Tentative de suicide à l’adolescence : quel sens ?

Abstract

BackgroundThis article examines the understanding of suicide attempts in adolescence, a phenomenon which is particularly worrying nowadays and causes serious concern, which mental health professionals often have to deal with in their clinical practice. Some crucial clinical questions arise, in relation to this phenomenon: is the suicidal gesture a sign of an internal disaster, or a sign of reconstruction and psychic reorganisation? This question, which psychoanalysis has been particularly concerned with, gives rise to diverse theoretical and clinical questions: does the suicidal gesture indicate a desire to live or a desire to die? Does it indicate a search for the other or the object's annihilation? What part do life and death play in attempted suicide in adolescence? On one hand, when exclusively focusing on the destructive aspect of this act, the demands of suicidal adolescents towards objects may be neglected. On the other hand, only recognising the relational dimensions of such an act and its function of elaboration could lead us to deny its death function. While dealing with suicidal adolescents, the clinician must face the difficult task of “listening” to the suffering on many contradictory levels. MethodIn this paper, we will try to illustrate the complexity of the suicidal adolescent's psychic mechanisms. Firstly, a number of basic ideas from the Anglophone and Francophone psychoanalytic literature and research, regarding this topic, will be presented, in order to stress the complementary but often contradictory features of different theoretical and clinical contributions. This part of the article focuses on the dimension of destructiveness, which is discussed in its link to adolescent processes. Secondly, the case of a fifteen-year-old suicidal teenager, Lea, will be presented, in order to highlight the psychic mechanisms participating in suicide attempts in adolescence. Findings/ConclusionThe study of Lea's discourse reveals that the suicidal gesture in adolescence is linked to very different psychic processes that can coexist within the same subject. Certain forms of acting out may have a relational function and thus a constructive value, while others reveal more primary processes and in some cases a withdrawal from the object, as a result of the diffusion of instincts. The objective of this article is to encourage clinicians to consider the plurality of the psychic mechanisms participating in suicide attempts during adolescence.