A Psychodynamic Perspective on Suicidal Desire in the Elderly

Rational Suicide in Elderly Adults: A Clinician's Perspective

“…Mr. A's deceased wife, his adult children, his friends, and peers at the Senior Center are possible partners in the dyad. The quality of his relationship with his wife, the manner of her death, his reactions to it, his identity as a widower, and the presence of survival guilt must be explored . It is important to not exclude deceased loved ones in these conversations, because individuals have been reported to harbor unconscious fantasies of reunion with dead individuals by way of suicide .…”

“…The clinician must be attuned to the possibility of a split in the perception of a person's healthy and sick parts of themselves, especially in the event of acute illnesses. 16,17 AGING AND RELATIONAL CHANGES Edwin Schneidman described suicide as a dyadic event, such that the "suicidal drama" in the mind always involves interplay with another individual. 18 Many older adults find themselves outliving spouses, siblings, and friends; becoming empty-nesters; and losing work colleagues.…”

“…It is possible that suicidal fantasies create a mental image of "a way out," providing a sense of control and comfort. 16,24 Mr. A verbalized his suicidal wish without a clear timeline and vehemently denied the intent to act on his thoughts at the time of the above-mentioned evaluation. An understanding of the purpose that the suicidal thought serves Mr. A is important.…”

“…Older adults are left to redefine notions of their physical selves, and each individual's ability to integrate changes depends on long‐held ideas of what their bodies meant to them. Mr. A's death wish must be understood in the context of his lifelong attitudes toward his body, his recent medical illness, and the physical changes resulting from it . One must examine whether he has been able to integrate the effect of the recent surgery and the need to use a walker into this schema.…”

“…The “sick” self can be perceived intrapsychically as alien, with the “healthy” self harboring the wish to destroy it. The clinician must be attuned to the possibility of a split in the perception of a person's healthy and sick parts of themselves, especially in the event of acute illnesses …”