Viewed psychodynamically, if depression represents anger turned inward, then behind every suicide lies the repressed act of murder. The act of suicide seals the lips of its victim to the betrayal, lack of love and empathy and unbearable humiliation that have led to self-murder. Because both suicide and murder are taboo, humans by nature tend to avoid open discussion of these subjects, even more so when dealing with children and adolescents. Therapists must break through this taboo by directly confronting any past, present or future suicidality. Suicidality includes suicidal fantasies, even in the passive form of just wishing to be dead, self-destructive or high risk behaviors (like the use of alcohol or other drugs while driving) and any form of self-mutilation (which tries to displace psychic pain with physical pain).
Shining the light of knowledge, insight and compassion signiﬁcantly reduces the risk for completed suicide. Though none of us has the power to prevent suicide, family, partners, friends, religious or spiritual resources, other therapists, crisis hotlines or even psychiatric hospitalization can all be joined together as a safety net for suicidal patients. Both psychopharmacology and the treatment of underlying substance abuse are critical resources in strengthening this safety net.
Suicidality is commonly a symptom of mood disorder. Using mood stabilizing medications like lithium, Depakote, Serouquel or Lamictal, often in combination with antidepressants, can save patients lives. Psychopharmacology must always be supplemented by individual, family and/or marital psychotherapy, cognitive therapy and psychoeducation that includes a therapeutic suicide plan.