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Descent into Despair: Suicide Dynamics

Shweta Sharma, PsyD

Suicidal patients present frightening challenges for clinicians, and many of us have or will experience the devastating loss of a patient or family member to suicide at some time in our lives. Our knowledge about suicidal risk and dynamics was greatly abetted by John Terry Maltsberger, who was both a psychoanalyst and suicidologist who spent his professional lifetime studying suicidal patients. He asserted that suicidal breakdown involves a superego attack on the self and an ego regression. He designated four associated aspects of ego disintegration: affective flooding, desperate maneuvering to counter the mental emergency, loss of self, and grandiose mental scheming for psychic survival. Shweta Sharma and Christopher Fowler provide a detailed case study from their work at Menninger, linking an adolescent’s suicidal crisis to Maltsberger’s psychodynamic formulation. They believed that a mentalizing approach to therapy opened up nonsuicidal pathways for enduring and dealing with suffering, while supporting the adolescent’s developmental needs. The recent article by Emeric Bojarski and Zheala Qayyum discussed the suicidal dynamics specific to LGBT youth, who show much higher rates of suicide than other populations. Jane Tillman, who works at Austen Riggs Center and also researches and writes extensively about suicide, suggested several dynamics involved in the intergenerational transmission of suicide. Based on the case of writer Walker Percy and his family history of suicides, Tillman suggested the role of moral injury and the mysterious object.

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