Treatment Following a Near Fatal Suicide Attempt

This series of discussions is about a patient we call David who made a near lethal suicide attempt. Fortuitously he was found alive and entered the mental health system, where his treatment and recovery began. Parts of this discussion were initially presented at the AAS conference in Boston in 2007. Five senior clinicians take up various aspects of the patient’s presentation and treatment and elaborate various points of view. Obviously, one therapist cannot be all things to every patient, and one patient’s therapy cannot describe all there is to treating such complicated problems. We present here a sampling of interesting and appealing thoughts on the curative process. We start the discussion of this case with Terry Maltsberger’s description of the patient seen as a self in crisis. He recognizes the self as the psychic holder of inner stability. When challenged by loss and depression the self cannot function to provide life sustaining energy and a suicidal crisis results. Elsa Ronningstam discusses the importance of shame as a suicide driving affect. Mark Schechter takes up the patient’s coping abilities and underscores the therapeutic benefits of validation. Mark Goldblatt describes the treatment in light of the patient’s ego defense mechanisms combating internal and external hostility. Roberto Olivardia describes a cognitive behavioral approach to treatment. Through this range of therapeutic options we hope to present some of the complexity involved in dealing with seriously lethal patients and stimulate discussion of effective treatment interventions.