Psychotherapy with Suicidal Patients (Specialized Techniques in Individual Psychotherapy 16)

It seems logical that before we consider what the psychotherapy of a suicidal person ought to be that we have some common understanding of the suicidal state itself. Of course, everybody agrees that suicide is an enormously complicated term, encompassing a wide variety (and different ranges) of dysphoria, disturbance, self-abnegation, resignation, terror-cum-pain—to mention but a few inner states that are involved. But perhaps nowhere is there as insightful a description of suicide in as few words as that found in the opening paragraph of Melville's Moby-Dick: "a damp and drizzly November in my soul.”
For that is what, metaphorically, most suicide is: a dreary and dismal wintry gale within the mind, where the vital issue that is being debated is whether to try to stay afloat in a stormy life or willfully to go under to nothingness.
Suicide is the human act of self-inflicted, self-intended cessation (i.e., the permanent stopping of consciousness). It is best understood as a bio-socio-psychologico-existential state of malaise. It is obviously not a disease and just as obviously a number of kinds of trained individuals other than physicians can help individuals who are in a suicidal state.
If we are to escape many of the current somewhat simplistic notions of suicide (especially those which totally equate a disease called suicide with a disease called depression), then we need to explicate what the suicidal state of mind is like. Our key source in this can be the ordinary dictionary—eschewing any nomenclature of technical and, especially, technically diagnostic terms. In the dictionary there are words, e.g., angered, anguished, cornered, dependent, frustrated, guilty, helpless, hopeless, hostile, rageful, shamed, that will help us in our understanding. For us, in this chapter, two less common (but ordinary) dictionary words—perturbation and lethality—will be the keystone words..