Triangulation or strangulation: managing the suicidal patient

Abstract

The suicidal person is tortured by an internal dilemma to do with unbearable feelings of separation and loss which seem to be insoluble. The suicidal act is an attempt to resolve this by creating a phantasy in which the intolerable pain associated with a grievance is projected and obliterated by murdering the body that has become identified with it. This type of assault on the self reveals a major confusion between mind and body, affecting the capacity to think and resulting in two-dimensional, rather than three-dimensional, thinking, which can permeate therapeutic efforts, at both individual and systemic levels, in the way these patients are managed by their carers. It is suggested that a safety-net made up of mindful carers, based on a triangular principle, can provide a symbolic or mental space, and a containment for the patient's intolerable states of mind, which can be analogous to an ego-function that is lacking internally, and works well if the net can manage to function as a healthy parental couple. Two case studies are presented as an attempt to illuminate some of the dynamics and difficulties in maintaining the safety-net.