Self-silencing and suicide.

Abstract

Silence in the therapeutic encounter has multiple meanings and complex determinants and is often associated with early childhood trauma or neglect but may also be found in patients with character pathology, who try to exert a sense of control when they feel overwhelmed. Self-silencing is a form of nonverbal communication, which may be autonomic or culturally syntonic, serving as protection of independence and safety, see for example, where renunciation of self-interest is used interpersonally to preserve a relationship with a significant other. Loneliness and isolation arising from such impaired relatedness then increase vulnerability to suicide. Self-silencing often serves to manage intense affects but may also contribute to increased suicidal preoccupation when life circumstances overwhelm personality functioning and self-regulation becomes inundated by unbearable affective distress. Under such circumstances, patients may feel desperately isolated and alone but are still unable or unwilling to communicate their distress to others, including their therapists. Consequently, self-silencing may be unnoticed in the therapeutic relationship, both by the patient and by the psychotherapist. Suicidal action can serve as the ultimate fulfillment of a silencing of the self. In this article, we discuss the effect of self-silencing on therapeutic process and suicidal vulnerability.