Le rôle des angoisses de perte dans la récidive suicidaire

Abstract

Objectives

Repeated suicide attempts are a particularly difficult clinical problem. Multiple suicide attempts in the same patient often leave caregivers with a feeling of incomprehension and therapeutic powerlessness. Far from being a “raptus,” the act of suicidal recividism is underpinned by complex psychic processes. In particular, we look at the role of the object and the loss of perception of the object in the dynamics of repeated suicidal acts.

Method

We conducted research with three women hospitalized in a psychiatric unit. We offered them a semi-directive interview, followed by the Rorschach and the T.A.T., and finally an open interview. Part of the research process was designed to give the participants the opportunity to express themselves freely, leaving room for imaginative reverie based on the rule of free association. Our methodology is based on an individual case study.

Results

Frédérique, Nora, and Olga all took the projective tests. However, the T.A.T. showed some difficulty in processing the instructions. The protocols as a whole showed little investment of thought, a form of passivity in the face of the material, with a predominance of avoidant maneuvers. Using our data, we will question the quality and capacity of our subjects to summon a sufficiently solid internal object. We will also analyze our patients’ narratives, which are more invested in an anaclitic mode, where relationships, and particularly specular relationships, are at the forefront. The narratives are thus mainly mobilized around the treatment of loss through the excitement it can arouse in our subjects.

Discussion

Object support is particularly invested in a negative function. We thus studied the relational modalities of our subjects with regard to object dependence, the question of loss and the anxiety it can engender, as well as its associated manifestations.

Conclusion

By exploring the unconscious dynamics underlying suicidal acts, and in particular recidivism, we are led to believe that this type of act contains an address to the object, an address that remains unknown to the subject itself and that requires a response from the object for which it is intended. The absence of a response from the object would give rise to an unbearable excitation, for which the subject can imagine no other solution than resorting to a suicidal act. The inevitable return of these unworkable situations would explain suicidal recidivism.