SUICIDALITY IN MEN IN PSYCHODYNAMIC PSYCHOTHERAPY

Abstract

Based on the evidence of empirical gender differences in attempted suicide and suicide, this paper develops psychodynamic hypotheses on gender‐specific biographic, intra‐psychic and treatment aspects of suicidality among men. ‘Forming Types by Understanding’ is a qualitative method, based on a systematic analysis of similarity and differential reference points to develop ideal types of suicidal men. A random sample of 20 suicidal men who were receiving out‐patient psychodynamic psychotherapy was studied.

Four ideal types of suicidal men were identified: (1) ideal type ‘disconnected’: a predominance of disconnected feelings that is associated with rejection experiences; (2) ideal type ‘hurt’: aggressive conflicts and the realization of disillusioned life reality combined with experiences of real loss and real trauma; (3) ideal type ‘stormy’: an attached‐symbiotic transference offer mobilizes unrealistic wishes to help against a background of unresolved dependency conflicts; and (4) ideal type ‘object dependent’: concrete facts are important in relationships; in case of separation, real repossession of the woman must occur, a lack of emotional experience is compensated. The danger of suicidality, especially in the early stage of psychotherapy, is particularly acute for patients who cannot reach their therapists emotionally and vice versa. Disturbance of the early experience of inseparability from the mother, gender‐specific conflicts in the development of separation and individuation, and failed triangulation are of central psychodynamic importance.

ACKNOWLEDGEMENTS

The author wishes to thank the TZS psychotherapists and research discussion participants, Georg Fiedler, Ilan Gans, Benigna Gerisch, Paul Götze and Monika Richter for their invaluable clinical and theoretical contributions. My special thanks go to Ulrich Stuhr for his continuous research supervision.

This study was sponsored by a Consultant Grant and a Research Grant from the Research Advisory Board (RAB) of the International Psychoanalytical Association (IPA).