Who is killing what or whom?

SUMMARY The psychiatric literature on suicide tends to focus on the external world of the suicidal patient and this, though valuable, is not sufficient for understanding and managing the individual case. This paper aims both to explore the ‘internal phenomenology’ of the suicidal act and to show how this deeper understanding is essential for proper management of the individual case. The body that is attacked in a suicidal act is a body that has become identified with a psychic object that cannot be tolerated. The author explores the psychoanalytic understanding of suicide starting with the work of Freud and then its development by Klein. He offers case examples to illustrate the theory and also to show how this deeper understanding of the individual case has immediate implications for management. The author gives particular emphasis to the functioning of a primitive cruel superego, showing how this comes to operate not only at the individual level but also at the level of the institution. Finally, the author suggests that the perspective offered in this paper has implications for Mental Health Policy. ‘The ego can kill itself only if … it can treat itself as an object.’ (Freud 1915, p.252).