, “to save a man against his will is just the same as tis to kill.”2 (p. 59) Thomas Browne turns autonomy on its head in observing “it is not in the strongest to deprive us of death,”3 (p. 49) and J. S. Mill proclaimed the individual sovereign over his own mind and body.4 Yet even in their debate over the merits of self-determination in suicide, most writers distinguished the pseudoautonomy of impulsivity from genuine integrity. Impulsivity that masks fears of coping or want of patience and judgement is quite different from the more seemly and deliberate decision of the whole individual to bow before the sad and inevitable vicissitudes of fortune. With a still broader view, Burton perceived some suicide to be a consequence of disorder.5 He also recognized a puzzle: in all other afflictions men will do anything for relief and restoration of their beings, yet apparently not so in Melancholia.


Suicidal Patient Deliberate Decision Suicidal Individual Suicidal Idea Potential Suicide 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Epictetus Discourses Passim. New York, Leob Classical Library, 1959Google Scholar
  2. 2.
    Quote from Ars Poetica, line 467, in Trechmann EJ (translator): Essays of Montaigne, New York, Oxford University PressGoogle Scholar
  3. 3.
    Browne T: Religio Medici and Other Writings of Sir Thomas Browne, Part I. New York, Everymans Library-EP Dutton, 1928Google Scholar
  4. 4.
    Mill JS: On Liberty, in Collected Works of J. S. Mill, Volume 18, Chapter 4 and passim. Toronto, University of Toronto Press, 1963Google Scholar
  5. 5.
    Burton, R: Anatomy of Melancholy, Part I, Sections 2 and 3 passim. New York, Vintage Books, 1977Google Scholar
  6. 6.
    Peterson CV: John Davidson, Lammas 1896. New York, Twayne Publishing, 1972Google Scholar

Copyright information

© Plenum Press, New York 1982

Authors and Affiliations

  • Alvin Kahn
    • 1
  1. 1.Harvard Medical SchoolUSA

Personalised recommendations